Sarah Marie Pittman

All Publications

• The Postoperative Breast: Imaging Findings and Diagnostic Pitfalls After Breast-Conserving Surgery and Oncoplastic Breast Surgery. Journal of breast imaging Pittman, S. M., Rosen, E. L., DeMartini, W. B., Nguyen, D. H., Poplack, S. P., Ikeda, D. M. 2024

  Abstract

  Breast surgery is the cornerstone of treatment for early breast cancer. Historically, mastectomy and conventional breast-conserving surgery (BCS) were the main surgical techniques for treatment. Now, oncoplastic breast surgery (OBS), introduced in the 1990s, allows for a combination of BCS and reconstructive surgery to excise the cancer while preserving or enhancing the contour of the breast, leading to improved aesthetic results. Although imaging after conventional lumpectomy demonstrates typical postsurgical changes with known evolution patterns over time, OBS procedures show postsurgical changes/fat necrosis in locations other than the lumpectomy site. The purpose of this article is to familiarize radiologists with various types of surgical techniques for removal of breast cancer and to distinguish benign postoperative imaging findings from suspicious findings that warrant further work-up.

  View details for DOI 10.1093/jbi/wbad105

  View details for PubMedID 38262628

• The ACR Learning Network: Facilitating Local Performance Improvement Through Shared Learning. Journal of the American College of Radiology : JACR Larson, D. B., Tomkins, K. G., Zacharias-Andrews, K., Irani, N., Pittman, S. M., Purysko, A. S., Wandtke, B., Bhargavan-Chatfield, M. 2023; 20 (3): 369-376

  Abstract

  The ACR Learning Network was established to test the viability of the learning network model in radiology. In this report, the authors review the learning network concept, introduce the ACR Learning Network and its components, and report progress to date and plans for the future.Patterned after institutional programs developed by the principal investigator, the ACR Learning Network was composed of four distinct improvement collaboratives. Initial participating sites were solicited through broad program advertisement. Candidate programs were selected on the basis of assessments of local leadership support, experience with quality improvement initiatives, intraorganizational relationships, and access to data and analytic support. Participation began with completing a 27-week formal quality improvement training and project support program, with local teams reporting weekly progress on a common performance measure.Four improvement collaborative topics were chosen for the initial cohort with the following numbers of participating sites: mammography positioning (6), prostate MR image quality (6), lung cancer screening (6), and follow-up on recommendations for management of incidental findings (4). To date, all sites have remained actively engaged and have progressed in an expected fashion. A detailed report of the results of the improvement phase will be provided in a future publication.To date, the ACR Learning Network has successfully achieved planned milestones outlined in the program's plan, with preparation under way for the second and third cohorts. By providing a shared platform for improvement training and knowledge sharing, the authors are optimistic that the network may facilitate widespread performance improvement in radiology on a number of topics for years to come.

  View details for DOI 10.1016/j.jacr.2023.01.004

  View details for PubMedID 36922112

• Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade. Clinical imaging Karandikar, A., Solberg, A., Fung, A., Lee, A. Y., Farooq, A., Taylor, A. C., Oliveira, A., Narayan, A., Senter, A., Majid, A., Tong, A., McGrath, A. L., Malik, A., Brown, A. L., Roberts, A., Fleischer, A., Vettiyil, B., Zigmund, B., Park, B., Curran, B., Henry, C., Jaimes, C., Connolly, C., Robson, C., Meltzer, C. C., Phillips, C. H., Dove, C., Glastonbury, C., Pomeranz, C., Kirsch, C. F., Burgan, C. M., Scher, C., Tomblinson, C., Fuss, C., Santillan, C., Daye, D., Brown, D. B., Young, D. J., Kopans, D., Vargas, D., Martin, D., Thompson, D., Jordan, D. W., Shatzkes, D., Sun, D., Mastrodicasa, D., Smith, E., Korngold, E., Dibble, E. H., Arleo, E. K., Hecht, E. M., Morris, E., Maltin, E. P., Cooke, E. A., Schwartz, E. S., Lehrman, E., Sodagari, F., Shah, F., Doo, F. X., Rigiroli, F., Vilanilam, G. K., Landinez, G., Kim, G. G., Rahbar, H., Choi, H., Bandesha, H., Ojeda-Fournier, H., Ikuta, I., Dragojevic, I., Schroeder, J. L., Ivanidze, J., Katzen, J. T., Chiang, J., Nguyen, J., Robinson, J. D., Broder, J. C., Kemp, J., Weaver, J. S., Conyers, J. M., Robbins, J. B., Leschied, J. R., Wen, J., Park, J., Mongan, J., Perchik, J., Barbero, J. P., Jacob, J., Ledbetter, K., Macura, K. J., Maturen, K. E., Frederick-Dyer, K., Dodelzon, K., Cort, K., Kisling, K., Babagbemi, K., McGill, K. C., Chang, K. J., Feigin, K., Winsor, K. S., Seifert, K., Patel, K., Porter, K. K., Foley, K. M., Patel-Lippmann, K., McIntosh, L. J., Padilla, L., Groner, L., Harry, L. M., Ladd, L. M., Wang, L., Spalluto, L. B., Mahesh, M., Marx, M. V., Sugi, M. D., Sammer, M. B., Sun, M., Barkovich, M. J., Miller, M. J., Vella, M., Davis, M. A., Englander, M. J., Durst, M., Oumano, M., Wood, M. J., McBee, M. P., Fischbein, N. J., Kovalchuk, N., Lall, N., Eclov, N., Madhuripan, N., Ariaratnam, N. S., Vincoff, N. S., Kothary, N., Yahyavi-Firouz-Abadi, N., Brook, O. R., Glenn, O. A., Woodard, P. K., Mazaheri, P., Rhyner, P., Eby, P. R., Raghu, P., Gerson, R. F., Patel, R., Gutierrez, R. L., Gebhard, R., Andreotti, R. F., Masum, R., Woods, R., Mandava, S., Harrington, S. G., Parikh, S., Chu, S., Arora, S. S., Meyers, S. M., Prabhu, S., Shams, S., Pittman, S., Patel, S. N., Payne, S., Hetts, S. W., Hijaz, T. A., Chapman, T., Loehfelm, T. W., Juang, T., Clark, T. J., Potigailo, V., Shah, V., Planz, V., Kalia, V., DeMartini, W., Dillon, W. P., Gupta, Y., Koethe, Y., Hartley-Blossom, Z., Wang, Z. J., McGinty, G., Haramati, A., Allen, L. M., Germaine, P. 2022

  View details for DOI 10.1016/j.clinimag.2022.07.011

  View details for PubMedID 36064645

• Breast Density Legislation Impact on Breast Cancer Screening and Risk Assessment. Journal of breast imaging Kothari, P., Tseng, J. J., Chalfant, J. S., Pittman, S. M., Hoyt, A. C., Larsen, L., Sheth, P., Yamashita, M., Downey, J., Ikeda, D. M. 2022; 4 (4): 371-377

  Abstract

  To evaluate breast density notification legislation (BDNL) on breast imaging practice patterns, risk assessment, and supplemental screening.A 20-question anonymous web-based survey was administered to practicing Society of Breast Imaging radiologists in the U.S. between February and April 2021 regarding breast cancer risk assessment, supplemental screening, and density measurements. Results were compared between facilities with and without BDNL using the two-sided Fisher's exact test.One hundred and ninety-seven radiologists from 41 U.S. states, with (187/197, 95%) or without (10/197, 5%) BDNL, responded. Fifty-seven percent (113/197) performed breast cancer risk assessment, and 93% (183/197) offered supplemental screening for women with dense breasts. Between facilities with or without BDNL, there was no significant difference in whether risk assessment was (P = 0.19) or was not performed (P = 0.20). There was no significant difference in supplemental screening types (P > 0.05) between BDNL and non-BDNL facilities. Thirty-five percent (69/197) of facilities offered no supplemental screening studies, and 25% (49/197) had no future plans to offer supplemental screening. A statistically significant greater proportion of non-BDNL facilities offered no supplemental screening (P < 0.03) and had no plans to offer supplemental screening compared to BDNL facilities (P < 0.02).Facilities in BDNL states often offer supplemental screening compared to facilities in non-BDNL states. Compared to BDNL facilities, a statistically significant proportion of non-BDNL facilities had no supplemental screening nor plans for implementation. Our data suggest that upcoming federal BDNL will impact how supplemental screening is addressed in currently non-BDNL states.

  View details for DOI 10.1093/jbi/wbac034

  View details for PubMedID 38416983

• Breast Density Legislation Impact on Breast Cancer Screening and Risk Assessment JOURNAL OF BREAST IMAGING Kothari, P., Tseng, J. J., Chalfant, J. S., Pittman, S. M., Hoyt, A. C., Larsen, L., Sheth, P., Yamashita, M., Downey, J., Ikeda, D. M. 2022

  View details for DOI 10.1093/jbi/wbac034

  View details for Web of Science ID 000812340900001

• FDG Avid Abnormalities in the Breast: Breast Cancer Mimics CURRENT RADIOLOGY REPORTS Faast, A., Ikeda, D. M., Pittman, S., DeMartini, W., Kozlov, A. 2021; 9 (8)

  View details for DOI 10.1007/s40134-021-00383-5

  View details for Web of Science ID 000679401000001

• Adaptations of Breast Imaging Centers to the COVID-19 Pandemic: A Survey of California and Texas. Journal of breast imaging Chalfant, J. S., Cohen, E. O., Leung, J. W., Pittman, S. M., Kothari, P. D., Downey, J. R., Sohlich, R. E., Chong, A., Grimm, L. J., Hoyt, A. C., Ojeda-Fournier, H., Joe, B. N., Trinh, L., Rosen, E. L., Feig, S. A., Aminololama-Shakeri, S., Ikeda, D. M. 2021; 3 (3): 343-353

  Abstract

  To determine the early impact of the COVID-19 pandemic on breast imaging centers in California and Texas and compare regional differences.An 11-item survey was emailed to American College of Radiology accredited breast imaging facilities in California and Texas in August 2020. A question subset addressed March-April government restrictions on elective services ("during the shutdown" and "after reopening"). Comparisons were made between states with chi-square and Fisher's tests, and timeframes with McNemar's and paired t-tests.There were 54 respondents (54/240, 23%, 26 California, 28 Texas). Imaging volumes fell during the shutdown and remained below pre-pandemic levels after reopening, with reduction in screening greatest (ultrasound 12% of baseline, mammography 13%, MRI 23%), followed by diagnostic MRI (43%), procedures (44%), and diagnostics (45%). California reported higher volumes during the shutdown (procedures, MRI) and after reopening (diagnostics, procedures, MRI) versus Texas (P = 0.001-0.02). Most screened patients (52/54, 96% symptoms and 42/54, 78% temperatures), and 100% (53/53) modified check-in and check-out. Reading rooms or physician work were altered for social distancing (31/54, 57%). Physician mask (45/48, 94%), gown (15/48, 31%), eyewear (22/48, 46%), and face shield (22/48, 46%) use during procedures increased after reopening versus pre-pandemic (P < 0.001-0.03). Physician (47/54, 87%) and staff (45/53, 85%) financial impacts were common, but none reported terminations.Breast imaging volumes during the early pandemic fell more severely in Texas than in California. Safety measures and financial impacts on physicians and staff were similar in both states.

  View details for DOI 10.1093/jbi/wbab020

  View details for PubMedID 38424771

• Adaptations of Breast Imaging Centers to the COVID-19 Pandemic: A Survey of California and Texas JOURNAL OF BREAST IMAGING Chalfant, J. S., Cohen, E. O., Leung, J. T., Pittman, S. M., Kothari, P. D., Downey, J. R., Sohlich, R. E., Chong, A., Grimm, L. J., Hoyt, A. C., Ojeda-Fournier, H., Joe, B. N., Trinh, L., Rosen, E. L., Feig, S. A., Aminololama-Shakeri, S., Ikeda, D. M. 2021; 3 (3)

  View details for DOI 10.1093/jbi/wbab020

  View details for Web of Science ID 000672810000014

• Impact of the COVID-19 Pandemic on Breast Imaging Education. Journal of breast imaging Chalfant, J. S., Pittman, S. M., Kothari, P. D., Chong, A., Grimm, L. J., Sohlich, R. E., Leung, J. W., Downey, J. R., Cohen, E. O., Ojeda-Fournier, H., Hoyt, A. C., Joe, B. N., Feig, S. A., Trinh, L., Rosen, E. L., Aminololama-Shakeri, S., Ikeda, D. M. 2021; 3 (3): 354-362

  Abstract

  Objective: To determine the impact of the COVID-19 pandemic on breast imaging education.Methods: A 22-item survey addressing four themes during the early pandemic (time on service, structured education, clinical training, future plans) was emailed to Society of Breast Imaging members and members-in-training in July 2020. Responses were compared using McNemar's and Mann-Whitney U tests; a general linear model was used for multivariate analysis.Results: Of 136 responses (136/2824, 4.8%), 96 U.S. responses from radiologists with trainees, residents, and fellows were included. Clinical exposure declined during the early pandemic, with almost no medical students on service (66/67, 99%) and fewer clinical days for residents (78/89, 88%) and fellows (48/68, 71%). Conferences shifted to remote live format (57/78, 73%), with some canceled (15/78, 19%). Compared to pre-pandemic, resident diagnostic (75/78, 96% vs 26/78, 33%) (P < 0.001) and procedural (73/78, 94% vs 21/78, 27%) (P < 0.001) participation fell, as did fellow diagnostic (60/61, 98% vs 47/61, 77%) (P = 0.001) and procedural (60/61, 98% vs 43/61, 70%) (P < 0.001) participation. Most thought that the pandemic negatively influenced resident and fellow screening (64/77, 83% and 43/60, 72%, respectively), diagnostic (66/77, 86% and 37/60, 62%), and procedural (71/77, 92% and 37/61, 61%) education. However, a majority thought that decreased time on service (36/67, 54%) and patient contact (46/79, 58%) would not change residents' pursuit of a breast imaging fellowship.Conclusion: The pandemic has had a largely negative impact on breast imaging education, with reduction in exposure to all aspects of breast imaging. However, this may not affect career decisions.

  View details for DOI 10.1093/jbi/wbab021

  View details for PubMedID 34056594

• Multishot Diffusion-Weighted MRI of the Breast With Multiplexed Sensitivity Encoding (MUSE) and Shot Locally Low-Rank (Shot-LLR) Reconstructions. Journal of magnetic resonance imaging : JMRI Hu, Y., Ikeda, D. M., Pittman, S. M., Samarawickrama, D., Guidon, A., Rosenberg, J., Chen, S., Okamoto, S., Daniel, B. L., Hargreaves, B. A., Moran, C. J. 2020

  Abstract

  BACKGROUND: Diffusion-weighted imaging (DWI) has shown promise to screen for breast cancer without a contrast injection, but image distortion and low spatial resolution limit standard single-shot DWI. Multishot DWI methods address these limitations but introduce shot-to-shot phase variations requiring correction during reconstruction.PURPOSE: To investigate the performance of two multishot DWI reconstruction methods, multiplexed sensitivity encoding (MUSE) and shot locally low-rank (shot-LLR), compared to single-shot DWI in the breast.STUDY TYPE: Prospective.POPULATION: A total of 45 women who consented to have multishot DWI added to a clinically indicated breast MRI.FIELD STRENGTH/SEQUENCES: Single-shot DWI reconstructed by parallel imaging, multishot DWI with four or eight shots reconstructed by MUSE and shot-LLR, 3D T2 -weighted imaging, and contrast-enhanced MRI at 3T.ASSESSMENT: Three blinded observers scored images for 1) general image quality (perceived signal-to-noise ratio [SNR], ghosting, distortion), 2) lesion features (discernment and morphology), and 3) perceived resolution. Apparent diffusion coefficient (ADC) of the lesion was also measured and compared between methods.STATISTICAL TESTS: Image quality features and perceived resolution were assessed with a mixed-effects logistic regression. Agreement among observers was estimated with a Krippendorf's alpha using linear weighting. Lesion feature ratings were visualized using histograms, and correlation coefficients of lesion ADC between different methods were calculated.RESULTS: MUSE and shot-LLR images were rated to have significantly better perceived resolution (P<0.001), higher SNR (P<0.005), and a lower level of distortion (P<0.05) with respect to single-shot DWI. Shot-LLR showed reduced ghosting artifacts with respect to both MUSE (P<0.001) and single-shot DWI (P<0.001). Eight-shot DWI had improved perceived SNR and perceived resolution with respect to four-shot DWI (P<0.005).DATA CONCLUSION: Multishot DWI enables increased resolution and improved image quality with respect to single-shot DWI in the breast. Shot-LLR reconstructs multishot DWI with minimal ghosting artifacts. The improvement of multishot DWI in image quality increases with an increased number of shots.LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

  View details for DOI 10.1002/jmri.27383

  View details for PubMedID 33067849

• Diffusion-weighted double-echo steady-state with a three-dimensional cones trajectory for non-contrast-enhanced breast MRI. Journal of magnetic resonance imaging : JMRI Moran, C. J., Cheng, J. Y., Sandino, C. M., Carl, M. n., Alley, M. T., Rosenberg, J. n., Daniel, B. L., Pittman, S. M., Rosen, E. L., Hargreaves, B. A. 2020

  Abstract

  The image quality limitations of echo-planar diffusion-weighted imaging (DWI) are an obstacle to its widespread adoption in the breast. Steady-state DWI is an alternative DWI method with more robust image quality but its contrast for imaging breast cancer is not well-understood. The aim of this study was to develop and evaluate diffusion-weighted double-echo steady-state imaging with a three-dimensional cones trajectory (DW-DESS-Cones) as an alternative to conventional DWI for non-contrast-enhanced MRI in the breast. This prospective study included 28 women undergoing clinically indicated breast MRI and six asymptomatic volunteers. In vivo studies were performed at 3 T and included DW-DESS-Cones, DW-DESS-Cartesian, DWI, and CE-MRI acquisitions. Phantom experiments (diffusion phantom, High Precision Devices) and simulations were performed to establish framework for contrast of DW-DESS-Cones in comparison to DWI in the breast. Motion artifacts of DW-DESS-Cones were measured with artifact-to-noise ratio in volunteers and patients. Lesion-to-fibroglandular tissue signal ratios were measured, lesions were categorized as hyperintense or hypointense, and an image quality observer study was performed in DW-DESS-Cones and DWI in patients. Effect of DW-DESS-Cones method on motion artifacts was tested by mixed-effects generalized linear model. Effect of DW-DESS-Cones on signal in phantom was tested by quadratic regression. Correlation was calculated between DW-DESS-Cones and DWI lesion-to-fibroglandular tissue signal ratios. Inter-observer agreement was assessed with Gwet's AC. Simulations predicted hyperintensity of lesions with DW-DESS-Cones but at a 3% to 67% lower degree than with DWI. Motion artifacts were reduced with DW-DESS-Cones versus DW-DESS-Cartesian (p < 0.05). Lesion-to-fibroglandular tissue signal ratios were not correlated between DW-DESS-Cones and DWI (r = 0.25, p = 0.38). Concordant hyperintensity/hypointensity was observed between DW-DESS-Cones and DWI in 11/14 lesions. DW-DESS-Cones improved sharpness, distortion, and overall image quality versus DWI. DW-DESS-Cones may be able to eliminate motion artifacts in the breast allowing for investigation of higher degrees of steady-state diffusion weighting. Malignant breast lesions in DW-DESS-Cones demonstrated hyperintensity with respect to surrounding tissue without an injection of contrast. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 1.

  View details for DOI 10.1002/jmri.27492

  View details for PubMedID 33382171