Faculty Bibliography

RATIONALE AND OBJECTIVES: This study aimed to characterize recent National Institutes of Health (NIH) funding for diagnostic radiology departments at US medical schools. MATERIALS AND METHODS: This retrospective study did not use private identifiable information and thus did not constitute human subjects research. The public NIH Research Portfolio Online Reporting Tools Expenditure and Results system was used to extract information regarding 887 NIH awards in 2015 to departments of "Radiation-Diagnostic/Oncology." Internet searches were conducted to identify each primary investigator (PI)'s university web page, which was used to identify the PI's departmental affiliation, gender, degree, and academic rank. A total of 649 awards to diagnostic radiology departments, based on these web searches, were included; awards to radiation oncology departments were excluded. Characteristics were summarized descriptively. RESULTS: A total of 61 unique institutions received awards. The top five funded institutions represented 33.6% of all funding. The most common institutes administering these awards were the National Cancer Institute (29.0%) and the National Institute of Biomedical Imaging and Bioengineering (21.6%). Women received 15.9% of awards and 13.3% of funding, with average funding per award of $353,512 compared to $434,572 for men. PhDs received 77.7% of all awards, with average funding per award of $457,413 compared to $505,516 for MDs. Full professors received 51.2% of awards (average funding per award of $532,668), compared to assistant professors who received 18.4% of awards ($260,177). Average funding was $499,859 for multiple-PI awards vs. $397,932 for single-PI awards. Common spending categories included "neurosciences," "cancer," "prevention," and "aging." CONCLUSIONS: NIH funding for diagnostic radiology departments has largely been awarded to senior-ranking male PhD investigators, commonly at large major academic medical centers. Initiatives are warranted to address such disparities and promote greater diversity in NIH funding among diagnostic radiology investigators.

PURPOSE: Prior work has demonstrated marked growth in the volume of abdominal imaging performed by radiologists. However, decisions to pursue imaging are largely driven by referring providers. In this study, we take the novel approach of investigating abdominal imaging utilization patterns by referring provider specialty. METHODS: Data on imaging services were obtained from the 2014 DocGraph Medicare Referring Provider Utilization for Procedures (MrPUP) public use file. MrPUP contains aggregated transaction data for combinations of unique referring provider and service code. Imaging services were classified by modality and body region using the Neiman Institute Types of Service (NITOS). Each referring provider's specialty was determined using Medicare Physician Compare. Abdominal imaging ordering patterns were summarized by referring specialty. RESULTS: The final dataset included 5,824,754 abdominal imaging transactions. The most common ordering specialties of abdominal imaging were as follows: (1) internal medicine; (2) urology; (3) emergency medicine; (4) family practice; and (5) gastroenterology. The most common ordering specialties by abdominal imaging modality were emergency medicine for CT; gastroenterology for MRI and nuclear medicine; and internal medicine for ultrasound and radiography. While numerous specialties commonly ordered abdominal radiography and CT, urologists also commonly ordered retroperitoneal ultrasound and retrograde urography, and gastroenterologists also commonly ordered abdominal ultrasound, abdominal MRI, and esophagrams. Internal medicine, family practice, and emergency medicine providers ordered a much broader mix of imaging, including many non-abdominal imaging examinations. CONCLUSION: Referring specialty abdominal imaging ordering patterns are varied but distinct. Awareness of these patterns may facilitate focused educational and policy initiatives to improve abdominal imaging appropriateness and utilization.

RATIONALE AND OBJECTIVES: This study aims to assess the impact of off-campus facility expansion by a large academic health system on patient travel times for screening mammography. MATERIALS AND METHODS: Screening mammograms performed from 2013 to 2015 and associated patient demographics were identified using the NYU Langone Medical Center Enterprise Data Warehouse. During this time, the system's number of mammography facilities increased from 6 to 19, reflecting expansion beyond Manhattan throughout the New York metropolitan region. Geocoding software was used to estimate driving times from patients' homes to imaging facilities. RESULTS: For 147,566 screening mammograms, the mean estimated patient travel time was 19.9 +/- 15.2 minutes. With facility expansion, travel times declined significantly (P < 0.001) from 26.8 +/- 18.9 to 18.5 +/- 13.3 minutes (non-Manhattan residents: from 31.4 +/- 20.3 to 18.7 +/- 13.6). This decline occurred consistently across subgroups of patient age, race, ethnicity, payer status, and rurality, leading to decreased variation in travel times between such subgroups. However, travel times to pre-expansion facilities remained stable (initial: 26.8 +/- 18.9 minutes, final: 26.7 +/- 18.6 minutes). Among women undergoing mammography before and after expansion, travel times were shorter for the postexpansion mammogram in only 6.3%, but this rate varied significantly (all P < 0.05) by certain demographic factors (higher in younger and non-Hispanic patients) and was as high as 18.2%-18.9% of patients residing in regions with the most active expansion. CONCLUSIONS: Health system mammography facility geographic expansion can improve average patient travel burden and reduce travel time variation among sociodemographic populations. Nonetheless, existing patients strongly tend to return to established facilities despite potentially shorter travel time locations, suggesting strong site loyalty. Variation in travel times likely relates to various factors other than facility proximity.

The radiologist's role extends far beyond interpretation and reporting of medical imaging. In this manuscript, we describe the role of the Director of Prostate Imaging. We believe that this model can and should be implemented at other institutions, ultimately serving to improve the care for prostate cancer patients. Moreover, this model can be translated to support the development of an array of patient-centered service lines not only in abdominal imaging, but throughout radiology practices at large.

OBJECTIVE: The purpose of this study was to determine the outcomes of hyperechoic renal lesions measuring 1 cm or less at ultrasound examination. MATERIALS AND METHODS: This retrospective study included 161 hyperechoic renal lesions measuring 1 cm or less at ultrasound that were evaluated with follow-up ultrasound, CT, or MRI. Follow-up imaging examinations were reviewed to assess for definitive lesion characterization or size stability. RESULTS: Follow-up included 11 unenhanced CT, 39 contrast-enhanced CT, 52 unenhanced and contrast-enhanced CT, two unenhanced MRI, 50 unenhanced and contrast-enhanced MRI, and 87 ultrasound examinations. At CT or MRI 58.4% of lesions were confirmed to be angiomyolipomas. At CT, one lesion represented a stone, and one a hyperdense cyst. At CT or MRI 11.8% of the lesions had no correlate; 3.1% were not visualized at follow-up ultrasound. An additional 23.6% were stable at 2-year follow-up imaging or beyond. Two lesions were evaluated with only contrast-enhanced CT less than 1 month after ultrasound, and the CT images did not show macroscopic fat or calcification or meet the criteria for a simple cyst. These lesions were considered indeterminate. One lesion in a 65-year-old man was imaged with unenhanced and contrast-enhanced CT 23 months after ultrasound, and the CT showed an increase in size, solid enhancement, and no macroscopic fat. This lesion was presumed to represent renal cell carcinoma. Overall, the one lesion presumed malignant and the two indeterminate lesions constituted 1.9% of the cohort. The other 98.1% of lesions were considered clinically insignificant. CONCLUSION: Most hyperechoic renal lesions measuring 1 cm or smaller were clinically insignificant, suggesting that such lesions may not require additional imaging. Patient demographics, symptoms and risk factors for malignancy may help inform the decision to forgo follow-up imaging of such lesions.

RATIONALE AND OBJECTIVES: Patients' willingness to travel farther distances for certain imaging services may reflect their perceptions of the degree of differentiation of such services. We compare patients' travel times for a range of imaging examinations performed across a large academic health system. MATERIALS AND METHODS: We searched the NYU Langone Medical Center Enterprise Data Warehouse to identify 442,990 adult outpatient imaging examinations performed over a recent 3.5-year period. Geocoding software was used to estimate typical driving times from patients' residences to imaging facilities. Variation in travel times was assessed among examination types. RESULTS: The mean expected travel time was 29.2 +/- 20.6 minutes, but this varied significantly (p < 0.001) among examination types. By modality, travel times were shortest for ultrasound (26.8 +/- 18.9) and longest for positron emission tomography-computed tomography (31.9 +/- 21.5). For magnetic resonance imaging, travel times were shortest for musculoskeletal extremity (26.4 +/- 19.2) and spine (28.6 +/- 21.0) examinations and longest for prostate (35.9 +/- 25.6) and breast (32.4 +/- 22.3) examinations. For computed tomography, travel times were shortest for a range of screening examinations [colonography (25.5 +/- 20.8), coronary artery calcium scoring (26.1 +/- 19.2), and lung cancer screening (26.4 +/- 14.9)] and longest for angiography (32.0 +/- 22.6). For ultrasound, travel times were shortest for aortic aneurysm screening (22.3 +/- 18.4) and longest for breast (30.1 +/- 19.2) examinations. Overall, men (29.9 +/- 21.6) had longer (p < 0.001) travel times than women (27.8 +/- 20.3); this difference persisted for each modality individually (p