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

{"title":"Re-evaluating Endometrial Thickness in Symptomatic Postmenopausal Patients for Excluding Cancer: Systematic Review and Meta-Analysis.","authors":"Ryan K W Chee, Reshma M Koshy, Jordan Haidey, Mohammad H Murad, Gavin Low, Mitchell P Wilson","doi":"10.1016/j.jacr.2024.11.008","DOIUrl":"10.1016/j.jacr.2024.11.008","url":null,"abstract":"<p><strong>Purpose: </strong>The current ACR and American College of Obstetricians and Gynecologists guidelines recommend a ≤4-mm endometrial thickness threshold for excluding endometrial cancer in symptomatic postmenopausal patients. This systematic review and meta-analysis aims to re-evaluate the optimal endometrial thickness threshold on imaging for excluding cancer in symptomatic postmenopausal patients.</p><p><strong>Materials and methods: </strong>A systematic search of MEDLINE, EMBASE, Cochrane Library, and Scopus from inception to October 2023 was performed in addition to a gray literature search. Studies were included if they evaluated the diagnostic imaging accuracy of endometrial thickness thresholds for detecting endometrial cancer in symptomatic postmenopausal patients. The reference standard was histopathology. Full-text review and data extraction were performed independently by two reviewers. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed using a bivariate mixed-effects regression model.</p><p><strong>Results: </strong>Thirty-five studies with 6,302 patients met inclusion criteria. Mean age range was 51 to 68 years. The sensitivities and specificities with 95% confidence intervals for the 2- to 7-mm thresholds are 95% (84%-98%) and 22% (8%-49%) for ≤2 mm, 94% (82%-98%) and 35% (24%-47%) for ≤3 mm, 95% (86%-98%) and 45% (34%-56%) for ≤4 mm, 88% (75%-95%) and 56% (42%-68%) for ≤5 mm, 84% (63%-94%) and 60% (43%-74%) for ≤6 mm, and 85% (56%-96%) and 62% (49%-73%) for ≤7 mm. Studies were deemed predominantly low risk for bias across domains.</p><p><strong>Conclusion: </strong>This comprehensive meta-analysis supports the ≤4-mm endometrial thickness threshold for excluding endometrial cancer in symptomatic postmenopausal patients.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683806","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":"Predictors of Physician Agreement With Radiologist-Recommended Follow-up Imaging.","authors":"Moses Flash, Elyse A Lynch, Ronilda Lacson, Jeffrey P Guenette, Sonali Desai, Neena Kapoor","doi":"10.1016/j.jacr.2024.11.006","DOIUrl":"10.1016/j.jacr.2024.11.006","url":null,"abstract":"<p><strong>Objective: </strong>Although recommendations for additional imaging are common in radiology reports, completion of follow-up imaging does not always occur, which could reflect disagreement between radiologist and referring provider. We assessed how frequently referring providers agree with radiologists' follow-up recommendations, reasons for disagreement, and factors associated with radiologist-referring provider agreement.</p><p><strong>Methods: </strong>This institutional review board-exempt, retrospective study was performed at a large academic center. A PACS-integrated tool allowed radiologists to send follow-up imaging recommendations to referring providers, who used the tool to document agreement or disagreement with recommendations. The study included recommendations sent for outpatients between October 21, 2019, and October 31, 2022. Multivariable logistic regression analysis was performed to identify patient, radiologist, and imaging examination factors associated with radiologist-referring provider agreement.</p><p><strong>Results: </strong>Of the 9,406 recommendations meeting inclusion criteria, 8,331 (88.6%) resulted in agreement. The most common reason for disagreement was that the recommendation was considered not clinically relevant (44.5%, 478 of 1,075). The following factors were associated with low rates of agreement: referring provider being a surgeon (odds ratio [OR] 0.73, P < .001) or recommendation for follow-up nuclear imaging (OR 0.64, P = .012). The odds of agreement were higher for recommendations made by thoracic radiologists (OR 1.41, P = .002) and for recommendations with longer follow-up time frames (weeks) (OR 1.03, P < .001). Patient race, ethnicity, insurance type, and living in a socio-economically disadvantaged neighborhood were not significantly associated with radiologist-referring provider agreement.</p><p><strong>Discussion: </strong>Referring providers frequently agree with follow-up imaging recommendations made by radiologists for outpatients, and patient demographics and socio-economic factors do not seem to significantly impact radiologist-referring provider agreement.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649825","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":"Recent Trends in Academic Versus Nonacademic Radiologist Compensation and Clinical Productivity.","authors":"Ajay Malhotra, Dheeman Futela, Rudra Joshi, Seyedmehdi Payabvash, Ben White, David Seidenwurm, Dheeraj Gandhi, Richard Duszak","doi":"10.1016/j.jacr.2024.10.020","DOIUrl":"10.1016/j.jacr.2024.10.020","url":null,"abstract":"<p><strong>Background: </strong>Recent radiologist compensation and clinical productivity trends have not been well characterized, especially across academic versus nonacademic practice settings.</p><p><strong>Purpose: </strong>To assess recent trends in in financial compensation and clinical productivity between academic and nonacademic settings in diagnostic radiology (DR) and interventional radiology (IR).</p><p><strong>Materials and methods: </strong>We studied deidentified data from the Medical Group Management Association for both DR and IR physicians in academic and nonacademic practices from 2014 to 2023. Median, 25th and 75th percentiles, and mean values were analyzed for compensation, collections, and work relative value units (wRVUs). Compensation and productivity data were compared by radiology subspecialty (DR versus IR), practice type (academic versus nonacademic provider), geographical region of the United States, and practice size. Trends in absolute changes were analyzed with linear regression.</p><p><strong>Results: </strong>The Medical Group Management Association Survey data for 2023 included responses for 3,769 radiologists (2,883 in DR and 886 in IR). In 2023, nonacademic radiologists had greater total median compensation than academic faculty in both DR (by 27%) and IR (by 32%). From 2014 to 2023, median compensation increased faster for academic DR physicians (3.2% annually) than for nonacademic DR physicians (1.9% annually). In 2023, DR physicians produced greater median wRVUs than IR physicians (by 53% for nonacademic and 46% for academic radiologists) with higher collections, but IR physicians had higher compensation (by 16% in nonacademic and 10% in academic settings). Over the last decade, IR physician compensation increased by 3.9% and 3.4% annually for nonacademic and academic IR physicians, respectively, whereas median wRVUs trended downward (by -1.5% for nonacademic and -2.4% for academic physicians) with declining collections (by -4.4% annually for nonacademic and -2.1% for academic physicians).</p><p><strong>Conclusion: </strong>Over the last decade, the salary gap between academic and nonacademic radiologists has narrowed. Physician compensation has increased at a faster pace in IR, despite relatively lower clinical productivity and declining collections.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634241","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":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Female Breast Cancer Screening: 2024 Update.","authors":"Aatiqah Aziz, Sonya Bhole","doi":"10.1016/j.jacr.2024.09.017","DOIUrl":"10.1016/j.jacr.2024.09.017","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634240","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":"Patient Photograph Association With Radiologist Recommendations for Additional Imaging.","authors":"Jeffrey P Guenette, Jungwun Lee, Sebastien Haneuse, Jarvis T Chen, Neena Kapoor, Ronilda Lacson, Ramin Khorasani","doi":"10.1016/j.jacr.2024.10.018","DOIUrl":"10.1016/j.jacr.2024.10.018","url":null,"abstract":"<p><strong>Objective: </strong>Assess whether display of a patient photograph in the electronic health record (EHR) alongside head and neck CT or MRI radiology examinations is associated with recommendations for additional imaging (RAI) and whether self-reported race modifies that association.</p><p><strong>Methods: </strong>This multi-institution health care system retrospective observational study from June 1, 2021 to May 31, 2022 included all patients with a head/neck CT or MRI report. We investigated association of photograph with RAIs using mixed-effects models adjusting for age, sex, complexity score, race, and area deprivation index while conditioning on patient and radiologist. Race was subsequently included as an interaction term. Multiple imputation was used as sensitivity analysis to address missing race data.</p><p><strong>Results: </strong>In all, 60,543 reports were included from 48,143 patients (55.6% female; median age 58 years, interquartile range 40-70). The EHR included a photograph at the time 18.2% (11,048 of 60,543) of reports were signed. RAIs were included in 7.5% (4,522 of 60,543) of reports. Reports signed when a photograph was displayed had lower estimated odds of containing RAIs (odds ratio: 0.85, 95% confidence interval: 0.77-0.93, P < .001), consistent in sensitivity analysis, with no clear interaction between race and photograph (odds ratio: 0.99, 95% confidence interval: 0.69-1.46, P = .97).</p><p><strong>Discussion: </strong>Patients with a photograph in the EHR had a lower probability of receiving RAIs and this difference did not seem to be the result of implicit racial bias but may be due to personalization of the encounter. This effect may influence radiology reporting for millions of patients per year. Further research is needed to determine whether the association has a positive or negative impact on care quality and outcomes.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634238","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":"Factors Affecting Adherence to Fine Needle Aspiration Recommendations of TI-RADS 4 Thyroid Nodules.","authors":"Jean Lee, Melissa Shuhui Lee, Richard Wiggins, Amani Jridi, Yoshimi Anzai","doi":"10.1016/j.jacr.2024.10.013","DOIUrl":"10.1016/j.jacr.2024.10.013","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549389","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":"Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review.","authors":"Nadia L Samaha, Leila J Mady, Maria Armache, Madison Hearn, Rachel Stemme, Reshma Jagsi, Laila A Gharzai","doi":"10.1016/j.jacr.2024.04.024","DOIUrl":"10.1016/j.jacr.2024.04.024","url":null,"abstract":"<p><strong>Objective: </strong>Despite the pervasiveness and adverse impacts of financial toxicity (FT) in cancer care, there are no definitive measures for FT screening that have been widely integrated into clinical practice. The aim of this review is to evaluate current methods of assessing FT among patients with cancer and confirm factors associated with higher risk of FT.</p><p><strong>Methods: </strong>A systematic review was performed according to PRISMA guidelines. We included peer-reviewed studies that cross-sectionally, longitudinally, or prospectively measured the self-reported financial impact of patients undergoing cancer care in the United States.</p><p><strong>Results: </strong>Out of 1,085 identified studies, 51 met final inclusion criteria. Outcomes evaluated included FT measures or tools, time and setting of screening, FT prevalence, and sociodemographic or clinical patient-level associated factors. Our findings demonstrate that there is wide variability in FT screening practices including in the timing (diagnosis versus treatment versus survivorship), setting (clinic-based, online, telephone or mail), tools used (21 unique tools, 7 previously validated), and interpretations of screening results (varying FT score cutoffs defining high versus low FT). Younger age, lower income, lower education, non-White race, employment status change, advanced cancer stage, and systemic or radiation therapy were among factors associated with worse FT across the studies.</p><p><strong>Discussion: </strong>FT screening remains heterogenous within the United States. With the ever-escalating cost of cancer care, and the strong association between FT and poor patient outcomes, universal and routine FT screening is imperative in cancer care. Further research and multifaceted interventions identifying best practices for FT screening are needed.</p>","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":"1380-1397"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961031","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":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Urinary Tract Infection-Child.","authors":"Anna Cernich, Saadiya Sehareen","doi":"10.1016/j.jacr.2024.06.021","DOIUrl":"10.1016/j.jacr.2024.06.021","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545627","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":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Staging and Post-Therapy Assessment of Head and Neck Cancer.","authors":"Corey Feuer, Sharon L D'Souza","doi":"10.1016/j.jacr.2024.06.017","DOIUrl":"10.1016/j.jacr.2024.06.017","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499753","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":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Parathyroid Adenoma.","authors":"Christian P Haskett, Gregory J Czuczman","doi":"10.1016/j.jacr.2024.06.016","DOIUrl":"10.1016/j.jacr.2024.06.016","url":null,"abstract":"","PeriodicalId":73968,"journal":{"name":"Journal of the American College of Radiology : JACR","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499752","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}