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The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine fibroid and adenomyoma.The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e. 200, 600 and 800 s/mm²) were obtained from nine fibroid and five adenomyoma patients, immediately after, and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment outcome evaluation.Our finding showed that immediately after MRgFUS treatment, the DWI acquired using 200 s/mm² b-value gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/ mm² showed the best correlation (R² = 0.938) with post-contrast NPV. At 12 months follow-up, there was no specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the post-contrast NPV and NPV ratio.We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm²), is feasible for delineation and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12 months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.

Study Objectives: Mounting evidence suggests that emergency physicians tend to avoid patients with gynecologic chief complaints. In one study of all emergency department (ED) visits, patient pickup time was 12 minutes for the chief complaint of vaginal bleeding compared to a median pickup time of 6 minutes for all other complaints (Patterson et al, AEM, 2016). A recent study found that male EM residents were less likely than female EM residents to assign themselves to patients with vaginal bleeding (Agarwal et al, AJEM, 2021).We hypothesized that an underlying reason could be discomfort with performing a pelvic exam. The goal of this study was to assess whether male EM residents report greater discomfort with pelvic exams than female EM residents.Methods: We performed a cross-sectional, IRB-approved survey of EM residents at five academic programs. Of 100 residents who completed the survey, 63 self-identified as male, 36 as female, and one selected "prefer not to say" and was excluded from analysis. Residents were asked about their personal comfort with performing pelvic exams, with response options of "very comfortable, " "hesitate to do, " "do not feel comfortable, " or "avoid doing whenever possible." Responses were compared between male and females using a chi-square test. In secondary analysis, we used a t-test to compare preferences for various chief complaints as well as frequency of performing pelvic exams.Results: Self-reported comfort with pelvic exams did not differ significantly between males and females (p¼0.4249). Females reported a slightly higher, though not statistically significant, number of pelvic exams performed over a span of five shifts (mean¼2.1, CI¼1.6-2.5) than males (mean¼1.7, CI¼1.3-2.0). Self-reported barriers for male respondents in performing pelvic exams include lack of training, general dislike, and concern that the patient will want a female provider. However, 67% (CI¼54%-78%) of male residents reported supervised pelvic exams with faculty in the ED as part of their training, compared to 36% (CI¼21%-54%) of female residents. On a preference scale of 1-5, male residents had a statistically significant lower preference ranking for patients with a chief complaint of vaginal bleeding compared to female residents (mean difference¼0.48, CI¼0.11, 0.87). Preference ranking was the same between male and females on other chief complaints.Conclusion: There is a sex disparity among male and female EM residents in attitudes towards patients with vaginal bleeding. However, the results from this study do not demonstrate a significant difference in self-reported comfort amongst male and female residents in performing pelvic exams. This may be due to reporting bias, or this disparity may be driven by other barriers including self-reported lack of training and concern about patients' physician sex preferences.