Journal of the American College of Radiology最新文献

{"title":"Outcomes of Implementation of a Same-Day Breast Biopsy Program in a Safety-Net Public Hospital","authors":"Nhat-Tuan Tran MD ,&nbsp;Ivy Ewald MD ,&nbsp;Grayson L. Baird PhD ,&nbsp;Antonio Escamilla Guevarra MPH ,&nbsp;Christopher Doyle MD ,&nbsp;Randy C. Miles MD, MPH","doi":"10.1016/j.jacr.2025.04.024","DOIUrl":"10.1016/j.jacr.2025.04.024","url":null,"abstract":"<div><h3>Purpose</h3><div>Safety-net hospitals play an important role in providing care to patients from historically underserved groups, representing a natural target for initiatives to reduce health disparities. This study evaluates the implementation of a same-day biopsy (SDB) program on time to breast biopsy in the safety-net setting.</div></div><div><h3>Materials and methods</h3><div>This study used an interrupted time series design with pre- and postanalysis. After institutional review board approval, all diagnostic and ultrasound (US) examinations leading to US-guided biopsy during the phase-in period (May 2021 to February 2022), official implementation period (March 2022 to April 2023), and follow-up period (May 2023 to December 2023) were identified. Demographic characteristics of the groups using Wilcoxon rank-sum tests for continuous variables in χ² tests of independence for categorical variables were evaluated. Spline modeling with generalized linear models was used to assess differences in days from biopsy recommendation to biopsy and rates of having a SDB in pre- and postimplementation groups.</div></div><div><h3>Results</h3><div>A total of 677 patients received recommended US-guided breast biopsies during the study period, with 233 patients in the phase-in group, 306 patients in the official implementation group, and 138 patients in the follow-up group. For all patients, the SDB program reduced the median time from biopsy recommendation to biopsy from 13.0 to 3.5 (interquartile range: 6.0-12.0) days (<em>P</em> &lt; .0001). There was no statistically significant decrease in time from biopsy recommendation to initial surgical (19.0-15.0 days; <em>P</em> = .29) or oncologic (26.0-21.0 days; <em>P</em> = .19) appointment.</div></div><div><h3>Conclusion</h3><div>Implementation of a SDB program is effective in reducing overall diagnostic delays after a breast biopsy recommendation for patients seen in safety-net institutions. Additional administrative and ancillary support may be required, however, to aid surgical and oncologic services to further improve overall time to treatment in these settings.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 758-765"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014622","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":"Electronic Health Record Improvements to Reduce Emergency Department CT Prescan Times at a Safety-Net Hospital","authors":"Hardik P. Patel MD, MPH ,&nbsp;Mouna Chebaane MD ,&nbsp;Rolando G. Gerena MD ,&nbsp;Corey A. Thompson MD ,&nbsp;Adam Schwertner MD ,&nbsp;Bradley D. Shy MD ,&nbsp;David M. Naeger MD ,&nbsp;John McMenamy MD, MBA","doi":"10.1016/j.jacr.2025.04.028","DOIUrl":"10.1016/j.jacr.2025.04.028","url":null,"abstract":"<div><h3>Introduction</h3><div>CT is a cornerstone of radiologic imaging in the emergency department (ED), and its utilization has increased over time. CT turnaround times remain a frequent focus for improvement initiatives, especially in resource-limited safety net hospitals (SNHs). Because of the critical nature of CT imaging in the care of acutely ill ED patients and significant resource limitations SNHs face, SNHs must focus on process improvements, ideally that unburden their technologists, over additional resources to meet increasing volumes and rising expectations. In this study, we describe electronic health record (EHR) improvements to reduce the adult ED CT prescan interval by unburdening the CT technologists. Specifically, we hypothesized that by focusing on EHR improvements we would significantly reduce ED CT order-to-begin times and ED CT order-to-begin time variability.</div></div><div><h3>Methods</h3><div>Five EHR-based interventions were conceptualized and implemented by an interdisciplinary team of radiologists, CT technologists, ED physicians, and ED registered nurse leadership: examination order pick lists, integrated screening policies, technologist protocoling, CT Technologist Details tab, and banners for communication. A pre- and postintervention retrospective review was performed from January 1, 2021, through June 30, 2023. All CT examinations done on adults (≥18 years old), on either of the two hospital CTs, were included. Project periods were 6 months long and included preintervention, intervention, postintervention, and two additional sets of postintervention data: sustainment period 1 and sustainment period 2. Examination order and examination begin times were collected from the Epic EHR (Epic Systems, Madison, Wisconsin). Comparison of examination order-to-begin times pre- and postintervention were made using Wilcoxon’s rank-sum test analysis.</div></div><div><h3>Results</h3><div>In all, 62,540 CTs were performed during the 30 months of data collection: 11,499 preintervention, 12,475 intervention, 12,496 postintervention, 13,062 sustainment 1, and 13,008 sustainment 2. Median order-to-begin times decreased by 16 min after the implementation of the first three interventions in July 2021 and decreased by 13 min after the last two interventions in December 2021. Overall, the five selected interventions reduced ED CT prescan examination order-to-begin times by 46.6% (69 versus 37 min, <em>P</em> &lt; .001) and interquartile range variability by 38.0%, demonstrating the effectiveness of EHR improvements.</div></div><div><h3>Discussion</h3><div>EHR improvements were effective in reducing ET CT prescan times and variability by unburdening CT technologist and improving ED CT performance.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 722-728"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061415","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":"Accessibility in Radiology and Need for Improvement","authors":"Karen Buch MD ,&nbsp;Amita Sharma MD ,&nbsp;Efrén J. Flores MD ,&nbsp;Stacy Smith MD","doi":"10.1016/j.jacr.2025.03.004","DOIUrl":"10.1016/j.jacr.2025.03.004","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 838-840"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733435","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":"Measuring Health-Related Social Risks in a Lung Cancer Screening Cohort","authors":"Farouk Dako MD, MPH ,&nbsp;Pavel Karasek ,&nbsp;James Seward MPH ,&nbsp;Kollin White ,&nbsp;Anil Vachani MD, MSCE ,&nbsp;Katharine Rendle PhD, MSW, MPH ,&nbsp;Carmen Guerra MD, MSCE","doi":"10.1016/j.jacr.2025.04.018","DOIUrl":"10.1016/j.jacr.2025.04.018","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility and limitations of measuring health-related social risks (HRSRs) affecting individuals in a lung cancer screening (LCS) cohort from multiple data sources.</div></div><div><h3>Methods</h3><div>A single-institution study analyzed data from 227 participants in a pragmatic LCS trial in west and southwest Philadelphia. HRSRs were assessed using three approaches: (1) electronic health records (EHRs) capturing individual-level social risks (eg, financial strain, housing stability); (2) neighborhood-level analysis using a modified Yost index to determine socio-economic status; and (3) semistructured interviews with 15 participants to identify barriers and facilitators to LCS adherence.</div></div><div><h3>Results</h3><div>EHR data revealed financial strain and housing instability as the most documented HRSRs, although missing data ranged from 64% to 69%. Neighborhood-level analysis showed participants had lower socio-economic status compared with their broader communities, with Yost index scores of 1.28 (west Philadelphia) and 1.20 (southwest Philadelphia). Interviews highlighted limited knowledge of LCS (87% unaware before clinician referral), reliance on public or supplemental transportation, and overall trust in health care providers. Transportation was not a significant reported barrier to LCS adherence.</div></div><div><h3>Discussion</h3><div>This study demonstrates the promise and limitations of EHR data, neighborhood-level data, and patient interviews to assess HRSRs. Although EHRs provided limited and inconsistent data, interviews captured granular individual experiences, and neighborhood-level analysis contextualized socio-economic influences. Comprehensive and consistent data collection across multiple sources is critical in understanding HRSRs experienced by individuals.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 737-743"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065318","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":"AI in the Era of GPT: Transforming the Future of Work and Discovery","authors":"Juan M.Lavista Ferres PhD ,&nbsp;Elliot K. Fishman MD ,&nbsp;Linda C. Chu MD ,&nbsp;Felipe Lopez-Ramirez MD ,&nbsp;Charles K. Crawford ,&nbsp;Steven P. Rowe MD, PhD","doi":"10.1016/j.jacr.2025.02.007","DOIUrl":"10.1016/j.jacr.2025.02.007","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 850-852"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384269","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":"Matching the Message to the Audience—Understanding What Your Customer Needs to Hear","authors":"Shenan Reed MD ,&nbsp;Elliot K. Fishman MD ,&nbsp;Linda C. Chu MD ,&nbsp;Steven P. Rowe MD, PhD ,&nbsp;Charles K. Crawford","doi":"10.1016/j.jacr.2025.02.004","DOIUrl":"10.1016/j.jacr.2025.02.004","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 853-855"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384336","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":"A Systematic Review and Meta-Analysis of Racial Disparities in Hemodialysis Vascular Access Utilization and Outcomes in the United States","authors":"Chi Trinh BA ,&nbsp;Tej Mehta MD ,&nbsp;Rebecca Choi MD ,&nbsp;Nima Hafezi Nejad MD, MPH ,&nbsp;Christopher Bailey MD","doi":"10.1016/j.jacr.2025.03.003","DOIUrl":"10.1016/j.jacr.2025.03.003","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review compares the utilization and outcome of hemodialysis vascular access among racial groups in the United States, highlighting disparities and their implications.</div></div><div><h3>Methods</h3><div>The original search using Medline, Embase, Cochrane, and PubMed yielded 349 studies, of which 32 met inclusion criteria. Data on utilization rate, patency, maturation, complications, and survival rate were collected.</div></div><div><h3>Results</h3><div>In pooled analyses, Black patients had significantly lower odds of receiving fistula (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.58-0.77) but twice the odds of receiving grafts (OR 2.01, 95% CI 1.60-2.53) for access than White patients. No statistically significant difference in the odds of dialysis catheter existed between the two groups (OR 0.89, 95% CI 0.66-1.19). According to 7 of 32 studies, Black patients also experienced a higher risk of fistula failure, lower rate of fistula maturation, higher risk of graft and fistula patency loss, and higher complications compared with White patients. Pooled analyses showed no statistically significant difference in the odds of fistula use between White and Hispanic patients (OR 0.93, 95% CI 0.76-1.15). According to 5 of 32 studies, Hispanic patients experienced slightly higher rate of grafts, slightly higher probability of fistula maturation, and slightly better patency rates for both grafts and fistulas than White patients. Mortality rates after vascular access procedures were higher in White than all non-White patients combined. Data regarding vascular access in other racial and ethnic minorities were limited.</div></div><div><h3>Discussions</h3><div>Overall, Black patients disproportionately received inferior hemodialysis vascular access choices and experienced worse outcomes. These findings highlight the need for interventions to address hemodialysis care disparities in the United States.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 801-820"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733444","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":"Sustainability of Rideshare Programs to Promote Engagement of Underrepresented Populations in Breast Cancer Screening Trials","authors":"Bhavika K. Patel MD ,&nbsp;Jhenitza P. Raygoza MPH ,&nbsp;Heidi E. Kosiorek MS ,&nbsp;Carmen C. Soto ,&nbsp;Diana Y. Grijalva ,&nbsp;Etta Pisano MD ,&nbsp;Donald Northfelt MD ,&nbsp;Suganya Karuppana MD ,&nbsp;Jessica D. Austin PhD, MPH","doi":"10.1016/j.jacr.2025.04.026","DOIUrl":"10.1016/j.jacr.2025.04.026","url":null,"abstract":"<div><h3>Background</h3><div>Transportation barriers significantly limit participation in breast cancer screening trials among Hispanic women, exacerbating disparities in breast cancer outcomes and underrepresentation in clinical research. Rideshare programs have emerged as a potential solution, but their long-term sustainability remains underexplored. Understanding sustainability capacity is critical to ensuring these programs can address structural barriers, promote health equity, and improve outcomes for underserved populations. The aim of this study is to evaluate sustainability capacity of a no-cost rideshare program and to identify potential strategies to support sustainability.</div></div><div><h3>Methods</h3><div>This explanatory, sequential, mixed-methods study evaluated the sustainability capacity of a no-cost rideshare program aimed at increasing Hispanic women’s participation in the Tomosynthesis Mammographic Imaging Screening Trial. Analyses and data integration were guided by the Capacity for Sustainability Framework. Average domain scores on the Program Sustainability Assessment Tool survey were calculated ranging from 1 to 7, with higher scores indicating higher levels for each domain, and structured interviews were analyzed using a rapid qualitative approach. Program Sustainability Assessment Tool and interview findings were integrated using a joint display.</div></div><div><h3>Results</h3><div>Survey responses (n = 37) indicated strengths in environmental support (mean score: 5.4) and partnerships (6.0), but challenges in funding stability (4.2) and strategic planning (4.5). Interview findings emphasized the importance of program champions and collaborative partnerships and highlighted gaps in securing diverse funding sources and engaging institutional leadership in strategic planning. Participants identified opportunities to strengthen communication, evaluate program impact, and adapt processes to meet evolving needs.</div></div><div><h3>Discussion</h3><div>Strong partnerships and champions supported the program’s initial success, but funding instability and insufficient strategic planning threaten sustainability. Future efforts should prioritize securing diverse funding, engaging leadership, and fostering collaboration to scale rideshare programs, thereby reducing disparities and advancing equity in breast cancer screening and research participation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 766-779"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009139","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":"The State of Paid Family and Medical Leave Policies: An ACR, AAWR, SWRO Member Survey","authors":"Kirti Magudia MD, PhD ,&nbsp;Rachel S. Lee BS ,&nbsp;Elizabeth H. Dibble MD ,&nbsp;Dominick Parris BS ,&nbsp;Claire C. Baniel MD ,&nbsp;Sara Beltran Ponce MD ,&nbsp;Olga Laur MD ,&nbsp;Susan Hamman MD ,&nbsp;Elizabeth Kagan Arleo MD ,&nbsp;Candice Johnstone MD, MPH ,&nbsp;Johnson Lightfoote MD, MBA, FACR ,&nbsp;Eric Rubin MD ,&nbsp;Lori Deitte MD ,&nbsp;Reshma Jagsi MD, DPhil ,&nbsp;Amy L. Kotsenas MD ,&nbsp;Thomas S.C. Ng MD, PhD","doi":"10.1016/j.jacr.2025.03.006","DOIUrl":"10.1016/j.jacr.2025.03.006","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 831-837"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774727","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":"Not All That Glitters Is Gold, nor All Artificial Intelligence a Large Language Soul","authors":"Teodoro Martín-Noguerol MD,&nbsp;Pilar López-Úbeda PhD,&nbsp;Antonio Luna MD, PhD","doi":"10.1016/j.jacr.2025.04.010","DOIUrl":"10.1016/j.jacr.2025.04.010","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 7","pages":"Pages 713-714"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044173","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}