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To determine imaging utilization rates in outpatient primary care visits and factors influencing likelihood of imaging use. We used 2013 to 2018 National Ambulatory Medical Care Survey cross-sectional data. All visits to primary care clinics during the study period were included in the sample. Descriptive statistics on visit characteristics including imaging utilization were calculated. Logistic regression analyses evaluated the influence of a variety of patient-, provider-, and practice-level variables on the odds of obtaining diagnostic imaging, further subdivided by modality (radiographs, CT, MRI, and ultrasound). The data's survey weighting was accounted for to produce valid national-level estimates of imaging use for US office-based primary care visits. Using survey weights, approximately 2.8 billion patient visits were included. Diagnostic imaging was ordered at 12.5% of visits with radiographs the most common (4.3%) and MRI the least common (0.8%). Imaging utilization was similar or greater among minority patients compared with White, non-Hispanic patients. Physician assistants used imaging at higher rates than physicians, in particular CT at 6.5% of visits compared with 0.7% for doctors of medicine and doctors of osteopathic medicine (odds ratio 5.67, 95% confidence interval 4.07-7.88). Disparities in rates of imaging utilization for minorities seen in other health care settings were not present in this sample of primary care visits, supporting that access to primary care is a path to promote health equity. Higher rates of imaging utilization among advanced-level practitioners highlight an opportunity to evaluate imaging appropriateness and promote equitable, high-value imaging among all practitioners. [ABSTRACT FROM AUTHOR]

Radiology has widely acknowledged the need to improve inclusion of racial, ethnic, gender, and sexual minorities, with recent discourse also underscoring the importance of disability diversity and inclusion efforts. Yet studies have shown a paucity of diversity among radiology residents, despite increasing efforts to foster diversity and inclusion. Thus, the purpose of this study is to assess radiology residency program websites' diversity statements for inclusion of race and ethnicity, gender, sexual orientation, and disability as commonly underrepresented groups. A cross-sectional, observational study of websites of all diagnostic radiology programs in the Electronic Residency Application Service directory was conducted. Program websites that met inclusion criteria were audited for presence of a diversity statement; if the statement was specific to the residency program, radiology department, or institution; and if it was presented or linked on the program or department website. All statements were evaluated for the inclusion of four diversity categories: race or ethnicity, gender, sexual orientation, and disability. One hundred ninety-two radiology residencies were identified using Electronic Residency Application Service. Programs with missing or malfunctioning hyperlinks (n = 33) or required logins (n = 1) were excluded. One hundred fifty-eight websites met inclusion criteria for analysis. Two-thirds (n = 103; 65.1%) had a diversity statement within their residency, department, or institution, with only 28 (18%) having residency program–specific statements and 22 (14%) having department-specific statements. Of the websites with diversity statements, inclusion of gender diversity was most frequent (43.0%), followed by race or ethnicity (39.9%), sexual orientation (32.9%), and disability (25.3%). Race or ethnicity was most included in institution-level diversity statements. Less than 20% of radiology residency websites include a diversity statement, and disability is the least-included category among the diversity statements. As radiology continues to lead diversity and inclusion efforts in health care, a more comprehensive approach with equitable representation of different groups, including those with disabilities, would foster a broader sense of belonging. This comprehensive approach can help to overcome systemic barriers and bridge gaps in disability representation. [ABSTRACT FROM AUTHOR]

Imaging is a central determinant of health outcomes, and radiologic disparities can cascade throughout a patient's illness course. Innovative efforts in radiology are constant, but innovation that is driven by short-term profit-making incentives without explicit regard for principles of justice can lead to exclusion of the vulnerable from potential benefits and widening of inequities. Accordingly, we must consider the ways in which the field of radiology can shape innovative efforts to ensure that innovation ameliorates injustice instead of exacerbating it. The authors propose a distinction between approaches to innovation that prioritize justice and those that do not. The authors argue that the field's institutional incentives should be adjusted to prioritize forms of innovation that are likely to ameliorate imaging inequities, and they provide examples of initial steps that can be taken to make these adjustments. The authors propose the term justice-oriented innovation as a way of describing forms of innovation that are motivated by reducing injustice and can reasonably be expected to do so. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the presence or absence of accredited breast imaging facilities in ZIP codes with high or low neighborhood socioeconomic deprivation. A retrospective ecological study design was used. Neighborhood socioeconomic disadvantage rankings at the ZIP code level were defined by the University of Wisconsin Neighborhood Atlas Area Deprivation Index. Outcomes included the presence or absence of FDA- or ACR-accredited mammographic facilities, accredited stereotactic biopsy or breast ultrasound facilities, and ACR Breast Imaging Centers of Excellence. US Department of Agriculture rural-urban commuting area codes were used to define urban and rural status. Access to breast imaging facilities in high-disadvantage (≥97th percentile) and low-disadvantage (≤3rd percentile) ZIP codes was compared using χ2 tests, stratified by urban or rural status. Among 41,683 ZIP codes, 2,796 were classified as high disadvantage (1,160 rural, 1,636 urban) and 1,028 as low disadvantage (39 rural, 989 urban). High-disadvantage ZIP codes were more likely rural (P <.001) and less likely to have FDA-certified mammographic facilities (28% versus 35%, P <.001), ACR-accredited stereotactic biopsy (7% versus 15%, P <.001), breast ultrasound (9% versus 23%, P <.001), or Breast Imaging Centers of Excellence (7% versus 16%, P <.001). Among urban areas, high-disadvantage ZIP codes were less likely to have FDA-certified mammographic facilities (30% versus 36%, P =.002), ACR-accredited stereotactic biopsy (10% versus 16%, P <.001), breast ultrasound (13% versus 23%, P <.001), and Breast Imaging Centers of Excellence (10% versus 16%, P <.001). People living in ZIP codes with high socioeconomic disadvantage are less likely to have accredited breast imaging facilities within their ZIP codes, which may contribute to disparities in access to breast cancer care experienced by underserved groups living in these areas. [ABSTRACT FROM AUTHOR]

Health care workforce diversity is vital in combating health disparities. Despite much recent attention to downstream strategies to improve diversity in radiology, such as increased recruitment efforts and holistic application review, workforce diversity has not tangibly improved in recent decades. Yet, little discussion has been devoted to defining the obstacles that might delay, complicate, or altogether prevent persons from groups that have been traditionally marginalized and minoritized from a career in radiology. Refocusing attention to upstream barriers to medical education is vital to develop sustainable workforce diversity efforts in radiology. The purpose of this article is to highlight the varied obstacles students and trainees from historically underrepresented communities may face along the radiology career pathway and to provide concrete corollary programmatic solutions. Using a reparative justice framework, which encourages race- and gender-conscious repair of historical injustices, and the socioecological model, which recognizes an individual's choices are informed by historical and ongoing systems of power, this article advocates for tailored programs to improve justice, equity, diversity, and inclusion in radiology. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Health care-related cost concerns and financial toxicity are increasingly recognized barriers along the breast cancer care continuum. The purpose of this study was to evaluate the association between patient-reported cost concerns and screening mammography utilization.Methods: Survey participants aged 40 to 74 years from the 2018 National Health Interview Survey without personal history of breast cancer were included (response rate: 64%). Respondents were queried if they had experienced specific access-related health care barriers. Multiple variable logistic regression analyses were performed to evaluate the association between barriers to care and patient-reported screening mammography utilization.Results: Of survey respondents, 7,511 women were included. Of this group, 68.9% reported receiving a screening mammogram within the last 2 years and 52.2% reported receiving a screening mammogram within the last year. Of all survey respondents, 48.4% reported worry paying medical bills. Patients who reported worry about paying medical bills (odds ratio [OR] 0.86; 95% confidence interval [CI]: 0.76-0.97; P = .01), challenges affording dental care (OR 0.65; 95% CI: 0.54-0.77; P < .01), and challenges affording eyeglasses (OR 0.67; 95% CI: 0.54-0.84; P < .01) were less likely to report screening mammography use than their respective counterparts. Patients who skipped medication doses (OR 0.69; 95% CI: 0.52-0.91; P < .01), took less medication, (OR 0.63; 95% CI: 0.48-0.82; P < .01), and delayed filling prescriptions (OR 0.71; 95% CI: 0.56-0.90; P < .01) to save money were also less likely to report receiving mammography screening.Conclusion: Patient-reported cost-related barriers are associated with decreased utilization of routine mammography. [ABSTRACT FROM AUTHOR]

Purpose: CT colonography (CTC) is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). Prior studies suggest that CTC utilization remains low. However, there are few studies evaluating recent CTC utilization and predictors of CTC utilization. Our purpose was to estimate recent nationwide CTC utilization and evaluate predictors of CTC utilization using 2019 nationally representative cross-sectional survey data.Methods: Participants between ages 50 and 75 without colorectal cancer history in the 2019 National Health Interview Survey cross-sectional data were included. The proportion of participants reporting utilization of CTC was estimated, accounting for complex survey design elements. Multiple variable logistic regression analyses evaluated predictors of CTC utilization. Analyses were conducted accounting for complex survey design elements to obtain valid estimates for the civilian, noninstitutionalized US population.Results: In all, 13,709 respondents were included, and 1.4% reported undergoing CTC, of whom 39.9% underwent CTC within the last year, 18.5% within the last 2 years, 13.0% within the last 3 years, 7.8% within the last 5 years, 11.2% within the last 10 years, and 9.6% underwent CTC 10 years ago or more. Multiple variable logistic regression analyses revealed that Hispanic (odds ratio 2.67, 95% confidence interval 1.66-4.29, P < .001) and Black (odds ratio 2.47, 95% confidence interval 1.60-3.82, P < .001) participants were more likely than White participants to undergo CTC.Conclusion: Survey results suggest that nationwide utilization of CTC remains low. Black and Hispanic participants were more likely than White participants to report undergoing CTC. Promotion of CTC may reduce racial and ethnic disparities in colorectal cancer screening. [ABSTRACT FROM AUTHOR]

Rationale: Over the past decade, technological advances have provided new tools for radiologists. However, the effect of these technological advances on radiologist workload and detecting pathologies needs to be assessed.Objective: The purpose of this study is to assess the workload, including non-interpretative tasks, associated with Computed Tomography Angiogram (CTA) of Aorta exams performed in the Emergency Department (ED) over a 10-year period and their relationship to detection of aortic pathology.Materials and Methods: This is a retrospective analysis of CTAs of Aorta performed on adults with suspected acute aortic pathology within the ED at an academic level I quaternary care hospital from January 1, 2005, through December 31, 2015. Data assessed included (1) Interpretive tasks: total number of images, number of reformat series, number of radiology reports with positive aortic pathologies; and (2) Non-interpretative tasks: recommendations and documentation of verbal communication with requesting providers. Statistical analyses were performed to assess temporal trends of variables. P values less than 0.05 are considered significant.Results: A total of 4368 examinations (mean age: 69.8, M/F: 56.8%/43.2%) were performed. Studies per year increased significantly from 2005 (n = 278) to 2007 (n = 445), but not significantly after. The number of images and reformat series per scan increased from 487 to 2819 and 6.4 to 13.7, respectively (both P-value < 0.01). The proportion of exams with aortic findings did not significantly change (28.1% in 2005 and 24.9% in 2015). However, The proportions of exams with verbal communication increased from 9.3% to 24.6% and with recommendations from 1.8% to 28.9% (both P-value < 0.01).Conclusion: During a 10-year period, CTAs performed in the ED for suspected aortic pathology were associated with a significant increase in images created, reformat series generated, recommendations, and verbal communications with ordering providers without a concomitant increase in the rate of aortic pathologies. To completely capture the complexities of CTA workloads, non-interpretive tasks such as radiologist recommendations and verbal communications should also be included. [ABSTRACT FROM AUTHOR]

Purpose: Coronavirus disease 2019 and the publicly documented deaths of countless Black individuals have highlighted the need to confront systemic racism, address racial/ethnic disparities, and improve diversity and inclusion in radiology. Several radiology departments have begun to create diversity, equity, and inclusion (DEI) committees to systematically address DEI issues in radiology. However, there are few articles that provide departments with guidance on how to create DEI committees to comprehensively address DEI issues in radiology. The purpose of this review is to provide readers with a framework and practical tips for creating a comprehensive, institutionally aligned radiology DEI committee.Methods: The authors describe key components of the strategic planning process and lessons learned in the creation of a radiology DEI committee, on the basis of the experience of an integrated, academic northeastern radiology department.Results: A hospital-based strategic planning process defining the DEI vision, mission, goals, and strategies was used to inform the formation of the radiology department DEI committee. The radiology department performed gap analyses by conducting internal and external research. Strengths, weaknesses, opportunities, and threats analyses were performed on the basis of consultations with institutional and other departmental DEI leaders as well as DEI leaders from other academic medical centers. This framework served as the basis for the creation of the radiology departmental DEI committee, including a steering committee and four task forces (education, research, patient experience, and workforce development), each charged with addressing specific institutional goals and strategies.Conclusions: This review provides academic radiology departments with a blueprint to create a comprehensive, institutionally aligned radiology DEI committee. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the readability of breast cancer online patient educational materials (OPEM) written in Spanish and to compare to equivalent English-language OPEM.Methods: The breast cancer-related terms cáncer de seno (breast cancer), detección de cáncer de seno (breast cancer screening), and biopsia de seno (breast biopsy) were queried using an online search engine. After each query, educational information related to the queried term was downloaded from each website appearing on the first five search engine result pages. Readability of Spanish-language OPEM was evaluated using the Crawford reading grade score. When available, equivalent English-language OPEM from the same website was then evaluated using the mean of five validated readability indices. Differences in readability, word count, and reading time between Spanish- and English-language OPEM were compared using an unpaired t test. The Fisher exact test was used to compare the proportion of websites meeting AMA recommendations for patient educational resources.Results: Queries for cáncer de seno, detección de cáncer de seno, and biopsia de seno yielded 27, 31, and 30 results of term-specific OPEM. Equivalent English-language versions were available for 19 (70.4%), 18 (58.1%), and 20 (66.7%) websites, respectively. Spanish-language OPEM were written at a lower grade reading level than equivalent English-language versions overall (5.49 ± 0.50 versus 7.77 ± 1.95, P < .01). Spanish-language OPEM were also more likely than English-language OPEM to meet AMA recommendations (82.9% versus 40.4%, P < .01).Conclusions: Breast cancer-related Spanish-language OPEM were written at a significantly lower grade reading level compared with equivalent information written in English. [ABSTRACT FROM AUTHOR]

Purpose: Disproportionally high rates of coronavirus disease 2019 (COVID-19) have been noted among communities with limited English proficiency, resulting in an unmet need for improved multilingual care and interpreter services. To enhance multilingual care, the authors created a freely available web application, RadTranslate, that provides multilingual radiology examination instructions. The purpose of this study was to evaluate the implementation of this intervention in radiology.Methods: The device-agnostic web application leverages artificial intelligence text-to-speech technology to provide standardized, human-like spoken examination instructions in the patient's preferred language. Standardized phrases were collected from a consensus group consisting of technologists, radiologists, and ancillary staff members. RadTranslate was piloted in Spanish for chest radiography performed at a COVID-19 triage outpatient center that served a predominantly Spanish-speaking Latino community. Implementation included a tablet displaying the application in the chest radiography room. Imaging appointment duration was measured and compared between pre- and postimplementation groups.Results: In the 63-day test period after launch, there were 1,267 application uses, with technologists voluntarily switching exclusively to RadTranslate for Spanish-speaking patients. The most used phrases were a general explanation of the examination (30% of total), followed by instructions to disrobe and remove any jewelry (12%). There was no significant difference in imaging appointment duration (11 ± 7 and 12 ± 3 min for standard of care versus RadTranslate, respectively), but variability was significantly lower when RadTranslate was used (P = .003).Conclusions: Artificial intelligence-aided multilingual audio instructions were successfully integrated into imaging workflows, reducing strain on medical interpreters and variance in throughput and resulting in more reliable average examination length. [ABSTRACT FROM AUTHOR]

Objective: We aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screening interventions.Methods: Adult participants from the 2015 National Health Interview Survey were included. Among patients nonadherent to national breast, colorectal, or lung cancer screening guidelines, the proportion of patients reporting an ED visit within the last year was estimated, accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and screening adherence.Results: Of screening eligible respondents, 17.2% of women nonadherent to mammography screening, 16.9% of patients nonadherent to colorectal cancer screening, and 25.0% of patients nonadherent to lung cancer screening reported at least one ED visit in the preceding year. Patients visiting the ED with postsecondary school education were more likely to be up to date with mammography screening than those without advanced education (odds ratio [OR] 1.45; 95% confidence interval [CI]: 1.21-1.74; P = .01). Patients without insurance were less likely than those with insurance to report being up to date with both mammography screening (OR 0.31; 95% CI: 0.21-0.48; P = .01) and colorectal cancer screening (OR 0.56; 95% CI: 0.34-0.93; P = .03).Discussion: Opportunities to improve cancer screening adherence exist through ED-based preventative care interventions, which leverage multidisciplinary partnerships, including radiologists, to reach large volumes of patients who are not engaged in cancer screening. [ABSTRACT FROM AUTHOR]

Purpose: Millions of patients undergo CT imaging examinations every year. These encounters may represent opportunities to improve colorectal cancer (CRC) screening rates among patients who have not received recommended CRC screening. Using a nationally representative cross-sectional survey, our purpose was to estimate the proportion of patients who have undergone CT examinations who have not received recommended CRC screening.Methods: Survey respondents aged 45-75 years in the 2015 National Health Interview Survey without history of CRC were included. Proportion of patients who have undergone CT examinations among those who have not received recommended CRC screening was estimated. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and CRC screening adherence. Analyses were conducted accounting for complex survey design features.Results: Sixteen thousand two hundred and six survey respondents met inclusion criteria. About 44.3% (43.1, 45.5) reported having ever received a CT scan and 50.8% (49.6, 51.9) underwent CRC screening. Among those who previously had CT scans, Asian race participants and participants without health insurance coverage had lower odds of adherence, while increasing household income and education were associated with higher odds of adherence (P < 0.01). Among participants who did not receive CRC screening, 33.7% (32.1%, 35.3%) reported having a CT scan, representing an estimated 15,278,667 people across the United States.Conclusion: Among patients who have not received recommended CRC screening, nearly 1 out of 3 report having undergone a CT examination. CT encounters may represent opportunities to improve overall CRC screening rates. [ABSTRACT FROM AUTHOR]

Purpose: It is unclear whether patients and providers have started to knowingly request lung cancer screening (LCS) outside US guidelines and insurance coverage for risk factors besides a history of heavy smoking. The authors analyzed their institution's best practices advisory (BPA) clinical decision support system to determine whether providers knowingly order guideline-discordant LCS and the indications given.Methods: CT examinations ordered for LCS at an academic medical center that triggered BPA alerts from November 2018 to December 2019 were reviewed. Alerts were triggered by attempts to order examinations outside Medicare coverage, which resembles most US guidelines. Providers can override alerts to order the examinations. Primary outcomes were the number of examinations performed using orders with overridden BPA alerts and indications given. Qualitative exploratory and directed content analyses identified motivators and decision-making processes that drove guideline-discordant screening use.Results: Forty-two patients underwent guideline-discordant LCS, constituting 1.9% of all patients screened (42 of 2,248): 42.9% (18 of 42) were <54 or >77 years old, 14.3% (6 of 42) had never smoked, 40.5% (17 of 42) had quit >15 years earlier, and 31% (13 of 42) had smoked <30 pack-years; 45.2% (19 of 42) fell outside all US guidelines. The most common indication was a family history of lung cancer (21.4% [9 of 42]). Perceptions of elevated cancer risk from both patients and referring providers drove guideline-discordant screening use.Conclusions: Referring providers knowingly ordered screening CT examinations outside Medicare coverage and US guidelines, including for never smokers, for indications including a family history of lung cancer. LCS programs may need tailored strategies to guide these patients and providers, such as help with cancer risk assessment. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the differences in timeliness to MRI appointments and missed MRI appointment rates before and after the implementation of a rideshare program.Methods: Retrospective analysis of a rideshare program was performed 9 months after implementation to compare the effects before and after implementation. Variables obtained included demographics, MRI appointment variables, and data related to rideshare use. Descriptive statistics and linear and logistic regression analyses were used to compare demographic characteristics among patients using the rideshare program with (1) those who did not use the rideshare program after implementation and (2) patients before rideshare implementation. Rates of missed appointments derived from patient-related, same-day appointment cancellations were analyzed using logistic regression analyses. Timeliness was analyzed using linear regression analyses. All analyses were adjusted for potential confounders.Results: Of 7,707 patients scheduled for MRI appointments during the postintervention period, 151 patients used the rideshare service (1.95%). There were no statistically significant differences in missed appointment rates after rideshare implementation (adjusted odds ratio, 1.09; 95% confidence interval, 0.93-1.27; P = .275). Patients using the rideshare service were more likely to be on time (adjusted coefficient = 13.0; 95% confidence interval, 5.4-20.5; P = .001). Older patients (P = .001), unemployed patients (P < .001), and patients without commercial insurance (P < .001) were more likely to use the rideshare service.Conclusions: Implementation of a rideshare program did not significantly decrease missed appointment rates, but it significantly improved timeliness to MRI appointments while assisting at-risk patient populations reporting transportation barriers. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: While affiliated imaging centers play an important role in healthcare systems, little is known of how their operations are impacted by the COVID-19 pandemic. Our goal was to investigate imaging volume trends during the pandemic at our large academic hospital compared to the affiliated imaging centers.Materials and Methods: This was a descriptive retrospective study of imaging volume from an academic hospital (main hospital campus) and its affiliated imaging centers from January 1 through May 21, 2020. Imaging volume assessment was separated into prestate of emergency (SOE) period (before SOE in Massachusetts on March 10, 2020), "post-SOE" period (time after "nonessential" services closure on March 24, 2020), and "transition" period (between pre-SOE and post-SOE).Results: Imaging volume began to decrease on March 11, 2020, after hospital policy to delay nonessential studies. The average weekly imaging volume during the post-SOE period declined by 54% at the main hospital campus and 64% at the affiliated imaging centers. The rate of imaging volume recovery was slower for affiliated imaging centers (slope = 6.95 for weekdays) compared to main hospital campus (slope = 7.18 for weekdays). CT, radiography, and ultrasound exhibited the lowest volume loss, with weekly volume decrease of 41%, 49%, and 53%, respectively, at the main hospital campus, and 43%, 61%, and 60%, respectively, at affiliated imaging centers. Mammography had the greatest volume loss of 92% at both the main hospital campus and affiliated imaging centers.Conclusion: Affiliated imaging center volume decreased to a greater degree than the main hospital campus and showed a slower rate of recovery. Furthermore, the trend in imaging volume and recovery were temporally related to public health announcements and COVID-19 cases. [ABSTRACT FROM AUTHOR]

Purpose: To determine the variability in out-of-pocket costs of lung cancer screening (LCS) for uninsured patients and assess accessibility of this information by telephone or Internet.Methods: LCS centers from the ACR's LCS database were randomly selected. Centers were called between July and August 2019 to determine out-of-pocket cost. Telephone call variables, accessibility of cost information on screening centers' websites, screening centers' chargemasters, and publicly available facility and state insurance coverage variables were obtained. Cost information was summarized using descriptive analyses. Multiple variable linear regression analyses were conducted to evaluate effects of facility and state-level characteristics on out-of-pocket costs.Results: Fifty-five ACR-accredited LCS centers were included with 78% (43 of 55) willing to provide out-of-pocket cost. Average out-of-pocket cost was $583 ± $607 (mean ± standard deviation), range $49 to $2,409. Average telephone call length 6 ± 3.8 min. Two of fifty-five screening centers' websites provided out-of-pocket cost information, and one matched cost given over the telephone. A chargemaster was found for 30 of 55 screening centers. No statistically significant differences in out-of-pocket costs were found by geographic region, state percentages of uninsured residents, state percentages of residents with public insurance, or facility safety net hospital affiliation.Discussion: Out-of-pocket LCS costs for uninsured patients and availability of this information is highly variable. Radiology practices should be aware of this variability that may influence participation rates among uninsured patients. [ABSTRACT FROM AUTHOR]

Objective: Tobacco use is the leading cause of preventable mortality in the United States. Screening mammography (SM) visits present opportunities for radiology practices to reduce tobacco-related morbidity and mortality. Our study evaluates implementation of a program that provides tobacco cessation service referrals and screens for lung cancer screening (LCS) eligibility among smokers presenting for SM at a community health center.Methods: In 2018, two sets of questions were added to our SM patient intake questionnaire to assess (1) smoking history and (2) interest in referral to the health center-based tobacco cessation program for mailed information, telephone-based consultation, and in-person counseling. Primary outcomes were proportion of current smokers who requested a referral and of all smokers who were LCS-eligible. Bivariate logistic regression analyses compared sociodemographic characteristics of smokers who requested versus declined a referral.Results: Of the 89.3% (1,907 of 2,136) who responded, 10.5% (201 of 1,907) were current and 29.1% (555 of 1,907) were former smokers. Of current smokers, 26.4% (53 of 201) requested referrals: mailed information by 23.9% (48 of 201), in-person counseling by 9% (18 of 201), and telephone-based consultation by 7.5% (15 of 201). No sociodemographic predictors for referral requests were identified. Of all smokers, 9.3% (70 of 756) were eligible for LCS, of which 31.4% (22 of 70) were up to date.Conclusion: One in ten women who underwent SM at our community health center were current smokers, of which one-quarter requested tobacco cessation referrals. Among LCS-eligible smokers, one-third were up to date. SM presents opportunities for radiology practices to advance population health goals such as tobacco cessation and LCS. [ABSTRACT FROM AUTHOR]

Purpose: To assess temporal trends and utilization patterns of diagnostic imaging performed for substance use disorder (SUD)-related indications in an academic radiology emergency department (ED).Methods: Retrospective analyses of ED imaging examinations acquired from 2005 to 2015 were performed. Imaging examinations performed for suspected SUD-related indications, based on the order history, were compared with those without a SUD-related indication. Unadjusted analyses comparing demographic and imaging characteristics between SUD-related versus non-SUD-related indications used Wilcoxon and Pearson's χ2 tests. Multivariable logistic regression models, within each imaging modality subgroup and combined, were employed to examine the odds of imaging examinations having an SUD-related indication as a function of demographic and imaging characteristics.Results: Among 938,245 examinations, 0.17% had an SUD-related indication. Patients with SUD-related indications were younger (mean 37.2 ± 11.1 versus 53.5 ± 22.4, P < .001) and more commonly male (65% versus 52%, P < .001). The proportions of MR (17%), spine (17%), and extremities (33%) studies performed for SUD-related indications were larger among SUD than non-SUD indications (6%, 8%, 26%, respectively, all P < .001). Regression analysis demonstrated the odds of acquiring an ED imaging examination with an SUD-related indication significantly increased over time (P < .001, adjusted odds ratio [aOR] = 1.06), which was most pronounced among MR (P < .001, aOR = 1.23). For all regression models, younger age, male gender, and body part being imaged were identified as independent predictors of an SUD-related indication for ED imaging.Conclusion: Imaging performed for an SUD-related indication represented a small but increasing subset of overall ED imaging. Utilization of MR for SUD-related indications significantly outpaced growth of MR without SUD-related indications. [ABSTRACT FROM AUTHOR]

Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking, delays in cancer diagnosis, and inequities in cancer treatment. Additionally, adults with SMI experience patient, clinician, and health care system-level barriers to accessing cancer screening, such as cognitive deficits that impact understanding of cancer risk, higher rates of poverty and social isolation, patient-provider communication challenges, decreased access to tobacco cessation, and the fragmentation of primary care and mental health care. Despite the proven benefits and mandated coverage by public and private payers, lung cancer screening participation rates remain low among eligible patients, below 4% a year. Given disparities in other cancer screening modalities, these rates are likely to be even lower among individuals with SMI. This article provides a brief overview of current challenges in lung cancer screening and describes a pilot collaboration between radiology and psychiatry that has potential to improve access to lung cancer screening for individuals with serious mental illness. [ABSTRACT FROM AUTHOR]

Purpose: One in five US women report that they have been victims of intimate partner violence (IPV) during their lifetime. With millions of women presenting for mammography every year, breast imaging centers may represent ideal venues to identify women at risk for IPV and refer them to appropriate support services. Our purpose was to evaluate implementation of a novel IPV screening and referral system for women presenting for mammography.Methods: A question was added to intake questionnaire ("Do you feel safe in your home?") for adult women presenting for screening or diagnostic mammography from 2016 to 2017 at our hospital outpatient breast imaging sites. The proportion of women presenting for screening or diagnostic mammogram who felt unsafe was calculated. Bivariate logistic regression analyses were performed to compare baseline characteristics of women who stated that they felt unsafe at home versus women who did not state that they felt unsafe at home.Results: In all, 99,029 examinations were performed (68,158 unique patients). Of these patients, 71 stated that they felt unsafe at home (71 of 68,158, 0.1%). Women presenting for their first mammogram were more likely to report feeling unsafe at home (odds ratio 3.03, 95% confidence interval 1.31-7.06, P = .01). No differences were found in age (P = .148), ethnicity (P = .271), gravida (P = .676), parity (P = .752), age at menarche (P = .775), and history of breast cancer (P = .726).Conclusions: Our results demonstrate the feasibility of a screening and referral system for IPV in radiology departments. [ABSTRACT FROM AUTHOR]

Disparities in outcomes exist for breast, colon, and lung cancer among diverse populations, particularly racial and ethnic underrepresented minorities (URMs) and individuals from lower socioeconomic status. For example, blacks experience mortality rates up to about 42% higher than whites for these cancers. Furthermore, although overall death rates have been declining, the differential access to screening and care has aggravated disparities. Our purpose is to assess how the coverage policies of CMS and the United States Preventive Services Task Force (USPSTF) influence these disparities. Additionally, barriers are often encountered in accessing screening tests and receiving prompt treatment. To narrow, and potentially eliminate, outcomes disparities, CMS and USPSTF could consider revising their decision-making processes regarding coverage. Some options include (1) extending their evidence base to include observational studies that involve groups at higher risk; (2) lowering the threshold ages for screening to encompass differences in incidence; (3) CMS approving screening CT colonography coverage, which can even increase compliance with other screening tests; (4) clarifying and streamlining guidelines; (5) supporting research on improving access to screening; and (6) encouraging the development of more navigation services for URMs. [ABSTRACT FROM AUTHOR]

Our goal is to define patient navigation for an imaging audience, present a focused selection of published experiences with navigation programs for breast and colorectal cancer screening, and expose principal barriers to the success of such programs. Despite numerous advances in the early detection of cancers, many patients still present with advanced disease. A disproportionate number are low-income minority patients who experience worse health outcomes than their white or more financially stable counterparts. Patient navigation, which aims to assist the medically underserved by overcoming specific barriers to care, may represent one solution to narrowing disparities. Related research suggests that in general, patient navigation programs that have addressed breast or colorectal cancer screening have been successful in improving screening rates and timeliness of follow-up care. However, although beneficial, navigation is expensive and may present an unmanageable financial burden for many health care centers. To overcome this challenge, navigation efforts will likely need to target those patients that are most likely to benefit. Further research to identify such patients will be critically important for improving the sustainability of navigation programs, and, in turn, for realizing the benefits of such programs in reducing cancer disparities. [ABSTRACT FROM AUTHOR]

Purpose: As health care payment systems transition from fee-for-service to bundled payments, there is an increasing opportunity for radiologists to collaborate to improve population-based health care outcomes. Our purpose was to estimate the extent to which patients engaged in mammography underwent other additional imaging- and non-imaging-based preventative health services using Centers for Disease Control National Population Health Surveys.Methods: Women aged 40 to 74 in the 2014 Behavioral Risk Factor Surveillance System cross-sectional survey without histories of breast cancer who reported having a mammogram within the past 2 years were included. Adherence to recommended preventative services was based on US Preventive Services Task Force Recommendations, relative to the time at which the survey participant responded to the survey. Among women reporting being engaged in mammography, proportions of eligible women obtaining recommended preventative health services were calculated and stratified by demographics.Results: Of 172,245 women, 122,434 (71.1%) reported mammography within 2 years. The following percentages obtained recommended flu vaccines (49.2%), pneumococcal vaccines (69.5%), colorectal cancer screening (74.8%), and Papanicolaou test (93.2%). Women reporting mammography within the last 2 years with lower levels of education and income and who lacked health insurance or personal doctors were less likely to report receiving recommended preventative services (P < .001).Conclusions: National population-based survey results suggest that large proportions of women engaged in mammography report are not up to date with a wide variety of recommended preventative health services, suggesting ample opportunities for radiology practices to partner with providers to improve population-based health outcomes and add value to health care systems. [ABSTRACT FROM AUTHOR]

Highlights from the article: Graph: Fig 1 Illustrating the difference between health inequality, health equality, and health equity using access to lung cancer screening. 2 L.K. Brennan Ramirez E.A. Baker M. Metzler Promoting health equity: a resource to help communities address social determinants of health Available at: https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/sdoh-workbook.pdf 18 K.Y. Wang C.M. Malayil Lincoln M.M. Chen Radiology Support, Communication, and Alignment Network and Its Role to Promote Health Equity in the Delivery of Radiology Care J Am Coll Radiol 16 2019 638 643

Highlights from the article: Serving the Needs of Transgender and Gender-Diverse Persons in Radiology Transgender and gender-diverse (TGD) persons experience an inner sense of gender that does not align with the sex assigned to them at birth [1]. A rising prevalence of TGD persons in the United States (an estimated 1.4 million or 1 in 250 adults) coupled with increasing desire and insurance coverage for TGD health services has fueled a need for knowledgeable providers of gender-affirming hormonal and surgical therapies [1].

Purpose: The lexicons of the radiologist and the referring physician may not be synonymous, which could cause confusion with radiology reporting. To further explore this possibility, we surveyed radiologists and primary care physicians (PCPs) regarding their respective interpretations of report terminology.Methods: A survey was distributed to radiologists and PCPs through an internal listserv. Respondents were asked to provide an interpretation of the statistical likelihood of the presence of metastatic disease based upon the terminology used within a hypothetical radiology report. Ten common modifying terms were evaluated. Potential responses for the statistical likelihoods included 0%-25%, 26%-50%, 51%-75%, 76%-99%, and 100%. Differences between the groups were evaluated using either a χ2 test or Fisher exact test, as appropriate.Results: The phrases "diagnostic for metastatic disease" and "represents metastatic disease" were selected by a high percentage of both groups as conferring a 100% likelihood of "true metastatic disease." The phrases "cannot exclude metastatic disease" and "may represent metastatic disease" were selected by a high proportion of both groups as conferring a 0% likelihood of "true metastatic disease." Radiologists assigned a higher statistical likelihood to the terms "diagnostic for metastatic disease" (P = .016), "represents metastatic disease" (P = .004), "suspicious for metastatic disease" (P = .04), "consistent with metastatic disease" (P < .0001), and "compatible with metastatic disease" (P = .003).Conclusion: A qualitative agreement among radiologists and PCPs exists concerning the significance of the evaluated terminology, although radiologists assigned a higher statistical likelihood than PCPs for several phrases. [ABSTRACT FROM AUTHOR]

Osteoporosis is underdiagnosed, especially in ethnic and racial minorities who are thought to be protected against bone loss, but often have worse outcomes after an osteoporotic fracture. We aimed to determine the prevalence of osteoporosis by opportunistic CT in patients who underwent lung cancer screening (LCS) using non-contrast CT in the Northeastern United States. Demographics including race and ethnicity were retrieved. We assessed trabecular bone and body composition using a fully-automated artificial intelligence algorithm. ROIs were placed at T12 vertebral body for attenuation measurements in Hounsfield Units (HU). Two validated thresholds were used to diagnose osteoporosis: high-sensitivity threshold (115–165 HU) and high specificity threshold (<115 HU). We performed descriptive statistics and ANOVA to compare differences across sex, race, ethnicity, and income class according to neighborhoods' mean household incomes. Forward stepwise regression modeling was used to determine body composition predictors of trabecular attenuation. We included 3708 patients (mean age 64 ± 7 years, 54 % males) who underwent LCS, had available demographic information and an evaluable CT for trabecular attenuation analysis. Using the high sensitivity threshold, osteoporosis was more prevalent in females (74 % vs. 65 % in males, p < 0.0001) and Whites (72 % vs 49 % non-Whites, p < 0.0001). However, osteoporosis was present across all races (38 % Black, 55 % Asian, 56 % Hispanic) and affected all income classes (69 %, 69 %, and 91 % in low, medium, and high-income class, respectively). High visceral/subcutaneous fat-ratio, aortic calcification, and hepatic steatosis were associated with low trabecular attenuation (p < 0.01), whereas muscle mass was positively associated with trabecular attenuation (p < 0.01). In conclusion, osteoporosis is prevalent across all races, income classes and both sexes in patients undergoing LCS. Opportunistic CT using a fully-automated algorithm and uniform imaging protocol is able to detect osteoporosis and body composition without additional testing or radiation. Early identification of patients traditionally thought to be at low risk for bone loss will allow for initiating appropriate treatment to prevent future fragility fractures. N/A • Opportunistic chest CT using an AI algorithm can be used to screen for osteoporosis. • Osteoporosis is prevalent in patients undergoing CT for lung cancer screening. • Osteoporosis is prevalent in both sexes, across all races and income classes. [ABSTRACT FROM AUTHOR]

To assess radiology representation, multimedia content, and multilingual content of United States lung cancer screening (LCS) program websites. We identified the websites of US LCS programs with the Google internet search engine using the search terms lung cancer screening , low-dose CT screening , and lung screening. We used a standardized checklist to assess and collect specific content, including information regarding LCS staff composition and references to radiologists and radiology. We also tabulated types and frequencies of included multimedia and multilingual content and patient narratives. We analyzed 257 unique websites. Of these, only 48% (124 of 257) referred to radiologists or radiology in text, images, or videos. Radiologists were featured in images or videos on only 14% (36 of 257) of websites. Radiologists were most frequently acknowledged for their roles in reading or interpreting imaging studies (35% [90 of 574]). Regarding multimedia content, only 36% (92 of 257) of websites had 1 image, 27% (70 of 257) included 2 or more images, and 26% (68 of 257) of websites included one or more videos. Only 3% (7 of 257) of websites included information in a language other than English. Patient narratives were found on only 15% (39 of 257) of websites. The field of Radiology is mentioned in text, images, or videos by less than half of LCS program websites. Most websites make only minimal use of multimedia content such as images, videos, and patient narratives. Few websites provide LCS information in languages other than English, potentially limiting accessibility to diverse populations. • Representation of radiologists on lung cancer screening program websites is low. • Improved presence may increase awareness of the key role of radiologists in cancer screening. • Website multimedia content could be increased to improve educational effectiveness. • Currently minimal website multilingual content could be augmented to improve accessibility. [ABSTRACT FROM AUTHOR]

• Public health crises like the COVID-19 pandemic can exacerbate existing health disparities related to social determinants of health. • Radiology departments have a central role in mitigating emerging health disparities exacerbated during crises, like the COVID-19 pandemic. • Our response can be enhanced using the modified health disparity research framework (HDRF): Detecting, Understanding, Reducing, Evaluating. • This modified HDRF can aid in ensuring that a rapid response to crisis is also an equitable response for those most vulnerable. [ABSTRACT FROM AUTHOR]

Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support In Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS. Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention. Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers. [ABSTRACT FROM AUTHOR]

Purpose: To compare image quality and radiation doses for chest DECT acquired with dual-source and rapid-kV switching techniques.Materials and Methods: Our institutional Review Board approved retrospective study included 97 patients (54 men, 43 women; 63 ± 14 years) who underwent contrast-enhanced chest DECT with both single source, rapid kV-switching (SS-DECT) and dual source (DS-DECT) techniques per standard of care departmental protocols. Reconstructed images from both scanners had identical section thickness and section interval for virtual monoenergetic and material decomposition iodine (MDI) images. Two thoracic radiologists independently evaluated all DECT for findings, quality of images, perfusion defects (MDI), and presence of artifacts. Radiation dose descriptor, size-specific dose estimates (SSDE), was recorded. Data were analyzed with Wilcoxon Signed Rank and Cohen's Kappa tests.Results: There were no significant differences in patient weight or SSDE for the two DECT techniques (p > 0.06). Both radiologists reported no difference in lesion and artifact evaluation on the virtual monoenergetic images from either technique (p > 0.05). However, SS-DECT (in 63-71/97 patients) had substantial artifactual heterogeneity in pulmonary perfusion on MDI images compared to none on DS-DECT (p < 0.001).Conclusion: Despite identical patients and associated radiation doses, there were substantial differences in material decomposition iodine images generated from SS-DECT and DS-DECT techniques. Pulmonary heterogeneity on MDI images from SS-DECT leads to artifactual areas of low perfusion and can confound interpretation of true pulmonary perfusion. [ABSTRACT FROM AUTHOR]