Faculty Bibliography

OBJECTIVE: The purpose of this study is to assess features of patient satisfaction scores for U.S. radiologists using a popular physician rating website. MATERIALS AND METHODS: Patient reviews were retrieved from the website RateMDs for all listed radiologists in all 297 U.S. cities with population 100,000 or greater. Reviews included rating scores of 1-5 (5 = highest) in four categories (staff, punctuality, knowledge, and helpfulness). Additional physician information was obtained from Medicare files. Common words in patient free-text comments were assessed. Statistical analyses were performed. RESULTS: We identified 1891 patient reviews for 1259 radiologists. In all four categories, the most common score was 5 for excellent (62.7-74.3%), and the second most common score was 1 for terrible (13.5-20.4%); scores of 2-4 were far less frequent (1.9-11.6%). Scores for all four categories highly correlated with one another (r = 0.781-0.951). Radiologists in the Northeast scored significantly lower (p < 0.001) than those elsewhere for both staff and punctuality. Radiologists attending a designated top 50 medical school showed nonsignificant trends toward lower scores for helpfulness (p = 0.073) and knowledge (p = 0.062). The most common words in free-text comments for positive reviews were "caring," "knowledgeable," and "professional." For negative reviews, "rude," "pain," and "unprofessional" were most common. CONCLUSION: Overall, most radiologists rated online by their patients score well, but reviews tended to be either strongly positive or negative. Scores across various categories are highly correlated, suggesting that there is a halo effect. Radiologists should recognize the effect of both facility- and radiologist-related factors in influencing patients' overall perceptions.

OBJECTIVE: To perform a survey-based assessment of current contrast reaction training in US diagnostic radiology residency programs. METHODS: An electronic survey was distributed to radiology residency program directors from 9/2015-11/2015. RESULTS: 25.7% of programs responded. 95.7% of those who responded provide contrast reaction management training. 89.4% provide didactic lectures (occurring yearly in 71.4%). 37.8% provide hands-on simulation training (occurring yearly in 82.3%; attended by both faculty and trainees in 52.9%). CONCLUSION: Wide variability in contrast reaction education in US diagnostic radiology residency programs reveals an opportunity to develop and implement a national curriculum.

Purpose To test the impact of existing Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) decision rules, as well as of proposed adjustments to these decision rules, on detection of Gleason score (GS) 7 or greater (GS >/=7) prostate cancer. Materials and Methods Two radiologists independently provided PI-RADS V2 scores for the dominant lesion on 343 prostate magnetic resonance (MR) examinations. Diagnostic performance for GS >/=7 tumor was assessed by using MR imaging-ultrasonography fusion-targeted biopsy as the reference. The impact of existing PI-RADS V2 decision rules, as well as a series of exploratory proposed adjustments, on the frequency of GS >/=7 tumor detection, was evaluated. Results A total of 210 lesions were benign, 43 were GS 6, and 90 were GS >/=7. Lesions were GS >/=7 in 0%-4.1% of PI-RADS categories 1 and 2, 11.4%-27.1% of PI-RADS category 3, 44.4%-49.3% of PI-RADS category 4, and 72.1%-73.7% of PI-RADS category 5 lesions. PI-RADS category 4 or greater had sensitivity of 78.9%-87.8% and specificity of 75.5%-79.1 for detecting GS >/=7 tumor. The frequency of GS >/=7 tumor for existing PI-RADS V2 decision rules was 30.0%-33.3% in peripheral zone (PZ) lesions upgraded from category 3 to 4 based on dynamic contrast enhancement (DCE) score of positive; 50.0%-66.7% in transition zone (TZ) lesions upgraded from category 3 to 4 based on diffusion-weighted imaging (DWI) score of 5; and 71.7%-72.7% of lesions in both zones upgraded from category 4 to 5 based on size of 15 mm or greater. The frequency of GS >/=7 tumor for proposed adjustments to the decision rules was 30.0%-60.0% for TZ lesions upgraded from category 3 to 4 based on DWI score of 4; 33.3%-57.1% for TZ lesions upgraded from category 3 to 4 based on DCE score of positive when incorporating new criteria (unencapsulated sheetlike enhancement) for DCE score of positive in TZ; and 56.4%-61.9% for lesions in both zones upgraded from category 4 to 5 based on size of 10-14 mm. Other proposed adjustments yielded GS >/=7 tumor in less than 15% of cases for one or more readers. Conclusion Existing PI-RADS V2 decision rules exhibited reasonable performance in detecting GS >/=7 tumor. Several proposed adjustments to the criteria (in TZ, upgrading category 3 to 4 based on DWI score of 4 or modified DCE score of positive; in PZ or TZ, upgrading category 4 to 5 based on size of 10-14 mm) may also have value for this purpose. (c) RSNA, 2016 Online supplemental material is available for this article.

OBJECTIVE: To determine how ipsilateral (ipsi) and contralateral (contra) systematic biopsies (SB) impacts detection of clinically significant versus insignificant prostate cancer (PCa) in men with unilateral MRI lesion undergoing MRI fusion target biopsy (MRF-TB). MATERIALS AND METHODS: 211 cases with one unilateral MRI lesion were subjected to SB and MRF-TB. Biopsy tissue cores from the MRF-TB, ipsi-SB and contra-SB were analyzed separately. RESULTS: A direct relationship was observed between MRI suspicious score (SS) and detection of any cancer, Gleason 6 PCa and Gleason > 6 PCa. MRF-TB alone, MRF-TB + ipsi-SB and MRF-TB + contra-SB detected 64.1%, 89.1% and 76.1% of all PCa, respectively, 53.5%, 81.4% and 69.8% of Gleason 6 PCa, respectively, and 73.5%, 96.0% and 81.6% of Gleason >6 PCa, respectively. MRF-TB + ipsi-SB detected 96% of clinically significant PCa and avoided detection of 18.6% of clinically insignificant PCa. MRF-TB + contra-SB detected 81.6% of clinically significant PCa and avoided detection of 30.2% of clinically insignificant PCa. CONCLUSION: Our study suggests that ipsi-SB should be added to MRF-TB as detection of clinically significant PCa increases with only a modest increase in clinically insignificant PCa detection. Contra-SB in this setting may be deferred since it primarily detects clinically insignificant PCa.

PURPOSE: To evaluate whole-lesion ADC histogram metrics for assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs), including in comparison with conventional MRI features. METHODS: Eighteen branch-duct IPMNs underwent MRI with DWI prior to resection (n = 16) or FNA (n = 2). A blinded radiologist placed 3D volumes-of-interest on the entire IPMN on the ADC map, from which whole-lesion histogram metrics were generated. The reader also assessed IPMN size, mural nodularity, and adjacent main-duct dilation. Benign (low-to-intermediate grade dysplasia; n = 10) and malignant (high-grade dysplasia or invasive adenocarcinoma; n = 8) IPMNs were compared. RESULTS: Whole-lesion ADC histogram metrics demonstrating significant differences between benign and malignant IPMNs were: entropy (5.1 +/- 0.2 vs. 5.4 +/- 0.2; p = 0.01, AUC = 86%); mean of the bottom 10th percentile (2.2 +/- 0.4 vs. 1.6 +/- 0.7; p = 0.03; AUC = 81%); and mean of the 10-25th percentile (2.8 +/- 0.4 vs. 2.3 +/- 0.6; p = 0.04; AUC = 79%). The overall mean ADC, skewness, and kurtosis were not significantly different between groups (p >/= 0.06; AUC = 50-78%). For entropy (highest performing histogram metric), an optimal threshold of >5.3 achieved a sensitivity of 100%, a specificity of 70%, and an accuracy of 83% for predicting malignancy. No significant difference (p = 0.18-0.64) was observed between benign and malignant IPMNs for cyst size >/=3 cm, adjacent main-duct dilatation, or mural nodule. At multivariable analysis of entropy in combination with all other ADC histogram and conventional MRI features, entropy was the only significant independent predictor of malignancy (p = 0.004). CONCLUSION: Although requiring larger studies, ADC entropy obtained from 3D whole-lesion histogram analysis may serve as a biomarker for identifying the malignant potential of IPMNs, independent of conventional MRI features.

OBJECTIVE: To study differences in imaging utilization downstream to initial emergency department (ED) ultrasound examinations interpreted by radiologists versus nonradiologists. METHODS: Using 5% Medicare Research Identifiable Files from 2009 to 2014, we identified episodes where the place of service was "emergency room hospital" and the patient also underwent an ultrasound examination. We determined whether the initial ultrasound was interpreted by a radiologist or nonradiologist and then summed all additional imaging events occurring within 7, 14, and 30 days of each initial ED ultrasound. For each year and each study window, we calculated the mean number of downstream imaging procedures by specialty group. RESULTS: Of 200,357 ED ultrasound events, 163,569 (81.6%) were interpreted by radiologists and 36,788 (18.4%) by nonradiologists. Across all study years, ED patients undergoing ultrasound examinations interpreted by nonradiologists underwent 1.08, 1.22, and 1.34 additional diagnostic imaging studies at 7, 14, and 30 days, respectively (P < .01) compared with when the initial ultrasound examination was interpreted by a radiologist. From 2010 to 2014, the volume of downstream imaging for both radiologists and nonradiologists significantly decreased, with each year resulting in 0.08 fewer imaging examinations (P < .001) 14 days after the ED ultrasound event. Despite that decline, differences in downstream imaging between radiologists and nonradiologists persisted over time. CONCLUSION: Downstream imaging after an initial ED ultrasound is significantly reduced when the ultrasound examination is interpreted by a radiologist rather than a nonradiologist.

PURPOSE: To evaluate the impact of an array of nongeographic patient and within-year temporal factors on variation in Medicare imaging utilization. METHODS: Using the CMS Chronic Conditions Data Warehouse, we identified imaging events nationally per 1,000 Medicare beneficiaries from 2008 through 2014 on a quarterly basis. We also stratified imaging utilization by a variety of clinical and sociodemographic patient factors. Data were summarized descriptively. RESULTS: On a quarterly basis from 2008 through 2014, mean and median imaging utilization were highest in the second quarter (878 and 885 imaging events per 1,000 beneficiaries, respectively) and lowest in the fourth quarter (844 and 846, respectively) of each year. Imaging events per 1,000 beneficiaries increased progressively with increasing patient comorbidities (0 conditions, 511 events; 1-3 conditions, 2,033 events; 4-5 conditions, 3,188 events; 6+ conditions, 5,774 events). Imaging utilization was also higher in dual Medicaid eligibility beneficiaries than in others (3,855 versus 3,200 events) and in those eligible for Medicare owing to end-stage renal disease versus age or disability (7,876 versus 3,225 and 3,501, respectively). Imaging utilization showed additional variation with beneficiary age, gender, and ethnic group. CONCLUSIONS: In the Medicare population, the utilization of medical imaging varies greatly in association with a variety of patient and within-year temporal factors that have previously received little attention. As radiologists embark on risk-bearing contracts, the timing and length of such arrangements should be carefully considered, as well as specific features of the patient population attributed to their practices.

PURPOSE: The Internet provides a potentially valuable mechanism for radiology practices to communicate with patients and enhance the patient experience. The aim of this study was to assess the websites of US radiology private practices, with attention to the frequency of content of potential patient interest. METHODS: The 50 largest private practice radiology facilities in the United States were identified from RadiologyBusiness.com. Websites were reviewed for information content and functionality. RESULTS: Content regarding radiologists' names, medical schools, residencies, fellowships, photographs, and board certification status; contact for billing questions; and ability to make online payments was present on 80% to 98% of sites. Content regarding examination preparation, contrast use, examination duration, description of examination experience, scheduling information, directions, privacy policy, radiologists' role in interpretation, and ACR accreditation was present on 60% to 78%. Content regarding accepted insurers, delivery of results to referrers, report turnaround times, radiologists' years of experience, radiation safety, and facility hours was present on 40% to 58%. Content regarding technologist certification, registration forms, instructions for requesting a study on disc, educational videos, and patient testimonials was present on 20% to 38%. Content regarding examination prices, patient satisfaction scores, peer review, online scheduling, online report and image access, and parking was present on <20%. CONCLUSIONS: Radiology practices' websites most frequently provided information regarding their radiologists' credentials, as well as billing and payment options. Information regarding quality, safety, and the examination experience, as well as non-payment-related online functionality, was less common. These findings regarding the most common deficiencies may be useful for radiology practices in expanding their websites' content, thereby improving communication and potentially the patient experience.