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ACR Appropriateness Criteria® Sepsis

Brixey, Anupama G.; Fung, Alice; De Leon, Alberto Diaz; Walker, Christopher M.; Porter, Kristin K.; Khatri, Gaurav; Bang, Tami J.; Batra, Kiran; Carter, Brett W.; Christensen, Jared D.; Cox, Christian W.; Davis, Andrew M.; Holley, Aaron B.; Kandathil, Asha; Little, Brent P.; Madan, Rachna; Mehta, Parth; Moore, William H.; Shroff, Girish S.; Uyeda, Jennifer W.; Nikolaidis, Paul; Kamel, Ihab R.; Chung, Jonathan H.
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. A search for the underlying cause of infection typically includes radiological imaging as part of this investigation. This document focuses on thoracic and abdominopelvic causes of sepsis. In 2017, the global incidence of sepsis was estimated to be 48.9 million cases, with 11 million sepsis-related deaths (accounting for nearly 20% of all global deaths); therefore, understanding which imaging modalities and types of studies are acceptable or not acceptable is imperative. The 5 variants provided include the most commonly encountered scenarios in the setting of sepsis along with recommendations and data for each imaging study. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
SCOPUS:85192915299
ISSN: 1546-1440
CID: 5659452

ACR Appropriateness Criteria® Sepsis

,; Brixey, Anupama G; Fung, Alice; De Leon, Alberto Diaz; Walker, Christopher M; Porter, Kristin K; Khatri, Gaurav; Bang, Tami J; Batra, Kiran; Carter, Brett W; Christensen, Jared D; Cox, Christian W; Davis, Andrew M; Holley, Aaron B; Kandathil, Asha; Little, Brent P; Madan, Rachna; Mehta, Parth; Moore, William H; Shroff, Girish S; Uyeda, Jennifer W; Nikolaidis, Paul; Kamel, Ihab R; Chung, Jonathan H
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. A search for the underlying cause of infection typically includes radiological imaging as part of this investigation. This document focuses on thoracic and abdominopelvic causes of sepsis. In 2017, the global incidence of sepsis was estimated to be 48.9 million cases, with 11 million sepsis-related deaths (accounting for nearly 20% of all global deaths); therefore, understanding which imaging modalities and types of studies are acceptable or not acceptable is imperative. The 5 variants provided include the most commonly encountered scenarios in the setting of sepsis along with recommendations and data for each imaging study. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
PMID: 38823951
ISSN: 1558-349x
CID: 5664182

Radiation Therapy for Lung Cancer: Imaging Appearances and Pitfalls

Toussie, Danielle; Ginocchio, Luke A; Cooper, Benjamin T; Azour, Lea; Moore, William H; Villasana-Gomez, Geraldine; Ko, Jane P
Radiation therapy is part of a multimodality treatment approach to lung cancer. The radiologist must be aware of both the expected and the unexpected imaging findings of the post-radiation therapy patient, including the time course for development of post- radiation therapy pneumonitis and fibrosis. In this review, a brief discussion of radiation therapy techniques and indications is presented, followed by an image-heavy differential diagnostic approach. The review focuses on computed tomography imaging examples to help distinguish normal postradiation pneumonitis and fibrosis from alternative complications, such as infection, local recurrence, or radiation-induced malignancy.
PMID: 38816092
ISSN: 1557-8216
CID: 5663852

Chest Intensive Care Unit Imaging: Pearls and Pitfalls

Villasana-Gomez, Geraldine; Toussie, Danielle; Kaufman, Brian; Stojanovska, Jadranka; Moore, William H; Azour, Lea; Traube, Leah; Ko, Jane P
Imaging plays a major role in the care of the intensive care unit (ICU) patients. An understanding of the monitoring devices is essential for the interpretation of imaging studies. An awareness of their expected locations aids in identifying complications in a timely manner. This review describes the imaging of ICU monitoring and support catheters, tubes, and pulmonary and cardiac devices, some more commonly encountered and others that have been introduced into clinical patient care more recently. Special focus will be placed on chest radiography and potential pitfalls encountered.
PMID: 38816084
ISSN: 1557-8216
CID: 5663832

Incidental Apical Pleuroparenchymal Scarring on Computed Tomography: Diagnostic Yield, Progression, Morphologic Features and Clinical Significance

Toussie, Danielle; Finkelstein, Mark; Mendoza, Dexter; Concepcion, Jose; Stojanovska, Jadranka; Azour, Lea; Ko, Jane P; Moore, William H; Singh, Ayushi; Sasson, Arielle; Bhattacharji, Priya; Eber, Corey
PURPOSE/OBJECTIVE:Apical pleuroparenchymal scarring (APPS) is commonly seen on chest computed tomography (CT), though the imaging and clinical features, to the best of our knowledge, have never been studied. The purpose was to understand APPS's typical morphologic appearance and associated clinical features. PATIENTS AND METHODS/METHODS:A random generator selected 1000 adult patients from all 21516 chest CTs performed at urban outpatient centers from January 1, 2016 to December 31, 2016. Patients with obscuring apical diseases were excluded to eliminate confounding factors. After exclusions, 780 patients (median age: 64 y; interquartile range: 56 to 72 y; 55% males) were included for analysis. Two radiologists evaluated the lung apices of each CT for the extent of abnormality in the axial plane (mild: <5 mm, moderate: 5 to 10 mm, severe: >10 mm), craniocaudal plane (extension halfway to the aortic arch, more than halfway, vs below the arch), the predominant pattern (nodular vs reticular and symmetry), and progression. Cohen kappa coefficient was used to assess radiologists' agreement in scoring. Ordinal logistic regression was used to determine associations of clinical and imaging variables with APPS. RESULTS:APPS was present on 65% (507/780) of chest CTs (54% mild axial; 80% mild craniocaudal). The predominant pattern was nodular and symmetric. Greater age, female sex, lower body mass index, greater height, and white race were associated with more extensive APPS. APPS was not found to be associated with lung cancer in this cohort. CONCLUSION/CONCLUSIONS:Classifying APPS by the extent of disease in the axial or craniocaudal planes, in addition to the predominant pattern, enabled statistically significant associations to be determined, which may aid in understanding the pathophysiology of apical scarring and potential associated risks.
PMID: 38798201
ISSN: 1536-0237
CID: 5663232

Evaluation of Socioeconomic Disparities in Follow-up Completion for Incidental Pulmonary Nodules

Thakore, Nitya L; Russo, Rienna; Hang, Tianchu; Moore, William H; Chen, Yu; Kang, Stella K
OBJECTIVE:To evaluate the association between census-tract level measures of social vulnerability and residential segregation and IPN follow up. METHODS:This retrospective cohort study included patients with IPN ≥6 mm in size or multiple subsolid/ground-glass IPNs <6 mm (with non-optional follow-up recommendations) diagnosed between January 1, 2018 and December 30, 2019 at a large urban tertiary center and followed ≥two years. Geographic sociodemographic context was characterized by 2018 U.S. Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and the Index of Concentration at the Extreme (ICE), categorized in quartiles. Multivariable binomial regression models were utilized with a primary outcome of inappropriate IPN follow up (late or no follow up). Models were also stratified by nodule risk. RESULTS:The study consisted of 2,492 patients (mean age 65.6 years +/- 12.6 years; 1,361 women). Top-quartile SVI patients were more likely to have inappropriate follow up (Risk Ratio [RR]: 1.24, 95% Confidence Interval [95% CI], 1.12-1.36]), compared with the bottom quartile; risk was also elevated in top-quartile SVI subcategories of Socioeconomic Status (RR: 1.23, 95% CI, 1.13-1.34), Minority Status and Language (RR: 1.24, 95% CI, 1.03-1.48), Housing and Transportation (RR: 1.13, 95% CI, 1.02-1.26), and ICE (RR: 1.20, 95% CI, 1.11-1.30). Further, top-quartile ICE was associated with greater risk of inappropriate follow up among high-risk vs. lower-risk IPN (1.33 [1.18-1.50] vs. 1.13 [1.02-1.25]), respectively, P for interaction= 0.017). DISCUSSION/CONCLUSIONS:Local social vulnerability and residential segregation are associated with inappropriate IPN follow up and may inform policy or interventions tailored for neighborhoods.
PMID: 37473854
ISSN: 1558-349x
CID: 5536032

The Role of Proton MRI to Evaluate Patient Pathophysiology in Severe Asthma

Moore, William H; Chandarana, Hersh
PMID: 38166342
ISSN: 2638-6135
CID: 5626022

Reduction in Radiologist Interpretation Time of Serial CT and MR Imaging Findings with Deep Learning Identification of Relevant Priors, Series and Finding Locations

Weikert, Thomas; Litt, Harold I; Moore, William H; Abed, Mohammed; Azour, Lea; Noor, Abass M; Friebe, Liene; Linna, Nathaniel; Yerebakan, Halid Ziya; Shinagawa, Yoshihisa; Hermosillo, Gerardo; Allen-Raffl, Simon; Ranganath, Mahesh; Sauter, Alexander W
RATIONALE AND OBJECTIVES/OBJECTIVE:Finding comparison to relevant prior studies is a requisite component of the radiology workflow. The purpose of this study was to evaluate the impact of a deep learning tool simplifying this time-consuming task by automatically identifying and displaying the finding in relevant prior studies. MATERIALS AND METHODS/METHODS:The algorithm pipeline used in this retrospective study, TimeLens (TL), is based on natural language processing and descriptor-based image-matching algorithms. The dataset used for testing comprised 3872 series of 246 radiology examinations from 75 patients (189 CTs, 95 MRIs). To ensure a comprehensive testing, five finding types frequently encountered in radiology practice were included: aortic aneurysm, intracranial aneurysm, kidney lesion, meningioma, and pulmonary nodule. After a standardized training session, nine radiologists from three university hospitals performed two reading sessions on a cloud-based evaluation platform resembling a standard RIS/PACS. The task was to measure the diameter of the finding-of-interest on two or more exams (a most recent and at least one prior exam): first without use of TL, and a second session at an interval of at least 21 days with the use of TL. All user actions were logged for each round, including time needed to measure the finding at all timepoints, number of mouse clicks, and mouse distance traveled. The effect of TL was evaluated in total, per finding type, per reader, per experience (resident vs. board-certified radiologist), and per modality. Mouse movement patterns were analyzed with heatmaps. To assess the effect of habituation to the cases, a third round of readings was performed without TL. RESULTS:Across scenarios, TL reduced the average time needed to assess a finding at all timepoints by 40.1% (107 vs. 65 seconds; p < 0.001). Largest accelerations were demonstrated for assessment of pulmonary nodules (-47.0%; p < 0.001). Less mouse clicks (-17.2%) were needed for finding evaluation with TL, and mouse distance traveled was reduced by 38.0%. Time needed to assess the findings increased from round 2 to round 3 (+27.6%; p < 0.001). Readers were able to measure a given finding in 94.4% of cases on the series initially proposed by TL as most relevant series for comparison. The heatmaps showed consistently simplified mouse movement patterns with TL. CONCLUSION/CONCLUSIONS:A deep learning tool significantly reduced both the amount of user interactions with the radiology image viewer and the time needed to assess findings of interest on cross-sectional imaging with relevant prior exams.
PMID: 37210268
ISSN: 1878-4046
CID: 5508202

Differentiating Imaging Features of Post-lobectomy Right Middle Lobe Torsion

Tamizuddin, Farah; Ocal, Selin; Toussie, Danielle; Azour, Lea; Wickstrom, Maj; Moore, William H; Kent, Amie; Babb, James; Fansiwala, Kush; Flagg, Eric; Ko, Jane P
PURPOSE/OBJECTIVE:The purpose of this study was to identify differences in imaging features between patients with confirmed right middle lobe (RML) torsion compared to those suspected yet without torsion. MATERIALS AND METHODS/METHODS:This retrospective study entailing a search of radiology reports from April 1, 2014, to April 15, 2021, resulted in 52 patients with suspected yet without lobar torsion and 4 with confirmed torsion, supplemented by 2 additional cases before the search period for a total of 6 confirmed cases. Four thoracic radiologists (1 an adjudicator) evaluated chest radiographs and computed tomography (CT) examinations, and Fisher exact and Mann-Whitney tests were used to identify any significant differences in imaging features (P<0.05). RESULTS:A reversed halo sign was more frequent for all readers (P=0.001) in confirmed RML torsion than patients without torsion (83.3% vs. 0% for 3 readers, one the adjudicator). The CT coronal bronchial angle between RML bronchus and bronchus intermedius was larger (P=0.035) in torsion (121.28 degrees) than nontorsion cases (98.26 degrees). Patients with torsion had a higher percentage of ground-glass opacity in the affected lobe (P=0.031). A convex fissure towards the adjacent lobe on CT (P=0.009) and increased lobe volume on CT (P=0.001) occurred more often in confirmed torsion. CONCLUSION/CONCLUSIONS:A reversed halo sign, larger CT coronal bronchial angle, greater proportion of ground-glass opacity, fissural convexity, and larger lobe volume on CT may aid in early recognition of the rare yet highly significant diagnosis of lobar torsion.
PMID: 37732714
ISSN: 1536-0237
CID: 5614062

ACR Appropriateness Criteria® Routine Chest Imaging

Bang, Tami J; Chung, Jonathan H; Walker, Christopher M; Brixey, Anupama G; Christensen, Jared D; Faiz, Saadia A; Hanak, Michael; Hobbs, Stephen B; Kandathil, Asha; Little, Brent P; Madan, Rachna; Moore, William H; Richman, Ilana B; Setters, Belinda; Todd, Michael J; Yang, Stephen C; Donnelly, Edwin F
Routine chest imaging has been used to identify unknown or subclinical cardiothoracic abnormalities in the absence of symptoms. Various imaging modalities have been suggested for routine chest imaging. We review the evidence for or against the use of routine chest imaging in different clinical scenarios. This document aims to determine guidelines for the use of routine chest imaging as initial imaging for hospital admission, initial imaging prior to noncardiothoracic surgery, and surveillance imaging for chronic cardiopulmonary disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
PMID: 37236745
ISSN: 1558-349x
CID: 5508732