Faculty Bibliography
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Diagnostic & interventional radiology (Ankara, Turkey). 2018:24(1):46-53.DOI: 10.5152/dir.2018.17285
Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy
PURPOSE/OBJECTIVE:Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-radiotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy. METHODS:A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T endorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling. RESULTS:Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI. CONCLUSION/CONCLUSIONS:This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.
PMCID:5765929
PMID: 29317377
ISSN: 1305-3612
CID: 3064222
Journal of the American College of Radiology : JACR. 2018:15(1 Pt A):65-68.DOI: 10.1016/j.jacr.2017.07.013
The Reading Room Coordinator: Reducing Radiologist Burnout in the Digital Age
PMID: 28899708
ISSN: 1558-349x
CID: 2702082
A Comparison of Radiologists' and Urologists' Opinions Regarding Prostate MRI Reporting: Results From a Survey of Specialty Societies
OBJECTIVE: The purpose of this study is to compare radiologists' and urologists' opinions regarding prostate MRI reporting. SUBJECTS AND METHODS: Radiologist members of the Society of Abdominal Radiology and urologist members of the Society of Urologic Oncology received an electronic survey regarding prostate MRI reporting. RESULTS: The response rate was 12% (135/1155) for Society of Abdominal Radiology and 8% (54/663) for Society of Urologic Oncology members. Most respondents in both specialties prefer Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) (radiologists, 84%; urologists, 84%), indicate that it is used at their institution (radiologists, 84%; urologists, 78%), understand its implications for patient care (radiologists, 89%; urologists, 71%), and agree that radiologists apply PI-RADSv2 categories correctly (radiologists, 57%; urologists, 61%). Both specialties agreed regarding major barriers to PI-RADSv2 adoption: radiologist inexperience using PI-RADSv2 (radiologists, 51%; urologists, 51%), urologist inexperience using PI-RADSv2 (radiologists, 46%; urologists, 51%), and lack of standardized templates (radiologists, 47%; urologists, 52%). The specialties disagreed (p
PMID: 29064758
ISSN: 1546-3141
CID: 2757402
Impact of patient questionnaires on completeness of clinical information and identification of causes of pain during outpatient abdominopelvic CT interpretation
PURPOSE: To evaluate the impact of questionnaires completed by patients at the time of abdominopelvic CT performed for abdominal pain on the completeness of clinical information and the identification of potential causes of pain, compared with order requisitions alone. METHODS: 100 outpatient CT examinations performed for the evaluation of abdominal pain were retrospectively reviewed. The specificity of the location of pain was compared between the order requisition and patient questionnaire. An abdominal imaging fellow (Reader 1) and abdominal radiologist (Reader 2) reviewed the examinations independently in two sessions 6 weeks apart (one with only the order requisition and one also with the questionnaire). Readers recorded identified causes of pain and rated their confidence in interpretation (1-5 scale; least to greatest confidence). RESULTS: In 30% of patients, the questionnaire provided a more specific location for pain. Among these, the pain was localized to a specific quadrant in 40%. With having access to the questionnaire, both readers identified additional causes for pain not identified in session 1 (Reader 1, 8.6% [7/81]; Reader 2 5.3% [4/75]). Additional identified causes of pain included diverticulitis, cystitis, peritoneal implants, epiploic appendagitis, osseous metastatic disease, umbilical hernia, gastritis, and SMA syndrome. Confidence in interpretation was significantly greater using the questionnaire for both readers (Reader 1: 4.8 +/- 0.6 vs. 4.0 +/- 0.5; Reader 2: 4.9 +/- 0.3 vs. 4.7 +/- 0.5, p < 0.001). CONCLUSION: Patient questionnaires provide additional relevant clinical history, increased diagnostic yield, and improve radiologists' confidence. Radiology practices are encouraged to implement questionnaires and make these readily available to radiologists at the time of interpretation.
PMID: 28647766
ISSN: 2366-0058
CID: 2614502
Journal of the American College of Radiology : JACR. 2017:14(12):1538-1544.DOI: 10.1016/j.jacr.2017.04.005
Medicare Claims Data Resources: A Primer for Policy-Focused Radiology Health Services Researchers
As societal stakeholders call for increased evidence-based health policy, considerable attention has focused on Medicare, the country's largest payer. Concurrently, medical imaging has come under considerable scrutiny as a contributor to rising health care expenditures. Accordingly, many recent studies have focused on multiple factors related to the utilization of imaging among Medicare beneficiaries. This article summarizes several national Medicare fee-for-service data sources relevant to supporting ongoing investigations. Aggregated 100% data sets include the Physician/Supplier Procedure Summary Master Files and the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File. The former focuses on services, specialties, and sites of service; the latter focuses on providers. Both permit high-level national assessments of imaging utilization and spending. Individual 5% random-sample claims-level data sources include the Carrier Standard Analytical File Limited Data Set and the Research Identifiable File, which contain greater beneficiary-level information. Both facilitate more robust patient- and encounter-level analyses and some assessment of downstream outcomes but involve greater costs and require greater privacy oversight. More recently, Medicare data are being merged with registry data (eg, Surveillance, Epidemiology, and End Results-Medicare Linked Database files), creating opportunities for even more robust analyses given richer clinical information. Understanding these data sets and trade-offs in their use will aid policy-focused imaging health services researchers in most effectively conducting their investigations.
PMID: 28566134
ISSN: 1558-349x
CID: 2591792
Technologist-Directed Repeat Musculoskeletal and Chest Radiographs: How Often Do They Impact Diagnosis?
OBJECTIVE:Radiologic technologists may repeat images within a radiographic examination because of perceived suboptimal image quality, excluding these original images from submission to a PACS. This study assesses the appropriateness of technologists' decisions to repeat musculoskeletal and chest radiographs as well as the utility of repeat radiographs in addressing examinations' clinical indication. MATERIALS AND METHODS/METHODS:We included 95 musculoskeletal and 87 chest radiographic examinations in which the technologist repeated one or more images because of perceived image quality issues, rejecting original images from PACS submission. Rejected images were retrieved from the radiograph unit and uploaded for viewing on a dedicated server. Musculoskeletal and chest radiologists reviewed rejected and repeat images in their timed sequence, in addition to the studies' remaining images. Radiologists answered questions regarding the added value of repeat images. RESULTS:The reviewing radiologist agreed with the reason for rejection for 64.2% of musculoskeletal and 60.9% of chest radiographs. For 77.9% and 93.1% of rejected radiographs, the clinical inquiry could have been satisfied without repeating the image. For 75.8% and 64.4%, the repeated images showed improved image quality. Only 28.4% and 3.4% of repeated images were considered to provide additional information that was helpful in addressing the clinical question. CONCLUSION/CONCLUSIONS:Most repeated radiographs (chest more so than musculoskeletal radiographs) did not add significant clinical information or alter diagnosis, although they did increase radiation exposure. The decision to repeat images should be made after viewing the questionable image in context with all images in a study and might best be made by a radiologist rather than the performing technologist.
PMID: 28898128
ISSN: 1546-3141
CID: 2920672
The U.S. Online News Coverage of Mammography Based on a Google News Search
RATIONALE AND OBJECTIVES: To characterize online news coverage relating to mammography, including articles' stance toward screening mammography. MATERIALS AND METHODS: Google News was used to search U.S. news sites over a 9-year period (2006-2015) based on the search terms "mammography" and "mammogram." The top 100 search results were recorded. Identified articles were manually reviewed. RESULTS: The top 100 news articles were from the following sources: local news outlet (50%), national news outlet (24%), nonimaging medical source (13%), entertainment or culture news outlet (6%), business news outlet (4%), peer-reviewed journal (1%), and radiology news outlet (1%). Most common major themes were the screening mammography controversy (29%), description of a new breast imaging technology (23%), dense breasts (11%), and promotion of a public screening initiative (11%). For the most recent year, article stance toward screening mammography was 59%, favorable; 16%, unfavorable; and 25%, neutral. After 2010, there was an abrupt shift in articles' stances from neutral to both favorable and unfavorable. CONCLUSIONS: A wide range of online news sources addressed a range of issues related to mammography. National, rather than local, news sites were more likely to focus on the screening controversy and more likely to take an unfavorable view. The controversial United States Preventive Services Task Force guidelines may have influenced articles to take a stance on screening mammography. As such online news may impact public perception of the topic and thus potentially impact guideline adherence, radiologists are encouraged to maintain awareness of this online coverage and to support the online dissemination of reliable and accurate information.
PMID: 28693758
ISSN: 1878-4046
CID: 2630602
3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy
RATIONALE AND OBJECTIVES: This study aimed to assess a novel method of three-dimensional (3D) co-registration of prostate magnetic resonance imaging (MRI) examinations performed before and after prostate cancer focal therapy. MATERIALS AND METHODS: We developed a software platform for automatic 3D deformable co-registration of prostate MRI at different time points and applied this method to 10 patients who underwent focal ablative therapy. MRI examinations were performed preoperatively, as well as 1 week and 6 months post treatment. Rigid registration served as reference for assessing co-registration accuracy and precision. RESULTS: Segmentation of preoperative and postoperative prostate revealed a significant postoperative volume decrease of the gland that averaged 6.49 cc (P = .017). Applying deformable transformation based on mutual information from 120 pairs of MRI slices, we refined by 2.9 mm (max. 6.25 mm) the alignment of the ablation zone, segmented from contrast-enhanced images on the 1-week postoperative examination, to the 6-month postoperative T2-weighted images. This represented a 500% improvement over the rigid approach (P = .001), corrected by volume. The dissimilarity by Dice index of the mapped ablation zone using deformable transformation vs rigid control was significantly (P = .04) higher at the ablation site than in the whole gland. CONCLUSIONS: Our findings illustrate our method's ability to correct for deformation at the ablation site. The preliminary analysis suggests that deformable transformation computed from mutual information of preoperative and follow-up MRI is accurate in co-registration of MRI examinations performed before and after focal therapy. The ability to localize the previously ablated tissue in 3D space may improve targeting for image-guided follow-up biopsy within focal therapy protocols.
PMCID:6025844
PMID: 29122471
ISSN: 1878-4046
CID: 2772952
Journal of the American College of Radiology : JACR. 2017:14(11):1396-1402.DOI: 10.1016/j.jacr.2017.05.014
Factors Influencing List Prices for Radiologists' Services
PURPOSE: To identify factors associated with list price variation for radiologists' services. METHODS: The 2014 Medicare Physician and Other Supplier Public Use File was used to identify submitted charges ("list prices") and payments for radiologists' services (ie, not hospital service charges). Charge-to-payment ratios were computed for individual radiologists as a measure of excess charges. Numerous radiologist-level factors identifiable using publicly available data sets were explored. RESULTS: Among 26,715 radiologists nationally, the mean charge-to-payment ratio was 4.2 +/- 2.0. A greater charge-to-payment ratio was most strongly predicted for those serving higher-complexity patients (ratio ranging from 3.8 +/- 1.8 to 4.1 +/- 1.6 for radiologists in the first through third quartiles in terms of patient complexity, compared with a ratio of 4.8 +/- 2.8 for radiologists in the highest quartile in terms of patient complexity). A higher charge-to-payment ratio was also observed among those with, rather than without, a teaching institutional affiliation (4.7 +/- 2.8 versus 4.0 +/- 1.8, respectively) and among subspecialists rather than generalists (4.4 +/- 2.5 versus 3.9 +/- 1.5, respectively). Among subspecialties, charge-to-payment ratios ranged from 3.3 +/- 1.3 (breast imaging) to 5.7 +/- 4.1 (interventional radiology). Charge-to-payment ratios showed weak inverse correlations with total service volume (r = -0.13) and total payments (r = -0.11). CONCLUSION: Distinct from hospital prices and historically considered arbitrary, higher charges for radiologists' services demonstrate consistent patterns of variation and are most strongly seen for those serving higher complexity patients. As price transparency initiatives expand, radiologists should be aware of how and why their list prices compare with local and national benchmarks.
PMID: 28734684
ISSN: 1558-349x
CID: 2654082
The episode, the PTAC, cost, and the neurointerventionalist
Episodic care forms a payment methodology of increasing relevance to neurointerventional specialists and other providers. Episodic care payment models are currently recognized in both payment paths described by the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA): the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. Understanding the cost of care, as well as how such costs are shaped in the context of episodic care, will be critical to success in both of these paths.
PMID: 27934634
ISSN: 1759-8486
CID: 2354432
