Author: Logan Young

With therapies evolving and technology updating, radiologists the world over are ready to rise to the challenge of delivering more precise staging and follow-up for rectal cancer.

On Sunday, April 12 in Pittsburgh, PA, abdominal imaging experts from both hemispheres will convene at the David L. Lawrence Convention Center and online for Rectal MRI, the 2026 ARRS Annual Meeting Global Exchange course featuring faculty from the Royal Australian and New Zealand College of Radiologists (RANZCR).

Codirectors Aliya Qayyum (ARRS) and Kirsten Gormly (RANZCR) are bringing together the field’s finest to share evidence-based insight and technical pearls designed for immediate clinical application. For radiologists seeking to refine staging, elevate posttreatment evaluations, and stay ahead of emerging imaging biomarkers, this expertly curated course offers globally relevant guidance.

Rectal MRI: A Cornerstone of Modern Care

Once an emerging tool, rectal MRI is now the gold standard for staging, enabling assessment of the T stage and detecting key prognostic features such as mesorectal fascia involvement (MRF) and extramural venous invasion (EMVI) (Fig. 1).

Fig. 1—59-year-old patient with rectal cancer with extramesorectal
vessel involvement, consistent with T category of T4b. Axial (top) and
axial oblique (bottom) T2-weighted images show rectal tumor that extends
through extramesorectal vein (arrow), which according to expert opinion
warrants classification as T4b.

Dr. James Costello (ARRS) will lead a session on foundational principles of T staging, MRF, and EMVI, emphasizing actionable strategies to refine reports and guide multidisciplinary teams. Building upon Dr. Costello’s foundation, Dr. Verity Wood (RANZCR) addresses the myriad nuances of assessing lymph nodes and how to identify poor prognostic tumor deposits. Pointing out pitfalls left and right, her lecture during the 2026 ARRS Annual Meeting Global Exchange with RANZCR will provide the latest imaging criteria to help radiologists render more confident interpretations.

From Early Detection to Posttreatment Decision-Making

As screening programs detect more early-stage tumors, MRI also has the ability to evaluate these lesions. Dr. Gormly will discuss how to assess early cancers and why acquisition technique for high-resolution T2-weighted images directly impacts interpretive accuracy for all rectal MRI parameters (Fig. 2).

Fig. 2—Morphologic features of metastatic mesorectal nodes on MRI
and potential pitfalls in assessment. 58-year-old woman with rectal
adenocarcinoma. Oblique axial T2-weighted MRI (left) shows apparently
spiculated node (arrow). Graininess of image is related to poor signal-tonoise
ratio (SNR). Coronal T2-weighted MRI (right) shows that same node is
homogeneously T2 hyperintense with dark capsule (arrow), which is typical
of reactive mesorectal node. This image has superior SNR. Suboptimal images
can lead to erroneous assessment of nodal morphologic features. This
patient proceeded directly to surgery. Total of 38 lymph nodes (0.3–1.3 cm)
were harvested. Eleven of larger lymph nodes were serially sectioned before
submission for histologic processing. Final pathology revealed T3N0 disease.

Of course, staging is only part of the story. With the emergence of total neoadjuvant therapy (TNT) and “watch and wait” (W&W) protocols, radiologists play an increasingly vital role in posttreatment imaging. Dr. Raj Mohan Paspulati (ARRS) will outline W&W strategies in the United States, comparing tumor regression grading (TRG) systems and illustrating how MRI supports individualized care plans that may spare patients surgery.

The ability of MRI to predict patient outcomes can be considered more important than direct pathological correlation. Dr. Gormly will close the 2026 ARRS Annual Meeting Global Exchange course with her experiences in assessing emerging imaging biomarkers such as the “split scar sign,” aiming to improve patient selection for W&W, following a detailed explanation of how to assess residual tumor on high-resolution T2-weighted images. This is a key part of any posttreatment assessment system and is the cornerstone of the mrTRG system—the most validated MRI-based grading method globally.

Alliances Advancing Imaging

The mission of the ARRS Global Partner Society Program is to build long-standing relationships with key leaders and organizations in the worldwide imaging community—increasing awareness of our society’s services in specific nations, while raising the stature of Global Partner Societies among ARRS members. Every year, the ARRS Annual Meeting Global Exchange incorporates one partner society into the educational and social fabric of our meeting. ARRS members then reciprocate at the partner society’s meeting that same year.

Founded in 1949, RANZCR promotes and continuously improves the standards of training and practice in radiology and radiation oncology for the betterment of the people of Australia and New Zealand.

Rectal MRI not only reflects the robust collaboration between ARRS and RANZCR but also celebrates the global standardization of rectal MRI protocols.

And as Dr. Gormly told InPractice, “Australia and New Zealand’s early and ongoing partnerships with global leaders like Professor Gina Brown have positioned our region at the forefront of rectal MRI innovation. And this course is about sharing those insights with the world.”

Deborah A. Baumgarten, MD, MPH
2025-2026 ARRS President

For our next installment of serendipity here in InPractice, we’re jumping ahead pretty far in time, as you’ll note by the color photograph of Professor Torsten Almén. As a young radiologist from Malmo, Sweden (not far from Copenhagen, Denmark), he was concerned about the pain of injected iodinated contrast, especially when it was administered arterially.

Dr. Almen’s serendipitous contribution is that he was struck by how little his eyes stung when swimming in the relatively isotonic Baltic Sea, as compared to the more hypertonic North Sea. He then wondered if a patient’s pain had anything to do with the tonicity of the contrast material that was administered. In 1967, Almen went to Temple University in Philadelphia, PA as a postdoctorate fellow and was given the choice on working on a steerable catheter that he’d helped design or working on this notion of toxicity and tonicity of contrast. Fortunately, he chose the latter. Almen was able to show in a bat model that his theory was correct, but he had to go about designing something that could be utilized in humans—a more ideal contrast agent. He wasn’t a chemist, so he bought some textbooks, taught himself the basics of organic chemistry, and tried to get someone interested in producing this theoretical compound. He finally persuaded Nygard, which later became Nycomed, to produce his low osmolar contrast material metrizamide in 1969. It was released several years later, quickly followed by other contributions to low osmolar contrast: Isovue by Bracco in 1981, Omnipaque by GE in 1982, and Optiray by Mallinckrodt in 1989.

I dare say this gentleman is at least as recognizable as our society’s namesake, Wilhelm Conrad Roentgen. Sir Godfrey Newbold Hounsfield has had such a profound effect on our field. It was during an outing in the country when the idea came that he could determine what was inside a box by taking x-rays from all angles around the object, then somehow combine the different shadows the x-rays would produce to form an image of that object.

This is a sketch of his first idea of the CT scanner and the prototype. It’s one thing to formulate the idea of using x-ray readings, of course. But it was Dr. Hounsfield’s open mind that allowed him to realize not only the potential, but the necessity of using computers to analyze the data generated by taking all of the x-ray angles needed to create a CT image.

. . . compared to his prototype!

The following quotation by Dr. Louis Pasteur is particularly appropriate in this particular case: “In the field of observation, chance favors only the prepared mind.” Doctors Allan Cormack and Hounsfield shared the 1979 Nobel Prize in Physiology or Medicine for their work in CT. 

Moving away from radiological discoveries for a moment, I love this quotation: “Eureka, I found what I wasn’t looking for!” This is associated with a book called Happy Accidents by a renowned abdominal radiologist named Dr. Mort Meyers, who spent his career at the State University of New York at Stony Brook. Again, emphasizing that the open mind is primed to take advantage of serendipity, how many of you know that the invention of the microwave oven had its origins when an engineer working with radar sets had a candy bar melt in his pocket, realizing it must’ve been from emitted radio waves? Or that Viagra was discovered by Pfizer when looking for a drug that increased blood flow to the heart, only to find that it increased blood flow a little lower? Or the discovery of artificial sweeteners by Constantin Fahlberg, a chemist working on coal tar derivatives, came from his inadvertent tasting of saccharine? Aspartame’s discovery came later, thanks to James Shaler, a chemist working on anti-ulcer drugs. Sure, their tasting of unfamiliar lab compounds is completely not up to today’s standards, but we can excuse them for that.

There are so many more examples of serendipity in science. Sir Alexander Fleming‘s discovery of penicillin came while working on compounds to inhibit bacterial growth, serendipitously noting one plate that had some mold on it seemed to be doing better than the other ones. Or veterinary pathologist Frank Schofield‘s discovery that spoiled sweet clover hay led to a hemorrhagic illness in cows, eventually leading to the isolation of dicoumarol, or Warfarin. Or the serendipity of the population in the United Kingdom erroneously getting a half-dose of the Oxford AstraZeneca COVID-19 vaccine before a second full dose that gave a 90% effectiveness rate against COVID-19, as compared to the 62% when two full doses were tested in Brazil and South Africa.

British biologist and pharmacologist Dr. Alexander Fleming gave this sample of penicillium notatum to a colleague at St. Mary’s Hospital, London, in 1935.

Physiologist Menko Victor “Pek” van Andel at the University of Groningen in the Netherlands studies serendipity patterns in knowledge and discovery, and he’s categorized three main types of serendipity. Positive serendipity is when a surprising fact is seen and followed by a correct interpretation (e.g., x-rays). Pseudo-serendipity is to discover something you were looking for, but in a surprising way. An example that van Andel uses is penicillin. Meanwhile, negative serendipity is when a surprising fact is seen, but not optimally investigated. And I’d like to think Dr. Donald Cameron never pursuing sodium iodine salts would be that kind of negative serendipity, although it was found positively later by Dr. Earl Osbourne (see Part I here).

Pek van Andel was one of the first researchers to extract serendipity patterns for accidental unsought knowledge discovery.

Others have built on van Andel’s work, including Darbellay et al., who published a paper titled “Interdisciplinary Research Boosted by Serendipity.” Their contention is that getting rid of the silos that house most of our disciplines and opening one’s mind to the unexpected are fundamental to the work of researchers who position themselves between and beyond disciplines. That serendipity itself is an important part of interdisciplinary research. As a creative process, serendipity is foundational in interdisciplinary collaboration, boosting the exchange of ideas to exploit the unexpected.

Examples of this interdisciplinary research aided by serendipity mentioned by Darbellay and colleagues include a team at Dow Chemical tasked with inventing a chemical compound for protecting the windscreens of airplanes. Upon application of substance 401, the researchers realized they could no longer remove the measurement device that they were utilizing on the windscreen. The team was worried because this was very costly equipment, so they called their boss, Harry Coover, who had a doctorate in chemistry. When faced with this unexpected effect of the substance 401, he realized the researchers had unknowingly and unintentionally discovered superglue, which was a substance that could bond metal and glass. Under Coover’s initiative, Dow abandoned trying to find something better for windscreens, channeled its efforts into developing superglue, and began marketing the product so many of us use today. Other accounts dispute Darbellay et al.’s retelling of this discovery, instead noting that Coover discovered superglue (cyanoacrylate) at the Eastman Kodak company, where he realized clear plastic gun sights stuck to everything. He first rejected the substance but later recognized its potential as an adhesive, so serendipitous no matter the origin!

Ironically, the near complete opposite of superglue was also a serendipitous discovery. Spencer Silver and colleague Arthur Fry stumbled upon the idea for Post-it® notes while working at 3M. Silver discovered an adhesive that sticks permanently without a permanent bond and only does so in one direction, allowing an object to be repositioned. Fry’s contribution was finding use for the adhesive while singing in his church choir and lamenting that his bookmarks kept falling out of hymnals—his own eureka moment when he remembered Silver’s invention. The original yellow? Also, an accident; it was the color of a scrap of paper in an adjoining lab.

Art Fry, 93, in Saint Paul, Minnesota

Switching gears for just a moment, how about looking at serendipity on a more personal level? I’ve always been fascinated by the role of luck in my life and in the lives of others. When I was a child, whenever anything good in my life happened, I would tell my mom “I got lucky,” to which my mom would say, “we make our own luck.” This phrase has stuck with me for a very long time, and may be my own definition of serendipity: being open to possibilities when they happen and taking advantage of them. In one sense, I could describe my ascent to becoming president of the American Roentgen Ray Society as luck. Again, lucky in the sense that I repeatedly said “yes” to volunteer opportunities, even if that opportunity wasn’t glamorous or meant a lot of work.

So, here is what I conclude about serendipity. For those of you already well involved in research, getting your feet wet in research, or wanting to become involved in research, know that chance, luck, serendipity—whatever you want to call it—will play a role in your career. Keep an open mind, expect the unexpected, then turn it on its head. Seek out ways to collaborate with people who are in unrelated fields. Take advantage of the opportunity to network and build your community at meetings such as ARRS with those outside of your chosen field or discipline and those inside your chosen field or discipline. There will be so many more serendipitous discoveries in our lifetime and many lifetimes to come. It’s what keeps our field and so many others so very interesting. I understand everybody’s time is limited and valuable, but truly consider an opportunity before saying “no.” You never know which opportunities will lead to something bigger, so keep an open mind about saying, “yes.” You never know who will be touched by your words and actions, who will change your life with a chance encounter, or whose lives will be changed by a chance encounter with you.

References:

1. Nyman U, Ekberg O, Aspelin P. Torsten Almén (1931-2016): the father of non-ionic iodine contrast media. Acta Radiol 2016. 57:1072–1078
2. Gagnon L. ‘A diagnostic revolutionary’—the legacy of Godfrey Hounsfield. Aunt Minnie website. www.auntminnie.com/clinical-news/ct/article/15631616/a-diagnostic-revolutionary-the-legacy-of-godfrey-hounsfield. Published August 11, 2022. Accessed August 8, 2025
3. Meyers MA. Happy accidents—serendipity in modern medical breakthroughs. New York: Arcade Publishing 2007
4. Van Andel P. Anatomy of the un-sought finding. Brit J Philo Sci 2014. 45;631–648
5. Darbellay F, Moody Z, Sedooka A, Steffen G. Interdisciplinary research boosted by serendipity. Create Research J 2014. 26;1–10
6. Post-it® website. www.post-it.com/3M/en_US/post-it/contact-us/about-us. Accessed August 8, 2025

Recognizing this hallmark pattern can spare unnecessary confusion, guiding the right surgical call.

The Big Picture

Xanthogranulomatous pyelonephritis (XGP) is a rare, destructive renal infection, most often in women with staghorn calculi. It replaces functioning parenchyma with lipid-laden macrophages and inflammatory tissue, often extending beyond the kidney.

Nine months later, we see much more exuberant inflammation—soft-tissue thickening extending out from the kidney into the retroperitoneum.

Patient underwent renal scintigraphy prior to getting a nephrectomy, and we can see that that right kidney is not contributing to the renal function.

Key Takeaways

• Classic appearance: Enlarged kidney, staghorn calculi, and a contracted pelvis—the “bear paw.”
• Functional loss: Renal scintigraphy often shows little or no contribution from the affected kidney . . .

• Extrarenal extension: Look for inflammation tracking into the retroperitoneum, psoas, or paraspinal muscles.
• Definitive treatment: Because the kidney is typically nonfunctional, nephrectomy is the standard.

Challenges Ahead

• Distinguishing XGP from renal cell carcinoma or pyonephrosis can be difficult without correlating imaging and functional data.
• Awareness of extrarenal spread is crucial to surgical planning.
• Early recognition can prevent unnecessary biopsy or delay in definitive management.

Presented by Anup Shetty, MD, during ‘Radiology Case Review: Genitourinary Imaging,’ part of the ARRS 2025 Annual Meeting. Watch the full session now: arrs.org/am25

Bottom Line

When you see that “bear paw” (i.e., staghorn calculus, perinephric inflammation, and an enlarged, poorly functioning kidney), think XGP!

Deborah A. Baumgarten, MD, MPH
2025-2026 ARRS President

There’s no discussion about serendipity without mentioning the namesake of our society, Wilhelm Conrad Roentgen. I’m sure we all also recognize the world’s first radiograph on the right, taken on November 8, 1895. It’s an image of his wife Anna Bertha’s hand only a couple of weeks after Roentgen discovered what he termed “x-rays”—x for something unknown. Roentgen was studying cathode rays in his lab in a dark room, and he noted a glow several feet away from where he was standing. Although he was not the first to note that cathode rays could permeate thin metal sheets or light up a fluorescent screen near them, he was the first to put those pieces together. And for that, he won the first Nobel Prize in physics in 1901.

I love this quotation attributed to Albert Szent-Györgyi, a Hungarian biochemist, who, among other things, aptly won a Nobel Prize in 1937 for the isolation of vitamin C: “Discovery consists of seeing what everyone else has seen and thinking what no one else has thought.” Many have called the discovery of x-rays serendipity—defined by the Oxford Dictionary as the occurrence in development of events by chance, in a happy or beneficial way, and by Merriam-Webster as a faculty or phenomenon of finding valuable or agreeable things not sought for. The term was first used in 1754 by Horace Walpole, the fourth Earl of Orford, who is remembered for a silly fairytale about three princes from the country of Serendip. Due to a series of accidents and keen mental judgment, these princes were able to discern the nature of a lost camel, of all things. But there’s another factor that lets serendipity thrive: keeping an open mind. There are many other points in the history of science and radiology where serendipity and open-mindedness played a role, and we’ll look at a few of those stories here in InPractice.

This is Dr. John McIntyre of Glasgow, Scotland. Although not a radiologist, he was actually the first person to in the world to set up an x-ray department in March of 1896, after lecturing on “The New Light: X-rays” a mere month after their discovery. The serendipity in his story is the chance intersection of electricity and medicine. An apprentice electrician before studying medicine, Dr. McIntyre was fascinated by the potential uses of electricity in medicine. He was named consulting medical electrician at the Glasgow Royal Infirmary in 1895, and although mainly interested in diseases of the ears, nose, and throat, Dr. McIntyre was the first to image a renal stone in vivo in April of 1896. He was also the first to show movement of a frog’s leg using cineradiography, later a beating heart, and then a bismuth meal in the stomach.

But even before the word serendipity made it into the English vernacular, the notion of serendipity existed. “The greatest part of the invention being, but a luckey bitt of chance [sic]” is attributed to English polymath Robert Hook in 1679. A man of many talents, he is credited for being the first to describe cells under a microscope. In fact, Hook designed his own compound microscope and coined the term cell. He also described the force applied to a spring and its deformation, what’s known as Hook’s law of elasticity.

Our next story nicely illustrates Robert Hook’s thoughts about invention and chance. This is Dr. Earl Osborne, who was a dermatology resident at the Mayo Clinic. Dr. Osborne, along with physician and pharmacologist Leonard Rowntree, is credited with discovering that intravenous administration of sodium iodine salts for treating syphilis faintly opacified the urinary tract. Dr. Osborne is said to have serendipitously noted the opacification of the bladder in one of his patients who had an abdominal roentgenogram during treatment. When asked about this discovery, he stated, “it occurred to one of us that if in roentgenology of the urinary tract advantage could be taken of the fact that sodium iodine, after its introduction into the body is normally excreted in the urine, roentgenograms of the kidneys, ureters, and bladder might be secured without the need for catheterization.” Anybody recognize the term KUB in this statement?

Initial investigations of sodium iodide also included a radiologist named Charles Sutherland and a urologist named Albert Scholl and were published in JAMA in February of 1923. The image on the left is from that paper, taken two hours after the administration of 200 cc of a 20% solution of sodium iodine showing opacification of the bladder. The roentgenogram on the right was taken about an hour after the administration of 100 cc of a 10% solution. You can see that the bladder is opacified, and there’s faint opacification of the kidneys, spleen, and liver. Ironically, neither Dr. Osborne nor Dr. Rowntree pursued this any further, but Dr. Osborne did go on to help found the American Board of Dermatology.

Dr. Donald Cameron, a young Minnesota surgeon, is seemingly forgotten in all of the fuss about Drs. Rowntree and Osborne. He published a preliminary report about the oral and intravenous administration of sodium iodine as an opaque medium in roentgenology in JAMA in 1918, five years before Sutherland’s paper came out. Cameron published this preliminary report in case he didn’t return from World War I. He published one more article a few months later, but then never pursued this line of research any further. But he did return from WWI and established a hospital in the Midwest now called the Cameron Memorial Community Hospital that still exists today.

Like the discovery that sodium iodine opacifies the urinary tract, the origins of oral cholecystography are serendipitous, too. As the story goes, Dr. Warren Cole was working in a lab experimenting with compounds that were known to be excreted by the liver into bile. Four and a half months went by before he even ever saw a gallbladder image, until one day this image was obtained in one of the lab dogs.

Now, where is the serendipity in this particular story? The dog’s caretaker forgot to feed that particular dog that morning. (But don’t worry, he got his evening meal!) It was only a few months later that the experiment was successfully duplicated in human subjects. These are images after an administration of the compound showing progressive opacification of the gallbladder by 24 hours, then washout at 32 hours.

I look forward to continuing our exploration of serendipity and the open mind in the Fall issue of ARRS InPractice magazine.

A new Harvey L. Neiman Health Policy Institute study, published in the American Journal of Roentgenology (AJR), investigated whether office-based providers are more likely to refer imaging to a radiologist, or to self-refer and interpret the ordered imaging studies themselves. “Self-Interpretation of Imaging Studies by Ordering Providers: Frequency and Associated Provider and Practice Characteristics” found that 43.6% of office-based studies were interpreted by the ordering provider, while 58.5% were interpreted within the ordering provider’s practice. Additionally, rates of self-interpretation varied by the specialty of the ordering provider and the imaging modality.

Self-Read Rates Vary by Modality and Specialty

Based on more than 1.6 million office-based imaging claims for Medicare fee-for-service beneficiaries in 2022 that were ordered by non-radiologists, by modality and across all specialties, this AJR Original Research manuscript by Christensen et al. found that the self-interpretation rate for office-based imaging was as follows:

• 50.4% for radiography and fluoroscopy
• 52.0% for ultrasound
• 39.5% for nuclear medicine
• 5.3% for CT
• 6.1% for MR

Meanwhile, self-interpretation by specialty broke down accordingly:

• 19.9% for primary care physicians
• 75.7% for orthopedic/sports medicine physicians
• 30.5% for non-physician practitioners

Another key determinant of self-interpretation rates was the size of the practice. Rates of self-interpretation were substantially less in the largest practices (500 or more providers) than the smallest practices (only 1-9 providers): 24.2% versus 48.9%, respectively, according to the researchers’ findings.

Access to Radiologists Could Curb Self-Reading

Whether or not there was a radiologist in the ordering provider’s practice was highly correlated with self-interpretation of imaging by the ordering provider (Fig. 1). “If there was a radiologist in the practice, the odds of self-interpretation were about one-half compared to practices without a radiologist on staff,” said Eric W. Christensen, PhD, research director at the Neiman Institute in Reston, VA. “Conversely, the odds of within-practice interpretation were generally 2 to 3 times higher if there was a radiologist in the practice.”

Continuing consolidation of health care—“which is creating larger, multispecialty practices,” Dr. Christensen added—could reduce imaging self-interpretation via increased access to radiologists within practice. “Such centralization of radiology services may encourage referral of imaging interpretation to the within practice radiologist, in lieu of potential self-interpretation.”

Training Gaps, Policy Questions, and Equity Decisions Remain

“Our results raise potential implications for quality of patient care. Nonradiologist specialties, aside from cardiology, lack the rigorous and comprehensive training in imaging interpretation that occurs during the 4 years of a radiology residency program,” said Vijay M. Rao, MD, senior vice president of enterprise radiology at Jefferson Health and professor of radiology at Thomas Jefferson University in Philadelphia, PA.

Pointing out that some specialties may provide targeted training in imaging interpretation that is narrow in scope, such as in ultrasound for emergency medicine or obstetrics/gynecology, “the large differences between radiologists and non-radiologists in interpretation training could lead to differences in diagnostic accuracy,” Dr. Rao said.

And as Kerry L. Thomas, MD, noted in her AJR Editorial Comment, while defined personnel qualifications—including for the interpreting physician—are clearly delineated when accrediting outpatient imaging centers, “such quality standards are lacking for the interpreting provider of in-office examinations.”

Importantly, to avoid secondary disparities related to health care quality, “images should be interpreted by providers with appropriate training for the specific examination being reviewed, agnostic of the care setting,” said Dr. Thomas from H. Lee Moffit Cancer Center and the department of diagnostic imaging and interventional radiology at University of South Florida’s Morsani College of Medicine in Tampa.

A “Stark” Surprise

Concerns of financial conflicts of interest related to self-referral contributed to the passage of the federal Stark Law in 1989. Named after U.S. House Representative Pete Stark of California, the Stark Law prohibits physician self-referral for designated health services, including radiology, under Medicare. Over time, certain exceptions (à la the in-office ancillary services rule) were added to allow necessary in-practice imaging referrals within guidelines.

Intended to curb the practice of self-referral, in reality, there remain too few restrictions on imaging interpretation by non-radiologists. And as the authors of this AJR article found, the Stark Law’s in-office ancillary exception greatly weakens its ability to restrict imaging self-referral. “Hence, our results highlight a need to revisit the in-office ancillary exception policy to impact the potential financial incentives that lead to self-referral,” Dr. Rao concluded.

The American Roentgen Ray Society (ARRS) proudly recognizes the following four radiologists and their research projects with the 2025 ARRS Resident/Fellow in Radiology Awards:

• Jordan H. Chamberlin, MD
  • Resident/Fellow in Radiology President’s Award “Machine Learning Based Optimization of Root Factors Associated with Image Quality of Myocardial Late Iodine Enhancement”
• Shadi Ebrahimian, MD
  • Resident/Fellow in Radiology Executive Council Award “Evaluating AI Performance in Large Vessel Occlusion Detection: Impact on Time-to-Thrombectomy and Clinical Workflow Efficiency”
• Ariel S. Kniss, MD, PhD
  • Resident/Fellow in Radiology Executive Council Award “Mammographic Breast Density and Its Impact on Screening Performance Metrics: An Analysis of 489,439 Screening Mammograms”
• Capt. Tej Mehta, MD
  • Resident/Fellow in Radiology Melissa Rosado de Christenson Award “Multiparametric, Multimodal Delta-Radiomics for the Prediction of Transarterial Chemoembolization Outcomes in Hepatocellular Carcinoma”

Supported by The Roentgen Fund®, the ARRS Resident/ Fellow in Radiology Awards are available to all ARRS In-Training Members in imaging and allied sciences research to acknowledge their work and present their results during the ARRS Annual Meeting. ARRS Resident/Fellow in Radiology Awards are based on the competence and promise of the candidate in radiological research, education, or administration and the scientific merit and potential impact of the candidate’s research.

Since 1990, The Roentgen Fund has granted millions of dollars to hundreds of imaging professionals for both research pursuits and professional development. Today, through six vital scholarship and fellowship programs, the generosity of The Roentgen Fund’s donors is channeled to every corner of the globe—establishing dual foundations in innovation and leadership for a true diversity of radiology’s next generation.

Scholar Update: Derek Nguyen on Imaging-Focused Management of Architectural Distortions

According to research published in the American Journal of Roentgenology (AJR), imaging surveillance may be a safe alternative to surgical excision for architectural distortions (ADs) detected by digital breast tomosynthesis (DBT) alone with no sonographic correlate showing benign pathology without atypia on core needle biopsy (CNB). “The malignancy rate was 0% for ADs without atypia, versus 20% for ADs with atypia, on CNB,” explained first author and 2022 recipient of The Roentgen Fund’s Melissa Rosado de Christenson Award Derek L. Nguyen, MD, from the radiology department at Duke University School of Medicine in Durham, NC. Dr. Nguyen and colleagues’ AJR accepted manuscript included patients with ADs detected by DBT alone with no ultrasound correlate and nonmalignant results on stereotactic CNB with 12 vacuum-assisted 9-gauge cores from July 1, 2020 to December 31, 2023. ADs detected by DBT alone with no ultrasound correlate showing concordant benign pathology or radial scar without atypia on CNB were recommended to undergo 6-month and 12-month diagnostic imaging follow-up before returning to annual screening, whereas those showing atypia (with or without radial scar) on CNB were recommended to undergo surgical excision; however, patients could electively undergo the alternative management option. Nguyen et al. then assessed malignancy rates, considering ADs to be nonmalignant based on results of repeat CNB, surgical excision, or 12-month diagnostic imaging follow-up. Ultimately, for ADs detected by DBT alone with no ultrasound correlate and nonmalignant results on CNB obtaining 12 vacuum-assisted 9-gauge samples, malignancy rates were 0% (0/94) in the absence of atypia (with or without radial scar), versus 20% (3/15) in the presence of atypia (with or without radial scar), on CNB.

And during the 2025 ARRS Annual Meeting in San Diego, Dr. Nguyen participated in Breast Procedures: Tips, Tricks, and Updates with Tanya Moseley, MD, 2025 ARRS Distinguished Educator of the Year.

Roentgen Fund Roll Call

Dozens of prior awardees, like Dr. Nguyen, returned to present during all four days of the 2025 ARRS Annual Meeting in San Diego, CA. Congratulations to these trailblazing scholars and visionary educators—all of whom will continue to shape the future of our specialty:

• Opportunities and Obligations in Imaging Patients with Alzheimer’s Disease with Tammie L.S. Benzinger, MD, 2008 ARRS Scholar
• Critical Education for Safe, Ethical, and Successful AI in Radiology with Charles E. Kahn Jr., MD, MS, 1993 ARRS Scholar
• Wellness Symposium – Creating a Positive Work Environment in Radiology with Christine B. Chung, MD, 2003 Figley Fellow
• ARRS Scholar Presentation – Leveraging the “Art of Medicine” within Radiology: Investigation of Report Framing as a Digital Therapeutic To Mitigate Nocebo Effects with Steven A. Rothenberg, MD, BS, 2023 ARRS Scholar
• ARRS Scholar Presentation – Deep Learning Tool to Eliminate Nephrographic Phase Images and Reduce Radiation Dose in CT Urography with Andrew L. Wentland, MD, PhD, 2023 ARRS Scholar
• Quality and Safety in Radiology – The Unrelenting Pursuit of Excellence with Richard B. Gunderman, MD, PhD, 2011 Berlin Scholar
• Cardiac Imaging in the Acute Setting with Jadranka Stojanovska, MD, 2015 Figley Fellow and Brett W. Carter, MD, 2016 Figley Fellow
• Challenging Abdominal Cases with Perry J. Pickhardt, MD, 2002 Figley Fellow
• Radiology Year in Review with Erin Alaia, MD, 2025 Figley Fellow and Domen Plut, MD, PhD, 2025 Rogers Fellow
• Mastering Radiology: A Comprehensive Board Review for Residents and Refresher for Radiologists in Practice with Tanya Moseley, MD, 2025 Distinguished Educator
• Categorical Course – Imaging in the ED Musculoskeletal Emergencies: Fractures and Infections with Sameer Raniga, MD, FRCR, 2018 Rogers Fellow
• Gastrointestinal Imaging – Gastric Gliomas/Tumors, Bowel Ischemia and Bariatric Surgery with Benjamin Yeh, MD, 2006 ARRS Scholar
• GI Post-treatment Imaging with Samuel Galgano, MD, 2022 Figley Fellow
• Neuroradiology – CT Radiomics and Machine Learning with Suresh K. Mukherji, MD, 1998 Figley Fellow
• Radiology Case Review – Musculoskeletal Imaging with Erin Alaia, MD, 2025 Figley Fellow
• Award Winning Exhibits – Gastrointestinal Imaging with Benjamin Yeh, MD, 2006 ARRS Scholar
• ABR Update: 2025 with John A. Kaufman, MD, 1996 Figley Fellow
• Gastrointestinal Imaging – Hepatocellular Carcinoma with Claude B. Sirlin, MD, 2002 ARRS Scholar
• Upper Extremity Challenging Cases with Christine B. Chung, MD, 2003 Figley Fellow
• Categorical Course – Comprehensive Insights into Transplant Imaging: Bone Marrow Transplant with Meghan G. Lubner, MD, 2018 Figley Fellow
• Neurovascular Disease with Achala S. Vagal, MD, 2012 ARRS Scholar
• Gastrointestinal Imaging – Treatment Response Assessment with Neeraj Lalwani, MD, 2019 Figley Fellow