Social Determinants of Health Framework to Identify and Reduce Barriers to Imaging in Marginalized Communities.

Social determinants of health (SDOH) are conditions influencing individuals' health based on their environment of birth, living, working, and aging. Addressing SDOH is crucial for promoting health equity and reducing health outcome disparities. For conditions such as stroke and cancer screening where imaging is central to diagnosis and management, access to high-quality medical imaging is necessary. This article applies a previously described structural framework characterizing the impact of SDOH on patients who require imaging for their clinical indications. SDOH factors can be broadly categorized into five sectors: economic stability, education access and quality, neighborhood and built environment, social and community context, and health care access and quality. As patients navigate the health care system, they experience barriers at each step, which are significantly influenced by SDOH factors. Marginalized communities are prone to disparities due to the inability to complete the required diagnostic or screening imaging work-up. This article highlights SDOH that disproportionately affect marginalized communities, using stroke and cancer as examples of disease processes where imaging is needed for care. Potential strategies to mitigate these disparities include dedicating resources for clinical care coordinators, transportation, language assistance, and financial hardship subsidies. Last, various national and international health initiatives are tackling SDOH and fostering health equity.

Time-Driven, Activity-Based Costing to Reduce Interventional Radiology Suite Idle Time.

Background With the ever-increasing complexity of today's healthcare environment, it is evident that there is a higher demand to deliver high-quality, accessible, efficient, and affordable healthcare. At the same time, these changes are accompanied by decreasing rates of reimbursement. This can be attributed to the shift from fee-for-service to value-based payment methods in the industry. The reception of such changes in the appropriate manner is crucial to improvement and the much-demanded reform in our healthcare system. To adapt to this changing landscape, hospitals and healthcare systems must incorporate proper measures to identify extraneous spending, control costs, and streamline patient care. Our goal in this study was to use the time-driven, activity-based costing (TDABC) model to quantify the costs at every step as an inpatient goes through the care process in an interventional radiology department. Methodology After identification and mapping of all the steps involved from interventional radiology (IR) consult placement to patient transport to the postoperative recovery area, time data were collected for each step of the process. One of the steps was then selected for intervention. Our focus was on the time interval between one patient leaving after a completed procedure and the next scheduled patient entering the IR suite (heretofore referred to as idle time). To decrease the idle room time between patients, the interventional radiologists, IR administrations, nurse manager, transportation manager, and charge nurse first met as a group to set a realistic initial goal. Pre-intervention data were collected. Results After the collection of pre-intervention data, the average idle time of the IR suite was found to be 40 minutes. After a multidisciplinary discussion, our goal was to reduce this time to 25 minutes. Post-intervention data found the average time decreased to 24 minutes. Calculation of average costs per unit time for staff, IR room, and equipment yielded an approximate cost of $57 per minute of time in the IR suite. Conclusions Considering the near 40% decrease in suite idle time as well as the cost per minute of material, equipment, and staff (at ~80% capacity), this study proves that the TDABC system is a viable method of targeting bottlenecks in operations and streamlining patient care by reducing costs while optimizing the process patients go through during care continuum.

Embolization of Large Internal Iliac Artery Pseudoaneurysm through a Retrograde Trans-Superior Gluteal Arterial Access.

The presence of osteal stenosis/occlusion or osteal exclusion by prior interventions poses a challenge to selective catheterization of the internal iliac artery. We describe a case where a retrograde access through the superior gluteal artery (SGA) was used to successfully treat an internal iliac artery pseudoaneurysm (PSA) in a patient when an antegrade catheterization was not feasible due to internal iliac osteal exclusion by an endograft.

Changes in Measures of Vestibular and Balance Function and Hippocampus Volume in Alzheimer's Disease and Mild Cognitive Impairment.

OBJECTIVE: To test the hypotheses that people with Alzheimer's disease and mild cognitive impairment have increased frequency of vestibular impairments and decreased hippocampal volume compared with healthy age-matched controls. STUDY DESIGN: Retrospective, with some historical controls. SETTING: Out-patient, tertiary care center. SUBJECTS: People with mild to moderate dementia diagnosed with Alzheimer's disease and with mild cognitive impairment. Main Outcome Measures: A standard clinical battery of objective tests of the vestibular system, and screening for balance; available clinical diagnostic magnetic resonance imaging (MRIs) were reviewed and postprocessed to quantify the left and right hippocampal volumes utilizing both manual segmentation and computer automated segmentation. RESULTS: Study subjects (N = 26) had significantly more vestibular impairments, especially on Dix-Hallpike maneuvers and cervical vestibular evoked myogenic potentials (cVEMP), than historical controls. No differences were found between mild and moderate dementia subjects. Independence on instrumental activities of daily living in subjects with age-normal balance approached statistical differences from subjects with age-abnormal balance. MRI data were available for 11 subjects. Subjects with abnormal cVEMP had significantly reduced left hippocampal MRIs using manual segmentation compared with subjects with normal cVEMP. CONCLUSION: The data from this small sample support and extend previous evidence for vestibular impairments in this population. The small MRI sample set should be considered preliminary evidence, and suggests the need for further research, with a more robust sample and high-resolution MRIs performed for the purpose of hippocampal analysis.

Angiogenic gene networks are dysregulated in opioid use disorder: evidence from multi-omics and imaging of postmortem human brain.

Opioid use disorder (OUD) is a public health crisis in the U.S. that causes over 50 thousand deaths annually due to overdose. Using next-generation RNA sequencing and proteomics techniques, we identified 394 differentially expressed (DE) coding and long noncoding (lnc) RNAs as well as 213 DE proteins in Brodmann Area 9 of OUD subjects. The RNA and protein changes converged on pro-angiogenic gene networks and cytokine signaling pathways. Four genes (LGALS3, SLC2A1, PCLD1, and VAMP1) were dysregulated in both RNA and protein. Dissecting these DE genes and networks, we found cell type-specific effects with enrichment in astrocyte, endothelial, and microglia correlated genes. Weighted-genome correlation network analysis (WGCNA) revealed cell-type correlated networks including an astrocytic/endothelial/microglia network involved in angiogenic cytokine signaling as well as a neuronal network involved in synaptic vesicle formation. In addition, using ex vivo magnetic resonance imaging, we identified increased vascularization in postmortem brains from a subset of subjects with OUD. This is the first study integrating dysregulation of angiogenic gene networks in OUD with qualitative imaging evidence of hypervascularization in postmortem brain. Understanding the neurovascular effects of OUD is critical in this time of widespread opioid use.

Intraspinal pseudomeningoceles: A rare complication of spinal trauma and surgery.

We present two cases of acute and delayed presentations of intraspinal pseudomeningoceles, which is a rare complication of spinal trauma or surgery. Our goal is to discuss the pathophysiology, clinical presentation, imaging findings, and treatment of this rare entity. This diagnosis should be considered in patients with unexplained neurologic symptoms in the setting of prior cervical spine injury or surgery.

Volumetric Analysis of the Vocal Folds Using Computed Tomography: Effects of Age, Height, and Gender.

OBJECTIVE: The goal of this study was to use computed tomography (CT) volumetric analysis to assess the effect of age, gender, height, body mass index (BMI), and ethnicity on vocal fold volume in patients with normal larynges. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Vocal fold length, width, and height were measured in a total of 105 patients without a history of laryngeal or thyroid pathology on thin-section soft-tissue neck CTs. The product of the three dimensions was used to calculate vocal fold volume. Simple and multiple linear regression analyses were used to assess for an association between vocal fold volume and age, gender, height, BMI, and ethnicity. Intraclass correlation coefficients (ICCs) were estimated to evaluate the degree interobserver and intraobserver agreement. RESULTS: Vocal fold volume was not associated with age, BMI, or ethnicity. Gender-adjusted height (P = .002) and height-adjusted gender (P = .016) were significantly associated with volume. Height remained significantly associated with volume after stratifying by gender (P < 0.001). There was moderate-to-good correlation in both interobserver (ICC = 0.690 to 0.761) and intraobserver (ICC = 0.733 to 0.873) agreement. CONCLUSION: Age was not associated with vocal fold volume, which is in accordance with several prior negative studies. Age-related vocal fold atrophy may not substantially contribute to presbyphonia symptoms, but other processes such as changes in the extracellular matrix may play a larger role. However, both gender and height were independently associated with vocal fold volume. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E240-E247, 2021.

To Sustain or not to Sustain: Varying Educational Sessions on Advanced Imaging of Low Back Pain and R-SCAN.

PURPOSE: The aim is to present our long-term institutional experience on the use of the American College of Radiology's (ACR's) Radiology Support, Communication, and Alignment Network (R-SCAN) via educational presentations and guideline dissemination in sustaining lumbar spine magnetic resonance imaging (MRI) appropriateness for low back pain. METHODS: Initial educational presentations on appropriate use criteria for lumbar spine MRI were given to referring providers at three county clinics in April and May of 2016. A second educational refresher was given to the same 3 clinics in November 2017: Clinic A received guideline dissemination, Clinic B served as a control group, and Clinic C received a refresher presentation. Wilcoxon rank-sum test was used to compare the monthly MRI referral rate and ACR Appropriateness Criteria rating. RESULTS: There was no significant difference in monthly referral rates and ACR Appropriateness Criteria after the second education. Monthly referral rates were significantly lower than the baseline rates before the first education for Clinic A (P <0.001), C (P = 0.004), and the combined total (P = 0.002). ACR Appropriateness Criteria ratings were significantly higher than the baseline ratings before the first education for Clinic C (P = 0.002) and the combined total (P = 0.024). DISCUSSION: After the second education, inappropriateness, and referral rates remained significantly lower when compared to rates before but not after the first education. Radiology Support, Communication, and Alignment Network is an invaluable online tool for both radiology practices and referring clinicians to become familiar in preparing to comply with the Protecting Access to Medicare Act and satisfying the Improvement Activities category of the Merit Based Incentive Payment Systems.

Adult Primary Brain Neoplasm, Including 2016 World Health Organization Classification.

In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.

Intracranial Rhabdomyosarcoma of the Cerebellopontine Angle in a 6-year-old Child: A Case Report.

Rhabdomyosarcoma (RMS) is the most common soft-tissue malignancy in children under 15 years of age. Approximately, 35% of RMS cases originate from the head and neck region. Among various sites in the head and neck region, intracranial extension is more likely to occur with parameningeal tumors, which is also considered an unfavorable prognostic factor in children with RMS. About 20% of RMS occurs in a parameningeal site. Intracranial RMS are rare tumors that usually arise from parameningeal sites or metastasis from an extracranial site. Primary intracranial types are even rarer, with only 50 reported cases of primary intracranial RMS in the literature. Hereby, we report the case of a 6-year-old boy who presented with clinical and radiologic features of a cerebellopontine angle lesion, which turned out to be a RMS.

Assessment of the Radiology Support, Communication and Alignment Network to Reduce Medical Imaging Overutilization: A Multipractice Cohort Study.

PURPOSE: The aim of this study was to determine whether participation in Radiology Support, Communication and Alignment Network (R-SCAN) results in a reduction of inappropriate imaging in a wide range of real-world clinical environments. METHODS: This quality improvement study used imaging data from 27 US academic and private practices that completed R-SCAN projects between January 25, 2015, and August 8, 2018. Each project consisted of baseline, educational (intervention), and posteducational phases. Baseline and posteducational imaging cases were rated as high, medium, or low value on the basis of validated ACR Appropriateness Criteria®. Four cohorts were generated: a comprehensive cohort that included all eligible practices and three topic-specific cohorts that included practices that completed projects of specific Choosing Wisely topics (pulmonary embolism, adnexal cyst, and low back pain). Changes in the proportion of high-value cases after R-SCAN intervention were assessed for each cohort using generalized estimating equation logistic regression, and changes in the number of low-value cases were analyzed using Poisson regression. RESULTS: Use of R-SCAN in the comprehensive cohort resulted in a greater proportion of high-value imaging cases (from 57% to 79%; odds ratio, 2.69; 95% confidence interval, 1.50-4.86; P = .001) and 345 fewer low-value cases after intervention (incidence rate ratio, 0.45; 95% confidence interval, 0.29-0.70; P < .001). Similar changes in proportion of high-value cases and number of low-value cases were found for the pulmonary embolism, adnexal cyst, and low back pain cohorts. CONCLUSIONS: R-SCAN participation was associated with a reduced likelihood of inappropriate imaging and is thus a promising tool to enhance the quality of patient care and promote wise use of health care resources.

Construction of a Machine Learning Dataset through Collaboration: The RSNA 2019 Brain CT Hemorrhage Challenge.

This dataset is composed of annotations of the five hemorrhage subtypes (subarachnoid, intraventricular, subdural, epidural, and intraparenchymal hemorrhage) typically encountered at brain CT.

Erratum: Construction of a Machine Learning Dataset through Collaboration: The RSNA 2019 Brain CT Hemorrhage Challenge.

[This corrects the article DOI: 10.1148/ryai.2020190211.].

Adult Primary Brain Neoplasm, Including 2016 World Health Organization Classification.

In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.

Acute Subdural Hemorrhage of a Convexity Meningioma in the Postpartum Period; Case Report and Literature Review.

New onset seizures in pregnancy or the postpartum period can be of great importance and denote various underlying pathologies. Eclampsia and cerebrovascular accidents are common, and brain tumors are uncommon causes of postpartum seizures among others. Acute presentation of brain tumors in pregnancy or the postpartum period is extremely rare. Meningiomas are the most common benign intracranial tumors. Although 1.3 to 2.4% of these benign tumors may bleed, acute presentation of them with hemorrhage is quite rare. Herein, we report a rare case of a 36-year-old lady who presented with severe headache, seizure, and loss of consciousness in the postpartum period, five days after delivery of a full-term baby. Primary emergency evaluation revealed an extra-axial lesion with subdural hemorrhage. A Decompressive craniectomy was performed, hematoma was evacuated, and the tumor was totally resected. Histopathologic evaluation was consistent with a fibroblastic meningioma (WHO grade I). She was discharged in good general condition. Our case highlights the significance of complete evaluation of patients with new-onset seizures in pregnancy or the postpartum period. Although uncommon, brain tumors in pregnancy can have potentially devastating outcomes which may necessitate prompt surgical intervention.

Radiology Support, Communication, and Alignment Network and Its Role to Promote Health Equity in the Delivery of Radiology Care.

Racial, ethnic, and socioeconomic disparities in radiological care have been well documented in both the emergency and outpatient setting. Health IT has the potential to facilitate equitable care across diverse populations. Ordering the appropriate study is the first step in the greater mission of improving access and equity for everyone. Radiology Support, Communication, and Alignment Network (R-SCAN) is an informatics-based solution using clinical decision support (CDS) to promote health equity through optimization in appropriate imaging utilization. R-SCAN and CDS may help combat the potential implicit bias of clinicians by providing evidence-based imaging guidelines at the point of care and ensure that patients will receive equitable and appropriate imaging regardless of ethnic and socioeconomic background. By fostering multidisciplinary collaboration between radiologists and referring clinicians, R-SCAN initiatives across the nation have demonstrated successful reductions in inappropriate imaging utilization, particularly in regions with vulnerable populations.