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1.
J Am Coll Radiol ; 20(1): 79-86, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36494062

RESUMO

PURPOSE: Many practices have implemented support services to assist radiologists with noninterpretive tasks; however, little research has been performed to assess the overall effect of these services. The purpose of this study was to evaluate the effect of a team of imaging service navigators (ISNs) incorporated into a practice on (1) number of communications, (2) time saved by radiologists, and (3) radiologist satisfaction with the service. METHODS: The numbers and types of reports dictated by radiologists were captured for 6-month periods before and after ISN implementation. Communication rates before and after implementation were then calculated. The amount of perceived time savings using the ISN team and satisfaction with the service were assessed through pre- and postimplementation surveys of participating radiologists. Mean and median time savings and satisfaction rates were calculated. RESULTS: The overall communication rate increased from 2.196% before ISNs to 3.278% after ISNs (49% increase; 95% confidence interval, 47%-52%). Communication rates increased among all communication subtypes (critical, urgent, routine, and actionable), with the highest increases in urgent (94%) and actionable (75%) findings. Before implementation, radiologists reported spending 39 min on average per day on communications tasks, with only 33% of radiologists indicating that the communication process was efficient. After implementation, radiologists reported mean time savings of 28 min (95% confidence interval, 19.9-35.1), and 82% of radiologists indicated a positive or highly positive view of the ISN service. CONCLUSIONS: After ISN implementation, communication rates increased and radiologists reported spending less time performing communications. Most radiologists were satisfied with the service.


Assuntos
Diagnóstico por Imagem , Radiologistas , Humanos , Comunicação , Inquéritos e Questionários , Satisfação Pessoal
2.
J Am Coll Radiol ; 18(11S): S251-S267, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34794587

RESUMO

The appropriate evaluation of adrenal masses is strongly dependent on the clinical circumstances in which it is discovered. Adrenal incidentalomas are masses that are discovered on imaging studies that have been obtained for purposes other than adrenal disease. Although the vast majority of adrenal incidentalomas are benign, further radiological and biochemical evaluation of these lesions is important to arrive at a specific diagnosis. Patients with a history of malignancy or symptoms of excess hormone require different imaging evaluations than patients with incidentalomas. This document reviews imaging approaches to adrenal masses and the various modalities utilized in evaluation of adrenal lesions. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Neoplasias das Glândulas Suprarrenais , Radiologia , Diagnóstico por Imagem , Humanos , Sociedades Médicas , Estados Unidos
3.
J Am Coll Radiol ; 16(11S): S378-S383, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685105

RESUMO

Lower urinary tract symptoms due to benign prostatic enlargement have a high prevalence in men over 50 years of age. Diagnosis is made with a combination of focused history and physician examination and validated symptom questionnaires. Urodynamic studies can help to differentiate storage from voiding abnormalities. Pelvic ultrasound may be indicated to assess bladder volume and wall thickness. Other imaging modalities, including prostate MRI, are usually not indicated in the initial workup and evaluation of uncomplicated lower urinary tract symptoms from an enlarged prostate. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Radiologia/normas , Urodinâmica/fisiologia , Idoso , Medicina Baseada em Evidências , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Controle de Qualidade , Sociedades Médicas/normas , Ultrassonografia Doppler/métodos , Estados Unidos
4.
J Am Coll Radiol ; 16(11S): S392-S398, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685107

RESUMO

Lower urinary tract injury is most commonly the result of blunt trauma but can also result from penetrating or iatrogenic trauma. Clinical findings in patients with a mechanism of penetrating trauma to the lower urinary tract include lacerations or puncture wounds of the pelvis, perineum, buttocks, or genitalia, as well as gross hematuria or inability to void. CT cystography or fluoroscopy retrograde cystography are usually the most appropriate initial imaging procedures in patients with a mechanism of penetrating trauma to the lower urinary tract. CT of the pelvis with intravenous contrast, pelvic radiography, fluoroscopic retrograde urethrography, and CT of the pelvis without intravenous contrast may be appropriate in some cases. Arteriography, radiographic intravenous urography, CT of the pelvis without and with intravenous contrast, ultrasound, MRI, and nuclear scintigraphy are usually not appropriate. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Guias de Prática Clínica como Assunto , Bexiga Urinária/lesões , Sistema Urinário/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Meios de Contraste , Cistografia/métodos , Medicina Baseada em Evidências , Feminino , Humanos , Escala de Gravidade do Ferimento , Imageamento por Ressonância Magnética/métodos , Masculino , Tomografia por Emissão de Pósitrons/métodos , Controle de Qualidade , Radiologia/normas , Sensibilidade e Especificidade , Sociedades Médicas/normas , Tomografia Computadorizada por Raios X/métodos , Estados Unidos , Uretra/diagnóstico por imagem , Uretra/lesões , Bexiga Urinária/diagnóstico por imagem , Sistema Urinário/diagnóstico por imagem
5.
J Am Coll Radiol ; 16(11S): S417-S427, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685109

RESUMO

Urothelial cancer is the second most common cancer, and cause of cancer death, related to the genitourinary tract. The goals of surveillance imaging after the treatment of urothelial cancer of the urinary bladder are to detect new or previously undetected urothelial tumors, to identify metastatic disease, and to evaluate for complications of therapy. For surveillance, patients can be stratified into one of three groups: (1) nonmuscle invasive bladder cancer with no symptoms or additional risk factors; (2) nonmuscle invasive bladder cancer with symptoms or additional risk factors; and (3) muscle invasive bladder cancer. This article is a review of the current literature for urothelial cancer and resulting recommendations for surveillance imaging. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Guias de Prática Clínica como Assunto , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Cistografia/métodos , Cistoscopia/métodos , Medicina Baseada em Evidências , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Monitorização Fisiológica , Gradação de Tumores , Invasividade Neoplásica/patologia , Prognóstico , Controle de Qualidade , Radiologia/normas , Sensibilidade e Especificidade , Sociedades Médicas/normas , Tomografia Computadorizada por Raios X/métodos , Estados Unidos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
6.
J Am Coll Radiol ; 16(5S): S38-S43, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31054757

RESUMO

An acute scrotum is defined as testicular swelling with acute pain and can reflect multiple etiologies including epididymitis or epididymo-orchitis, torsion of the spermatic cord, or torsion of the testicular appendages. Quick and accurate diagnosis of acute scrotum and its etiology with imaging is necessary because a delayed diagnosis of torsion for as little as 6 hours can cause irreparable testicular damage. Ultrasound duplex Doppler of the scrotum is usually appropriate as the initial imaging for the acute onset of scrotal pain without trauma or antecedent mass in an adult or child. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Dor Aguda/diagnóstico por imagem , Escroto/diagnóstico por imagem , Doenças Testiculares/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Masculino , Sociedades Médicas , Estados Unidos
7.
AJR Am J Roentgenol ; 212(3): 490-496, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30620681

RESUMO

OBJECTIVE: The purposes of this article are to describe the creation of template report formats and content for a variety of abdominal and pelvic CT and MRI examinations and discuss a review-of-systems approach to text and avoidance of pitfalls of report templates. CONCLUSION: Organ system-specific report templates for CT and MRI incorporate radiologist preferences. Disease-specific report templates are created from these reports to provide a consistent radiologist and referring physician experience across the report templates.


Assuntos
Imageamento por Ressonância Magnética , Prontuários Médicos , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Controle de Formulários e Registros , Humanos
8.
J Am Coll Radiol ; 15(5S): S150-S159, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29724418

RESUMO

Muscle-invasive bladder cancer (MIBC) has a tendency toward urothelial multifocality and is at risk for local and distant spread, most commonly to the lymph nodes, bone, lung, liver, and peritoneum. Pretreatment staging of MIBC should include imaging of the urothelial upper tract for synchronous lesions; imaging of the chest, abdomen, and pelvis for metastases; and MRI pelvis for local staging. CT abdomen and pelvis without and with contrast (CT urogram) is recommended to assess the urothelium and abdominopelvic organs. Pelvic MRI can improve local bladder staging accuracy. Chest imaging is also recommended with chest radiograph usually being adequate. FDG-PET/CT may be appropriate to identify nodal and metastatic disease. Chest CT may be useful in high-risk patients and those with findings on chest radiograph. Nonurogram CT and MRI of the abdomen and pelvis are usually not appropriate, and neither is radiographic intravenous urography, Tc-99m whole body bone scan, nor bladder ultrasound for pretreatment staging of MIBC. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia , Meios de Contraste , Medicina Baseada em Evidências , Humanos , Estadiamento de Neoplasias , Sociedades Médicas , Estados Unidos
9.
Am J Surg ; 209(4): 703-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25172167

RESUMO

BACKGROUND: The aim of our study was to evaluate factors associated with percutaneous drainage (PCD) failure, complications, and stoma creation for patients undergoing sigmoidectomy for diverticular abscess. METHODS: Data for patients with diverticular abscess greater than or equal to 3 cm in diameter treated with initial PCD from 1994 to 2012 were identified. RESULTS: One hundred fourteen patients (54% male) with a mean age of 57 years and a mean abscess diameter of 7.1 ± 2.4 cm were identified. American Society of Anesthesiologists 4 was the only independent factor associated with PCD failure (P < .001). On multivariate analysis, factors associated with postoperative morbidity (n = 42, 37%) included PCD failure (P = .02) and older age (P = .04), while risk for stoma creation was associated with PCD failure (P < .001), multiple PCD attempts (P = .002), older age (P < .001), Hinchey II (P = .03), and increased body mass index (P = .01). American Society of Anesthesiologists 4 was the only factor associated with permanent stoma (P = .02). CONCLUSIONS: In patients with large diverticular abscess, a successful PCD is associated with reduced postoperative morbidity. However, a large proportion of patients require stoma creation. Significant comorbidity is associated with both failure of PCD and permanent stoma risk.


Assuntos
Abscesso Abdominal/cirurgia , Diverticulite/cirurgia , Drenagem/métodos , Doenças do Colo Sigmoide/terapia , Abscesso Abdominal/complicações , Diverticulite/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Doenças do Colo Sigmoide/complicações , Resultado do Tratamento
10.
J Magn Reson Imaging ; 40(1): 113-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24130008

RESUMO

PURPOSE: To compare abdominopelvic and lower extremity venous enhancement in contrast-enhanced magnetic resonance venography (ceMRV), using iron-based ferumoxytol and gadolinium-based gadofosveset. MATERIALS AND METHODS: This was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. Thirty-four patients were identified who had undergone ceMRV using either ferumoxtyol (Group A, all with chronic renal insufficiency) or gadofosveset (Group B). Two radiologists rated confidence for evaluation of the major abdominopelvic and lower extremity veins from 4 (excellent confidence) to 1 (nondiagnostic). A third radiologist measured signal intensity ratios (SIRs) of venous segments compared with adjacent muscles. Scores were compared using repeated-measures analysis of variance (ANOVA). The medical record was searched for contemporaneous imaging to confirm the ceMRV findings. RESULTS: In Group A, 14/225 venous segments were thrombosed, compared with 18/282 in Group B. There was no statistically significant difference between confidence scores (3.79 ± 0.44 vs. 3.85 ± 0.44, P = 0.34) or SIRs (2.40 ± 0.73 vs. 2.38 ± 0.51, P = 0.51) for patent segments in the two groups, nor were confidences scores (3.89 ± 0.29 vs. 3.72 ± 0.46, P = 0.31) or SIRs (0.90 ± 0.12 vs. 0.84 ± 0.19, P = 0.31) significantly different for thrombosed segments. Contemporaneous imaging confirmed ceMRV findings in 227 segments. CONCLUSION: ceMRV can be performed with ferumoxytol, yielding similar image quality to a blood pool gadolinium-based contrast agent.


Assuntos
Óxido Ferroso-Férrico , Gadolínio , Falência Renal Crônica/patologia , Angiografia por Ressonância Magnética/métodos , Compostos Organometálicos , Flebografia/métodos , Artéria Renal/patologia , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Aumento da Imagem/métodos , Compostos de Ferro , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
Pediatr Radiol ; 36(5): 440-4, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16532347

RESUMO

A Günther Tulip retrievable inferior vena cava filter was placed in a 9-year-old boy with T-cell ALL who had both iliofemoral deep vein thrombosis (DVT) and acute intracranial hemorrhage. The filter was removed 147 days after placement, when the patient was no longer at increased risk for DVT or pulmonary embolus. Removal of the filter did not compromise flow through the vena cava.


Assuntos
Remoção de Dispositivo/métodos , Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Criança , Traumatismos Craniocerebrais/complicações , Humanos , Masculino , Trombose Venosa/terapia
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