{"title":"Cost-Effectiveness of Follow-Up Imaging for Incidental Adrenal Nodules to Rule Out Adrenocortical Carcinoma","authors":"Mark M. Hammer MD , William W. Mayo-Smith MD","doi":"10.1016/j.jacr.2025.05.012","DOIUrl":"10.1016/j.jacr.2025.05.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Several follow-up recommendations have been developed to assess the risk for malignancy of incidental adrenal nodules, but none has been validated in prospective trials. The purpose of this study was to develop a simulation model that evaluates the cost-effectiveness of follow-up imaging to detect adrenocortical carcinoma in adrenal nodules in patients with no known malignancy.</div></div><div><h3>Methods</h3><div>Using 1 million simulated adult patients with incidental adrenal nodules measuring 1 to 4 cm detected on contrast-enhanced CT, follow-up strategies were evaluated, including ACR and American Urological Association recommendations. Variants of the ACR recommendations using noncontrast CT only, or noncontrast MRI only, instead of washout CT were also evaluated. Costs and life years (LYs) were calculated for the simulated cohort. A probabilistic sensitivity analysis was performed by varying model parameters.</div></div><div><h3>Results</h3><div>In the base-case analysis, the only cost-effective strategy under a willingness-to-pay threshold of $100,000 per LY was the variant ACR recommendation using noncontrast CT only at the time of diagnosis ($241 per patient). The standard ACR recommendation with washout CT resulted in fewer LYs at increased cost. The probabilistic sensitivity analysis demonstrated that at the $100,000 per LY threshold, the variant ACR recommendation with noncontrast CT was cost effective in 50% of simulations, the American Urological Association recommendations (washout-disregarded variant) were cost effective in 20%, the variant ACR recommendation with MRI was cost effective in 16%, and no follow-up was cost effective in 10%.</div></div><div><h3>Conclusions</h3><div>Follow-up imaging with noncontrast CT for incidental adrenal nodules appears to be cost effective to rule out adrenocortical carcinoma. However, strategies using washout CT are not cost effective.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 877-886"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096375","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}
Angellica O. Gordon MD , Ali Rashidi MD , Jeremy P. Harris MD , Laila A. Gharzai MD, LLM , Gelareh Sadigh MD
{"title":"Prevalence of Health-Related Social Needs and Associated Missed Imaging Appointments Among Patients With Cancer","authors":"Angellica O. Gordon MD , Ali Rashidi MD , Jeremy P. Harris MD , Laila A. Gharzai MD, LLM , Gelareh Sadigh MD","doi":"10.1016/j.jacr.2025.04.002","DOIUrl":"10.1016/j.jacr.2025.04.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Health-related social needs (HRSNs) lead to health disparities and impact cancer care, but their link with missed imaging appointments in patients with cancer is unclear. We assessed screen rate and prevalance of HRSNs and their association with missed imaging appointments among patients with cancer.</div></div><div><h3>Methods</h3><div>Patients aged ≥18 years with cancer who completed an oncology wellness form as part of usual care between January 1, 2022, and September 30, 2023, who had an imaging examination scheduled at the same health system within 3 months after form completion were included. The form assessed HRSNs (financial, transportation, and housing) and patients’ preference for written or verbal information about HRSNs services. Multivariable regression models evaluated the association between HRSNs and missed imaging appointments.</div></div><div><h3>Results</h3><div>In all, 3,495 (16.6%) of patients had a completed oncology wellness form during 3,964 (4.3%) encounters; of those, 2,890 had imaging scheduled in the next 3 months and were included (mean age: 61.6 ± 15.9 years; 50.2% female; 20.1% Asian, 2.8% Black, 57% White, 20.6% Hispanic). HRSNs were reported during 22.9% of encounters, with 82.9%, 40.2%, and 37.5% of reported HRSNs being due to financial hardship, transportation, and housing issues. Only 6.5% and 4.4% of encounters positive for HRSNs reported a desire for written information or to speak with someone about their HRSNs, respectively. At least one imaging encounter was missed by 70% in the subsequent 3 months. Adjusting for sociodemographic factors, patients reporting HRSNs were more likely to miss their imaging appointment (odds ratio, 1.29; 95% confidence interval, 1.03-1.61).</div></div><div><h3>Conclusion</h3><div>Patients with cancer with self-reported HRSNs tend to have higher missed imaging appointments.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 861-868"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993878","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®: Acute Respiratory Illness in Immunocompetent Patients: 2025 Update","authors":"Avani Shinde , Sherry S. Wang MBBS","doi":"10.1016/j.jacr.2025.04.032","DOIUrl":"10.1016/j.jacr.2025.04.032","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Page 975"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058130","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}
Ajay Malhotra MD, MMM , Dheeman Futela MBBS , Seyedmehdi Payabvash MD , Max Wintermark MD, MBA , Dheeraj Gandhi MD , Richard Duszak MD
{"title":"Trends in Academic Radiology Faculty Promotion in US Medical Schools","authors":"Ajay Malhotra MD, MMM , Dheeman Futela MBBS , Seyedmehdi Payabvash MD , Max Wintermark MD, MBA , Dheeraj Gandhi MD , Richard Duszak MD","doi":"10.1016/j.jacr.2025.04.003","DOIUrl":"10.1016/j.jacr.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Faculty promotion is important for retention in academic medicine and has implications for diversity.</div></div><div><h3>Purpose</h3><div>We aimed to assess faculty promotion trends in academic radiology in US medical schools over time and assess variations based on gender and race or ethnicity.</div></div><div><h3>Materials and methods</h3><div>Using the Association of American Medical Colleges faculty roster, full-time faculty appointed between January 1, 2020, and December 31, 2009 (primary cohort), were followed for 14 years till January 1, 2024. Promotion rates and average time to promotion were compared by faculty track, gender, and race or ethnicity using bivariate analyses. Recent trends in promotions were assessed by comparing 7-year promotion end points between the primary cohort and a secondary cohort appointed between January 1, 2010, and December 31, 2016.</div></div><div><h3>Results</h3><div>The primary cohort included 2,497 faculty (182 instructors, 1,589 assistant professors, and 726 associate professors) from academic radiology departments, appointed between January 1, 2020, and December 31, 2009. Clinical educator-track faculty had a marginally higher promotion rate (39.6% versus 36.4%, <em>P</em> = .116) but a significantly longer time to promotion (8.25 versus 7.4 years, <em>P</em> < .0001) versus those on traditional track. For clinical educator-track faculty, promotion rates over 14 years tended to be greater for women (42.3%) than men (38.3%, <em>P</em> = .12) across all ranks. The average time to promotion was significantly greater for women (8.9 years) assistant professors compared with men (8.2 years) (mean difference of 0.65 years, <em>P</em> = .013). For the more recent faculty cohort, rates of promotion over a 7-year period were higher (26% versus 15% for assistant professors, <em>P</em> < .001), and average time to promotion was shorter (5.7 versus 6.0 years for assistant professors, <em>P</em> = .002) across all ranks and for both men and women.</div></div><div><h3>Conclusion</h3><div>Over time, promotion rates in US academic radiology departments have gone up and time to promotion has declined. Promotion rates for men and women are similar.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 946-952"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029971","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}
Priya Dave MD , Olga R. Brook MD , Alexander Brook PhD , Andrew W. Bowman MD , Luke Yoon MD , Robert W. Morris MD , Jonathan A. Flug MD , Ethan A. Smith MD , Bettina Siewert MD
{"title":"Causes of Moral Distress in Academic Radiologists: Variation Among Institutions","authors":"Priya Dave MD , Olga R. Brook MD , Alexander Brook PhD , Andrew W. Bowman MD , Luke Yoon MD , Robert W. Morris MD , Jonathan A. Flug MD , Ethan A. Smith MD , Bettina Siewert MD","doi":"10.1016/j.jacr.2025.04.001","DOIUrl":"10.1016/j.jacr.2025.04.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess whether causes of moral distress vary by academic institution. Moral distress is experienced when health care providers are unable to provide the right care to patients because of institutional or resource constraints.</div></div><div><h3>Materials and methods</h3><div>A survey was performed based on Moral Distress Scale-Revised for Health Care Professionals for 16 clinical scenarios assessing frequency and severity of moral distress among academic radiologists. The survey was sent to members of the RSNA Quality Improvement Committee for distribution to their department. Measure of Moral Distress for Health Care Professionals (MMD-HP) was calculated for individuals and moral distress index for clinical scenarios. MMD-HP were compared by sex, ethnicity, age, years of practice, weekly work hours, practice setting or type, and consideration of leaving the workplace. Statistical analysis was performed using Kruskal-Wallis test and Kendall ordinal correlation.</div></div><div><h3>Results</h3><div>In all, 126 respondents from five institutions from five different states were included in the analysis. MMD-HP ranged from 24 to 66 (maximum 266). Median MMD-HP was higher in radiologists working >60 hours per week (59 versus 32.5, <em>P</em> = .048). Radiologists across institutions consistently reported four main sources of moral distress: pressure to perform unsafe numbers of studies (108 of 126, 85%), high workloads impeding resident teaching (102 of 126, 81%), lack of administrative support for patient care issues (102 of 126, 81%), and pressure to conduct unnecessary imaging (111 of 126, 88%). Higher MMD-HPs correlated significantly with job turnover intentions or past job changes (<em>P</em> < .001). The average percentage of radiologists with an intention to leave or having left as position was 44% with a range of 26% to 84%.</div></div><div><h3>Conclusion</h3><div>Moral distress is pervasive in radiology, with four primary causes consistently identified across academic institutions. Strong association between higher moral distress levels and job turnover intentions highlights its impact on workforce retention.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 935-945"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054839","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":"Negotiating Gadolinium Supply Chain Instability Amid a Global Trade War","authors":"Vrushab Gowda MD, JD , Onofrio A. Catalano MD, PhD , Jad S. Husseini MD , Avinash Kambadakone MBBS , Sanjay Saini MD","doi":"10.1016/j.jacr.2025.04.023","DOIUrl":"10.1016/j.jacr.2025.04.023","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 964-966"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059435","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®: Dementia: 2025 Update","authors":"Abby Newman , Vincent M. Timpone MD","doi":"10.1016/j.jacr.2025.04.033","DOIUrl":"10.1016/j.jacr.2025.04.033","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Page 976"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059438","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}
Samra Iftikhar MD , Saeed Rahmani MD, MPH, MBA , Omar A. Zaree MD , Ahmed Kertam MD , Thomas Farquhar MD, PhD , Long H. Tu MD, PhD
{"title":"The Value of Radiology Consultation: Effort Allocation, Clinical Impact, and Untapped Opportunities","authors":"Samra Iftikhar MD , Saeed Rahmani MD, MPH, MBA , Omar A. Zaree MD , Ahmed Kertam MD , Thomas Farquhar MD, PhD , Long H. Tu MD, PhD","doi":"10.1016/j.jacr.2025.04.006","DOIUrl":"10.1016/j.jacr.2025.04.006","url":null,"abstract":"<div><div>A substantial proportion of work in radiology involves activities beyond the primary interpretation of imaging. In this review, the authors discuss the current state of consultative work in radiology and evaluate potential strategies for more equitable reimbursement of these activities. “Noninterpretive” or “consultative” activities may constitute 35% to 60% of work hours. These activities routinely impact patient care; for example, changes in management are seen with 3-9% of radiologist-protocoled exams, 8-37% of secondary interpretations, 12-55% of ad-hoc (“curbside”) consultations, and 8-58% of multidisciplinary conferences. Currently, ad hoc and multidisciplinary consultations are not associated with formal mechanisms for documentation or billing, despite together constituting 10% to 15% of radiologists’ work hours. Existing and future mechanisms, however, could help bridge this gap. Practice in radiology might benefit from dedicated consultation Current Procedural Terminology billing codes, similar to those already in place for consultations in pathology. Existing non–face-to-face (electronic) consultation codes represent a potential stopgap solution. Practices may alternatively negotiate compensation for noninterpretive tasks as part of a value-based reimbursement model. Any viable solution would need to account for the opportunity cost of time spent on nonbillable activities (usually >5 work relative value units/hour). Consultation is likely to play an increasingly important role in the future of radiology with advances in imaging and artificial intelligence–based technologies. Individual radiologists and group practices would benefit from recognizing and leveraging the value of their consultative work.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 887-896"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030640","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}
Mara M. Kunst MD , Richard E. Sharpe Jr. MD, MBA , Christoph Wald MD, PhD, MBA , Jennifer C. Broder MD
{"title":"Peer Learning and Artificial Intelligence in Radiology: Partners in Progress or Rivals in the Race for Accuracy?","authors":"Mara M. Kunst MD , Richard E. Sharpe Jr. MD, MBA , Christoph Wald MD, PhD, MBA , Jennifer C. Broder MD","doi":"10.1016/j.jacr.2025.04.009","DOIUrl":"10.1016/j.jacr.2025.04.009","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 961-963"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993877","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}
Shiva D. Yagobian BS , Franklin Iheanacho BA , Amy Patel MD , Efrén J. Flores MD , Toma S. Omofoye MD , Megha Garg MD, MPH , Randy C. Miles MD, MPH
{"title":"Application of the Socio-Ecological Model to Address Recruitment, Promotion, and Leadership Development of Women in Radiology","authors":"Shiva D. Yagobian BS , Franklin Iheanacho BA , Amy Patel MD , Efrén J. Flores MD , Toma S. Omofoye MD , Megha Garg MD, MPH , Randy C. Miles MD, MPH","doi":"10.1016/j.jacr.2025.04.011","DOIUrl":"10.1016/j.jacr.2025.04.011","url":null,"abstract":"<div><div>Women, who represent nearly 50% of medical school graduates, consistently comprise approximately 25% of radiology residency spots. Recruitment, promotion, and leadership development of radiologists from diverse backgrounds is important for continued growth of the field. Despite major radiological societies and journals championing this cause across all practice levels, efforts to improve diversity in the field have been limited. The socio-ecological model has been used to address challenges in health care by evaluating the interplay between individuals and their environment. In this article, we build on prior literature describing challenges faced by women in recruitment, promotion, and leadership development by applying the socio-ecological model to systematically understand and address barriers to the advancement of qualified women in radiology. We evaluate challenges women face in terms of recruitment, promotion, and leadership development at each level of the socio-ecological model and propose evidence-based solutions aimed at addressing barriers to the advancement of women in the field.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 8","pages":"Pages 953-960"},"PeriodicalIF":5.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060060","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}