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Purpose: With the rapid development of immunotherapy, cancer treatment has entered a new phase. Medical imaging, as a primary diagnostic method, is closely related to cancer immunotherapy. However, until now, there has been no systematic bibliometric analysis of the state of this field. Therefore, the main purpose of this article is to clarify the past research trajectory, summarize current research hotspots, reveal dynamic scientific developments, and explore future research directions. Patients and Methods: A comprehensive search was conducted on the Web of Science Core Collection (WoSCC) database to identify publications related to immunotherapy specifically for the medical imaging of carcinoma. The search spanned the period from the year 2003 to 2023. Several analytical tools were employed. These included CiteSpace (6.2.4), and the Microsoft Office Excel (2016). Results: By searching the database, a total of 704 English articles published between 2003 and 2023 were obtained. We have observed a rapid increase in the number of publications since 2018. The two most active countries are the United States (n=265) and China (n=170). Pittock, Sean J and Abu-sbeih, Hamzah are very concerned about the relationship between cancer immunotherapy and medical images and have published more academic papers (n = 5; n = 4). Among the top 10 co-cited authors, Topalian Sl (n=43) cited ranked first, followed by Graus F (n=40) cited. According to clustering, timeline, and burst word analysis, the results show that the current research focus is on "MRI", "deep learning", "tumor microenvironment" and so on. Conclusion: Medical imaging and cancer immunotherapy are hot topics. The United States is the country with the most publications and the greatest influence in this field, followed by China. "MRI", "PET/PET-CT", "deep learning", "immune-related adverse events" and "tumor microenvironment" are currently hot research topics and potential targets. [ABSTRACT FROM AUTHOR]

Purpose To develop a model of clinical leadership that encompasses the specialized technical skills and leadership behaviors exhibited by clinical radiography leaders. Methods During this quantitative study, 432 clinical radiography leaders completed the Clinical Radiography Leadership Survey, which measured the technical skills and leadership behaviors aligned with clinical leadership in radiography. Data analysis included a correlational analysis to examine the relationships between the dimensions measuring technical skills and dimensions measuring leadership behaviors when defining clinical radiography leaders. Results Participant responses were correlated individually and aggregated by dimension, with Pearson values greater than 0.3 indicating a moderate or strong relationship. The highest interdimensional correlation existed between dimensions 1 (patient care skills) and 2 (technical and radiographic skills) (P = .715), while exhibiting weak correlations to dimensions associated with clinical leadership behaviors. The confirmatory factor analysis revealed that a more global view of clinical leadership behaviors, in addition to patient care and technical skills, informed participants' view of clinical radiography leadership. Discussion Participants viewed the technical aspect of their practice as the most salient, and survey items related to professional communication and using sound clinical decision-making skills correlated highly with the leadership behaviors exhibited and valued by clinical radiography leaders. Conclusion By defining the clinical expertise, technical skills, and commonly practiced leadership behaviors that clinical radiography leaders encompass, other health care professionals will recognize the unique contribution that the radiologic science profession provides. [ABSTRACT FROM AUTHOR]

Simple Summary: Pancreatic ductal adenocarcinoma (PDAC) has the most elevated fatality rate among the primary types of solid malignancies, posing an urgent need for early detection of PDAC to improve survival rates. Recent progress in medical imaging and computational algorithms provides potential solutions, with deep learning, particularly convolutional neural networks (CNNs), showing promise. However, progress is hindered by a lack of clinical data. This study introduces a new model, 3DGAUnet, employing generative adversarial networks (GANs) to generate realistic 3D CT images of PDAC. In contrast to conventional 2D models, 3DGAUnet maintains contextual information between slices, leading to substantial improvements in efficiency and accuracy. The key innovation lies in integrating a 3D U-Net architecture into the generator, augmenting the learning of shape and texture for PDAC tumors and pancreatic tissue. Thorough validation demonstrates the model's efficacy across diverse datasets, presenting a promising solution to overcome data scarcity, enhance synthesized data quality, and advance deep learning for accurate PDAC detection, with broader implications for other solid tumors in medical imaging. Pancreatic ductal adenocarcinoma (PDAC) presents a critical global health challenge, and early detection is crucial for improving the 5-year survival rate. Recent medical imaging and computational algorithm advances offer potential solutions for early diagnosis. Deep learning, particularly in the form of convolutional neural networks (CNNs), has demonstrated success in medical image analysis tasks, including classification and segmentation. However, the limited availability of clinical data for training purposes continues to represent a significant obstacle. Data augmentation, generative adversarial networks (GANs), and cross-validation are potential techniques to address this limitation and improve model performance, but effective solutions are still rare for 3D PDAC, where the contrast is especially poor, owing to the high heterogeneity in both tumor and background tissues. In this study, we developed a new GAN-based model, named 3DGAUnet, for generating realistic 3D CT images of PDAC tumors and pancreatic tissue, which can generate the inter-slice connection data that the existing 2D CT image synthesis models lack. The transition to 3D models allowed the preservation of contextual information from adjacent slices, improving efficiency and accuracy, especially for the poor-contrast challenging case of PDAC. PDAC's challenging characteristics, such as an iso-attenuating or hypodense appearance and lack of well-defined margins, make tumor shape and texture learning challenging. To overcome these challenges and improve the performance of 3D GAN models, our innovation was to develop a 3D U-Net architecture for the generator, to improve shape and texture learning for PDAC tumors and pancreatic tissue. Thorough examination and validation across many datasets were conducted on the developed 3D GAN model, to ascertain the efficacy and applicability of the model in clinical contexts. Our approach offers a promising path for tackling the urgent requirement for creative and synergistic methods to combat PDAC. The development of this GAN-based model has the potential to alleviate data scarcity issues, elevate the quality of synthesized data, and thereby facilitate the progression of deep learning models, to enhance the accuracy and early detection of PDAC tumors, which could profoundly impact patient outcomes. Furthermore, the model has the potential to be adapted to other types of solid tumors, hence making significant contributions to the field of medical imaging in terms of image processing models. [ABSTRACT FROM AUTHOR]

To explore if physical therapists are practicing skills necessary to refer patients for musculoskeletal imaging. An expert panel established a list of nine requisite skills to refer for musculoskeletal imaging. A blinded expert panel validated the list using a 5-point Likert scale. The skills list was examined via an electronic survey distributed to United States physical therapists. 4,796 respondents were included. Each of the nine skills were routinely performed by a majority of the respondents (range: 54.52–94.72%). Respondents routinely performed 6.95 (± 0.06) skills, with 67.41% routinely performing seven or more skills. Doctors of physical therapy routinely performed more imaging skills (7.15 ± 0.06) compared to their masters- (6.44 ± 0.19) and bachelors-trained (5.95 ± 0.21) counterparts (p < 0.001). Residency/fellowship-trained physical therapists were more likely to routinely perform more imaging skills (7.60 ± 0.11 vs. 6.79 ± 0.07, p < 0.001). Imaging skill performance was greater among board-certified physical therapists (7.39 ± 0.09 vs. 6.71 ± 0.08, p < 0.001) and APTA members (7.06 ± 0.07 vs. 6.65 ± 0.12, p < 0.001). Physical therapists are routinely practicing the requisite imaging skills to directly refer to a radiologist for musculoskeletal imaging. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to illuminate the enduring contributions of underrepresented pioneers in radiology, emphasizing their resilience, innovations, and the significant barriers they overcame. By weaving their achievements into the broader narrative of medical science, this research highlights the critical role of diversity and progress in the evolution of radiology., Historical Exploration: This narrative review chronicles the significant contributions of underrepresented radiologists from the early 20th century to the present. By synthesizing historical data, biographical sketches, and contemporary medical literature, we highlight the pivotal roles these pioneers have played in advancing radiology. Their groundbreaking work not only enhanced medical imaging technologies and practices but also championed the cause of diversity and inclusion within the field. These stories of perseverance and innovation underscore the ongoing need for an inclusive approach in the medical community, reflecting on how diversity has shaped and will continue to influence the evolution of radiology., Findings and Conclusion: The study identifies several pivotal figures, such as Marcus F. Wheatland, the first known African American radiologist, and Ivy O. Roach Brooks, the first woman to lead a radiology department at a major U.S. hospital. It explores their wide-ranging contributions from clinical practice and education to leadership and advocacy for diversity within the medical profession. The legacies of these radiologists illuminate not just their individual accomplishments but also reflect the broader struggle for equality and representation in the medical field. Their determination and excellence have paved the way for future generations, significantly enhancing the inclusivity and diversity of the radiology field., Clinical Relevance and Application: Understanding the contributions of these underrepresented radiologists enriches the field's perspective on diversity, equity, and inclusion. Highlighting these pioneers underscores the importance of mentorship, representation, and advocacy in creating an environment where all talented individuals can thrive. Insights from this historical analysis are crucial for shaping future policies and practices in radiology and medical education, ensuring the continuation of these trailblazers' inspiring legacy., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: The Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study is quantifying the association between cumulative radiation exposure from fetal and/or childhood medical imaging and subsequent cancer risk. This manuscript describes the study cohorts and research methods. Methods: The RIC Study is a longitudinal study of children in two retrospective cohorts from 6 U.S. healthcare systems and from Ontario, Canada over the period 1995–2017. The fetal-exposure cohort includes children whose mothers were enrolled in the healthcare system during their entire pregnancy and followed to age 20. The childhood-exposure cohort includes children born into the system and followed while continuously enrolled. Imaging utilization was determined using administrative data. Computed tomography (CT) parameters were collected to estimate individualized patient organ dosimetry. Organ dose libraries for average exposures were constructed for radiography, fluoroscopy, and angiography, while diagnostic radiopharmaceutical biokinetic models were applied to estimate organ doses received in nuclear medicine procedures. Cancers were ascertained from local and state/provincial cancer registry linkages. Results: The fetal-exposure cohort includes 3,474,000 children among whom 6,606 cancers (2394 leukemias) were diagnosed over 37,659,582 person-years; 0.5% had in utero exposure to CT, 4.0% radiography, 0.5% fluoroscopy, 0.04% angiography, 0.2% nuclear medicine. The childhood-exposure cohort includes 3,724,632 children in whom 6,358 cancers (2,372 leukemias) were diagnosed over 36,190,027 person-years; 5.9% were exposed to CT, 61.1% radiography, 6.0% fluoroscopy, 0.4% angiography, 1.5% nuclear medicine. Conclusion: The RIC Study is poised to be the largest study addressing risk of childhood and adolescent cancer associated with ionizing radiation from medical imaging, estimated with individualized patient organ dosimetry. [ABSTRACT FROM AUTHOR]

With more and more engineered nanoparticles (NPs) being translated to the clinic, the United States Food and Drug Administration (FDA) has recently issued the latest draft guidance on nanomaterial‐containing drug products with an emphasis on understanding their in vivo transport and nano–bio interactions. Following these guidelines, NPs can be designed to target and treat diseases more efficiently than small molecules, have minimum accumulation in normal tissues, and induce minimum toxicity. In this Minireview, we integrate this guidance with our ten‐year studies on developing renal clearable luminescent gold NPs. These gold NPs resist serum protein adsorption, escape liver uptake, target cancerous tissues, and report kidney dysfunction at early stages. At the same time, off‐target gold NPs can be eliminated by the kidneys with minimum accumulation in the body. Additionally, we identify challenges to the translation of renal clearable gold NPs from the bench to the clinic. NPs get clearance: Animal studies of renal clearable gold nanoparticles from the Zheng group in the past decade are revisited from the viewpoint of in vivo transport of nanoparticles and nano–bio interactions in tissues/organs. Additionally, these results are integrated with the latest FDA guidance on nanomedicines. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for survivors. The aims of this paper are to describe cancer survivors’ level of worry about medical imaging radiation (MIR) and to identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust.Method: This cross-sectional study used the 2012-2013 Health Information National Trends Survey of US adults conducted by the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic regression analysis was used to evaluate factors associated with higher MIR worry (reporting “some” or “a lot” of MIR worry).Results: Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in unadjusted analysis.Conclusion: Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns of worry could aid efforts to improve these individuals’ survivorship care and education. [ABSTRACT FROM AUTHOR]

Purpose: To analyze peer-reviewed articles in the American Society of Radiologic Technologists (ASRT) scholarly journals, Radiologic Technology and Radiation Therapist , and identify types of research and collaborative efforts among top producers., Methods: A retrospective analysis was conducted by searching the Radiologic Technology and Radiation Therapist archives on the ASRT website to evaluate peer-reviewed articles from 2011 to 2021. A Microsoft Excel spreadsheet was created to document the types of research being published in the ASRT journals, as well as the number of authors for each peer-reviewed article, education levels of authors, collaborative efforts of top producers of scholarship, and mean authorship index of top producers., Results: During this 11-year period, 217 peer-reviewed articles were published in the ASRT journals with most being original research studies (152, 70.0%). Most of the articles were written by 2 authors (68, 31.3%) or 4 or more authors (65, 30.0%). Of the 635 total authors, most held a doctoral degree (247, 38.9%) or a master's degree (212, 33.4%). Five top producers of research were identified as having published 5 or more peer-reviewed articles, and their mean authorship index was 95.5. Four top producers routinely collaborated on research articles., Discussion: Initiatives, such as mentorships, to promote continued publication of original research studies and increase standalone literature reviews and case studies specific to the ASRT journals might be warranted. Medical imaging and radiation therapy educators can capitalize on collaboration by mentoring undergraduate and graduate students in various research opportunities to prepare future scholars in the profession. Further, medical imaging and radiation therapy authors should consider rotating author responsibilities on a collaborative team. Because the ASRT is the premier professional association for the medical imaging and radiation therapy community, authors should consider publishing in their 2 journals to advance and add to the profession's body of knowledge., Conclusion: Research articles in the ASRT journals demonstrate high collaborative authorship efforts. This study provides a foundation for future research to improve advancement of knowledge in the medical imaging and radiation therapy profession., (© 2023 American Society of Radiologic Technologists.)

Purpose: To examine U.S. radiologic technologists' perceived level of knowledge of radiation effective dose, their level of comfort communicating effective dose information for common imaging procedures to patients, and their ability to compare effective doses for different medical imaging procedures., Methods: A national cross-sectional study was conducted using a simple randomized sample of American Society of Radiologic Technologists (ASRT) members employed in radiography, computed tomography (CT), mammography, or radiology management. Survey items were created; descriptive and categorical statistics were analyzed; and relationships among knowledge of effective dose, comfort explaining effective dose, and procedural rank-order accuracy scores were evaluated with chi-square tests., Results: More than half (56.5%) of participants perceived themselves as knowledgeable about radiation effective dose and 67.5% were comfortable discussing radiation effective dose information with patients. More than three-quarters (75.1%) of participants achieved a rank-order accuracy score of 75% or higher. A significant relationship was found between perceived knowledge of effective dose and perceived level of comfort explaining effective dose., Discussion: Perceived knowledge of radiation effective dose, comfort explaining effective dose, and rank-order accuracy scores were higher among U.S. radiologic technologists in this study compared with similar assessments reported in the literature. However, rank-order derived methodology might not represent an in-depth assessment of radiologic technologists' radiation effective dose knowledge., Conclusion: The findings demonstrate that radiologic technologists have average-to-good perceived radiation effective dose knowledge, neutral-to-good levels of comfort explaining effective dose information to patients, and, in general, can rank-order common medical imaging procedures by effective dose., (© 2022 American Society of Radiologic Technologists.)

Augmented and virtual reality devices are being actively investigated and implemented for a wide range of medical uses. However, significant gaps in the evaluation of these medical devices and applications hinder their regulatory evaluation. Addressing these gaps is critical to demonstrating the devices' safety and effectiveness. We outline the key technical and clinical evaluation challenges discussed during the US Food and Drug Administration's public workshop, "Medical Extended Reality: Toward Best Evaluation Practices for Virtual and Augmented Reality in Medicine" and future directions for evaluation method development. Evaluation challenges were categorized into several key technical and clinical areas. Finally, we highlight current efforts in the standards communities and illustrate connections between the evaluation challenges and the intended uses of the medical extended reality (MXR) devices. Participants concluded that additional research is needed to assess the safety and effectiveness of MXR devices across the use cases., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

• The proliferation of novel viruses has put traditional health systems under immense pressure and posed several serious issues. Henceforth, early detection, identification, rapid testing, and advanced surveillance systems are required to address public health emergencies. • The widespread of COVID-19 and other infectious diseases have significantly emphasized the importance of Information and Communication Technology (ICT) for timely detection, prevention, and control of viral infections. • This paper assesses the international research status of this field in terms of citation structure, prolific journals, co-occurrence network, intellectual landscape, and country contributions. • This article explores influential articles, active research topics, resarch hotspots, and emerging ICT trends in the scientific literature of infectious diseases. The prevalence of severe infectious diseases has become a major global health concern. Currently, the COVID-19 outbreak has spread across the world and has created an unprecedented humanitarian crisis. The proliferation of novel viruses has put traditional health systems under immense pressure and posed several serious issues. Henceforth, early detection, identification, rapid testing, and advanced surveillance systems are required to address public health emergencies. However, Information and Communication Technology (ICT) tackles several issues raised by this pandemic and significantly improves the quality of services in the health care sector. This paper presents an ICT-assisted scientometric analysis of infectious diseases, namely, airborne, food & waterborne, fomite-borne, sexually transmitted illnesses, and vector-borne illnesses. It assesses the international research status of this field in terms of citation structure, prolific journals, and country contributions. It has used the CiteSpace tool to address the visualization needs and in-depth insights of scientific literature to pinpoint core hotspots, research frontiers, emerging research areas, and ICT trends. The research finding reveals that mobile apps, telemedicine, and artificial intelligence technologies have greater scope to reduce the threats of infectious diseases. COVID-19, influenza, HIV, and malaria viruses have been identified as research hotspots whereas COVID-19, contact tracing applications, security and privacy concerns about users' data are the recent challenges in this field that need to address. The United States has produced higher research output in all domains of infectious diseases. Furthermore, it explores the co-occurrence network analysis and intellectual landscape of each domain of infectious diseases. It provides potential research directions and insightful clues to researchers and the academic fraternity for further research. [ABSTRACT FROM AUTHOR]

Abstract: Pathology and demography have combined to fuel exponential demand for advanced medical imaging. To support this demand, radiology must move beyond traditional department or modality-based picture archiving and communication systems (PACS) to solutions that ensure access regardless of location. This article delineates underlying reasons for the growth in demand for access to medical imaging in both Europe and the United States. It explains why teleradiology/PACS is critical to support this growth in Europe. It discusses the benefits of and barriers to its widespread implementation as discovered in Canada and the U.S. and how these lessons learned relate to Europe. The article establishes the technological imperatives for teleradiology/PACS and presents three real-world case studies of successful data sharing and shared workflow models via single imaging implementations. [•] CML HealthCare: Geographically spanning Canada and the United States with 129 sites performing nearly 5 million plus annual exams. [•] Shields MRI: 29 facilities, including 3 Radiation Oncology centers, across an area 4 times the size of Switzerland. [•] MRA/Novant: 40 radiologists working in a complete subspecialty reporting environment. Finally, it provides a high-level list of selection criteria for teleradiology/PACS and examines how industry trends affecting the U.S. are important baseline considerations to the success of teleradiology/PACS in Europe. [Copyright &y& Elsevier]

The transformations in radiology induced by new imaging technology can be understood as instances of 'doing distinctions' by both technology and human actors. This paper combines the analytical frameworks of Gieryn and Bourdieu to understand the reconfigurations engendered by the medical implementation of visualization apparatuses such as magnetic resonance imaging (MRI). It examines the reactions of radiologists to these transformations, which forced them to renegotiate visual expertise and to reconstitute their professional and disciplinary identity. The paper argues that imaging practices are practices of boundary work and distinction, aimed at regaining professional authority and accumulating symbolic capital within the professional field. Boundary work and distinction practices are thus means to improve both the prestige of the profession and the actors' individual status within the scientific or hospital community. The paper further argues that visualization machines and images are not exclusively used for diagnostic and research purposes but are also material and epistemic resources that are deployed in practices of boundary work and distinction. Technology and pictures serve as tools to demonstrate professional skills and power, to increase one's reputation, and to renegotiate identity. Drawing on interviews, documents and fieldwork in several radiology departments and MRI centres in Europe and the USA, the paper reconstructs processes of 'doing distinctions' related to the implementation of MRI and other imaging technologies in medicine. It explores the identity and accumulation strategies of radiologists and other medical specialists through an examination of their boundary work and distinction practices, which are focused on material, social and epistemic resources, and boundaries. [ABSTRACT FROM AUTHOR]

Clinical trials play a crucial role in testing new drugs or devices in modern clinical practice. Medical imaging has become an important tool in clinical trials because images provide a unique and fast diagnosis with visual observance and quantitative assessment. A typical imaging-based clinical trial consists of: (1) A well-defined rigorous clinical trial protocol, (2) a radiology core that has a quality control mechanism, a biostatistics component, and a server for storing and distributing data and analysis results; and (3) many field sites that generate and send clinical trial image studies to the radiology core. With ever-increasing number of clinical trials, it becomes a great challenge for a radiology core which handles multiple clinical trials to have a robust server to administrate multiple trials as well as satisfy the requirements to quickly distribute information to participating radiologists/clinicians worldwide to assess trials' results. Data Grid in the grid computing technology can satisfy the aforementioned requirements of imaging-based clinical trials. In this paper, we present a Data Grid architecture for worldwide imaging-based clinical trials. The Data Grid testbed has been set up in three international sites: Image Processing and Informatics (IPI) Laboratory at University of Southern California, USA; the Hong Kong Polytechnic University; and InCor (Heart Institute) at Sao Paulo, Brazil. The three chosen sites are connected with high speed international networks including the Internet2, the HARNET (Hong Kong Academic and Research Network), and the Brazilian National Research and Education Network (RNP2). The concept, design and implementation of the Data Grid are presented. Grid computing technology open source software Globus Toolkit 4.0 and DICOM technology were used to implement the DICOM compliance Data Grid. This paper also describes results of using Data Grid in imaging-based clinical trails for fault tolerance image data backup. The successful implementation and evaluation of the Data Grid for imaging-based clinical trials provide three major benefits: (1) an understanding of the methodology for using data grid technology and high speed networks in clinical trails; (2) an establishment of the performance benchmarks of Data Grid over high speed networks; and (3) a Data Grid test bed for performing worldwide imaging based clinical trials. [ABSTRACT FROM AUTHOR]

Objectives: To describe the use of computed tomography (CT) and ultrasound (US) imaging for the evaluation of neck infections in pediatric patients in United States emergency departments (EDs)., Methods: This is a cross-sectional analysis, using the National Emergency Department Sample database, of pediatric patients evaluated for common neck infections between 2012 and 2018. We used bivariable analysis to assess for differences in US and CT use by ED type. We performed multivariable logistic regression to adjust for potential confounding factors including patient characteristics (sex, age, insurance status, discharge diagnosis) and ED characteristics (metropolitan statistical area, pediatric center). Results are reported as odds ratios and adjusted odds ratios with 95% confidence intervals., Results: There were 19,363 ED visits for pediatric neck infections in the database over the study period, representing 84,439 national visits. Of those imaged, 80.8% were imaged with CT and 19.2% were imaged with US. Pediatric patients evaluated in general EDs as compared to pediatric EDs (aOR 5.32, 95% CI 3.06, 9.24) and patients with a diagnosis of peritonsillar abscess (aOR 2.11, 95% CI 1.34, 3.33) and retropharyngeal abscess (aOR 6.12, 95% CI 2.14, 17.53) were more likely to be imaged with CT scan., Conclusions: Children with neck infections evaluated in general EDs are significantly more likely to undergo CT scans when compared to those evaluated in pediatric EDs. To reduce exposure to radiation in children, we propose the dissemination of US-first protocols in general EDs for the evaluation of pediatric neck infections., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: The Radiology Support, Communication and Alignment Network (R-SCAN) is a quality improvement program through which patients, referring clinicians, and radiologists collaborate to improve imaging appropriateness based on Choosing Wisely recommendations and ACR Appropriateness Criteria. R-SCAN was shown previously to increase the odds of obtaining an appropriate, higher patient or diagnostic value, imaging study. In the current study, we aimed to estimate the potential imaging cost savings associated with R-SCAN use for the Medicare population., Material and Methods: The R-SCAN data set was used to determine the proportion of appropriate and lesser value imaging studies performed, as well as the percent change in the total number of imaging studies performed, before and after an R-SCAN educational intervention. Using a separate CMS data set, we then identified the total number of relevant imaging studies and associated total costs using a 5% sample of Medicare beneficiaries in 2017. We applied R-SCAN proportions to the CMS data set to estimate the potential impact of the R-SCAN interventions across a broader Medicare population., Results: We observed a substantial reduction in the costs associated with lesser value imaging in the R-SCAN cohort, totaling $260,000 over 3.5 months. When extrapolated to the Medicare population, the potential cost reductions associated with the decrease in lesser value imaging totaled $433 million yearly., Conclusion: If expanded broadly, R-SCAN interventions can result in substantial savings to the Medicare program., (Copyright © 2020 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider's first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories ("usually appropriate" [green], "may be appropriate" [yellow], "usually not appropriate" [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provider exposure to CDSM using logistic regression fits and Wald tests. The number of providers and requisitions included was 244,158 and 7,345,437, respectively. For 10,123 providers with ≥ 200 requisitions (2,024,600 total requisitions), the fraction of green, yellow, and red requisitions among the last 10 requisitions changed by +3.0% (95% confidence interval +2.6% to +3.4%), -0.8% (95% CI -0.5% to -1.1%), and -3.0% (95% CI 3.3% to -2.7%) in comparison with the first 10, respectively. Providers with > 190 requisitions had 8.5% (95% CI 6.3% to 10.7%) more green requisitions, 2.3% (0.7% to 3.9%) fewer yellow requisitions, and 0.5% (95% CI -1.0% to 2.0%) fewer red (not statistically significant) requisitions relative to providers with ≤ 10 requisitions. Increasing provider exposure to CDSM is associated with improved appropriateness scores for advanced imaging requisitions., (© 2021. The Author(s).)

Background: Recent clinical trials have established the efficacy of endovascular stroke therapy and intravenous thrombolysis using advanced imaging, particularly computed tomography perfusion (CTP). The availability and utilization of CTP for patients and hospitals that treat acute ischemic stroke (AIS), however, is uncertain., Methods: We performed a retrospective cross-sectional analysis using 2 complementary Medicare datasets, full sample Texas and 5% national fee-for-service data from 2014 to 2017. AIS cases were identified using International Classification of Diseases , Ninth Revision and International Classification of Diseases , Tenth Revision coding criteria. Imaging utilization performed in the initial evaluation of patients with AIS was derived using Current Procedural Terminology codes from professional claims. Primary outcomes were utilization of imaging in AIS cases and the change in utilization over time. Hospitals were defined as imaging modality-performing if they submitted at least 1 claim for that modality per calendar year. The National Medicare dataset was used to validate state-level findings, and a local hospital-level cohort was used to validate the claims-based approach., Results: Among 50 797 AIS cases in the Texas Medicare fee-for-service cohort, 64% were evaluated with noncontrast head CT, 17% with CT angiography, 3% with CTP, and 33% with magnetic resonance imaging. CTP utilization was greater in patients treated with endovascular stroke therapy (17%) and intravenous thrombolysis (9%). CT angiography (4%/y) and CTP (1%/y) utilization increased over the study period. These findings were validated in the National dataset. Among hospitals in the Texas cohort, 100% were noncontrast head CT-performing, 77% CT angiography-performing, and 14% CTP-performing in 2017. Most AIS cases (69%) were evaluated at non-CTP-performing hospitals. CTP-performing hospitals were clustered in urban areas, whereas large regions of the state lacked immediate access., Conclusions: In state-wide and national Medicare fee-for-service cohorts, CTP utilization in patients with AIS was low, and most patients were evaluated at non-CTP-performing hospitals. These findings support the need for alternative means of screening for AIS recanalization therapies.

The rational clinical examination is important. The authors raised the concept of "medical imaging clinical appropriateness (MICA) " to meet the medical need in clinic (for diagnosis or assessment of a kind of disease or syndrome), which means radiologists and clinicians work together to carefully evaluate the necessity and rationality of an examination according to evidence of evidence-based medicine, expertise, experience, and patient's willing.The necessity is prerequisite, the rationality is the core, the evaluation of evidence is the basis, the application of evidence-based medicine is the important method. This work will provide us a series of criteria in the format of guidelines, providing evidence of rational examination for clinicians. Based on hard working and cooperation between radiologists and clinicians, we will establish the system of MICA in China, standardizing medical process, promoting rationalization, optimizing medical resources allocation and usage.

Hemoptysis, the expectoration of blood, ranges in severity from nonmassive to massive. This publication reviews the literature on the imaging and treatment of hemoptysis. Based on the literature, the imaging recommendations for massive hemoptysis are both a chest radiograph and CT with contrast or CTA with contrast. Bronchial artery embolization is also recommended in the majority of cases. In nonmassive hemoptysis, both a chest radiograph and CT with contrast or CTA with contrast is recommended. Bronchial artery embolization is becoming more commonly utilized, typically in the setting of failed medical therapy. Recurrent hemoptysis, defined as hemoptysis that recurs following initially successful cessation of hemoptysis, is best reassessed with a chest radiograph and either CT with contrast or CTA with contrast. Bronchial artery embolization is increasingly becoming the treatment of choice in recurrent hemoptysis, with the exception of infectious causes such as in cystic fibrosis. 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., (Copyright © 2020 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Rationale and Objective: To review response rates published in medical imaging journals, and to analyze potential factors which contributed to a low response rate., Materials and Methods: A literature search was performed in MEDLINE and Embase to identify and assess published medical imaging survey studies. Variables assessed were response rate, incentives such as reminders and remuneration, and rationales provided for a potential low response rate. Statistical significance was calculated using unpaired t tests, ANOVA, Mann-Whitney, and Kruskal-Wallis tests., Results: Three hundred and fifty-six unique surveys were included for analysis. The mean survey response rate in the current age of predominately electronic surveys was 45%. Factors which statistically significantly demonstrated a difference in response rate were survey location (European countries: 52%, Canada: 47%, United States: 42%; p < 0.05), survey topic (musculoskeletal: 69%, nuclear medicine: 64%, and education: 47%; p < 0.05), survey delivery method (telephone: 76%, email: 41%; p < 0.0001), and survey question type (short answer: 62%, multiple choice: 43%; p < 0.01). Statistically significant linear correlations were observed between the response rate compared to the number of reminders sent (r = 0.27; p < 0.01) and the number of participants (r = -0.26; p < 0.0001)., Conclusion: The survey response rate serves as a surrogate marker for nonresponse bias. Survey response controlled for intrinsic nonadjustable characteristics offer achievable research goals. Adjustable factors to low response, including survey delivery method, question type, and number of reminders demonstrated statistical difference in response rate, and can be utilized by researchers to prospectively minimize nonresponse bias., (Copyright © 2019 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate medical imaging and radiation therapy professionals' perceptions of conducting research., Methods: Using a descriptive survey approach, a random sample of 10 000 American Society of Radiologic Technologists (ASRT) members was invited to share their experiences with conducting research, including challenges, reasons for not engaging in research, potential motivators, and support measures that would enhance their ability to conduct research in the medical imaging and radiation therapy profession. Three hundred ninety completed responses were analyzed for this study., Results: The majority (284, 72.8%) of the participants had no knowledge of or were slightly knowledgeable of the research process, and more than 75% of the participants did not feel prepared or felt they were only slightly prepared to conduct research. However, 257 (65.9%) of the participants believed it was very important to conduct research to advance the medical imaging and radiation therapy profession. Eighty-eight participants who indicated that they had conducted research named collecting data (34, 38.6%) and analyzing the results (20, 22.7%) as their greatest barriers. Participants who had not conducted research (302, 77.4%) said that the main reason was because it was not required in their current position (193, 63.9%). More than half of participants indicated that having time allocated to conduct research, conducting research with an experienced individual, collaborating with a research mentor, and attending continuing education were support measures that might enable them to conduct research., Discussion: It is essential that medical imaging and radiation therapy professionals be aware of the importance of conducting research and participating in scholarly activities so that the profession can advance as a distinct allied health discipline. Opportunities to increase or improve research endeavors in the profession include encouraging professionals to publish and present their research results, allocating time and resources to conduct research, and providing research mentorships., Conclusion: Increasing or improving the research being conducted among medical imaging technologists and radiation therapists and making such endeavors a priority can advance the profession and lead to better service to patients., (© 2020 American Society of Radiologic Technologists.)

The immunocompromised patient with an acute respiratory illness (ARI) may present with fever, chills, weight loss, cough, shortness of breath, or chest pain. The number of immunocompromised patients continues to rise with medical advances including solid organ and stem cell transplantation, chemotherapy, and immunomodulatory therapy, along with the continued presence of human immunodeficiency virus and acquired immunodeficiency syndrome. Given the myriad of pathogens that can infect immunocompromised individuals, identifying the specific organism or organisms causing the lung disease can be elusive. Moreover, immunocompromised patients often receive prophylactic or empiric antimicrobial therapy, further complicating diagnostic evaluation. Noninfectious causes for ARI should also be considered, including pulmonary edema, drug-induced lung disease, atelectasis, malignancy, radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, and pulmonary thromboembolic disease. As many immunocompromised patients with ARI progress along a rapid and potentially fatal course, timely selection of appropriate imaging is of great importance in this setting. 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., (Copyright © 2019 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the preparedness of medical imaging and radiation therapy educators to handle and respond to an active shooter event and their confidence to control their classrooms and protect their students., Methods: Using a cross-sectional research design and a mixed-methods approach, the authors surveyed 366 educators from radiography, radiation therapy, magnetic resonance, and medical dosimetry programs accredited by the Joint Review Committee on Education in Radiologic Technology, documenting their preparedness to respond and their confidence to control their classrooms and protect their students during an active shooter event., Results: Most (166, 45.4%) participants in this study felt moderately prepared to respond to an active shooter event in their classroom. In addition, most participants felt moderately confident in their abilities to control their classrooms (159, 43.4%) and protect their students (154, 42.1%) during an active shooter incident. Most (135, 36.9%) participants agreed that the possibility of an active shooter event is taken seriously at their institution., Discussion: Pearson chi-square calculations revealed significant associations between educators' level of preparedness to respond appropriately to an active shooter event and having an institutional active shooter policy, offering active shooter training, and conducting active shooter drills. An analysis of the open-ended survey responses revealed 3 themes: lack of preparedness, lack of policy, and proactive techniques., Conclusion: Although most participants in this study felt moderately prepared to respond to an active shooter event, areas for improvement include implementing a policy and training program for addressing an active shooter situation, mandating active shooter response training for all employees and students, conducting active shooter drills routinely, and focusing the training program on response and preventive measures., (©2019 American Society of Radiologic Technologists.)

There is an increased consensus in the medical and research community about the huge benefits quantitative imaging can bring to radiology. According to the Organisation for Economic Co-operation and Development, approximately 80 million CT and 34 million MRI scans are performed yearly in the United States alone, and the vast majority are currently evaluated through visual inspection. However, quantitative imaging can greatly reduce the burden on radiologists, by diminishing read time and improving diagnostic accuracy. This research was funded by the National Science Foundation's I-Corps and Beat-the-Odds programs to interview more than 350 medical imaging professionals (clinicians, radiologists, policymakers, companies) around the world and determine current needs and trends in the use of postprocessing tools. Here the authors present a summary of these interviews for the adult and pediatric realms. The results indicate that clinical quantitative image analysis is increasingly popular and that we are at the cusp of a revolution in the field in terms of adoption., (Copyright © 2019 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

While there is no single diagnostic test for heart failure (HF), imaging plays a supportive role beginning with confirmation of HF, especially by detecting ventricular dysfunction (Variant 1). Ejection fraction (EF) is important in HF classification, and imaging plays a subsequent role in differentiation between HF with reduced EF (HFrEF) versus preserved EF (HFpEF) (Variant 2). Once HFrEF is identified, distinction between ischemic and nonischemic etiologies with imaging support (Variant 3) facilitates further planning. Imaging approaches which are usually appropriate include: both resting transthoracic echocardiography (TTE) and chest radiography for Variant 1; resting TTE and/or MRI (including functional, without absolute need for contrast) for Variant 2; and for Variant 3, a. Coronary CTA or coronary arteriography (if high pretest probability/symptoms for ischemic disease) for coronary assessment; b. Rest/vasodilator stress SPECT/CT, PET/CT, or MRI for myocardial perfusion assessment; c. Rest/exercise or inotropic stress TTE for myocardial contraction assessment; or d. MRI (including morphologic with contrast) for myocardial characterization. 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., (Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: Although all critical access hospitals (CAHs) provide basic medical and radiographic imaging services, it remains unclear how CAHs provide additional imaging services given relatively low patient volumes and high resource costs. The aim of this study was to examine whether CAHs with more resources or access to resources through affiliation with larger systems are more likely to offer other imaging services in their communities., Methods: Linking data from the American Hospital Association's annual hospital surveys and the American Hospital Directory's annual surveys from 2009 to 2011, multivariate logistic regressions were performed to estimate the likelihood of individual CAHs with greater financial resources or network affiliations providing specific imaging services (MRI, CT, ultrasound, mammography, and PET/CT), while adjusting for the number of beds, personnel, inpatient revenue share, case mix, rural status, year, and geographic location., Results: Hospital total expenditures were positively associated with the provision of MRI (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.07-1.19), mammography (OR, 1.11; 95% CI, 1.01-1.16), and PET/CT (OR, 1.04; 95% CI, 1.01-1.06). Network affiliation was positively associated with the availability of MRI (OR, 1.75; 95% CI, 1.27-2.39), CT (OR, 2.17; 95% CI, 1.15-4.09), ultrasound (OR, 2.03; 95% CI, 1.17-3.52), and mammography (OR, 2.00; 95% CI, 1.47-2.71). Rural location was negatively associated with the availability of PET/CT (OR, 0.65; 95% CI, 0.49-0.88)., Conclusions: Total hospital expenditures and network participation are important determinants of whether CAHs provide certain imaging services. Encouraging CAHs' participation in larger systems or networks may facilitate access to highly specialized services in rural and underserved areas., (Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to assess state-level trends in per beneficiary Medicare spending on medical imaging., Materials and Methods: Medicare part B 5% research identifiable files from 2004 through 2012 were used to compute national and state-by-state annual average per beneficiary spending on imaging. State-to-state geographic variation and temporal trends were analyzed., Results: National average per beneficiary Medicare part B spending on imaging increased 7.8% annually between 2004 ($350.54) and its peak in 2006 ($405.41) then decreased 4.4% annually between 2006 and 2012 ($298.63). In 2012, annual per beneficiary spending was highest in Florida ($367.25) and New York ($355.67) and lowest in Ohio ($67.08) and Vermont ($72.78). Maximum state-to-state geographic variation increased over time, with the ratio of highest-spending state to lowest-spending state increasing from 4.0 in 2004 to 5.5 in 2012. Spending in nearly all states decreased since peaks in 2005 (six states) or 2006 (43 states). The average annual decrease among states was 5.1% ± 1.8% (range, 1.2-12.2%) The largest decrease was in Ohio. In only two states did per beneficiary spending increase (Maryland, 12.5% average annual increase since 2005; Oregon, 4.8% average annual increase since 2008)., Conclusion: Medicare part B average per beneficiary spending on medical imaging declined in nearly every state since 2005 and 2006 peaks, abruptly reversing previously reported trends. Spending continued to increase, however, in Maryland and Oregon. Identification of state-level variation may facilitate future investigation of the potential effect of specific and regional changes in spending on patient access and outcomes.

Objective: The purpose of this article was to study regional variation in Medicare Physician Fee Schedule (MPFS) payments for medical imaging to radiologists compared with nonradiologists., Materials and Methods: Using a 5% random sample of all Medicare enrollees, which covered approximately 2.5 million Part B beneficiaries in 2011, total professional-only, technical-only, and global MPFS spending was calculated on a state-by-state and United States Census Bureau regional basis for all Medicare Berenson-Eggers Type of Service-defined medical imaging services. Payments to radiologists versus nonradiologists were identified and variation was analyzed., Results: Nationally, mean MPFS medical imaging spending per Medicare beneficiary was $207.17 ($95.71 [46.2%] to radiologists vs $111.46 [53.8%] to nonradiologists). Of professional-only (typically interpretation) payments, 20.6% went to nonradiologists. Of technical-only (typically owned equipment) payments, 84.9% went to nonradiologists. Of global (both professional and technical) payments, 70.1% went to nonradiologists. The percentage of MPFS medical imaging spending on nonradiologists ranged from 32% (Minnesota) to 69.5% (South Carolina). The percentage of MPFS payments for medical imaging to nonradiologists exceeded those to radiologists in 58.8% of states. The relative percentage of MPFS payments to nonradiologists was highest in the South (58.5%) and lowest in the Northeast (48.0%)., Conclusion: Nationally, 53.8% of MPFS payments for medical imaging services are made to nonradiologists, who claim a majority of MPFS payments in most states dominated by noninterpretive payments. This majority spending on nonradiologists may have implications in bundled and capitated payment models for radiology services. Medical imaging payment policy initiatives must consider the roles of all provider groups and associated regional variation.

Purpose: The purpose of this study was to better understand the availability and scope of imaging services at critical access hospitals (CAHs) throughout the United States., Methods: Recent American Hospital Association (AHA) annual survey data (containing 1,063 variables providing comprehensive information on organizational characteristics and availability of various services at 6,317 hospitals nationwide) and US census data were merged. Imaging survey data included mammography, ultrasound, CT, MRI, single photon emission CT, and combined PET/CT. Availability and characteristics of imaging services at the 1,060 CAHs in 45 states for which sufficient data were available were studied., Results: Mammography, ultrasound, and some form of CT were the most widely available of all imaging services, but were available in all CAHs in only 13%, 33%, and 56% of all states, respectively. In no states were ≥64-slice CT, MRI, single photon emission CT, and combined PET/CT available in all CAHs., Conclusions: An overall scarcity of access to imaging services exists at CAHs throughout the United States. With 19.3% of the US population residing in rural areas and almost entirely dependent on CAHs for health services, the policy implications for imaging access could be profound. Further research is necessary to investigate the effect of imaging access on CAH patient outcomes., (Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Scientists at the National Institute of Allergy and Infectious Diseases Integrated Research Facility at Fort Detrick, Frederick, Maryland, coordinate and facilitate preclinical research on infectious diseases to develop medical countermeasures for high-consequence pathogens. This facility is unique in that it is the only maximum containment laboratory in the world where conventional and molecular medical imaging equipments are incorporated into the design of the facility. This capability provides investigators with unique tools to dissect disease pathogenesis, evaluate the ability of animal models to recapitulate human disease, and test candidate countermeasures. Importantly, advanced molecular imaging has the potential to provide alternative endpoints to lethality. Using these alternative endpoints, investigators can reduce the number of animals used in experiments and evaluate countermeasures in sublethal models. With the incorporation of medical imaging modalities, a clinical laboratory modeled after those existing in hospitals, and a highly trained veterinary medicine team, IRF-Frederick is uniquely suited to advance our understanding of emerging infectious diseases and to facilitate the development of medical countermeasures and clinical care paradigms previously considered impossible., (Published 2014. This article is a US Government work and is in the public domain in the USA.)