Journal of the American College of Radiology最新文献

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Imaging of the Axilla","authors":"Christian P. Haskett PhD, AEMT , Sonya Bhole MD","doi":"10.1016/j.jacr.2024.11.018","DOIUrl":"10.1016/j.jacr.2024.11.018","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Page 514"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752472","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}

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Altered Mental Status, Coma, Delirium, and Psychosis: 2024 Update","authors":"Giorgia Villa BS , Orit Ariel Glenn MD","doi":"10.1016/j.jacr.2024.11.019","DOIUrl":"10.1016/j.jacr.2024.11.019","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Page 513"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752515","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}

{"title":"External Validation of the Neiman Imaging Comorbidity Index in Medicare, Medicaid, and Private Payer Claims Data","authors":"Casey E. Pelzl MPH ,&nbsp;Alexandra Drake MPH ,&nbsp;Andrew B. Rosenkrantz MD ,&nbsp;Elizabeth Y. Rula PhD ,&nbsp;Eric W. Christensen PhD","doi":"10.1016/j.jacr.2024.11.007","DOIUrl":"10.1016/j.jacr.2024.11.007","url":null,"abstract":"<div><h3>Objective</h3><div>The Neiman Imaging Comorbidity Index (NICI) was developed and validated in a claims dataset encompassing &gt;10 million privately insured beneficiaries, in which it outperformed the commonly used Charlson Comorbidity Index (CCI) in predicting advanced imaging use. This external validation assessed the broader generalizability of NICI for predicting receipt of advanced imaging in nationally representative populations, including patients insured by Medicare, Medicaid, and private payers.</div></div><div><h3>Methods</h3><div>All 2018 to 2019 patient-level claims from the CMS Medicare 5% Research Identifiable File, CMS Medicaid 100% Research Identifiable File, and private insurance (commercial and Medicare Advantage) claims from Inovalon Insights, LLC, were included. Using 2018 comorbidity data, beneficiaries were assigned CCI and NICI. Area under the receiver operator characteristic curves (AUCs) measured index performance predicting advanced imaging in 2019. AUCs for NICI and CCI were compared overall, across age groups, and after adjusting for age and sex.</div></div><div><h3>Results</h3><div>A total of 108,846,549 beneficiaries were included across Medicare (n = 2,536,403), Medicaid (n = 49,685,052), and private insurance (n = 56,625,094) datasets. NICI outperformed CCI in Medicare (AUC: 0.7709, 95 confidence interval [CI]: 0.7702-0.7716 versus AUC: 0.7503, 95% CI: 0.7496-0.7510; <em>P</em> &lt; .001), Medicaid (AUC: 0.6876, 95% CI: 0.6874-0.6878 versus AUC: 0.6798 95% CI: 0.6796-0.6800]; <em>P</em> &lt; .001), and private insurance data (AUC: 0.6658, 95% CI: 0.6656-0.6660 versus AUC: 0.6479, 95% CI: 0.6477-0.6481; <em>P</em> &lt; .001). NICI outperformed CCI in adjusted models and in nearly all age strata across the three cohorts.</div></div><div><h3>Discussion</h3><div>The NICI outperformed CCI in predicting advanced imaging in populations insured by numerous different payers. Validation data support NICI as the preferred index to adjust for patient comorbidities when studying advanced imaging as an outcome, but further investigations are warranted.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Pages 436-443"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873606","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}

{"title":"Incidental Detection of Previously Unknown Strokes on Head CT Examinations: An Untapped Opportunity for Secondary Prevention","authors":"Carys L. Kenny-Howell BS ,&nbsp;Irene Dixe de Oliveira Santo MD ,&nbsp;Charles Wira MD ,&nbsp;Adam de Havenon MD, MS ,&nbsp;Long H. Tu MD, PhD","doi":"10.1016/j.jacr.2024.11.010","DOIUrl":"10.1016/j.jacr.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>The incidental discovery of previously unknown strokes on neuroimaging is an opportunity to implement secondary prevention, reducing the risk of recurrent strokes by up to 80%.</div></div><div><h3>Objective</h3><div>To evaluate the prevalence of previously unknown strokes on emergency department (ED) head CT imaging and identify associated patient and imaging factors.</div></div><div><h3>Methods</h3><div>Retrospective study of adult patients receiving head CT (age ≥ 18 years) at three EDs between July and December 2023. Old strokes on CT imaging were categorized as previously known or unknown. Patient and imaging factors associated with unknown strokes were assessed via univariable regression, multivariable regression, and decision tree analysis.</div></div><div><h3>Results</h3><div>In 21,985 ED encounters with head CT, 869 (4.0%) examinations demonstrated an old stroke (mean age, 74.4 years ± 14.0 [SD]), of which 372 (43%; 1.7% of all CTs) were unknown. Univariable analysis showed that unknown strokes were associated with greater age (odds ratio [OR], 1.03; 95% confidence interval [CI]: 1.02-1.04; <em>P</em> &lt; .001), a single site of old stroke (OR, 2.7; 95% CI: 2.06-3.58; <em>P</em> and &lt; .001), smaller strokes (OR, 1.8, 95% CI: 1.6-2.0, <em>P</em> &lt; .001), as well as gangliocapsular (OR, 2.8; 95% CI: 1.9-4.0; <em>P</em> &lt; .001) and cerebellar location (OR, 2.1; 95% CI: 1.4-3.2; <em>P</em> &lt; .001). Results of further analyses corroborated those of the univariable regression.</div></div><div><h3>Conclusion</h3><div>More than a third of old strokes on head CT imaging are unknown to patients and clinicians. Capturing this opportunity for secondary prevention could benefit 100,000 to 200,000 patients per year in the United States, based on trends in ED care.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Pages 461-470"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689637","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}

{"title":"Desperate Times Call for Innovative Solutions","authors":"Linda C. Chu MD ,&nbsp;Elliot K. Fishman MD","doi":"10.1016/j.jacr.2024.09.018","DOIUrl":"10.1016/j.jacr.2024.09.018","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Pages 505-506"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738265","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}

{"title":"Patient Photograph Association With Radiologist Recommendations for Additional Imaging","authors":"Jeffrey P. Guenette MD, MPH ,&nbsp;Jungwun Lee PhD ,&nbsp;Sebastien Haneuse PhD ,&nbsp;Jarvis T. Chen ScD ,&nbsp;Neena Kapoor MD ,&nbsp;Ronilda Lacson MD, PhD ,&nbsp;Ramin Khorasani MD, MPH","doi":"10.1016/j.jacr.2024.10.018","DOIUrl":"10.1016/j.jacr.2024.10.018","url":null,"abstract":"<div><h3>Objective</h3><div>Assess whether display of a patient photograph in the electronic health record (EHR) alongside head and neck CT or MRI radiology examinations is associated with recommendations for additional imaging (RAI) and whether self-reported race modifies that association.</div></div><div><h3>Methods</h3><div>This multi-institution health care system retrospective observational study from June 1, 2021 to May 31, 2022 included all patients with a head/neck CT or MRI report. We investigated association of photograph with RAIs using mixed-effects models adjusting for age, sex, complexity score, race, and area deprivation index while conditioning on patient and radiologist. Race was subsequently included as an interaction term. Multiple imputation was used as sensitivity analysis to address missing race data.</div></div><div><h3>Results</h3><div>In all, 60,543 reports were included from 48,143 patients (55.6% female; median age 58 years, interquartile range 40-70). The EHR included a photograph at the time 18.2% (11,048 of 60,543) of reports were signed. RAIs were included in 7.5% (4,522 of 60,543) of reports. Reports signed when a photograph was displayed had lower estimated odds of containing RAIs (odds ratio: 0.85, 95% confidence interval: 0.77-0.93, <em>P</em> &lt; .001), consistent in sensitivity analysis, with no clear interaction between race and photograph (odds ratio: 0.99, 95% confidence interval: 0.69-1.46, <em>P</em> = .97).</div></div><div><h3>Discussion</h3><div>Patients with a photograph in the EHR had a lower probability of receiving RAIs and this difference did not seem to be the result of implicit racial bias but may be due to personalization of the encounter. This effect may influence radiology reporting for millions of patients per year. Further research is needed to determine whether the association has a positive or negative impact on care quality and outcomes.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Pages 478-485"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634238","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}

{"title":"Recent Trends in Academic Versus Nonacademic Radiologist Compensation and Clinical Productivity","authors":"Ajay Malhotra MD, MMM ,&nbsp;Dheeman Futela MBBS ,&nbsp;Rudra Joshi MD ,&nbsp;Seyedmehdi Payabvash MD ,&nbsp;Ben White MD ,&nbsp;David Seidenwurm MD ,&nbsp;Dheeraj Gandhi MD ,&nbsp;Richard Duszak MD","doi":"10.1016/j.jacr.2024.10.020","DOIUrl":"10.1016/j.jacr.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Recent radiologist compensation and clinical productivity trends have not been well characterized, especially across academic versus nonacademic practice settings.</div></div><div><h3>Purpose</h3><div>To assess recent trends in in financial compensation and clinical productivity between academic and nonacademic settings in diagnostic radiology (DR) and interventional radiology (IR).</div></div><div><h3>Materials and methods</h3><div>We studied deidentified data from the Medical Group Management Association for both DR and IR physicians in academic and nonacademic practices from 2014 to 2023. Median, 25th and 75th percentiles, and mean values were analyzed for compensation, collections, and work relative value units (wRVUs). Compensation and productivity data were compared by radiology subspecialty (DR versus IR), practice type (academic versus nonacademic provider), geographical region of the United States, and practice size. Trends in absolute changes were analyzed with linear regression.</div></div><div><h3>Results</h3><div>The Medical Group Management Association Survey data for 2023 included responses for 3,769 radiologists (2,883 in DR and 886 in IR). In 2023, nonacademic radiologists had greater total median compensation than academic faculty in both DR (by 27%) and IR (by 32%). From 2014 to 2023, median compensation increased faster for academic DR physicians (3.2% annually) than for nonacademic DR physicians (1.9% annually). In 2023, DR physicians produced greater median wRVUs than IR physicians (by 53% for nonacademic and 46% for academic radiologists) with higher collections, but IR physicians had higher compensation (by 16% in nonacademic and 10% in academic settings). Over the last decade, IR physician compensation increased by 3.9% and 3.4% annually for nonacademic and academic IR physicians, respectively, whereas median wRVUs trended downward (by −1.5% for nonacademic and −2.4% for academic physicians) with declining collections (by −4.4% annually for nonacademic and −2.1% for academic physicians).</div></div><div><h3>Conclusion</h3><div>Over the last decade, the salary gap between academic and nonacademic radiologists has narrowed. Physician compensation has increased at a faster pace in IR, despite relatively lower clinical productivity and declining collections.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Pages 486-494"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634241","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}

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Radiologic Management of Lower Gastrointestinal Tract Bleeding","authors":"Jeshwanth Mohan ,&nbsp;Shari T. Jawetz MD","doi":"10.1016/j.jacr.2024.11.011","DOIUrl":"10.1016/j.jacr.2024.11.011","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Page 512"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712073","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}

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Liver Lesion-Initial Characterization","authors":"Corey Feuer BA ,&nbsp;Saadiya Sehareen DO","doi":"10.1016/j.jacr.2024.11.016","DOIUrl":"10.1016/j.jacr.2024.11.016","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Page 516"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752476","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}

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Radiologic Management of Portal Hypertension","authors":"Corey Feuer BA ,&nbsp;Sherry S. Wang MBBS","doi":"10.1016/j.jacr.2024.11.017","DOIUrl":"10.1016/j.jacr.2024.11.017","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 4","pages":"Page 515"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752522","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}