Journal of the American College of Radiology : JACR最新文献

Objective: Cross-application is increasingly common in radiology yet remains understudied. We aimed to quantify the prevalence, characterize patterns, and identify predictors of cross-application among diagnostic radiology (DR) and interventional radiology (IR) applicants.

Methods: We analyzed all Electronic Residency Application Service applications submitted to DR and IR programs between 2020 and 2023. Cross-applications were defined as those applying to DR or IR and at least one non-radiology specialty. Applicant demographics, educational background, and academic characteristics were compared using chi-square and t-tests. Independent predictors of cross-application were assessed using multivariable logistic regression.

Results: Among 9,012 radiology applications, 41.8% (N=3,770) were cross-applications. Cross-application was most frequent among IR-only applications (94.0%), and more common in international medical graduates (63.9%), DOs (46.6%), and applicants ≥30 years old (56.0%). Compared with radiology-only applications, cross-applications had more publications but fewer research and volunteer experiences. Independent predictors of cross-application included IR-only status (OR=31.75; 95% CI: 22.42-46.54), IMG (OR=2.86; 95% CI: 2.47-3.31), DO (OR=1.90; 95% CI: 1.65-2.18), age ≥30 (OR=1.71; 95% CI: 1.54-1.90), and reapplication (OR=2.10; 95% CI: 1.80-2.44), while AOA membership reduced odds (OR=0.48; 95% CI: 0.39-0.59).

Conclusion: Cross-application is a frequent strategy among radiology applicants. These results highlight the challenges of navigating a competitive match and the importance of advising that accounts for diverse applicant backgrounds and career goals. Understanding cross-application as a common and often pragmatic strategy may help inform advising practices and reduce misinterpretation of applicant intent.

Purpose: The aim of this study was to compare imaging use on pediatric outpatients at children's hospitals (CHs) versus non-children's hospitals (NCHs) to identify differences across modalities that differ in ionizing radiation exposure.

Methods: CMS Medicaid Research Identifiable Files were used to identify all year 2019 pediatric (ages 0-17 years) outpatient claims from hospital outpatient facilities (HOFs) and emergency departments (EDs). CMS data from 2018 were used to calculate the pediatric comorbidity index (PCI) for risk adjustment. Primary outcomes were CT, MR, ultrasound, or radiography (XR) use at each visit, comparing frequencies between CHs and NCHs. Additional covariates included age group (0, 1-2, 3-5, 6-11, and 12-17 years), PCI (0, 1 or 2, 3-6, 7), and place of service (HOF vs ED).

Results: A total of 5,474,082 claims meeting the selection criteria were identified. More than half of visits (53%) were to CHs, and 15% were to EDs. CH encounters were more likely (vs NCH encounters) to be among patients aged 0 to 5 years versus >5 years (41.2% vs 38.7%, P < .01), those with PCI > 2 (32.3% vs 22.9%, P < .01), and those seen at HOFs (87.8% vs 81.9%, P < .01). The most commonly used modalities were XR (9.5%) and ultrasound (2.1%). Use of XR (11.8% vs 7.5%, P < .01) and CT (1.0% vs 0.5%, P < .01) was more frequent at NCHS. Use of ultrasound (2.5% vs 1.7%, P < .01) and MR (0.9% vs 0.5%, P < .01) was more frequent at CHs.

Conclusions: This study reveals that imaging modalities that expose children to ionizing radiation are used more frequently at NCHs than at CHs. The clinical implications of these variations warrant further investigation.

Objective: To assess factors associated with offering patients same-day procedures following implementation of a standardized same-day procedure program.

Methods: This quality improvement study reviewed data from all patients at our single-site academic institution who were recommended for a breast procedure from 3/20/24-6/3/24. Patient and diagnostic examination characteristics, and time between diagnostic examination and procedure appointments, were recorded. Enacting "add-on" procedures, defined as the creation of an additional same-day procedure slot through overbooking, was also recorded. Associations between patient sociodemographic characteristics and diagnostic examination characteristics with same-day procedures logistics were evaluated using a nominal logistic model.

Results: Of 315 patients (mean age 53.8 years ± 16.4 years), 168 (53%) were offered a same-day biopsy appointment based on procedure availability. Another 35 patients (11%) were offered an "add-on" procedure; 8 (3%) were for urgent BI-RADS 2 findings (such as abscess). On multivariable analysis, factors associated with increased likelihood of being offered same-day biopsy appointment were morning recommendation time (p < 0.001) and ultrasound-guided biopsy (p = 0.027). Time to biopsy was not significantly different across race/ethnicity. On univariable analysis, patients had higher likelihood of being offered an "add-on" procedure for ultrasound-guided aspirations (p < 0.001) and fluid collections (seroma/abscess; p < 0.001), as well as for BI-RADS 5 final assessment (p < 0.001).

Discussion: Scheduling diagnostic workups should be considered earlier in the day at institutions that offer same-day procedure services, particularly for cases involving highly suspicious lesions, abscesses or seromas, or patients with psychosocial factors that could otherwise delay care.

Chronic pancreatitis (CP) is a progressive disorder of the pancreas characterized by irreversible parenchymal and ductal changes, leading to chronic pain and pancreatic insufficiency. Its impact on quality of life can be profound and may further be complicated by acute inflammation superimposed on CP (ACP), potentially accelerating functional decline and increasing morbidity. Imaging plays an important role in diagnosing both CP and ACP, determining severity, identifying underlying causes, and detecting complications. CT is particularly effective at detecting parenchymal calcifications, typically seen in later disease, and for rapid evaluation of ACP. MRI with MRCP is more sensitive for early ductal and parenchymal changes, with secretin-stimulated MRCP further improving detection in mild or early disease. In certain cases, endoscopic ultrasound adds diagnostic value and offers therapeutic intervention. Early and accurate imaging, paired with clinical and laboratory evaluation, is essential for guiding effective patient care in CP. 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.