Journal of the American College of Radiology最新文献

英文中文

Patient-Friendly Summary of the ACR Appropriateness Criteria®: Nonvariceal Upper Gastrointestinal Bleeding 对患者友好的ACR适宜性标准总结：非静脉曲张上消化道出血。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-04-01 DOI: 10.1016/j.jacr.2024.11.012

Naomi Hoffer MA, MCHES , Sharon D’Souza MD, MPH

引用次数: 0

Patient-Friendly Summary of the ACR Appropriateness Criteria®: Clinically Suspected Vascular Malformation of the Extremities ACR适宜性标准的患者友好总结®：临床怀疑四肢血管畸形。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-04-01 DOI: 10.1016/j.jacr.2024.11.013

Grace O’Malley BS , Lynne M. Koweek MD

引用次数: 0

Impact of a Clinical Decision Support System on CT Pulmonary Angiography Yield and Utilization in Hospitalized Patients 临床决策支持系统对住院患者肺血管造影成像率和利用率的影响。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-04-01 DOI: 10.1016/j.jacr.2024.11.030

Amita Sharma MBBS , Mark Isabelle BA , Andetta Hunsaker MD , Sayon Dutta MD, MPH , David Lucier MD, MBA, MPH , Rachel P. Rosovsky MD, MPH , Sanjay Saini MD , Adam Landman MD , Ali S. Raja MD, MBA , Ramin Khorasani MD, MPH , Ronilda Lacson MD, PhD

Purpose

The aims of this study were to determine whether point-of-order clinical decision support (CDS) based on the Wells criteria improves CT pulmonary angiography (CTPA) yield and utilization in hospitalized patients in an enterprise-wide health system and to identify yield-related factors.

Methods

This retrospective, institutional review board–approved, cross-sectional study in an urban, multi-institution health system included hospitalized patients undergoing CTPA 12 months before and after CDS implementation (entire cohort). The χ² test was used to compare pulmonary embolism (PE) yield in patients in whom providers overrode versus followed CDS alerts after CDS implementation. It was also used to compare utilization and yield before- versus after the intervention. Univariate and multivariable regression analyses were performed on patient factors and post-CDS Wells scores to evaluate yield-related factors.

Results

For 2,429 inpatient CT pulmonary angiographic examinations after the intervention, CTPA yield was significantly higher when CDS recommendations were followed (18.3% [250 of 1,365]) compared with those overridden (14.2% [151 of 1,064]) (P < .01). For 5,372 CT pulmonary angiographic examinations in the entire cohort, there was no difference in PE yield before (448 of 2,943 [15.2%]) versus after (401 of 2,429 [16.5%]) CDS implementation (P = .20). However, in 340,146 admissions over the study period, a 7.4% relative decrease in CTPA utilization (from 17.5 to 16.2 CT pulmonary angiographic examinations per 1,000 admissions before and after CDS, respectively, P = .003) was observed.

Conclusions

When CDS recommendations were followed, the yield of CTPA was significantly higher than when clinicians overrode CDS alerts. In addition, point-of-order CDS to reduce unnecessary CTPA in hospitalized patients resulted in a significant decrease in CTPA utilization after CDS implementation, with a modest although nonsignificant increase in CTPA yield.

目的：确定基于Wells标准的点订单临床决策支持（CDS）是否能提高企业卫生系统住院患者CT肺血管造影（CTPA）的产出率和利用率，并确定产出率相关因素。方法：这项回顾性的经irb批准的横断面研究在一个城市、多机构的卫生系统中进行，包括在实施CDS前后12个月接受CTPA的住院患者（整个队列）。卡方检验用于比较提供者在实施CDS后无视CDS警报和遵循CDS警报的患者的PE率。它还用于比较干预前后的利用率和产量。对患者因素和cds后的Wells评分进行单变量和多变量回归分析，以评估产量相关因素。结果：干预后2429例住院CTPA患者中，遵循CDS建议的CTPA产出率（18.3%[250/1365]）明显高于不采纳CDS建议的CTPA产出率（14.2%[151/1064]）。讨论：遵循CDS建议的CTPA产出率显著高于不采纳CDS警报的CTPA产出率。此外，为了减少住院患者不必要的CTPA，使用点订单CDS导致实施CDS后CTPA利用率显著降低，CTPA产量略有增加，但不显著。

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引用次数: 0

A 3-Minute Ultrafast MRI and MRA Protocol for Screening of Acute Ischemic Stroke

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-03-01 DOI: 10.1016/j.jacr.2025.01.002

Maria Camila Cortes-Albornoz MD , Bryan Clifford PhD , Wei-Ching Lo PhD , Seonghwan Yee PhD , Brooks P. Applewhite MD , Azadeh Tabari MD , Claire White-Dzuro BA , Stephen F. Cauley PhD , Pamela W. Schaefer MD , Otto Rapalino MD , Michael H. Lev MD , Berkin Bilgic , Thorsten Feiweier , Susie Y. Huang MD, PhD , John M. Conklin MD , Min Lang MD, MSc

Objective

To evaluate the diagnostic performance of a 3-min ultrafast brain MRI and MRA protocol for screening of acute ischemic stroke.

Methods

This study involved 67 adult patients who underwent ultrafast and reference MRI and MRA scans from September 2023 to June 2024 for stroke evaluation. Two readers independently assessed the ultrafast and reference MRI and MRA images in a masked and randomized manner for acute and chronic infarct and hemorrhage as well as large-vessel occlusion and severe stenosis. A 3-point Likert scale was used to evaluate diagnostic quality of the ultrafast sequences and Cohen’s κ was used to assess interrater agreement.

Results

The ultrafast MRI and MRA protocol showed high diagnostic quality, with 98% of sequences rated as diagnostic. Raters showed perfect agreement in identifying acute infarcts, aneurysms, and vascular occlusions using both ultrafast and reference protocols and near-perfect agreement (>95%) for detecting acute hemorrhage and severe stenosis. For chronic conditions such as chronic infarction and chronic hemorrhage, there was substantial agreement with κ values ranging from 0.73 to 0.76.

Discussion

The screening ultrafast MRI and MRA protocol can effectively identify acute ischemic stroke and intracranial large-vessel occlusion with high diagnostic accuracy while significantly reducing acquisition time, making it suitable for initial stroke triage. Evaluation for chronic pathologies on the ultrafast protocol is inferior compared with standard MRI and MRA imaging.

{"title":"A 3-Minute Ultrafast MRI and MRA Protocol for Screening of Acute Ischemic Stroke","authors":"Maria Camila Cortes-Albornoz MD , Bryan Clifford PhD , Wei-Ching Lo PhD , Seonghwan Yee PhD , Brooks P. Applewhite MD , Azadeh Tabari MD , Claire White-Dzuro BA , Stephen F. Cauley PhD , Pamela W. Schaefer MD , Otto Rapalino MD , Michael H. Lev MD , Berkin Bilgic , Thorsten Feiweier , Susie Y. Huang MD, PhD , John M. Conklin MD , Min Lang MD, MSc","doi":"10.1016/j.jacr.2025.01.002","DOIUrl":"10.1016/j.jacr.2025.01.002","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic performance of a 3-min ultrafast brain MRI and MRA protocol for screening of acute ischemic stroke.</div></div><div><h3>Methods</h3><div>This study involved 67 adult patients who underwent ultrafast and reference MRI and MRA scans from September 2023 to June 2024 for stroke evaluation. Two readers independently assessed the ultrafast and reference MRI and MRA images in a masked and randomized manner for acute and chronic infarct and hemorrhage as well as large-vessel occlusion and severe stenosis. A 3-point Likert scale was used to evaluate diagnostic quality of the ultrafast sequences and Cohen’s κ was used to assess interrater agreement.</div></div><div><h3>Results</h3><div>The ultrafast MRI and MRA protocol showed high diagnostic quality, with 98% of sequences rated as diagnostic. Raters showed perfect agreement in identifying acute infarcts, aneurysms, and vascular occlusions using both ultrafast and reference protocols and near-perfect agreement (>95%) for detecting acute hemorrhage and severe stenosis. For chronic conditions such as chronic infarction and chronic hemorrhage, there was substantial agreement with κ values ranging from 0.73 to 0.76.</div></div><div><h3>Discussion</h3><div>The screening ultrafast MRI and MRA protocol can effectively identify acute ischemic stroke and intracranial large-vessel occlusion with high diagnostic accuracy while significantly reducing acquisition time, making it suitable for initial stroke triage. Evaluation for chronic pathologies on the ultrafast protocol is inferior compared with standard MRI and MRA imaging.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 366-375"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using Radiology as a Screening Tool to Identify Intimate Partner Violence

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-03-01 DOI: 10.1016/j.jacr.2025.01.003

Patrick J. Lenehan MD, PhD , Anji Tang MD , Gaurav V. Watane MD , Rahul Gujrathi MD , Hyesun Park MD , Babina Gosangi MD , Richard Thomas MD , Felipe Boschini Franco MD , Krishna Patel MPH , Ilana Warsofsky MD , Bernard Rosner PhD , Bharti Khurana MD, MBA

Objective

To identify imaging utilization patterns and radiologically evident injuries suggestive of intimate partner violence (IPV).

Methods

This retrospective case-control study analyzed historical imaging reports from women reporting physical IPV between 2013 and 2018 (“cases”; n = 265; 6,401 imaging studies) and age- and race-matched controls not reporting IPV (n = 875; 13,462 imaging studies). Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression to compare imaging utilization by organ system or modality. Logistic regression calculated adjusted odds ratios (aORs) for canceled studies and studies conducted in the emergency department (ED), overnight, or on weekends. Injury patterns were assessed by calculating aIRRs of injury by anatomic site and comparing synchronous and asynchronous injury detection. A time-to-event analysis using Cox proportional hazards regression compared the cumulative incidence of asynchronous injury in patients with at least one injury.

Results

Patients experiencing IPV underwent imaging at a higher rate than controls (aIRR: 1.5, 95 confidence interval [CI]: 1.5-1.6). They were more likely to cancel screening mammograms (aOR: 3.2, 95% CI: 1.8-5.7) and undergo imaging in the ED (aOR: 3.8, 95% CI: 2.9-5.0), overnight (aOR: 1.6, 95% CI: 1.3-1.9) and on weekends (aOR: 1.3, 95% CI: 1.1-1.5). The injury rate was higher in cases (aIRR: 15.1, 95% CI: 12.5-18.1), particularly for cranial (aIRR: 104.5, 95% CI: 14.2-770.1), facial (aIRR: 47.0, 95% CI: 18.9-117.0), and thoracic (aIRR: 32.6, 95% CI: 11.5-92.2) injuries. Cases were more likely to have multiple injuries in a single encounter (aOR: 4.7, 95% CI: 1.5-14.1) or multiple encounters with unique injuries (hazard ratio: 4.9, 95% CI: 2.6-9.3).

Conclusion

Patients experiencing IPV had higher rates of imaging studies, imaging utilization in the ED, weekend, and overnight settings, screening examination cancellation, and radiologically evident injuries than controls.

{"title":"Using Radiology as a Screening Tool to Identify Intimate Partner Violence","authors":"Patrick J. Lenehan MD, PhD , Anji Tang MD , Gaurav V. Watane MD , Rahul Gujrathi MD , Hyesun Park MD , Babina Gosangi MD , Richard Thomas MD , Felipe Boschini Franco MD , Krishna Patel MPH , Ilana Warsofsky MD , Bernard Rosner PhD , Bharti Khurana MD, MBA","doi":"10.1016/j.jacr.2025.01.003","DOIUrl":"10.1016/j.jacr.2025.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>To identify imaging utilization patterns and radiologically evident injuries suggestive of intimate partner violence (IPV).</div></div><div><h3>Methods</h3><div>This retrospective case-control study analyzed historical imaging reports from women reporting physical IPV between 2013 and 2018 (“cases”; n = 265; 6,401 imaging studies) and age- and race-matched controls not reporting IPV (n = 875; 13,462 imaging studies). Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression to compare imaging utilization by organ system or modality. Logistic regression calculated adjusted odds ratios (aORs) for canceled studies and studies conducted in the emergency department (ED), overnight, or on weekends. Injury patterns were assessed by calculating aIRRs of injury by anatomic site and comparing synchronous and asynchronous injury detection. A time-to-event analysis using Cox proportional hazards regression compared the cumulative incidence of asynchronous injury in patients with at least one injury.</div></div><div><h3>Results</h3><div>Patients experiencing IPV underwent imaging at a higher rate than controls (aIRR: 1.5, 95 confidence interval [CI]: 1.5-1.6). They were more likely to cancel screening mammograms (aOR: 3.2, 95% CI: 1.8-5.7) and undergo imaging in the ED (aOR: 3.8, 95% CI: 2.9-5.0), overnight (aOR: 1.6, 95% CI: 1.3-1.9) and on weekends (aOR: 1.3, 95% CI: 1.1-1.5). The injury rate was higher in cases (aIRR: 15.1, 95% CI: 12.5-18.1), particularly for cranial (aIRR: 104.5, 95% CI: 14.2-770.1), facial (aIRR: 47.0, 95% CI: 18.9-117.0), and thoracic (aIRR: 32.6, 95% CI: 11.5-92.2) injuries. Cases were more likely to have multiple injuries in a single encounter (aOR: 4.7, 95% CI: 1.5-14.1) or multiple encounters with unique injuries (hazard ratio: 4.9, 95% CI: 2.6-9.3).</div></div><div><h3>Conclusion</h3><div>Patients experiencing IPV had higher rates of imaging studies, imaging utilization in the ED, weekend, and overnight settings, screening examination cancellation, and radiologically evident injuries than controls.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 395-404"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Table of Content

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-03-01 DOI: 10.1016/S1546-1440(25)00053-5

引用次数: 0

Quantifying the Opportunity and Economic Value of Bone Density Screening Using Opportunistic CT: A Medicare Database Analysis

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-03-01 DOI: 10.1016/j.jacr.2024.10.003

Soterios Gyftopoulos MD, MBA , Casey E. Pelzl MPH , Connie Y. Chang MD

Purpose

The aim of this study was to determine the potential impact of opportunistic CT bone density screening in terms of increasing screening rates and cost avoidance.

Methods

The analytic dataset was extracted from the Medicare 5% Research Identifiable Files (2015-2022). All dual-energy x-ray absorptiometry (DEXA) procedures and contrast and/or noncontrast CT procedures of pertinent body regions were identified using Current Procedural Terminology codes. Outcomes of interest included osteoporosis screening imaging and fragility fractures of the hip or spine. Potential annual cost avoidance was calculated.

Results

In total, 2,897,040 beneficiaries were identified for analysis, of whom 584,391 beneficiaries (20.2%) underwent DEXA and 658,703 beneficiaries (22.7%) did not undergo DEXA but did undergo at least one CT examination that included the L1 vertebral body, 446,706 (67.8%) without and 211,997 (32.2%) with contrast. In the noncontrast and contrast CT groups, there were 2,766 (0.6%) and 613 (0.3%) hip and 23,889 (5.3%) and 5,222 (2.5%) spine fragility fractures within 1 year of CT. The osteoporosis screening rate would increase by 76% using only noncontrast CT studies and by 113% using all CT studies. If only noncontrast CT was used to identify osteoporosis and treatment was successfully implemented in 100% of eligible beneficiaries, this study population would see a medical cost avoidance in excess of $17 million. If any CT was used, potential annual cost avoidance for this study’s population would be nearly $100 million and $2.5 billion for all 2023 Medicare fee-for-service beneficiaries.

Conclusions

Implementing opportunistic CT bone density screening could potentially have a substantial patient care and economic impact.

{"title":"Quantifying the Opportunity and Economic Value of Bone Density Screening Using Opportunistic CT: A Medicare Database Analysis","authors":"Soterios Gyftopoulos MD, MBA , Casey E. Pelzl MPH , Connie Y. Chang MD","doi":"10.1016/j.jacr.2024.10.003","DOIUrl":"10.1016/j.jacr.2024.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to determine the potential impact of opportunistic CT bone density screening in terms of increasing screening rates and cost avoidance.</div></div><div><h3>Methods</h3><div>The analytic dataset was extracted from the Medicare 5% Research Identifiable Files (2015-2022). All dual-energy x-ray absorptiometry (DEXA) procedures and contrast and/or noncontrast CT procedures of pertinent body regions were identified using Current Procedural Terminology codes. Outcomes of interest included osteoporosis screening imaging and fragility fractures of the hip or spine. Potential annual cost avoidance was calculated.</div></div><div><h3>Results</h3><div>In total, 2,897,040 beneficiaries were identified for analysis, of whom 584,391 beneficiaries (20.2%) underwent DEXA and 658,703 beneficiaries (22.7%) did not undergo DEXA but did undergo at least one CT examination that included the L1 vertebral body, 446,706 (67.8%) without and 211,997 (32.2%) with contrast. In the noncontrast and contrast CT groups, there were 2,766 (0.6%) and 613 (0.3%) hip and 23,889 (5.3%) and 5,222 (2.5%) spine fragility fractures within 1 year of CT. The osteoporosis screening rate would increase by 76% using only noncontrast CT studies and by 113% using all CT studies. If only noncontrast CT was used to identify osteoporosis and treatment was successfully implemented in 100% of eligible beneficiaries, this study population would see a medical cost avoidance in excess of $17 million. If any CT was used, potential annual cost avoidance for this study’s population would be nearly $100 million and $2.5 billion for all 2023 Medicare fee-for-service beneficiaries.</div></div><div><h3>Conclusions</h3><div>Implementing opportunistic CT bone density screening could potentially have a substantial patient care and economic impact.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 349-357"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Applying Artificial Intelligence to Quantify Body Composition on Abdominal CTs and Better Predict Kidney Transplantation Wait-List Mortality

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-03-01 DOI: 10.1016/j.jacr.2025.01.004

Karim Yatim MD , Guilherme T. Ribas PhD , Daniel C. Elton PhD , Marcio A.B.C. Rockenbach MD , Ayman Al Jurdi MD , Perry J. Pickhardt MD , John W. Garrett PhD , Keith J. Dreyer DO, PhD , Bernardo C. Bizzo MD, PhD , Leonardo V. Riella MD, PhD

Background

Prekidney transplant evaluation routinely includes abdominal CT for presurgical vascular assessment. A wealth of body composition data are available from these CT examinations, but they remain an underused source of data, often missing from prognostication models, as these measurements require organ segmentation not routinely performed clinically by radiologists. We hypothesize that artificial intelligence facilitates accurate extraction of abdominal CT body composition data, allowing better prediction of outcomes.

Methods

We conducted a retrospective, single-center observational study of kidney transplant candidates wait-listed between January 1, 2007, and December 31, 2017, with available CT data. Validated deep learning models quantified body composition including fat, aortic calcification, bone density, and muscle mass. Logistic regression was used to compare body composition data to Expected Post-Transplant Survival Score (EPTS) as a predictor of 5-year wait-list mortality.

Results

In all, 899 patients were followed for a median 943 days (interquartile range 320-1,697). Of 899, 589 (65.5%) were men and 680 of 899 (75.6%) were White, non-Hispanic. Of 899, 167 patients (18.6%) died while on the waiting list. Myosteatosis (defined as the lowest tertile of muscle attenuation) and increased total aortic and abdominal calcification were associated with increased 5-year wait-list mortality. Logistic regression showed that imaging parameters performed similarly to EPTS at predicting 5-year wait-list mortality (area under receiver operating characteristic curve 0.70 [0.64-0.75] versus 0.67 [0.62-0.72], respectively), and combining body composition parameters with EPTS led to a slight improved survival prediction (area under receiver operating characteristic curve = 0.72, 95% confidence interval 0.66-0.76).

Conclusions

Fully automated quantification of body composition in kidney transplant candidates is feasible. Myosteatosis and atherosclerosis are associated with 5-year wait-list mortality.

{"title":"Applying Artificial Intelligence to Quantify Body Composition on Abdominal CTs and Better Predict Kidney Transplantation Wait-List Mortality","authors":"Karim Yatim MD , Guilherme T. Ribas PhD , Daniel C. Elton PhD , Marcio A.B.C. Rockenbach MD , Ayman Al Jurdi MD , Perry J. Pickhardt MD , John W. Garrett PhD , Keith J. Dreyer DO, PhD , Bernardo C. Bizzo MD, PhD , Leonardo V. Riella MD, PhD","doi":"10.1016/j.jacr.2025.01.004","DOIUrl":"10.1016/j.jacr.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Prekidney transplant evaluation routinely includes abdominal CT for presurgical vascular assessment. A wealth of body composition data are available from these CT examinations, but they remain an underused source of data, often missing from prognostication models, as these measurements require organ segmentation not routinely performed clinically by radiologists. We hypothesize that artificial intelligence facilitates accurate extraction of abdominal CT body composition data, allowing better prediction of outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center observational study of kidney transplant candidates wait-listed between January 1, 2007, and December 31, 2017, with available CT data. Validated deep learning models quantified body composition including fat, aortic calcification, bone density, and muscle mass. Logistic regression was used to compare body composition data to Expected Post-Transplant Survival Score (EPTS) as a predictor of 5-year wait-list mortality.</div></div><div><h3>Results</h3><div>In all, 899 patients were followed for a median 943 days (interquartile range 320-1,697). Of 899, 589 (65.5%) were men and 680 of 899 (75.6%) were White, non-Hispanic. Of 899, 167 patients (18.6%) died while on the waiting list. Myosteatosis (defined as the lowest tertile of muscle attenuation) and increased total aortic and abdominal calcification were associated with increased 5-year wait-list mortality. Logistic regression showed that imaging parameters performed similarly to EPTS at predicting 5-year wait-list mortality (area under receiver operating characteristic curve 0.70 [0.64-0.75] versus 0.67 [0.62-0.72], respectively), and combining body composition parameters with EPTS led to a slight improved survival prediction (area under receiver operating characteristic curve = 0.72, 95% confidence interval 0.66-0.76).</div></div><div><h3>Conclusions</h3><div>Fully automated quantification of body composition in kidney transplant candidates is feasible. Myosteatosis and atherosclerosis are associated with 5-year wait-list mortality.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 332-341"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Screening via Imaging: Updates and Innovations

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-03-01 DOI: 10.1016/j.jacr.2025.01.007

Resmi A. Charalel MD, MPH , Jeffrey P. Guenette MD, MPH , Christoph I. Lee MD, MS, MBA

引用次数: 0

Using Self-Scheduling to Improve Screening Mammography Completion Rates

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-03-01 DOI: 10.1016/j.jacr.2024.10.007

Gillean Cortes DO , Wen-Pin Chen MS , Ziogas Aryagus PhD , Ali Rashidi MD , Irene Tsai MD , Gelareh Sadigh MD

Purpose

Self-scheduling has the potential to enhance convenience and patient engagement. We compared outpatient screening mammography completion rates before and after implementing an online self-scheduling system between patients who use self-scheduling versus traditional scheduling.

Methods

In February 2021, a self-scheduling process was implemented at an institutional level through the Epic MyChart online portal, allowing patients to self-schedule screening mammography. This retrospective cohort study included women aged 18 and over who scheduled outpatient screening mammography in a tertiary health care facility from October 1, 2017, to June 30, 2023, had at least one encounter during the pre-implementation phase and one encounter during the postimplementation period, and only used one scheduling method (self-scheduling or traditional scheduling) in the postimplementation period. Difference-in-difference analyses were conducted to compare screening mammography completion rates between patients who used traditional versus self-scheduling in the postimplementation period.

Results

In all, 29,893 screening mammography were scheduled by 7,203 patients (mean age: 58.1 years; 70.0% White, 18.2% Asian, 1.8% Black, and 19.5% Hispanic). The overall mammography completion rate in pre-implementation period was 78.9% and increased to 79.8% in the postimplementation period. Using difference-in-difference estimator, the completion rates in the self-scheduling cohort was 8.4 percentage point (95% confidence interval, 5.2-11.6) higher than traditional scheduling. The change in screening mammography completion rate from the postimplementation to pre-implementation period was +8.5 percentage point (88.1% postimplementation versus 79.6% pre-implementation) for the self-scheduling cohort and +0.1 percentage point (80.8% postimplementation versus 80.7% pre-implementation) for the traditional scheduling cohort.

Conclusion

Self-scheduling was linked to increased screening mammography completion rates postimplementation when compared to traditional scheduling.

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