Faculty Bibliography

As the first part of several focused updates to the clinical practice guideline on the treatment and management of COVID-19 in adults, children, and pregnant people, developed by the Infectious Diseases Society of America, the panel presents four new recommendations. These recommendations include pre-exposure prophylaxis for immunocompromised persons and treatment of severe or critical COVID-19. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

BACKGROUND:Hispanic/Latinx males and those who are non-English proficient are significantly less likely to receive germline genetic evaluation for prostate cancer. Undertesting can impact downstream outcomes, including reduced access to approved targeted therapies, barriers to precision medicine trials, and hereditary cancer assessment for patients and family members. The goal of our study was to explore the knowledge and perceptions of genetic testing among U.S. Hispanic males, with the ultimate goal to identify potentially actionable targets to increase guideline-concordant genetic evaluation. METHODS:We conducted a nationwide online survey including U.S. Hispanic males aged ≥ 40 in English and Spanish using the 9-item Knowledge of Hereditary Prostate Cancer Scale and adapted questions about desire for more information from the Behavioral Beliefs about BRCA Genetic Counseling scale. RESULTS:Among 807 participants, the mean score for genetic knowledge was 5.8 out of 9, with gaps in understanding of incomplete penetrance of genes and maternal genetic inheritance. Medical mistrust and lower health literacy were associated with significantly lower knowledge of prostate cancer genetics. Overall, attitudes toward genetic counseling were favorable, with the majority of participants endorsing that it would help with decision-making, is concordant with cultural beliefs, and that they were interested in more information. Concerns about genetic evaluation included cost and impact for insurance. CONCLUSIONS:Despite generally favorable attitudes toward genetic evaluation among Hispanic males, there are important knowledge gaps, including the importance of both maternal and paternal family history, as well as logistical concerns. Addressing these gaps through culturally targeted outreach may help to promote equitable uptake of germline genetic evaluation.

BACKGROUND:Molecular imaging, particularly positron emission tomography (PET), has significantly advanced the diagnosis and management of disease by visualizing biological processes at a cellular and molecular level. PET imaging of the brain, spine, and head/neck, summarized under the umbrella term Neuro-PET, enables noninvasive diagnosis and monitoring of diseases such as dementia, epilepsy, cancer, movement, or autoimmune disorders. The rising prevalence of these conditions, as well as new treatment options necessitating response assessment, are expected to escalate Neuro-PET imaging volumes, with projections for a significant increase in the need for specialized imaging services. This increasing clinical need highlights existing workforce shortages and underscores the need for neuroradiologists to acquire proficiency in molecular imaging. This expanded role seeks to address the growing demand. To this end, we propose a rigorous, structured, patient-centered, and collaborative framework for expanding neuroradiologists' training and practice to include Neuro-PET interpretation. METHODS:This ASNR consensus statement outlines competency recommendations, training pathways, and implementation strategies to incorporate Neuro-PET into neuroradiology practice. This approach is based on existing guidelines and was informed by survey data from neuroradiologists and molecular imaging subspecialists revealing current practice patterns and training needs. For neuroradiology fellows, structured training encompasses hands-on Neuro-PET imaging experience, understanding the biologic and molecular basis of radiopharmaceuticals used in Neuro-PET, and integrating molecular insights with anatomical data. Neuroradiologists beyond fellowship can undertake practice-based curriculum involving supervised case interpretation, standardized reader training courses, continuing medical education (CME), and peer review. KEY MESSAGE/CONCLUSIONS:Neuroradiologists, with their in-depth expertise of central nervous system structure and function, are well positioned to meld molecular imaging data with traditional anatomical findings. They can achieve competency and should be granted practice privileges in interpreting Neuro-PET studies through a comprehensive combination of structured training, hands-on clinical experience, and documented CME hours. ABBREVIATIONS/BACKGROUND:PET = positron emission tomography; CME = continuing medical education; ACR= American College of Radiology.

INTRODUCTION/BACKGROUND:Dorsal preservation rhinoplasty (DPR) is increasingly popular, with some suggesting superior outcomes over open structural rhinoplasty (OSR). To date, there has been little investigation into comparative outcomes between the techniques. This study aims to ascertain whether experts in the field can differentiate between the techniques in aesthetic outcomes. METHODS:A survey was created that consisted of OSR and DPR cases with an average 2.5 month and 1 year follow-up. The survey was distributed to the Rhinoplasty Society and Dallas Rhinoplasty instructors. Results were correlated to expertise in rhinoplasty. Univariate analysis was performed using Chi-square or Fischer's exact test for categorical variables and Student's t-test for continuous variables. Pearson's correlation coefficient was used to assess the relationship between study variables. Statistical significance was defined as p < 0.05. RESULTS:Fifty-one plastic surgeons responded (24.2 % response rate). Participants averaged almost 10 years of experience, with an average 58 rhinoplasties performed annually. 59% used open techniques and 39% used both open and closed. 54.5% utilized preservation techniques. The average correct survey score was 58% at 2.5 months and 61% at 1 year. There was no positive correlation between survey score and rhinoplasties performed, experience in years, comfort level or utilization of preservation rhinoplasty techniques. CONCLUSIONS:The study demonstrates no discernable differences in aesthetic results when using OSR and DPR techniques at 1 year after surgery. Ultimately, OSR and DPR techniques should both be considered and potentially combined, when performing rhinoplasty. LEVEL OF EVIDENCE V/METHODS:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

INTRODUCTION/BACKGROUND:Delays in time to surgery (TTS) for patients with a hip fracture negatively affect patient outcomes, including mortality. Surgery within 24 to 48 hours of admission for a hip fracture markedly reduces these risks; however, attempts at improving TTS after hip fracture have had mixed results. Drivers of delays in TTS across different settings in the United States are not well described. Therefore, the aim of this study was to identify drivers of delays in TTS for patients with a hip fracture from different settings to inform where patient- and context-specific improvements in TTS may be implemented. METHODS:Semistructured interviews were completed using the Consolidated Framework for Implementation Research and Theoretical Domains Framework. Interviews were completed with stakeholders involved in hip fracture care between June 2023 and October 2023. Transcripts were analyzed iteratively through a combined inductive and deductive approach. The data were analyzed to synthesize overarching themes related to drivers of delays of TTS. RESULTS:A total of 25 stakeholders, 24 orthopaedic surgeons, and 1 nurse practitioner, from 22 different hospital systems across the United States participated in semistructured interviews. Eight themes of drivers of delayed TTS emerged: (1) patient health; (2) structural drivers of health; (3) care coordination; (4) prioritization; (5) improvement climate; (6) availability; (7) incentive structure; and (8) empowerment. CONCLUSION/CONCLUSIONS:Eight major themes related to drivers in TTS for patients with a hip fracture were identified across hospital systems. These findings inform the process of identifying site-specific drivers of delayed TTS at individual health systems and implementing targeted improvement programs for TTS for patients with a hip fracture.

STUDY DESIGN/METHODS:Prospective, multi-center analysis. OBJECTIVE:Evaluate the impact that self-image has upon operative vs. nonoperative treatment choice for adult spine deformity (ASD) patients, and evaluate the association of post-treatment self-image with treatment satisfaction. SUMMARY OF BACKGROUND DATA/BACKGROUND:ASD outcomes traditionally focus upon pain and physical function. Self-image is an important outcome measure for pediatric spine deformity. Little data exists regarding the impact self-image has upon ASD treatment choice and outcomes. METHODS:Factor analysis and decision tree modeling was performed upon ASD patients prospectively enrolled into a multi-center study from 2009-2020. Data elements from physical examination, demographics, spinal alignment, and individual questions from administered PROMs including SRS-22r, ODI, SF-36, and NRS back and leg pain were evaluated for variables that correlated most with (1) patients electing for operative vs. nonoperative treatment and (2) treatment satisfaction at minimum 2-year follow-up. RESULTS:Evaluation of 735 ASD patients demonstrated operatively treated patients (OP; n=548) were older (58.0±15.3 vs. 52.4±16.0 years; P<0.0001), had similar scoliosis (44.9±20.1° vs. 45.5±16.1°; P=0.5555) but worse sagittal malalignment than nonoperatively treated patients (NON; n=187; P<0.0001, respectively). Baseline PROMs were worse for OP vs. NON (P<0.0001). Gradient-boosted decision trees, factor analysis, and logistic regression of demographic, physical examination, radiographic, and PROM variables associated with treatment choice demonstrated self-image (odds ratio=4.5; 95% CI=3.4-6.0; P<0.0001) had the greatest correlation for patients choosing operative treatment. At minimum 2-year follow-up self-image demonstrated the greatest health domain improvement for OP and self-image improvement correlated most with post-treatment satisfaction, while NON demonstrated deterioration of self-image and reported poor treatment satisfaction. CONCLUSION/CONCLUSIONS:Multi-variable evaluation of 735 operative and nonoperative treated ASD patients demonstrated baseline self-image strongly correlated with ASD patients pursuing surgical treatment and postoperative treatment satisfaction. Patient self-image is a critical measure that must be assessed in ASD.

Trauma is a personal stress response to experiences perceived as harmful or life-threatening, and has ongoing impacts on illness and health. Exposure to trauma is increasingly prevalent, and the risk of medical trauma or re-traumatization is heightened for people living with serious illness. Trauma not only impacts health outcomes, but can also interfere with decision-making and worsen symptom burden at the end of life. Thus, it is critical that palliative care clinicians in all professions be skilled at providing high-quality trauma-informed care (TIC). TIC seeks to provide more holistic and equitable care through better understanding of how a person's life situation impacts behavior, reactions, behavior, responses, or relationships. A clinician using a trauma-informed lens asks, "What has happened to this person?" instead of, "What is wrong with this person?" A "universal precautions" approach is recommended, encouraging broad acknowledgment of possible trauma and recognition of signs of trauma responses, to better understand triggers for medical retraumatization among patients, caregivers, and even us as clinicians. TIC provides a framework that guides clinicians to acknowledge the widespread experience and consequences of trauma, recognize the symptoms of traumatic stress, mitigate mistrust and disempowerment, and advocate for culture change in health care systems to reduce the risk of further health care-based traumatization.

A digital twin is a computational model that provides a virtual representation of a specific physical object, system, or process and predicts its behavior at future time points. These simulation models form computational profiles for new diagnosis and prevention models. The digital twin is a concept borrowed from engineering. However, the rapid evolution of this technology has extended its application across various industries. In recent years, digital twins in healthcare have gained significant traction due to their potential to revolutionize medicine and drug development. In the context of radiology, digital twin technology can be applied in various areas, including optimizing medical device design, improving system performance, facilitating personalized medicine, conducting virtual clinical trials, and educating radiology trainees. Also, radiologic image data is a critical source of patient-specific measures that play a role in generating advanced intelligent digital twins. Generating a practical digital twin faces several challenges, including data availability, computational techniques, validation frameworks, and uncertainty quantification, all of which require collaboration among engineers, healthcare providers, and stakeholders. This review focuses on recent trends in digital twin technology and its intersection with radiology by reviewing applications, technological advancements, and challenges that need to be addressed for successful implementation in the field.

BACKGROUND:While treat-to-target urate-lowering therapy (ULT) is endorsed as best practice in gout management, limited data exist on its impact on health-related quality of life (HRQoL). We assessed the impact of treat-to-target ULT on HRQoL among participants receiving protocolized gout care, identifying factors associated with HRQoL and HRQoL change. METHODS:This was a post-hoc analysis of a 72-week randomized trial, pooling data from allopurinol and febuxostat treatment arms. The VR-12 and EQ-5D-3L were administered at baseline, 24-, 48-, and 72-weeks. HRQoL changes over follow-up were examined using paired t-tests. Factors associated with baseline HRQoL were evaluated using multivariable linear regression. General estimating equations (GEE) were used to identify determinants of HRQoL change over follow-up. RESULTS:Participants (n=878) in this analysis were 98.9% male, had a mean age of 62.4 years, and 67.4% self-reported White race. HRQoL scores overall, and particularly the domains of physical function, mobility and pain, improved significantly over 72-weeks (p<0.001) with improvements noted by 24-weeks. Poorer enrollment HRQoL was associated with younger age, non-White race, tophi (for EQ-5D-3L), higher serum urate, and greater comorbidity. Baseline factors associated with HRQoL improvements over 72-weeks of ULT included lower C-reactive protein and lower comorbidity scores with similar changes observed by ULT assignment. CONCLUSIONS:Treat-to-target ULT in gout is accompanied by HRQoL improvements evident by 24-weeks and sustained through 72-weeks. HRQoL gains with treat-to-target ULT are most prominent in the domains of physical function, mobility, and pain and are greatest in those with lower baseline levels of inflammation and comorbidity.

BACKGROUND:Motor stereotypies (MS) represent one of the transdiagnostic symptom dimensions identified by the NIMH Research Domain Criteria work group as relevant to psychopathology. MS are common in neurodevelopmental conditions, but they remain poorly understood, particularly in early childhood. The present study examined MS in 648 toddlers with autism spectrum disorder (autism, n = 455) and other neurodevelopmental conditions (non-autism, n = 193) and their concurrent and prospective links with other phenotypic characteristics. METHODS:Toddlers were recruited between February 2000 and October 2018 and evaluated at 24 +/- 5 months (Time 1, N = 648) and 41 +/- 6 months (Time 2, N = 455). The presence of MS was determined based on the Autism Diagnostic Observation Schedule assessment. The phenotypic measures included adaptive socialization skills, severity of social symptoms of autism, and verbal, nonverbal, and motor skills. The analysis was conducted using the general linear models while controlling for age, sex, visit year, group, and other relevant covariates. RESULTS: CONCLUSIONS:Motor stereotypies are present in toddlers with and without autism and may represent a distinct transdiagnostic dimension expressed early in development, associated with core developmental skills and, putatively, characterized by shared pathophysiology across neurodevelopmental conditions.