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

Objectives: There is a paucity of data on missed imaging appointments, also known as imaging missed care opportunities (IMCOs), in pediatric nuclear medicine (NM) and related sociodemographic factors, specifically, Child Opportunity Index (COI), a composite measure of US neighborhood resources linked to healthy child development. COI levels group neighborhoods into quintiles: very low, low, moderate, high, and very high opportunity. The primary aim was to examine association of COI with IMCOs for ambulatory pediatric NM examinations and secondarily assess other sociodemographic factors affecting IMCOs.

Methods: Retrospective single-center cross-sectional review was performed of outpatient pediatric NM examinations (patient age ≤ 21 years) from 2017 to 2022, after institutional review board approval. The primary outcome was IMCOs (patient nonarrival; incomplete appointment upon arrival; or non-provider-driven cancellation ≤ 1 day before the appointment). The primary exposure was COI 3.0 level. Covariates included patient (age, gender, race or ethnicity, language, insurance, and residency type) and appointment factors (imaging group, year, season, and wait days). Univariate and multivariable analyses were performed, with P < .05 considered statistically significant.

Results: Seven thousand six hundred twenty patients (12,864 appointments) met inclusion criteria. Median age (interquartile range) was 8 years (3-15), and 920 (7.2%) appointments resulted in IMCOs. There were 66% higher odds of IMCOs for patient appointments from zip codes with very low or low compared with very high COI levels (P < .001). Other predictors of IMCOs were age (P = .020), race or ethnicity (P = .026), insurance (P < .001), season (P < .001), and imaging group (P < .001).

Conclusions: COI was significantly associated with IMCOs for pediatric NM examinations. Interventions are needed to reduce imaging inequities and IMCOs from lower-opportunity neighborhoods.

Objective: Allostatic load (AL) is a measure of physiologic dysregulation representing the cumulative effect of activation of the stress response system. The purpose of this study was to evaluate the association between AL and malignant pathology on image-guided breast biopsy.

Methods: This retrospective cohort study evaluated data from women aged 18 and older who underwent stereotactic-guided or ultrasound-guided breast biopsy at our tertiary academic institution from April 1, 2017, to March 31, 2022. We recorded patient age, race, ethnicity, Gail Model breast cancer risk score, area deprivation index, as well as AL calculated using clinical laboratory metrics from four major physiological systems-cardiovascular, immune, metabolic, and renal. The primary outcome was malignant pathology, and the secondary outcome was high-risk pathology. The association between AL and pathology result was evaluated using multivariable logistic regressions.

Results: In all, 253 patients were included in the study with mean age of 61 years (SD 12). After adjustment for age, race, ethnicity, and area deprivation index, higher AL was associated with a 22% increase in odds of malignant breast pathology (odds ratio [OR] 1.22 per additional biomarker positivity, 95% confidence interval [CI] 1.03-1.44). The association remained positive but was no longer significant after further adjustment for the Gail 5-year risk score (OR 1.17, 95% CI 0.93-1.47). Of note, 33.6% of patients had missing Gail risk score. No significant association of AL with high-risk pathology (OR 0.99, 95% CI 0.77-1.28) was observed.

Discussion: Our study results suggest that increased AL is associated with malignant pathology result in women undergoing image-guided core needle breast biopsy. This has implications for efforts to optimize personalized screening recommendations and reduce cancer disparities.