Faculty Bibliography

BACKGROUND:Abdominal computed tomography (CT) is commonly performed in adults. Abdominal aortic calcification (AAC) can be visualized and quantified using artificial intelligence (AI) on CTs performed for other clinical purposes (opportunistic CT). We sought to investigate the value of AI-enabled AAC quantification as a predictor of coronary artery disease and its association with cardiovascular events. METHODS:A fully automated AI algorithm to quantify AAC from the diaphragm to aortic bifurcation using the Agatston score was retrospectively applied to a cohort of patient that underwent both non-contrast abdominal CT for routine clinical care and cardiac CT for coronary artery calcification (CAC) assessment. Subjects were followed for a median of 36 months for major adverse cardiovascular events (MACE, composite of death, myocardial infarction [MI], ischemic stroke, coronary revascularization) and major coronary events (MCE, MI or coronary revascularization). RESULTS:Our cohort included 3599 patients (median age 60 years, 62% male, 74% white) with an evaluable abdominal and cardiac CT. There was a positive correlation between presence and severity of AAC and CAC (r=0.56, P<0.001). AAC showed excellent discriminatory power for detecting or ruling out any CAC (AUC for PREVENT risk score 0.701 [0.683 to 0.718]; AUC for PREVENT plus AAC 0.782 [0.767 to 0.797]; P<0.001). There were 324 MACE, of which 246 were MCE. Following adjustment for the 10-year cardiovascular disease PREVENT score, the presence of AAC was associated with a significant risk of MACE (adjHR 2.26, 95% CI 1.67-3.07, P<0.001) and MCE (adjHR 2.58, 95% CI 1.80-3.71, P<0.001). A doubling of the AAC score resulted in an 11% increase in the risk of MACE and a 13% increase in the risk of MCE. CONCLUSIONS:Using opportunistic abdominal CTs, assessment of AAC using a fully automated AI algorithm, predicted CAC and was independently associated with cardiovascular events. These data support the use of opportunistic imaging for cardiovascular risk assessment. Future studies should investigate whether opportunistic imaging can help guide appropriate cardiovascular prevention strategies.

Diversity, equity, and inclusion (DEI) is important for delivering high-quality, culturally competent care and ensuring equal access to resources and opportunities in healthcare. However, the implementation of DEI has been met with unique challenges and successes across the globe. The International Skeletal Society (ISS), a multidisciplinary musculoskeletal society, made a conscious effort to promote DEI. This article discusses advantages and controversies of DEI approaches, DEI initiatives implemented by the ISS, and experiences of the ISS DEI committee members from their respective continents. The ISS DEI committee implemented educational webinars with expert panel discussions, revising membership criteria and policies for enhancing inclusiveness, advising on programing and speakers for the annual meeting, and fostering mentorship. From a global perspective, in North America, DEI has improved health outcomes and patient care, but anti-DEI legislation has posed significant challenges. Europe relies on international recruitment but faces challenges in staff retention. South America's cultural diversity necessitates culturally sensitive approaches, but discussions about DEI are scarce, and gender inequalities persist in leadership. In Africa, DEI principles are underdeveloped, with limited engagement among stakeholders. In Asia, DEI is emerging, with more women being appointed to faculty positions and leadership roles in academic societies. The implementation of meaningful DEI initiatives requires long-term institutional buy-in and the global participation and commitment of employees and institutional leaders at all levels.

OBJECTIVE:Mechanisms underlying metabolic improvement following metabolic and bariatric surgery (MBS) may provide insight into novel therapies. Vasopressin improves body composition and protects against hypoglycemia. Associations of copeptin, a stable cleavage product of vasopressin, with BMI and insulin resistance suggest an adaptive increase in vasopressin to counteract metabolic disruption. To our knowledge, no study has investigated copeptin before and after MBS in humans. This study's aim was to investigate copeptin changes following MBS and associations with metabolic parameters. METHODS:) undergoing MBS (n = 34) or nonsurgical (NS) lifestyle management (n = 30). Fasting copeptin, hemoglobin A1c (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), body composition, and resting energy expenditure (REE) were assessed. RESULTS:Over 12 months, copeptin increased more (time-by-treatment p = 0.017) whereas HbA1c and adiposity decreased more after MBS than NS (ps ≤ 0.036). Copeptin changes correlated negatively with percentage fat mass and REE changes (rho ≤ -0.29; ps ≤ 0.025) in the whole group, and they correlated positively with HbA1c and HOMA-IR (rho ≥ 0.41; false discovery rate-adjusted p = 0.05) and negatively with REE changes (rho = -0.55; false discovery rate-adjusted p = 0.036) in the MBS group. CONCLUSIONS:Increases in copeptin after weight loss in MBS compared with NS were associated with lower REE and higher HbA1c/HOMA-IR values. Vasopressin may contribute to MBS-related metabolic modifications.

BACKGROUND:Pancreatic steatosis has been associated with obesity and the metabolic syndrome. Studies in adults have demonstrated improvement in pancreatic steatosis following sleeve gastrectomy (SG) with concomitant improvement in glucose homeostasis. OBJECTIVES/OBJECTIVE:To examine changes in pancreatic steatosis in youth with severe obesity 24 months following SG. SETTING/METHODS:Academic hospital system. METHODS:Forty-seven youth (13-24 years) with severe obesity (37 females) were followed for 24 months; 23 had SG and 24 were nonsurgical (NS) controls. Attenuations of the pancreas and spleen were measured using computed tomography (CT) at baseline, 12- and 24-month follow-up. Subjects underwent magnetic resonance imaging (MRI) for subcutaneous and visceral adipose tissue (SAT, VAT), dual energy x-ray absorptiometry (DXA) for body composition, blood sampling for glycated hemoglobin (A1C), and fasting and postprandial insulin and glucose. Linear mixed effects (LMEs) models were used to compare within- and between-group changes over 24 months. RESULTS:At baseline, SG had higher body mass index (BMI) versus NS (P = .033). Over 24 months, significant reductions were noted in weight, BMI, VAT, SAT, fat mass (FM), and lean mass (LM) in the SG versus NS groups (P ≤ .0001). There was a significant 24-month decrease in pancreatic steatosis in the SG group (P = .006). In the whole group, 24-month reductions in pancreatic steatosis correlated with BMI and FM decreases. No associations were found between pancreatic steatosis and glucose homeostasis parameters. CONCLUSIONS:Pancreatic steatosis measured by CT improved after SG in youth. Further studies are needed to understand the relationship between pancreatic steatosis and glucose homeostasis.

Access to an academic clinical research center (CRC) in health professional shortage areas (HPSA) can help address healthcare disparities and increase research accessibility and enrollment. Here we describe the development of a community-centered CRC in the underserved area of Sunset Park, Brooklyn, New York, centered within a larger academic health network and the evaluation of its outcomes within the first two years. In addition to resources and space, establishment of the CRC required a culturally competent and multilingual team of healthcare professionals and researchers and buy-in from the community. Between 1/2022 and 12/2023, the CRC opened 21 new trials (10 interventional and 11 noninterventional) with greater than 500 participant visits that reflect the racial and ethnic diversity of the community. These participants represent 110 distinct zip codes; 76% of these zip codes are underserved and designated HPSA. 60% self-identified as non-White and 20% identified as Hispanic, with 12 other distinct ethnicities represented. 28% of participants speak 11 languages other than English. Community-based CRCs can be created with sustainable growth to align with the mission of the National Institutes of Health and U.S. Food and Drug Administration to meet the ever-growing clinical, social, and research needs of the communities they serve.

RATIONALE/BACKGROUND:The percentage of women in radiology has remained at 25 % for decades. Our institutions identified the need to recruit, support and retain women in our departments in order to change this status quo. METHODS:Our institutions created two different frameworks for Women in Radiology (WIR) programs in order to meet the needs of each distinct department. The organizational structure (trainee led vs faculty led and hybrid), the need for departmental chair support, and types of events and speakers are outlined with unique programs provided by each institution. Collaboration with established programs for women within the institutions and within the region was utilized to support the developing programs. RESULTS:Each of the (WIR) programs has been successful in creating community, impact and sustainable programming, including a peer and faculty mentoring programs for all genders, improvements in gender equity in the workplace, the implementation of trainee parental support programs, and an overall increase in the percentage of women trainees and faculty. Over the last 3 years, the integration of the two programs into a single Women in Radiology program, also encompassing the new enterprise radiology group, has led the way during the initiation of a large institutional merger from two institutions to one large institution. OUTCOMES/RESULTS:We have provided two frameworks for developing a successful women in radiology program as well as a roadmap for combining best practices in a time of change and institutional merger at a major academic institution.

OBJECTIVE:The objective of this study is to assess the status and perception of work from home (WFH) in three academic musculoskeletal radiology divisions. MATERIALS AND METHODS/METHODS:A 17-item anonymous online survey related to WFH was administered to all musculoskeletal (MSK) faculty (n = 27) of three academic radiology divisions between April and July 2023. Survey items included demographics, clinical work environment, presence of a WFH policy, number of days WFH and desired WFH days, commute, perceived benefits and drawbacks of WFH, and symptoms of burnout. Statistical analysis included the Cochrane-Armitage trend test and Fisher exact test. The study was exempt from IRB approval. RESULTS:The survey response rate was 85% (57% men, 57% white, 57% established career, defined by > 10 years in practice). In 47%, an informal policy allowed WHF on certain rotations including moonlighting/call. Seventeen percent had no opportunity to WFH. WFH 1-2 days/week was reported in 73% of respondents while 27% did not WFH. None of the respondents worked from home more than 2 days/week. Women worked from home more compared to men (p = 0.02). Perceived advantages of WFH included efficiency (no commute/parking) (76%), flexibility (52%), autonomy (33%), and increased productivity (29%). Fifty-seven percent preferred in-person read out particularly for first year trainees, with 52% preferring a virtual or hybrid model. CONCLUSION/CONCLUSIONS:WFH is common in academic MSK practices and perceived to be beneficial to MSK faculty. These findings should be taken into consideration when designing WFH policies.