Journal of the American College of Radiology最新文献

英文中文

The US Government’s Latest Presidential Executive Order on Artificial Intelligence: Potential Implications in Radiology 美国政府关于人工智能的最新总统行政令：对放射学的潜在影响。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.002

引用次数: 0

Disparities in Study Inclusion and Breast Cancer Screening Rates Among Transgender People: A Systematic Review 变性人乳腺癌筛查率的研究纳入和筛查率差异：系统回顾。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.006

Background

Breast cancer screening trends of transgender and gender diverse (TGD) people remain largely unknown. This is concerning, as data are necessary to inform recommendations made by clinicians to their patients and by national guidelines to clinicians. The aim of this review is to explore the state of existing research literature and provide a summary report of current breast cancer screening rates in TGD adults.

Methods

All articles were identified using Medical Subject Headings terms. Inclusion criteria were all the following: (1) documents inclusion of at least one participant who identifies as a TGD person; (2) at least one TGD participant with top surgery or currently receiving estrogen-based gender-affirming hormone therapy; (3) results that report rates of breast cancer screening or mammogram referral.

Results

Twelve articles met inclusion criteria, six cross-sectional studies and six retrospective chart reviews. Three studies conducted secondary analysis of the Behavioral Risk Factor Surveillance System national dataset, and nine articles recruited their own sample with number of TGD participants ranging from 30 to 1,822 and number of cisgender women ranging from 242 to 18,275. Three studies found lower rates of screening in transfeminine persons receiving gender-affirming care compared with cisgender women; two studies found lower rates among TGD people compared with cisgender women; and three studies found no differences between the breast cancer screening rates of TGD and cisgender participants.

Conclusion

Limited studies recruit and report trends in breast cancer screening of TGD people. Those that do include TGD participants have mixed results, but overall TGD people had lower rates of breast cancer screening. More research is needed regarding breast cancer screening of TGD people to inform the development of protocols that ensure equitable access to preventative care.

背景变性人和性别多元化（TGD）人群的乳腺癌筛查趋势在很大程度上仍不为人所知。这是一个令人担忧的问题，因为临床医生向患者提出建议以及国家指南向临床医生提出建议都需要数据作为依据。本综述旨在探讨现有研究文献的现状，并提供一份关于目前变性和性别多元化成年人乳腺癌筛查率的总结报告。纳入标准如下(结果12 篇文章符合纳入标准，其中6 篇为横断面研究，6 篇为回顾性图表综述。三项研究对行为风险因素监测系统的国家数据集进行了二次分析，九篇文章自行招募样本，其中TGD参与者人数从30人到1822人不等，顺性别女性人数从242人到18275人不等。三项研究发现，与顺性别女性相比，接受性别确认护理的变性人的筛查率较低；两项研究发现，与顺性别女性相比，变性人的筛查率较低；三项研究发现，变性人与顺性别参与者的乳腺癌筛查率之间没有差异。纳入 TGD 参与者的研究结果不一，但总体而言，TGD 患者的乳腺癌筛查率较低。需要对 TGD 患者的乳腺癌筛查进行更多的研究，以便为制定确保公平获得预防性护理的方案提供信息。

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引用次数: 0

A Model for Predicting Clinically Significant Prostate Cancer Using Prostate MRI and Risk Factors 利用前列腺磁共振成像和风险因素预测临床重大前列腺癌的模型。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.02.035

Purpose

The aim of this study was to develop and validate a predictive model for clinically significant prostate cancer (csPCa) using prostate MRI and patient risk factors.

Methods

In total, 960 men who underwent MRI from 2015 to 2019 and biopsy either 6 months before or 6 months after MRI were identified. Men diagnosed with csPCa were identified, and csPCa risk was modeled using known patient factors (age, race, and prostate-specific antigen [PSA] level) and prostate MRI findings (location, Prostate Imaging Reporting and Data System score, extraprostatic extension, dominant lesion size, and PSA density). csPCa was defined as Gleason score sum ≥ 7. Using a derivation cohort, a multivariable logistic regression model and a point-based scoring system were developed to predict csPCa. Discrimination and calibration were assessed in a separate independent validation cohort.

Results

Among 960 MRI reports, 552 (57.5%) were from men diagnosed with csPCa. Using the derivation cohort (n = 632), variables that predicted csPCa were Prostate Imaging Reporting and Data System scores of 4 and 5, the presence of extraprostatic extension, and elevated PSA density. Evaluation using the validation cohort (n = 328) resulted in an area under the curve of 0.77, with adequate calibration (Hosmer-Lemeshow P = .58). At a risk threshold of >2 points, the model identified csPCa with sensitivity of 98.4% and negative predictive value of 78.6% but prevented only 4.3% potential biopsies (0-2 points; 14 of 328). At a higher threshold of >5 points, the model identified csPCa with sensitivity of 89.5% and negative predictive value of 70.1% and avoided 20.4% of biopsies (0-5 points; 67 of 328).

Conclusions

The point-based model reported here can potentially identify a vast majority of men at risk for csPCa, while avoiding biopsy in about 1 in 5 men with elevated PSA levels.

目的利用前列腺磁共振成像和患者风险因素，开发并验证具有临床意义的前列腺癌（csPCa）预测模型：我们确定了在 2015-2019 年期间接受 MRI 和活检的 960 名男性，他们在 MRI 之前 6 个月或之后 6 个月接受了活检。我们确定了被诊断为 csPCa 的男性，并利用已知的患者因素（年龄、种族、PSA）和前列腺 MRI 检查结果（位置、PI-RADS 评分、前列腺外扩展、主要病灶大小、PSA 密度 [PSAD]）对 csPCa 风险进行了建模。csPCa 被定义为 Gleason Sum ≥ 7。利用衍生队列建立了一个多变量逻辑回归模型和基于点的评分系统来预测 csPCa。在一个单独的独立验证队列中对辨别和校准进行了评估：结果：960 份 MRI 报告中有 552 份（57.5%）来自确诊为 csPCa 的男性。在推导队列（632 人）中，预测 csPCa 的变量是 PI-RADS 4 和 5、存在前列腺外延伸和 PSAD 升高。使用验证队列（n=328）进行评估后，AUC 为 0.77，校准充分（Hosmer-Lemeshow p=0.58）。在风险阈值大于 2 点时，该模型识别 csPCa 的灵敏度为 98.4%，阴性预测值 (NPV) 为 78.6%，但仅阻止了 4.3%（0-2 点；14/328）的潜在活检。在大于 5 点的较高阈值下，该模型识别 csPCA 的灵敏度为 89.5%，阴性预测值为 70.1%，避免了 20.4%（0-5 点；67/328）的活检：讨论：我们基于点的模型有可能识别出绝大多数有患 csPCa 风险的男性，同时使每 5 名 PSA 升高的男性中就有 1 人免于活组织检查。

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引用次数: 0

Patient-Friendly Summary of the ACR Appropriateness Criteria®: Imaging of Invasive Breast Cancer ACR 适宜性标准®患者友好型摘要：浸润性乳腺癌成像。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.015

引用次数: 0

The Digital Disruption: YouTube’s Role in Information on Radiology Residency 数字颠覆：YouTube 在放射科住院医生信息中的作用。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.05.010

引用次数: 0

Analysis of Longitudinal Assessment: Role of Radiology Online Longitudinal Assessment–Type Questions 纵向评估分析：放射学 OLA 类型问题的作用。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.03.011

Objective

The purpose of this investigation was to assess gaps in radiologists’ medical knowledge using abdominal subspecialty online longitudinal assessment (OLA)-type questions. Secondarily, we evaluated what question-centric factors influenced radiologists to pursue self-directed additional reading on topics presented.

Methods

A prospective OLA-type test was distributed nationally to radiologists over a 4-month period. Questions were divided into multiple groupings, including arising from three different time periods of literature (≤5 years, 6-15 years, and >20 years), relating to common versus uncommon modalities, and guideline-based versus knowledge-based characterization. After each question, participants rated their confidence in diagnosis and perceived question relevance. Answers were provided, and links to answer explanations and references were provided and tracked. A series of regression models were used to test potential predictors of correct response, participant confidence, and perceived question relevance.

Results

In all, 119 participants initiated the survey, with 100 answering at least one of the questions. Participants had significantly lower perceived relevance (mean: 51.3, 59.2, and 62.1 for topics ≤5 years old, 6-15 years old, and >20 years old, respectively; P < .001) and confidence (mean: 48.4, 57.8, and 63.4, respectively; P < .001) with questions on newer literature compared with older literature. Participants were significantly more likely to read question explanations for questions on common modalities compared with uncommon (46% versus 40%; P = .005) and on guideline-based questions compared with knowledge-based questions (49% versus 43%; P = .01).

Discussion

OLA-type questions function by identifying areas in which radiologists lack knowledge or confidence and highlight areas in which participants have interest in further education.

目的：这项调查的目的是利用腹部亚专业在线纵向评估（OLA）类型的问题来评估放射科医生在医学知识方面的差距。其次，我们还评估了哪些以问题为中心的因素会影响放射科医生对所提出的问题进行自主补充阅读：方法：在四个月的时间里，我们在全国范围内向放射科医生分发了一份前瞻性 OLA 类型的测试。问题分为多个组别，包括来自三个不同时期的文献（≤ 5 年、6-15 年和 > 20 年）、与常见和不常见模式相关的问题，以及基于指南和基于知识的特征描述。每个问题结束后，参与者都会对自己的诊断信心和认为问题的相关性进行评分。提供了答案，并提供和跟踪了答案解释和参考文献的链接。我们使用了一系列回归模型来测试正确回答、参与者信心和感知问题相关性的潜在预测因素：119 名参与者发起了调查，其中 100 人至少回答了一个问题。参与者对问题相关性的感知明显较低（平均值为 51.3、59.2、59.2、51.3、51.3、59.2、59.2）：平均值：≤5 岁、6-15 岁和大于 20 岁的题目分别为 51.3、59.2 和 62.1；p 讨论：OLA类问题的作用是找出放射科医生缺乏知识或信心的领域，并强调参与者有兴趣接受进一步教育的领域。

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引用次数: 0

Attempting to Improve Prostate MR Image Quality at Scale Through the ACR Learning Network 尝试通过 ACR 学习网络大规模改善前列腺 MR 图像质量。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.03.018

引用次数: 0

Future Potential Challenges of Using Large Language Models Like ChatGPT in Daily Medical Practice: Let Us Address Them and See the Bright Side 在日常医疗实践中使用 ChatGPT 等大型语言模型的未来潜在挑战：让我们应对挑战，看到光明的一面。

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2023.12.033

引用次数: 0

Teach the Mentor: A Six-Session Program Universally Improves Mentorship Skills Among a Diverse Group of Radiology Faculty 教导导师：一项为期六节的计划可普遍提高不同放射科教师的指导技能

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.01.001

引用次数: 0

Associations of State Supplemental Nutrition Assistance Program Eligibility Policies With Mammography 州补充营养援助计划（SNAP）资格政策与乳房 X 射线照相术的关系

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

Journal of the American College of Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.028

Purpose

The Supplemental Nutrition Assistance Program (SNAP) addresses food insecurity for low-income households, which is associated with access to care. Many US states expanded SNAP access through policies eliminating the asset test (ie, restrictions based on SNAP applicant assets) and/or broadening income eligibility. The objective of this study was to determine whether state SNAP policies were associated with the use of mammography among women eligible for breast cancer screening.

Methods

Data for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility.

Results

In total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; P = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; P = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; P = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; P = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; P = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility.

Conclusions

State policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states.

目的补充营养援助计划（SNAP）解决低收入家庭的粮食不安全问题，这与获得护理有关。美国许多州通过取消资产测试（即基于 SNAP 申请人资产的限制）和/或扩大收入资格的政策来扩大 SNAP 的使用范围。本研究的目的是确定各州的 SNAP 政策是否与符合乳腺癌筛查条件的妇女使用乳房 X 线照相术有关。方法从 2006 年至 2019 年的行为风险因素监测系统中获得了 40 至 79 岁符合收入条件的妇女的数据。结果在取消资产测试政策和提高收入资格政策分析中，分别纳入了 171,684 名和 294,647 名符合收入条件的女性受访者。58.4%的受访者表示在 1 年内进行了乳腺 X 射线检查。分别有 28 个和 22 个州采用了取消 SNAP 资产测试和提高收入资格的政策。采用取消资产测试政策与 1 年内接受乳房 X 射线照相术的人数增加 2.11 个百分点（95% 置信区间 [CI]，0.07-4.15；P = .043）有关，尤其是非大城市居民（4.14 个百分点；95% CI，1.07-7.21 个百分点；P = .008）、家庭收入为 25,000 美元的居民（2.82个百分点；95% CI，0.68-4.97个百分点；P = .01），以及居住在南方各州（3.08个百分点；95% CI，0.17-5.99个百分点；P = .038）或未根据《患者保护和可负担医疗法案》扩大医疗补助范围的人群（3.35个百分点；95% CI，0.36-6.34；P = .028）。结论各州取消 SNAP 收入资格资产测试要求的政策与有资格接受乳腺癌筛查的低收入妇女接受乳房 X 线照相术的人数增加有关，特别是那些收入最低的妇女或居住在非大都市地区或未扩大医疗补助范围的州的妇女。

{"title":"Associations of State Supplemental Nutrition Assistance Program Eligibility Policies With Mammography","authors":"","doi":"10.1016/j.jacr.2024.04.028","DOIUrl":"10.1016/j.jacr.2024.04.028","url":null,"abstract":"<div><h3>Purpose</h3><p>The Supplemental Nutrition Assistance Program (SNAP) addresses food insecurity for low-income households, which is associated with access to care. Many US states expanded SNAP access through policies eliminating the asset test (ie, restrictions based on SNAP applicant assets) and/or broadening income eligibility. The objective of this study was to determine whether state SNAP policies were associated with the use of mammography among women eligible for breast cancer screening.</p></div><div><h3>Methods</h3><p>Data for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility.</p></div><div><h3>Results</h3><p>In total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; <em>P</em> = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; <em>P</em> = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; <em>P</em> = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; <em>P</em> = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; <em>P</em> = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility.</p></div><div><h3>Conclusions</h3><p>State policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states.</p></div>","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":"https://www.sciencedirect.com/science/article/pii/S1546144024004526/pdfft?md5=2399d50c6211191e773fb0052bd9c601&pid=1-s2.0-S1546144024004526-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141397825","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}

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