302 results on '"Halpern EF"'
Search Results
2. Role of recanalization in acute stroke outcome: rationale for a CT angiogram-based 'benefit of recanalization' model
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Rosenthal, Es, Schwamm, Lh, Roccatagliata, Luca, Coutts, Sb, Demchuk, Am, Schaefer, Pw, Gonzalez, Rg, Hill, Md, Halpern, Ef, and Lev, Mh
- Published
- 2008
3. Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of shortterm results
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Adriaensen, MEAPM (Miraude), Bosch, Joke, Halpern, EF, Hunink, Myriam, Gazelle, GS, Radiology & Nuclear Medicine, and Epidemiology
- Published
- 2002
4. Representing both first- and second-order uncertainties by Monte Carlo simulation for groups of patients
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Halpern, EF, Weinstein, MC, Hunink, Myriam, Gazelle, PS, and Epidemiology
- Published
- 2000
5. Positive predictive value of breast MRI in cancer detection.
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Gavenonis, SC, primary, Lee, JM, additional, Halpern, EF, additional, and Rafferty, EA, additional
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- 2009
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6. Location-weighted CTP analysis predicts early motor improvement in stroke: a preliminary study.
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Payabvash S, Souza LC, Kamalian S, Wang Y, Passanese J, Fung SH, Halpern EF, Schaefer PW, Gonzalez RG, Furie KL, Lev MH, Payabvash, S, Souza, L C S, Kamalian, S, Wang, Y, Passanese, J, Fung, S H, Halpern, E F, Schaefer, P W, and Gonzalez, R G
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- 2012
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7. Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation.
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Zalis ME, Blake MA, Cai W, Hahn PF, Halpern EF, Kazam IG, Keroack M, Magee C, Näppi JJ, Perez-Johnston R, Saltzman JR, Vij A, Yee J, Yoshida H, Zalis, Michael E, Blake, Michael A, Cai, Wenli, Hahn, Peter F, Halpern, Elkan F, and Kazam, Imrana G
- Abstract
Background: Colon screening by optical colonoscopy (OC) or computed tomographic colonography (CTC) requires a laxative bowel preparation, which inhibits screening participation.Objective: To assess the performance of detecting adenomas 6 mm or larger and patient experience of laxative-free, computer-aided CTC.Design: Prospective test comparison of laxative-free CTC and OC. The CTC included electronic cleansing and computer-aided detection. Optical colonoscopy examinations were initially blinded to CTC results, which were subsequently revealed during colonoscope withdrawal; this method permitted reexamination to resolve discrepant findings. Unblinded OC served as a reference standard. (ClinicalTrials.gov registration number: NCT01200303)Setting: Multicenter ambulatory imaging and endoscopy centers.Participants: 605 adults aged 50 to 85 years at average to moderate risk for colon cancer.Measurements: Per-patient sensitivity and specificity of CTC and first-pass OC for detecting adenomas at thresholds of 10 mm or greater, 8 mm or greater, and 6 mm or greater; per-lesion sensitivity and survey data describing patient experience with preparations and examinations.Results: For adenomas 10 mm or larger, per-patient sensitivity of CTC was 0.91 (95% CI, 0.71 to 0.99) and specificity was 0.85 (CI, 0.82 to 0.88); sensitivity of OC was 0.95 (CI, 0.77 to 1.00) and specificity was 0.89 (CI, 0.86 to 0.91). Sensitivity of CTC was 0.70 (CI, 0.53 to 0.83) for adenomas 8 mm or larger and 0.59 (CI, 0.47 to 0.70) for those 6 mm or larger; sensitivity of OC for adenomas 8 mm or larger was 0.88 (CI, 0.73 to 0.96) and 0.76 (CI, 0.64 to 0.85) for those 6 mm or larger. The specificity of OC at the threshold of 8 mm or larger was 0.91 and at 6 mm or larger was 0.94. Specificity for OC was greater than that for CTC, which was 0.86 at the threshold of 8 mm or larger and 0.88 at 6 mm or larger (P= 0.02). Reported participant experience for comfort and difficulty of examination preparation was better with CTC than OC.Limitations: There were 3 CTC readers. The survey instrument was not independently validated.Conclusion: Computed tomographic colonography was accurate in detecting adenomas 10 mm or larger but less so for smaller lesions. Patient experience was better with laxative-free CTC. These results suggest a possible role for laxative-free CTC as an alternate screening method. [ABSTRACT FROM AUTHOR]- Published
- 2012
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8. Regional ischemic vulnerability of the brain to hypoperfusion: the need for location specific computed tomography perfusion thresholds in acute stroke patients.
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Payabvash S, Souza LC, Wang Y, Schaefer PW, Furie KL, Halpern EF, Gonzalez RG, Lev MH, Payabvash, Seyedmehdi, Souza, Leticia C S, Wang, Yifei, Schaefer, Pamela W, Furie, Karen L, Halpern, Elkan F, Gonzalez, R Gilberto, and Lev, Michael H
- Published
- 2011
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9. Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists.
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Abujudeh HH, Boland GW, Kaewlai R, Rabiner P, Halpern EF, Gazelle GS, Thrall JH, Abujudeh, Hani H, Boland, Giles W, Kaewlai, Rathachai, Rabiner, Pavel, Halpern, Elkarn F, Gazelle, G Scott, and Thrall, James H
- Abstract
Objective: To assess the discrepancy rate for the interpretation of abdominal and pelvic computed tomography (CT) examinations among experienced radiologists.Methods: Ninety abdominal and pelvic CT examinations reported by three experienced radiologists who specialize in abdominal imaging were randomly selected from the radiological database. The same radiologists, blinded to previous interpretation, were asked to re-interpret 60 examinations: 30 of their previous interpretations and 30 interpreted by others. All reports were assessed for the degree of discrepancy between initial and repeat interpretations according to a three-level scoring system: no discrepancy, minor, or major discrepancy. Inter- and intrareader discrepancy rates and causes were evaluated.Results: CT examinations included in the investigation were performed on 90 patients (43 men, mean age 59 years, SD 14, range 19-88) for the following indications: follow-up/evaluation of malignancy (69/90, 77%), pancreatitis (5/90, 6%), urinary tract stone (4/90, 4%) or other (12/90, 13%). Interobserver and intraobserver major discrepancy rates were 26 and 32%, respectively. Major discrepancies were due to missed findings, different opinions regarding interval change of clinically significant findings, and the presence of recommendation.Conclusions: Major discrepancy of between 26 and 32% was observed in the interpretation of abdominal and pelvic CT examinations. [ABSTRACT FROM AUTHOR]- Published
- 2010
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10. Changes in MRS neuronal markers and T cell phenotypes observed during early HIV infection.
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Lentz MR, Kim WK, Lee V, Bazner S, Halpern EF, Venna N, Williams K, Rosenberg ES, González RG, Lentz, M R, Kim, W K, Lee, V, Bazner, S, Halpern, E F, Venna, N, Williams, K, Rosenberg, E S, and González, R G
- Published
- 2009
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11. Hyperdense basilar artery sign on unenhanced CT predicts thrombus and outcome in acute posterior circulation stroke.
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Goldmakher GV, Camargo EC, Furie KL, Singhal AB, Roccatagliata L, Halpern EF, Chou MJ, Biagini T, Smith WS, Harris GJ, Dillon WP, Gonzalez RG, Koroshetz WJ, Lev MH, Goldmakher, Gregory V, Camargo, Erica C S, Furie, Karen L, Singhal, Aneesh B, Roccatagliata, Luca, and Halpern, Elkan F
- Published
- 2009
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12. In vivo characterization of murine myocardial perfusion with myocardial contrast echocardiography: validation and application in nitric oxide synthase 3 deficient mice.
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Raher MJ, Thibault H, Poh KK, Liu R, Halpern EF, Derumeaux G, Ichinose F, Zapol WM, Bloch KD, Picard MH, Scherrer-Crosbie M, Raher, Michael J, Thibault, Hélène, Poh, Kian Keong, Liu, Rong, Halpern, Elkan F, Derumeaux, Geneviève, Ichinose, Fumito, Zapol, Warren M, and Bloch, Kenneth D
- Published
- 2007
13. Lipomatous hypertrophy of the interatrial septum: prevalence and features on fusion 18F fluorodeoxyglucose positron emission tomography/CT.
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Kuester LB, Fischman AJ, Fan CM, Halpern EF, Aquino SL, Kuester, Landon B, Fischman, Alan J, Fan, Chieh-Min, Halpern, Elkan F, and Aquino, Suzanne L
- Abstract
Objective: To determine the prevalence of lipomatous hypertrophy of the interatrial septum (LHIS) on CT and its metabolic pattern on 18F fluorodeoxyglucose (FDG)-positron emission tomography (PET).Method and Materials: Eight hundred two CT PET scans were reviewed. Patients were included if the interatrial septum was > or = 1 cm and excluded if there was evidence of malignancy in the adjacent lung, hilum, or mediastinum. CT scans were fused with PET scans, and the mean standardized uptake value (SUV) was calculated over the LHIS, chest wall (CW) fat, and mediastinal blood pool. CT scans were reviewed for presence of excessive fat in the mediastinum, pericardial, peridiaphragmatic, peritoneal, and retroperitoneal regions and for the presence of emphysema. Medical records were reviewed for body mass index (BMI) and history of arrhythmia.Results: Twenty-three of 802 patients (2.8%) had LHIS on CT (9 women and 14 men); average age was 75.6 years (range, 58 to 95 years). Average BMI of 17 patients (+/- SD) was 31 +/- 4.9 (range, 22.1 to 39.9). Mean CT values were as follows: thickening of LHIS, 1.47 +/- 0.35 cm (range, 1.07 to 2.25 cm); LHIS, - 79.6 + 24.5 Hounsfield unit (HU) [range, - 11 to - 121 HU]. LHIS was dumbbell shaped in 18 patients. Mean SUVs were as follows: LHIS, 1.84 +/- 0.10 (range, 0.48 to 3.48); CW fat, 0.36 + 0.37 (range, 0.04 to 1.98); blood pool, 1.74 + 0.51 (range, 0.25 to 2.71). The SUV of LHIS was greater than the SUV of CW wall fat in all patients (p < 0.0001). There was significant correlation between SUV and thickness of the LHIS on CT (p < 0.0001, r = 0.883). Those with dumbbell-shaped LHIS (p < 0.003) and presence of emphysema (p < 0.0377) had greater LHIS mean SUV.Conclusion: The SUV of LHIS was greater than the SUV of CW fat in all patients. LHIS with greater thickness or dumbbell shape had greater FDG uptake. These findings on CT and PET are important to recognize in order to avoid false-positive FDG-PET interpretations. [ABSTRACT FROM AUTHOR]- Published
- 2005
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14. Diagnostic evaluation of patients with a brain mass as the presenting manifestation of cancer.
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Mavrakis AN, Halpern EF, Barker FG 2nd, Gonzalez RG, Henson JW, Mavrakis, A N, Halpern, E F, Barker, F G 2nd, Gonzalez, R G, and Henson, J W
- Published
- 2005
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15. Quantitative assessment of regional myocardial function in mice by tissue Doppler imaging: comparison with hemodynamics and sonomicrometry.
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Sebag IA, Handschumacher MD, Ichinose F, Morgan JG, Hataishi R, Rodrigues ACT, Guerrero JL, Steudel W, Raher MJ, Halpern EF, Derumeaux G, Bloch KD, Picard MH, and Scherrer-Crosbie M
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- 2005
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16. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography.
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Jang I, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, Shishkov M, Houser S, Aretz HT, Halpern EF, Bouma BE, Jang, Ik-Kyung, Tearney, Guillermo J, MacNeill, Briain, Takano, Masamichi, Moselewski, Fabian, Iftima, Nicusor, Shishkov, Milen, Houser, Stuart, and Aretz, H Thomas
- Published
- 2005
17. Comparison of preference-based utilities of the Short-Form 36 Health Survey and Health Utilities Index before and after treatment of patients with intermittent claudication.
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Bosch JL, Halpern EF, and Gazelle GS
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The authors compared SF-36 utilities with Health Utilities Index (HUI) utilities (HUI2 and HUI3) assessed in patients with intermittent claudication. A total of 87 patients with intermittent claudication completed the SF-36 and HUI before and 1, 3, and 12 months after revascularization. Utilities were estimated using SF-36 and HUI published algorithms (i.e., both algorithms were based on standard-gamble utilities assessed in random samples of the general population). The utilities were compared using repeated-measures multivariate analysis of variance, paired t tests, and univariate linear regression analyses. Before treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.66, P = 0.92) and less than the mean HUI2 utility (0.70, P = 0.02). After treatment, all utilities showed improvement from before treatment (P < 0.05); the gain in utilities from treatment was lowest when using the SF-36 (e.g., 0.74, 0.80, 0.77 at 3 months for the SF-36, HUI2, and HUI3, respectively). The correlations of changes over time of the SF-36 with HUI2 utilities and of the SF-36 with HUI3 utilities were 0.39 and 0.49, respectively. The relationships between the SF-36 and HUI2 or HUI3 utilities were moderate to good (i.e., range-adjusted R2 = 31% to 72%). The results suggest that SF-36 data can be transformed to preference-based utilities and be used for economic evaluation in health care. The gain in utilities from treatment, however, was less for SF-36 utilities than for HUI utilities. [ABSTRACT FROM AUTHOR]
- Published
- 2002
18. Biasing the interpretation of mammography screening data by age grouping: nothing changes abruptly at age 50.
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Kopans DB, Moore RH, McCarthy KA, Hall DA, Hulka C, Whitman GJ, Slanetz PJ, and Halpern EF
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- 1998
19. Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter?
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Brown SD, Ecker JL, Ward JR, Halpern EF, Sayeed SA, Buchmiller TL, Mitchell C, and Donelan K
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OBJECTIVE: We sought to characterize practices and attitudes of maternal-fetal medicine (MFM) and fetal care pediatric (FCP) specialists regarding fetal abnormalities. STUDY DESIGN: This was a self-administered survey of 434 MFMs and FCPs (response rate: MFM 60.9%; FCP 54.2%). RESULTS: For Down syndrome (DS), congenital diaphragmatic hernia (CDH), spina bifida: MFMs were more likely than FCPs to support termination (DS 52% vs 35%, P < .001; CDH 49% vs 36%, P < .001; spina bifida 54% vs 35%, P < .001), and consider offering termination options as highly important (DS 90% vs 70%, P < .001; CDH 88% vs 69%, P < .001; spina bifida 88% vs 70%, P < .001). For DS only, MFMs were less likely than FCPs to think that pediatric specialist consultation should be offered prior to a decision regarding termination (54% vs 75%, P < .001). MFMs reported report higher termination rates among patients only for DS (DS 51% vs 21%, P < .001). CONCLUSION: MFM and FCP specialists' counseling attitudes differ for fetal abnormalities. [ABSTRACT FROM AUTHOR]
- Published
- 2012
20. Election Night Projections for Radiologists.
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Halpern EF
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- Humans, United States, Radiology, Radiologists, Politics
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- 2024
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21. Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results.
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Lee JM, Lowry KP, Cott Chubiz JE, Swan JS, Motazedi T, Halpern EF, Tosteson ANA, Gazelle GS, and Donelan K
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Massachusetts epidemiology, Middle Aged, Risk, Anxiety, Breast Neoplasms psychology, False Positive Reactions, Mammography psychology, Quality of Life
- Abstract
Objective: The impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall., Methods: Women participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0-100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments., Results: The final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p < 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p < 0.05)., Conclusions: Women with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen., Competing Interests: Declaration of competing interest JML and KPL receive research support from GE Healthcare. GSG was previously a consultant for GE Healthcare until 2018., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2020
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22. Assessing Radiology Research on Artificial Intelligence: A Brief Guide for Authors, Reviewers, and Readers-From the Radiology Editorial Board.
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Bluemke DA, Moy L, Bredella MA, Ertl-Wagner BB, Fowler KJ, Goh VJ, Halpern EF, Hess CP, Schiebler ML, and Weiss CR
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- Databases, Factual, Humans, Image Interpretation, Computer-Assisted, Manuscripts, Medical as Topic, Artificial Intelligence, Biomedical Research standards, Radiography standards, Radiology organization & administration
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- 2020
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23. Comparison of 18 F-FDG avidity at PET of benign and malignant pure ground-glass opacities: a paradox? Part II: artificial neural network integration of the PET/CT characteristics of ground-glass opacities to predict their likelihood of malignancy.
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Scott JA, McDermott S, Kilcoyne A, Wang Y, Halpern EF, and Ackman JB
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- Adult, Diagnosis, Differential, Female, Fluorodeoxyglucose F18, Humans, Lung Neoplasms pathology, Male, Predictive Value of Tests, Radiographic Image Interpretation, Computer-Assisted, Radiopharmaceuticals, Retrospective Studies, Lung Neoplasms diagnostic imaging, Neural Networks, Computer, Positron Emission Tomography Computed Tomography
- Abstract
Aim: To assess the ability of artificial neural networks (ANNs) to predict the likelihood of malignancy of pure ground-glass opacities (GGOs), using observations from computed tomography (CT) and 2-[
18 F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) images and relevant clinical information., Materials and Methods: One hundred and twenty-five cases of pure GGOs described in a previous article were used to train and evaluate the performance of an ANN to predict the likelihood of malignancy in each of the GGOs. Eighty-five cases selected randomly were used for training the network and the remaining 40 cases for testing. The ANN was constructed from the image data and basic clinical information. The predictions of the ANN were compared with blinded expert estimates of the likelihood of malignancy., Results: The ANN showed excellent predictive value in estimating the likelihood of malignancy (AUC = 0.98±0.02). Employing the optimal cut-off point from the receiver operating characteristic (ROC) curve, the ANN correctly identified 11/11 malignant lesions (sensitivity 100%) and 27/29 benign lesions (specificity 93.1%). The expert readers found 23 lesions indeterminate and correctly identified 17 lesions as benign., Conclusion: ANNs have potential to improve diagnostic certainty in the classification of pure GGOs, based upon their CT appearance, intensity of FDG uptake, and relevant clinical information, and may therefore, be useful to help direct clinical and imaging follow-up., (Copyright © 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)- Published
- 2019
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24. Comparison of the 18 F-FDG avidity at PET of benign and malignant pure ground-glass opacities: a paradox?
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McDermott S, Kilcoyne A, Wang Y, Scott JA, Halpern EF, and Ackman JB
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- Adult, Aged, Aged, 80 and over, Contrast Media, Female, Fluorodeoxyglucose F18, Humans, Image Interpretation, Computer-Assisted, Male, Middle Aged, Radiopharmaceuticals, Retrospective Studies, Solitary Pulmonary Nodule pathology, Lung Neoplasms diagnostic imaging, Positron Emission Tomography Computed Tomography, Solitary Pulmonary Nodule diagnostic imaging
- Abstract
Aim: To determine if pure ground-glass opacities (GGOs) and the subgroup of ground-glass nodules (GGNs) typically demonstrate higher 2-[
18 F]-fluoro-2-deoxy-d-glucose (18 F-FDG) uptake at positron-emission tomography (PET) when benign than when malignant., Materials and Methods: Informed consent was waived for this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA) compliant, retrospective study. A review of all 1,864 combined PET/computed tomography (CT) examinations performed in 2011 on a single system to identify pure GGOs with mean diameter ≥1 cm yielded 166 GGOs. Two blinded subspecialty-trained thoracic radiologists independently assessed GGO size, morphology, attenuation, and location on CT. A blinded nuclear radiologist procured the SUVmax for each GGO. Final diagnosis of malignancy (n=21) was made based on histopathology or upon increased size and attenuation; a final diagnosis of benignity (n=106) was made if GGO resolved, was new within 3 months, evolved in a manner consistent with pulmonary fibrosis, or was stable for ≥60 months; 29 were indeterminate and were excluded, along with 10 cases with unreliable SUVmax measurements, yielding 127 GGOs, of which 68 were GGNs, in 76 patients., Results: The SUVmax was significantly higher in benign than malignant GGOs (p=0.0017) and in the GGN subgroup (p=0.03). A threshold SUVmax >1.5 for GGOs, including GGNs, assured benignity in this cohort., Conclusion: Benign GGOs and the benign GGN subgroup demonstrated significantly higher FDG uptake at PET than malignant GGOs/GGNs. Awareness of this finding may prevent misinterpretation of highly18 FDG-avid pure GGOs/GGNs as definitively malignant, which could lead to unnecessary thoracic surgery and its associated risks., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)- Published
- 2019
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25. Repeat CT Performed Within One Month of CT Conducted in the Emergency Department for Abdominal Pain: A Secondary Analysis of Data From a Prospective Multicenter Study.
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Lee LK, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, Miller CM, Herring MS, Tramontano AC, Kambadakone A, Catalano OA, Harisinghani M, Halpern EF, Donelan K, Gazelle GS, and Pandharipande PV
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- Disease Progression, Emergencies, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Multicenter Studies as Topic, Prospective Studies, Time Factors, Tomography, X-Ray Computed methods, Abdominal Pain diagnostic imaging, Tomography, X-Ray Computed statistics & numerical data
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Objective: The purpose of this study is to determine both the frequency of repeat CT performed within 1 month after a patient visits the emergency department (ED) and undergoes CT evaluation for abdominal pain and the frequency of worsened or new CT-based diagnoses., Subjects and Methods: Secondary analysis was performed on data collected during a prospective multicenter study. The parent study included patients who underwent CT in the ED for abdominal pain between 2012 and 2014, and these patients constituted the study group of the present analysis. The proportion of patients who underwent (in any setting) repeat abdominal CT within 1 month of the index CT examination was calculated. For each of these patients, results of the index and repeat CT scans were compared by an independent panel and categorized as follows: no change (group 1); same process, improved (group 2); same process, worse (group 3); or different process (group 4). The proportion of patients in groups 1 and 2 versus groups 3 and 4 was calculated, and patient and ED physician characteristics were compared., Results: The parent study included 544 patients (246 of whom were men [45%]; mean patient age, 49.4 years). Of those 544 patients, 53 (10%; 95% CI, 7.5-13%) underwent repeat abdominal CT. Patients' CT comparisons were categorized as follows: group 1 for 43% of patients (23/53), group 2 for 26% (14/53), group 3 for 15% (8/53), and group 4 for 15% (8/53). New or worse findings were present in 30% of patients (16/53) (95% CI, 19-44%). When patients with findings in groups 1 and 2 were compared to patients with findings in groups 3 and 4, no significant difference was noted in patient age (p = 0.25) or sex (p = 0.76), the number of days between scans (p = 0.98), and the diagnostic confidence of the ED physician after the index CT scan was obtained (p = 0.33)., Conclusion: Short-term, repeat abdominal CT was performed for 10% of patients who underwent CT in the ED for abdominal pain, and it yielded new or worse findings for 30% of those patients.
- Published
- 2019
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26. Performance of Screening Breast MRI After Negative Full-Field Digital Mammography Versus After Negative Digital Breast Tomosynthesis in Women at Higher Than Average Risk for Breast Cancer.
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Roark AA, Dang PA, Niell BL, Halpern EF, and Lehman CD
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- Adult, Aged, Aged, 80 and over, False Negative Reactions, Female, Humans, Middle Aged, Retrospective Studies, Risk Assessment, Breast Neoplasms diagnostic imaging, Early Detection of Cancer methods, Magnetic Resonance Imaging, Mammography methods
- Abstract
Objective: The objective of our study was to compare the supplemental cancer yield and performance of breast MRI in women at higher-than-average risk for breast cancer after negative 2D full-field digital mammography (FFDM) or negative digital breast tomosynthesis (DBT)., Materials and Methods: Retrospective review identified 4418 screening breast MRI examinations: 2291 were performed from January 2010 through January 2012 of patients with a negative FFDM examination in the 12 months before MRI (FFDM group), and 2127 were performed from January 2013 through January 2015 of patients with a negative DBT examination in the 12 months before MRI (DBT group). Screening indications included genetic predisposition, personal history of breast cancer or high-risk lesion, prior chest irradiation, family history, or other risk factors conferring a lifetime risk of greater than 20%. Supplemental cancer detection rate (CDR), abnormal interpretation rate (AIR), and positive predictive values (PPVs) were estimated with 95% exact CIs. Logistic regression analysis, adjusting for differences in patient demographics, was used to compare metrics., Results: There was no significant difference in the CDR of MRI in the FFDM group versus the DBT group (11 vs 16 cancers per 1000 examinations, respectively; odds ratio, 1.4; 95% CI, 0.4-1.2; p = 0.23). The AIR, PPV1, PPV2, and PPV3 were 7.4%, 15%, 23%, and 28% for the FFDM group and 7.3%, 22%, 33%, and 35% for the DBT group, with no statistical differences. Of the cancers detected in both groups, the majority were invasive, less than 1 cm, and node-negative., Conclusion: In women at higher-than-average risk of breast cancer screened with DBT, the supplemental CDR of MRI is similar to that of MRI after FFDM screening, with most cancers being invasive, subcentimeter, and node-negative.
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- 2019
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27. Predictors of surveillance mammography outcomes in women with a personal history of breast cancer.
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Lowry KP, Braunstein LZ, Economopoulos KP, Salama L, Lehman CD, Gazelle GS, Halpern EF, Giess CS, Taghian AG, and Lee JM
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- Adult, Aged, Breast Neoplasms diagnosis, Breast Neoplasms etiology, Cohort Studies, Early Detection of Cancer, Female, Humans, Mass Screening, Middle Aged, Neoplasm Grading, Neoplasm Staging, Neoplasms, Second Primary diagnosis, Neoplasms, Second Primary epidemiology, Neoplasms, Second Primary etiology, Odds Ratio, Prognosis, Breast Neoplasms epidemiology, Mammography methods
- Abstract
Purpose: To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features., Methods: This study was HIPAA compliant and IRB approved. We performed an electronic medical record review for a cohort of women with American Joint Committee on Cancer (AJCC) Stage I or II invasive breast cancer treated with breast conservation therapy who developed subsequent in-breast treatment recurrence (IBTR) or contralateral breast cancer (CBC). Poor surveillance outcome was defined as second breast cancer not detected by surveillance mammography, including interval cancers (diagnosed within 365 days of surveillance mammogram with negative results) and clinically detected cancers (diagnosed without a surveillance mammogram in the preceding 365 days). Univariate and multivariate logistic regression were performed to identify predictors of poor mammography surveillance outcome, including patient and primary tumor characteristics, breast density, mode of primary tumor detection, and time to second cancer diagnosis., Results: 164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis < 50 years (p < 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age < 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001)., Conclusion: Women younger than age 50 at primary breast cancer diagnosis are at risk of poor surveillance mammography outcomes, and may be appropriate candidates for more intensive clinical and imaging surveillance.
- Published
- 2018
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28. Temporal/compartmental changes in viral RNA and neuronal injury in a primate model of NeuroAIDS.
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González RG, Fell R, He J, Campbell J, Burdo TH, Autissier P, Annamalai L, Taheri F, Parker T, Lifson JD, Halpern EF, Vangel M, Masliah E, Westmoreland SV, Williams KC, and Ratai EM
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- Animals, Disease Models, Animal, Macaca mulatta, Minocycline, Acquired Immunodeficiency Syndrome blood, Acquired Immunodeficiency Syndrome cerebrospinal fluid, Acquired Immunodeficiency Syndrome diagnostic imaging, Acquired Immunodeficiency Syndrome drug therapy, Anti-Retroviral Agents pharmacology, Magnetic Resonance Imaging, Neurons virology, RNA, Viral blood, RNA, Viral cerebrospinal fluid, Simian Acquired Immunodeficiency Syndrome blood, Simian Acquired Immunodeficiency Syndrome cerebrospinal fluid, Simian Acquired Immunodeficiency Syndrome diagnostic imaging, Simian Acquired Immunodeficiency Syndrome drug therapy, Simian Immunodeficiency Virus
- Abstract
Despite the advent of highly active anti-retroviral therapy HIV-associated neurocognitive disorders (HAND) continue to be a significant problem. Furthermore, the precise pathogenesis of this neurodegeneration is still unclear. The objective of this study was to examine the relationship between infection by the simian immunodeficiency virus (SIV) and neuronal injury in the rhesus macaque using in vivo and postmortem sampling techniques. The effect of SIV infection in 23 adult rhesus macaques was investigated using an accelerated NeuroAIDS model. Disease progression was modulated either with combination anti-retroviral therapy (cART, 4 animals) or minocycline (7 animals). Twelve animals remained untreated. Viral loads were monitored in the blood and cerebral spinal fluid, as were levels of activated monocytes in the blood. Neuronal injury was monitored in vivo using magnetic resonance spectroscopy. Viral RNA was quantified in brain tissue of each animal postmortem using reverse transcription polymerase chain reaction (RT-PCR), and neuronal injury was assessed by immunohistochemistry. Without treatment, viral RNA in plasma, cerebral spinal fluid, and brain tissue appears to reach a plateau. Neuronal injury was highly correlated both to plasma viral levels and a subset of infected/activated monocytes (CD14+CD16+), which are known to traffic the virus into the brain. Treatment with either cART or minocycline decreased brain viral levels and partially reversed alterations in in vivo and immunohistochemical markers for neuronal injury. These findings suggest there is significant turnover of replicating virus within the brain and the severity of neuronal injury is directly related to the brain viral load.
- Published
- 2018
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29. Metabolomic Prediction of Human Prostate Cancer Aggressiveness: Magnetic Resonance Spectroscopy of Histologically Benign Tissue.
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Vandergrift LA, Decelle EA, Kurth J, Wu S, Fuss TL, DeFeo EM, Halpern EF, Taupitz M, McDougal WS, Olumi AF, Wu CL, and Cheng LL
- Subjects
- Adult, Aged, Analysis of Variance, Biomarkers, Tumor blood, Biopsy, Disease Progression, Follow-Up Studies, Humans, Kallikreins blood, Kaplan-Meier Estimate, Male, Metabolome, Middle Aged, Neoplasm Recurrence, Local, Prostate-Specific Antigen blood, Prostatectomy, Prostatic Hyperplasia pathology, Prostatic Neoplasms blood, Retrospective Studies, Statistics, Nonparametric, Magnetic Resonance Spectroscopy methods, Metabolomics methods, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms pathology
- Abstract
Prostate cancer alters cellular metabolism through events potentially preceding cancer morphological formation. Magnetic resonance spectroscopy (MRS)-based metabolomics of histologically-benign tissues from cancerous prostates can predict disease aggressiveness, offering clinically-translatable prognostic information. This retrospective study of 185 patients (2002-2009) included prostate tissues from prostatectomies (n = 365), benign prostatic hyperplasia (BPH) (n = 15), and biopsy cores from cancer-negative patients (n = 14). Tissues were measured with high resolution magic angle spinning (HRMAS) MRS, followed by quantitative histology using the Prognostic Grade Group (PGG) system. Metabolic profiles, measured solely from 338 of 365 histologically-benign tissues from cancerous prostates and divided into training-testing cohorts, could identify tumor grade and stage, and predict recurrence. Specifically, metabolic profiles: (1) show elevated myo-inositol, an endogenous tumor suppressor and potential mechanistic therapy target, in patients with highly-aggressive cancer, (2) identify a patient sub-group with less aggressive prostate cancer to avoid overtreatment if analysed at biopsy; and (3) subdivide the clinicopathologically indivisible PGG2 group into two distinct Kaplan-Meier recurrence groups, thereby identifying patients more at-risk for recurrence. Such findings, achievable by biopsy or prostatectomy tissue measurement, could inform treatment strategies. Metabolomics information can help transform a morphology-based diagnostic system by invoking cancer biology to improve evaluation of histologically-benign tissues in cancer environments.
- Published
- 2018
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30. Walking speed measurement with an Ambient Measurement System (AMS) in patients with multiple sclerosis and walking impairment.
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Bethoux F, Varsanik JS, Chevalier TW, Halpern EF, Stough D, and Kimmel ZM
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Multiple Sclerosis physiopathology, Multiple Sclerosis rehabilitation, Disabled Persons rehabilitation, Gait physiology, Multiple Sclerosis diagnosis, Walking physiology, Walking Speed physiology
- Abstract
Background: Walking speed is an important measure of gait impairment in multiple sclerosis (MS). The clinical assessment of walking speed requires dedicated time, space, and personnel, and may not accurately gauge real-world performance. The term "Ambient Measurement System" (AMS) refers to a new class of device that passively measures walking speed at home, without the need for dedicated space or specialized setup. This study compared an AMS, Echo5D, versus in-clinic standard measures of walking speed on a straight path., Methods: Twenty participants with MS and walking impairment were recruited from the Cleveland Clinic Mellen Center for MS. Each participant traversed an electronic GAITRite CIRFace (GC) sensor mat four times (two at comfortable pace, two at fast pace). Each participant then performed the Timed 25-Foot Walk (T25FW) twice, measured by a manual stopwatch (SW). All traversals were simultaneously measured by an array of Echo5D devices. Echo5D speeds were correlated with the Patient-Determined Disease Steps and the MS Walking Scale-12 patient-reported outcomes., Results: Pearson correlations between Echo5D and clinical tests ranged from 0.89 to 0.98 (p < 0.0001). No statistically significant bias was found between Echo5D and GC. A small statistically significant bias was found between Echo5D and SW, with Echo5D reporting approximately 5% faster walking speeds in aggregate., Conclusions: Among MS patients with walking impairments, the Echo5D AMS acquired walking speeds which were closely correlated with the standard measures of GC and SW. The strong agreement supports the use of Echo5D to assess in-home, real-world walking performance in MS., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2018
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31. Essentials of Statistical Methods for Assessing Reliability and Agreement in Quantitative Imaging.
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Anvari A, Halpern EF, and Samir AE
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- Humans, Observer Variation, Reproducibility of Results, Radiography
- Abstract
Quantitative imaging is increasing in almost all fields of radiological science. Modern quantitative imaging biomarkers measure complex parameters including metabolism, tissue microenvironment, tissue chemical properties or physical properties. In this paper, we focus on measurement reliability assessment in quantitative imaging. We review essential concepts related to measurement such as measurement variability and measurement error. We also discuss reliability study methods for intraobserver and interobserver variability, and the applicable statistical tests including: intraclass correlation coefficient, Pearson correlation coefficient, and Bland-Altman graphs and limits of agreement, standard error of measurement, and coefficient of variation., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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32. A Verbal Electronic Checklist for Timeouts Linked to the Electronic Health Record.
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Uppot RN, McCarthy CJ, Haynes AB, Burk KS, Mills T, Trifanov DS, Koo TK, Salazar GM, Halpern EF, and Yu AY
- Subjects
- Humans, Program Development, User-Computer Interface, Checklist, Electronic Health Records, Mobile Applications, Patient Safety standards, Practice Patterns, Physicians' statistics & numerical data, Radiology, Interventional organization & administration
- Published
- 2017
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33. Behind the Numbers: Sensitivity Analysis in Cost-Effectiveness Modeling.
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Halpern EF and Pandharipande PV
- Subjects
- Humans, Cost-Benefit Analysis, Models, Economic
- Published
- 2017
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34. Contraction Timing Patterns in Patients Treated for Breast Cancer Before and After Anthracyclines Therapy.
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Cheng KH, Handschumacher MD, Assuncao BMBL, Sebag IA, Halpern EF, and Scherrer-Crosbie M
- Subjects
- Antineoplastic Agents administration & dosage, Antineoplastic Agents adverse effects, Boston, Breast Neoplasms physiopathology, Controlled Before-After Studies, Excitation Contraction Coupling drug effects, Female, Heart Failure chemically induced, Heart Failure diagnostic imaging, Heart Failure physiopathology, Humans, Middle Aged, Quebec, Reproducibility of Results, Sensitivity and Specificity, Stroke Volume, Treatment Outcome, Ultrasonography methods, Ventricular Dysfunction, Left diagnostic imaging, Anthracyclines administration & dosage, Anthracyclines adverse effects, Breast Neoplasms drug therapy, Myocardial Contraction drug effects, Ventricular Dysfunction, Left chemically induced, Ventricular Dysfunction, Left physiopathology
- Abstract
Background: During the development of heart failure (HF), the changes of contraction timing pattern and temporal heterogeneity of segmental contraction happen early and may precede both symptomatic HF and the decrease in left ventricular ejection fraction (LVEF). In patients treated with anthracyclines, both symptomatic HF and the decrease of LVEF are detected once significant myocardial injury has occurred. The aim of the current study was to investigate whether changes in the timing of contraction can be detected early after anthracyclines therapy., Methods: Forty-one women (50 ± 11 years old) with newly diagnosed breast cancer were prospectively enrolled in two centers and underwent an echocardiogram before and after anthracyclines. Peak longitudinal myocardial systolic strain was measured on the apical four- and two-chamber views. The time to peak systolic longitudinal strain (TP), ejection time (ET), isovolumic contraction time (IVCT), systolic time, and diastolic time were measured using strain curves and Doppler tracings and compared before and after anthracyclines. The heterogeneity of contraction (dyssynchrony) was measured by the SD of the TP of all segments., Results: Anthracyclines treatment was associated with an increase in heart rate (HR) and a decrease in TP. TP was correlated with HR. TP/ET was independent of HR and inversely correlated to peak strain both at baseline and after anthracyclines. TP/ET increased after anthracyclines (1.26 ± 0.19 to 1.31 ± 0.22; P < .001), and this increase was correlated with the decrease in strain. The increase in TP/ET was due to an increase in IVCT/ET. A similar degree of dyssynchrony was found at baseline and after anthracyclines., Conclusions: Anthracyclines treatment induces an increase in the duration of contraction, mainly by increasing the IVCT. This increase is correlated to the decrease in strain and may therefore have additional prognostic value., (Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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35. Role of CT in the Diagnosis of Nonspecific Abdominal Pain: A Multicenter Analysis.
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Eisenberg JD, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, Miller CM, Tramontano AC, Herring MS, Dowling EC, Halpern EF, Donelan K, Gazelle GS, and Pandharipande PV
- Subjects
- Age Distribution, Female, Humans, Male, Middle Aged, Prevalence, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Sex Distribution, United States epidemiology, Abdominal Pain diagnosis, Abdominal Pain epidemiology, Clinical Competence statistics & numerical data, Radiography, Abdominal statistics & numerical data, Tomography, X-Ray Computed statistics & numerical data
- Abstract
Objective: The objective of our study was to determine whether specific patient and physician factors-known before CT-are associated with a diagnosis of nonspecific abdominal pain (NSAP) after CT in the emergency department (ED)., Materials and Methods: We analyzed data originally collected in a prospective multicenter study. In the parent study, we identified ED patients referred to CT for evaluation of abdominal pain. We surveyed their physicians before and after CT to identify changes in leading diagnoses, diagnostic confidence, and admission decisions. In the current study, we conducted a multiple regression analysis to identify whether the following were associated with a post-CT diagnosis of NSAP: patient age; patient sex; physicians' years of experience; physicians' pre-CT diagnostic confidence; and physicians' pre-CT admission decision if CT had not been available. We analyzed patients with and those without a pre-CT diagnosis of NSAP separately. For the sensitivity analysis, we excluded patients with different physicians before and after CT., Results: In total, 544 patients were included: 10% (52/544) with a pre-CT diagnosis of NSAP and 90% (492/544) with a pre-CT diagnosis other than NSAP. The leading diagnoses changed after CT in a large proportion of patients with a pre-CT diagnosis of NSAP (38%, 20/52). In regression analysis, we found that physicians' pre-CT diagnostic confidence was inversely associated with a post-CT diagnosis of NSAP in patients with a pre-CT diagnosis other than NSAP (p = 0.0001). No other associations were significant in both primary and sensitivity analyses., Conclusion: With the exception of physicians' pre-CT diagnostic confidence, the factors evaluated were not associated with a post-CT diagnosis of NSAP.
- Published
- 2017
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36. Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma.
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Lubitz CC, De Gregorio L, Fingeret AL, Economopoulos KP, Termezawi D, Hassan M, Parangi S, Stephen AE, Halpern EF, Donelan K, and Swan JS
- Subjects
- Adolescent, Adult, Aged, Anxiety psychology, Carcinoma, Papillary pathology, Carcinoma, Papillary physiopathology, Carcinoma, Papillary psychology, Depression psychology, Female, Humans, Lymph Nodes pathology, Male, Middle Aged, Neoplasm Staging, Patient Reported Outcome Measures, Radiotherapy, Adjuvant, Thyroid Cancer, Papillary, Thyroid Neoplasms pathology, Thyroid Neoplasms physiopathology, Thyroid Neoplasms psychology, Young Adult, Carcinoma, Papillary therapy, Health Status, Iodine Radioisotopes therapeutic use, Quality of Life, Thyroid Neoplasms therapy, Thyroidectomy
- Abstract
Background: Thyroid cancer incidence is increasing. The effect of diagnosis and treatment on health-related quality of life (HRQoL) is an essential variable in the absence of a change in life span for the majority of patients. HRQoL instruments, with data useful for between-disease comparisons, are being increasingly used for health policy and outcomes evaluation. Variation exits among the instruments based on the impact of a specific disease. We assessed which of four well-validated, preference-based surveys detect changes in health and clinical intervention in patients diagnosed with papillary thyroid cancer (PTC)., Methods: Four commonly used HRQoL questionnaires (Short Form-12v2® [SF6D], EuroQol-5D [EQ5D], and Health Utilities Index Mark 2 and 3 [HUI2, HUI3]) were administered to patients with the diagnosis of PTC at three perioperative time points during the first year of treatment. Clinicopathological and treatment course data were assessed for HRQoL impact including complications from surgery, re-operation for persistence/early recurrence, and adjuvant radioactive iodine treatment. We compared standard metrics, including ceiling effect, intraclass correlation coefficient, effect sizes, and quality-adjusted life-years between the four instruments., Results: Of 117 patients, 27% had a preoperative diagnosis of anxiety or depression, 41% had regional lymph node metastases, three had distant metastases and 49% underwent adjuvant radioactive iodine treatment. The ceiling effect (i.e., proportion with a perfect score) was greatest with EQ5D and least with SF6D. Index scores ranged from 0.77 (SF6D) to 0.90 (EQ5D). All scores declined at two weeks postoperatively and returned to pretreatment levels at six months. The SF6D was the only instrument to exceed the conventional minimally important difference between all three time points. Quality-adjusted life-years were as follows: SF6D, 0.79; EQ5D, 0.90; HUI2, 0.88; and HUI3, 0.86., Conclusions: Our results reflect the general good health of PTC patients. The effect on quality of life is primarily related to emotional and social impacts of treatment. The results support the measurement of a similar underlying construct, although variation in detecting changes in health exists between the instruments. Of the instruments assessed, the SF6D is the most responsive to treatment effects and should be utilized in future economic analyses in this patient population.
- Published
- 2017
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37. Adipose tissue and muscle attenuation as novel biomarkers predicting mortality in patients with extremity sarcomas.
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Veld J, Vossen JA, De Amorim Bernstein K, Halpern EF, Torriani M, and Bredella MA
- Subjects
- Biomarkers, Extremities, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Sarcoma diagnostic imaging, Soft Tissue Neoplasms diagnostic imaging, Abdominal Fat diagnostic imaging, Psoas Muscles diagnostic imaging, Sarcoma mortality, Soft Tissue Neoplasms mortality, Tomography, X-Ray Computed
- Abstract
Objectives: To assess CT-attenuation of abdominal adipose tissue and psoas muscle as predictors of mortality in patients with sarcomas of the extremities., Methods: Our study was IRB approved and HIPAA compliant. The study group comprised 135 patients with history of extremity sarcoma (mean age: 53 ± 17 years) who underwent whole body PET/CT. Abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and psoas muscle attenuation (HU) was assessed on non-contrast, attenuation-correction CT. Clinical information including survival, tumour stage, sarcoma type, therapy and pre-existing comorbidities were recorded. Cox proportional hazard models were used to determine longitudinal associations between adipose tissue and muscle attenuation and mortality., Results: There were 47 deaths over a mean follow-up period of 20 ± 17 months. Higher SAT and lower psoas attenuation were associated with increased mortality (p = 0.03 and p = 0.005, respectively), which remained significant after adjustment for age, BMI, sex, tumor stage, therapy, and comorbidities (p = 0.002 and p = 0.02, respectively). VAT attenuation was not associated with mortality., Conclusion: Attenuation of SAT and psoas muscle, assessed on non-contrast CT, are predictors of mortality in patients with extremity sarcomas, independent of other established prognostic factors, suggesting that adipose tissue and muscle attenuation could serve as novel biomarkers for mortality in patients with sarcomas., Key Points: • CT-attenuation of adipose tissue and muscle predict mortality in sarcoma patients • CT-attenuation predicts mortality independent of established prognostic factors • Patients with sarcomas often undergo CT for staging or surveillance • Adipose tissue and muscle attenuation could serve as biomarkers for mortality.
- Published
- 2016
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38. Changes in Physician Decision Making after CT: A Prospective Multicenter Study in Primary Care Settings.
- Author
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Pandharipande PV, Alabre CI, Coy DL, Zaheer A, Miller CM, Herring MS, Tramontano AC, Dowling EC, Eisenberg JD, Ashar BH, Halpern EF, Donelan K, and Gazelle GS
- Subjects
- Adult, Aged, Aged, 80 and over, Clinical Competence standards, Emergency Medicine standards, Emergency Service, Hospital statistics & numerical data, Female, Humans, Male, Middle Aged, Pilot Projects, Prospective Studies, Referral and Consultation statistics & numerical data, Tomography, X-Ray Computed, Young Adult, Abdominal Pain diagnostic imaging, Clinical Decision-Making, Physicians, Primary Care standards
- Abstract
Purpose To determine the effect of computed tomography (CT) results on physician decision making in three common clinical scenarios in primary care. Materials and Methods This research was approved by the institutional review board (IRB) and was HIPAA compliant. All physicians consented to participate with an opt-in or opt-out mechanism; patient consent was waived with IRB approval. In this prospective multicenter observational study, outpatients referred by primary care providers (PCPs) for CT evaluation of abdominal pain, hematuria, or weight loss were identified. Prior to CT, PCPs were surveyed to elicit their leading diagnosis, confidence in that diagnosis (confidence range, 0%-100%), a rule-out diagnosis, and a management plan if CT were not available. Surveys were repeated after CT. Study measures were the proportion of patients in whom leading diagnoses and management changed (PCP management vs specialist referral vs emergency department transfer), median changes in diagnostic confidence, and the proportion of patients in whom CT addressed rule-out diagnoses. Regression analyses were used to identify associations between study measures and site and participant characteristics. Specifically, logistic regression analysis was used for binary study measures (change in leading diagnosis, change in management), and linear regression analysis was used for the continuous study measure (change in diagnostic confidence). Accrual began on September 5, 2012, and ended on June 28, 2014. Results In total, 91 PCPs completed pre- and post-CT surveys in 373 patients. In patients with abdominal pain, hematuria, or weight loss, leading diagnoses changed after CT in 53% (131 of 246), 49% (36 of 73), and 57% (27 of 47) of patients, respectively. Management changed in 35% (86 of 248), 27% (20 of 74), and 54% (26 of 48) of patients, respectively. Median absolute changes in diagnostic confidence were substantial and significant (+20%, +20%, and +19%, respectively; P ≤ .001 for all); median confidence after CT was high (90%, 88%, and 80%, respectively). PCPs reported CT was helpful in confirming or excluding rule-out diagnoses in 98% (184 of 187), 97% (59 of 61), and 97% (33 of 34) of patients, respectively. Significant associations between primary measures and site and participant characteristics were not identified. Conclusion Changes in PCP leading diagnoses and management after CT were common, and diagnostic confidence increased substantially.
© RSNA, 2016 Online supplemental material is available for this article.- Published
- 2016
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39. Impact of Nonvascular Thoracic MR Imaging on the Clinical Decision Making of Thoracic Surgeons: A 2-year Prospective Study.
- Author
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Ackman JB, Gaissert HA, Lanuti M, Digumarthy SR, Shepard JA, Halpern EF, and Wright CD
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Thoracic Diseases surgery, Clinical Decision-Making methods, Magnetic Resonance Imaging methods, Surgeons, Thoracic Diseases diagnostic imaging
- Abstract
Purpose To determine the impact of nonvascular thoracic magnetic resonance (MR) imaging on the clinical decision making and diagnostic certainty of thoracic surgeons. Materials and Methods Seven thoracic surgeons at Massachusetts General Hospital, an academic quaternary referral hospital, participated in this 2-year, prospective, institution review board-approved, HIPAA-compliant pre- and post-MR imaging survey study after completing a one-time demographic survey. Between July 16, 2013, and July 13, 2015, each time a thoracic surgeon ordered a nonvascular thoracic MR imaging study via radiology order entry, he or she was sent a link to the pre-test survey that ascertained the clinical rationale for MR imaging, the clinical management plan if MR imaging was not an option, and pre-test diagnostic certainty. Upon completion of the MR imaging report, the surgeon was sent a link to the post-test survey assessing if/how MR imaging changed clinical management, the surgeon's comfort with the clinical management plan, and post-test diagnostic certainty. Data were analyzed with Student t, Wilcoxon, and McNemar tests. Results A total of 99 pre- and post-test surveys were completed. Most MR imaging studies (64 of 99 [65%]) were requested because of indeterminate computed tomographic findings. The use of MR imaging significantly reduced the number of planned surgical interventions (P < .001), modified the surgical approach in 54% (14 of 26) of surgical cases, and increased surgeon comfort with the patient management plan in 95% (94 of 99) of cases. Increased diagnostic certainty as a result of MR imaging was highly significant (P < .0001). In 21% (21 of 99) of cases, definitive MR imaging results warranted no further follow-up or clinical care. Conclusion In appropriate cases, assessment with nonvascular thoracic MR imaging substantially affects the clinical decision making and diagnostic certainty of thoracic surgeons. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on May 2, 2016.
- Published
- 2016
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40. Multi-laboratory inter-institute reproducibility study of IVOCT and IVUS assessments using published consensus document definitions.
- Author
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Gerbaud E, Weisz G, Tanaka A, Kashiwagi M, Shimizu T, Wang L, Souza C, Bouma BE, Suter MJ, Shishkov M, Ughi GJ, Halpern EF, Rosenberg M, Waxman S, Moses JW, Mintz GS, Maehara A, and Tearney GJ
- Subjects
- Angioplasty, Balloon, Coronary mortality, Cardiac Catheterization methods, Consensus, Coronary Disease mortality, Elective Surgical Procedures methods, Female, Humans, Male, Observer Variation, Reproducibility of Results, Stents, Survival Rate, Treatment Outcome, Vascular Patency physiology, Angioplasty, Balloon, Coronary methods, Coronary Disease diagnostic imaging, Coronary Disease therapy, Tomography, Optical Coherence methods, Ultrasonography, Interventional methods
- Abstract
Aims: The aim of this study was to investigate the reproducibility of intravascular optical coherence tomography (IVOCT) assessments, including a comparison to intravascular ultrasound (IVUS). Intra-observer and inter-observer variabilities of IVOCT have been previously described, whereas inter-institute reliability in multiple laboratories has never been systematically studied., Methods and Results: In 2 independent laboratories with intravascular imaging expertise, 100 randomized matched data sets of IVOCT and IVUS images were analysed by 4 independent observers according to published consensus document definitions. Intra-observer, inter-observer, and inter-institute variabilities of IVOCT qualitative and quantitative measurements vs. IVUS measurements were assessed. Minor inter- and intra-observer variability of both imaging techniques was observed for detailed qualitative and geometric analysis, except for inter-observer mixed plaque identification on IVUS (κ = 0.70) and for inter-observer fibrous cap thickness measurement reproducibility on IVOCT (ICC = 0.48). The magnitude of inter-institute measurement differences for IVOCT was statistically significantly less than that for IVUS concerning lumen cross-sectional area (CSA), maximum and minimum lumen diameters, stent CSA, and maximum and minimum stent diameters (P < 0.001, P < 0.001, P < 0.001, P = 0.02, P < 0.001, and P = 0.01, respectively). Minor inter-institute measurement variabilities using both techniques were also found for plaque identification., Conclusion: In the measurement of lumen CSA, maximum and minimum lumen diameters, stent CSA, and maximum and minimum stent diameters by analysts from two different laboratories, reproducibility of IVOCT was more consistent than that of IVUS., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)
- Published
- 2016
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41. Radiologist Peer Review by Group Consensus.
- Author
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Harvey HB, Alkasab TK, Prabhakar AM, Halpern EF, Rosenthal DI, Pandharipande PV, and Gazelle GS
- Subjects
- Consensus, Feasibility Studies, Humans, Peer Review, Health Care methods, Quality Assurance, Health Care organization & administration, Radiology Department, Hospital standards
- Abstract
Purpose: The objective of this study was to evaluate the feasibility of the consensus-oriented group review (COGR) method of radiologist peer review within a large subspecialty imaging department., Methods: This study was institutional review board approved and HIPAA compliant. Radiologist interpretations of CT, MRI, and ultrasound examinations at a large academic radiology department were subject to peer review using the COGR method from October 2011 through September 2013. Discordance rates and sources of discordance were evaluated on the basis of modality and division, with group differences compared using a χ(2) test. Potential associations between peer review outcomes and the time after the initiation of peer review or the number of radiologists participating in peer review were tested by linear regression analysis and the t test, respectively., Results: A total of 11,222 studies reported by 83 radiologists were peer reviewed using COGR during the two-year study period. The average radiologist participated in 112 peer review conferences and had 3.3% of his or her available CT, MRI and ultrasound studies peer reviewed. The rate of discordance was 2.7% (95% confidence interval [CI], 2.4%-3.0%), with significant differences in discordance rates on the basis of division and modality. Discordance rates were highest for MR (3.4%; 95% CI, 2.8%-4.1%), followed by ultrasound (2.7%; 95% CI, 2.0%-3.4%) and CT (2.4%; 95% CI, 2.0%-2.8%). Missed findings were the most common overall cause for discordance (43.8%; 95% CI, 38.2%-49.4%), followed by interpretive errors (23.5%; 95% CI, 18.8%-28.3%), dictation errors (19.0%; 95% CI, 14.6%-23.4%), and recommendation (10.8%; 95% CI, 7.3%-14.3%). Discordant cases, compared with concordant cases, were associated with a significantly greater number of radiologists participating in the peer review process (5.9 vs 4.7 participating radiologists, P < .001) and were significantly more likely to lead to an addendum (62.9% vs 2.7%, P < .0001)., Conclusions: COGR permits departments to collect highly contextualized peer review data to better elucidate sources of error in diagnostic imaging reports, while reviewing a sufficient case volume to comply with external standards for ongoing performance review., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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42. Myocardial Strain Is Associated with Adverse Clinical Cardiac Events in Patients Treated with Anthracyclines.
- Author
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Ali MT, Yucel E, Bouras S, Wang L, Fei HW, Halpern EF, and Scherrer-Crosbie M
- Subjects
- Aged, Comorbidity, Elastic Modulus, Elasticity Imaging Techniques statistics & numerical data, Female, Heart physiopathology, Hematologic Neoplasms drug therapy, Hematologic Neoplasms mortality, Humans, Incidence, Male, Massachusetts epidemiology, Middle Aged, Reproducibility of Results, Retrospective Studies, Risk Factors, Sensitivity and Specificity, Shear Strength, Survival Rate, Treatment Outcome, Anthracyclines therapeutic use, Death, Sudden, Cardiac epidemiology, Drug-Related Side Effects and Adverse Reactions diagnostic imaging, Drug-Related Side Effects and Adverse Reactions mortality, Heart diagnostic imaging, Heart Failure diagnostic imaging, Heart Failure mortality
- Abstract
Background: Anthracycline-induced symptomatic heart failure is often irreversible, underlining the usefulness of pretreatment risk assessment. Global longitudinal strain (GLS) before or after chemotherapy is associated with a later decrease in left ventricular ejection fraction (LVEF); however, whether prechemotherapy GLS is associated with symptomatic heart failure and cardiac death in patients treated with anthracyclines is unknown., Methods: Patients with hematologic cancers treated with anthracyclines who underwent prechemotherapy echocardiography between November 2006 and June 2011 were retrospectively recruited. Basic demographic data, end-diastolic and end-systolic left ventricular volumes, LVEF, and GLS were measured. Clinical cardiac events (CEs) were defined as cardiac death or symptomatic heart failure. The association of prechemotherapy parameters with CEs was analyzed using proportional hazard analysis., Results: Over a median follow-up period of 1,593 days (range, 13-2,891 days) after the start of chemotherapy, 28 of 450 patients (6%) experienced CEs. Prechemotherapy LVEF and GLS were lower in patients with CEs compared with those without CEs (58 ± 10% vs 62 ± 7% [P = .005] and -15.0 ± 2.8% vs -19.7 ± 2.7% [P < .0001], respectively). Diabetes (hazard ratio [HR], 7.06; P < .0001), hypertension (HR, 2.22; P = .04), LVEF (HR, 0.93; P = .005), and GLS (HR, 1.47; P < .0001) were associated with CEs. After controlling for clinical variables, prechemotherapy GLS remained independently associated with CEs (P < .0001). GLS less than the absolute value of -17.5% was found in 105 patients (23%) and was associated with a sixfold increase in CEs (P < .0001)., Conclusions: Prechemotherapy GLS is an effective tool to stratify patients at high risk for CEs after anthracycline therapy and may help tailor treatments to decrease anthracycline-induced cardiotoxicity., (Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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43. Left Ventricular Global Longitudinal Strain in HER-2 + Breast Cancer Patients Treated with Anthracyclines and Trastuzumab Who Develop Cardiotoxicity Is Associated with Subsequent Recovery of Left Ventricular Ejection Fraction.
- Author
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Fei HW, Ali MT, Tan TC, Cheng KH, Salama L, Hua L, Zeng X, Halpern EF, Taghian A, MacDonald SM, and Scherrer-Crosbie M
- Subjects
- Anthracyclines, Antineoplastic Agents administration & dosage, Antineoplastic Agents adverse effects, Breast Neoplasms complications, Breast Neoplasms metabolism, Cardiotoxins adverse effects, Cardiotoxins therapeutic use, Elastic Modulus drug effects, Elasticity Imaging Techniques methods, Female, Humans, Longitudinal Studies, Middle Aged, Receptor, ErbB-2 metabolism, Recovery of Function, Stroke Volume drug effects, Trastuzumab administration & dosage, Trastuzumab adverse effects, Treatment Outcome, Ventricular Dysfunction, Left diagnostic imaging, Antineoplastic Combined Chemotherapy Protocols adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms drug therapy, Echocardiography methods, Ventricular Dysfunction, Left chemically induced, Ventricular Dysfunction, Left physiopathology
- Abstract
Aim: The combination of anthracyclines (AC) and trastuzumab (TRZ) is highly effective in patients with aggressive HER-2 + breast cancer, but has a significant risk of cardiotoxicity (CT). Trastuzumab-induced CT may be reversible. The aim of this study was to identify echocardiographic parameters associated with recovery of left ventricular ejection fraction (LVEF) in patients who developed CT after AC and TRZ treatment., Methods and Results: Women with newly diagnosed breast cancer treated with AC followed by TRZ and monitored with serial echocardiograms were retrospectively studied. Left ventricular end-diastolic and systolic volumes, LVEF, and global longitudinal strain (GLS) were examined. Development and reversibility of CT were defined based on changes in LVEF according to the 2014 ASE/EACVI recommendations. Cox analysis was used to determine the association of echocardiographic variables with the subsequent development and reversibility of CT. Ninety-five patients underwent 5 echocardiograms or more in a 17-month (13-28 months) follow-up period. Nineteen patients (20%) developed CT. Left ventricular volumes, LVEF, and GLS measured after AC completion identified the subsequent development of CT. Of the 19 patients with CT, the LVEF partially or fully recovered in 13 (68%). GLS at the time of CT diagnosis was associated with subsequent recovery of LVEF (P = 0.004)., Conclusion: In patients with breast cancer treated with AC and TRZ who develop CT, GLS at the time of CT diagnosis is associated with subsequent recovery of LVEF and may be useful for risk stratification and to guide treatment., (© 2016, Wiley Periodicals, Inc.)
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- 2016
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44. CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making.
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Pandharipande PV, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, Miller CM, Avery LL, Herring MS, Tramontano AC, Dowling EC, Abujudeh HH, Eisenberg JD, Halpern EF, Donelan K, and Gazelle GS
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prospective Studies, United States, Decision Making, Emergency Service, Hospital organization & administration, Practice Patterns, Physicians' statistics & numerical data, Tomography, X-Ray Computed statistics & numerical data
- Abstract
Purpose: To determine how physicians' diagnoses, diagnostic uncertainty, and management decisions are affected by the results of computed tomography (CT) in emergency department settings., Materials and Methods: This study was approved by the institutional review board and compliant with HIPAA. Data were collected between July 12, 2012, and January 13, 2014. The requirement to obtain patient consent was waived. In this prospective, four-center study, patients presenting to the emergency department who were referred for CT with abdominal pain, chest pain and/or dyspnea, or headache were identified. Physicians were surveyed before and after CT to determine the leading diagnosis, diagnostic confidence (on a scale of 0% to 100%), alternative "rule out" diagnosis, and management decisions. Primary measures were the proportion of patients for whom the leading diagnosis or admission decision changed and median changes in diagnostic confidence. Secondary measures addressed alternative diagnoses and return-to-care visits (eg, to emergency department) at 1-month follow-up. Regression analysis was used to identify associations between primary measures and site and participant characteristics., Results: Both surveys were completed for 1280 patients by 245 physicians. The leading diagnosis changed in 235 of 460 patients with abdominal pain (51%), 163 of 387 with chest pain and/or dyspnea (42%), and 103 of 433 with headache (24%). Pre-CT diagnostic confidence was inversely associated with the likelihood of a diagnostic change (P < .0001). Median changes in confidence were substantial (increases of 25%, 20%, and 13%, respectively, for patients with abdominal pain, chest pain and/or dyspnea, and headache; P < .0001); median post-CT confidence was high (95% for all three groups). CT helped confirm or exclude at least 95% of alternative diagnoses. Admission decisions changed in 116 of 457 patients with abdominal pain (25%), 72 of 387 with chest pain and/or dyspnea (19%), and 81 of 426 with headache (19%). During follow-up, 70 of 450 patients with abdominal pain (15%), 53 of 387 with chest pain and/or dyspnea (14%), and 49 of 433 with headache (11%) returned for the same indication. In general, changes in leading diagnosis, diagnostic confidence, and admission decisions were not well explained with site or participant characteristics., Conclusion: Physicians' diagnoses and admission decisions changed frequently after CT, and diagnostic uncertainty was alleviated.
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- 2016
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45. Occult Histopathology and Its Predictors in Contralateral and Bilateral Prophylactic Mastectomies.
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Mattos D, Gfrerer L, Ling IT, Reish RG, Hughes KS, Halpern EF, Cetrulo C, Colwell AS, Winograd JM, Yaremchuk MJ, Austen WG Jr, and Liao EC
- Subjects
- Adult, Breast Neoplasms surgery, Carcinoma, Ductal, Breast surgery, Carcinoma, Intraductal, Noninfiltrating surgery, Carcinoma, Lobular surgery, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Prognosis, Prospective Studies, Retrospective Studies, Breast Neoplasms pathology, Carcinoma, Ductal, Breast pathology, Carcinoma, Intraductal, Noninfiltrating pathology, Carcinoma, Lobular pathology, Mastectomy
- Abstract
Background: The last decade has seen an increasing prevalence of prophylactic mastectomies with decreasing age of patients treated for breast cancer. Data are limited on the prevalence of histopathologic abnormalities in this population. This study aimed to measure the prevalence of histopathologic findings in contralateral prophylactic mastectomy (CPM) and bilateral prophylactic mastectomy (BPM) patients and identify predictors of findings., Methods: Our institution's prophylactic mastectomies from 2004 to 2011 were reviewed. Breast specimens with prior malignancies were excluded. Patient factors and pathology reports were collected. Independent predictive factors were identified with univariate and multivariate logistic analysis., Results: A total of 524 specimens in 454 patients were identified. Malignancy was found in 7.0% of CPM and 5.7% of BPM specimens. In CPM patients, ipsilateral lobular carcinoma-in situ [odds ratio (OR) 4.0] and mammogram risk group (OR 2.0) were predictive of malignancy. Age group (OR 1.5), ipsilateral lobular carcinoma-in situ (OR 2.3), and prior bilateral salpingo-oophorectomy (OR 0.3) were predictive of moderate- to high-risk histopathology. Only increasing age group was predictive of increased moderate- to high-risk histopathology in BPM patients (OR 2.3). There were no independent predictors of malignancy in BPM. BRCA status was not predictive in either CPM or BPM., Conclusions: Patients with lobular carcinoma-in situ in the index breast or high-risk mammograms have a higher prevalence of malignancies. Although BRCA patients may benefit from prophylactic mastectomy, the genetic diagnosis does not increase the prevalence of detecting occult pathology. BPM patients can be counseled about relative risk, where occult pathology increases with age.
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- 2016
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46. Radiology Malpractice Claims in the United States From 2008 to 2012: Characteristics and Implications.
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Harvey HB, Tomov E, Babayan A, Dwyer K, Boland S, Pandharipande PV, Halpern EF, Alkasab TK, Hirsch JA, Schaefer PW, Boland GW, and Choy G
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- Humans, Liability, Legal, United States, Compensation and Redress legislation & jurisprudence, Diagnostic Errors economics, Diagnostic Errors legislation & jurisprudence, Malpractice economics, Malpractice legislation & jurisprudence, Radiology economics, Radiology legislation & jurisprudence
- Abstract
Purpose: The aim of this study was to compare the frequency and liability costs associated with radiology malpractice claims relative to other medical services and to evaluate the clinical context and case disposition associated with radiology malpractice claims., Methods: This HIPAA-compliant study was exempted from institutional review board approval. The Comparative Benchmarking System database, a repository of more than 300,000 medical malpractice cases in the United States, was queried for closed claims over a five-year period (2008-2012). Claims were categorized by the medical service primarily responsible for the claim and the paid total loss. For all cases in which radiology was the primary responsible service, the case abstracts were evaluated to determine injury severity, claimant type by setting, claim allegation, process of care involved, case disposition, modality involved, and body section. Intracategory comparisons were made on the basis of the frequency of indemnity payment and total indemnity payment for paid cases, using χ(2) and Wilcoxon rank-sum tests., Results: Radiology was the eighth most likely responsible service to be implicated in a medical malpractice claim, with a median total paid loss (indemnity payment plus defense cost plus administrative expense) per closed case of $30,091 (mean, $205,619 ± $508,883). Radiology claims were most commonly associated with high- and medium-severity injuries (93.3% [820 of 879]; 95% confidence interval [CI], 91.7%-94.95%), the outpatient setting (66.3% [581 of 876]; 95% CI, 63.0%-69.2%), and diagnosis-related allegations (ie, failure to diagnose or delayed diagnosis) (57.3% [504 of 879]; 95% CI, 54.0%-60.6%). A high proportion of claims pertained to cancer diagnoses (44.0% [222 of 504]; 95% CI, 39.7%-48.3%). A total of 62.3% (548 of 879; 95% CI, 59.1%-65.5%) of radiology claims were closed without indemnity payments; 37.7% (331 of 879; 95% CI, 34.5%-40.9%) were closed with a median indemnity payment of $175,000 (range, $112-$6,691,762; mean $481,094 ± $727,636)., Conclusions: Radiology malpractice claims most commonly involve diagnosis-related allegations in the outpatient setting, particularly cancer diagnoses, with approximately one-third of claims resulting in payouts to the claimants., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
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- 2016
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47. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies.
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Chang CY, Huang AJ, Bredella MA, Torriani M, Halpern EF, Rosenthal DI, and Springfield DS
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- Adolescent, Adult, Aged, Biopsy, Needle statistics & numerical data, Boston epidemiology, Child, Child, Preschool, Cryopreservation statistics & numerical data, Female, Humans, Longitudinal Studies, Male, Middle Aged, Observer Variation, Point-of-Care Testing statistics & numerical data, Prevalence, Radiography, Interventional statistics & numerical data, Reproducibility of Results, Risk Assessment, Sensitivity and Specificity, Young Adult, Bone Neoplasms epidemiology, Bone Neoplasms pathology, Image-Guided Biopsy statistics & numerical data, Soft Tissue Neoplasms epidemiology, Soft Tissue Neoplasms pathology, Tomography, X-Ray Computed statistics & numerical data
- Abstract
Objective: To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate?, Materials and Methods: This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ(2) test or Fisher's exact test., Results: In all, 140 of 963 (15%) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96%). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8%), POC cytology (25%), or neither (24%) were significantly different (P < 0.0001)., Conclusion: Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a benign lesion, a non-diagnostic biopsy may be considered reassuring. Frozen pathology may decrease the non-diagnostic biopsy rate.
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- 2015
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48. Detection and Measurement of Stones With Ultrasound Strain Elastography: A Phantom Study.
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Li Q, Chen L, Halpern EF, and Samir AE
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- Humans, ROC Curve, Reproducibility of Results, Elasticity Imaging Techniques methods, Phantoms, Imaging, Urinary Calculi diagnostic imaging
- Abstract
The sonoelastographic appearances of stones in a phantom were evaluated in this study. Ten stones were embedded into a tissue-mimicking meat phantom. The stone axial (vertical) and transverse (horizontal) dimensions measured by an electronic digital caliper, gray-scale ultrasound, and strain elastography (SE) were compared in 5 groups with stones embedded at different depths. In this study, physically measured axial and transverse stone dimensions were 1.17 to 6.86 and 1.30 to 11.15 mm, respectively. Strain elastography showed a characteristic 3-layer pattern associated with stones, comprising a superficial transition region, a hard region, and a deep transition region. As SE data were available in group 5, only data of groups 1 to 4 were analyzed. Compared with physical measurements, measurement mean errors of SE horizontal and SE vertical dimensions ranged from -0.20 to 0.42 mm and from -1.28 to -0.05 mm, respectively, in the 4 groups. Paired t testing demonstrated a significant horizontal dimension measurement error difference between B mode and SE method in group 4 (0.44 vs -0.20 mm, P < 0.05; F = 1.18, P > 0.05), but not in the other groups. Strain elastography horizontal dimension measurement error was not statistically correlated with stone size in the 4 groups. Strain elastography vertical dimension measurement error significantly correlated with stone size only in group 4 (P < 0.05). Preliminary results indicate that stone horizontal and vertical dimensions can be measured using SE in a soft tissue phantom, including when shadowing precludes measurement of vertical dimension on conventional 2-dimensional ultrasound. These results provide substantial motivation to further investigate SE as a modality to image stones in clinical practice.
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- 2015
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49. Non-Research-Related Physician-Industry Relationships of Radiologists in the United States.
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Harvey HB, Alkasab TK, Pandharipande PV, Halpern EF, Prabhakar AM, Oklu R, Rosenthal DI, Hirsch JA, Gazelle GS, and Brink JA
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- Databases, Factual, Female, Humans, Income, Industry ethics, Male, Patient Protection and Affordable Care Act economics, Research, United States, Industry economics, Interinstitutional Relations, Practice Patterns, Physicians' economics, Radiology economics
- Abstract
Purpose: To evaluate non-research-related, physician-industry financial relationships in the United States, in 2013, as reported pursuant to the Physician Payments Sunshine Act (a provision of the Affordable Care Act)., Methods: In September 2014, CMS released the first five months (August 2013 to December 2013) of data disclosing physician-industry financial relationships. The frequency and value of non-research-related transfers in radiology were calculated and compared with those for 19 other specialties. Subanalyses of the frequency and value of such transfers in radiology were performed, based on state of licensure, radiologic subspecialty, nature of payment, manufacturer identity, and drug or device involved., Results: A total of 7.4% (2,654 of 35,768) of radiologists from the United States had reportable non-research-related financial relationship(s) with industry during the 5-month period, the second-lowest level among the medical specialties evaluated. The average value of non-research-related transfers of value to radiologists, excluding royalties and licenses, was low ($438.71; SD: $2,912.15; median: $43.85), with <4% of radiologists receiving >$10 per month. Of all categories, that of food and beverage had the most transfers of value (86.0%; 5,655 of 6,577); royalties and licensure were associated with the greatest average value ($27,072.34; SD: $67,524.92). Although high-value relationships were rare, 57.8% (26 of 45) of radiologists who received a value >$1,000 per month held leadership positions in imaging enterprises., Conclusions: Less than 4% of radiologists have non-research-related financial relationships with industry that are valued at >$10 per month, suggesting that meaningful, deleterious effects of such relationships on radiology practice, if present, are infrequent., (Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
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- 2015
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50. Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid: Diagnostic Accuracy and Optimal Measurement Plane.
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Samir AE, Dhyani M, Anvari A, Prescott J, Halpern EF, Faquin WC, and Stephen A
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- Adenocarcinoma, Follicular diagnostic imaging, Adenocarcinoma, Follicular pathology, Adenoma diagnostic imaging, Adenoma pathology, Adult, Aged, Aged, 80 and over, Biopsy, Fine-Needle, Female, Humans, Male, Middle Aged, Preoperative Care, Prospective Studies, Risk Assessment, Thyroid Diseases pathology, Thyroid Neoplasms diagnostic imaging, Thyroid Neoplasms pathology, Thyroid Nodule diagnostic imaging, Thyroid Nodule pathology, Elasticity Imaging Techniques methods, Thyroid Diseases diagnostic imaging
- Abstract
Purpose: To evaluate the diagnostic accuracy of shear-wave elastography (SWE) for the diagnosis of malignancy in follicular lesions and to identify the optimal SWE measurement plane., Materials and Methods: The institutional review board approved this HIPAA-compliant, single-institution, prospective pilot study. Subjects scheduled for surgery after a previous fine-needle aspiration report of "atypia of undetermined significance" or "follicular lesion of undetermined significance," "suspicion for follicular neoplasm," or "suspicion for Hurthle cell neoplasm," were enrolled after obtaining informed consent. Subjects underwent conventional ultrasonography (US), Doppler evaluation, and SWE preoperatively, and their predictive value for thyroid malignancy was evaluated relative to the reference standard of surgical pathologic findings., Results: Thirty-five patients (12 men, 23 women) with a mean age of 55 years (range, 23-85 years) and a fine-needle aspiration diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (n = 16), suspicion for follicular neoplasm (n = 14), and suspicion for Hurthle cell neoplasm (n = 5) were enrolled in the study. Male sex was a statistically significant (P = .02) predictor of malignancy, but age was not. No sonographic morphologic parameter, including nodule size, microcalcification, macrocalcification, halo sign, taller than wide dimension, or hypoechogenicity, was associated with malignancy. Similarly, no Doppler feature, including intranodular vascularity, pulsatility index, resistive index, or peak-systolic velocity, was associated with malignancy. Higher median SWE tissue Young modulus estimates from the transverse insonation plane were associated with malignancy, yielding an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.62, 1.00) for differentiation of malignant from benign nodules. At a cutoff value of 22.3 kPa, sensitivity, specificity, positive predictive value, and negative predictive value of 82%, 88%, 75%, and 91%, respectively, were observed., Conclusion: This prospective pilot study indicates that SWE may be a valuable tool in preoperative malignancy risk assessment of follicular-patterned thyroid nodules., (© RSNA, 2015)
- Published
- 2015
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