Journal of the American College of Radiology : JACR最新文献

{"title":"If Not Now, When? Follow-Up Imaging for Patients Who Are Incarcerated.","authors":"Justin Berk, Emily Lupez","doi":"10.1016/j.jacr.2026.10.025","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.025","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordance Under Compression: Methodological Concerns in LLM-Based AI Monitoring.","authors":"Jiawei Gu","doi":"10.1016/j.jacr.2026.10.022","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.022","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent Care Radiography for Low Back Pain Is Rarely Followed by Emergency Advanced Imaging.","authors":"Michael Hood, Joel K R Samuel, Praneet Khanna, Ali Ebada, Arya Rao, Marc D Succi","doi":"10.1016/j.jacr.2026.10.023","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.023","url":null,"abstract":"<p><strong>Objective: </strong>Workup of low back pain (LBP) in emergency departments (EDs) commonly involves CT or MRI, even though guidelines reserve advanced imaging for patients with red flags. We measured how often urgent care center (UCC) radiography for low-acuity LBP was followed by advanced imaging in the ED within 30 days, and compared per-study resource intensity between UCC radiography and ED CT or MRI.</p><p><strong>Methods: </strong>This retrospective cohort study included adults imaged for LBP at 23 UCCs and affiliated EDs between 2019 and 2025. We excluded red-flag presentations by screening keywords from the order indication. We identified 30-day returns by linking medical record numbers between cohorts, and two radiologists reviewed each one. Resource intensity was measured as Total Relative Value Units (RVU) per study, converted to approximate Medicare-allowed dollars.</p><p><strong>Results: </strong>Among 16,754 studies (2,924 UCC radiographs, 13,830 ED studies) from 15,759 patients, UCC patients were younger (median 50 vs 67 years, P < 0.001). Median Total RVU was 1.43 (UCC) versus 5.14 (ED) (about $48 vs $171, P < 0.001). Twenty-four UCC studies were followed by ED advanced imaging within 30 days (0.82%, 95% CI 0.55-1.22), 12 within 24 hours. Radiologists judged one return a true radiographic miss. Return rates were similar across UCC networks (P = 1.00).</p><p><strong>Discussion: </strong>UCC radiography for low-acuity LBP was rarely followed by ED advanced imaging within 30 days and entailed lower per-study imaging resource use than ED CT or MRI.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective AI Search for Missed Pulmonary Nodules on Emergency Department Chest Radiographs: A Multicenter Brief Report.","authors":"Bruno Hochhegger, Amit Gupta, João Martins da Fonseca, Hiren Mehta, Pratik Patel, Daniela Hochhegger, Julio Min Fei Zhang","doi":"10.1016/j.jacr.2026.10.024","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.024","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Efficiency and Quality in Thyroid Biopsy: The Long-Term Impact of Implementation of a Program of Dedicated Sonographer-Performed Thyroid Biopsies.","authors":"Sangeet Ghai, Anna M Sawka, Tamar Kass Perel, Katherine Lajkosz, Catherine Tian-Ai Tan, Pamela Dalton, David P Goldstein, Jesse D Pasternak, Lorne E Rotstein, Korosh Khalili, Xiaoyang Liu, Ciara O'Brien, Hyang Mi Ko, Yongheng Jia, Rudolf Boci, Kulsoom A Maan, Wasim Javed, Joerg Schwock","doi":"10.1016/j.jacr.2026.10.021","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.021","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term diagnostic performance and consistency of a dedicated sonographer-performed thyroid FNAB program under radiologist supervision.</p><p><strong>Materials and methods: </strong>This retrospective quality improvement study (QIRC 23-0591) analyzed consecutive thyroid FNABs performed between 2008 and 2022 at a single academic center. A structured sonographer training program was implemented in 2011. Biopsies were categorized into three periods: pre-implementation (2008-April 2011), early post-implementation (August 2011-2013), and late post-implementation (2014-2022). FNABs performed by other clinicians during the late implementation period served as a contemporaneous control group. Outcomes were assessed at the nodule level using the Bethesda System for Reporting Thyroid Cytopathology. Trend analyses were performed using the Cochran-Armitage test; chi-square tests compared groups.</p><p><strong>Results: </strong>A total of 14,127 thyroid nodules were biopsied in the radiology (4,382 pre-implementation; 2,561 early post-implementation; 7,184 late post-implementation period). Nondiagnostic rates decreased from 34% (1492/4382) pre-implementation to 21% (534/2561) early post-implementation and 8.6% (617/7184) late post-implementation period (p<.001). Malignant cytology increased from 4.9% to 5.6% to 7.7%, and combined Bethesda V/VI diagnoses increased from 8.9% to 8.5% to 12.1% (both p<.001). During late post-implementation period, sonographer-performed FNABs demonstrated lower nondiagnostic rates (8.6% vs 29%, p<.001) and higher malignant yield (7.6% vs 4.5%, p<.001) compared with other clinicians. Adoption of ACR TI-RADS in 2020 was not associated with significant changes in adequacy or malignancy rates.</p><p><strong>Conclusions: </strong>A dedicated sonographer-performed thyroid FNAB program improved diagnostic adequacy and malignancy yield over 11 years, supporting safe delegation of thyroid FNAB to trained physician extenders under radiologist supervision.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timeliness of an Expedited Diagnostic Pathway for Screening Mammography Recalls.","authors":"Babita Panigrahi, Swathi Raman, Lisa A Mullen, Kelly S Myers, Katharine Yao, Emily B Ambinder","doi":"10.1016/j.jacr.2026.10.019","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.019","url":null,"abstract":"<p><strong>Objective: </strong>To compare diagnostic and biopsy timeliness, malignancy yield, and cancer characteristics between expedited and standard screening mammography recall pathways.</p><p><strong>Methods: </strong>An expedited recall workflow implemented in Epic enabled radiologists to flag highly suspicious BI-RADS 0 findings for telephone scheduling into reserved appointments, targeting diagnostic evaluation within one week. We retrospectively reviewed recalls from 11/1/2024-1/31/2026. Primary outcomes were time from screening to diagnostic evaluation and malignancy yield (PPV1 and PPV3). Secondary outcomes included diagnostic-to-biopsy and screening-to-biopsy intervals, delayed diagnostic imaging (≥30 days from screening), delayed biopsy (≥30 days from diagnostic), and malignancy characteristics. Intervals were measured in calendar days.</p><p><strong>Results: </strong>Among 36,384 screening mammograms, 4,647 were BI-RADS 0 (recall rate 12.8%); 57 (1.2%) were expedited. After excluding 247 standard pathway cases without follow-up, 4,400 were analyzed. Expedited patients were older (median 64.6 vs 52.5 years, p<0.001) with shorter median screening-to-diagnostic (7 vs 25 days), diagnostic-to-biopsy (14 vs 19 days), and screening-to-biopsy intervals (24 vs 45 days; all p<0.001). Delayed diagnostic imaging (7.0% vs 38.2%, p<0.001) and biopsy (1.8% vs 14.5%, p=0.004) were less frequent. Expedited cases had higher BI-RADS 4/5 rates (96.5% vs 30.1%, p<0.001) and malignancy yield (PPV1 91.2% vs 5.2%; PPV3 94.5% vs 18.2%; p<0.001). Multivariable logistic regression among 278 cancers identified mass findings (OR 3.36, p<0.001) and imaging size (OR 1.03/mm, p=0.003) as predictors of expedited routing.</p><p><strong>Discussion: </strong>Radiologists identified highly suspicious screening mammography findings for expedited evaluation. Expedited routing was associated with shorter diagnostic and biopsy intervals and high malignancy yield, supporting diagnostic resource prioritization.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping International Lung Cancer Screening Quality Indicators to the American College of Radiology Lung Cancer Screening Registry: A Crosswalk Analysis.","authors":"Gavin Stoel, Ella A Kazerooni, Charles S White, Shawn D Teague, Kyle Edwards, Judy Burleson, Kristin C Frisby, Madison Wulfeck, Dhiraj Baruah, Lauren K Groner","doi":"10.1016/j.jacr.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.017","url":null,"abstract":"<p><p>The International Association for the Study of Lung Cancer (IASLC) established 26 consensus quality indicators (QIs) for lung cancer screening (LCS) programs, of which 20 were rated as essential and 6 as desirable by the expert panel. We evaluated the extent to which the American College of Radiology (ACR) Lung Cancer Screening Registry (LCSR), the largest LCS registry in the U.S., can support measurement of the IASLC QIs. We performed a crosswalk analysis, mapping all 26 IASLC QIs to the LCSR Data Dictionary and its 46 clinical performance measures, classifying each as directly measurable, derivable, or not measurable. The crosswalk was reviewed and independently validated by members of the ACR Early Lung Cancer Detection Registry Quality and Education Committee. Eight QIs (30.8%) were directly measurable, 10 (38.5%) were derivable, and 8 (30.8%) were not measurable from LCSR data alone. The LCSR therefore contains sufficient data elements to support measurement of approximately 69% of IASLC QIs. Remaining gaps involve screening uptake, clinical investigation, procedure complications, curative-intent treatment, treatment equity, diagnostic investigation equity and selected wait-time measures and would require additional registry fields or external data linkage.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multilevel Intervention to Improve Lung Cancer Screening Among Hispanic Patients: A Pilot Randomized Controlled Trial.","authors":"Mahnur Bharucha, Omar Gutierrez, Aarushi Madan, Richard Echeverria, Leonardo Aguilar-Lopez, Wen-Pin Chen, Michael A Hoyt, Karen Llave, Sunmin Lee, Tan Nguyen, Argyrios Ziogas, Gelareh Sadigh","doi":"10.1016/j.jacr.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.016","url":null,"abstract":"<p><strong>Purpose: </strong>We evaluated the preliminary efficacy of Empower LCS, a culturally-adapted multilevel intervention, compared with enhanced usual care (EUC) for improving LCS uptake among Hispanic patients.</p><p><strong>Methods: </strong>In this pilot randomized controlled trial, Hispanic patients aged 50-80 years who met 2021 US Preventive Services Task Force LCS eligibility criteria were enrolled between February 2024 and August 2025. Participants were randomized 1:1 to EUC or Empower LCS. EUC included usual care plus a one-page educational handout. Empower LCS included a culturally adapted decision aid, provider notifications, patient text reminders, and health-related social needs support. The primary outcome was LDCT ordering within 4 months, assessed by medical record review or self-report. Analyses used chi-square tests and logistic regressions.</p><p><strong>Results: </strong>Sixty patients were randomized (mean age, 60.8 years ± 7.4; 37/60 [61.7%] male; 21/60 [35.0%] Spanish-speaking). At 4 months, LDCT ordering was higher with Empower LCS than with EUC (15/30 [50.0%] vs 4/30 [13.3%]; p=0.002), as were LCS discussions (12/30 [40.0%] vs 5/30 [16.7%]; p=0.045). LDCT completion was higher but not significant (9/30 [30.0%] vs 4/30 [13.3%]; p=0.117), likely due to small sample size. In exploratory adjusted models, Empower LCS was associated with higher odds of LCS ordering (OR, 7.32; 95% CI, 1.97-34.16), and discussion (OR, 4.1; 95% CI, 1.20-16.28). Qualitative interviews identified provider trust and logistical barriers as drivers of screening engagement and completion, respectively.</p><p><strong>Conclusions: </strong>Empower LCS increased LDCT ordering and screening discussions in this pilot trial. These findings support culturally tailored, low-cost, scalable interventions to reduce disparities in LCS participation.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LungCheck: Pilot Testing a Theory-Informed Multicomponent Strategy to Increase Lung Cancer Screening in Primary Care Settings.","authors":"Lauren K Groner, Katja Reuter, Nathalie Moise, Charlene Thomas, Carlyn Wisherop, Rulla M Tamimi, Erica Phillips","doi":"10.1016/j.jacr.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.020","url":null,"abstract":"<p><strong>Objective: </strong>Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer-specific and all-cause mortality, yet uptake remains low. This study evaluates LungCheck, a theory-informed multicomponent behavior change and implementation strategy designed to increase LDCT ordering in two diverse primary care settings.</p><p><strong>Methods: </strong>This pilot study compared 16-month pilot and pre-pilot periods at a federally qualified health center (FQHC) and an academic faculty practice in New York City. LungCheck comprised educational meetings, materials and clinician reminders, an implementation blueprint, patient navigation, and EHR modifications. LDCT ordering rates (primary outcome) were compared using generalized estimating equations (GEE). Post-implementation surveys assessed acceptability, appropriateness, and feasibility.</p><p><strong>Results: </strong>A total of 5,918 patient-period observations were included (1,569 academic; 4,349 FQHC). Among patients with documented LCS eligibility, the odds of LDCT ordering were significantly higher during the pilot at both the academic practice (OR, 2.67; 95% CI, 1.47-4.85; p=0.001) and FQHC (OR, 4.53; 95% CI, 2.29-8.94; p<0.001). A combined-site multivariable model adjusting for site, age, sex, and race confirmed higher odds of LDCT ordering during the pilot (OR, 1.95; 95% CI, 1.44-2.63; p<0.001). Among patients with an LDCT order, completion was 71.4% (10/14) pre-pilot versus 35.7% (15/42) during the pilot at the academic practice and 42.9% (18/42; 95% CI, 28%-59%) versus 39.3% (24/61; 95% CI, 27%-53%) at the FQHC. The strategy was rated as highly acceptable (AIM, 4.47/5), appropriate (IAM, 4.44/5), and feasible (FIM, 4.41/5).</p><p><strong>Discussion: </strong>LungCheck was associated with significantly increased LDCT ordering at both sites, high acceptability, feasibility, and appropriateness ratings and high provider knowledge, confidence, and perceived skills related to LCS. Although a corresponding improvement in LDCT completion was not observed, the small number of LDCT orders limited the precision of completion estimates. Persistent environmental and patient-level barriers underscore the need to adapt LungCheck into a multilevel intervention addressing patient-, provider, and system-level barriers across the LCS continuum, to be evaluated in a future cluster randomized trial.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-Enhanced CTA Triage Improves Detection of Intracranial Vessel Occlusions in Routine Clinical Workflow.","authors":"James Milburn, Paul Gulotta, Vilert Loving, Maximilian Morvant, Aran Toshav","doi":"10.1016/j.jacr.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.jacr.2026.10.014","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}