Journal of the American College of Radiology最新文献

{"title":"Risk-Stratified Screening: A Simulation Study of Scheduling Templates on Daily Mammography Recalls","authors":"Yannan Lin MD, MPH, PhD ,&nbsp;Anne C. Hoyt MD ,&nbsp;Vladimir G. Manuel MD ,&nbsp;Moira Inkelas MPH, PhD ,&nbsp;Mehmet Ulvi Saygi Ayvaci PhD ,&nbsp;Mehmet Eren Ahsen PhD ,&nbsp;William Hsu PhD","doi":"10.1016/j.jacr.2024.12.010","DOIUrl":"10.1016/j.jacr.2024.12.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Risk-stratified screening (RSS) scheduling may facilitate more effective use of same-day diagnostic testing for potentially abnormal mammograms, thereby reducing the need for follow-up appointments (“recall”). Our simulation study assessed the potential impact of RSS scheduling on patients recommended for same-day diagnostics.</div></div><div><h3>Methods</h3><div>We used a discrete event simulation to model workflow at a high-volume breast imaging center, incorporating artificial intelligence (AI)-triaged same-day diagnostic workups after screening mammograms. The RSS design sequences patients in the daily screening schedule using cancer risk categories developed from Tyrer-Cuzick and deep learning model scores. We compared recall variance, required hours of operation to accommodate all patients, and patient wait times using traditional (random) and RSS schedules.</div></div><div><h3>Results</h3><div>The baseline simulation included 60 daily patients, with an average of 42% receiving screening mammograms and 11% (about three patients) being recommended for diagnostic workups. Compared with traditional scheduling, RSS scheduling reduces recall variance by up to 30% (1.98 versus 2.82, <em>P</em> &lt; .05). With same-day diagnostics, RSS scheduling had a modest impact, increasing the number of patients served within normal operating hours by up to 1.3% (55.4 versus 54.7, <em>P</em> &lt; .05), decreasing necessary operational hours by 12 min (10.3 versus 10.5 hours, <em>P</em> &lt; .05), and increasing patient waiting times by an average of 2.4 min (0.24 versus 0.20 hours, <em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>Our simulation study suggests that RSS scheduling could reduce recall variance. This approach might enable same-day diagnostics using AI triage by accommodating patients within normal operating hours.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 297-306"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529857","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":"A Comparison of Radiography, X-Ray Tomosynthesis, and CT for Intraorbital Metallic Foreign Body Screening","authors":"Christina L. Brunnquell PhD ,&nbsp;Ana Gabriela Vasconcelos MS ,&nbsp;Michael N. Hoff PhD ,&nbsp;Jalal B. Andre MD ,&nbsp;Bryan A. Comstock MS ,&nbsp;Diana L. Lam MD ,&nbsp;Pattana Wangaryattawanich MD ,&nbsp;Jason Hartman MD ,&nbsp;Nathan M. Cross MD","doi":"10.1016/j.jacr.2024.12.002","DOIUrl":"10.1016/j.jacr.2024.12.002","url":null,"abstract":"<div><h3>Objective</h3><div>Before MRI examination, patients are often screened for intraorbital metallic foreign bodies (IMFBs) via questioning, clinical record review, and imaging when appropriate. This work compares the screening performance of digital radiography (DR), digital tomosynthesis (DT), and CT in detecting IMFBs composed of various metals and identifies their limits of detection.</div></div><div><h3>Methods</h3><div>Fragments of aluminum, steel, and cobalt-cemented tungsten carbide were produced. A human skull model, with metal fragments embedded in grapes placed in each orbit, was submerged in a water bath to create a semi-anthropomorphic phantom. Phantom orbit images were acquired with DR, DT, and CT. Six experienced radiologists reviewed images and scored their confidence in detecting IMFBs. Receiver operating characteristic analysis was performed and a multireader, multicase analysis of variance was used to compare the modalities.</div></div><div><h3>Results</h3><div>Performance comparison across modalities yielded area under the receiver operating characteristic curve values of 0.90, 0.79, and 0.78 for CT, DT, and DR, respectively. Pairwise comparison revealed that CT was superior to both DT and DR (<em>P</em> &lt; .05). When stratified by metal type, a significant performance difference among modalities was only observed for steel. Steel fragments of mass 0.8 mg and smaller were not detected using DT or DR, but even the smallest steel fragments of 0.4 mg were detectable with CT.</div></div><div><h3>Conclusion</h3><div>CT outperformed DT and DR in detecting IMFBs using a semi-anthropomorphic phantom. This performance difference is largely attributed to differences in detection of steel fragments. Since steel is often ferromagnetic, this distinction is relevant for imaging modality selection for orbit screening before MRI.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 386-394"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529385","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":"Potential Impact of Opportunistic CT for Closing Diagnosis Gaps in Primary Hyperparathyroidism","authors":"Paul M. Bunch MD ,&nbsp;Joseph Rigdon PhD ,&nbsp;Leon Lenchik MD ,&nbsp;Matthew A. Gorris MD ,&nbsp;Reese W. Randle MD","doi":"10.1016/j.jacr.2024.09.009","DOIUrl":"10.1016/j.jacr.2024.09.009","url":null,"abstract":"<div><h3>Objective</h3><div>Primary hyperparathyroidism (PHPT) is underdiagnosed. Opportunistic assessment for enlarged parathyroid glands on routine CT examinations is a proposed approach to improve diagnosis. However, the proportion of at-risk patients with a relevant CT is unknown. We aimed to determine the proportion of individuals with hypercalcemia untested for PHPT who had CT examinations on which opportunistic screening could have been performed and to assess characteristics associated with imaging availability.</div></div><div><h3>Methods</h3><div>This retrospective study included adults with hypercalcemia untested for PHPT within our health system between January 2018 and December 2022. Each patient was classified as imaging available versus unavailable based on the presence of contrast-enhanced CTs including the parathyroid region performed between January 2013 and December 2022. Characteristics of these groups were compared.</div></div><div><h3>Results</h3><div>The sample comprised 10,702 patients (mean age, 57 years; 6,422 female and 4,280 male patients) with CTs available in 1,318 (12.3%). Characteristics associated with the greatest odds of available CT were Charlson Comorbidity Index ≥ 5 (odds ratio [OR] 5.29, <em>P</em> &lt; .0001), death during the study period (OR 2.31, <em>P</em> &lt; .0001), fatigue (OR 1.90, <em>P</em> &lt; .0001), weakness (OR 1.60, <em>P</em> &lt; .0001), and calcium &gt; 12.0 mg/dL (OR 1.44, <em>P</em> &lt; .0001). Characteristics associated with the lowest odds of available CT were age ≥ 85 years (OR 0.27, <em>P</em> &lt; .0001), age &lt; 35 years (OR 0.58, <em>P</em> &lt; .0001), and chronic kidney disease (OR 0.64, <em>P</em> &lt; .0001).</div></div><div><h3>Conclusion</h3><div>More than 12% of patients with hypercalcemia who were untested for PHPT had at least one CT that could have been used to opportunistically assess the parathyroid glands. Patients with imaging tended to have more comorbidities than those without.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 376-385"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529372","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 Multicomponent Behavior Change and Implementation Strategy to Increase Lung Cancer Screening in Primary Care Practices: The IBREATHE Study","authors":"Lauren K. Groner DO, MS ,&nbsp;Katja Reuter PhD ,&nbsp;Nathalie Moise MD, MS ,&nbsp;Laura Robbins DSW ,&nbsp;Rulla Tamimi ScD ,&nbsp;Rishikesh P. Dalal MD, MPH ,&nbsp;Stephen J. Peterson MD, MACP ,&nbsp;Luis Blanco BFA ,&nbsp;Kimberly L. Murdaugh MD, MS ,&nbsp;Erica Phillips MD, MS","doi":"10.1016/j.jacr.2024.12.004","DOIUrl":"10.1016/j.jacr.2024.12.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite broader eligibility under the 2021 US Preventive Services Task Force guidelines, national lung cancer screening (LCS) uptake remains at around 16%. This radiologist-led study sought to identify LCS barriers in primary care settings and develop a theory-based behavior change and implementation strategy to improve screening rates in these settings.</div></div><div><h3>Methods</h3><div>A multiphase approach was used, including qualitative methods and frameworks (ie, Behavior Change Wheel; Capability, Opportunity, and Motivation of Behavior model; Theoretical Domains Framework; and Expert Recommendations for Implementing Change glossary) to understand and address LCS barriers.</div></div><div><h3>Results</h3><div>LCS barriers are represented by five major themes: (1) insurance pre-authorization; (2) patients’ cognitive and psychosocial barriers; (3) provider-patient knowledge and communication barriers; (4) the culture of a busy primary care practice; and (5) the test is ordered, patients do not follow through. Barriers impact primary care providers’ capability, opportunity, and motivation to implement guideline-concordant LCS into practice. The final multicomponent strategy (LungCheck) addressing these barriers includes educational meetings and materials, an implementation blueprint, a LCS navigator, a practical pack-year calculator, and electronic health records optimization.</div></div><div><h3>Conclusions</h3><div>We provide a road map for using behavioral and implementation science to understand LCS barriers and design an evidence-based, theory-informed multicomponent strategy to improve LCS uptake. Our radiologist-driven strategy addresses LCS barriers in primary care, has the potential to increase screening rates, and can serve as a model for implementing similar preventive health initiatives in other settings. The multicomponent strategy will be evaluated in a pilot study with two primary care practice models.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 280-290"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529855","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":"Incidentally Detected Adrenal Nodules on Lung Cancer Screening CT","authors":"Aparna Singh MD,&nbsp;Mark M. Hammer MD,&nbsp;Suzanne C. Byrne MD","doi":"10.1016/j.jacr.2024.12.003","DOIUrl":"10.1016/j.jacr.2024.12.003","url":null,"abstract":"<div><h3>Objective</h3><div>To assess adherence to ACR recommendations for managing incidental adrenal lesions detected on lung cancer screening (LCS) CT examinations.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of all LCS CT examinations within our health care system from January 2015 to August 2023. We included CTs that were reported with Lung-RADS “S” modifier for a focal adrenal lesion. We recorded whether follow-up imaging and biochemical testing were recommended and whether they were performed. Follow-up recommendations in reports were assessed for adherence to ACR recommendations.</div></div><div><h3>Results</h3><div>During the study period, 191 patients had a focal adrenal nodule reported. Per ACR recommendations, 36 of 191 (19%) warranted follow-up, but only 23 of 36 (64%) of these received follow-up recommendations. Of those 191, 155 (81%) did not require follow-up per ACR, and 25 of those 155 (16%) received follow-up recommendations. Of those who were advised follow-up, 34 of 48 (71%) received dedicated follow-up, 9 of 48 (19%) received follow-up imaging for another reason, and 5 of 48 (10%) did not receive any follow-up. Among those in whom follow-up was not recommended, 21 of 143 (15%) received dedicated follow-up, 101 of 143 (71%) received follow-up imaging for another reason, and 21 of 143 (15%) did not receive any follow-up. No malignant lesions were diagnosed. Per ACR recommendations, 183 of 191 (96%) of patients should have received biochemical testing; however, it was recommended in only 4 patients (2%).</div></div><div><h3>Discussion</h3><div>There was suboptimal adherence to ACR recommendations for managing incidental adrenal lesions on LCS CTs, with both unnecessary and missing follow-up recommendations. Recommendations for biochemical testing were nearly nonexistent, despite being part of the ACR algorithm.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 291-296"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529856","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-Reported Barriers and Preferred Interventions to Improve Lung Cancer Screening Uptake","authors":"Jinho Jung BS ,&nbsp;Eisa Razzak BA ,&nbsp;Axs Roc Avenido BS ,&nbsp;Ali Rashidi MD ,&nbsp;Stephanie Jia BS ,&nbsp;Natalie Q. Tran BS ,&nbsp;Rachel Yao BS ,&nbsp;Emily L. Nguyen BS ,&nbsp;Arsanyous Bernaba BS ,&nbsp;Richard Echeverria MSc ,&nbsp;Tan Q. Nguyen MD ,&nbsp;Amir Imanzadeh MD ,&nbsp;Gelareh Sadigh MD","doi":"10.1016/j.jacr.2024.10.010","DOIUrl":"10.1016/j.jacr.2024.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>Lung cancer screening (LCS) utilization remains low. We aimed at assessing LCS patient-reported barriers and preferred interventions to improve uptake.</div></div><div><h3>Methods</h3><div>Between July and November 2023, an electronic 60-item survey was completed by consented patients aged 50 to 80 years who were due to receive LCS, and their eligibility for LCS was confirmed. The survey assessed patients’ LCS perceptions and preferences to increase uptake. Regression analyses was performed to assess associated sociodemographic factors.</div></div><div><h3>Results</h3><div>In all, 12,558 patients were contacted; 1,396 responded, 871 were interested, and 86 were eligible and enrolled (mean age: 62.4; 40% female; 79.1% White, 4.7% Asian, 2.3% Black). LCS was perceived as beneficial for early lung cancer detection by 91.9%, yet only 24.4% had undergone LCS previously. Of the respondents, 54.7% identified barriers to LCS with the most common being cost (23.3%) and lack of symptoms (23.3%). Current (versus former) smokers reported higher barrier scores (B coefficient: 7.06, 95% confidence interval [CI], 1.71-13.12) and lower self-efficacy scores (B coefficient: −5.15; 95% CI, −8.73 to −1.56). Patients with prior cancer screening had higher self-efficacy scores (B coefficient, 8.92; 95% CI, 1.95-15.88). Preferred interventions included patient reminders (63.3%), primary care provider notification about LCS eligibility (62.0%), and educational materials (60.8%). Patients with higher self-efficacy (odds ratio, 1.16; 95% CI, 1.06-1.27) were more likely to prefer reminders. Patients with personal cancer history were more likely to prefer primary care provider notification (odds ratio, 5.81; 95% CI, 1.15,29.22).</div></div><div><h3>Conclusions</h3><div>Our results underscore the LCS perceived benefits and barriers, as well as patient-preferred interventions to enhance screening participation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 269-279"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529854","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":"Bone Mineral Density and Trabecular Microarchitecture Screening in Lung Transplant Candidates","authors":"Alain E. Sherman MD, MBA ,&nbsp;Aspan M. Shokrekhuda MD ,&nbsp;Deepak P. Kalbi MD ,&nbsp;Jenny T. Bencardino MD ,&nbsp;Kwang J. Chun MD","doi":"10.1016/j.jacr.2024.12.009","DOIUrl":"10.1016/j.jacr.2024.12.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Lung transplant candidates routinely undergo dual-energy x-ray absorptiometry (DXA) screening due to increased risk of osteoporosis secondary to comorbidities and prolonged immunosuppression. Nonetheless, postoperative insufficiency fractures have been well documented, even in patients with normal bone mineral density (BMD). This study investigated the added value of trabecular bone score (TBS) as a complementary screening index of bone microarchitecture.</div></div><div><h3>Methods</h3><div>A retrospective review of 143 lung transplant candidates who underwent preoperative DXA screening was performed. TBS was calculated from DXA of the lumbar spine. DXA and TBS measurements were standardized using T-scores with reference to established population-based datasets.</div></div><div><h3>Results</h3><div>Differences in the observed rates of osteopenia (36.4%), osteoporosis (11.2%), partially degraded bone (35.0%), and degraded bone (35.0%) were statistically significant (<em>P</em> &lt; .001). Abnormal trabecular microarchitecture was significantly more prevalent than abnormal BMD (69.9% versus 47.6%; <em>P</em> &lt; .001). TBS T-scores (mean = −1.98, SD = 1.39) were, on average, significantly lower than DXA T-scores (mean = −0.80, SD = 1.57; <em>t</em>[142] = 9.09; <em>P</em> &lt; .001). Hispanic patients (mean = −1.25, SD = 1.28) had significantly lower DXA T-scores compared with White (mean = −0.28, SD = 1.14) or Black patients (mean = −0.30, SD = 1.31; <em>F</em>[2, 109] = 8.28; <em>P</em> &lt; .001). By contrast, TBS T-scores did not differ by race or ethnicity (<em>F</em>[2, 109] = 0.26; <em>P</em> = .78).</div></div><div><h3>Conclusions</h3><div>Impaired trabecular microarchitecture is extremely common among lung transplant candidates, with a substantial proportion at risk of fracture through degraded bone despite normal BMD. TBS offers promise as a simple, robust, inexpensive, and noninvasive screening adjunct to DXA in this unique and vulnerable population.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 342-348"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529368","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":"Opportunistic Detection of Hepatocellular Carcinoma Using Noncontrast CT and Deep Learning Artificial Intelligence","authors":"Chengzhi Peng MBBS ,&nbsp;Philip Leung Ho Yu PhD ,&nbsp;Jianliang Lu MPhil ,&nbsp;Ho Ming Cheng PhD ,&nbsp;Xin-Ping Shen MD ,&nbsp;Keith Wan-Hang Chiu MD ,&nbsp;Wai-Kay Seto MD","doi":"10.1016/j.jacr.2024.12.011","DOIUrl":"10.1016/j.jacr.2024.12.011","url":null,"abstract":"<div><h3>Objective</h3><div>Hepatocellular carcinoma (HCC) poses a heavy global disease burden; early diagnosis is critical to improve outcomes. Opportunistic screening—the use of imaging data acquired for other clinical indications for disease detection—as well as the role of noncontrast CT have been poorly investigated in the context of HCC. We aimed to develop an artificial intelligence algorithm for efficient and accurate HCC detection using solely noncontrast CTs.</div></div><div><h3>Methods</h3><div>A 3-D convolutional block attention module (CABM) model was developed and trained on noncontrast multiphasic CT scans. HCC was diagnosed following American Association for the Study of Liver Disease guidelines and confirmed via 12-month clinical composite reference standard. CT observations were reviewed by radiologists; observations in at-risk patients were annotated via the Liver Imaging Reporting and Data System. Internal validation, independent external testing, and sensitivity analyses were performed to evaluate model performance and generalizability.</div></div><div><h3>Results</h3><div>In all, 2,223 patients were included. The CBAM model achieved an area under the receiver operating curve (AUC) of 0.807 (95% confidence interval [CI] 0.772-0.841) on the internal validation cohort, comparable to radiological interpretation at 0.851 (95% CI 0.820-0.882). Among at-risk patients, cases with definite HCC outcomes, indeterminate scans, and scans with small lesions &lt; 2 cm in size, the model attained AUCs of 0.769 (95% CI 0.721-0.817), 0.815 (95% CI 0.778-0.853), 0.769 (95% CI 0.704-0.834), and 0.773 (95% CI 0.692-0.854). On external testing cohort with 584 patients, the CBAM model achieved an AUC of 0.789 (95% CI 0.750-0.827).</div></div><div><h3>Discussion</h3><div>The CBAM model achieved a diagnostic accuracy comparable to radiological interpretation during internal validation. Artificial intelligence analysis of noncontrast CTs has a potential role in HCC opportunistic screening.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 249-259"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529426","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":"Racial and Ethnic Disparities in Screening Mammography During COVID-19 in the Upper Midwest","authors":"Nia Foster BS ,&nbsp;Arissa Milton BS ,&nbsp;Ryan W. Woods MD, MPH ,&nbsp;Mai Elezaby MD ,&nbsp;Joan Neuner MD, MPH ,&nbsp;Kelly Hackett MPH ,&nbsp;Noelle LoConte MD, MS ,&nbsp;Elizabeth S. Burnside MD, MHS, MS ,&nbsp;Anand K. Narayan MD, PhD","doi":"10.1016/j.jacr.2025.01.001","DOIUrl":"10.1016/j.jacr.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>Studies conducted prior to COVID-19 suggested that racial and ethnic disparities in mammographic screening have reduced over time. COVID-19 has had devastating effects on racial and ethnic minority populations, resulting in delays in preventive screening. Our purpose was to determine if racial and ethnic minority groups were less likely to receive mammographic screening during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>Retrospective cross-sectional study was conducted in a multisite academic medical center in the Upper Midwest to evaluate screening disparities during the COVID-19 pandemic. Participants included 50- to 74-year-old female individuals (June 2021 to May 2022). Additional control group was included for pre-COVID-19 case-control comparison (June 2018 to May 2019). Unadjusted and adjusted logistic regression analyses estimated the association between screening and race and ethnicity including interaction terms to assess temporal interactions associated with COVID-19. Study was deemed exempt from institutional review board review.</div></div><div><h3>Results</h3><div>In all, 37,509 eligible female patients were included. Of them, 73.8% of eligible patients received a mammogram within the last 2 years (White 74.7%, Black 57.6%, Asian 67.0%, American Indian 60.1%, Hispanic 64.2%). In our adjusted analyses, Black (<em>P</em> &lt; .001), Asian (<em>P</em> = .003), and American Indian patients (<em>P</em> = .001) were less likely to receive screening. Hispanic patients were comparably likely to receive screening (<em>P</em> = .338). Non-English-preferred languages, uninsured or Medicaid, and living in rural areas were associated with decreased screening (<em>P</em> &lt; .001). In all, 36,768 eligible female patients were included for pre-COVID-19 comparison. Compared with the pre–COVID-19 time period, COVID-19 was associated with increased screening disparities (<em>P</em> &lt; .001) for Black and Hispanic women (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic was associated with increased racial and ethnic screening disparities. Targeted outreach efforts are required to ensure equitable access to mammographic screening for medically underserved patient populations.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 315-323"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529491","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":"Association of Average Cyst Diameter Versus Single Maximum Diameter of Pancreatic Cysts to Cyst Volume and Impact on Screening Guideline Classification","authors":"Sara Babapour MD ,&nbsp;Abraham F. Bezuidenhout MD ,&nbsp;Miriel Handler MD ,&nbsp;Clarissa Lee ,&nbsp;Alexander Brook PhD ,&nbsp;Leo L. Tsai MD, PhD","doi":"10.1016/j.jacr.2024.12.005","DOIUrl":"10.1016/j.jacr.2024.12.005","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the association of single maximum diameter and average cyst diameter of pancreatic cysts measured on magnetic resonance cholangiopancreatography (MRCP) with segmented cyst volume and secondarily evaluate the effect of average cyst diameter on screening guideline classification.</div></div><div><h3>Methods</h3><div>Consecutive patients with pancreatic cysts &lt; 3 cm on MRCP in 2017 were retrospectively identified. The single maximum diameter and perpendicular short axis diameter of pancreatic cysts obtained on coronal MRCP were measured and their average was taken to determine average cyst diameter. Calculated volume approximations based on single maximum diameter and average cyst diameter were compared with segmented cyst volume. Subsequently, patients were classified based on average cyst diameter versus single maximum diameter according to a currently used screening guideline. Intraclass correlation was used to assess interobserver agreement. Williams’s test was used to compare between-group correlation coefficients.</div></div><div><h3>Results</h3><div>The mean value of single maximum diameters and average cyst diameter of the 86 included cysts were 15.4 ± 7.3 mm and 12.6 ± 6.1 mm, respectively. The mean volume of segmented cysts was 1,521 ± 1,983 mm³. Interreader agreement for measurement of cyst diameters was excellent (<em>r</em> = 0.99). The volume calculated based on the average cyst diameter correlated better to segmented cyst volume (<em>r</em> = 0.88) than single maximum diameter (<em>r</em> = 0.73, <em>P</em> &lt; .0001). Of 86 patients, 24 (28%) were classified to a less stringent follow-up strategy by using average cyst diameter.</div></div><div><h3>Discussion</h3><div>The average cyst diameter more accurately reflects the segmented cyst volume than a single maximum diameter. Utilization of average cyst diameter in existing screening guidelines reclassified 28% of patients into lower-risk screening groups, which would reduce subsequent surveillance imaging overall.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 3","pages":"Pages 324-331"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529492","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}