Faculty Bibliography

PURPOSE/OBJECTIVE:The number and roles of US nonphysician practitioners (NPPs) have expanded considerably, but little is known about their use by radiology practices. The authors assessed characteristics and trends of radiology practices employing Medicare-recognized NPPs. METHODS:Using Medicare databases from 2017 through 2019, the authors mapped all nurse practitioners and physician assistants (together "NPPs") to employer groups for which all physicians were radiologists ("radiology practices"). Practices were characterized by size, geography, and radiologist characteristics. Temporal changes were assessed, and NPP employment likelihood was estimated using multivariate logistic regression modeling. RESULTS:As the number of US radiology practices declined by 36.5% (from 2,643 to 1,679) between 2017 and 2019, the number employing NPPs increased by 10.5% (from 228 [8.6%] to 252 [15.0%]). The number of radiologists in NPP-employing practices increased by 10.4% (from 6,596 [35.1%] to 7,282 [40.0%]) as the number of radiology-employed NPPs increased by 17.5% (from 588 to 691). Practices were more likely to employ NPPs when medium (odds ratio [OR], 1.31) or large (OR, 1.25) in size, when urban located (OR, 1.35), and as their percentages of interventional radiologists increased (OR, 5.53 per percentage point) (P < .01 for all). Practices were less likely to employ NPPs as mean radiologist years since completing training increased (OR, 0.99 per year; P < .01). CONCLUSIONS:Employment of NPPs by radiology practices has grown considerably in recent years, particularly in larger and urban practices and in those that employ more interventional and early-career radiologists. More work is necessary to better understand how this expanding use of NPPs affects the specialty.

PURPOSE/OBJECTIVE:To evaluate the effect of enema and dietary restrictions on prostate MR image quality metrics and to assess inter-reader agreement for these metrics. METHODS:This retrospective study included 195 men divided into groups based on their compliance with preparation instructions before prostate MRI (Enema + Diet, n = 98; Enema, n = 42; Diet, n = 35; Control [no compliance], n = 20). Four readers independently assessed six image quality metrics on a 5-point scale. Between-group comparisons were made using Wilcoxon rank sum test. Inter-reader agreement was calculated using Fleiss' kappa. RESULTS:Compared with the Control group, image quality with respect to rectal stool/gas, distortion of diffusion-weighted images, overall image quality, and confidence in assessment was higher in the Enema + Diet, Enema, and Diet groups (p  < 0.05 for all comparisons). The Enema + Diet and Enema groups had significantly higher scores than the Diet group for rectal stool/gas (p < 0.001 and 0.005, respectively). The Enema + Diet and Diet groups had higher scores than the Control group for rectal peristalsis (p = 0.027 and 0.009, respectively), but there were no significant differences in motion artifacts on T2-weighted images. Agreement among readers was fair, with kappa values ranging from 0.25 to 0.37. CONCLUSION/CONCLUSIONS:Enema and dietary restriction can improve the quality of prostate MRI by decreasing rectal distension and distortion of diffusion-weighted images and by increasing reader confidence in image assessment. Inter-reader agreement using subjective criteria for analysis of MRI quality is fair.

PURPOSE/OBJECTIVE:To assess the impact of instructional videos in patients' primary language on abdominal MR image quality for whom English is a second language (ESL). METHODS:Twenty-nine ESL patients viewed Spanish or Mandarin Chinese instructional videos (approximately 2.5 min in duration) in the preparation room before abdominal MRI (ESL-video group). Comparison groups included 50 ESL patients who underwent MRI before video implementation (ESL-no video group) and 81 English-speaking patients who were matched for age, sex, magnet strength, and history of prior MRI with patients in the first two groups. Three radiologists independently assessed respiratory motion and image quality on turbo spin-echo T2-weighted images (T2WI) and postcontrast T1-weighted images (T1WI) using 1 to 5 Likert scales. Groups were compared using Kruskal-Wallis tests as well as generalized estimating equations (GEEs) to adjust for possible confounders. RESULTS:For T2WI respiratory motion and T2WI overall image quality, Likert scores of the ESL-no video group (mean score across readers of 2.6 ± 0.1 and 2.6 ± 0.1) were lower (all P < .001) compared with English-speaking (3.3 ± 0.2 and 3.3 ± 0.1) and ESL-video (3.2 ± 0.1 and 3.0 ± 0.2) groups. In the GEE model, mean T2WI respiratory motion (both adjusted P < .001) and T2WI overall quality (adjusted P = .03 and .11) were higher in English and ESL-video groups compared with ESL-no video group. For T1WI respiratory motion and T1WI overall image quality, Likert scores were not different between groups (P > .05), including in the GEE model (adjusted P > .05). CONCLUSION/CONCLUSIONS:Providing ESL patients with an instructional video in their primary language before abdominal MRI is an effective intervention to improve imaging quality.