Ho An Lau, BS, MS
Philadelphia College of Osteopathic Medicine

Why did you choose to submit a case?

As a fourth-year medical student, I often found myself curious to learn about selecting the imaging modality that would best answer the primary team’s clinical question. With that, I discovered the ACR^® Appropriateness Criteria® for Imaging and sought to contribute to this resource through the ACR Radiology-TEACHES^® program.

Why did you select this case topic for submission?

During my third-year clerkship with the Neuroradiology department at Geisinger Medical Center, I encountered a vestibular schwannoma case that fueled my interest in the field of radiology. As such, I sought to enhance my own understanding of pathology, management and radiographic characteristics of vestibular schwannoma while simultaneously providing clarity on ordering medical imaging when there is concern for this pathology.

What should readers expect to learn from this case?

One of the key takeaways of this case is that MRI protocoling is invaluable in ensuring the region of interest is adequately imaged and assessed for pathological disease/processes. For this case, which describes a presentation of progressive unilateral hearing loss coupled with concern for a vestibular schwannoma, an MRI head and internal auditory canal (IAC)/temporal bone protocol should be utilized to take high-resolution thin sections through the IAC and temporal bones. Moreover, the MRI should be completed with and without IV contrast to better visualize a potential neoplasm.

What did you learn from working on the case?

Through my work on this case, I developed an appreciation for the nuances of ordering medical imaging to best answer the clinical question. With complex cases, the radiologist-primary care team relationship is pivotal, as open communication amongst both teams allows for more effective clinical decision making, discernibility of necessary imaging modalities and protocols, and interdisciplinary patient care.

What else would you like to share about the case?

This was my first case submitted to ACR Radiology-TEACHES. I look forward to my continued participation and contribution!

Buffy Dekmar, MD
Emory University
Specialty: Diagnostic Radiology

Why did you choose to submit this module?

This module was born out of a series of experiences I had as a fourth-year medical student, preparing to match into radiology. First, I encountered a screening mammogram with an unusual image pattern, which turned out to be free silicone injections for breast augmentation in a transgender woman. The patient had received this treatment in the 1990s, before safer gender-affirming procedures were available. This case sparked my curiosity about the implications of free silicone injections, as well as the history of gender-affirming procedures as a whole. On a broader level, it prompted me to consider the injustices and inequities transgender patients often face in healthcare.

Why did you select this topic for submission?

As I collected more transgender breast cases for my own learning, I began to read about transgender patient experiences — many of which had unfortunately impacted health outcomes in a negative way. During my radiology-pathology correlation rotation, I had an opportunity to assist in breast surgery for a transgender patient. Through interactions with hospital staff and care providers, I realized that there was a gap in education in this area, partly because of the historical exclusion of this patient group from health literature and society as a whole. While health professionals do not intend to harm transgender patients, we lack both a common lexicon and an evidence base for guiding their medical care. This lack of understanding tends to create awkward, harmful or humiliating situations that deter patients from seeking healthcare in the future.

What should readers learn from this module?

Through sharing this knowledge, I hope to improve access to healthcare for this vulnerable population. As doctors, APPs, nurses and medical technologists, we commit to providing high-quality care, regardless of a patient's gender, race, heritage, culture or creed. Understanding gender diversity, gender-affirming therapies and trans-specific cancer risks will make us more culturally competent and will ultimately improve health outcomes for our patients.

What did you learn from working on the module?

I learned that there is work to be done in understanding how gender-affirming hormone therapy affects breast cancer risk. I'm excited to see new developments in this field in the years to come.

How did guidance from any mentors or senior staff at your institution impact your learning and module development?

I am grateful to Dr. Matthew Hartman, who helped me identify the growing need for knowledge in this area, and to Dr. Sarah Thomas, who helped me find interesting cases to consider and present.

Arnold C. Friedman, MD, FACR, FSAR
University of California San Francisco
Specialty: Body Imaging

Why did you choose to mentor for Radiology-TEACHES?

I am semi-retired, and I think I saw something about the program in an email from the ACR. In my second year of medical school on my surgery rotation I was turned on to radiology by Dr. Bernie Suster who had a once-a-week teaching conference with the medical students on the surgery rotation. He didn't have much to work with besides plain films (back then a tomogram was a big deal), but he presented the cases as if they were puzzles for a detective to solve. All you had to do was observe and draw the proper inferences. As Chairman during my residency, Dr. Jacobson used to say "the answer is always on the film." Drs. Suster and Jacobson were instrumental in my choosing radiology, and I have them to thank for the long and wonderful career I've had. I wanted to mentor with Radiology-TEACHES as a way of paying it back.

What positive outcome have you experienced by mentoring?

It is always great speaking with medical students, because they are so eager to learn, and there is so much they have to learn. There is no substitute for the one-on-one interaction between the mentee and the mentor — and for the opportunity for both of us to learn.

What advice would you give to other mentors or those considering becoming a mentor?

Take the plunge. It can be an experience that both mentee and mentor will never forget.

What else would you like to share about the mentoring experience?

Looking back on my career, my publishing is largely out of date, and my name is no longer recognized, but the warmth with which my former residents greet me at the RSNA never goes away. You can create that type of relationship easily and quickly with a mentee and have a positive effect on their career.