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Imaging Facilities' Adherence to PI-RADS v2 Minimum Technical Standards for the Performance of Prostate MRI

Esses, Steven J; Taneja, Samir S; Rosenkrantz, Andrew B
PURPOSE: This study aimed to assess variability in imaging facilities' adherence to the minimum technical standards for prostate magnetic resonance imaging acquisition established by Prostate Imaging-Reporting and Data System (PI-RADS) version 2 (v2). METHODS: A total of 107 prostate magnetic resonance imaging examinations performed at 107 unique imaging facilities after the release of PI-RADS v2 and that were referred to a tertiary care center for secondary interpretation were included. Image sets, DICOM headers, and outside reports were reviewed to assess adherence to 21 selected PI-RADS v2 minimum technical standards. RESULTS: Hardware arrangements were 23.1%, 1.5T without endorectal coil; 7.7%, 1.5T with endorectal coil; 63.5%, 3T without endorectal coil; and 5.8%, 3T with endorectal coil. Adherence to minimum standards was lowest on T2 weighted imaging (T2WI) for frequency resolution /=1400 s/mm2) images were included in 58.0% (calculated in 25.9%). Adherence to T2WI phase resolution and DWI inter-slice gap were greater (P < .05) at 3T than at 1.5T. Adherence did not differ (P > .05) for any parameter between examinations performed with and without an endorectal coil. Adherence was greater for examinations performed at teaching facilities for T2WI slice thickness and DCE temporal resolution (P < .05). Adherence was not better for examinations performed in 2016 than in 2015 for any parameter (P > .05). CONCLUSION: Facilities' adherence to PI-RADS v2 minimum technical standards was variable, being particularly poor for T2WI frequency resolution and DCE temporal resolution. The standards warrant greater community education. Certain technical standards may be too stringent, and revisions should be considered.
PMID: 29107458
ISSN: 1878-4046
CID: 2773212

Historic Physician Quality and Reporting System Reporting by Radiologists: A Wake-up Call to Avoid Penalties Under the Medicare Access and CHIP Reauthorization Act (MACRA)

Ginocchio, Luke; Duszak, Richard Jr; Nicola, Gregory N; Rosenkrantz, Andrew B
PURPOSE: The Medicare Access and CHIP Reauthorization Act (MACRA) Quality performance category is the successor to the Physician Quality and Reporting System (PQRS) program and now contributes to physicians' income adjustments based upon performance rates calculated for a minimum of six measures. We assess radiologists' frequency of reporting PQRS measures as a marker of preparedness for MACRA. METHODS: Medicare-participating radiologists were randomly searched through the Physician Compare website until identifying 1,000 radiologists who reported at least one PQRS measure. Associations were explored between the number of reported measures and radiologist characteristics. RESULTS: For PQRS-reporting radiologists, the number of reported PQRS measures was 1 (25.2%), 2 (27.3%), 3 (18.2%), 4 (19.3%), 5 (8.3%), and 6 (1.7%). The most commonly reported measures were "documenting radiation exposure time for procedures using fluoroscopy" (64.3%) and "accurate measurement of carotid artery narrowing" (56.8%). Reporting at least two measures was significantly (P < .001) more likely for nonacademic (77.3%) versus academic (44.9%) radiologists, generalists (82.7%) versus subspecialists (59.1%), and radiologists in smaller (/=100 members) (39.7%) practices. Reporting six measures was significantly (P < .05) more likely for generalists (2.6%) versus subspecialists (0.4%). CONCLUSION: Most PQRS-reporting radiologists reported only one or two measures, well below MACRA's requirement of six. Radiologists continuing such reporting levels will likely be disadvantaged in terms of potential payment adjustments under MACRA. Lower reporting rates for academic and subspecialized radiologists, as well as those in larger practices, may relate to such radiologists' reliance on their hospitals or networks for PQRS reporting. Qualified clinical data registries should be embraced to facilitate more robust measure reporting.
PMID: 29107575
ISSN: 1558-349x
CID: 2773202

Citation Impact of Collaboration in Radiology Research

Rosenkrantz, Andrew B; Parikh, Ujas; Duszak, Richard Jr
PURPOSE: Team science involving multidisciplinary and multi-institutional collaboration is increasingly recognized as a means of strengthening the quality of scientific research. The aim of this study was to assess associations between various forms of collaboration and the citation impact of published radiology research. METHODS: In 2010, 876 original research articles published in Academic Radiology, the American Journal of Roentgenology, JACR, and Radiology were identified with at least one radiology-affiliated author. All articles were manually reviewed to extract features related to all authors' disciplines and institutions. Citations to these articles through September 2016 were extracted from Thomson Reuters Web of Science. RESULTS: Subsequent journal article citation counts were significantly higher (P < .05) for original research articles with at least seven versus six or fewer authors (26.2 +/- 30.8 versus 20.3 +/- 23.1, respectively), with authors from multiple countries versus from a single country (32.3 +/- 39.2 versus 22.0 +/- 25.0, respectively), with rather than without a nonuniversity collaborator (28.7 +/- 38.6 versus 22.4 +/- 24.9, respectively), and with rather than without a nonclinical collaborator (26.5 +/- 33.1 versus 21.9 +/- 24.4, respectively). On multivariate regression analysis, the strongest independent predictors of the number of citations were authors from multiple countries (beta = 9.14, P = .002), a nonuniversity collaborator (beta = 4.80, P = .082), and at least seven authors (beta = 4.11, P = .038). CONCLUSIONS: With respect to subsequent journal article citations, various forms of collaboration are associated with greater scholarly impact of published radiology research. To enhance the relevance of their research, radiology investigators are encouraged to pursue collaboration across traditional disciplinary, institutional, and geographic boundaries.
PMID: 29100883
ISSN: 1558-349x
CID: 2765692

A Comparison of Radiologists' and Urologists' Opinions Regarding Prostate MRI Reporting: Results From a Survey of Specialty Societies

Spilseth, Benjamin; Ghai, Sangeet; Patel, Nayana U; Taneja, Samir S; Margolis, Daniel J; Rosenkrantz, Andrew B
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

Apparent Diffusion Coefficient Values of Prostate Cancer: Comparison of 2D and 3D ROIs

Tamada, Tsutomu; Huang, Chenchan; Ream, Justin M; Taffel, Myles; Taneja, Samir S; Rosenkrantz, Andrew B
OBJECTIVE: The purpose of this study was to compare the reproducibility and diagnostic performance of 2D and 3D ROIs for prostate apparent diffusion coefficient (ADC) measurements. MATERIALS AND METHODS: The study included 56 patients with prostate cancer undergoing 3-T MRI including DWI (b = 50 and 1000 s/mm2) before radical prostatectomy. Histologic findings from prostatectomy specimens were reviewed to denote each patient's dominant tumor and a benign region with visually decreased ADC. Three readers independently measured the ADCs of both areas using an ROI placed on a single slice through the lesion (2D) and an ROI encompassing all slices through the lesion (3D). Readers repeated measurements after 3 weeks. Assessment included Bland-Altman analysis (coefficient of repeatability [CR] in which lower values indicated higher reliability) and ROC analysis. RESULTS: For intrareader variability, the CRs across readers for all ROIs were 9.9% for 2D and 9.3% for 3D. For tumor ROIs the CRs were 10.6% for 2D and 9.6% for 3D. For interreader variability, the CRs across readers for all ROIs were 17.1% for 2D and 20.5% for 3D and for tumor ROIs were 17.9% for 2D and 22.2% for 3D. For combined reader data, the AUCs for benign and malignant findings were 0.77 for 2D and 0.78 for 3D (p = 0.146). For differentiating Gleason score (GS) 3 + 3 from GS > 3 + 3 tumors, the AUCs were 0.92 for 2D and 0.92 for 3D ROIs (p = 0.649). For differentiating GS /= 4 + 3 tumors, the AUCs were 0.70 for 2D and 0.67 for 3D ROIs (p = 0.004). CONCLUSION: Use of a 3D ROI did not improve intrareader or interreader reproducibility or diagnostic performance compared with use of a 2D ROI for prostate ADC measurements. Interreader reproducibility of 2D ROIs was suboptimal nonetheless.
PMID: 29045185
ISSN: 1546-3141
CID: 2743082

AHCA meets BCRA; timeline, context, and future directions [Editorial]

Hirsch, Joshua A; Rosenkrantz, Andrew B; Allen, Bibb; Nicola, Greg N; Klucznik, Richard P; Manchikanti, Laxmaiah
PMID: 28963361
ISSN: 1759-8486
CID: 2717422

Participation and payments in the PQRS Maintenance of Certification Program: Implications for future merit based payment programs

Glover, McKinley; Duszak, Richard Jr; Silva, Ezequiel 3rd; Rao, Sandhya K; Babb, James S; Rosenkrantz, Andrew B
PMID: 28890261
ISSN: 2213-0772
CID: 2702192

The Reading Room Coordinator: Reducing Radiologist Burnout in the Digital Age

Rosenkrantz, Andrew B; Kang, Stella K; Rybak, Leon; Alexa, Daniel; Recht, Michael P
PMID: 28899708
ISSN: 1558-349x
CID: 2702082

Quantitative Proton Spectroscopy of the Testes at 3 T: Toward a Noninvasive Biomarker of Spermatogenesis

Storey, Pippa; Gonen, Oded; Rosenkrantz, Andrew B; Khurana, Kiranpreet K; Zhao, Tiejun; Bhatta, Rajesh; Alukal, Joseph P
OBJECTIVES: The aim of this study was to compare testicular metabolite concentrations between fertile control subjects and infertile men. MATERIALS AND METHODS: Single voxel proton magnetic resonance spectroscopy ((1)H-MRS) was performed in the testes with and without water suppression at 3 T in 9 fertile control subjects and 9 infertile patients (8 with azoospermia and 1 with oligospermia). In controls only, the T1 and T2 values of water and metabolites were also measured. Absolute metabolite concentrations were calculated using the unsuppressed water signal as a reference and correcting for the relative T1 and T2 weighting of the water and metabolite signals. RESULTS: Testicular T1 values of water, total choline, and total creatine were 2028 +/- 125 milliseconds, 1164 +/- 105 milliseconds, and 1421 +/- 314 milliseconds, respectively (mean +/- standard deviation). T2 values were 154 +/- 11 milliseconds, 342 +/- 53 milliseconds, and 285 +/- 167 milliseconds, respectively. Total choline concentration was lower in patients (mean, 1.5 mmol/L; range, 0.9-2.1 mmol/L) than controls (mean, 4.4 mmol/L; range, 3.2-5.7 mmol/L; P = 4 x 10(-)(5)). Total creatine concentration was likewise reduced in patients (mean, 1.1 mmol/L; range, undetectable -2.7 mmol/L) compared with controls (mean, 3.6 mmol/L; range, 2.5-4.7 mmol/L; P = 1.6 x 10(-)(4)). The myo-inositol signal normalized to the water reference was also lower in patients than controls (P = 4 x 10(-)(5)). CONCLUSIONS: Testicular metabolite concentrations, measured by proton spectroscopy at 3 T, may be valuable as noninvasive biomarkers of spermatogenesis.
PMCID:5746479
PMID: 28877046
ISSN: 1536-0210
CID: 2688672

Characteristics of the Most Recently Awarded Magnetic Resonance Imaging Patents in the United States

Gaddam, Sushma; Lemberskiy, Gregory; Rosenkrantz, Andrew B
PURPOSE: To characterize recent magnetic resonance imaging (MRI) technical development and innovation based on data regarding MRI-related patents awarded in 2016. METHODS: The US Patent and Trademark Office website was searched for patents awarded in 2016 and an abstract containing "magnetic resonance." Patent characteristics were summarized. An MRI physicist classified patents' themes. RESULTS: A total of 423 MRI-related patents were awarded in 2016. Among these, 29% had 1 inventor, 24% had 2 inventors, and 47% had >/=2 inventors. Mean interval between patents being filed and awarded was 1389 +/- 559 days (range: 167-4029). Most common countries of patents' first assignee were USA (40%), Germany (24%), Netherlands (10%), and Japan (10%). In all, 3% included assignees with different countries (most common collaborators USA and Germany). Patents' first assignee had an industry affiliation in 76% vs an academic affiliation in 21% (4% indeterminate); and 3% had industry-academia collaboration. Patents' most common themes were coils (n = 77), sequence design (n = 65), and noncoil scanner hardware (n = 41). These top themes were similar for USA, international, and industry-based patents; however, for academic-based patents, the most common themes were sequence design, reconstruction, and exogenous agents. Less common themes included image analysis, postprocessing, spectroscopy, relaxometry, diffusion, motion correction, radiation therapy, implants, wireless devices, and positron emission tomography-MRI. CONCLUSION: Most MRI-related patents were by non-US inventors. A large majority had industry affiliation; minimal industry-academic collaboration was observed. Patents from industry and academic inventors had distinct top focuses: hardware and software, respectively. Awareness of the most recent years' MRI patents may provide insights into forthcoming clinical translations and help guide ongoing research and entrepreneurism.
PMID: 28843639
ISSN: 1535-6302
CID: 2679932