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Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

Abashidze, Nino; Stecher, Chad; Rosenkrantz, Andrew B; Duszak, Richard; Hughes, Danny R
Importance/UNASSIGNED:Prostate cancer screening and diagnosis exhibit known racial and ethnic disparities. Whether these disparities persist in prostate magnetic resonance imaging (MRI) utilization after elevated prostate-specific antigen (PSA) results is poorly understood. Objective/UNASSIGNED:To assess potential racial and ethnic disparities in prostate MRI utilization following elevated PSA results. Design, Setting, and Participants/UNASSIGNED:This cohort study of 794 809 insured US men was drawn from deidentified medical claims between January 2011 and December 2017 obtained from a commercial claims database. Eligible participants were aged 40 years and older and received a single PSA result and no prior PSA screening or prostate MRI claims. Analysis was performed in January 2021. Main Outcomes and Measures/UNASSIGNED:Multivariable logistic regression was used to examine associations between elevated PSA results and follow-up prostate MRI. For patients receiving prostate MRI, multivariable regressions were estimated for the time between PSA and subsequent prostate MRI. PSA thresholds explored included PSA levels above 2.5 ng/mL, 4 ng/mL, and 10 ng/mL. Analyses were stratified by race, ethnicity, and age. Results/UNASSIGNED:Of 794 809 participants, 51 500 (6.5%) had PSA levels above 4 ng/mL; of these, 1524 (3.0%) underwent prostate MRI within 180 days. In this sample, mean (SD) age was 59.8 (11.3) years (range 40-89 years); 31 350 (3.9%) were Asian, 75 935 (9.6%) were Black, 107 956 (13.6%) were Hispanic, and 455 214 (57.3%) were White. Compared with White patients, Black patients with PSA levels above 4 ng/mL and 10 ng/mL were 24.1% (odds ratio [OR], 0.78; 95% CI, 0.65-0.89) and 35.0% (OR, 0.65; 95% CI, 0.50-0.85) less likely to undergo subsequent prostate MRI, respectively. Asian patients with PSA levels higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients with PSA levels above 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo subsequent prostate MRI compared with White patients. Black patients between ages 65 and 74 years with PSA above 4 ng/mL and 10 ng/mL were 23.6% (OR, 0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.35-0.91) less likely to undergo MRI, respectively. Race and ethnicity were not significantly associated with mean time between PSA and MRI. Conclusions and Relevance/UNASSIGNED:Among men with elevated PSA results, racial and ethnic disparities were evident in subsequent prostate MRI utilization and were more pronounced at higher PSA thresholds. Further research is needed to better understand and mitigate physician decision-making biases and other potential sources of disparities in prostate cancer diagnosis and management.
PMID: 34748010
ISSN: 2574-3805
CID: 5050252

A workflow to generate patient-specific three-dimensional augmented reality models from medical imaging data and example applications in urologic oncology

Wake, Nicole; Rosenkrantz, Andrew B; Huang, William C; Wysock, James S; Taneja, Samir S; Sodickson, Daniel K; Chandarana, Hersh
Augmented reality (AR) and virtual reality (VR) are burgeoning technologies that have the potential to greatly enhance patient care. Visualizing patient-specific three-dimensional (3D) imaging data in these enhanced virtual environments may improve surgeons' understanding of anatomy and surgical pathology, thereby allowing for improved surgical planning, superior intra-operative guidance, and ultimately improved patient care. It is important that radiologists are familiar with these technologies, especially since the number of institutions utilizing VR and AR is increasing. This article gives an overview of AR and VR and describes the workflow required to create anatomical 3D models for use in AR using the Microsoft HoloLens device. Case examples in urologic oncology (prostate cancer and renal cancer) are provided which depict how AR has been used to guide surgery at our institution.
PMID: 34709482
ISSN: 2365-6271
CID: 5042602

Oncologic Errors in Diagnostic Radiology: A 10-Year Analysis Based on Medical Malpractice Claims

Rosenkrantz, Andrew B; Siegal, Dana; Skillings, Jillian A; Muellner, Ada; Nass, Sharyl J; Hricak, Hedvig
PURPOSE/OBJECTIVE:To retrospectively analyze the nature and extent of oncology-related errors accounting for malpractice allegations in diagnostic radiology. METHODS:The Comparative Benchmarking System of the Controlled Risk Insurance Company, a database containing roughly 30% of medical malpractice claims in the United States, was searched retrospectively for the period 2008 to 2017. Claims naming radiology as a primary service were identified and were stratified and compared by oncologic versus nononcologic status, allegation type (diagnostic versus nondiagnostic), and imaging modality. RESULTS:Over the 10-year period, radiology was the primary responsible service for 3.9% of all malpractice claims (2,582 of 66,061) and 12.8% of claims with diagnostic allegations (1,756 of 13,695). Oncology (neoplasms) accounted for 44.0% of radiology cases with diagnostic allegations, a larger share than any other category of medical condition. Among radiology cases with diagnostic allegations, high-severity harm occurred in 79% of oncologic but just 42% of nononcologic cases. Of all oncologic radiology cases, 97.4% had diagnostic allegations, and just 55.0% of nononcologic radiology cases had diagnostic allegations. Imaging misinterpretation was a contributing factor for a large majority (80.7% [623 of 772]) of oncologic radiology cases with diagnostic allegations. The modalities most commonly used in oncologic radiology cases with diagnostic allegations involving misinterpretation were mammography, CT, and MRI. CONCLUSION/CONCLUSIONS:Oncology represents the most common source of radiology malpractice cases with diagnostic allegations. Oncologic radiology malpractice cases are more likely than nononcologic radiology cases to be due to diagnostic errors and be associated with high-severity harm. Efforts are warranted to reduce misinterpretations of oncologic imaging.
PMID: 34058137
ISSN: 1558-349x
CID: 4891002

Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations

Santavicca, Stefan; Duszak, Richard; Nicola, Gregory N; Golding, Lauren Parks; Rosenkrantz, Andrew B; Wernz, Christian; Hughes, Danny R
PURPOSE/OBJECTIVE:The aim of this study was to temporally characterize radiologist participation in Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). METHODS:Using CMS Physician and Other Supplier Public Use Files, ACO provider-level Research Identifiable Files, and Shared Savings Program ACO Public-Use Files for 2013 through 2018, characteristics of radiologist ACO participation were assessed over time. RESULTS:Between 2013 and 2018, the percentage of Medicare-participating radiologists affiliated with MSSP ACOs increased from 10.4% to 34.9%. During that time, the share of large ACOs (>20,000 beneficiaries) with participating radiologists averaged 87.0%, while the shares of medium ACOs (10,000-20,000) and small ACOs (<10,000) with participating radiologists rose from 62.5% to 66.0% and from 26.3% to 51.6%, respectively. The number of physicians in MSSP ACOs with radiologists was substantially larger than those without radiologists (mean range across years, 573-945 vs. 107-179). Primary care physicians constituted a larger percentage of the physician population for ACOs without radiologists (average across years, 66.3% vs 38.5%), while ACOs with radiologists had a higher rate of specialist representation (56.0% vs 33.7%). Beneficiary age, race, and gender demographics were similar among radiologist-participating versus nonparticipating ACOs. CONCLUSIONS:In recent years, radiologist participation in MSSP ACOs has increased substantially. ACOs with radiologist participation are large and more diverse in their physician specialty composition. Nonparticipating radiologists should prepare accordingly.
PMID: 34022135
ISSN: 1558-349x
CID: 4887352

Editor's Notebook: August 2021 [Editorial]

Rosenkrantz, Andrew B
PMID: 34292088
ISSN: 1546-3141
CID: 4948432

Editor's Notebook: July 2021 [Editorial]

Rosenkrantz, Andrew B
PMID: 34180711
ISSN: 1546-3141
CID: 4926242

Radiologist Characteristics Associated with Interpretive Performance of Screening Mammography: A National Mammography Database (NMD) Study

Lee, Cindy S; Moy, Linda; Hughes, Danny; Golden, Dan; Bhargavan-Chatfield, Mythreyi; Hemingway, Jennifer; Geras, Agnieszka; Duszak, Richard; Rosenkrantz, Andrew B
Background Factors affecting radiologists' performance in screening mammography interpretation remain poorly understood. Purpose To identify radiologists characteristics that affect screening mammography interpretation performance. Materials and Methods This retrospective study included 1223 radiologists in the National Mammography Database (NMD) from 2008 to 2019 who could be linked to Centers for Medicare & Medicaid Services (CMS) datasets. NMD screening performance metrics were extracted. Acceptable ranges were defined as follows: recall rate (RR) between 5% and 12%; cancer detection rate (CDR) of at least 2.5 per 1000 screening examinations; positive predictive value of recall (PPV1) between 3% and 8%; positive predictive value of biopsies recommended (PPV2) between 20% and 40%; positive predictive value of biopsies performed (PPV3) between the 25th and 75th percentile of study sample; invasive CDR of at least the 25th percentile of the study sample; and percentage of ductal carcinoma in situ (DCIS) of at least the 25th percentile of the study sample. Radiologist characteristics extracted from CMS datasets included demographics, subspecialization, and clinical practice patterns. Multivariable stepwise logistic regression models were performed to identify characteristics independently associated with acceptable performance for the seven metrics. The most influential characteristics were defined as those independently associated with the majority of the metrics (at least four). Results Relative to radiologists practicing in the Northeast, those in the Midwest were more likely to achieve acceptable RR, PPV1, PPV2, and CDR (odds ratio [OR], 1.4-2.5); those practicing in the West were more likely to achieve acceptable RR, PPV2, and PPV3 (OR, 1.7-2.1) but less likely to achieve acceptable invasive CDR (OR, 0.6). Relative to general radiologists, breast imagers were more likely to achieve acceptable PPV1, invasive CDR, percentage DCIS, and CDR (OR, 1.4-4.4). Those performing diagnostic mammography were more likely to achieve acceptable PPV1, PPV2, PPV3, invasive CDR, and CDR (OR, 1.9-2.9). Those performing breast US were less likely to achieve acceptable PPV1, PPV2, percentage DCIS, and CDR (OR, 0.5-0.7). Conclusion The geographic location of the radiology practice, subspecialization in breast imaging, and performance of diagnostic mammography are associated with better screening mammography performance; performance of breast US is associated with lower performance. ©RSNA, 2021 Online supplemental material is available for this article.
PMID: 34156300
ISSN: 1527-1315
CID: 4918312

Gender Variation in Invited Presenters at Two National Radiology Specialty Meetings

Liu, Shu; Rosenkrantz, Andrew B
RATIONALE AND OBJECTIVES/OBJECTIVE:To assess gender balance amongst invited speakers at 2 national radiology conferences over the past decade. MATERIALS AND METHODS/METHODS:The 2009, 2014, and 2019 Association of University Radiologists (AUR) and American Roentgen Ray Society (ARRS) conference programs were evaluated for the number and gender of invited speakers, as well as various presentation characteristics. Gender balance was stratified across conferences and years. RESULTS:The final analysis included 1657 invited speakers and 45, 602 minutes of presentation. AUR showed a nonsignificant increase in the percent of presentations by women from 42.2% to 46.5% and in the percent of distinct female presenters from 41.6% to 46.0%. For ARRS, percentage of female presenters varied minimally from 36.1% to 38.2%. In AUR 2009, female presenters spoke on average 5.7min less than men (P= 0.042) and 6.5% of women gave lectures over 30 minutes vs 22.2% of men (P = 0.032). Subsequent AUR and ARRS conferences did not demonstrate presentation length disparities. For AUR, no keynote female speaker was identified. For ARRS, there was no significant difference in percentage of keynote speakers based on gender (P ≥0.516). A disproportionately high percentage of presentations before 8am (44.4%-66.7%) were by women. CONCLUSION/CONCLUSIONS:Female representation was greater than among the overall radiology workforce, highlighting a role of national societies in promoting female radiologists. Nonetheless, such representation is confounded by disproportionate underrepresentation in visibility of invited talks. While improvement in some presentation measures were observed, continued efforts are warranted to promote equal opportunities for female radiologists at national conferences.
PMID: 32553673
ISSN: 1535-6302
CID: 4485012

Comparison of Radiologists and Other Specialists in the Performance of Lumbar Puncture Procedures Over Time

Johnson, D R; Waid, M D; Rula, E Y; Hughes, D R; Rosenkrantz, A B; Duszak, R
BACKGROUND AND PURPOSE/OBJECTIVE:Lumbar punctures may be performed by many different types of health care providers. We evaluated the percentages of lumbar punctures performed by radiologists-versus-nonradiologist providers, including changes with time and discrepancies between specialties. MATERIALS AND METHODS/METHODS:statistical analyses were performed. RESULTS:< .001). CONCLUSIONS:Radiologists now perform most lumbar puncture procedures for Medicare beneficiaries in both the inpatient and outpatient settings. The continuing shift in lumbar puncture responsibility from other specialists to radiologists has implications for clinical workflows, cost, radiation exposure, and postgraduate training.
PMID: 33664117
ISSN: 1936-959x
CID: 4802432

Value of the New General Radiologist in Private Practice

Youmans, David C; Duszak, Richard; Rosenkrantz, Andrew B; Fleishon, Howard D; Friedberg, Eri B; Rodgers, Daniel A
PMID: 33676913
ISSN: 1558-349x
CID: 4808862