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

{"title":"Electronic Health Record Improvements to Reduce Emergency Department CT Prescan Times at a Safety Net Hospital.","authors":"Hardik Patel, Mouna Chebaane, Rolando G Gerena, Corey A Thompson, Adam Schwertner, Bradley D Shy, David M Naeger, John McMenamy","doi":"10.1016/j.jacr.2025.04.028","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.028","url":null,"abstract":"<p><strong>Introduction: </strong>CT is a cornerstone of radiologic imaging in the ED and its utilization has increased over time. CT turnaround times remain a frequent focus for improvement initiatives, especially in resource-limited safety net hospitals (SNH). Due to the critical nature of CT imaging in the care of acutely ill ED patients and significant resource limitations SNHs face, SNHs must focus on process improvements, ideally that unburden their technologists, over additional resources to meet increasing volumes and rising expectations. In this study, we describe electronic health record (EHR) improvements to reduce the adult ED CT prescan interval by unburdening the CT technologists. Specifically, we hypothesized that by focusing on EHR improvements we would significantly reduce ED CT order-to-begin times and ED CT order-to-begin time variability.</p><p><strong>Methods: </strong>Five EMR-based interventions were conceptualized and implemented by an interdisciplinary team of radiologists, CT technologists, ED physicians, and ED RN leadership: exam order pick lists, integrated screening policies, technologist protocoling, CT technologist details tab, and banners for communication. A pre- and post-intervention retrospective review was performed from January 1^st, 2021, through June 30^th, 2023. All CT exams done on adults (≥18 years old), on either of the two hospital CTs were included. Project periods were 6 months long and included pre-intervention, intervention, post-intervention, and two additional sets of post-intervention data: sustainment period 1 and sustainment period 2. Exam order and exam begin times were collected from the Epic EHR. Comparison of exam order-to-begin times pre- and post-intervention were made using Wilcoxon Rank Sum Test analysis.</p><p><strong>Results: </strong>62,540 CT were performed during the 30 months of data collection: 11,499 pre-intervention, 12,475 intervention, 12,496 post-intervention, 13,062 sustainment 1, and 13,008 sustainment 2.Median order-to-begin times decreased by 16 minutes after the implementation of the first three interventions in July 2021 and decreased by 13 minutes after the last two interventions in December 2021.Overall, thefiveselected interventions reduced ED CT prescan exam order-to-begin times by 46.6% (69 vs. 37 minutes, P <0.001) and interquartile range variability by 38.0%, demonstrating the effectiveness of EHR improvements.</p><p><strong>Discussion: </strong>EHR improvements were effective in reducing ET CT prescan times and variability by unburdening CT technologist and improving ED CT performance.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061415","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":"Sustainability of Rideshare Programs to Promote Engagement of Underrepresented Populations in Breast Cancer Screening Trials.","authors":"Bhavika K Patel, Jhenitza P Raygoza, Heidi E Kosiorek, Carmen C Soto, Diana Y Grijalva, Etta Pisano, Donald Northfelt, Suganya Karuppana, Jessica D Austin","doi":"10.1016/j.jacr.2025.04.026","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.026","url":null,"abstract":"<p><strong>Background: </strong>Transportation barriers significantly limit participation in breast cancer screening trials among Hispanic women, exacerbating disparities in breast cancer outcomes and underrepresentation in clinical research. Rideshare programs have emerged as a potential solution, but their long-term sustainability remains underexplored. Understanding sustainability capacity is critical to ensuring these programs can address structural barriers, promote health equity, and improve outcomes for underserved populations. The aim of this study is to evaluate sustainability capacity of a no-cost rideshare program and to identify potential strategies to support sustainability.</p><p><strong>Methods: </strong>This explanatory, sequential, mixed-methods study evaluated the sustainability capacity of a no-cost rideshare program aimed at increasing Hispanic women's participation in the Tomosynthesis Mammographic Imaging Screening Trial (TMIST). Analyses and data integration were guided by the Capacity for Sustainability Framework. Average domain scores on the Program Sustainability Assessment Tool (PSAT) survey were calculated ranging from 1 to 7 with higher scores indicating higher levels for each domain, and structured interviews were analyzed using a rapid qualitative approach. PSAT and interview findings were integrated using a joint display.</p><p><strong>Results: </strong>Survey responses (N=37) indicated strengths in environmental support (mean score: 5.4) and partnerships (6.0), but challenges in funding stability (4.2) and strategic planning (4.5). Interview findings emphasized the importance of program champions and collaborative partnerships, while highlighting gaps in securing diverse funding sources and engaging institutional leadership in strategic planning. Participants identified opportunities to strengthen communication, evaluate program impact, and adapt processes to meet evolving needs.</p><p><strong>Discussion: </strong>Strong partnerships and champions supported the program's initial success, but funding instability and insufficient strategic planning threaten sustainability. Future efforts should prioritize securing diverse funding, engaging leadership, and fostering collaboration to scale rideshare programs, thereby reducing disparities and advancing equity in breast cancer screening and research participation.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009139","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":"Contrast in Conflict: Negotiating Gadolinium Supply Chain Instability Amid a Global Trade War.","authors":"Vrushab Gowda, Onofrio A Catalano, Jad S Husseini, Avinash Kambadakone, Sanjay Saini","doi":"10.1016/j.jacr.2025.04.023","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.023","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059435","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":"Utilization of Mammography Screening in Female Veterans: Cross-Sectional Survey Results from the National Health Interview Survey.","authors":"Arissa Milton, Randy Miles, Lori Mankowski Gettle, Peter Van Geertruyden, Anand K Narayan","doi":"10.1016/j.jacr.2025.04.017","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.017","url":null,"abstract":"<p><strong>Purpose: </strong>Although women are the fastest growing group of veterans across all military branches, there are limited data about mammography screening utilization in female veterans. Using a nationally representative cross-sectional survey, we evaluated the association between veteran status and mammography screening.</p><p><strong>Methods: </strong>Female survey respondents aged 40 to 74 in the 2019 National Health Interview Survey without history of breast cancer were included. The proportion of patients who reported undergoing mammography screening in the last year was estimated, stratified by veteran status. Logistic regression analyses evaluated the association between screening and veteran status, adjusted for potential confounders. Analyses accounted for complex survey sampling design to obtain valid estimates for the civilian, noninstitutionalized US population.</p><p><strong>Results: </strong>In all, 8,996 female survey respondents met inclusion criteria (veterans 1.9% [estimated 1,190,169 women], military health coverage 3.2% [estimated 2,156,863 women]). Of the veterans, 57.9% reported screening mammography within the last year and 55.2% of nonveterans reported screening mammography within the last year. Veteran status was not associated with differences in mammography screening percentages (P = .959). Among survey participants with health insurance, military health insurance was not associated with differences in mammography screening percentages (P = .132).</p><p><strong>Conclusions: </strong>Female veterans were comparably likely to undergo mammography screening in our unadjusted and adjusted analyses. With more than 1 million female veterans and growing eligible for mammography screening in the United States, radiology practices should design proactive outreach strategies to address the needs of veterans who may face increased breast cancer risk due to military environmental exposures.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043380","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":"Patients' Reported Preferences for Episode-Based Cost-Sharing Models: A Survey Study.","authors":"Kevin Dao, Ozivefueshe Dimowo, Olutola Akande, Darrys Reese, Aishwarya Joshi, S Sriram, Michal Horný, A Mark Fendrick, Ruth C Carlos, Gelareh Sadigh","doi":"10.1016/j.jacr.2025.04.020","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.020","url":null,"abstract":"<p><strong>Purpose: </strong>Episode-based cost-sharing (EBCS), defined as prospectively set patients' cost-sharing obligations for an entire episode of care, is proposed to reduce cost uncertainty for patients. We aimed to assess patient preferences for EBCS for three hypothetical care episodes: breast cancer screening (BCS), lung cancer screening (LCS) and childbirth.</p><p><strong>Methods: </strong>Adult, English-speaking Amazon Mechanical Turk workers participated in three surveys, with eligibility varying based on the screening eligibility criteria for BCS, LCS, and the ability to give birth. Using a choice-based experiment, participants stated their preferred cost-sharing model for BCS, LCS, and childbirth. Selections were from nine models constructed based on two attributes each with 3 levels: (1) initial cost (no/low, intermediate, high), and (2) subsequently revealed additional cost if other/different medical services were needed (no, intermediate, uncertain). Data were analyzed using Hierarchical Bayesian conjoint analysis to compare preferences for EBCS (high or intermediate initial cost, no subsequent cost for additional services) vs. the status quo (no/low initial cost with uncertain cost of additional services).</p><p><strong>Results: </strong>A total of 103, 103, and 102 individuals participated in the BCS, LCS, and childbirth surveys. Across all three surveys, EBCS models were preferred over the status quo by 18.1 percentage points (pp) (95% CI 17.8, 18.4) for BCS, 12.0 pp (95% CI 11.7, 12.3) for LCS, and 44.5 pp (95% CI 44.1, 44.9) for childbirth. Cost-sharing models with uncertain additional costs were the least preferred across all surveys.</p><p><strong>Conclusions: </strong>Health care consumers prefer cost-sharing models that prospectively guarantee out-of-pocket costs for entire care episodes.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025630","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":"Myth Busted! Dispelling Myths Surrounding Pediatric Radiology as a Career.","authors":"Shannon G Farmakis, Aashim Bhatia, Susan D John, Mesha Martinez, Sarah S Milla, Cory Pfeifer, Desi M Schiess","doi":"10.1016/j.jacr.2025.04.022","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.022","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029850","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":"Data Driven Ventures: A Path to Higher Returns and Greater Gender Equity.","authors":"Jenny Abramson, Elliot K Fishman, Linda C Chu, Steven P Rowe, Charles K Crawford","doi":"10.1016/j.jacr.2025.04.021","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.021","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014621","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":"Beyond the Battlefield: Military Radiology and Its Unique Practice Challenges.","authors":"Anand Singh, John R Dryden, Mohammad Naeem, Matthew Lutynski, Dan Davis","doi":"10.1016/j.jacr.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.015","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993873","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":"Radiology Utilization in an Academic Center Partnership With a Federally Qualified Health Center: A Cross-Sectional Study.","authors":"Ashley M Stuckwisch, Maria Daniela Martin Rother, Thomas M Grist, Kenneth R Loving, Jason W Stephenson, Anand K Narayan","doi":"10.1016/j.jacr.2025.04.019","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.019","url":null,"abstract":"<p><strong>Objective: </strong>Federally qualified health centers (FQHCs) serve medically underserved populations. In 2013, UW Health, the health system of the University of Wisconsin, partnered with Access Community Health Centers (ACHC), the FQHC network in Madison, Wisconsin, to provide on-site outpatient imaging. This study characterized radiography utilization associated with the UW Health-ACHC partnership compared with other UW Health outpatient imaging sites.</p><p><strong>Methods: </strong>We included health record data from January 2013 to December 2022 on all outpatient radiographs completed at UW Health sites. We compared characteristics between patients ever seen at ACHC clinics with patients seen only at non-ACHC UW Health clinics using χ² and t tests. Logistic regression was used to assess factors associated with imaging utilization at ACHC.</p><p><strong>Results: </strong>Over the study period, 4% (23,794 of 650,685) of imaging encounters occurred at ACHC and 4% (10,986 of 246,104) of patients used ACHC facilities at least once. ACHC clinic patients were younger (41 versus 42) and more often female (55% versus 53%), Black or African American (22% versus 5%), Hispanic or Latino (34% versus 4%), with Medicaid (33% versus 9%), uninsured (18% versus 4%), and living in metropolitan areas (98% versus 88%) with higher Social Deprivation Index scores (53 versus 31) (P < .001). In multivariable analyses, patients from racial or ethnic minority groups, without commercial insurance, residing in a metropolitan area, and with a non-English primary language were more likely to ever use ACHC radiography services (P < .001).</p><p><strong>Discussion: </strong>FQHCs represent trusted, community health centers serving medically underserved populations. Partnerships between academic institutions and FQHCs can increase geographic imaging access among these groups.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030405","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":"Measuring Health-Related Social Risks in a Lung Cancer Screening Cohort.","authors":"Farouk Dako, Pavel Karasek, James Seward, Kollin White, Anil Vachani, Katharine Rendle, Carmen Guerra","doi":"10.1016/j.jacr.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.jacr.2025.04.018","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and limitations of measuring health-related social risks (HRSRs) affecting individuals in a lung cancer screening (LCS) cohort from multiple data sources.</p><p><strong>Methods: </strong>A single-institution study analyzed data from 227 participants in a pragmatic LCS trial in west and southwest Philadelphia. HRSRs were assessed using three approaches: (1) electronic health records (EHRs) capturing individual-level social risks (eg, financial strain, housing stability); (2) neighborhood-level analysis using a modified Yost index to determine socio-economic status; and (3) semistructured interviews with 15 participants to identify barriers and facilitators to LCS adherence.</p><p><strong>Results: </strong>EHR data revealed financial strain and housing instability as the most documented HRSRs, although missing data ranged from 64% to 69%. Neighborhood-level analysis showed participants had lower socio-economic status compared with their broader communities, with Yost index scores of 1.28 (west Philadelphia) and 1.20 (southwest Philadelphia). Interviews highlighted limited knowledge of LCS (87% unaware before clinician referral), reliance on public or supplemental transportation, and overall trust in health care providers. Transportation was not a significant reported barrier to LCS adherence.</p><p><strong>Discussion: </strong>This study demonstrates the promise and limitations of EHR data, neighborhood-level data, and patient interviews to assess HRSRs. Although EHRs provided limited and inconsistent data, interviews captured granular individual experiences, and neighborhood-level analysis contextualized socio-economic influences. Comprehensive and consistent data collection across multiple sources is critical in understanding HRSRs experienced by individuals.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065318","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}