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

Demyelinating diseases of the central nervous system represent a diverse spectrum of inflammatory disorders affecting myelin sheaths, including multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD). MRI is the cornerstone imaging modality, providing superior sensitivity over CT for detecting demyelinating lesions in the brain and spinal cord. Advanced MRI techniques such as diffusion tensor imaging, magnetization transfer imaging, and AI applications enhance diagnostic accuracy. The 2024 McDonald criteria integrate new imaging features such as central vein sign and paramagnetic rim lesions, improving MS diagnosis with 94% accuracy at 3T MRI. Gadolinium enhancement patterns distinguish active inflammatory lesions from chronic plaques, with specific morphologic characteristics differentiating MS from NMOSD and MOGAD. Spinal cord MRI reveals characteristic lesion patterns: short peripheral lesions in MS versus longitudinally extensive lesions in NMOSD. 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.

Trauma remains the leading cause of mortality in the United States for those <45 years of age, and it is the fourth leading cause of death overall. Polytrauma is defined as an injury to at least two body parts, including the head, neck, chest, abdomen, pelvis, or an extremity, with any one or a combination of these injuries being potentially fatal. This document covers imaging of major blunt trauma or polytrauma resulting in multiple organ injuries. Burn injuries, and injuries to pediatric patients are excluded. 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.

Preprocedural chest or cardiac imaging for cardiothoracic surgery is focused on the imaging necessary to inform the performance of a surgical procedure after an initial diagnosis and the decision to operate has been made with consideration of patient comorbidities and anesthesia risk. The diverse range of noncoronary cardiac surgeries, coronary cardiac surgeries, and thoracic surgeries each have their own unique surgical techniques, risks, and complications, which can further vary between patients undergoing first time or repeat cardiothoracic surgery. This document reviews the literature for preprocedural chest or cardiac imaging in patients with and without a history of cardiothoracic surgery. 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.

Trauma is a common indication for seeking medical treatment including falls, motor vehicle collision (MVC), and assault. Minor blunt trauma can be defined as minor nonfatal injury to a single body part or minor injury with a low-risk mechanism including limited assault, ground-level falls, low-speed MVC, fall from bicycle, and blunt sports injuries. Patients are assumed to be ambulatory without distracting injuries to limit physical examination with normal mental status. 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.

Purpose: To estimate the turnover rate and its association with workload and radiologist and practice characteristics given the detrimental aspects of turnover on radiology practices.

Methods: This retrospective study (2013-2022) examined practice turnover rates (leaving one practice to join another) of radiologists by year (radiologist-years). Radiologist and practice characteristics were obtained from CMS (Medicare Data on Provider Practice and Specialty and National Downloadable Files). Radiologists' workload was estimated based on 5% sample of CMS Medicare fee-for-service claims and Inovalon Insights, LLC (Bowie, MD), claims (commercial, Medicaid, and Medicare Advantage). Radiologists' total workload was extrapolated from these claims based on the population represented in these data. Turnover odds by radiologist and practice characteristics and workload were estimated by logistic regression.

Results: Between 2013 and 2022, 280,692 radiologist-years (39,439 radiologists) met the selection criteria. Turnover increased from 5.3% to 8.5% (from 2013 to 2022). Adjusted turnover odds were 1.96 (95% confidence interval [CI]: 1.83-2.10) in 2022 versus 2013, were higher for female versus male (odds ratio [OR]: 1.06; 95% CI: 1.02-1.10) and metropolitan versus nonmetropolitan (OR: 1.12; 95% CI: 1.05-1.20), and were lower for academic versus nonacademic (OR: 0.91; 95% CI: 0.86-0.97) radiologists and decreased with years of practice (YOP). The turnover rate decreased as workload increased until reaching a minimum rate-an inflection point-and then increased. This inflection point was lower for academic versus nonacademic radiologists and with more YOP.

Conclusions: Factors associated with higher turnover included excessive workload, nonacademic practices, females, lower YOP, and metropolitan setting. Practices should consider these factors as they design retention efforts.

Chest pain is a common complaint in children and adolescents. The causes of chest pain are varied and include musculoskeletal, pulmonary or pleural, gastrointestinal, psychogenic, and cardiac etiologies. The etiology of pediatric chest pain is often benign but typically generates evaluation in the emergency room, urgent care, or outpatient setting. Diagnostic imaging is often used in the evaluation of pediatric chest pain. This document will discuss various clinical scenarios for children presenting with chest pain and will highlight initial imaging that is usually or may be appropriate, based on the best available evidence or expert consensus. Chest pain limited to the chest wall, from suspected pneumothorax or pneumomediastinum, secondary to suspected pulmonary embolism, from known or suspected cardiac disease, in the setting of sickle cell disease, and from suspected psychogenic causes, will be reviewed. 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.

This document addresses the management of pulmonary nodules and masses, a frequent and clinically significant finding in thoracic imaging given the prevalence and mortality burden of lung cancer. The document was developed and updated by a multidisciplinary expert panel through systematic review of peer-reviewed literature and supplemented as needed by expert consensus. Clinical variants considered in this document include stable solitary pulmonary nodules, enlarging nodules, centrally versus peripherally located nodules, nodules in patients with prior malignancy, and persistent ground-glass opacities suspicious for adenocarcinoma. For each scenario, available imaging and procedural options-such as follow-up CT, PET/CT, percutaneous or endobronchial biopsy, ablation, stereotactic body radiotherapy, and surgery-were systematically evaluated. Key recommendations emphasize the role of tissue sampling in enlarging or suspicious nodules, the selective role of PET/CT in characterization and treatment planning, and the importance of balancing diagnostic yield with procedure-related risks such as pneumothorax and hemorrhage. 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.

This document discusses the appropriateness of imaging modalities for cardiac masses under 3 variants: 1) adult with suspected cardiac mass, initial imaging; 2) adult with known cardiac mass in echocardiography of unknown etiology, next imaging; and 3) adult with known cardiac mass and established etiology, follow-up imaging. US echocardiography transthoracic resting, MRI heart function and morphology without and with contrast, and CT heart function and morphology with contrast are usually appropriate for Variant 1. US echocardiography transesophageal, US echocardiography transthoracic resting, MRI heart function and morphology without and with contrast, CT heart function and morphology with contrast, FDG-PET/CT heart, and FDG-PET/MRI heart are usually appropriate for Variant 2. US echocardiography transthoracic resting, MRI heart function and morphology without and with contrast, MRI heart function and morphology without contrast, CT heart function and morphology with contrast, and FDG-PET/MRI heart are usually appropriate for Variant 3. 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.