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Patient-Friendly Summary of the ACR Appropriateness Criteria®: Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up ACR Appriateness Criteria® 的患者友好型摘要:胸腹主动脉瘤或夹层:治疗计划和随访。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.013
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引用次数: 0
Studying Guaranteed Income in Oncology: Lessons Learned From Launching the Guaranteed Income and Financial Treatment Trial 为什么要在肿瘤学中研究保证收入?从启动保证收入和经济治疗 (G.I.F.T.) 试验中汲取的经验教训。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.06.008

By targeting income and financial stress as key social determinants of health, unconditional cash transfers (UCTs) may improve cancer health outcomes and reduce cancer health disparities. Described in policy circles as guaranteed or basic income, UCTs have been shown to improve a range of health outcomes in low-income populations but have not yet been examined as a targeted intervention for people with cancer. This article describes some of the lessons learned from launching the Guaranteed Income and Financial Treatment trial, a two-arm randomized controlled trial of UCTs in oncology, along with a rationale for studying UCTs in people with cancer who have low incomes, and presents an introductory primer on UCT research for oncology clinicians and researchers and future directions for research.

无条件现金转移支付(UCTs)将收入和经济压力作为健康的主要社会决定因素,可以改善癌症患者的健康状况,减少癌症健康差异。无条件现金转移支付在政策界被称为有保障的收入或基本收入,已被证明可以改善低收入人群的一系列健康状况,但尚未作为针对癌症患者的干预措施进行过研究。本文介绍了 "保证收入和经济治疗试验"(一项在肿瘤学领域开展的两臂随机对照试验)的一些经验教训,以及在低收入癌症患者中研究 "统合疗法 "的基本原理,并为肿瘤学临床医生和研究人员介绍了 "统合疗法 "研究的入门知识以及未来的研究方向。
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引用次数: 0
Screening for Health-Related Social Needs and Financial Toxicity Among Patients With Cancer Treated With Radiation Therapy: Findings From a Quality Improvement Project 筛查接受放射治疗的癌症患者的健康相关社会需求和经济毒性:质量改进项目的研究结果。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.07.001

Introduction

Financial toxicity is common among patients with cancer, as are co-occurring health-related social risks (HRSRs). There is limited evidence to support best practices in screening for HRSRs and financial toxicity in the cancer context. This analysis sought to understand variations of identified needs based on treatment course using data from a large screening program.

Methods

This 2022 to 2023 screening quality improvement program included four services (breast, gastrointestinal, gynecologic, thoracic) at an urban comprehensive cancer center. The Comprehensive Score for Financial Toxicity measured financial toxicity. Patients completed an HRSR checklist documenting food, housing, medication, or transportation insecurity and financial borrowing practices. Differences were evaluated by treatment course (radiation therapy [RT] versus other treatment and RT plus chemotherapy versus other treatment).

Results

Screening surveys were sent to 70,983 unique patients; 38,249 completed a screening survey (54% response rate). Of responders, 4% (n = 1,686) underwent RT in the 120 days before their survey, and 3% (n = 1,033) received RT in combination with chemotherapy. Overall, patients receiving RT had lower unadjusted Comprehensive Score for Financial Toxicity scores, indicating worse financial toxicity. The proportion of patients receiving RT reporting unmet transportation (15% versus 12%, P < .001) and food (13% versus 11%, P = .02) needs was significantly higher than for patients not receiving RT. More patients receiving RT borrowed money than did patients not receiving RT (17% versus 15%, P = .02). In multivariable models, RT (alone or in combination) was associated with worse financial toxicity and transportation difficulties.

Conclusions

Screening for financial toxicity and HRSR is possible at a large cancer center. Patients receiving RT have higher transportation insecurity and worse financial toxicity compared with those receiving other treatments. Tailored intervention throughout the treatment trajectory is essential.

简介在癌症患者中,财务毒性很常见,与健康相关的社会风险(HRSR)也是如此。在癌症患者中,支持筛查健康相关社会风险(HRSR)和财务毒性的最佳实践的证据非常有限。本分析试图利用一项大型筛查计划的数据,了解基于治疗过程的已识别需求的变化:该 2022-2023 年筛查质量改进计划包括城市综合癌症中心的四项服务(乳腺、胃肠道、妇科、胸部)。财务毒性综合评分(COST)衡量财务毒性。患者填写一份 HRSR 核对表,记录食物、住房、药物和/或交通不安全情况以及金融借贷行为。根据治疗过程(放疗与其他治疗、放疗+化疗与其他治疗)对差异进行评估:共向 70,983 名患者发送了筛查调查问卷;38,249 人完成了筛查调查(回复率为 54%)。在回复者中,4%(n=1686)在调查前 120 天内接受了 RT 治疗,3%(n=1033)在接受 RT 治疗的同时接受了化疗。总体而言,RT 患者的未调整 COST 评分较低,表明经济毒性较差。报告未满足交通需求的 RT 患者比例(15% vs. 12%,p 结论:在大型癌症中心可以筛查经济毒性和HRSR。与接受其他治疗的患者相比,接受 RT 治疗的患者交通不安全性更高,经济毒性更严重。在整个治疗过程中进行有针对性的干预至关重要。
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引用次数: 0
Cost-Effectiveness of Artificial Intelligence–Based Opportunistic Compression Fracture Screening of Existing Radiographs 基于人工智能的现有射线照片压缩骨折机会性筛查的成本效益。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2023.11.029

Purpose

Osteoporotic vertebral compression fractures (OVCFs) are a highly prevalent source of morbidity and mortality, and preventive treatment has been demonstrated to be both effective and cost effective. To take advantage of the information available on existing chest and abdominal radiographs, the authors’ study group has developed software to access these radiographs for OVCFs with high sensitivity and specificity using an established artificial intelligence deep learning algorithm. The aim of this analysis was to assess the potential cost-effectiveness of implementing this software.

Methods

A deterministic expected-value cost-utility model was created, combining a tree model and a Markov model, to compare the strategies of opportunistic screening for OVCFs against usual care. Total costs and total quality-adjusted life-years were calculated for each strategy. Screening and treatment costs were considered from a limited societal perspective, at 2022 prices.

Results

In the base case, assuming a cost of software implantation of $10 per patient screened, the screening strategy dominated the nonscreening strategy: it resulted in lower cost and increased quality-adjusted life-years. The lower cost was due primarily to the decreased costs associated with fracture treatment and decreased probability of requiring long-term care in patients who received preventive treatment. The screening strategy was dominant up to a cost of $46 per patient screened.

Conclusions

Artificial intelligence–based opportunistic screening for OVCFs on existing radiographs can be cost effective from a societal perspective.

目的:骨质疏松性椎体压缩骨折(OVCFs)是一种发病率和死亡率都很高的疾病,而预防性治疗已被证明既有效又具有成本效益。为了利用现有胸部和腹部X光片上的信息,作者的研究小组开发了一款软件,利用成熟的人工智能深度学习算法,以高灵敏度和高特异性获取这些X光片上的OVCF。本分析旨在评估实施该软件的潜在成本效益:方法:结合树状模型和马尔可夫模型,创建了一个确定性预期价值成本效用模型,以比较机会性筛查 OVCF 与常规护理的策略。计算了每种策略的总成本和总质量调整生命年。筛查和治疗成本是从有限的社会角度考虑的,按 2022 年的价格计算:在基础案例中,假设每名接受筛查的患者的软件植入成本为 10 美元,筛查策略在非筛查策略中占优势:成本更低,质量调整生命年数更高。成本降低的主要原因是接受预防性治疗的患者骨折治疗相关费用减少,需要长期护理的概率降低。每筛查一名患者的成本为 46 美元,筛查策略占主导地位:从社会角度来看,基于人工智能的机会性筛查OVCFs具有成本效益。
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引用次数: 0
Let’s Talk About Low-Dose Contrast Medium as an Option to Lower Carbon Footprint 让我们来谈谈低剂量造影剂作为降低碳足迹的选择。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.03.012
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引用次数: 0
Incidence, Timing, and Long-Term Outcomes of COVID-19 Vaccine-Related Lymphadenopathy on Screening Mammography 乳腺放射摄影筛查中 COVID-19 疫苗相关淋巴腺病的发病率、时间和长期结果。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.02.032

Objective

To determine the incidence, timing, and long-term outcomes of unilateral axillary lymphadenopathy ipsilateral to vaccine site (UIAL) on screening mammography after COVID-19 vaccination.

Methods

This retrospective, multisite study included consecutive patients undergoing screening mammography February 8, 2021, to January 31, 2022, with at least 1 year of follow-up. UIAL was typically considered benign (BI-RADS 1 or 2) in the setting of recent (≤6 weeks) vaccination or BI-RADS 0 (ultrasound recommended) when accompanied by a breast finding or identified >6 weeks postvaccination. Vaccination status and manufacturer were obtained from regional registries. Lymphadenopathy rates in vaccinated patients with and without UIAL were compared using Pearson’s χ2 test.

Results

There were 44,473 female patients (mean age 60.4 ± 11.4 years) who underwent screening mammography at five sites, and 40,029 (90.0%) received at least one vaccine dose. Ninety-four (0.2%) presented with UIAL, 1 to 191 days postvaccination (median 13.5 [interquartile range: 5.0-31.0]). Incidence declined from 2.1% to 0.9% to ≤0.5% after 1, 2, and 3 weeks and persisted up to 36 weeks (P < .001). UIAL did not vary across manufacturer (P = .15). Of 94, 77 (81.9%) were BI-RADS 1 or 2 at screening. None were diagnosed with malignancy at 1-year follow-up. Seventeen (18.1%) were BI-RADS 0 at screening. At diagnostic workup, 13 (76.5%) were BI-RADS 1 or 2, 2 (11.8%) were BI-RADS 3, and 2 (11.8%) were BI-RADS 4. Both BI-RADS 4 patients had malignant status and ipsilateral breast malignancies. Of BI-RADS 3 patients, at follow-up, one was biopsied yielding benign etiology, and one was downgraded to BI-RADS 2.

Discussion

Isolated UIAL on screening mammography performed within 6 months of COVID-19 vaccination can be safely assessed as benign.

目的确定接种 COVID-19 疫苗后进行乳房 X 线照相筛查时疫苗接种部位同侧单侧腋窝淋巴结病 (UIAL) 的发生率、时间和长期结果:这项多站点回顾性研究纳入了 2021 年 8 月 2 日至 2022 年 8 月 1 日至 2022 年 8 月 31 日接受乳房 X 光筛查且随访至少一年的连续患者。在最近接种疫苗(接种后六周)的情况下,UIAL通常被认为是良性的(BI-RADS 1/2)。疫苗接种情况和生产商均来自地区登记处。采用皮尔逊卡方检验比较了接种过疫苗和未接种过 UIAL 的患者的淋巴腺病发病率:44473名女性患者(平均60.4岁 +/- 11.4岁)在五个地点接受了乳腺X光筛查。40029人(90.0%)至少接种了一剂疫苗。94人(0.2%)在接种疫苗后1-191天(中位数91.0 [IQR:37.0-170.0])出现乳腺增生症。发病率从 2.1% 降至 0.9%:COVID-19疫苗接种后六个月内进行的乳房X光筛查中出现的孤立UIAL可安全地评估为良性。
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引用次数: 0
Contemporary Management of Blunt Splenic Trauma in Adults: An Analysis of the Trauma Quality Improvement Program Registry 成人钝性脾脏创伤的现代处理方法:创伤质量改进计划登记分析》。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.03.007

Purpose

The aim of this study was to evaluate the effectiveness of management strategies for blunt splenic injuries in adult patients.

Methods

Patients 18 years and older with blunt splenic injuries registered via the Trauma Quality Improvement Program (2013-2019) were identified. Management strategies initiated within 24 hours of hospital presentation were classified as watchful waiting, embolization, surgery, or combination therapy. Patients were stratified by injury grade. Linear models estimated each strategy’s effect on hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality.

Results

Of 81,033 included patients, 86.3%, 10.9%, 2.5%, and 0.3% of patients received watchful waiting, surgery, embolization, and combination therapy, respectively. Among patients with low-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (9.4 days, Q < .001, Cohen’s d = .30) and ICU LOS (5.0 days, Q < .001, Cohen’s d = .44). Among patients with high-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (8.7 days, Q < .001, Cohen’s d = .12) and ICU LOS (4.5 days, Q < .001, Cohen’s d = .23). Among patients with low- and high-grade injuries, the odds ratios for in-hospital mortality associated with surgery compared with embolization were 4.02 (Q < .001) and 4.38 (Q < .001), respectively.

Conclusions

Among patients presenting with blunt splenic injuries and compared with surgery, embolization was associated with shorter hospital LOS, shorter ICU LOS, and lower risk for mortality.

目的:评估成年患者钝性脾损伤处理策略的有效性:通过创伤质量改进计划(2013-19 年)登记的 18 岁及以上钝性脾损伤患者。入院 24 小时内启动的治疗策略分为观察等待(WW)、栓塞、手术或综合治疗。患者按损伤等级进行分层。线性模型估算了每种策略对住院时间(LOS)、重症监护室(ICU)住院时间和死亡率的影响:在纳入的81033名患者中,分别有86.3%、10.9%、2.5%和0.3%的患者接受了WW、手术、栓塞和综合治疗。在低级别损伤患者中,与手术相比,栓塞治疗缩短了住院时间(9.4天,Q < .001,Cohen's d = .30)和重症监护室住院时间(5.0天,Q < .001,Cohen's d = .44)。在高级别损伤患者中,与手术相比,栓塞治疗缩短了住院时间(8.7 天,Q < .001,Cohen's d = .12)和重症监护室住院时间(4.5 天,Q < .001,Cohen's d = .23)。在低度和高度损伤患者中,与栓塞相比,手术的院内死亡率几率比分别为4.02(Q < .001)和4.38(Q < .001):结论:在钝性脾损伤患者中,与手术相比,栓塞治疗的住院时间更短、重症监护室住院时间更短、死亡风险更低。
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引用次数: 0
Patient-Friendly Summary of the ACR Appropriateness Criteria®: Diffuse Lung Disease 便于患者理解的 ACR 适宜性标准®摘要:弥漫性肺部疾病。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.022
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引用次数: 0
The Association Between Food Security and Mammography Screening: Cross-Sectional Survey Results From the National Health Interview Survey 食品安全与乳腺放射摄影筛查之间的关系:全国健康访谈调查的跨部门调查结果。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.05.005

Objective

There are limited data about food insecurity within the cancer screening setting. To inform the potential need for food insecurity interventions, our study evaluated the association between food security and mammographic screening among eligible participants.

Methods

Female respondents aged 40 to 74 years in the 2019 National Health Interview Survey without history of breast cancer were included. Food insecurity was assessed using the Six-Item Food Security Scale developed by the National Center for Health Statistics. The proportion of patients who reported mammographic screening within the last year was estimated, stratified by food security. Multiple variable logistic regression analyses evaluated the association between food security and mammography screening, adjusted for potential confounders. All analyses were performed accounting for complex survey design features.

Results

In all, 8,956 weighted survey respondents met inclusion criteria; 90.1% were classified as having high or marginal food security, of whom 56.6% reported screening; 6.1% were classified with low food security, of whom 42.1% reported screening; and 3.8% were classified with very low food security, of whom 43.1% reported screening. In our unadjusted analyses, participants with low food security (P < .001) and very low food security (P < .001) were less likely to report screening within the last year. In our adjusted analyses, participants with food insecurity (P = .009) were less likely to report screening.

Discussion

In a nationally representative cross-sectional survey, participants with food insecurity were less likely to report mammography screening. Radiology practices should consider screening patients for food insecurity and social determinants of health. Evidence-based food insecurity interventions may increase adherence to mammography screening.

目的:有关癌症筛查中食物不安全问题的数据十分有限。为了了解对食物不安全干预措施的潜在需求,我们的研究评估了符合条件的参与者中食物安全与乳房X光筛查之间的关联:方法:纳入 2019 年全国健康访谈调查中 40-74 岁无乳腺癌病史的女性受访者。采用美国国家卫生统计中心开发的六项目食品安全量表评估食品不安全状况。根据食品安全状况进行分层,估算出报告在过去一年中进行过乳腺 X 线照相筛查的患者比例。多变量逻辑回归分析评估了食品安全与乳腺放射摄影筛查之间的关系,并对潜在的混杂因素进行了调整。所有分析均考虑了复杂的调查设计特点:8956名加权调查对象符合纳入标准。90.1%的受访者被归类为食品安全程度高或边缘化,其中56.6%的受访者报告进行了筛查。6.1%的受访者被归类为低粮食安全水平,其中 42.1%的受访者报告进行了筛查。3.8%的人被归类为食品安全程度极低,其中 43.1%的人报告进行了筛查。在我们的未调整分析中,低食品安全参与者(pDiscussion:在一项具有全国代表性的横断面调查中,缺乏粮食安全的参与者较少报告进行乳腺放射摄影筛查。放射科应考虑对患者进行食物不安全和健康社会决定因素筛查。以证据为基础的食物不安全干预措施可提高乳腺放射摄影筛查的依从性。
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引用次数: 0
Emerging Value-Based Care Payment Mechanisms to Reduce Health Inequities: The Accountable Care Organization Realizing Equity, Access, and Community Health Model 减少健康不平等的新兴价值医疗支付机制:ACO REACH 模式。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.05.007
{"title":"Emerging Value-Based Care Payment Mechanisms to Reduce Health Inequities: The Accountable Care Organization Realizing Equity, Access, and Community Health Model","authors":"","doi":"10.1016/j.jacr.2024.05.007","DOIUrl":"10.1016/j.jacr.2024.05.007","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332682","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
期刊
Journal of the American College of Radiology
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