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1.
Jared S. Winoker Olamide O. Omidele Richard G. Stock Nelson N. Stone 《Brachytherapy》2019,18(2):192-197
PURPOSE
To evaluate the oncological and functional outcomes of young men treated with low-dose-rate brachytherapy (BT) for prostate cancer (PCa).MATERIALS AND METHODS
423 men aged ≤60 years with clinically localized PCa were treated with BT ± external beam radiation. Biochemical failure was defined by Phoenix criteria. Freedom from biochemical failure (FFbF) and cancer-specific survival (CSS) at 10 and 15 years were estimated by the Kaplan–Meier method with the log-rank test to compare outcomes between National Comprehensive Cancer Network risk groups. The Cox proportional hazards model was used to determine significant predictors for FFbF and CSS.RESULTS
Median followup was 9.9 years (range, 5.1–21.7). Median age was 57 years (range, 39–60), and median prostate-specific antigen was 6.1 ng/mL (range, 0.8–71). Overall, 10- and 15-year FFbF rates were 89% and 88%; 10- and 15-year CSS rates were 99% and 98%. Increasing disease risk was associated with lower FFbF and CSS (p < 0.0001). Biologically effective dose (p < 0.0001) and use of external beam radiation (p = 0.005) were significantly associated with higher FFbF. In men potent before BT, 64% (151/237) had preserved erectile function at a median 10.2 years. There was no significant difference between treatment groups with respect to long-term urinary function (p = 0.56).CONCLUSIONS
Younger men treated with BT experience excellent long-term PCa control with low rates of treatment-related toxicity. 相似文献2.
Jessica L. Conway Rachel Gerber Kathy Han Haiyan Jiang Jason Xie Akbar Beiki-Ardakani Anthony Fyles Michael Milosevic Deborah Williamson Jennifer Croke 《Brachytherapy》2019,18(2):133-140
Purpose
The treatment of locally advanced cervical cancer with definitive chemoradiation (CRT) is associated with vaginal toxicity and altered sexual satisfaction. This prospective study assessed patient-reported sexual adjustment, vaginal dosimetry, and physician-reported vaginal toxicity in patients with cervical cancer treated with CRT and MR-guided brachytherapy (BT).Materials and Methods
Between 2008 and 2010, International Federation of Gynecologists and Obstetricians stage IB-IVA patients with cervical cancer receiving definitive CRT were enrolled in a feasibility study assessing MR-guided BT. Patients completed the validated sexual adjustment questionnaire (SAQ) before BT (baseline) and during followup. Physician-reported vaginal toxicity was recorded. The International Commission on Radiation Units and Measurements rectovaginal point, mean vaginal dose, and D2cm3 were calculated. Mean SAQ scores at baseline and followup assessments were calculated. Mean time effects were estimated using a linear mixed-effects model. A multivariable linear mixed-effects model was used to examine the association between total and individual scores (repeated measures) and covariates.Results
Sixty patients were approached to participate: 29 consented and 27 completed the SAQ at baseline and followup. The diagnosis of cervical cancer and treatment negatively impacted sexual relationships in 61% and 39%, respectively. There were no significant changes in sexual adjustment over time (p = 0.599). There were no associations between sexual adjustment and the International Commission on Radiation Units and Measurements rectovaginal point dose or clinical vaginal involvement. Patients with higher International Federation of Gynecologists and Obstetricians stages (≥IIB) had significantly worse sexual adjustment (p = 0.005).Conclusion
CRT and MR-guided BT negatively impacted sexual relationships in patients with cervix cancer; however, there were no significant longitudinal changes in patient-reported sexual adjustment. Worse sexual adjustment may be associated with more advanced disease presentations. 相似文献3.
Nicholas G. Zaorsky Awad A. Ahmed Junjia Zhu Stella K. Yoo Clifton D. Fuller Charles R. Thomas Mehee Choi Emma B. Holliday 《Journal of the American College of Radiology》2019,16(2):244-251
Purpose
Industry payments to physicians are financial conflicts of interest and may influence research findings and medical decisions. We aim to (1) characterize industry payments within radiation oncology; and (2) explore the potential correlation between receiving disclosed industry payments and academic productivity.Materials/Methods
CMS database was used to extract 2015 industry payments. For academic radiation oncologists, research productivity was characterized by h- and m-indices, as well as receipt of National Institutes of Health (NIH) funding, which is not an industry payment. Logistic regression models were used to determine whether publication metrics (m-index, h-index) and other study characteristics such as gender, PhD status, NIH institution funding status, were associated with the endpoints, research and general payments. Associations between the amount of payments (if any) and publication metrics were further studied using linear regression models.Results
A total of 22,543 individual payments totaling $25,532,482 to 2,995 radiation oncologists were included. Among the 1,189 academic radiation oncologists, 75% received less than $167; on the other hand, 10 (<1%) individuals received $6,425,728 (51%) of payments. On multiple logistic regression, research payments were significantly associated with the m-index, odds ratio 2.86 (95% confidence interval, 1.84-4.45, p-value <0.0001); as well as with the h-index, odds ratio 1.03 (95% confidence interval, 1.01-1.05, p-value <0.0001). The linear regression model shows that both m-index and h-index were significantly positively associated with the amount of general payments (p-values <0.0001).Conclusion
There is an association between disclosed payment from the industry and increased individual research productivity metrics. Further research to find the cause behind this association is warranted. 相似文献4.
Edwin A. Takahashi Chad J. Fleming James C. Andrews 《Journal of vascular and interventional radiology : JVIR》2019,30(3):435-439
Purpose
To determine if there is a correlation between intrahepatic tumor volume and future liver remnant (FLR) hypertrophy after portal vein embolization (PVE).Materials and Methods
Forty-four consecutive patients with hepatocellular carcinoma or metastatic colorectal cancer who underwent PVE from 2009 to 2017 and who had complete imaging follow-up were retrospectively reviewed. To maximize the accuracy of tumor volume measurements, 11 patients were excluded for having more than 5 intrahepatic tumors. Volumetric analyses of the patient livers before and after PVE, as well as pre-embolization intrahepatic tumor burden, were performed.Results
A significant inverse correlation was observed between tumor volume and FLR hypertrophy after PVE (Spearman ρ = -0.53, P = .002). Initial FLR volume was also inversely correlated with subsequent hypertrophy (P = .01). Fourteen patients received neoadjuvant chemotherapy 1 month prior to intervention. The number of chemotherapy cycles did not affect hypertrophy (P = .57). Patients with cirrhosis experienced less FLR hypertrophy than patients without cirrhosis (P = .02).Conclusions
Patients with large intrahepatic tumor burden may experience limited FLR hypertrophy. 相似文献5.
Marcelina G. Perez Magali Fassiotto Jonathan Altamirano Gloria L. Hwang Yvonne Maldonado Shellie Josephs Daniel Y. Sze Nishita Kothary 《Journal of vascular and interventional radiology : JVIR》2019,30(4):579-583
Purpose
To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators.Materials and Methods
Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012–2017) were statistically compared to that of recurring male faculty.Results
From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P = .722; total publications P = .689; and authorship P = .662).Conclusions
This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record. 相似文献6.
Ning Lyu Yanan Kong Tao Pan Luwen Mu Shaolong Li Yaru Liu Haijing Deng Jibin Li Ming Shi Li Xu Rongping Guo Minshan Chen Peihong Wu Ming Zhao 《Journal of vascular and interventional radiology : JVIR》2019,30(3):349-357.e2
Purpose
To compare treatment with hepatic arterial infusion of chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC) with both extrahepatic spread (EHS) and intrahepatic tumor and patients with intrahepatic tumor only.Materials and Methods
This single-center retrospective study comprised 116 patients with advanced HCC with both intrahepatic tumor and EHS (EHS group; n = 50) or with intrahepatic tumor only (non-EHS group; n = 66) treated with HAIC including oxaliplatin, fluorouracil, and leucovorin between June 2014 and July 2016. Overall survival (OS) and radiologic responses to treatment were determined and compared between the 2 groups.Results
Both the objective response rate and the clinical benefit rate were higher in the non-EHS group than in the EHS group (37.9% vs 16% objective response rate, P = .010; 81.8% vs 62% clinical benefit rate, P = .017). Median OS was not statistically different between the 2 groups (14.8 months vs 9.8 months, P = .068). Subgroup analysis of OS found that patients with lung metastases survived for a shorter time (OS 7 months) than patients with other metastatic sites (P = .003) and patients free of metastases (P = .001).Conclusions
HAIC is a potential treatment option for advanced HCC with limited extrahepatic metastases in a population with hepatitis B virus infection. 相似文献7.
Christina Small Grant Harmon John Weaver Vince Vivirito Ramon Durazo-Arvizu William Small Matthew M. Harkenrider 《Brachytherapy》2019,18(2):141-145
Purpose
Concurrent chemoradiotherapy and brachytherapy is the standard of care for locally advanced cervical cancer. Brachytherapy is an integral part of treatment and has improved overall survival. Research is needed to ascertain the planning modalities and schedules to best use resources and optimize treatment time course. We hypothesized that MRI-based brachytherapy when delivered with the described regimen would not prolong, and potentially shorten, overall treatment time as compared with CT-based brachytherapy.Methods and Materials
This study was a single-institution retrospective review within the years 2008 through 2018. Patients with cervical cancer of any stage who underwent definitive chemoradiotherapy and either CT- or MRI-based brachytherapy were included. The primary outcome variable for this study was time (in days). Overall treatment time was defined as the number of days from the first until the last day of radiotherapy. Univariate analysis was performed using Stata statistical software.Results
External beam radiotherapy doses were generally 45–50.4 Gy. CT-based and MRI-based brachytherapy were performed in 55 and 49 patients, respectively. The median treatment time for brachytherapy with CT-based planning was 19.0 days and with MRI-based planning was 9.0 days (p < 0.001). The median treatment time for total radiation therapy with CT-based planning was 53 days, and with MRI-based planning was 50 days (p = 0.781).Conclusions
This study found that MRI-based brachytherapy, when performed with the proposed regimen, did not prolong overall treatment time and significantly decreased time to complete brachytherapy in comparison with CT-based brachytherapy on nonconsecutive days. This regimen favorably impacts timely completion of treatment and uses MRI resources well within the construct of our institution. 相似文献8.
Zhuhui Yuan Yang Wang Jim Zhang Jiasheng Zheng Wei Li 《Journal of the American College of Radiology》2019,16(3):302-314
Purpose
We conducted a meta-analysis assessing clinical outcomes of radiofrequency ablation (RFA) and microwave ablation (MWA) for treating lung cancer.Methods
Databases were searched up to 2017 to identify high-quality studies. The results were presented as pooled estimates with 95% confidence intervals (CIs).Results
Fifty-three studies were included, and up to 3,432 patients were pooled. The estimated 1-, 2-, 3-, 4-, and 5-year overall survival (OS) rates were higher for RFA-treated patients compared with those treated by MWA. The median OS, median progression-free survival (PFS), median local tumor PFS, complete ablation rate, and adverse events did not differ significantly. Subgroup analyses by tumor type showed that the median OS for RFA-treated patients with pulmonary metastases was higher than that of the MWA-treated patients.Conclusion
Thermal ablation, both RFA and MWA, is an effective approach for treating lung cancer with low risk of adverse events. RFA is associated with longer survival than MWA, and patients with pulmonary metastases showed better survival after RFA compared with MWA-treated patients. 相似文献9.
10.
Gerson M. Struik Jean-Philippe Pignol Inger-Karine Kolkman-Deurloo Jeremy Godart Gerda M. Verduijn Linetta B. Koppert Erwin Birnie Ali Ghandi Taco M. Klem 《Brachytherapy》2019,18(2):204-210
Purpose
Accelerated partial breast irradiation is a treatment option for selected patients with early-stage breast cancer. Some accelerated partial breast irradiation techniques lead to skin toxicity with the skin dose as a main risk factor. Biodegradable spacers are effective and safe in prostate brachytherapy to protect the rectum. We hypothesize that a subcutaneous spacer injection reduces the skin dose in breast brachytherapy.Methods and Materials
Ultrasound-guided spacer injections, either hyaluronic acid (HA) or iodined polyethylene glycol (PEG), were performed on fresh mastectomy specimens. Success was defined as a spacer thickness of ≥5 mm in the high-dose skin area. Usability was scored using the system usability scale. Pre and postinjection CT scans were used to generate low-dose-rate seed brachytherapy treatment plans after defining a clinical target volume. Maximum dose to small skin volumes (D0.2cc) and existence of hotspots (isodose ≥90% on 1 cm2 of skin) were calculated as skin toxicity indicators.Results
We collected 22 mastectomy specimens; half had HA and half had PEG injection. Intervention success was 100% for HA and 90.9% for PEG (p = NS). Hydrodissection was feasible in 81.8% with HA and 63.6% with PEG. Median system usability scale score was 97.5 for HA and 82.5 for PEG (p < 0.001). Mean D0.2cc was 80.8 Gy without spacer and 53.7 Gy with spacer (p < 0.001). Skin hotspots were present in 40.9% without spacer but none with spacer (p < 0.001).Conclusions
A spacer injection in mastectomy specimens is feasible. An extra 5 mm space is always achieved, thereby potentially reducing the skin dose dramatically in low-dose-rate seed breast brachytherapy. 相似文献11.
Daniel Rohan Phadke Daniel P. Sheeran Luke R. Wilkins John A. Kern Margaret C. Tracci John F. Angle 《Journal of vascular and interventional radiology : JVIR》2019,30(4):572-577
Purpose
To characterize the degree of venous collateralization before and after endovascular therapy and determine the effect of collateralization on success of thrombolysis and rate of repeat intervention in patients with Paget–Schroetter syndrome.Materials and Methods
A single-center retrospective study of 37 extremities in 36 patients (mean age, 32.64 y; range, 15–72 y; 24 men) with PSS treated with endovascular therapy from 2007 through 2017 was conducted. Venograms at presentation, after lysis, postoperatively, and at each repeat intervention were graded for venous stenosis, thrombus burden, and collateralization on a 5-point scale. Collateralization was classified as high-grade (9 extremities) or low-grade (28 extremities) based on grading of the venograms at presentation.Results
Primary technical success rate for endovascular treatment was 100%. Eighty-six percent of patients (32 of 37) underwent thrombolysis, 91% (34 of 37) underwent mechanical thrombectomy, and 83% (30 of 37) underwent balloon angioplasty. Overall primary patency rate was 50% at 12 months. The repeat intervention rate within 12 months was significantly higher for extremities with high- vs low-grade collateralization (89% vs 43%; P = .016). There was a significant decrease in the median grade of collateral severity after initial intervention (2 vs 1; P = .044) and 1 day postoperatively (2 vs 1; P = .040) vs the venogram at presentation.Conclusions
Severity of venous collateralization on the venogram at presentation of patients with PSS does not appear to affect success of endovascular therapy but may predict long-term patency of affected extremities. Patients in this cohort with severe collateralization on presentation were more likely to need repeat intervention. 相似文献12.
Martin T. King David D. Yang Vinayak Muralidhar Brandon Mahal Santino Butler Phillip M. Devlin Larissa J. Lee Kent. W. Mouw Neil M. Martin Anthony V. D&#x;Amico Paul L. Nguyen Peter F. Orio 《Brachytherapy》2019,18(2):186-191
Purpose
External beam radiation therapy (EBRT) with low-dose-rate (LDR) brachytherapy boost has been associated with improved biochemical progression–free survival and overall survival (OS) compared with dose-escalated EBRT (DE-EBRT) alone for unfavorable-risk prostate cancer. However, it is not known whether high-dose-rate (HDR) boost provides a similar benefit. We compare HDR boost against LDR boost and DE-EBRT with respect to OS.Methods
Using the National Cancer Database, we identified 122,896 patients who were diagnosed with National Comprehensive Cancer Network intermediate- or high-risk prostate cancer between 2004 and 2014 and treated with DE-EBRT (75.6–86.4 Gy), LDR boost, or HDR boost. We compared the OS among the three groups using multivariable Cox proportional hazards regression. Inverse probability treatment weighting was used to adjust for covariate imbalance.Results
On multivariable Cox proportional hazards regression, HDR boost was associated with a similar OS to LDR boost (adjusted hazard ratio [AHR] 1.03 [0.96, 1.11]; p = 0.38) but significantly better OS than DE-EBRT (AHR 1.36 [1.29, 1.44]; p < 0.001). Inverse probability treatment weighting analysis yielded similar results. There was no significant difference between LDR and HDR boosts for National Comprehensive Cancer Network intermediate-risk (AHR 1.05 [0.96, 1.15]; p = 0.32) and high-risk (AHR 1.00 [0.89, 1.12]; p = 0.98) subgroups (p-interaction = 0.55).Conclusions
Our results suggest that HDR brachytherapy boost yields similar OS benefits compared with LDR brachytherapy boost for unfavorable-risk prostate cancer. HDR boost may be a suitable alternative to LDR boost. 相似文献13.
Nassir Rostambeigi Patrick Scanlon Siobhan Flanagan Nicholas Frank Reza Talaie Rafael Andrade Jafar Golzarian Prashant Shrestha 《Journal of vascular and interventional radiology : JVIR》2019,30(3):453-459
Purpose
To compare the safety and efficacy of hook wire versus microcoil localization of pulmonary nodules prior to video-assisted thoracoscopic resection (VATS).Materials and Methods
A retrospective comparative review was conducted of 46 patients (26 hook wire and 20 microcoil) who underwent computed tomography fluoroscopic-guided nodule localizations prior to VATS in a single center between January 2012 and August 2016. Nodule characteristics, procedural details, clinical outcomes, and pathologic findings were collected. Baseline characteristics and lung nodule distribution were not significantly different between the 2 groups. Nodule sizes ranged from 2 mm to 28 mm and were similar between groups. Twenty-nine patients (63%) were male, with mean (standard deviation) age of 61 (11) years. Adverse events were classified using standard criteria. Patients were followed for up to 90 days, and the clinical outcomes were compared.Results
Successful resection of nodules was achieved in all patients. Twelve cases of displacement of the hook wire were observed compared to only 1 in the coil group (P < .01). The total complication rate was lower in the coil group (25% vs 54%, P = .04). Two patients required transition to thoracotomy in the hook wire group, compared to none in the coil group. Median blood loss was similar in both groups (median loss, 20–22 mL). One patient had positive margins in the hook wire group. There was a nonsignificant trend toward longer hospital stay and higher major complication rates after hook wire localization (P = .4).Conclusions
Pulmonary nodule localization with coils prior to VATS resection demonstrated fewer displacements and fewer perioperative complications compared to hook wires. 相似文献14.
Christer Ruff Gerd Grözinger Roland Syha Stefanie Elser Sasan Partovi Michael Bitzer Marius Horger Konstantin Nikolaou Ulrich Grosse 《Journal of vascular and interventional radiology : JVIR》2019,30(3):380-389.e4
Purpose
To compare different imaging techniques (volume perfusion CT, cone-beam CT, and dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid–enhanced dynamic contrast–enhanced MR imaging with golden-angle radial sparse parallel MR imaging) in evaluation of transarterial chemoembolization of hepatocellular carcinoma (HCC) using radiopaque drug-eluting embolics (DEE).Materials and Methods
MR imaging and CT phantom investigation of radiopaque DEE was performed. In the clinical portion of the study, 13 patients (22 HCCs) were prospectively enrolled. All patients underwent cross-sectional imaging before and after transarterial chemoembolization using 100–300 μm radiopaque DEE. Qualitative assessment of images using a Likert scale was performed.Results
In the phantom study, CT-related beam-hardening artifacts were markedly visible at a concentration of 12% (v/v) radiopaque DEE; MR imaging demonstrated no significant detectable signal intensity changes. Imaging obtained before transarterial chemoembolization showed no significant difference regarding tumor depiction. Visualization of tumor feeding arteries was significantly improved with volume perfusion CT (P < .001) and cone-beam CT (P = .002) compared with MR imaging. Radiopaque DEE led to significant decrease in tumor depiction (P = .001) and significant increase of beam-hardening artifacts (P = .012) using volume perfusion CT before versus after transarterial chemoembolization. Greater residual arterial tumor enhancement was detected with MR imaging (10 HCCs) compared with volume perfusion CT (8 HCCs) and cone-beam CT (6 HCCs).Conclusions
Using radiopaque DEE, the imaging modalities provided comparable early treatment assessment. In HCCs with dense accumulation of radiopaque DEE, treatment assessment using volume perfusion CT or cone-beam CT may be impaired owing to resulting beam-hardening artifacts and contrast stasis. Dynamic contrast–enhanced MR imaging may add value in detection of residual arterial tumor enhancement. 相似文献15.
Alexander J. Lin Comron Hassanzadeh Stephanie Markovina Julie Schwarz Perry Grigsby 《Brachytherapy》2019,18(2):163-170
Purpose
Small cell cancer involving the cervix and uterus is considered the same rare disease, but management is controversial and disparate. Patterns of care and outcomes in the United States are unclear.Methods and Materials
Clinical data from patients with small cell cancer of the cervix and uterus were abstracted from the National Cancer Database from 2004 to 2014. Patients with missing clinical stage, incomplete followup, or receiving treatment >90 days from diagnosis were excluded.Results
There were 621 cervical and 95 uterine patients with cancer treated from 2004 to 2014. Compared to patients with a cervix primary site, patients with a uterine primary site were older (median age 64 years vs. 47 years), more likely to present with distant metastatic disease (47% vs. 33%), less likely to receive any pelvic radiation (31% vs. 64%), less likely to receive brachytherapy (3% vs. 27%), more likely to have at least a total hysterectomy (58% vs. 28%), and less likely to receive chemotherapy (74% vs. 88%), all p < 0.05. Brachytherapy was associated with improved overall survival (OS) for patients with locally advanced cervical small cell carcinoma (II–IVA, p = 0.03), but only 38% of patients with Stage II–IVA disease received brachytherapy. For the uterine site, hysterectomy (p = 0.001) and external irradiation (p = 0.03) were associated with improved OS in unadjusted Kaplan–Meier analysis, but only chemotherapy and stage were significantly associated with higher OS in multivariable analysis.Conclusions
Brachytherapy may improve OS for Stage II–IVA small cell cancer of the cervix but appears underutilized. Brachytherapy was not commonly delivered for uterine primaries. 相似文献16.
Objectives
Crowdsourcing works through an institution outsourcing a function normally performed by an employee or group of individuals. Within a crowdsource users, known as the crowd, form a community who voluntarily undertake a task which involves the pooling of knowledge resources. A literature review was undertaken to identify how the tool is being used in health professions education, and potential for use in radiography education.Key Findings
17 papers were returned. Literature identified was assessed against an established crowdsourcing definition. Reviewing these yielded four themes for discussion: student selection procedures, lesson planning, teaching materials and assessment.Conclusion
Crowdsourcing is associated with innovative activities through collective solution seeking via a large network of users. It is increasingly being adopted in healthcare training and maybe transferable to educational activities within the field of radiography education. 相似文献17.
B. Strøm J.A. Pires Jorge N.R. Meystre T. Kukkes E. Metsälä B.N. Hafslund 《Radiography》2019,25(2):170-177
Objectives
To identify the roles of health care staff in interprofessional work related to breast cancer detection and diagnosis.Key findings
A comprehensive search was performed using PICO to support inclusion and exclusion criteria. A shortened version of the STROBE checklist ensured evaluation of the studies. 21 included studies resulted in three main categories describing the role of health care professionals; (1) Communicating breast cancer awareness; (2) The Professional's tasks; (3) Efficacy of Interprofessional Teamwork relative to the profession and the individuals.Conclusions
Health care professionals' roles in the breast cancer diagnostic process were described mostly from each professional's viewpoint. Support from leadership and management is needed in order to promote interprofessional work, which will benefit health care professions, professionals, and the patient. 相似文献18.
Felix M. Gonzalez J. Matthew Kerchberger Douglas D. Robertson Yara Younan Adam Singer Walter A. Carpenter Richard Duszak James R. Roberson Monica B. Umpierrez 《Journal of the American College of Radiology》2019,16(3):289-294
Purpose
To evaluate the appropriateness of MRI ordering practices and their effect on clinical management for nontraumatic knee pain at the primary care clinics of a large public urban hospital.Materials and Methods
In all, 196 consecutive MRIs for nontraumatic knee pain ordered from primary care clinics in a large public urban hospital over an 18-month period were studied. ACR Appropriateness Criteria (AC) scores for nontraumatic knee pain were retrospectively calculated from medical record reviews. The record was also reviewed to assess whether knee MRI changed clinical management. Knee osteoarthritis grading was performed. Tests were performed for differences in age, body mass index (BMI), gender, and ethnicity among appropriate and inappropriate MRIs.Results
Of the MRIs, 57% (108 knees) had “usually appropriate” (ie, 7-9) and 43% (8 knees) had “usually not appropriate” (ie, 1-3) AC scores (P > .1). Clinical management was changed in 26% of knees with “usually appropriate” and 20% of knees with “usually inappropriate” scores (P < .05), and 70% of the knees with “usually appropriate” and 61% of the knee with “usually not appropriate” scores had moderate to severe osteoarthritis. Age, BMI, gender, and ethnicity had no significant effect on AC scores.Conclusion
In patients referred from primary care for MRI for nontraumatic knee pain, adherence to AC was low. Additional focus on reducing “appropriate” studies that do not impact clinical management (eg, cases with radiographically evident moderate to severe osteoarthritis) is also warranted. 相似文献19.
Robert K. Horsley Juliana M. Kling Suneela Vegunta Roxanne Lorans H’hamed Temkit Bhavika K. Patel 《Journal of the American College of Radiology》2019,16(2):164-169
Objectives
Studies have shown that having a baseline mammogram, the first screening mammogram, available for comparison at the time of interpreting a subsequent mammogram significantly decreases the potential of a false-positive examination. Our aim was to evaluate knowledge of and perception about the significance of baseline mammograms in those women undergoing screening mammography.Materials and Methods
A cross-sectional prospective survey study was conducted in women without a history of breast cancer presenting for their screening mammogram. Respondents were surveyed anonymously between March and April 2017. The questionnaire was developed by primary care providers and radiologists and pretested for readability and clarity.Results
In all, 401 women (87% white, 93% educated beyond high school) completed surveys in which 77% of women reported having yearly mammograms, 31% reported having a history of an abnormal mammogram, and 45% had not heard the term baseline mammogram. Of those who had heard the term, the most commonly reported source was their primary care provider (31%). Although 74% chose the correct definition of a baseline mammogram, 67% did not think that a baseline mammogram was important for decreasing associated cost, time, and discomfort due to the number of mammograms incorrectly read as abnormal.Conclusion
In a group of educated women who routinely get mammograms, almost one-half had not heard the term baseline mammogram. Furthermore, most women did not think baseline mammography was important for decreasing associated cost, time, and discomfort due to mammograms incorrectly read as abnormal. This study suggests that efforts to improve women’s understanding of baseline mammograms and their importance are warranted, with greatest opportunity for health care providers and radiologists. 相似文献20.
Nancy M. Cappello Dorinda Richetelli Christoph I. Lee 《Journal of the American College of Radiology》2019,16(2):139-146