Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.08.022
Expert Panel on Urological Imaging, Samantha J. Barker MD , Esra Soylu MD , Brian C. Allen MD , Moises Auron MD , Daniel N. Costa MD , Marielia Gerena MD , Yair Lotan MD , Tracy L. Rose MD , Abhishek Solanki MD , Devaki Shilpa Surasi MD , Baris Turkbey MD , Pat Whitworth III MD , Aytekin Oto MD
Urothelial cancer is the second most common cancer, and cause of cancer death, related to the genitourinary tract. The goals of imaging for pretreatment staging of urothelial cancer are to evaluate for both local and distant spread of the cancer and assessing for synchronous sites of urothelial cancer in the upper tracts and bladder. For pretreatment staging of urothelial carcinoma, patients can be stratified into one of three groups: 1) nonmuscle invasive bladder cancer; 2) muscle invasive bladder cancer; and 3) upper urinary tract urothelial carcinoma. This document is a review of the current literature for urothelial cancer and resulting recommendations for pretreatment staging imaging.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
{"title":"ACR Appropriateness Criteria® Pretreatment Staging of Urothelial Cancer: 2024 Update","authors":"Expert Panel on Urological Imaging, Samantha J. Barker MD , Esra Soylu MD , Brian C. Allen MD , Moises Auron MD , Daniel N. Costa MD , Marielia Gerena MD , Yair Lotan MD , Tracy L. Rose MD , Abhishek Solanki MD , Devaki Shilpa Surasi MD , Baris Turkbey MD , Pat Whitworth III MD , Aytekin Oto MD","doi":"10.1016/j.jacr.2024.08.022","DOIUrl":"10.1016/j.jacr.2024.08.022","url":null,"abstract":"<div><div>Urothelial cancer is the second most common cancer, and cause of cancer death, related to the genitourinary tract. The goals of imaging for pretreatment staging of urothelial cancer are to evaluate for both local and distant spread of the cancer and assessing for synchronous sites of urothelial cancer in the upper tracts and bladder. For pretreatment staging of urothelial carcinoma, patients can be stratified into one of three groups: 1) nonmuscle invasive bladder cancer; 2) muscle invasive bladder cancer; and 3) upper urinary tract urothelial carcinoma. This document is a review of the current literature for urothelial cancer and resulting recommendations for pretreatment staging imaging.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages S464-S489"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564447","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.08.018
Expert Panel on Neurological Imaging, Bruno P. Soares MD , Robert Y. Shih MD , Pallavi S. Utukuri MD , Megan Adamson MD , Matthew J. Austin MD , Richard K.J. Brown MD , Judah Burns MD , Kelsey Cacic MD , Sammy Chu MD , Cathy Crone MD , Jana Ivanidze MD, PhD , Christopher D. Jackson MD , Aleks Kalnins MD, MBA , Christopher A. Potter MD , Sonja Rosen MD , Karl A. Soderlund MD , Ashesh A. Thaker MD , Lily L. Wang MBBS, MPH , Bruno Policeni MD, MBA
Altered mental status (AMS) and coma are terms used to describe disorders of arousal and content of consciousness. AMS may account for up to 4% to 10% of chief complaints in the emergency department setting and is a common accompanying symptom for other presentations. AMS is not a diagnosis, but rather a term for symptoms of acute or chronic disordered mentation, including confusion, disorientation, lethargy, drowsiness, somnolence, unresponsiveness, agitation, altered behavior, inattention, hallucinations, delusions, and psychosis. Some of the most common disorders associated with AMS are underlying medical conditions, substance use, and mental disorders. This document focuses on the appropriateness of neuroimaging in adult patients presenting with AMS changes including new onset delirium or new onset psychosis. In these cases, imaging is often expedited for initial stabilization and to exclude an intracranial process requiring intervention.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
{"title":"ACR Appropriateness Criteria® Altered Mental Status, Coma, Delirium, and Psychosis: 2024 Update","authors":"Expert Panel on Neurological Imaging, Bruno P. Soares MD , Robert Y. Shih MD , Pallavi S. Utukuri MD , Megan Adamson MD , Matthew J. Austin MD , Richard K.J. Brown MD , Judah Burns MD , Kelsey Cacic MD , Sammy Chu MD , Cathy Crone MD , Jana Ivanidze MD, PhD , Christopher D. Jackson MD , Aleks Kalnins MD, MBA , Christopher A. Potter MD , Sonja Rosen MD , Karl A. Soderlund MD , Ashesh A. Thaker MD , Lily L. Wang MBBS, MPH , Bruno Policeni MD, MBA","doi":"10.1016/j.jacr.2024.08.018","DOIUrl":"10.1016/j.jacr.2024.08.018","url":null,"abstract":"<div><div>Altered mental status (AMS) and coma are terms used to describe disorders of arousal and content of consciousness. AMS may account for up to 4% to 10% of chief complaints in the emergency department setting and is a common accompanying symptom for other presentations. AMS is not a diagnosis, but rather a term for symptoms of acute or chronic disordered mentation, including confusion, disorientation, lethargy, drowsiness, somnolence, unresponsiveness, agitation, altered behavior, inattention, hallucinations, delusions, and psychosis. Some of the most common disorders associated with AMS are underlying medical conditions, substance use, and mental disorders. This document focuses on the appropriateness of neuroimaging in adult patients presenting with AMS changes including new onset delirium or new onset psychosis. In these cases, imaging is often expedited for initial stabilization and to exclude an intracranial process requiring intervention.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages S372-S383"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565429","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.06.020
Janie M. Lee MD, MSc , Laura E. Ichikawa MS , Karla Kerlikowske MD , Diana S.M. Buist PhD, MPH , Christoph I. Lee MD, MS, MBA , Brian L. Sprague PhD , Louise M. Henderson PhD, MSPH , Tracy Onega PhD, MS, MPAS , Karen J. Wernli PhD , Kathryn P. Lowry MD , Natasha K. Stout PhD , Anna N.A. Tosteson ScD , Diana L. Miglioretti PhD
Objective
Mammography and MRI screening typically occur in combination or in alternating sequence. We compared multimodality screening performance accounting for the relative timing of mammography and MRI and overlapping follow-up periods.
Methods
We identified 8,260 screening mammograms performed 2005 to 2017 in the Breast Cancer Surveillance Consortium, paired with screening MRIs within ±90 days (combined screening) or 91 to 270 days (alternating screening). Performance for combined screening (cancer detection rate [CDR] per 1,000 examinations and sensitivity) was calculated with 1-year follow-up for each modality, and with a single follow-up period treating the two tests as a single test. Alternating screening performance was calculated with 1-year follow-up for each modality and also with follow-up ending at the next screen if within 1 year (truncated follow-up).
Results
For 3,810 combined screening pairs, CDR per 1,000 screens was 6.8 (95% confidence interval [CI]: 4.6-10.0) for mammography and 12.3 (95% CI: 9.3-16.4) for MRI as separate tests compared with 13.1 (95% CI: 10.0-17.3) as a single combined test. Sensitivity of each test was 48.1% (35.0%-61.5%) for mammography and 79.7% (95% CI: 67.7%-88.0%) for MRI compared with 96.2% (95% CI: 85.9%-99.0%) for combined screening. For 4,450 alternating screening pairs, mammography CDR per 1,000 screens changed from 3.6 (95% CI: 2.2-5.9) to zero with truncated follow-up; sensitivity was incalculable (denominator = 0). MRI CDR per 1,000 screens changed from 12.1 (95% CI 9.3-15.8) to 11.7 (95% CI: 8.9-15.3) with truncated follow-up; sensitivity changed from 75.0% (95% CI 63.8%-83.6%) to 86.7% (95% CI 75.5%-93.2%).
Discussion
Updating auditing approaches to account for combined and alternating screening sequencing and to address outcome attribution issues arising from overlapping follow-up periods can improve the accuracy of multimodality screening performance evaluation.
目的：乳房 X 线照相术和核磁共振成像筛查通常会同时进行或交替进行。我们比较了乳腺 X 线照相术和核磁共振成像的相对时间以及重叠随访期的多模态筛查效果：我们确定了乳腺癌监测联盟（Breast Cancer Surveillance Consortium）在 2005-2017 年进行的 8260 次乳腺 X 线照相筛查，并在 +/- 90 天内（联合筛查）或 91-270 天内（交替筛查）与核磁共振成像筛查配对。联合筛查的性能[每1000次检查的癌症检出率（CDR）和灵敏度]是在对每种方式进行一年随访的情况下计算得出的，在单次随访期间将这两项检查视为一次检查。在对每种检查方式进行为期一年的随访时，计算交替筛查的效果；如果随访时间在一年之内，则计算随访结束时间（截断随访）：在 3,810 对组合筛查中，乳腺 X 线照相术和核磁共振成像分别作为单独检查和单一组合检查，每 1000 次筛查的 CDR 分别为 6.8（95%CI：4.6-10.0）和 12.3（95%CI：9.3-16.4），而每 1000 次筛查的 CDR 分别为 13.1（95%CI：10.0-17.3）。乳房 X 线照相术和核磁共振成像的敏感性分别为 48.1%（35.0%-61.5%）和 79.7%（95%CI：67.7-88.0%），而联合筛查的敏感性分别为 96.2%（95%CI：85.9-99.0%）。在 4450 对交替筛查中，每 1000 次筛查的乳腺 X 线造影 CDR 从 3.6（95%CI：2.2-5.9）变为零，随访时间被截断；灵敏度无法计算（分母=0）。截断随访后，每 1000 个筛查的 MRI CDR 从 12.1（95%CI：9.3-15.8）变为 11.7（95%CI：8.9-15.3）；灵敏度从 75.0%（95%CI：63.8-83.6%）变为 86.7%（95%CI：75.5-93.2%）：讨论：更新审核方法以考虑联合和交替筛查顺序，并解决随访期重叠引起的结果归属问题，可以提高多模态筛查绩效评估的准确性。
{"title":"Relative Timing of Mammography and MRI for Breast Cancer Screening: Impact on Performance Evaluation","authors":"Janie M. Lee MD, MSc , Laura E. Ichikawa MS , Karla Kerlikowske MD , Diana S.M. Buist PhD, MPH , Christoph I. Lee MD, MS, MBA , Brian L. Sprague PhD , Louise M. Henderson PhD, MSPH , Tracy Onega PhD, MS, MPAS , Karen J. Wernli PhD , Kathryn P. Lowry MD , Natasha K. Stout PhD , Anna N.A. Tosteson ScD , Diana L. Miglioretti PhD","doi":"10.1016/j.jacr.2024.06.020","DOIUrl":"10.1016/j.jacr.2024.06.020","url":null,"abstract":"<div><h3>Objective</h3><div>Mammography and MRI screening typically occur in combination or in alternating sequence. We compared multimodality screening performance accounting for the relative timing of mammography and MRI and overlapping follow-up periods.</div></div><div><h3>Methods</h3><div>We identified 8,260 screening mammograms performed 2005 to 2017 in the Breast Cancer Surveillance Consortium, paired with screening MRIs within ±90 days (combined screening) or 91 to 270 days (alternating screening). Performance for combined screening (cancer detection rate [CDR] per 1,000 examinations and sensitivity) was calculated with 1-year follow-up for each modality, and with a single follow-up period treating the two tests as a single test. Alternating screening performance was calculated with 1-year follow-up for each modality and also with follow-up ending at the next screen if within 1 year (truncated follow-up).</div></div><div><h3>Results</h3><div>For 3,810 combined screening pairs, CDR per 1,000 screens was 6.8 (95% confidence interval [CI]: 4.6-10.0) for mammography and 12.3 (95% CI: 9.3-16.4) for MRI as separate tests compared with 13.1 (95% CI: 10.0-17.3) as a single combined test. Sensitivity of each test was 48.1% (35.0%-61.5%) for mammography and 79.7% (95% CI: 67.7%-88.0%) for MRI compared with 96.2% (95% CI: 85.9%-99.0%) for combined screening. For 4,450 alternating screening pairs, mammography CDR per 1,000 screens changed from 3.6 (95% CI: 2.2-5.9) to zero with truncated follow-up; sensitivity was incalculable (denominator = 0). MRI CDR per 1,000 screens changed from 12.1 (95% CI 9.3-15.8) to 11.7 (95% CI: 8.9-15.3) with truncated follow-up; sensitivity changed from 75.0% (95% CI 63.8%-83.6%) to 86.7% (95% CI 75.5%-93.2%).</div></div><div><h3>Discussion</h3><div>Updating auditing approaches to account for combined and alternating screening sequencing and to address outcome attribution issues arising from overlapping follow-up periods can improve the accuracy of multimodality screening performance evaluation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages 1722-1732"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141539037","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.07.016
Mariam E. Dogar MMS , Brittany M. Dacier MD, MPH , Javier Mora MD , Showly Nicholson MD , Jinel A. Scott MD, MBA , Adil H. Haider MD, MPH , Efren J. Flores MD , Gezzer Ortega MD, MPH
{"title":"Applying Cultural Dexterity to Patients in Radiology","authors":"Mariam E. Dogar MMS , Brittany M. Dacier MD, MPH , Javier Mora MD , Showly Nicholson MD , Jinel A. Scott MD, MBA , Adil H. Haider MD, MPH , Efren J. Flores MD , Gezzer Ortega MD, MPH","doi":"10.1016/j.jacr.2024.07.016","DOIUrl":"10.1016/j.jacr.2024.07.016","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages 1778-1780"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908573","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.06.013
Sarah M. Pittman MD , Kay Zacharias-Andrews MBA , Kandice Garcia Tomkins MS , Mythreyi Bhargavan-Chatfield PhD , David B. Larson MD, MBA
Purpose/Objective
To share the experience and results of the first cohort of the ACR Mammography Positioning Improvement Collaborative, in which participating sites aimed to increase the mean percentage of screening mammograms meeting the established positioning criteria to 85% or greater and show at least modest evidence of improvement at each site by the end of the improvement program.
Methods
The sites comprising the first cohort of the collaborative were selected on the basis of strength of local leadership support, intra-organizational relationships, access to data and analytic support, and experience with quality improvement initiatives. During the improvement program, participating sites organized their teams, developed goals, gathered data, evaluated their current state, identified key drivers and root causes of their problems, and developed and tested interventions. A standardized image quality scoring system was also established. The impact of the interventions implemented at each site was assessed by tracking the percentage of screening mammograms meeting overall passing criteria over time.
Results
Six organizations were selected to participate as the first cohort, beginning with participation in the improvement program. Interventions developed and implemented at each site during the program resulted in improvement in the average percentage of screening mammograms meeting overall passing criteria per week from a collaborative mean of 51% to 86%, with four of six sites meeting or exceeding the target mean performance of 85% by the end of the improvement program. Afterward, all respondents to the postprogram survey indicated that the program was a positive experience.
Conclusion
Using a structured improvement program within a learning network framework, the first cohort of the collaborative demonstrated that improvement in mammography positioning performance can be achieved at multiple sites simultaneously and validated the hypothesis that local sites’ shared experiences, insights, and learnings would not only improve performance but would also build a community of improvers collaborating to create the best experience for technologists, staff, and patients.
目的/目标：在该合作项目中，参与机构的目标是将符合既定定位标准的乳腺 X 线照相筛查平均百分比提高到 85% 或更高，并在改进计划结束时在每个机构至少显示出适度改进的证据：方法：根据当地领导的支持力度、组织内部关系、数据获取和分析支持以及质量改进（QI）计划的经验等因素，选出了合作计划的第一批参与单位。在改进计划期间，参与地点组织团队、制定目标、收集数据、评估现状、确定问题的关键驱动因素和根本原因，并制定和测试干预措施。此外，还建立了标准化的图像质量评分系统。通过跟踪一段时间内符合总体合格标准的乳腺 X 线造影筛查百分比，来评估各机构实施干预措施的效果：结果：六家机构被选为首批参与机构，开始参与改进计划。在改进计划期间，各医疗机构制定并实施的干预措施使每周符合总体合格标准的乳腺 X 光筛查平均百分比从合作平均值 51% 提高到 86%，在改进计划结束时，六家医疗机构中有四家达到或超过了 85% 的目标平均值。之后，所有参与计划后调查的受访者都表示该计划是一次积极的经历：通过在学习网络框架内实施结构化改进计划，合作组织的第一批成员证明了乳腺X光摄影定位性能的提高可以在多个地点同时实现，并验证了以下假设：当地地点分享经验、见解和学习成果不仅能提高性能，还能建立一个改进者社区，通过合作为技术人员、员工和患者创造最佳体验。
{"title":"The ACR Mammography Positioning Improvement Collaborative: A Multicenter Improvement Program Within a Learning Network Framework","authors":"Sarah M. Pittman MD , Kay Zacharias-Andrews MBA , Kandice Garcia Tomkins MS , Mythreyi Bhargavan-Chatfield PhD , David B. Larson MD, MBA","doi":"10.1016/j.jacr.2024.06.013","DOIUrl":"10.1016/j.jacr.2024.06.013","url":null,"abstract":"<div><h3>Purpose/Objective</h3><div>To share the experience and results of the first cohort of the ACR Mammography Positioning Improvement Collaborative, in which participating sites aimed to increase the mean percentage of screening mammograms meeting the established positioning criteria to 85% or greater and show at least modest evidence of improvement at each site by the end of the improvement program.</div></div><div><h3>Methods</h3><div>The sites comprising the first cohort of the collaborative were selected on the basis of strength of local leadership support, intra-organizational relationships, access to data and analytic support, and experience with quality improvement initiatives. During the improvement program, participating sites organized their teams, developed goals, gathered data, evaluated their current state, identified key drivers and root causes of their problems, and developed and tested interventions. A standardized image quality scoring system was also established. The impact of the interventions implemented at each site was assessed by tracking the percentage of screening mammograms meeting overall passing criteria over time.</div></div><div><h3>Results</h3><div>Six organizations were selected to participate as the first cohort, beginning with participation in the improvement program. Interventions developed and implemented at each site during the program resulted in improvement in the average percentage of screening mammograms meeting overall passing criteria per week from a collaborative mean of 51% to 86%, with four of six sites meeting or exceeding the target mean performance of 85% by the end of the improvement program. Afterward, all respondents to the postprogram survey indicated that the program was a positive experience.</div></div><div><h3>Conclusion</h3><div>Using a structured improvement program within a learning network framework, the first cohort of the collaborative demonstrated that improvement in mammography positioning performance can be achieved at multiple sites simultaneously and validated the hypothesis that local sites’ shared experiences, insights, and learnings would not only improve performance but would also build a community of improvers collaborating to create the best experience for technologists, staff, and patients.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages 1755-1764"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478131","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.07.021
Erin F. Alaia MD , Andrew B. Ross MD, MPH , Bangyan Chen MSc , Soterios Gyftopoulos MD, MBA, MSc
Purpose
The aim of this study was to use the National Ambulatory Medical Care Survey database to assess MRI utilization in patients 50 years and older with atraumatic hip or knee pain.
Methods
National Ambulatory Medical Care Survey weighted survey data (2007-2019) were obtained for ambulatory visits in patients 50 years and older with atraumatic hip or knee pain. The outcome variable was MRI ordering status, and analyzed characteristics included patient age, race/ethnicity, payer, physician specialty, metropolitan statistical area, and a coexistent radiography order. Multivariable logistic regressions were conducted to assess the association between MRI ordering status and the analyzed patient characteristics. All tests were two sided, and P values ≤.05 were considered to indicate statistical significance.
Results
In total, 88,978,804 knee pain and 28,675,725 hip pain patient visits (survey weighted) were analyzed, with 4,690,943 (5.3%) and 2,023,226 (7.1%) having knee or hip MRI orders, respectively. Overall, 2,454,433 knee pain visits (2.8%) and 575,155 hip pain visits (2.0%) had orders for both MRI and radiographs. Black patients (P = .03) and patients 80 years and older (P = .04) were less likely to have knee MRI ordered, whereas uninsured patients were less likely to have hip MRI ordered (P = .01). Patients with hip pain were more likely to have hip MRI ordered if seen by a surgical subspecialist (P = .01).
Conclusions
A low proportion of MRI examinations were ordered for visits in patients 50 years and older with atraumatic hip or knee pain. Groups with lower health care access were less likely to have an MRI order, highlighting known disparities in health care equity.
{"title":"Utilization of Hip or Knee MRI in Patients 50 Years and Older With Atraumatic Pain: An Analysis of the National Ambulatory Medical Care Survey","authors":"Erin F. Alaia MD , Andrew B. Ross MD, MPH , Bangyan Chen MSc , Soterios Gyftopoulos MD, MBA, MSc","doi":"10.1016/j.jacr.2024.07.021","DOIUrl":"10.1016/j.jacr.2024.07.021","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to use the National Ambulatory Medical Care Survey database to assess MRI utilization in patients 50 years and older with atraumatic hip or knee pain.</div></div><div><h3>Methods</h3><div>National Ambulatory Medical Care Survey weighted survey data (2007-2019) were obtained for ambulatory visits in patients 50 years and older with atraumatic hip or knee pain. The outcome variable was MRI ordering status, and analyzed characteristics included patient age, race/ethnicity, payer, physician specialty, metropolitan statistical area, and a coexistent radiography order. Multivariable logistic regressions were conducted to assess the association between MRI ordering status and the analyzed patient characteristics. All tests were two sided, and <em>P</em> values ≤.05 were considered to indicate statistical significance.</div></div><div><h3>Results</h3><div>In total, 88,978,804 knee pain and 28,675,725 hip pain patient visits (survey weighted) were analyzed, with 4,690,943 (5.3%) and 2,023,226 (7.1%) having knee or hip MRI orders, respectively. Overall, 2,454,433 knee pain visits (2.8%) and 575,155 hip pain visits (2.0%) had orders for both MRI and radiographs. Black patients (<em>P</em> = .03) and patients 80 years and older (<em>P</em> = .04) were less likely to have knee MRI ordered, whereas uninsured patients were less likely to have hip MRI ordered (<em>P</em> = .01). Patients with hip pain were more likely to have hip MRI ordered if seen by a surgical subspecialist (<em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>A low proportion of MRI examinations were ordered for visits in patients 50 years and older with atraumatic hip or knee pain. Groups with lower health care access were less likely to have an MRI order, highlighting known disparities in health care equity.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages 1733-1740"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914750","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.08.024
Saurabh Jha MBBS, MRCS, MS
{"title":"Whole-Body Overdiagnosis: Perils of Whole-Body MRI","authors":"Saurabh Jha MBBS, MRCS, MS","doi":"10.1016/j.jacr.2024.08.024","DOIUrl":"10.1016/j.jacr.2024.08.024","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages 1819-1821"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156795","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.07.025
Mark Isabelle BA , Ronilda Lacson MD, PhD , Heather Johnston MA , Oleg Pianykh PhD , Amita Sharma MBBS , Debra A. Gervais MD , Sanjay Saini MD , Ramin Khorasani MD, MPH , Daniel I. Glazer MD
Objective
To determine the volume of intravenous iodinated contrast media used for CT before, during, and after the global iohexol shortage over a total of 17 months at a multisite health system.
Methods
This retrospective study included all patients who underwent CT at a large health system with 12 sites. Standardized contrast doses for 13 CT examinations were implemented May 23, 2022. Mean contrast utilization per CT encounter was compared between three periods (preintervention: January 1, 2022, to May 22, 2022; intervention: May 23, 2022, to September 11, 2022; postintervention: September 12, 2022, to June 30, 2023). Contrast doses and CT encounter data were extracted from the enterprise data warehouse. Categorical variables were compared with a χ2 test, and continuous variables were compared with a two-tailed t test. Multivariable linear regression assessed significance, with coefficients noted to determine magnitude and direction of effect.
Results
Preintervention, there were 152,009 examinations (87,722 with contrast [57.7%]); during the intervention, there were 120,031 examinations (63,217 with contrast [52.7%]); and during the postintervention, there were 341,862 examinations (194,231 with contrast [56.8%]). Preintervention, mean contrast dose was 89.3 mL per examination, which decreased to 78.0 mL after standardization (Δ of −12.7%) (P < .001). This decrease continued throughout the intervention and persisted in the postintervention period (80.4 mL; Δ −10.0%, P < .001). On multivariable analysis, patient weight, sex, and performing site were all associated with variations in contrast dose. Most but not all sites (9 of 12) sustained the decreased contrast media dose in the postintervention period.
Discussion
Implementing standardized contrast media dosing for commonly performed CT examinations led to a rapid decrease in contrast media utilization, which persisted over 1 year.
{"title":"Reducing Intravenous Contrast Utilization for CT: A Health System–Wide Intervention With Sustained Impact","authors":"Mark Isabelle BA , Ronilda Lacson MD, PhD , Heather Johnston MA , Oleg Pianykh PhD , Amita Sharma MBBS , Debra A. Gervais MD , Sanjay Saini MD , Ramin Khorasani MD, MPH , Daniel I. Glazer MD","doi":"10.1016/j.jacr.2024.07.025","DOIUrl":"10.1016/j.jacr.2024.07.025","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the volume of intravenous iodinated contrast media used for CT before, during, and after the global iohexol shortage over a total of 17 months at a multisite health system.</div></div><div><h3>Methods</h3><div>This retrospective study included all patients who underwent CT at a large health system with 12 sites. Standardized contrast doses for 13 CT examinations were implemented May 23, 2022. Mean contrast utilization per CT encounter was compared between three periods (preintervention: January 1, 2022, to May 22, 2022; intervention: May 23, 2022, to September 11, 2022; postintervention: September 12, 2022, to June 30, 2023). Contrast doses and CT encounter data were extracted from the enterprise data warehouse. Categorical variables were compared with a χ<sup>2</sup> test, and continuous variables were compared with a two-tailed <em>t</em> test. Multivariable linear regression assessed significance, with coefficients noted to determine magnitude and direction of effect.</div></div><div><h3>Results</h3><div>Preintervention, there were 152,009 examinations (87,722 with contrast [57.7%]); during the intervention, there were 120,031 examinations (63,217 with contrast [52.7%]); and during the postintervention, there were 341,862 examinations (194,231 with contrast [56.8%]). Preintervention, mean contrast dose was 89.3 mL per examination, which decreased to 78.0 mL after standardization (Δ of −12.7%) (<em>P</em> < .001). This decrease continued throughout the intervention and persisted in the postintervention period (80.4 mL; Δ −10.0%, <em>P</em> < .001). On multivariable analysis, patient weight, sex, and performing site were all associated with variations in contrast dose. Most but not all sites (9 of 12) sustained the decreased contrast media dose in the postintervention period.</div></div><div><h3>Discussion</h3><div>Implementing standardized contrast media dosing for commonly performed CT examinations led to a rapid decrease in contrast media utilization, which persisted over 1 year.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages 1746-1754"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984123","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.05.013
Edward I. Bluth MD
{"title":"Radiology Retirement Age","authors":"Edward I. Bluth MD","doi":"10.1016/j.jacr.2024.05.013","DOIUrl":"10.1016/j.jacr.2024.05.013","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Page 1721"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728399","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jacr.2024.08.014
Expert Panel on Polytrauma Imaging, James T. Lee MD , Ahmed Sobieh MD, PhD , Stephanie Bonne MD , Marc A. Camacho MD, MS , Phyllis Glanc MD , James F. Holmes MD, MPH , Sanjeeva P. Kalva MD , Faisal Khosa MD, MBA , Krista Perry DO , Susan B. Promes MD, MBA , Thomas Ptak MD, PhD, MPH , Eric A. Roberge MD , LeAnn Shannon MD , Edwin F. Donnelly MD, PhD
This document assesses the appropriateness of various imaging studies for acute penetrating trauma to the torso. Penetrating trauma most commonly occurs from gunshots and stabbings, although any object can impale the patient. Anatomic location, type of penetrating trauma, and hemodynamic status are among the many important factors when deciding upon if, what, and when imaging is needed to further evaluate the patient. Imaging plays a critical role in the management of these patients. CT, in particular, aids in identifying and predicting internal injuries based upon trajectory of the object. Clinical variants are distinguished by ballistic versus nonballistic injuries, hemodynamic status, and compartment of the body injured. Ballistic trauma trajectory is less predictable, and imaging recommendations are adjusted for this unpredictability. Excluded from this document are penetrating traumatic injuries to pediatric patients and specific recommendations when the genitourinary system is clinically suspected to be injured, the latter of which is more specifically discussed in other Appropriateness Criteria documents.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are documented annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer documented journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer documented literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
{"title":"ACR Appropriateness Criteria® Penetrating Torso Trauma","authors":"Expert Panel on Polytrauma Imaging, James T. Lee MD , Ahmed Sobieh MD, PhD , Stephanie Bonne MD , Marc A. Camacho MD, MS , Phyllis Glanc MD , James F. Holmes MD, MPH , Sanjeeva P. Kalva MD , Faisal Khosa MD, MBA , Krista Perry DO , Susan B. Promes MD, MBA , Thomas Ptak MD, PhD, MPH , Eric A. Roberge MD , LeAnn Shannon MD , Edwin F. Donnelly MD, PhD","doi":"10.1016/j.jacr.2024.08.014","DOIUrl":"10.1016/j.jacr.2024.08.014","url":null,"abstract":"<div><div>This document assesses the appropriateness of various imaging studies for acute penetrating trauma to the torso. Penetrating trauma most commonly occurs from gunshots and stabbings, although any object can impale the patient. Anatomic location, type of penetrating trauma, and hemodynamic status are among the many important factors when deciding upon if, what, and when imaging is needed to further evaluate the patient. Imaging plays a critical role in the management of these patients. CT, in particular, aids in identifying and predicting internal injuries based upon trajectory of the object. Clinical variants are distinguished by ballistic versus nonballistic injuries, hemodynamic status, and compartment of the body injured. Ballistic trauma trajectory is less predictable, and imaging recommendations are adjusted for this unpredictability. Excluded from this document are penetrating traumatic injuries to pediatric patients and specific recommendations when the genitourinary system is clinically suspected to be injured, the latter of which is more specifically discussed in other Appropriateness Criteria documents.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are documented annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer documented journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer documented literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"21 11","pages":"Pages S448-S463"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564008","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}
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