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This article examines how radiologists can meet the objectives of patient- and family-centered care set forth by the National Committee for Quality Assurance (NCQA) program for primary care providers. The breadth of initiatives in radiology that can be mapped to the NCQA objectives is impressive and invites the idea of creating a similar program in radiology. ©RSNA, 2018.
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Modelos Organizacionais , Participação do Paciente , Assistência Centrada no Paciente/organização & administração , Administração da Prática Médica/organização & administração , Relações Profissional-Paciente , Garantia da Qualidade dos Cuidados de Saúde , Serviço Hospitalar de Radiologia/organização & administração , Humanos , Estados UnidosRESUMO
Purpose To evaluate the impact of accountable care organizations (ACOs) on use of screening mammography in the Medicare Shared Savings Program (MSSP), the largest value-based reimbursement program in U.S. HISTORY: Materials and Methods Institutional review board approval was waived, as the study used publicly available unidentifiable data. Medicare data were retrospectively obtained for participating ACOs from 2012 to 2014. Baseline information and the ACO-20 measure (percentage of women aged 40-69 years who underwent screening mammography within 24 months) were obtained. Negative binomial regression models were used to evaluate baseline and longitudinal mammography use, with stratified analyses performed for year of entry into the ACO, number of beneficiaries, and geographic region. Results A total of 333 ACOs with 5 329 831 Medicare beneficiaries (mean size, 16 006 beneficiaries) participated in the MSSP. Screening use varied across ACOs (median, 63.0%; range, 8.8%-90.3%), with differences found across regions (use was highest in the Midwest [66.6%] and lowest in the South [58.2%], P = .038). A total of 208 ACOs reported longitudinal outcomes, with mean change in screening mammography use of +2.6% (range, -33.2% to +42.2%), with 128 (61.6%) ACOs reporting improvements (incidence rate ratio, 1.04; 95% confidence interval: 1.02, 1.07) (P = .002). No longitudinal differences in use were seen across regions (P = .078), year of entry (P = .902), number of beneficiaries (P = .814), or total composite quality score (P = .324), nor was there a difference between ACOs that saved money and those that did not (P = .391). Conclusion ACOs in the MSSP have produced small significant improvements in screening mammography use. © RSNA, 2016.
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Organizações de Assistência Responsáveis/economia , Neoplasias da Mama/diagnóstico por imagem , Mamografia/economia , Mamografia/estatística & dados numéricos , Medicare/economia , Feminino , Humanos , Programas de Rastreamento/economia , Estudos Retrospectivos , Estados UnidosRESUMO
PURPOSE: To determine the diagnostic accuracy of a semiautomated (18)F-FDG PET/CT measurement of total lesion glycolysis (TLG), maximum and peak standardized uptake value at lean body mass (SUL-Max and SUL-Peak), qualitative estimates of left/right nodal symmetry and FDG uptake for differentiating lymphoma from reactive adenopathy in HIV-infected patients. METHODS: We retrospectively analyzed 41 whole-body (18)F-FDG PET/CT studies performed in HIV-infected patients for clinical reasons. The study received institutional review board approval. Of the 41 patients, 19 had biopsy-proven untreated lymphoma, and 22 with reactive adenopathy without malignancy on follow-up were used as controls. Nodal and extranodal visual qualitative metabolic scores, SUL-Max, SUL-Peak, CT nodal size, and PERCIST 1.0 threshold-based TLG and metabolic tumor volume (MTV) were determined. The qualitative intensity of nodal involvement and symmetry of uptake were compared using receiver operator curve (ROC) analysis. HIV plasma viral RNA measurements were also obtained. RESULTS: All of the quantitative PET metrics performed well in differentiating lymphoma from reactive adenopathy and performed better than qualitative visual intensity scores. The areas under the ROC curves (AUC) were significantly higher for TLG = 0.96, single SUL-Peak = 0.96, single SUL-Max = 0.97, and MTV = 0.96, compared to 0.67 for CT nodal size (p < 0.001). These PET metrics performed best in separating the two populations in aviremic patients, with AUCs of 1 (AUC 0.91 for CT nodal size). TLG, MTV, SUL-Peak and SUL-Max were more reliable markers among viremic individuals, with AUCs between 0.84 and 0.93, compared to other metrics. PET metrics were significantly correlated with plasma viral load in HIV-reactive adenopathy controls. Asymmetrical FDG uptake had an accuracy of 90.4 % for differentiating lymphoma from reactive adenopathy in HIV-infected patients. CONCLUSION: Quantitative PET metabolic metrics as well as the qualitative assessment of symmetry of nodal uptake appear to be valuable tools for differentiating lymphoma from reactive adenopathy in HIV-infected patients using FDG PET. These parameters appear more robust in aviremic patients.
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Fluordesoxiglucose F18 , Linfoma Relacionado a AIDS/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Adulto , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Cytomegalovirus (CMV) disease is the most common infectious complication after solid organ transplantation, frequently affecting the gastrointestinal (GI) tract. There are limited data on quantitative polymerase chain reaction (qPCR) for plasma CMV DNA as an adjunct diagnostic method for GI tract disease in kidney and liver transplant recipients. METHODS: We reviewed all records of adult kidney and liver transplant recipients with a GI tract biopsy and plasma CMV qPCR result within 15 days of biopsy during a 6.5-year period at our center. CMV GI tract disease was defined as histopathologic evidence of CMV on biopsy by immunohistochemistry or visualization of inclusion bodies. RESULTS: GI tract biopsy and qPCR results were available for 81 kidney and liver transplant recipients; 20 cases of confirmed CMV GI tract disease were identified. Overall, the sensitivity of qPCR for diagnosing CMV GI tract disease was 85% (95% confidence interval [CI], 61%-96%), and the specificity was 95% (95% CI, 85%-99%). For CMV-seronegative recipients (R(-)) with CMV-seropositive donors (D(+)), the sensitivity of qPCR was 100% (95% CI, 59%-99%), and the specificity was 80% (95% CI, 30%-99%). The lowest sensitivity was observed in CMV D(+)/R(+) cases (72.7%; 95% CI, 39%-93%). The mean plasma CMV copy number in patients with GI tract disease was 3.84 log10 (38 334 copies/mL). CONCLUSIONS: Plasma CMV qPCR had good sensitivity and excellent specificity for CMV GI tract disease in kidney and liver transplant recipients. Its sensitivity was 100% in CMV D(+)/R(-) cases but 72.7% in CMV D(+)/R(+) cases. This variation in assay performance according to host serostatus may reflect differences in disease pathogenesis.
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Colite/sangue , Colite/virologia , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/virologia , Citomegalovirus/isolamento & purificação , DNA Viral/sangue , Transplante de Rim , Transplante de Fígado , Adulto , Idoso , Estudos de Coortes , Colite/diagnóstico , Citomegalovirus/genética , Infecções por Citomegalovirus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Sistemas de Apoio a Decisões Clínicas , Diagnóstico por Imagem/estatística & dados numéricos , Mau Uso de Serviços de Saúde/prevenção & controle , Organizações de Assistência Responsáveis , Diagnóstico por Imagem/economia , Humanos , Equipe de Assistência ao Paciente , Radiografia , Aquisição Baseada em ValorRESUMO
PURPOSE: To determine the minimal image quality needed to preserve diagnostic performance relative to arthroscopy in the knee. MATERIALS AND METHODS: Synthetic noise was added to images from clinical MRI scans (three-dimensional SPACE pulse sequence; Siemens) from five patients who had undergone knee MRI with arthroscopic follow-up, resulting in 25 simulated sets of images with standardized signal-to-noise ratios (SNRs) of 1, 2, 5, 10, or 20. All cases were scored by four musculoskeletal radiologists progressing from low to high SNR and grading all cartilage surfaces, major ligaments and menisci on a 5-point scale. Receiver operator characteristic (ROC) curves were constructed for the detection of meniscal tears and cartilage abnormalities. The area under the ROC curve (AUC) was determined for each structure at each SNR level. In addition, reader confidence was measured and pairwise comparisons across SNR levels were performed. Results were compared with arthroscopy as the reference standard. RESULTS: ROC AUC was maximized for meniscal tears at SNR = 5 (structure specific CNR = 3.2) and for cartilage abnormalities at SNR = 10 (CNR = 4.2). Observer confidence was maximized for menisci at SNR = 5 (CNR = 8.0), for ligaments at SNR = 10 (CNR = 13.6) and cartilage at SNR = 10 (CNR = 8.2). CONCLUSION: For 3D isotropic imaging in the knee, images with SNR < 10 or CNR < 10 should be rejected as nondiagnostic.
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Interpretação de Imagem Assistida por Computador/métodos , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/psicologia , Variações Dependentes do Observador , Razão Sinal-Ruído , Percepção Visual , Humanos , Aumento da Imagem/métodos , Articulação do Joelho/cirurgia , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To investigate the accuracy of quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping for characterizing soft tissue masses (STMs) as cysts or solid masses. MATERIALS AND METHODS: This IRB-approved retrospective study included 36 subjects with 37 STMs imaged by conventional MRI (T1-weighted, T2-weighted, contrast-enhanced T1-weighted sequences) and DWI (b-values 50, 400, 800 s/mm(2)) with ADC mapping. STMs were defined as non-solid cysts by histology or clinical follow-up, and as solid by histology. For each STM, ADC values (range, mean) were recorded by two observers. Differences between ADC values in cysts and solid STMs were compared using Wilcoxon rank-sum and receiver-operating characteristic (ROC) analysis. RESULTS: There were higher minimum (1.65 vs 0.68, p = 0.003) and mean (2.31 vs 1.45, p = 0.005) ADC values in cysts than solid STMs respectively. Areas under the ROC for minimum and mean ADC values were 0.82 and 0.81 respectively. Using threshold ADC values of 1.8 (minimum) or 2.5 (mean) yielded a sensitivity of 60 % and 80 % respectively, and a specificity of 100 % for classifying a STM as a cyst; for tumors with high fluid-signal intensity, the performance of these threshold values was maintained. CONCLUSION: Diffusion-weighted imaging with ADC mapping provides a non-contrast MRI alternative for the characterization of STMs as cysts or solid masses. Threshold ADC values exist that provide 100 % specificity for differentiating cysts and solid STMs, even for tumors of high fluid-signal intensity on T2-weighted images.
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Cistos/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias de Tecidos Moles/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: The purposes of this review are to describe the principles and method of MR spectroscopy, summarize current published data on musculoskeletal lesions, and report additional cases that have been analyzed with recently developed quantitative methods. CONCLUSION: Proton MR spectroscopy can be used to identify key tissue metabolites and may serve as a useful adjunct to radiographic evaluation of musculoskeletal lesions. A pooled analysis of 122 musculoskeletal tumors revealed that a discrete choline peak has a sensitivity of 88% and specificity of 68% in the detection of malignancy. Modest improvements in diagnostic accuracy in 22 of 122 cases when absolute choline quantification was used encourage the pursuit of development of choline quantification methods.
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Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/metabolismo , Colina/metabolismo , Espectroscopia de Ressonância Magnética/métodos , Neoplasias Musculares/diagnóstico , Neoplasias Musculares/metabolismo , Algoritmos , Biomarcadores Tumorais/metabolismo , Meios de Contraste , Humanos , Interpretação de Imagem Assistida por Computador , Prótons , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Annual retinal exams for patients with diabetes are critical as diabetic retinopathy is the number one cause of preventable blindness in working-age adults in the United States. Currently, most patients with diabetes in the United States receive a referral from their primary care provider to see an ophthalmologist for their annual dilated eye exam, which can be an added inconvenience and expense. As such, there is a need for alternative screening strategies within an outpatient network. The use of a telemedicine platform in a primary care setting serves as a novel strategy to increase diabetic retinopathy screening rates. In order to provide better access to diabetic retinopathy screening for our patients, cameras were placed in 3 primary care practices in October 2017 as part of an 8-month pilot program. Specialized cameras from Intelligent Retinal Imaging Systems (IRIS) were used to acquire images that could be interpreted remotely by ophthalmologists within the LifeBridge Health network for the diagnosis of diabetic retinopathy and the detection of other types of pathology (eg, macular edema). OBJECTIVE: The aim of this retrospective descriptive study was to examine whether a telemedicine platform can be used as a cost-effective way to increase diabetic retinopathy screening rates in the primary care setting. METHODS: Aggregate screening volume and diagnostic data were collected for each of the 3 practice locations for the 8-month pilot period (October 30, 2017, through June 30, 2018). Additionally, payor reimbursement data and equipment cost data were used to determine the payback period for each of the 3 practice locations. RESULTS: The pilot program proved the business case that implementation of the IRIS camera in 3 practice locations could result in enough patients being screened to pay for the cost of the camera within a maximum of 2 years. The 3 practices showed increased diabetic retinopathy screening rates of 1%, 6%, and 24%, respectively, and were all able to screen enough patients to be on track to pay off the cost of the camera within 2 years of implementation. Aggregate data from the pilot period showed that of the 1213 patients who were screened, approximately 17.1% (n=207) were diagnosed with diabetic retinopathy and an additional 17.7% (n=215) were suspected of having some other form of pathology. Of note, 10.1% (n=123) were also identified as being "IRIS saves," defined as having pathology identified that was severe enough to be considered an imminent threat to their vision. CONCLUSIONS: This retrospective descriptive study suggests that a telemedicine platform can be used to improve diabetic retinopathy screening rates in the primary care setting within a large health care system in a cost-effective way that allows for the cost of the equipment to be recouped through billing within a maximum of 2 years.
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OBJECTIVE: This article will address ongoing efforts to track cumulative dose estimates of patient radiation exposure that have the potential to transform radiation protection research. CONCLUSION: There is no clear consensus on how to use this information clinically. A rational consideration of this question reveals that until the linear no-threshold model is supplanted, cumulative dose estimates are of little clinical relevance and never constitute a logical reason to avoid an imaging evaluation that is otherwise medically indicated.
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Modelos Biológicos , Neoplasias Induzidas por Radiação/prevenção & controle , Doses de Radiação , Radiografia/efeitos adversos , Radiometria/métodos , Medição de Risco/métodos , Carga Corporal (Radioterapia) , Simulação por Computador , Humanos , Neoplasias Induzidas por Radiação/etiologia , Estados UnidosRESUMO
BACKGROUND: Our health system set out to improve services to patients from the LGBTQ community as a step towards decreasing disparities in care. MATERIALS AND METHODS: A pilot education intervention targeting staff knowledge and skills regarding terminology with regards to gender fluidity and sexual orientation was designed and implemented. RESULTS: 81 staff members participated and we found improvements in knowledge but there remain uncertainties that can be addressed in future training sessions. CONCLUSIONS: LGBTQ staff education in radiology is feasible and effective. Additional education interventions may be necessary to address persistent knowledge gaps. Effects on patient acre are yet unknown.
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Radiologia , Minorias Sexuais e de Gênero , Feminino , Identidade de Gênero , Humanos , Masculino , Preferência do Paciente , Comportamento SexualRESUMO
BACKGROUND: Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system's finances in a value-based care or global budget environment. LifeBridge Health, a community health system in Maryland, United States, implemented an automated mobile patient engagement application as part of our enterprise-wide digital health strategy to improve patient engagement and reduce revisits to the ED. OBJECTIVE: The aim of this paper was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED. METHODS: The LifeBridge Health Innovation Department and ED staff from 2 participating health system hospitals collaborated with GetWellNetwork to customize their patient engagement application with automated check-in questions and other on-demand resources (eg, streaming content explaining aspects of self-care during COVID-19). An application link was emailed to adult patients discharged home from the ED. A study of ED visits for patients treated for general medicine and cardiology conditions between August 1, 2018, and July 31, 2019, was conducted using CRISP (Chesapeake Regional Information System for our Patients), Maryland's state-designated health information exchange. We also used data within GetWell Loop (GetWellNetwork) to track patient activation and engagement. The primary outcome was the number of ED patients who experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary outcomes included the overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Bivariate analysis comparing outcomes among patients who activated the GetWell Loop application to patients who did not was conducted using the Fisher exact test. Multivariate logistic regression modeling with elastic net regularization was also performed to account for potential confounders and potential collinearity of covariates. RESULTS: During this 1-year study, 1062 (27.4%) of 3866 of all emergency patients treated for general medicine or cardiology conditions, who received an invite to use the digital application, activated their account. The patients discharged from the ED, who were treated for general medicine conditions (n=2087) and who activated their GetWell Loop account, experienced a 30-day revisit rate of 17.3% (n=101) compared with 24.6% (n=369) for those who did not activate their account (P<.001). Of the patients treated for cardiology conditions (n=1779), 12.8% (n=61) of those who activated their GetWell account experienced a 30-day revisit compared with 17.7% (n=231) of those who did not activate their account (P=.01). The significance of these findings persisted after adjustment for confounding variables including age, race, sex, and payor in logistic regression modeling (adjusted odds ratio 0.75, 95% CI 0.62-0.92; P=.006). CONCLUSIONS: Our results suggest that a significant percentage of patients are willing to utilize a digital application following ED discharge to better engage in their own care, and that usage of such digital applications may significantly reduce 30-day revisit rates. LifeBridge Health's experience demonstrates that health care systems can leverage automated mobile apps to improve patient engagement and successfully impact clinical outcomes at scale.
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OBJECTIVES: Triaging patients at admission to determine subsequent deterioration risk can be difficult. This is especially true of coronavirus disease 2019 patients, some of whom experience significant physiologic deterioration due to dysregulated immune response following admission. A well-established acuity measure, the Rothman Index, is evaluated for stratification of patients at admission into high or low risk of subsequent deterioration. DESIGN: Multicenter retrospective study. SETTING: One academic medical center in Connecticut, and three community hospitals in Connecticut and Maryland. PATIENTS: Three thousand four hundred ninety-nine coronavirus disease 2019 and 14,658 noncoronavirus disease 2019 adult patients admitted to a medical service between January 1, 2020, and September 15, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Performance of the Rothman Index at admission to predict in-hospital mortality or ICU utilization for both general medical and coronavirus disease 2019 populations was evaluated using the area under the curve. Precision and recall for mortality prediction were calculated, high- and low-risk thresholds were determined, and patients meeting threshold criteria were characterized. The Rothman Index at admission has good to excellent discriminatory performance for in-hospital mortality in the coronavirus disease 2019 (area under the curve, 0.81-0.84) and noncoronavirus disease 2019 (area under the curve, 0.90-0.92) populations. We show that for a given admission acuity, the risk of deterioration for coronavirus disease 2019 patients is significantly higher than for noncoronavirus disease 2019 patients. At admission, Rothman Index-based thresholds segregate the majority of patients into either high- or low-risk groups; high-risk groups have mortality rates of 34-45% (coronavirus disease 2019) and 17-25% (noncoronavirus disease 2019), whereas low-risk groups have mortality rates of 2-5% (coronavirus disease 2019) and 0.2-0.4% (noncoronavirus disease 2019). Similarly large differences in ICU utilization are also found. CONCLUSIONS: Acuity level at admission may support rapid and effective risk triage. Notably, in-hospital mortality risk associated with a given acuity at admission is significantly higher for coronavirus disease 2019 patients than for noncoronavirus disease 2019 patients. This insight may help physicians more effectively triage coronavirus disease 2019 patients, guiding level of care decisions and resource allocation.
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PURPOSE: Medicare established its Hospital Outpatient Quality Reporting Program (HOQRP) to promote and incentivize quality care and appropriate utilization in the hospital outpatient setting. The program includes "imaging efficiency" metrics evaluating appropriate utilization of imaging examinations. Our purpose was to evaluate the longitudinal performance of the nation's hospitals on the HOQPR's imaging efficiency metrics. METHODS: Data were obtained from CMS Hospital Compare for hospitals participating in the Medicare HOQRP during both initial (January 1, 2011, to December 31, 2011) and follow-up (July 1, 2015, to June 30, 2016) periods. The six reported imaging efficiency metrics were: MRI lumbar spine for low back pain, mammography follow-up rates, abdomen and chest CT double scans (imaging with and without intravenous contrast), cardiac imaging for preoperative risk assessment for low-risk surgery, and simultaneous use of brain and sinus CT. Differences in imaging efficiency metrics were calculated using fixed effects linear regression models. RESULTS: Baseline and follow-up data were available for 3,960 hospitals. Median changes were MRI lumbar spine for low back pain: +3.6% (range: -27.9% to +31.4%; P < .001); mammography follow-up: -0.3% (range: -69.5% to +62.6%; P = .03); double scan abdomen CT: -1.9% (range: -73.5% to +32.3%; P < .001); double scan chest CT: -0.4% (range: -73.2% to +28.0%; P < .001); preoperative cardiac imaging: -0.7% (range: -10.0% to +9.9%; P < .001); simultaneous brain and sinus CT: -0.9% (range: -11.8% to +7.8%; P < .001). CONCLUSION: Medicare's nationwide hospital outpatient imaging efficiency reporting initiative was associating with worse performance in lumbar spine MRI utilization and small improvements in double CT scans. Because quality metrics are increasingly imposed on health care providers, health service researchers will need to rigorously evaluate their effectiveness before and during early implementation.
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Dor Lombar/diagnóstico por imagem , Imageamento por Ressonância Magnética/estatística & dados numéricos , Medicare/estatística & dados numéricos , Qualidade da Assistência à Saúde , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/métodos , Estudos de Coortes , Diagnóstico por Imagem/economia , Diagnóstico por Imagem/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Estudos Longitudinais , Dor Lombar/epidemiologia , Imageamento por Ressonância Magnética/economia , Masculino , Medicare/economia , Pacientes Ambulatoriais/estatística & dados numéricos , Análise e Desempenho de Tarefas , Tomografia Computadorizada por Raios X/economia , Estados UnidosRESUMO
AIM: There is controversy regarding the diagnosis and classification of vascular anomalies (VA). As torso and extremities are the second most common body part for presentation of VAs, musculoskeletal (MSK) radiologists play a central role in VA classification. The purpose of this study was to evaluate the awareness and clinical use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by MSK radiologists. MATERIALS AND METHODS: A Web-based survey was designed and electronically sent to Society of Skeletal Radiology (SSR) members, with 3 questions on demographics and 7 questions on ISSVA classification use and knowledge. The Z-test for binomial proportions is used to assess for statistical significance between subgroups. RESULTS: The response rate was 12% (130 of 1091), comprised of 64% (83 of 130) academic and 36% (47 of 130) nonacademic MSK radiologists. VAs accounted for only a small (0%-5%) proportion of clinical practice in the majority 92% (119 of 130). Only 17% (22 of 130) of MSK radiologists used the ISSVA classification in practice. Of all respondents, 74% (94 of 127) considered hemangioma a type of vascular malformation (VM). There was no significant difference in the response characteristics between academic and nonacademic radiologists. A greater proportion of MSK radiologists with >5 years' experience provided responses that were discordant with the ISSVA classification compared with less experienced radiologists (0-5 years) in diagnosing hemangiomas in adult patients (P = 0.02), and using the presence of phleboliths to diagnose hemangiomas (P = 0.004). CONCLUSION: Our survey results indicate a lack of familiarity with the ISSVA classification by the MSK radiology community.
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Conhecimentos, Atitudes e Prática em Saúde , Radiologistas , Malformações Vasculares/classificação , Malformações Vasculares/diagnóstico por imagem , Humanos , Sociedades Médicas , Inquéritos e QuestionáriosAssuntos
Organizações de Assistência Responsáveis , Acessibilidade aos Serviços de Saúde , Organizações de Assistência Responsáveis/economia , Estados Unidos , Humanos , Acessibilidade aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Equidade em Saúde , Mecanismo de Reembolso , Aquisição Baseada em Valor , Seguro de Saúde Baseado em Valor/economiaRESUMO
Granulocyte colony-stimulating factor (G-CSF) and stem cell factor (SCF) are potential new therapies to ameliorate post-myocardial infarction (post-MI) remodeling, as they enhance endogenous cardiac repair mechanisms and decrease cardiomyocyte apoptosis. Because both of these pathways undergo alterations with increasing age, we hypothesized that therapeutic efficacy of G-CSF and SCF is impaired in old versus young adult rats. MI was induced in 6- and 20-month-old rats by permanent ligation of the left coronary artery. In young animals, G-CSF/SCF therapy stabilized and reversed a decline in cardiac function, attenuated left ventricular dilation, decreased infarct size, and reduced cardiomyocyte hypertrophy. Remarkably, these effects on cardiac structure and function were absent in aged rodents. This could not be attributed to ineffective mobilization of bone marrow cells or decreased quantity of c-Kit(+) cells within the myocardium with aging. However, whereas the G-CSF/SCF cocktail reduced cardiac myocyte apoptosis in old as well as in young hearts, the degree of reduction was substantially less with age and the rate of cardiomyocyte apoptosis in old animals remained high despite cytokine treatment. These findings demonstrate that G-CSF/SCF lacks therapeutic efficacy in old animals by failing to offset periinfarct apoptosis and therefore raise important concerns regarding the efficacy of novel cytokine therapies in elderly individuals at greatest risk for adverse consequences of MI.
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Envelhecimento , Fator Estimulador de Colônias de Granulócitos/farmacologia , Infarto do Miocárdio/fisiopatologia , Fator de Células-Tronco/farmacologia , Remodelação Ventricular/efeitos dos fármacos , Adaptação Fisiológica , Animais , Antígenos CD34/metabolismo , Apoptose/efeitos dos fármacos , Contagem de Células Sanguíneas , Células Sanguíneas/metabolismo , Western Blotting , Combinação de Medicamentos , Ecocardiografia , Coração/fisiopatologia , Hipertrofia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/metabolismo , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Proteínas Proto-Oncogênicas c-kit/metabolismo , Ratos , Ratos Endogâmicos F344RESUMO
Sinusitis is common in children that usually resolves spontaneously. Imaging is not part of the standard of care for initial diagnosis, however may be necessary in cases with persistent or chronic sinusitis to guide surgical intervention, or to rule out intracranial and vascular complications of sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the leading imaging modalities. In this article, appropriateness in use of imaging modalities are discussed under common/clinically relevant scenarios. 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.
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Imageamento por Ressonância Magnética/métodos , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Criança , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Estados UnidosRESUMO
Recent legislation mandates the documentation of appropriateness criteria consultation when ordering advanced imaging for Medicare patients to remain eligible for reimbursement. Implementation of imaging clinical decision support (CDS) is a solution adopted by many systems to automate compliance with the new requirements. This article is intended to help radiologists who are employed by, contracted with, or otherwise affiliated with systems planning to implement CDS in the near future and ensure that they are able to understand and contribute to the process wherever possible. It includes an in-depth discussion of the legislation, evidence for and against the efficacy of imaging CDS, considerations for selecting a CDS vendor, tips for configuring CDS in a fashion consistent with departmental goals, and pointers for implementation and change management.
Assuntos
Sistemas de Apoio a Decisões Clínicas/classificação , Sistemas de Apoio a Decisões Clínicas/normas , Implementação de Plano de Saúde/organização & administração , Medicare/normas , Sistemas de Informação em Radiologia/normas , Radiologia/organização & administração , Encaminhamento e Consulta/organização & administração , Sistemas de Apoio a Decisões Clínicas/legislação & jurisprudência , Guias como Assunto , Medicare/legislação & jurisprudência , Sistemas de Informação em Radiologia/legislação & jurisprudência , Avaliação da Tecnologia Biomédica/métodos , Estados UnidosRESUMO
The concept of value in radiology has been strongly advocated in recent years as a means of advancing patient care and decreasing waste. This article explores the concept of value creation in radiology and offers a framework for how radiology practices can create value according to the needs of their referring clinicians. Value only exists in the eyes of a customer. We propose that the primary purpose of diagnostic radiology is to answer clinical questions using medical imaging to help guide management of patient care. Because they are the direct recipient of this service, we propose that referring clinicians are the direct customers of a radiology practice and patients are indirect customers. Radiology practices create value as they understand and fulfill their referring clinicians' needs. To narrow those needs to actionable categories, we propose a framework consisting of four major dimensions: (1) how quickly the clinical question needs to be answered, (2) the degree of specialization required to answer the question, (3) how often the referring clinician uses imaging, and (4) the breadth of imaging that the referring clinician uses. We further identify three major settings in which referring clinicians utilize radiological services: (1) emergent or urgent care, (2) primary care, and (3) specialty care. Practices best meet these needs as they engage with their referring clinicians, create a shared vision, work together as a cohesive team, structure the organization to meet referring clinicians' needs, build the tools, and continually improve in ways that help referring clinicians care for patients.