Fat necrosis of the breast is a challenging diagnosis due to the various appearances on mammography, ultrasound, CT, PET-CT, and MRI. Although mammography is more specific, ultrasound is a very important tool in making the diagnosis of fat necrosis. MRI has a wide spectrum of findings for fat necrosis and the appearance is the result of the amount of the inflammatory reaction, the amount of liquefied fat, and the degree of fibrosis. While CT and PET-CT are not first line imaging examinations for the diagnosis of breast cancer or fat necrosis, they are frequently performed in the surveillance and staging of disease. Knowledge of how fat necrosis presents on these additional imaging techniques is important to prevent misinterpretation of the imaging findings. Gross and microscopic appearances of fat necrosis depend on the age of the lesion; the histologic examination of fat necrosis is usually straightforward. Knowledge of the variable appearances of fat necrosis on a vast array of imaging modalities will enhance a radiologist's accuracy in the analysis and interpretation of fat necrosis versus other diagnoses.

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Objective Determine whether a regimen of fixed dose rate gemcitabine plus capecitabine is effective and tolerable for advanced pancreatic adenocarcinoma. Methods We performed a retrospective analysis of 62 patients with locally advanced or metastatic pancreatic adenocarcinoma treated at the University of California San Francisco between 2008 and 2016. Treatment was an alternate week schedule of fixed dose rate 1000 mg/m2 gemcitabine and capecitabine 1000 mg/m3 (58 patients), 1200 mg/m3 (12 patients), or 650 mg/m3 (1 patient) for intended 12 cycles. We evaluated overall survival (OS), progression-free survival (PFS), radiologic response, and adverse events necessitating treatment modification. Results For metastatic patients, median OS was 10.3 months (95% confidence interval [CI], 6.7–12.1 months), and PFS was 5.6 months (95% CI, 2.6–7.7 months). In locally advanced patients, OS was 12.0 months (95% CI, 4.9–17.1 months), and PFS was 5.4 months (95% CI, 2.5–9.4 months). Radiologic response for metastatic disease (42 patients) was 19% objective response, 45% stable disease, and 36% progressive disease. Treatment required modification for 22 patients due to adverse events, most frequently hand-foot syndrome (18 patients). Conclusions Alternate week schedule of fixed dose rate gemcitabine and capecitabine was active and tolerable for advanced pancreatic adenocarcinoma. Overall survival and PFS were comparable to first-line treatments. Importantly, adverse effects appear less severe than first-line treatments.

The American Board of Radiology's (ABR) new Core Exam is not working, at least not as well as it needs to. Having helped to prepare candidates (RG), studied for and taken the exam (WK), and talked with hundreds of candidates who have taken the exam (RG and WK), we believe that that one aspect of the exam, its validity, can be significantly enhanced.Just as we expect candidates for board certification and practicing radiologists to measure up to the high standards, so we should subject the board exam to continuous scrutiny, seeking opportunities to rectify errors and enhance the exam's overall quality, with a view to better promoting excellence in radiology practice and the care of patients. Here we focus on two exam parameters: validity and timing. The ExamTaken 36 months after the beginning of radiology residency, the Core Exam is administered over 2 days at either the Chicago or Tucson exam center. According to the board, it "tests knowledge and comprehension of anatomy, pathophysiology, all aspects of diagnostic radiology, and physics concepts important for diagnostic radiology." Eighteen categories are included: breast, cardiac, gastrointestinal, interventional, musculoskeletal, neuroradiology, nuclear, pediatric, reproductive or endocrinology, thoracic, urinary, vascular, computed 2 tomography, magnetic resonance, radiography or fluoroscopy, ultrasound, physics, and safety. The exam is administered twice per year, June and November. ValiditySimply put, the validity of a test is the extent to which it accurately assesses what it is intended to assess.A valid test is one whose results actually mean something, whereas an invalid test is one whose results fail to tell us much-or positively mislead us-about whatever the test is designed to assess.A famous example of a test with poor validity was the Scholastic Aptitude Test. After decades of research failed to support the hypothesis that the test actually provided useful assessment of scholastic aptitude, in the 1990s the test's owners finally changed its name to SAT (1). The test is not completely useless, but less than 20% of college performance is predicted by SAT scores.In radiology, a valid board certification test would provide meaningful insights into a candidate's degree of preparation to practice radiology independently, both avoiding errors that could harm patients and making substantial contributions to patient care. A single question captures this reasonably well: would I want this candidate providing a loved one's radiological care?A radiology board exam with a high degree of validity would enable experts in the field of radiology to answer this question with confidence. On the other hand, an exam with a low degree of validity would provide relatively little insight on this question, both with respect to individual candidates and to the aggregate of all candidates seeking certification.Assessing the validity of any test involves a number of factors, including its content, the way test-takers enter responses, the internal structure of the test, and t...

Teacher of the Year twice. Gatto was not merely better than other teachers at doing what every teacher in New York was expected to do. He did things differently, and he did different things, by encouraging his students to do the same (1). For example, he once sent a student to New Jersey to apologize to a town's chief of police for polluting his beach, in exchange for which the police chief offered her a one-day apprenticeship in small-town police procedures. Another day he sent three students at 6 AM to study the president of a trucking company as he dispatched his rigs all over the United States.