American Journal of Roentgenology最新文献

{"title":"The New CMS Measure of Excessive Radiation Dose or Inadequate Image Quality in CT: Issues and Ambiguities-Perspectives from an AAPM-Commissioned Panel.","authors":"Jered R Wells, Olav Christianson, Dustin Gress, Eric Gingold, Jurgen Jacobs, Kirsten Boedeker, Juan Carlos Ramirez-Giraldo, Lifeng Yu, Michael McNitt-Gray, Ehsan Samei","doi":"10.2214/AJR.24.32458","DOIUrl":"10.2214/AJR.24.32458","url":null,"abstract":"<p><p>CMS has adopted a new CT quality measure seeking to discourage excessive radiation dose while preserving image quality. The measure score is expressed as the percentage of qualifying studies that exceed predetermined thresholds indicating inadequate image quality (based on image noise) or excessive radiation dose. The measure has been incorporated into the major CMS quality-based payment programs, impacting hospitals and clinician payments; measure reporting began in January 2025. Following measure development, practitioners identified a spectrum of concerns and impediments, prompting the American Association of Physicists in Medicine to convene a multidisciplinary expert panel to provide further guidance. The panel identified 20 issues and ambiguities in the measure specifications, stemming from metrology concerns, unconventional terminology, and inconsistencies with practice standards or norms, while relating to themes of applicability, categories and metrics, informatics, performance expectations, and meta considerations. In this article, the panel presents these issues and ambiguities with associated recommendations to promote the measure's intentions. These recommendations include greater data access (e.g., to the measure's source data and to reporting elements for audit support) and a more holistic treatment of image quality. The panel ultimately urges a shift toward open-source, open-access, consensus-based, and community-owned strategies to ensure CT quality and safety.</p>","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment: Expanding the Imaging Horizon for Organ-Specific Contrast Enhancement With Photon Counting-Detector CT.","authors":"Takamichi Murakami","doi":"10.2214/AJR.25.32811","DOIUrl":"https://doi.org/10.2214/AJR.25.32811","url":null,"abstract":"","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment: Better, Faster, Stronger CTPA Protocols-What to Consider.","authors":"Stephanie Tan","doi":"10.2214/AJR.25.32814","DOIUrl":"https://doi.org/10.2214/AJR.25.32814","url":null,"abstract":"","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blockchain, Teleradiology, and Large Language Models: Future Perspectives.","authors":"Esat Kaba","doi":"10.2214/AJR.25.32717","DOIUrl":"https://doi.org/10.2214/AJR.25.32717","url":null,"abstract":"","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment: The Prognostic Value of the Solid-Component Doubling Time in Part-Solid Lung Lesions and the Need for Volumetric Precision.","authors":"Peter R Gunderman","doi":"10.2214/AJR.25.32803","DOIUrl":"https://doi.org/10.2214/AJR.25.32803","url":null,"abstract":"","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the <i>AJR</i>: Reevaluating the Impact of Artificial Intelligence on Radiologist Burnout.","authors":"Miriam Chisholm, Kirti Magudia","doi":"10.2214/AJR.25.32713","DOIUrl":"https://doi.org/10.2214/AJR.25.32713","url":null,"abstract":"","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI in Prostate Cancer Screening: A Review and Recommendations, From the <i>AJR</i> Special Series on Screening.","authors":"Ivo G Schoots, Masoom A Haider, Shonit Punwani, Anwar R Padhani","doi":"10.2214/AJR.24.32588","DOIUrl":"10.2214/AJR.24.32588","url":null,"abstract":"<p><p>Traditional PSA-based screening for prostate cancer (PCa) is challenged by an unfavorable benefit-to-harm ratio from underdiagnosis of clinically significant cancers, overdiagnosis of indolent cancers, and unnecessary biopsies, despite demonstrated reductions in PCa mortality. Inclusion of MRI in screening algorithms helps address these limitations by improving risk stratification of men suspected to have PCa and enabling targeted biopsies. The impact of MRI-based strategies on screening's benefit-to-harm ratio can be objectively assessed using ratios reflecting clinically significant cancers detected, indolent cancers detected, unproductive biopsies, and avoided biopsies. Among two overarching MRI-based screening strategies (sequential MRI after PSA testing and MRI alone), the sequential strategy is favored as a balanced and scalable approach. This article provides a detailed analysis of the role of MRI in PCa screening, targeted to radiologists. Recommendations are provided for optimizing use of MRI in PCa screening, including individualized risk assessments, tailored protocols, quality assurance for ensuring reliable and reproducible results, and consideration of new screening-specific scoring systems and biopsy thresholds. Ultimately, successful integration of MRI in PCa screening will require radiologists to actively engage in refining protocols, standardizing interpretations, and adopting emerging technologies. Such efforts will help maximize benefits while minimizing harms, enabling wider acceptance of PCa screening.</p>","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White Matter Hyperintensities on High-Resolution 3-T MRI: Frequency in Mild Traumatic Brain Injury and Associations with Clinical Markers-A Prospective Controlled Multicenter Study.","authors":"Manoj Tanwar, Eric Miller, Apostolos John Tsiouris, Joseph Nguyen, Vikas Agarwal, Luca Marinelli, Guzide Ayse Erdemir, Teena Shetty","doi":"10.2214/AJR.24.32274","DOIUrl":"10.2214/AJR.24.32274","url":null,"abstract":"<p><p><b>Background:</b> A challenge in management of patients with mild traumatic brain injury (mTBI) is the lack of objective biomarkers to guide diagnosis, classification, and prognostication. White matter hyperintensities (WMHs) on T2-weighted MRI sequences have been identified as a potential marker for this purpose. <b>Objective:</b> To compare WMHs on high-resolution 3-T MRI between individuals with and without mTBI and to assess associations of WMHs with clinical markers in mTBI. <b>Methods:</b> This prospective study recruited individuals with acute mTBI and a matched control group of individuals without mTBI from seven U.S. centers from November 2015 to January 2018. Participants underwent up to four clinical encounters (baseline through approximately 3 months after enrollment). At each encounter, clinical markers of head injury were tested, including the Rivermead Post-Concussion Symptoms Qustionnaire-3 (RPQ-3), assessing early postconcussive symptoms (physical symptoms), Rivermead Post-Concussion Symptoms Questionnaire-13 (RPQ-13), assessing late postconcussive symptoms (psychosocial functioning and lifestyle), and Balance Error Scoring System (BESS) test, assessing postural stability. Participants also underwent at each encounter 3-T MRI including a high-resolution isotropic 3D T2-weighted FLAIR sequence. Two neuroradiologists independently reviewed FLAIR sequences from baseline encounters for presence of at least one WMH and of abnormal WMHs (defined as ≥5 punctate foci, at least one focus measuring >3 mm, or at least one focus in an atypical location); discrepancies were resolved by a consensus process involving possible review by a group of four neuroradiologists. <b>Results:</b> The mTBI group included 303 participants (mean age, 21.6±8.2 years; 162 male, 141 female); the control group included 148 participants (mean age, 21.8±8.3 years; 71 male, 77 female). At least one WMH was present in 102 (34%) participants in the mTBI group, of which 40% (41) had abnormal WMHs, and 52 (35%) participants in the control group (p=.76), of which 35% (18) had abnormal WMHs (p=.50). Neither WMHs nor abnormal WMHs were associated with RPQ3-, RPQ-13, or BESS total score at any time point (p>.05). <b>Conclusion:</b> WMHs did not show significant differences between mTBI and control groups, nor significant associations with clinical markers in the mTBI group. <b>Clinical Impact:</b> The findings do not support WMHs as a marker of mTBI.</p>","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors for Pathologic N2 Disease in Resected Lung Cancers Assessed as N0 or N1 Disease on Preoperative Imaging.","authors":"Yura Ahn, Sang Min Lee, Jooae Choe, Sehoon Choi, Kyung-Hyun Do, Joon Beom Seo","doi":"10.2214/AJR.24.32486","DOIUrl":"10.2214/AJR.24.32486","url":null,"abstract":"<p><p><b>Background:</b> In certain patients with lung cancer, guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as the primary method to evaluate for metastatic mediastinal lymph nodes, defining pN2 disease. EBUS-TBNA has associated costs and complications and possibly limited availability. <b>Objectives:</b> To investigate the prevalence and risk factors for pN2 disease in patients undergoing resection of lung cancer assessed as having radiologic N0 or N1 disease. <b>Methods:</b> This retrospective study included 3581 patients (mean age, 63.8±9.4 years; 1917 male, 1664 female) with lung cancer who underwent chest CT and FDG PET/CT showing radiologic N0 or N1 disease before resection between January 2015 and December 2021. Tumor characteristics were assessed on chest CT. Patients were assessed for presence of guideline-based indications for EBUS-TBNA as evaluation for imaging-occult N2 disease. Pathologic N categories were determined from surgical specimens. Preoperative risk factors for pN2 disease were identified using logistic regression analyses. <b>Results:</b> A total of 1936 patients had radiologic rN0 disease without EBUS-TBNA indication, 1348 had radiologic N0 disease with EBUS-TBNA indication, and 297 had radiologic N1 disease. These groups had prevalence of pN2a disease of 4.1%, 6.5%, and 18.5%, respectively, and of pN2b disease of 1.2%, 2.4%, and 14.8%, respectively. In multivariable analyses, independent risk factors for pN2 disease in patients with radiologic N0 disease without EBUS-TBNA indication were female sex (OR=1.66), larger size of the tumor's solid portion (OR=1.05 [95% CI, 1.01-1.10]), pure-solid nodule (OR=5.53 [95% CI, 3.15-9.72]), and spiculation (OR=2.66 [95% CI, 1.72-4.11]); with radiologic N0 disease with EBUS-TBNA indication were younger age (OR=0.97 [95% CI, 0.96-0.99] per year), pure-solid nodule (OR=1.75 [95% CI, 1.10-2.80]), and lobulation (OR=1.96 [95% CI, 1.23-3.11]); and with radiologic N1 disease were younger age (OR=0.973 [95% CI, 0.948-0.999] per year), female sex (OR=2.91 [95% CI, 1.66-5.11]) and spiculation (OR=2.81 [95% CI, 1.66-4.76]). <b>Conclusion:</b> pN2b disease was uncommon in patients with radiologic N0 disease, regardless of indications for EBUS-TBNA, and increased in prevalence in patients with radiologic N1 disease. <b>Clinical Impact:</b> The identified risk factors can inform patient selection for EBUS-TBNA, to aid detection of occult pN2 disease.</p>","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"Blockchain, Teleradiology, and Large Language Models: Future Perspectives\".","authors":"Roger T Tomihama","doi":"10.2214/AJR.25.32779","DOIUrl":"https://doi.org/10.2214/AJR.25.32779","url":null,"abstract":"","PeriodicalId":55529,"journal":{"name":"American Journal of Roentgenology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}