Journal of the American College of Radiology最新文献

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up","authors":"","doi":"10.1016/j.jacr.2024.04.013","DOIUrl":"10.1016/j.jacr.2024.04.013","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1546144024004265/pdfft?md5=78dba52c2d6ad1f8788102f1bbc1783f&pid=1-s2.0-S1546144024004265-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140893050","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":"Studying Guaranteed Income in Oncology: Lessons Learned From Launching the Guaranteed Income and Financial Treatment Trial","authors":"","doi":"10.1016/j.jacr.2024.06.008","DOIUrl":"10.1016/j.jacr.2024.06.008","url":null,"abstract":"<div><p>By targeting income and financial stress as key social determinants of health, unconditional cash transfers (UCTs) may improve cancer health outcomes and reduce cancer health disparities. Described in policy circles as guaranteed or basic income, UCTs have been shown to improve a range of health outcomes in low-income populations but have not yet been examined as a targeted intervention for people with cancer. This article describes some of the lessons learned from launching the Guaranteed Income and Financial Treatment trial, a two-arm randomized controlled trial of UCTs in oncology, along with a rationale for studying UCTs in people with cancer who have low incomes, and presents an introductory primer on UCT research for oncology clinicians and researchers and future directions for research.</p></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1546144024005325/pdfft?md5=56697ed80948ba1bf3ef85c2958dbdb2&pid=1-s2.0-S1546144024005325-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441208","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":"Screening for Health-Related Social Needs and Financial Toxicity Among Patients With Cancer Treated With Radiation Therapy: Findings From a Quality Improvement Project","authors":"","doi":"10.1016/j.jacr.2024.07.001","DOIUrl":"10.1016/j.jacr.2024.07.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Financial toxicity is common among patients with cancer, as are co-occurring health-related social risks (HRSRs). There is limited evidence to support best practices in screening for HRSRs and financial toxicity in the cancer context. This analysis sought to understand variations of identified needs based on treatment course using data from a large screening program.</p></div><div><h3>Methods</h3><p>This 2022 to 2023 screening quality improvement program included four services (breast, gastrointestinal, gynecologic, thoracic) at an urban comprehensive cancer center. The Comprehensive Score for Financial Toxicity measured financial toxicity. Patients completed an HRSR checklist documenting food, housing, medication, or transportation insecurity and financial borrowing practices. Differences were evaluated by treatment course (radiation therapy [RT] versus other treatment and RT plus chemotherapy versus other treatment).</p></div><div><h3>Results</h3><p>Screening surveys were sent to 70,983 unique patients; 38,249 completed a screening survey (54% response rate). Of responders, 4% (n = 1,686) underwent RT in the 120 days before their survey, and 3% (n = 1,033) received RT in combination with chemotherapy. Overall, patients receiving RT had lower unadjusted Comprehensive Score for Financial Toxicity scores, indicating worse financial toxicity. The proportion of patients receiving RT reporting unmet transportation (15% versus 12%, <em>P</em> &lt; .001) and food (13% versus 11%, <em>P</em> = .02) needs was significantly higher than for patients not receiving RT. More patients receiving RT borrowed money than did patients not receiving RT (17% versus 15%, <em>P</em> = .02). In multivariable models, RT (alone or in combination) was associated with worse financial toxicity and transportation difficulties.</p></div><div><h3>Conclusions</h3><p>Screening for financial toxicity and HRSR is possible at a large cancer center. Patients receiving RT have higher transportation insecurity and worse financial toxicity compared with those receiving other treatments. Tailored intervention throughout the treatment trajectory is essential.</p></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1546144024005982/pdfft?md5=834972c6bf0738f388fdde8c96e0b756&pid=1-s2.0-S1546144024005982-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545628","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":"Cost-Effectiveness of Artificial Intelligence–Based Opportunistic Compression Fracture Screening of Existing Radiographs","authors":"","doi":"10.1016/j.jacr.2023.11.029","DOIUrl":"10.1016/j.jacr.2023.11.029","url":null,"abstract":"<div><h3>Purpose</h3><p>Osteoporotic vertebral compression fractures (OVCFs) are a highly prevalent source of morbidity and mortality, and preventive treatment has been demonstrated to be both effective and cost effective. To take advantage of the information available on existing chest and abdominal radiographs, the authors’ study group has developed software to access these radiographs for OVCFs with high sensitivity and specificity using an established artificial intelligence deep learning algorithm. The aim of this analysis was to assess the potential cost-effectiveness of implementing this software.</p></div><div><h3>Methods</h3><p>A deterministic expected-value cost-utility model was created, combining a tree model and a Markov model, to compare the strategies of opportunistic screening for OVCFs against usual care. Total costs and total quality-adjusted life-years were calculated for each strategy. Screening and treatment costs were considered from a limited societal perspective, at 2022 prices.</p></div><div><h3>Results</h3><p><span>In the base case, assuming a cost of software implantation of $10 per patient screened, the screening strategy dominated the nonscreening strategy: it resulted in lower cost and increased quality-adjusted life-years. The lower cost was due primarily to the decreased costs associated with </span>fracture treatment and decreased probability of requiring long-term care in patients who received preventive treatment. The screening strategy was dominant up to a cost of $46 per patient screened.</p></div><div><h3>Conclusions</h3><p>Artificial intelligence–based opportunistic screening for OVCFs on existing radiographs can be cost effective from a societal perspective.</p></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289841","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":"Let’s Talk About Low-Dose Contrast Medium as an Option to Lower Carbon Footprint","authors":"","doi":"10.1016/j.jacr.2024.03.012","DOIUrl":"10.1016/j.jacr.2024.03.012","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1546144024003004/pdfft?md5=2a8f831e2ac01a03ebaecc12517152ed&pid=1-s2.0-S1546144024003004-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289843","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":"Incidence, Timing, and Long-Term Outcomes of COVID-19 Vaccine-Related Lymphadenopathy on Screening Mammography","authors":"","doi":"10.1016/j.jacr.2024.02.032","DOIUrl":"10.1016/j.jacr.2024.02.032","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the incidence, timing, and long-term outcomes of unilateral axillary lymphadenopathy ipsilateral to vaccine site (UIAL) on screening mammography after COVID-19 vaccination.</p></div><div><h3>Methods</h3><p>This retrospective, multisite study included consecutive patients undergoing screening mammography February 8, 2021, to January 31, 2022, with at least 1 year of follow-up. UIAL was typically considered benign (BI-RADS 1 or 2) in the setting of recent (≤6 weeks) vaccination or BI-RADS 0 (ultrasound recommended) when accompanied by a breast finding or identified &gt;6 weeks postvaccination. Vaccination status and manufacturer were obtained from regional registries. Lymphadenopathy rates in vaccinated patients with and without UIAL were compared using Pearson’s χ² test.</p></div><div><h3>Results</h3><p>There were 44,473 female patients (mean age 60.4 ± 11.4 years) who underwent screening mammography at five sites, and 40,029 (90.0%) received at least one vaccine dose. Ninety-four (0.2%) presented with UIAL, 1 to 191 days postvaccination (median 13.5 [interquartile range: 5.0-31.0]). Incidence declined from 2.1% to 0.9% to ≤0.5% after 1, 2, and 3 weeks and persisted up to 36 weeks (<em>P</em> &lt; .001). UIAL did not vary across manufacturer (<em>P</em> = .15)<em>.</em> Of 94, 77 (81.9%) were BI-RADS 1 or 2 at screening. None were diagnosed with malignancy at 1-year follow-up. Seventeen (18.1%) were BI-RADS 0 at screening. At diagnostic workup, 13 (76.5%) were BI-RADS 1 or 2, 2 (11.8%) were BI-RADS 3, and 2 (11.8%) were BI-RADS 4. Both BI-RADS 4 patients had malignant status and ipsilateral breast malignancies. Of BI-RADS 3 patients, at follow-up, one was biopsied yielding benign etiology, and one was downgraded to BI-RADS 2.</p></div><div><h3>Discussion</h3><p>Isolated UIAL on screening mammography performed within 6 months of COVID-19 vaccination can be safely assessed as benign.</p></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S154614402400276X/pdfft?md5=956782ac48d7fc738b21f7bb44f7f772&pid=1-s2.0-S154614402400276X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095301","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":"Contemporary Management of Blunt Splenic Trauma in Adults: An Analysis of the Trauma Quality Improvement Program Registry","authors":"","doi":"10.1016/j.jacr.2024.03.007","DOIUrl":"10.1016/j.jacr.2024.03.007","url":null,"abstract":"<div><h3>Purpose</h3><p>The aim of this study was to evaluate the effectiveness of management strategies for blunt splenic injuries in adult patients.</p></div><div><h3>Methods</h3><p>Patients 18 years and older with blunt splenic injuries registered via the Trauma Quality Improvement Program (2013-2019) were identified. Management strategies initiated within 24 hours of hospital presentation were classified as watchful waiting, embolization<span>, surgery, or combination therapy. Patients were stratified by injury grade. Linear models estimated each strategy’s effect on hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality.</span></p></div><div><h3>Results</h3><p>Of 81,033 included patients, 86.3%, 10.9%, 2.5%, and 0.3% of patients received watchful waiting, surgery, embolization, and combination therapy, respectively. Among patients with low-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (9.4 days, <em>Q</em> &lt; .001, Cohen’s <em>d</em> = .30) and ICU LOS (5.0 days, <em>Q</em> &lt; .001, Cohen’s <em>d</em> = .44). Among patients with high-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (8.7 days, <em>Q</em> &lt; .001, Cohen’s <em>d</em> = .12) and ICU LOS (4.5 days, <em>Q</em> &lt; .001, Cohen’s <em>d</em> = .23). Among patients with low- and high-grade injuries, the odds ratios for in-hospital mortality associated with surgery compared with embolization were 4.02 (<em>Q</em> &lt; .001) and 4.38 (<em>Q</em> &lt; .001), respectively.</p></div><div><h3>Conclusions</h3><p>Among patients presenting with blunt splenic injuries and compared with surgery, embolization was associated with shorter hospital LOS, shorter ICU LOS, and lower risk for mortality.</p></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140141194","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®: Diffuse Lung Disease","authors":"","doi":"10.1016/j.jacr.2024.04.022","DOIUrl":"10.1016/j.jacr.2024.04.022","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1546144024004356/pdfft?md5=b5ae0e1d2537c80e3a1253cebf633c2a&pid=1-s2.0-S1546144024004356-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917638","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":"The Association Between Food Security and Mammography Screening: Cross-Sectional Survey Results From the National Health Interview Survey","authors":"","doi":"10.1016/j.jacr.2024.05.005","DOIUrl":"10.1016/j.jacr.2024.05.005","url":null,"abstract":"<div><h3>Objective</h3><p>There are limited data about food insecurity within the cancer screening setting. To inform the potential need for food insecurity interventions, our study evaluated the association between food security and mammographic screening among eligible participants.</p></div><div><h3>Methods</h3><p>Female respondents aged 40 to 74 years in the 2019 National Health Interview Survey without history of breast cancer were included. Food insecurity was assessed using the Six-Item Food Security Scale developed by the National Center for Health Statistics. The proportion of patients who reported mammographic screening within the last year was estimated, stratified by food security. Multiple variable logistic regression analyses evaluated the association between food security and mammography screening, adjusted for potential confounders. All analyses were performed accounting for complex survey design features.</p></div><div><h3>Results</h3><p>In all, 8,956 weighted survey respondents met inclusion criteria; 90.1% were classified as having high or marginal food security, of whom 56.6% reported screening; 6.1% were classified with low food security, of whom 42.1% reported screening; and 3.8% were classified with very low food security, of whom 43.1% reported screening. In our unadjusted analyses, participants with low food security (<em>P</em> &lt; .001) and very low food security (<em>P</em> &lt; .001) were less likely to report screening within the last year. In our adjusted analyses, participants with food insecurity (<em>P</em> = .009) were less likely to report screening.</p></div><div><h3>Discussion</h3><p>In a nationally representative cross-sectional survey, participants with food insecurity were less likely to report mammography screening. Radiology practices should consider screening patients for food insecurity and social determinants of health. Evidence-based food insecurity interventions may increase adherence to mammography screening.</p></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1546144024005076/pdfft?md5=b5d4829fb7287c588bf8bf85c0a48f28&pid=1-s2.0-S1546144024005076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263489","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":"Emerging Value-Based Care Payment Mechanisms to Reduce Health Inequities: The Accountable Care Organization Realizing Equity, Access, and Community Health Model","authors":"","doi":"10.1016/j.jacr.2024.05.007","DOIUrl":"10.1016/j.jacr.2024.05.007","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332682","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}