Interventional Radiology Physician Compensation at U.S. Medical Schools: Trends and Segments.

PURPOSE: The aim of this study was to assess recent US medical school trends in compensation for academic interventional radiologists (IR) and compensation characteristics based on rank, sex and race/ethnicity. METHODS: Data for IR and diagnostic radiologist (DR) compensation were obtained from the Association of American Medical Colleges (AAMC), which annually surveys U.S. medical schools. IR compensation data was analyzed from 2017 to 2023 with regard to rank, gender and race/ethnicity and compared with DR compensation. RESULTS: AAMC Faculty Salary Survey data for 2023 included responses for 874 IR faculty members, including 21 instructors, 457 assistant professors, 208 associate professors, 130 full professors, 42 chiefs and 16 chairs. Median compensation increased by a rate of 5.0% per year for instructors and 3.0-3.6% per year for all other ranks. Surveyed median, 25th and 75th percentile compensation for IR faculty were consistently greater than that of DR faculty at all ranks except chairs. From 2020 to 2023, this difference in compensation trended downwards. Compensation for women was lower than men with a 2023 gender pay difference of $35K (8.4%), $33K (7.5%), $26K (5.1%), and $32K (6.2%) for instructors, assistant, associate, and full professors respectively. In 2023, compared to White assistant professors, Asians made 94 cents on the dollar, Black/African-Americans made 97 cents on the dollar, and Hispanic/Latinx/Spanish-origin physicians made 95 cents on the dollar, at the same rank. CONCLUSION: IR faculty compensation has barely kept pace with inflation over recent years, overall increasing with rank, and overall higher than for DR counterparts.

Academic Radiology Physician Financial Compensation in the United States: Trends and Distribution.

Background The overall trends in academic radiology physician compensation are not well studied. Purpose To assess recent trends in academic radiology financial compensation and distribution based on rank, gender, race/ethnicity, and geography in U.S. medical schools. Materials and Methods This secondary analysis used deidentified data from the Association of American Medical Colleges (AAMC) Faculty Salary Report, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for full-time academic radiology faculty was collected from 2017 to 2023, stratified by rank, gender, race/ethnicity, and geography. The faculty salary report includes median, 25th, and 75th percentile compensation values for each rank, which were used to analyze trends with linear regression. Median compensation values were used to compare groups based on gender, race/ethnicity, and region. Results The AAMC Faculty Salary Report data for 2023 included responses for 5847 faculty members across all radiology departments, including 306 instructors, 2758 assistant professors, 1409 associate professors, 1004 full professors, 226 chiefs, and 144 chairs. On average, median faculty compensation increased by 2.6%-4.4% per year from 2017 to 2023, with the greatest increase (by 4.4% per year) at the instructor level and smaller increases (3.4%-2.6%) at the more senior ranks. Male faculty members were consistently compensated more than women at all ranks throughout the study period. The overall salary gap remained at 6% ($455 000 for women vs $483 000 for men) throughout the study period but increased numerically from $24 000 in 2019 to $28 000 in 2023. Black/African American faculty had a lower median compensation compared with White faculty (by 4% overall; $452 000 for Black/African American faculty vs $472 000 for White faculty) at all ranks except at professor rank. Instructor compensation in the Northeast region was substantially higher (by $278 000) than other regions, but this geographic differential did not exceed $35 000 at other ranks. Conclusion This study summarized the trends of full-time academic radiology faculty compensation and showed persistent salary inequities that should be addressed as part of a broader drive to increase diversity, equity, and inclusion. © RSNA, 2024 Supplemental material is available for this article.

Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis.

BACKGROUND: The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear. METHODS: In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses. RESULTS: 2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments. CONCLUSION: For patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.

Advanced US of the Skin, Nerves, and Muscles of the Neck: Pearls and Pitfalls with Use of High-Frequency Transducers.

High-frequency US provides excellent visualization of superficial structures and lesions, is a preferred diagnostic modality for anatomic characterization of neck abnormalities, and has a central role in clinical decision making. Recent technological advancements have led to the development of transducers that surpass 20 MHz, elevating high-frequency US to a highly valuable diagnostic tool with broader clinical use and enabling greater spatial resolution in the assessment of skin and superficial nerves and muscles. The authors focus on evolving applications of high-frequency US in neck imaging, emphasizing practical insights and strategies in skin and neuromuscular applications. ©RSNA, 2024 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Mediators of sex-specific differences in rates of stroke mimics among patients treated with intravenous thrombolysis: A nationwide analysis of 174,995 patients.

INTRODUCTION: Women are at higher risk of stroke mimics; however, the underlying reasons are unclear. METHODS: In this retrospective cohort study of the 2016-2020 National Inpatient Sample database, we identified patients treated with intravenous thrombolysis (IVT). Demographic information, vascular risk factors, comorbidities, and presence of known risk factors for stroke mimics (seizures, migraines, demyelinating diseases, psychiatric illnesses, and functional neurological disorders [FND]) were identified using ICD-10 codes. Rates of no cerebral infarction (NCI) were compared between men and women. Mediation analyses were conducted to identify significant drivers of sex-specific differences in the rate of NCI. RESULTS: 174,995 IVT-treated patients were identified; 41,605 (23.8 %) had NCI. Female patients had significantly higher rates of NCI compared to men (26.2 % vs. 20.9 %, p < 0.001). Women had significantly higher rates of stroke mimic risk factors (seizures, migraines, demyelinating disease, anxiety, depression, FND, and electrolyte derangements; all p < 0.001). Mediation analyses revealed that 39.8 %, 19.1 % of female sex's association with higher rates of NCI were mediated by higher rates of migraines and FND among women, respectively (both p < 0.001). CONCLUSIONS: IVT-treated women were more likely to have NCI than men. This relationship was largely mediated by higher rates of migraine and FND among women.

Distribution and Disparities of Industry Payments to Neuroradiologists.

BACKGROUND AND PURPOSE: Physician-industry relationships can be useful for driving innovation and technologic progress, though little is known about the scale or impact of industry involvement in neuroradiology. The purpose of this study was to assess the trends and distributions of industry payments to neuroradiologists. MATERIALS AND METHODS: Neuroradiologists were identified using a previously-validated method based on Work Relative Value Units and Neiman Imaging Types of Service classification. Data on payments from industry were obtained from the Open Payments database from the Centers for Medicare & Medicaid Services, from 2016 to 2021. Payments were grouped into 7 categories, including consulting fees, education, gifts, medical supplies, research, royalties/ownership, and speaker fees. Descriptive statistics were calculated. RESULTS: A total of 3019 neuroradiologists were identified in this study. Between 2016 and 2021, 48% (1440/3019) received at least 1 payment from industry, amounting to a total number of 21,967 payments. Each year, among those receiving payments from industry, each unique neuroradiologist received between a mean of 5.49-7.42 payments and a median of 2 payments, indicating a strong rightward skew to the distribution of payments. Gifts were the most frequent payment type made (60%, 13,285/21,967) but accounted for only 4.1% ($689,859/$17,010,546) of payment value. The greatest aggregate payment value came from speaker fees, which made up 36% ($6,127,484/$17,010,546) of the total payment value. The top 5% highest paid neuroradiologists received 42% (9133/21,967) of payments, which accounted for 84% ($14,284,120/$17,010,546) of the total dollar value. Since the start of the coronavirus 2019 (COVID-19) pandemic, the number of neuroradiologists receiving industry payments decreased from a mean of 671 neuroradiologists per year prepandemic (2016-2019) to 411 in the postpandemic (2020-2021) era (P = .030). The total number of payments to neuroradiologists decreased from 4177 per year prepandemic versus 2631 per year postpandemic (P = .011). CONCLUSIONS: Industry payments to neuroradiologists are highly concentrated among top earners, particularly among the top 5% of payment recipients. The number of payments decreased during the COVID-19 pandemic, though the dollar value of payments was offset by coincidental increases in royalty payments. Further investigation is needed in subsequent years to determine if the postpandemic changes in industry payment trends continue.

Post-Thrombectomy Subarachnoid Hemorrhage: Incidence, Predictors, Clinical Relevance, and Effect Modulators.

BACKGROUND: Subarachnoid hemorrhage (SAH) following endovascular thrombectomy (EVT) is a poorly understood phenomenon, and whether it is associated with clinical detriment is unclear. METHODS: This was an explorative analysis of a national database of real-world hospitalizations in the United States. Patients who underwent EVT were included. Patients were divided into SAH and non-SAH groups, and hospitalization outcomes were compared using multivariable logistic regression models. Regression models were also used to identify significant predictors for post-EVT SAH, and significant modulators of SAH's association with hospitalization outcomes were also assessed. RESULTS: A total of 99,219 EVT patients were identified; 6174 (6.2%) had SAH. Overall, SAH was independently associated with increased odds of in-hospital mortality (21.5% vs. 10.6%, adjusted OR 2.53 [95%CI 2.23-2.87], p < 0.001) and lower odds of routine discharge to home with self-care (18.2% vs. 28.0%, aOR 0.58 [95%CI 0.52-0.65], p < 0.001). Distal/medium vessel occlusion (DMVO), coagulopathy, angioplasty or stenting, concurrent intraparenchymal hemorrhage (IPH), and female sex were associated with higher odds of SAH. DMVO was associated with particularly heightened risk of death (31.8% vs. 7.9%, aOR 6.99 [95%CI 2.99 to 16.3], p < 0.001), which was an effect size significantly larger than other sites of vascular occlusion (interaction p > 0.05). CONCLUSION: SAH is an uncommon but likely clinically detrimental post-EVT complication. DMVO, coagulopathy, angioplasty or stenting, concurrent IPH, and female sex were independently associated with higher odds of post-EVT SAH. SAH associated with DMVO-EVT may be particularly harmful.

Proportion of industry payment value by category in radiology relative to other specialties.

BACKGROUND: Industry payments to physicians are common, but it is unknown how the payments in different categories to radiologists compare to other specialties. OBJECTIVE: The aim of this study is to assess the proportion of industry payments to physicians in radiology in certain categories relative to other specialties. METHODS: The Open Payments Database was analyzed from January 1, 2017 to December 31, 2021 for industry payments to all allopathic & osteopathic physicians, and classified into distinct clinical specialties. Payments to physicians in three categories were calculated in relation to total payments in each specialty during the study period: consulting fees, research, and royalties/ownership (royalty, license, or current or prospective ownership or investment). RESULTS: The total value of industry payments to physicians across all specialties was just under $13 billion over the six-year period from 2017 to 2022. During this period, 51.4 million total payments were made to 791,746 physicians. US physicians in radiology received 452,027 payments for a total value of $357 million (2.8 % of total value). For radiologists, 32.8 % of industry payment value was attributed to royalties/ownership and 9.9 % to research, collectively adding up to 42.7 % of all industry payment. The only specialties with higher payments in these two categories considered reflective of innovation payments were the surgical specialties with higher royalty payments. CONCLUSION: The proportion of industry payments in radiology in categories reflecting innovation (royalty/ownership and research fees) is high and second only to surgical specialties.

Higher proceduralist stroke thrombectomy volume is associated with reduced inpatient mortality.

BACKGROUND: The aim of this study was to determine the impact of endovascular thrombectomy (EVT) proceduralist volume on in-hospital mortality in acute ischemic stroke (AIS) patients. METHODS: We performed a retrospective cohort study using the 2020 Florida State Inpatient Database, including adult patients who had a diagnosis of AIS and underwent EVT during the same admission. The primary study outcome was in-hospital death. We used Youden's Index to define an optimal threshold for number of EVTs/year/provider. Based on this cut-point, the cohort was dichotomized into low and high proceduralist volume groups. We fit logistic regression models to mortality in the full cohort, both as univariate analyses and after adjusting for covariates. RESULTS: Among 3143 AIS patients who underwent EVT, 1907 patients across 59 hospitals and 106 providers met our inclusion criteria. Among the providers, the median number of EVTs performed was 13.5 (IQR 7-25). The optimal cut-point was 17 EVTs. Demographics and comorbidities were similar between the cohorts. The high volume strata had a lower rate of in-hospital mortality (low volume 11.0% vs high volume 7.2%, P=0.005). After adjusting for potential confounders, high proceduralist volume remained significantly associated with lower odds of in-hospital death (OR 0.52, 95% CI 0.36 to 0.76, P=0.001). The difference in absolute risk of death was 4.8% (P=0.005). CONCLUSIONS: We found that high proceduralist volume, defined by ≥18 EVTs/year, was associated with reduced in-hospital morality. Further research is necessary to understand the effects of proceduralist experience and benchmarks for technical proficiency in stroke care.

Deep learning for prediction of post-thrombectomy outcomes based on admission CT angiography in large vessel occlusion stroke.

Purpose: Computed Tomography Angiography (CTA) is the first line of imaging in the diagnosis of Large Vessel Occlusion (LVO) strokes. We trained and independently validated end-to-end automated deep learning pipelines to predict 3-month outcomes after anterior circulation LVO thrombectomy based on admission CTAs. Methods: We split a dataset of 591 patients into training/cross-validation (n = 496) and independent test set (n = 95). We trained separate models for outcome prediction based on admission "CTA" images alone, "CTA + Treatment" (including time to thrombectomy and reperfusion success information), and "CTA + Treatment + Clinical" (including admission age, sex, and NIH stroke scale). A binary (favorable) outcome was defined based on a 3-month modified Rankin Scale ≤ 2. The model was trained on our dataset based on the pre-trained ResNet-50 3D Convolutional Neural Network ("MedicalNet") and included CTA preprocessing steps. Results: We generated an ensemble model from the 5-fold cross-validation, and tested it in the independent test cohort, with receiver operating characteristic area under the curve (AUC, 95% confidence interval) of 70 (0.59-0.81) for "CTA," 0.79 (0.70-0.89) for "CTA + Treatment," and 0.86 (0.79-0.94) for "CTA + Treatment + Clinical" input models. A "Treatment + Clinical" logistic regression model achieved an AUC of 0.86 (0.79-0.93). Conclusion: Our results show the feasibility of an end-to-end automated model to predict outcomes from admission and post-thrombectomy reperfusion success. Such a model can facilitate prognostication in telehealth transfer and when a thorough neurological exam is not feasible due to language barrier or pre-existing morbidities.

Relative Cerebral Blood Flow as an Indirect Imaging Surrogate in Patients With Anterior Circulation Large Vessel Occlusion and Association of Baseline Characteristics With Poor Collateral Status.

BACKGROUND: In acute ischemic stroke (AIS), collateral status (CS) is an important predictor of favorable outcomes in patients with AIS. Among quantitative cerebral perfusion parameters, relative cerebral blood flow (rCBF) is considered an accurate perfusion-based indicator of CS. This study investigated the relationship between admission laboratory values, baseline characteristics, and CS as assessed by rCBF in patients with AIS-large vessel occlusion. METHODS AND RESULTS: In this retrospective multicenter study, consecutive patients presenting with AIS secondary to anterior circulation large vessel occlusion who underwent pretreatment computed tomography perfusion were included. The computed tomography perfusion data processed by RAPID (IschemaView, Menlo Park, CA) generated the rCBF. Binary logistic regression models assessed the relationship between patients' baseline characteristics, admission laboratory values, and poor CS. The primary outcome measure was the presence of poor CS, which was defined as rCBF <38% at a lesion size ≥27 mL. Between January 2017 and September 2022, there were 221 consecutive patients with AIS-large vessel occlusion included in our study (mean age 67.0±15.8 years, 119 men [53.8%]). Logistic regression showed that male sex (odds ratio [OR], 2.98 [1.59-5.59]; P=0.001), chronic kidney disease (OR, 5.18 [2.44-11.0]; P<0.001), admission National Institutes of Health Stroke Scale score ≥12 (OR, 5.17 [2.36-11.36]; P<0.001), and systolic blood pressure <140 (OR, 2.00 [1.07-3.76]; P=0.030) were associated with poor CS. CONCLUSIONS: Higher stroke severity on admission with National Institutes of Health Stroke Scale score ≥12, systolic blood pressure <140, chronic kidney disease, and male sex are statistically significantly associated with poor CS in patients with AIS due to anterior circulation large vessel occlusion as defined by rCBF <38%.

Hypoperfusion Intensity Ratio as an Indirect Imaging Surrogate in Patients With Anterior Circulation Large-Vessel Occlusion and Association of Baseline Characteristics With Poor Collateral Status.

BACKGROUND: Collateral status (CS) plays a crucial role in infarct growth rate, risk of postthrombectomy hemorrhage, and overall clinical outcomes in patients with acute ischemic stroke (AIS) secondary to anterior circulation large-vessel occlusions (LVOs). Hypoperfusion intensity ratio has been previously validated as an indirect noninvasive pretreatment imaging biomarker of CS. In addition to imaging, derangements in admission laboratory findings can also influence outcomes in patients with AIS-LVO. Therefore, our study aims to assess the relationship between admission laboratory findings, baseline characteristics, and CS, as assessed by hypoperfusion intensity ratio in patients with AIS-LVO. METHODS AND RESULTS: In this retrospective study, consecutive patients presenting with AIS secondary to anterior circulation LVO who underwent pretreatment computed tomography perfusion were included. The computed tomography perfusion data processed by RAPID (Ischema View, Menlo Park, CA) generated the hypoperfusion intensity ratio. Binary logistic regression models were used to assess the relationship between patients' baseline characteristics, admission laboratory findings, and poor CS. A total of 221 consecutive patients with AIS-LVO between January 2017 and September 2022 were included in our study (mean±SD age, 67.0±15.8 years; 119 men [53.8%]). Multivariable logistic regression showed that patients with AIS caused by cardioembolic and cryptogenic causes (adjusted odds ratio [OR], 2.67; 95% CI, 1.20-5.97; P=0.016), those who presented with admission National Institutes of Health Stroke Scale score ≥12 (adjusted OR, 3.12; 95% CI, 1.61-6.04; P=0.001), and male patients (adjusted OR, 2.06; 95% CI, 1.13-3.77; P=0.018) were associated with poor CS. CONCLUSIONS: Stroke caused by cardioembolic or cryptogenic causes, admission National Institutes of Health Stroke Scale score of ≥12, and male sex were associated with poor CS, as defined by hypoperfusion intensity ratio in the patients with AIS-LVO.

Industry relationships with interventional radiologists: Who are the high payment physicians?

PURPOSE: To identify characteristics of interventional radiologists receiving more than $100,000 in general industry payments over a 5-year period (2017-2021). METHODS: The Open Payments database was queried to identify interventional radiologists who received more than $100,000 in consulting fees, speaker fees, education, and/or gifts over a 5-year period from 2017 to 2021. The national provider identifier registry, Scopus, and a web-based search were used to identify physician characteristics, such as demographics, research profile, leadership positions, and social media presence. RESULTS: From 2017-2021, 125 interventional radiologists received cumulative payments greater than $100,000 in consulting fees, speaker fees, education, and gifts. For this subset of physicians, the median (IQR) cumulative payment value was $214,380 ($141,812 - $383,740), and the total payment value was $40 million. While the highest-paid subset of physicians represented only 3 % (125/4272) of all US interventional radiologists paid by industry, the total payment value represented 66 % ($40,039,610.08/$60,859,025) of the total payment value among all interventional radiologists. 47 % (59/125) had faculty appointments and 30 % (37/125) had hospital leadership positions. 22 % (27/125) were clinical practice guideline authors, while 18 % (23/125) served on journal editorial boards and 12 % (15/125) had positions in specialty association leadership. Castle Connolly recognized 26 % (32/125) as top doctors. Among the 96 % (120/125) with published research in the past 5 years, the median (IQR) H-index was 17 (7-31). 38 % (48/125) had a presence on Twitter with a median (IQR) Kardashian index of 2.03 (0.48-6.16). CONCLUSION: A small subset of interventional radiologists receive large payments from drug and medical device companies. These physicians are leaders in their field with influence in hospitals, research, associations, and social media. Further work is needed to understand how the concentration of these payments affects decisions in clinical practice and policy.

Endovascular thrombectomy versus medical management for acute basilar artery occlusion stroke in the elderly.

BACKGROUND AND PURPOSE: The efficacy and safety of endovascular thrombectomy (EVT) for elderly basilar artery occlusion (BAO) stroke patients is unclear. MATERIALS AND METHODS: This was an explorative retrospective analysis of the 2016-21 National Inpatient Sample in the United States. Elderly BAO stroke patients (80 years or older) with NIH stroke scale of at least 5 were included. Primary outcome was discharge to home. Secondary outcomes include in-hospital mortality and intracranial hemorrhage (ICH). Outcomes were compared between patients treated with EVT and those treated with medical management (MM) alone. Propensity score matching (PSM) was performed to control for confounders. Subgroup analyses were conducted for patients who did and did not receive intravenous thrombolysis (IVT). RESULTS: 2,520 elderly BAO patients were identified; 830 received EVT, and 1,690 received MM alone. After PSM, 1,115 patients and 715 patients remained in the MM and EVT groups, respectively. Compared to PSM controls, EVT was not significantly associated with different rates of home discharge (17.5% vs. 12.2%, OR 1.36 [95%CI 0.76-2.44], p=0.30) or in-hospital mortality (31.5% vs. 32.9%, OR 1.00 [95%CI 0.63-1.60], p=0.99), but it was significantly associated with higher rates of ICH (18.2% vs. 7.3%, OR 2.69 [95%CI 1.41- 5.15], p=0.003). Among patients who did not receive IVT, EVT was significantly associated with higher rates of home discharge (21.5% vs. 11.5%, OR 1.93 [95%CI 1.02-3.66], p=0.044), whereas EVT was not significantly associated with the same among those treated with IVT (5.6% vs. 15.0%, OR 0.28 [95%CI 0.05-1.46], p=0.13). Interaction analysis revealed that IVT was a negative modulator of EVT's positive association with home discharge (interaction p=0.031). CONCLUSIONS: EVT was not significantly associated with more favorable hospitalization outcomes for elderly BAO stroke patients, and it was significantly associated with increased risk of ICH. EVT may be an effective treatment for patients who did not receive IVT. ABBREVIATIONS: EVT = endovascular thrombectomy; BAO = basilar artery occlusion; ICH = intracranial hemorrhage; MM = medical management; PSM = propensity score matching; IVT = intravenous thrombolysis.

Endovascular thrombectomy versus medical management for moderate-to-severe anterior cerebral artery occlusion stroke.

BACKGROUND: There are no established patient selection criteria for endovascular thrombectomy (EVT) for anterior cerebral artery (ACA) stroke. METHODS: This was a retrospective cohort study of the 2016-2020 National Inpatient Sample in the United States. Isolated ACA-occlusion stroke patients with moderate-to-severe stroke symptoms (NIH stroke scale [NIHSS] ≥ 6) were included. Primary outcome was hospital discharge to home with self-care. Secondary outcomes include in-hospital mortality and intracranial hemorrhage (ICH). Confounders were accounted for by multivariable logistic regression. RESULTS: 6685 patients were included; 335 received EVT. Compared to medical management (MM), EVT patients were younger (mean 67.2 versus 72.2 years; p = 0.014) and had higher NIHSS (mean 16.0 versus 12.5; p < 0.001). EVT was numerically but not statistically significantly associated with higher odds of home discharge compared to MM (aOR 2.26 [95%CI 0.99-5.17], p = 0.053). EVT was significantly associated with higher odds of home discharge among patients with NIHSS 10 or greater (aOR 3.35 [95%CI 1.06-10.58], p = 0.039), those who did not receive prior thrombolysis (aOR 3.96 [95%CI 1.53-10.23], p = 0.005), and those with embolic stroke etiology (aOR 4.03 [95%CI 1.21-13.47], p = 0.024). EVT was not significantly associated with higher rates of mortality (aOR 1.93 [95%CI 0.80-4.63], p = 0.14); however, it was significantly associated with higher rates of ICH (22.4% vs. 8.5%, p < 0.001). CONCLUSION: EVT was associated with higher odds of favorable short-term outcomes for moderate-to-severe ACA-occlusion stroke in select patients. Future studies are needed to confirm the efficacy of EVT in terms of longer term neurological outcomes.

Intersectionality and Faculty Compensation in Academic Radiology in U.S.

BACKGROUND: The impact of intersectionality on academic radiology physician compensation is not well known. PURPOSE: The aim of this study was to assess impact of intersectionality on academic radiology financial compensation, based on rank, gender and race/ethnicity in US medical schools. METHODS: Data were collected from the AAMC Faculty Salary Survey, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for radiology faculty with MD or equivalent degree in diagnostic radiology (DR) as well as interventional radiology (IR) was collected for 2023, stratified by rank, gender, and race/ethnicity. RESULTS: The AAMC Faculty Salary Survey data for 2023 included responses for 683 IR (138 women, 545 men) and 2431 DR (862 women, 1569 men) faculty. Men had a higher median compensation than women at all ranks, for both IR and DR, except DR instructors. The gender pay gap was greater in IR faculty compared to DR faculty of the same rank. All intersectional groups among IR faculty reported a lower median compensation compared to White men of the same rank. All intersectional groups among DR faculty, except Asian Men, had a lower median compensation than White men of the same rank. Among IR faculty, Asian women assistant professors faced the greatest disparity in median compensation, down to $75 K (15%) lower than White men. Among DR faculty, Black/African American women assistant professors faced the greatest disparity on median compensation, down to $48 K (10.5%) lower than White men. CONCLUSION: The study results raise important concerns about impact of intersectionality on faculty compensation in radiology which needs further study and should be addressed as part of broader drive to increase diversity, equity, and inclusion in academic radiology.

Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion.

PURPOSE: To create and validate an automated pipeline for detection of early signs of irreversible ischemic change from admission CTA in patients with large vessel occlusion (LVO) stroke. METHODS: We retrospectively included 368 patients for training and 143 for external validation. All patients had anterior circulation LVO stroke, endovascular therapy with successful reperfusion, and follow-up diffusion-weighted imaging (DWI). We devised a pipeline to automatically segment Alberta Stroke Program Early CT Score (ASPECTS) regions and extracted their relative Hounsfield unit (rHU) values. We determined the optimal rHU cut points for prediction of final infarction in each ASPECT region, performed 10-fold cross-validation in the training set, and measured the performance via external validation in patients from another institute. We compared the model with an expert neuroradiologist for prediction of final infarct volume and poor functional outcome. RESULTS: We achieved a mean area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of 0.69±0.13, 0.69±0.09, 0.61±0.23, and 0.72±0.11 across all regions and folds in cross-validation. In the external validation cohort, we achieved a median [interquartile] AUC, accuracy, sensitivity, and specificity of 0.71 [0.68-0.72], 0.70 [0.68-0.73], 0.55 [0.50-0.63], and 0.74 [0.73-0.77], respectively. The rHU-based ASPECTS showed significant correlation with DWI-based ASPECTS (rS = 0.39, p<0.001) and final infarct volume (rS = -0.36, p<0.001). The AUC for predicting poor functional outcome was 0.66 (95%CI: 0.57-0.75). The predictive capabilities of rHU-based ASPECTS were not significantly different from the neuroradiologist's visual ASPECTS for either final infarct volume or functional outcome. CONCLUSIONS: Our study demonstrates the feasibility of an automated pipeline and predictive model based on relative HU attenuation of ASPECTS regions on baseline CTA and its non-inferior performance in predicting final infarction on post-stroke DWI compared to an expert human reader.