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Barrett TW, Garland NM, Freeman CL, Klar K, Dahlke J, Lancaster P, Prisco L, Chang SS, Goff LW, Russ S, Jones ID. Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings. Ann Emerg Med 2022; 80:235-242. [PMID: 35752517 DOI: 10.1016/j.annemergmed.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/01/2022]
Abstract
STUDY OBJECTIVE Abnormal findings unrelated to the indication for testing are identified on emergency department (ED) imaging studies. We report the design and implementation of an electronic health record-based interdisciplinary referral system and our experience from the first 13 months of ensuring that patients with incidental radiology findings were connected with the appropriate outpatient surveillance. METHODS Our informatics team standardized the contemporaneous reporting of critical radiology alerts using our ED trackboard and created a companion follow-up request form for the treating ED clinicians to complete. The forms were routed to nurse case managers, who arranged follow-ups based on the findings and clinical significance. The primary outcome was the proportion of ED patient visits with identified incidental findings that had documented communication of the incidental findings and surveillance plans. RESULTS Over the first 13 months after implementation, 932 ED patient visits had critical radiology alert referrals, for a total of 982 incidental findings. The primary outcome (confirmed post-ED communication and documented follow-up plan) was attained in 888 (95.3%, 95% confidence interval [CI] 93.9% to 96.6%) ED patient visits with confirmed post-ED communication and documented follow-up plans. The team was unable to contact or confirm follow-up with 44 (4.7%, 95% CI 3.4 to 6.1) patients by telephone or through the health care system's electronic communication tools. CONCLUSION We report the implementation of a standardized notification and referral system for ED patients with incidental radiology findings. The development of a reliable notification and follow-up system is an important patient safety intervention given the opportunity to potentially identify undiagnosed malignancies.
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Affiliation(s)
- Tyler W Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.
| | - Nicholas M Garland
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Clifford L Freeman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Katharine Klar
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Jan Dahlke
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Penny Lancaster
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Larry Prisco
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Laura W Goff
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Stephan Russ
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Sajid IM, Frost K, Paul AK. 'Diagnostic downshift': clinical and system consequences of extrapolating secondary care testing tactics to primary care. BMJ Evid Based Med 2022; 27:141-148. [PMID: 34099498 DOI: 10.1136/bmjebm-2020-111629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 12/21/2022]
Abstract
Numerous drivers push specialist diagnostic approaches down to primary care ('diagnostic downshift'), intuitively welcomed by clinicians and patients. However, primary care's different population and processes result in under-recognised, unintended consequences. Testing performs poorer in primary care, with indication creep due to earlier, more undifferentiated presentation and reduced accuracy due to spectrum bias and the 'false-positive paradox'. In low-prevalence settings, tests without near-100% specificity have their useful yield eclipsed by greater incidental or false-positive findings. Ensuing cascades and multiplier effects can generate clinician workload, patient anxiety, further low-value tests, referrals, treatments and a potentially nocebic population 'disease' burden of unclear benefit. Increased diagnostics earlier in pathways can burden patients and stretch general practice (GP) workloads, inducing downstream service utilisation and unintended 'market failure' effects. Evidence is tenuous for reducing secondary care referrals, providing patient reassurance or meaningfully improving clinical outcomes. Subsequently, inflated investment in per capita testing, at a lower level in a healthcare system, may deliver diminishing or even negative economic returns. Test cost poorly represents 'value', neglecting under-recognised downstream consequences, which must be balanced against therapeutic yield. With lower positive predictive values, more tests are required per true diagnosis and cost-effectiveness is rarely robust. With fixed secondary care capacity, novel primary care testing is an added cost pressure, rarely reducing hospital activity. GP testing strategies require real-world evaluation, in primary care populations, of all downstream consequences. Test formularies should be scrutinised in view of the setting of care, with interventions to focus rational testing towards those with higher pretest probabilities, while improving interpretation and communication of results.
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Affiliation(s)
- Imran Mohammed Sajid
- NHS West London Clinical Commissioning Group, London, UK
- University of Global Health Equity, Kigali, Rwanda
| | - Kathleen Frost
- NHS Central London Clinical Commissioning Group, London, UK
| | - Ash K Paul
- NHS South West London Health and Care Partnership STP, London, UK
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Kennedy GT, Azari FS, Bernstein E, Nadeem B, Chang A, Segil A, Carlin S, Sullivan NT, Encarnado E, Desphande C, Kularatne S, Gagare P, Thomas M, Kucharczuk JC, Christien G, Lacombe F, Leonard K, Low PS, Criton A, Singhal S. Targeted detection of cancer at the cellular level during biopsy by near-infrared confocal laser endomicroscopy. Nat Commun 2022; 13:2711. [PMID: 35581212 PMCID: PMC9114105 DOI: 10.1038/s41467-022-30265-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/23/2022] [Indexed: 12/21/2022] Open
Abstract
Suspicious nodules detected by radiography are often investigated by biopsy, but the diagnostic yield of biopsies of small nodules is poor. Here we report a method-NIR-nCLE-to detect cancer at the cellular level in real-time during biopsy. This technology integrates a cancer-targeted near-infrared (NIR) tracer with a needle-based confocal laser endomicroscopy (nCLE) system modified to detect NIR signal. We develop and test NIR-nCLE in preclinical models of pulmonary nodule biopsy including human specimens. We find that the technology has the resolution to identify a single cancer cell among normal fibroblast cells when co-cultured at a ratio of 1:1000, and can detect cancer cells in human tumors less than 2 cm in diameter. The NIR-nCLE technology rapidly delivers images that permit accurate discrimination between tumor and normal tissue by non-experts. This proof-of-concept study analyzes pulmonary nodules as a test case, but the results may be generalizable to other malignancies.
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Affiliation(s)
- Gregory T Kennedy
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Feredun S Azari
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Elizabeth Bernstein
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Bilal Nadeem
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Ashley Chang
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Alix Segil
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sean Carlin
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Neil T Sullivan
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Emmanuel Encarnado
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Charuhas Desphande
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | - Mini Thomas
- On Target Laboratories, West Lafayette, IN, USA
| | - John C Kucharczuk
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | | | - Sunil Singhal
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Kadom N, Venkatesh AK, Shugarman SA, Burleson JH, Moore CL, Seidenwurm D. Novel Quality Measure Set: Closing the Completion Loop on Radiology Follow-up Recommendations for Noncritical Actionable Incidental Findings. J Am Coll Radiol 2022; 19:881-890. [PMID: 35606263 DOI: 10.1016/j.jacr.2022.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Care gaps occur when radiology follow-up recommendations are poorly communicated or not completed, resulting in missed or delayed diagnosis potentially leading to worse patient outcomes. This ACR-led initiative assembled a technical expert panel (TEP) to advise development of quality measures intended to improve communication and drive increased completion rates for radiology follow-up recommendations. MATERIALS AND METHODS A multistakeholder TEP was assembled to advise the development of quality measures. The project scope, limited to noncritical actionable incidental findings (AIFs), encourages practices to develop and implement systems ensuring appropriate communication and follow-up to completion. RESULTS A suite of nine measures were developed: four outcome measures include closing the loop on completion of radiology follow-up recommendations for nonemergent AIFs (with pulmonary nodule and abdominal aortic aneurysm use cases) and overall cancer diagnoses. Five process measures address communication and tracking of AIFs: inclusion of available evidence or guidelines informing the recommendation, communication of AIFs to the practice managing ongoing care, identifying when AIFs have been communicated to the patient, and employing tracking and reminder systems for AIFs. CONCLUSION This ACR-led initiative developed a measure set intended to improve patient outcomes by ensuring that AIFs are appropriately communicated and followed up. The intent of these measures is to focus improvement on specific areas in which gaps in communication and AIF follow-up may occur, prompting systems to devote resources that will identify and implement solutions to improve patient care.
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Incidental imaging findings referred to a specialized sarcoma center: Frequency, determinants, and downstream healthcare costs. Clin Imaging 2022; 85:99-105. [DOI: 10.1016/j.clinimag.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/19/2022]
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Allen R, deSouza IS. Risk-benefit analysis of PoCUS for suspected, ruptured abdominal aortic aneurysm. Acad Emerg Med 2022; 29:812-813. [PMID: 35420235 DOI: 10.1111/acem.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Robert Allen
- Department of Emergency Medicine SUNY Downstate Health Sciences University Brooklyn New York USA
- Department of Emergency Medicine Kings County Hospital Center Brooklyn New York USA
| | - Ian S. deSouza
- Department of Emergency Medicine SUNY Downstate Health Sciences University Brooklyn New York USA
- Department of Emergency Medicine Kings County Hospital Center Brooklyn New York USA
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Ion D, Bolocan A, Filipescu A, Andronic O, Oproiu AM, Popa A, Păduraru D. A mesorectal incidentaloma: Rare localization of Castleman disease (Case report). Exp Ther Med 2022; 23:268. [DOI: 10.3892/etm.2022.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Daniel Ion
- General Surgery Department, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandra Bolocan
- General Surgery Department, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandru Filipescu
- General Surgery Department, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Octavian Andronic
- General Surgery Department, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana-Maria Oproiu
- General Surgery Department, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Adelina Popa
- Department of Dermatology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Dan Păduraru
- General Surgery Department, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Cystic duct cyst in adults: a systematic review of the sixth entity. Surg Today 2022; 53:527-543. [PMID: 35124738 DOI: 10.1007/s00595-022-02461-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
Over the past two decades, there have been an increasing number of reports describing a sixth type of choledochal cyst (cystic duct cyst) in adults that was not included in Todani's classification. This sixth entity has not yet been systematically reviewed in the literature. We therefore explored this condition in adults from the perspective of the clinical presentation, diagnosis and treatment through a systematic review of the evidence. The final analysis included 33 reported cases, with 55% of them reported in Asia. The mean age was 39.3 years old, with a female-to-male ratio of 1.5:1. Magnetic resonance cholangiopancreatography was accurate in establishing the diagnosis in 69% of cases. Where reported, standard laparoscopic/open cholecystectomy was performed in about 74% of patients, while around 25% of them needed extensive surgery. Associated malignancy was reported in 6.1% of cases, while 28% of patients had co-existent gallstone-related disease. No significant post-operative morbidity or mortality was reported. In this era of emergency laparoscopic cholecystectomy, surgeons should be aware of this rare condition, with the particular understanding that it is associated with gallstone-related disease in a significant number of reported cases.
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Smith S, Parker T, Parker P. The justification of non-obstetric ultrasound referrals: A safe and effective practice. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:52-61. [PMID: 35173779 PMCID: PMC8841939 DOI: 10.1177/1742271x211005510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In 2015 the British Medical Ultrasound Society released a referral justification document for rejection of inappropriate ultrasound referrals to help manage increasing demand and ensure correct utilisation of diagnostic imaging tests. In our trust, referrals that were not aligned with the guidance were cancelled and returned to general practitioners, providing reasons for cancellation and advising other diagnostic tests if appropriate.Methodology: In total, 1000 cases cancelled between April and August 2019 were retrospectively audited by a team of clinical specialist sonographers. Interoperator agreement against BMUS justification guidelines and safety of this cancellation process were established. Duplicate imaging referrals, referrals made that should have been placed on management pathways or referrals cancelled by the patient directly were excluded in the safety assessment. RESULTS There was strong agreement amongst sonographers regarding cancellations. After exclusions, 389 cases were included for review. The majority (90.5%) required no onward imaging and were therefore deemed cancelled appropriately. There were 37 patients found with pathology on subsequent imaging, two of which were found to have cancer and the remainder with benign pathology. CONCLUSIONS Overall, we found the cancellation process to be safe and the justification document easy to utilise in practice. This process has ensured a minimal waiting time for ultrasound imaging is maintained and that demand can be managed to meet the available capacity.
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Affiliation(s)
- Shaunna Smith
- Shaunna Smith, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK.
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The utility of surveillance CT scans in a cohort of survivors of colorectal cancer. J Cancer Surviv 2022:10.1007/s11764-021-01155-y. [PMID: 35040075 DOI: 10.1007/s11764-021-01155-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/04/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Colorectal cancer (CRC) is the third most common cancer worldwide. After curative intent treatment, international guidelines recommend surveillance protocols which include annual CT chest, abdomen and pelvis (CAP) and serum carcinoembryonic antigen (CEA) monitoring which aim to improve overall survival by early detection of recurrence. Despite the widespread recommendations, robust evidence of an overall survival benefit is lacking. Our study aimed to quantify the utility of annual CT CAP as a surveillance modality in comparison to the rate of potentially harmful false-positive and incidental findings. METHODS High-risk stage II and stage III CRC patients were retrospectively identified from the Sydney Cancer Survivorship Centre database. Findings on surveillance CT were classified into confirmed recurrence or the potentially harmful findings of (a) false-positive or (b) clinically significant incidental finding. RESULTS A total of 376 surveillance CT CAPs were performed in 174 survivors between 12 September 2013 and 30 June 2020. The recurrence rate during the study period was 23/174 (13.2%) with the majority of recurrences detected by abnormal CEA (14/23, 60.9%) versus surveillance CT (4/23, 17.4%), with the remainder identified on non-surveillance CT (5/23, 21.7%). Curative intent surgery was performed in 12/23 people with CRC recurrence. Surveillance CT was shown to result in high levels of false-positive (31/174, 17.8% of patients) or clinically significant incidental findings (30/174, 17.2% of patients). The risk of identifying these potentially harmful findings was ongoing with each year of surveillance CT. CONCLUSION Surveillance CT was associated with low detection rates and high rates of potentially harmful findings bringing this surveillance modality under further scrutiny. IMPLICATIONS FOR CANCER SURVIVORS An increased emphasis should be placed on educating survivors on the benefits of surveillance CT weighed against the risk of potentially harmful findings.
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Piek MW, de Vries LH, Donswijk ML, de Keizer B, de Boer JP, Lodewijk L, van Leeuwaarde RS, Vriens MR, Hartemink KJ, van der Ploeg IMC. Retrospective analysis of PSMA PET/CT thyroid incidental uptake in adults: incidence, diagnosis, and treatment/outcome in a tertiary cancer referral center and University Medical Center. Eur J Nucl Med Mol Imaging 2022; 49:2392-2400. [PMID: 35031811 DOI: 10.1007/s00259-022-05679-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/09/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE A prostate-specific membrane antigen (PSMA) thyroid incidentaloma (PTI) is an unexpected, PSMA-avid thyroid lesion, newly detected during the investigation of an unrelated condition using PSMA PET/CT. The aim of this study is to examine the incidence and clinical significance of PTI and the associated management strategies since the implementation of the PSMA PET/CT scan. METHODS This study involves a retrospective cohort study of 61 PTI cases depicted on PSMA PET/CT scans performed between January 2016 and July 2021, almost exclusively for (re)staging prostate cancer. The medical records of the included cases were retrospectively reviewed and data of the PSMA PET/CT scans, primary malignancy, thyroid diagnostics, treatment, and follow-up were collected. RESULTS PTI was reported in 1.1% of the patients who underwent oncologic PSMA PET/CT scans included in this study. Two PTI cases had a histologically proven thyroid cancer: one a benign thyroid lesion and one a metastasis of a renal cell carcinoma. In none of the cases in whom any form of further thyroid workup was withheld, the PTI became clinically relevant during follow-up (median 1.8 years (1.1-3.3)). Six patients (10%) died due to their primary cancer. CONCLUSION The incidence of thyroid incidentalomas on PSMA PET/CT was low (1.1%) in this large, two-center experience. Less than half of the PTI cases were analyzed and the risk of malignancy, despite being low, was not negligible. The clinical outcome was good using a standard diagnostic workup for PTI, while the prognosis of the patient was determined by the primary malignancy. The consideration to analyze and treat PTI cases should be part of the shared decision-making in cancer patients.
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Affiliation(s)
- Marceline W Piek
- Departments of Surgical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Lisa H de Vries
- Departments of Surgery, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten L Donswijk
- Departments of Nuclear Medicine, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Bart de Keizer
- Departments of Nuclear Medicine, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Paul de Boer
- Departments of Internal Medicine, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Lutske Lodewijk
- Departments of Surgery, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rachel S van Leeuwaarde
- Departments of Endocrine Oncology, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Menno R Vriens
- Departments of Surgery, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Koen J Hartemink
- Departments of Surgical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Departments of Surgical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands.
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Ahn TR, Jeong YM, Park SH, Jeon JY, Lee SW, Shim YS. Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center. PLoS One 2022; 17:e0262511. [PMID: 35025970 PMCID: PMC8758081 DOI: 10.1371/journal.pone.0262511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. Methods This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. Results The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). Conclusion Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.
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Affiliation(s)
- Tae Ran Ahn
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
- * E-mail:
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Maharjan U, Kauppila JH. Survival trends in gastric cancer patients between 1987 and 2016: a population-based cohort study in Finland. Gastric Cancer 2022; 25:989-1001. [PMID: 35933683 PMCID: PMC9587955 DOI: 10.1007/s10120-022-01326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric cancer is the fourth leading cause of cancer-related deaths globally. There is a paucity of national studies examining gastric cancer mortality in relation to treatment status. This study evaluated the survival trends in gastric adenocarcinoma and all gastric cancers stratified by treatment in Finland during 1987-2016. METHODS This population-based, nationwide, retrospective cohort study included all gastric cancer patients registered in the Finnish Cancer Registry and Patient Registry. The survival rates were calculated for 1, 3, and 5 years, stratified by treatment. Prognostic factors were determined using Cox regression. RESULTS A total of 18,713 non-cardia gastric adenocarcinoma, and 3617 cardia adenocarcinoma patients were included. Surgical treatment decreased for non-cardia adenocarcinoma and remained constant for cardia adenocarcinoma. In non-cardia adenocarcinoma, the 5-year survival declined from 17% to 16% from 1987-1991 to 2012-2016. In surgically treated patients, survival increased from 29% to 38%, while an increase from 4% to 7% in those undergoing chemotherapy and decrease from 6% to 3% in those not receiving any treatment were observed. In cardia adenocarcinoma, the 5-year survival increased from 10% to 18% in all patients, 16% to 40% in surgical patients, 0% to 5% in patients receiving chemotherapy, and from 5% to 9% in patients receiving no treatment. Earlier calendar periods, older age, male sex, and higher comorbidity were risk factors for poor prognosis. CONCLUSIONS Gastric non-cardia adenocarcinoma survival declined, limited to advanced stage patients not receiving any treatment. Gastric cardia cancer survival seems to have improved over time in Finland. This study evaluated survival trends of gastric cancer in Finland during 1987-2016 and established that the 5-year survival is declining in non-cardia adenocarcinoma but improving in all gastric cancers.
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Affiliation(s)
- Urgena Maharjan
- Present Address: Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Joonas H. Kauppila
- Present Address: Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Scans propagating exponential workload (SPEW). J Paediatr Child Health 2022; 58:205-206. [PMID: 35060237 DOI: 10.1111/jpc.2_15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022]
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65
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Parthiban H, Lakshmi S, Somasundaram E, Kumar BS. Radiographic analysis of idiopathic osteosclerosis of jaws in Indian sub-population: A cross-sectional study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_116_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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66
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OUP accepted manuscript. Clin Chem 2022; 68:627-632. [DOI: 10.1093/clinchem/hvac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022]
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Kathar Hussain MR, Kulasekeran N, Anand AM. An optimistic point in COVID-19 pandemic: a case report of large adult congenital cystic adenomatoid malformation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC7887559 DOI: 10.1186/s43055-021-00439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Covid-19 pandemic is a major health calamity causing global crisis involving every aspect of the society. CT chest has become an essential diagnostic investigation and as a prognostic tool for assessment for COVID-19 bronchopneumonia. This case report is about an incidental unexpected finding in a young female, who underwent CT chest screening with suspicion of COVID-19 bronchopneumonia. Case presentation A 29-year-old female came with the complaints of sore throat, myalgia, and fever for the past 3 days. She was referred to our department for plain screening CT chest to rule out COVID 19 infection. She was an active sports person since childhood. CT chest revealed a large well-defined bullous cystic lesion of size 16 × 9.5 × 9.5 cm in the left lung lower lobe with partial sparing of its superior, anterior, and posterior basal segments. Imaging diagnosis of large bullous cystic lesion with emphysematous changes was made. No features of COVID 19 bronchopneumonia. Thoracoscopy-guided lobectomy was done, and tissue was sent to histopathological examination. Final diagnosis was large type 1 congenital cystic adenomatoid malformation with mucinous metaplasia. Our case is unique in the sense that large adult CCAM with mucinous metaplasia of the epithelium is a rare presentation. Further it was diagnosed as a part of COVID 19 screening. Conclusion CCAM presentation in adult is rare. Asymptomatic CCAM lesion of this size diagnosed during COVID 19 chest CT screening was rarely described.
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Bellini P, Albano D, Dondi F, Mazzoletti A, Lucchini S, Giubbini R, Bertagna F. Clinical Meaning of 18F-FDG PET/CT Incidental Gynecological Uptake: An 8-Year Retrospective Analysis. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oren O, Gersh BJ, Bhatt DL. Improving Communication of Incidental Imaging Findings: Transforming Uncertainty Into Opportunity. Mayo Clin Proc 2021; 96:2753-2756. [PMID: 34579946 DOI: 10.1016/j.mayocp.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ohad Oren
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA.
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Pettit N, Cinbat M. Retrospective review of patients with lung cancer identified in the emergency department. Am J Emerg Med 2021; 50:394-398. [PMID: 34478945 DOI: 10.1016/j.ajem.2021.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obtaining a diagnosis of cancer following an emergency department (ED) visit is associated with poor outcomes and advanced stage. Limited data is available from EDs in the United States. We describe a cohort of patients that obtained a diagnosis of lung cancer because of an ED visit. METHODS This is a single center, retrospective cohort of patients with lung cancer who presented to the ED between December 2016 and December 2019. We investigated demographics, access to primary care, previous cancer screening, cancer type/stage, mortality, and imaging study that suggested cancer. The primary outcome is the percentage of lung cancer diagnoses over a 4-year period that resulted from an ED visit. RESULTS Among the 268 patients with lung cancer, 152 patients (57.6%) had presented to the ED with a workup that was concerning for lung cancer. Patients were generally elderly (median 62-years old), African American (n = 77, 51%), and smokers (n = 145, 95.4%) with a median smoking pack years of 40. Only 24 patients (15.8%) had seen a primary care physician within 1 year of diagnosis, and only 8 patients were appropriately screened for lung cancer. The most common type of cancer was non-small-cell carcinoma (111, 73.0%), with 61.3% of those being adenocarcinoma (n = 68). Patients were most likely to be stage IV (n = 86, 56.6%), and the overall mortality was 53.3% (n = 81, 1 year follow-up). Most patients (88/152, 57.9%) of patients were admitted to the hospital, and Medicare patients (OR 2.7, 95% CI 1.37-5.23) and patients with stage IV disease (OR 2.22, 95% CI1.15-4.29) were more likely to be admitted. Patients were more likely to have a concerning finding on computed tomography (CT) versus chest x-ray (55.9% versus 36.8%, respectively). CT scan reports were more likely to mention malignancy (OR 5.9, 95% CI 2.5-14.0) or metastasis (OR 30, 95% CI 7.1-127.1) than chest x-ray. CONCLUSION Patients that have lung cancer diagnosed through the ED are more likely to be advanced stage at time of diagnosis and are more likely to have CT scans demonstrate concerning findings. Given the lack of previous cancer screening, the advanced stage at presentation of lung cancer to the ED, and high mortality rates, the ED may serve a public health role in addressing lung cancer screening.
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Affiliation(s)
- Nicholas Pettit
- Indiana University, School of Medicine, Department of Emergency Medicine, 720 Eskenazi Ave, FOB, 3rd Floor, Indianapolis, IN 46202, United States of America.
| | - Melisa Cinbat
- Indiana University, School of Medicine, Department of Emergency Medicine, 720 Eskenazi Ave, FOB, 3rd Floor, Indianapolis, IN 46202, United States of America
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Tummalapalli SL, Zech JR, Cho HJ, Goetz C. Risk stratification for hydronephrosis in the evaluation of acute kidney injury: a cross-sectional analysis. BMJ Open 2021; 11:e046761. [PMID: 34389565 PMCID: PMC8365791 DOI: 10.1136/bmjopen-2020-046761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To validate an existing clinical decision support tool to risk-stratify patients with acute kidney injury (AKI) for hydronephrosis and compare the risk stratification framework with nephrology consultant recommendations. SETTING Cross-sectional study of hospitalised adults with AKI who had a renal ultrasound (RUS) ordered at a large, tertiary, academic medical centre. PARTICIPANTS Two hundred and eighty-one patients were included in the study cohort. Based on the risk stratification framework, 111 (40%), 76 (27%) and 94 (33%) patients were in the high-risk, medium-risk and low-risk groups for hydronephrosis, respectively. OUTCOMES Outcomes were the presence of unilateral or bilateral hydronephrosis on RUS. RESULTS Thirty-five patients (12%) were found to have hydronephrosis. The high-risk group had 86% sensitivity and 67% specificity for identifying hydronephrosis. A nephrology consult was involved in 168 (60%) patients and RUS was recommended by the nephrology service in 95 (57%) cases. Among patients with a nephrology consultation, 9 (56%) of the 16 total patients with hydronephrosis were recommended to obtain an RUS. CONCLUSIONS We further externally validated a risk stratification framework for hydronephrosis. Clinical decision support systems may be useful to supplement clinical judgement in the evaluation of AKI.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - John R Zech
- Department of Radiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Hyung J Cho
- Chief Value Officer, New York City Health and Hospitals, New York, NY, USA
- Senior Fellow, Lown Institute, Brookline, MA, USA
| | - Celine Goetz
- Director of Education, Division of Hospital Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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Schwartz FR, Roth CJ, Boardwine B, Hardister L, Thomas-Campbell S, Lander K, Montoya C, Jaffe TA. Electronic Health Record Closed-Loop Communication Program for Unexpected Nonemergent Findings. Radiology 2021; 301:123-130. [PMID: 34374592 DOI: 10.1148/radiol.2021210057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Reliance on examination reporting of unexpected imaging findings does not ensure receipt of findings or appropriate follow-up. A closed-loop communication system should include provider and patient notifications and be auditable through the electronic health record (EHR). Purpose To report the initial design of and results from using an EHR-integrated unexpected findings navigator (UFN) program that ensures closed-loop communication of unexpected nonemergent findings. Materials and Methods An EHR-integrated UFN program was designed to enable identification and communication of unexpected findings and aid in next steps in findings management. Three navigators (with prior training as radiologic technologists and sonographers) facilitated communication and documentation of results to providers and patients. Twelve months (October 2019 to October 2020) of results were retrospectively reviewed to evaluate patient demographics and program metrics. Descriptive statistics and correlation analysis were performed by using commercially available software. Results A total of 3542 examinations were reported within 12 months, representing 0.5% of all examinations performed (total of 749 649); the median patient age was 62 years (range, 1 day to 98 years; interquartile range, 23 years). Most patients were female (2029 of 3542 [57%]). Almost half of the examinations submitted were from chest radiography and CT (1618 of 3542 [46%]), followed by MRI and CT of the abdomen and pelvis (1123 of 3542 [32%]). The most common unexpected findings were potential neoplasms (391 of 3542 [11%]). The median time between examination performance and patient notification was 12 days (range, 0-136 days; interquartile range, 13 days). A total of 2127 additional imaging studies were performed, and 1078 patients were referred to primary care providers and specialists. Most radiologists (89%, 63 of 71 respondents) and providers (65%, 28 of 43 respondents) found the system useful and used it most frequently during regular business hours. Conclusion An electronic health record-integrated, navigator-facilitated, closed-loop communication program for unexpected radiologic findings led to near-complete success in notification of providers and patients and facilitated the next steps in findings management. © RSNA, 2021 See also the editorial by Safdar in this issue.
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Affiliation(s)
- Fides R Schwartz
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Christopher J Roth
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Brenda Boardwine
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Lisa Hardister
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Shannon Thomas-Campbell
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Katherine Lander
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Charlene Montoya
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Tracy A Jaffe
- From the Duke University Medical Center, Department of Radiology, 2301 Erwin Rd, Box 3808, Durham, NC 27710
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Wolfe JM, Wu CC, Li J, Suresh SB. What do experts look at and what do experts find when reading mammograms? J Med Imaging (Bellingham) 2021; 8:045501. [PMID: 34277890 DOI: 10.1117/1.jmi.8.4.045501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose: Radiologists sometimes fail to report clearly visible, clinically significant findings. Eye tracking can provide insight into the causes of such errors. Approach: We tracked eye movements of 17 radiologists, searching for masses in 80 mammograms (60 with masses). Results: Errors were classified using the Kundel et al. (1978) taxonomy: search errors (target never fixated), recognition errors (fixated < 500 ms ), or decision errors (fixated > 500 ms ). Error proportions replicated Krupinski (1996): search 25%, recognition 25%, and decision 50%. Interestingly, we found few differences between experts and residents in accuracy or eye movement metrics. Error categorization depends on the definition of the useful field of view (UFOV) around fixation. We explored different UFOV definitions, based on targeting saccades and search saccades. Targeting saccades averaged slightly longer than search saccades. Of most interest, we found that the probability that the eyes would move to the target on the next saccade or even on one of the next three saccades was strikingly low ( ∼ 33 % , even when the eyes were < 2 deg from the target). This makes it clear that observers do not fully process everything within a UFOV. Using a probabilistic UFOV, we find, unsurprisingly, that observers cover more of the image when no target is present than when it is found. Interestingly, we do not find evidence that observers cover too little of the image on trials when they miss the target. Conclusions: These results indicate that many errors in mammography reflect failed deployment of attention; not failure to fixate clinically significant locations.
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Affiliation(s)
- Jeremy M Wolfe
- Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Cambridge, Massachusetts, United States
| | - Chia-Chien Wu
- Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Cambridge, Massachusetts, United States
| | - Jonathan Li
- Melbourne Medical School, Melbourne, Victoria, Australia
| | - Sneha B Suresh
- Brigham and Women's Hospital, Boston, Massachusetts, United States
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Elfatih A, Mohammed I, Abdelrahman D, Mifsud B. Frequency and management of medically actionable incidental findings from genome and exome sequencing data; A systematic review. Physiol Genomics 2021; 53:373-384. [PMID: 34250816 DOI: 10.1152/physiolgenomics.00025.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The application of whole genome/exome sequencing technologies in clinical genetics and research has resulted in the discovery of incidental findings unrelated to the primary purpose of genetic testing. The American College of Medical Genetics and Genomics published guidelines for reporting pathogenic and likely pathogenic variants that are deemed to be medically actionable, which allowed us to learn about the epidemiology of incidental findings in different populations. However, consensus guidelines for variant reporting and classification are still lacking. We conducted a systematic literature review of incidental findings in whole genome/exome sequencing studies to obtain a comprehensive understanding of variable reporting and classification methods for variants that are deemed to be medically actionable across different populations. The review highlights the elements that demand further consideration or adjustment.
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Affiliation(s)
- Amal Elfatih
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
| | - Idris Mohammed
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
| | - Doua Abdelrahman
- Integrated Genomics Services, Translational Research, Research Branch, Sidra Medicine, Doha, Qatar
| | - Borbala Mifsud
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.,William Harvey Research Institute, Queen Mary University London, London, UK
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75
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Andersen CA, Brodersen J, Rudbæk TR, Jensen MB. Patients' experiences of the use of point-of-care ultrasound in general practice - a cross-sectional study. BMC FAMILY PRACTICE 2021; 22:116. [PMID: 34144701 PMCID: PMC8214303 DOI: 10.1186/s12875-021-01459-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/10/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of point-of-care ultrasonography (POCUS) performed by general practitioners (GPs) in primary care settings is increasing. Previous studies have focused on GP-reported outcomes and little is known about patients' perspectives on the use of POCUS technology within the general practice consultation. The purpose of this study was to examine patients' experiences with POCUS in general practice within the areas where GPs have indicated that POCUS affected aspects of the consultation. METHODS A questionnaire was developed using a mixed methods sequential design. Analytical themes from interviews with GPs were converted into items in a questionnaire by the research team. The questionnaire was then further developed in several rounds of pilot tests involving both patients and GPs. The final questionnaire was used in a cohort study conducted in 18 Danish office-based general practice clinics from January 2018 to August 2018. All patients examined with POCUS were asked to complete the questionnaire on tablets immediately after their consultation. RESULTS Out of 691 patients examined, 564 (81.6%) questionnaires were available for analysis. The patients reported that they were well informed about the purpose (98%) and the results (97%) of the POCUS examination; however, 29% reported that they were not informed about the difference between POCUS and an imaging-specialist's ultrasound examination. Almost all patients (99%) reported that POCUS was integrated naturally into the consultation, and 45% reported that POCUS improved the doctor-patient relationship. The majority of patients felt that they had been more thoroughly examined (92%) and taken more seriously (58%) when POCUS was part of the consultation. They felt POCUS gave them a better understanding of their health problem (82%), made them feel more secure (86%) and increased their trust in the physician's assessment (65%). Moreover, the patients reported that POCUS use improved the level of service (95%) they experienced and the quality of care (94%) in general practice. CONCLUSION We found that an examination including POCUS in general practice was a positive experience overall for the majority of patients. Future research should further explore reasons for patient confidence in POCUS and whether or not the reassuring value of POCUS is valid. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03416608.
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Affiliation(s)
- Camilla Aakjær Andersen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 13, 9220, Aalborg Øst, Denmark.
| | - John Brodersen
- Research Unit for General Practice and Section of General Practice Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, P. O. Box 2099, DK-1014, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | | | - Martin Bach Jensen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 13, 9220, Aalborg Øst, Denmark
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Alabousi M, Wilson E, Al-Ghetaa RK, Patlas MN. General Review on the Current Management of Incidental Findings on Cross-Sectional Imaging: What Guidelines to Use, How to Follow Them, and Management and Medical-Legal Considerations. Radiol Clin North Am 2021; 59:501-509. [PMID: 34053601 DOI: 10.1016/j.rcl.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
"Incidentalomas" are a common part of daily practice for radiologists, and knowledge of appropriate management guidelines is important in ensuring that no potentially clinically relevant findings are missed or are lost to follow-up in asymptomatic patients. Incidental findings of the brain, spine, thyroid, lungs, breasts, liver, adrenals, spleen, pancreas, kidneys, bowel, and ovaries are discussed, including where to find guidelines for management recommendations, how to follow them, and medical-legal considerations.
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Affiliation(s)
- Mostafa Alabousi
- Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
| | - Evan Wilson
- Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Rayeh Kashef Al-Ghetaa
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton General Hospital, 237 Barton St E, Hamilton, ON L8L 2X2, Canada
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77
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Wood L, Martin C, Polly D, Luchsinger S, Takahashi T. Incidental extraspinal imaging findings on adult EOS full body radiographs: prevalence and clinical importance. BMC Med Imaging 2021; 21:83. [PMID: 34001001 PMCID: PMC8127196 DOI: 10.1186/s12880-021-00607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to review our institutional experience with the EOS machine in order to identify the incidence and clinical significance of incidental extraspinal findings (IESF) in an adult spinal deformity population. Methods Our institutional database was queried for all full-length standing radiographs generated by the EOS machine. Dictations were reviewed and the number of incidental extraspinal findings were classified using a previously described system. All findings related to the spine were excluded. A subset of electronic medical records were reviewed to determine further workup for individual findings of suspected clinical significance. Results Original database query based on radiology reports returned a total of 1857 EOS studies. Duplicate studies, studies without the entire body, and patients with more than 1 study during the search period were excluded. 503 patient studies (55.5% female, mean age 59-years-old, range 18 to 91-years-old) met inclusion criteria. The overall rate of incidental extraspinal findings in our study was 60.4% (304 findings in 503 patients). Most findings were classified as Minor. The rate of Major and Moderate findings was 4.8%. The final rate of clinically significant incidental extraspinal findings was 0.8% and included 3 presumed metastatic lesions in long bones and 1 pulmonary nodule. Conclusion To our knowledge this is the first study that reports the rate of incidental extraspinal findings on full body EOS studies. We report a low rate (0.8%) of clinically significant incidental extraspinal findings which is lower than that of CT or MRI. Further research is warranted in comparing EOS and standard radiography.
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Affiliation(s)
- Lily Wood
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christopher Martin
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David Polly
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Samuel Luchsinger
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Takashi Takahashi
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA.
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Viteri Jusué A, Domínguez Fernández S, Pérez Persona E, Poza de Celis R. Urgent and unexpected findings in oncology and hematology patients: a practical approach to imaging. RADIOLOGIA 2021; 64:S0033-8338(21)00086-2. [PMID: 33985767 DOI: 10.1016/j.rx.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Urgent and unexpected findings are very common in oncology and hematology patients. This article reviews the most important points included in the European Society of Radiology's guidelines and proposes a practical approach to reporting and communicating these findings more efficiently. This approach is explained with illustrative examples. Radiologists can provide added value in the management of these findings by helping referring clinicians reach the best decisions. To this end, it is essential to know the imaging manifestations of the most common findings that must be reported urgently, such as the specific toxicity of different treatments, the complications of tumors and catheters, infections, and thrombosis. Moreover, it is crucial to consider the individual patient's treatment, risk factors, clinical situation, and immune status.
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Affiliation(s)
- A Viteri Jusué
- Servicio de Radiodiagnóstico, Hospital Universitario Araba, Vitoria-Gasteiz, España.
| | | | - E Pérez Persona
- Servicio de Hematología, Hospital Universitario Araba, Vitoria-Gasteiz, España
| | - R Poza de Celis
- Servicio de Oncología Radioterápica, Hospital Universitario Araba, Vitoria-Gasteiz, España
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Williamson F, Grant K, Warren J, Handy M. Trauma Tertiary Survey: Trauma Service Medical Officers and Trauma Nurses Detect Similar Rates of Missed Injuries. J Trauma Nurs 2021; 28:166-172. [PMID: 33949352 DOI: 10.1097/jtn.0000000000000578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma tertiary surveys (TTSs) can improve patient outcomes by identifying missed injuries following initial trauma reception and resuscitation. Most TTSs are conducted by medical officers despite the multidisciplinary team approach of modern trauma care. OBJECTIVE The study aim was to assess the accuracy of detecting missed injuries when the TTS was performed by specialist trauma nursing staff, rather than trauma service medical officers (TSMOs). METHODS A prospective, convenience sample of adult trauma patients admitted to a tertiary trauma center and attended by the trauma service between October 2015 and August 2018 was obtained. For this sample, a TTS was completed by both the TSMO and the trauma nurse (TN). The number of radiological investigations ordered and missed injuries identified were compared between the two clinicians. Additional injuries were graded using the Clavien-Dindo system. RESULTS The study sample consisted of 165 patients with a dual TTS, for which at least one team member requested 35 additional radiological investigations. There was fair agreement (κ = 0.36) between the TN and the TSMO in requesting additional radiological investigations. Ten missed injuries were identified by TN-initiated review (n = 24), and 4 missed injuries were identified by TSMO-initiated review (n = 21). Injuries identified following TTSs ranged in severity grading from 0 to 3. CONCLUSIONS Performance of the TN on the TTS in the identification of missed injuries is similar to that of the TSMO. Trauma nurses use an appropriate and rationalized approach to ordering additional radiological investigations and contribute a valuable addition to trauma patient care.
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Affiliation(s)
- Frances Williamson
- Trauma Service (Mss Williamson and Grant and Mr Handy) and Jamieson Trauma Institute (Mss Williamson and Warren and Mr Handy), Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia; and Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia (Ms Williamson)
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Martini K, Chassagnon G, Frauenfelder T, Revel MP. Ongoing challenges in implementation of lung cancer screening. Transl Lung Cancer Res 2021; 10:2347-2355. [PMID: 34164282 PMCID: PMC8182720 DOI: 10.21037/tlcr-2021-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the leading cause of cancer deaths in Europe and around the world. Although available therapies have undergone considerable development in the past decades, the five-year survival rate for lung cancer remains low. This sobering outlook results mainly from the advanced stages of cancer most patients are diagnosed with. As the population at risk is relatively well defined and early stage disease is potentially curable, lung cancer outcomes may be improved by screening. Several studies already show that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality. However, for a successful implementation of LCS programmes, several challenges have to be overcome: selection of high-risk individuals, standardization of nodule classification and measurement, specific training of radiologists, optimization of screening intervals and screening duration, handling of ancillary findings are some of the major points which should be addressed. Last but not least, the psychological impact of screening on screened individuals and the impact of potential false positive findings should not be neglected. The aim of this review is to discuss the different challenges of implementing LCS programmes and to give some hints on how to overcome them. Finally, we will also discuss the psychological impact of screening on quality of life and the importance of smoking cessation.
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Affiliation(s)
- Katharina Martini
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France.,Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France
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81
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Williams L, Carrigan A, Auffermann W, Mills M, Rich A, Elmore J, Drew T. The invisible breast cancer: Experience does not protect against inattentional blindness to clinically relevant findings in radiology. Psychon Bull Rev 2021; 28:503-511. [PMID: 33140228 PMCID: PMC8068567 DOI: 10.3758/s13423-020-01826-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/11/2022]
Abstract
Retrospectively obvious events are frequently missed when attention is engaged in another task-a phenomenon known as inattentional blindness. Although the task characteristics that predict inattentional blindness rates are relatively well understood, the observer characteristics that predict inattentional blindness rates are largely unknown. Previously, expert radiologists showed a surprising rate of inattentional blindness to a gorilla photoshopped into a CT scan during lung-cancer screening. However, inattentional blindness rates were higher for a group of naïve observers performing the same task, suggesting that perceptual expertise may provide protection against inattentional blindness. Here, we tested whether expertise in radiology predicts inattentional blindness rates for unexpected abnormalities that were clinically relevant. Fifty radiologists evaluated CT scans for lung cancer. The final case contained a large (9.1 cm) breast mass and lymphadenopathy. When their attention was focused on searching for lung nodules, 66% of radiologists did not detect breast cancer and 30% did not detect lymphadenopathy. In contrast, only 3% and 10% of radiologists (N = 30), respectively, missed these abnormalities in a follow-up study when searching for a broader range of abnormalities. Neither experience, primary task performance, nor search behavior predicted which radiologists missed the unexpected abnormalities. These findings suggest perceptual expertise does not protect against inattentional blindness, even for unexpected stimuli that are within the domain of expertise.
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Affiliation(s)
| | - Ann Carrigan
- Psychology, Macquarie University, Macquarie Park, Australia
| | - William Auffermann
- School of Medicine, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Megan Mills
- School of Medicine, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Anina Rich
- Cognitive Science, Macquarie University, Macquarie Park, Australia
| | - Joann Elmore
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Trafton Drew
- Psychology, University of Utah, Salt Lake City, UT, USA
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82
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Crable EL, Feeney T, Harvey J, Grim V, Drainoni ML, Walkey AJ, Steiling K, Drake FT. Management Strategies to Promote Follow-Up Care for Incidental Findings: A Scoping Review. J Am Coll Radiol 2021; 18:566-579. [DOI: 10.1016/j.jacr.2020.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/28/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022]
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83
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Mengou IV, Yakar D, Kasalak Ö, Kwee TC. Towards a benchmark of abdominal CT use during duty shifts: 15-year sample from the Netherlands. Abdom Radiol (NY) 2021; 46:1761-1767. [PMID: 33078244 PMCID: PMC8096762 DOI: 10.1007/s00261-020-02818-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/05/2020] [Accepted: 10/10/2020] [Indexed: 12/21/2022]
Abstract
Purpose To investigate temporal changes in the utilization and patient impact of abdominal CT during duty shifts in the past 15 years. Methods This study included a random sample of 1761 abdominal CT scans that were made during evening and night duty shifts in a tertiary care center between 2005 and 2019. Results The number of CT scans significantly increased (almost threefold) between 2005 and 2019 (Mann–Kendall tau of 0.829, P < 0.001). The proportion of negative CT scans (i.e., the absence of findings related to the reason that the CT scan was made and no disease deterioration or other new and clinically relevant findings compared to a previous imaging examination when available) was 40.0% (700/1749) in the entire 15-year study frame and did not significantly change over time (Mann–Kendall tau of − 0.219, P = 0.276). The overall frequency of same-day hospital discharge after negative CT was 20.6% (150/729) in the past 15 years and showed a significant increase over time (Mann–Kendall tau of 0.505, P = 0.010). The overall proportion of CT scans with incidental findings was 3.4% (60/1761) and remained statistically stable over the past 15 years (Mann–Kendall tau of − 0.057, P = 0.804). Conclusion Over the past 15 years, the number of CT scans and the frequency of same-day hospital discharge after negative CT have increased, while the proportions of negative CT scans and incidental findings have remained stable in our tertiary care center. The data from this study can be used for interinstitutional benchmarking to define, monitor, and improve the appropriateness of imaging utilization.
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Affiliation(s)
- Iliana V Mengou
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Ömer Kasalak
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Dental Trauma on whole Body Trauma CT-An underreported finding. Eur J Trauma Emerg Surg 2021; 48:1055-1060. [PMID: 33721050 PMCID: PMC9001627 DOI: 10.1007/s00068-021-01633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
Background The prevalence of dental injuries (DI) in polytrauma patients is unknown. The purpose of our study was to identify the frequency of dental injuries on whole body CTs acquired in a trauma setting and to estimate how often they are correctly reported by the radiologist. Methods In the time period between 2006 and 2018 the radiological database of one university hospital was screened for whole-body trauma CTs. A total of 994 CTs were identified and re-evaluated. Results Dental injuries were identified in 127 patients (12.8% of patients). There were 27 women (21.3%) and 100 men (78.7%) with a mean age of 51.0 ± 18.9 years (range 10–96 years). Regarding localization, most findings involved the molars (n = 107, 37.4%), followed by the incisors (n = 81, 28.3%), premolars (n = 59, 20.6%) and canines (n = 39, 13.7%). Most common findings were as follows: luxations (n = 49, 45.8%), followed by crown fractures (n = 46, 43%), root fractures (n = 10, 9.3%), extrusions (n = 1, 0.9%), and intrusions (n = 1, 0.9%). Only 15 findings (11.8% of all patients with dental injuries) were described in the original radiological reports. Conclusion DI had a high occurrence in polytrauma patients. A high frequency of underreported dental trauma findings was identified. Radiologists reporting whole-body trauma CT should be aware of possible dental trauma to report the findings adequately.
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85
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Schofield R, Goodwin B, Cotterill A, Musthaffa Y. Scans propagating exponential workload (SPEW). J Paediatr Child Health 2021:jpc.15418. [PMID: 33751706 DOI: 10.1111/jpc.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Rebekah Schofield
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Bruce Goodwin
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew Cotterill
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Yassmin Musthaffa
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Paediatrics, Logan Hospital, Brisbane, Queensland, Australia
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86
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CT Attenuation Values Do Not Reliably Distinguish Benign Sclerotic Lesions From Osteoblastic Metastases in Patients Undergoing Bone Biopsy. AJR Am J Roentgenol 2021; 216:1022-1030. [PMID: 32755207 DOI: 10.2214/ajr.20.24029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND. CT attenuation thresholds that accurately distinguish enostoses from untreated osteoblastic metastases have been published. In the Mayo Clinic practices, these thresholds have been applied more broadly to distinguish benign sclerotic bone lesions other than enostoses from osteoblastic metastases. OBJECTIVE. The purpose of this article is to determine if CT attenuation thresholds allow the distinguishing of benign sclerotic bone lesions from osteoblastic metastases in patients undergoing bone biopsy. METHODS. A retrospective search was conducted to identify sclerotic lesions described on CT between October 7, 1998, and July 15, 2018, that underwent subsequent biopsy. Two musculoskeletal radiologists recorded lesions' maximum and mean attenuation. Using previously published attenuation thresholds, sensitivity and specificity for differentiating benign sclerotic lesions from osteoblastic metastases were calculated. ROC curve analysis was performed to determine if more appropriate attenuation thresholds exist. Intraclass correlation coefficients (ICCs) were computed. RESULTS. A total of 280 patients met inclusion criteria. Of those, 162 had malignant biopsy results and 118 had benign biopsy results. Of the 162 malignant lesions, 81 had received prior treatment. Maximum and mean attenuation were not significantly different between benign and malignant lesions for either reader (all p > .05). For reader 1, to distinguish benign from malignant lesions, a maximum attenuation threshold of more than 1060 HU resulted in sensitivity of 23.7%, specificity of 87.0%, and accuracy of 60.6%. A mean attenuation threshold of greater than 885 HU resulted in sensitivity of 19.5%, specificity of 90.7%, and accuracy 60.7%. ROC curve analysis showed AUCs for mean and maximum attenuation thresholds of 51.8% and 54.6%, respectively. Subgroup analyses of benign versus malignant and treated versus untreated lesions had similar results. Similar findings were obtained for reader 2. The two readers' ICC was 0.946 for maximum attenuation and 0.918 for mean attenuation. CONCLUSION. Published attenuation thresholds for distinguishing enostoses from osteoblastic metastases had slightly decreased specificity and markedly decreased sensitivity when applied to the differentiation of benign sclerotic lesions from osteoblastic metastases in our sample of biopsy-proven lesions. ROC analysis showed no high-performing attenuation threshold alternative. CLINICAL IMPACT. Published CT attenuation thresholds intended for distinguishing enostoses from osteoblastic metastases should not be used more broadly. More accurate alternative thresholds could not be derived.
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87
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Incidental Findings: A Survey of Radiologists and Emergency Physicians. J Am Coll Radiol 2021; 18:853-856. [PMID: 33516766 DOI: 10.1016/j.jacr.2020.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/21/2022]
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88
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Srour MK, Lee M, Wolcott-Sapp S, Luu M, Chung A, Giuliano AE, Amersi F. Incidental radiologic findings in breast cancer patients who undergo staging prior to neo-adjuvant chemotherapy. Breast J 2021; 27:345-351. [PMID: 33491830 DOI: 10.1111/tbj.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Abstract
NCCN guidelines discourage the use of staging imaging for newly diagnosed patients with early breast cancer (BC). When performed, incidental radiologic findings of uncertain significance are often encountered. The purpose of this study was to compare incidental findings seen on staging imaging with distant recurrence in patients undergoing neo-adjuvant chemotherapy (NAC). 396 patients with BC who had NAC from 2008 to 2016 were identified from a prospectively maintained data base. Staging imaging was reviewed. Of 396 patients with BC treated with NAC, patients with a positive PET/CT for metastatic disease (n = 36, 9.1%), those that did not undergo staging imaging (n = 49, 12.4%), or those that did not have a reported incidental finding (n = 49, 12.4%) were excluded from analysis. Of the 262 patients who met criteria, mean age was 50 years (range: 26-88). 201 (76.7%) patients had stage I-II cancer, and 61 (23.3%) patients had stage III cancer. Overall, 146 (55.7%) patients had an incidental finding on imaging. 90 (34.4%) patients had one finding, 42 (16.0%) patients had two, and 14 (5.3%) patients had three or more findings. The majority of incidental findings were seen in the ovary/uterus (29.7%), followed by lung (18.4%), liver (10.3%), and bone (9.0%). 5 (3.4%) patients had additional imaging performed. At mean follow-up of 3.7 years (range: 0.7-10.8), 43 (15.6%) patients had a distant recurrence. Of these patients, only 5 (1.9%) patients had distant metastasis in the same organ that was initially thought to be an incidental finding. Our results suggest that breast cancer patients with incidental findings on preoperative staging imaging are unlikely to be indicative of sites for future metastasis.
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Affiliation(s)
- Marissa K Srour
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Minna Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sarah Wolcott-Sapp
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael Luu
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alice Chung
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Armando E Giuliano
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ozaki Y, Masuda J, Kataoka A, Oikado K, Uehiro N, Inagaki L, Kato C, Morizono H, Takano T, Ueno T, Ohno S. Utility of Preoperative Computed Tomography Scans for Coronavirus Disease in a Cancer Treatment Center. Cancer Cell 2021; 39:9-10. [PMID: 33340450 PMCID: PMC7833718 DOI: 10.1016/j.ccell.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Yukinori Ozaki
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Masuda
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akemi Kataoka
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Katsunori Oikado
- Diagnostic Imaging Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Natsue Uehiro
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Lina Inagaki
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Chieko Kato
- Department of Ultrasound, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetomo Morizono
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshimi Takano
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Ueno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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90
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Van Gerpen R. Creating an Incidental Pulmonary Nodule Safety-Net Program. Chest 2021; 159:2477-2482. [PMID: 33434500 DOI: 10.1016/j.chest.2020.12.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023] Open
Abstract
Pulmonary nodules are a frequent, incidental finding on CT scans, ranging from up to 8.4% on abdominal scans and up to 48% on CT angiograms. Incidental findings are sometimes disregarded or overshadowed by critical situations and may not be disclosed or documented on discharge. The costs and risks associated with incidental findings are not insignificant, including the risk of a delayed diagnosis of lung cancer. A medical center commitment to prevent overlooked incidental pulmonary nodules led to the development of an incidental pulmonary nodule program. The program, led by an advanced practice nurse, established processes to identify patients with incidental lung nodules on CT scans and developed criteria for further follow-up with the primary care provider and the patient. Improvements with consistent use of Fleischner guidelines in scan reports by radiologists and increased ownership in informing patients of incidental nodules by ED and trauma providers have occurred. As the frequency of chest CT imaging is increasing, the number of incidental nodules identified will also increase. A lung nodule surveillance process would greatly benefit every lung nodule clinic or hospital system for management of pulmonary nodules.
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91
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Nature and clinical significance of incidental findings in maxillofacial cone-beam computed tomography: a systematic review. Oral Radiol 2021; 37:547-559. [PMID: 33420943 DOI: 10.1007/s11282-020-00499-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/29/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This systematic review was conducted to assess the types, potential clinical significance, and treatment implications of incidental findings (IFs) in CBCT diagnostic imaging of the maxillofacial region. MATERIAL AND METHODS The authors searched several electronic databases and grey literature without time restriction for studies on the IFs in maxillofacial CBCT. Studies that classified the IFs based on their potential clinical significance were included. The methodological quality of the included studies was evaluated by the STROBE criteria. RESULTS The online searches of the electronic databases yielded 1323 records. Five articles were included in the final qualitative analysis. The methodological quality ranged from low to moderate risk of bias. Percentages of IFs with high (requiring intervention/referral), moderate (requiring monitoring), and low clinical significance ranged from 0.3 to 31.4%, 15.6 to 28.9%, and 43.46 to 71.1%, respectively. There was an inconsistency between the studies in the clinical significance of 58.8% of the IFs identified. CONCLUSION Most IFs in maxillofacial CBCT are either normal variants or findings that do not require referral or treatment. There was no clear consensus on the recommended management of most common IFs. The lack of consensus on clinical significance emphasizes the importance of collaboration between medical and dental specialties to establish professional guidelines for the management of commonly encountered IFs in CBCT.
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92
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Reis JMCD, Melo GDS, Oliveira MVD, Fernandez MM, Silva TMMFD, Ferreira HLDS, Andrade MCD. Achados cardiovasculares incidentais em tomografias de tórax solicitadas para suspeita de COVID-19. J Vasc Bras 2021; 20:e20210052. [PMID: 35096029 PMCID: PMC8759582 DOI: 10.1590/1677-5449.210052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/07/2021] [Indexed: 12/21/2022] Open
Abstract
Background Computed tomography scans of the chest are often requested as a complementary examination to investigate a clinical suspicion of pulmonary disease caused by the novel coronavirus 19 (COVID-19). Objectives Our objective was to analyze the prevalence of incidental cardiovascular findings on chest CT scans requested to assess radiological signs suggestive of COVID-19 infection. Methods This cross-sectional, descriptive, and retrospective study reviewed 1,444 chest tomographies conducted in the Radiology department of the Hospital de Clínicas Gaspar Vianna, from March 1 to July 30, 2020, describing the prevalence of images suggestive of viral pneumonia by COVID-19 and incidental pulmonary and cardiovascular findings. Results The mean age of the patients was 50.6 ± 16.4 years and female sex was more frequent. Computed tomography without contrast was the most frequently used method (97.2%). Aortic and coronary wall calcification and cardiomegaly were the most prevalent cardiovascular findings. CT angiography revealed aortic aneurysms (9.7%), aortic dissection (7.3%) and thoracic aortic ulcers (2.4%). Conclusions Incidental cardiovascular findings occurred in about half of the chest CT scans of patients with suspected COVID-19, especially aortic calcifications, cardiomegaly, and coronary calcification.
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93
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Perumal AR, Anyamele UA, Bhogal RK, McCauley G, Teh I, Bourke G, Rankine JJ, Wade RG. Incidental findings associated with magnetic resonance imaging of the brachial plexus. Br J Radiol 2021; 94:20200921. [PMID: 33156721 PMCID: PMC7774680 DOI: 10.1259/bjr.20200921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The identification and management of incidental findings is becoming increasingly problematic, particularly in relation to brachial plexus imaging because the prevalence is unknown. Therefore, we aimed to estimate the prevalence of incidental findings in symptomatic patients undergoing MRI of the brachial plexus. METHODS This retrospective cohort study included all children and adults who underwent MRI over a 12-year period, in a tertiary care centre in the UK. An incidental finding was any abnormality which was not a direct injury to or disease-process of the brachial plexus. An "incidentaloma" was defined by the need for further investigation or treatment. Multivariable logistic regression was used to estimate the odds ratio (OR) of an "incidentaloma". To estimate which factors were associated with the incident rate ratio (IRR) of incidental findings, multivariable Poisson regression was used. RESULTS Overall, 502 scans (72%) reported incidental anomalies. Although the number of MRIs performed per annum increased by 23%, the prevalence of "incidentalomas" remained static (p = 0.766). Musculoskeletal incidental findings were the most prevalent (63%) and when identified, there were a median of 3 incidental anomalies per patient. Overall, 125 (18%) anomalies were "incidentalomas" which required further investigation or treatment. The odds of having further investigation or treatment was strongly related to the frequency of incidental findings [adjusted OR 1.16 (95% CI 1.08, 1.24)] and when a tumour was identified [adjusted OR 2.86 (95% CI 1.81, 4.53)]. The number of incidental findings recorded per scan increased when trainees co-reported with consultants [adjusted IRR 0.36 (95% CI 0.05, 0.67)] and in the presence of a tumour [adjusted IRR 0.39 (95% CI 0.28, 0.49)]. CONCLUSIONS The prevalence of clinically important incidental findings on brachial plexus MRI is lower than organ-specific imaging, but still 18% of scans identified an 'incidentaloma' which required further investigation or treatment. ADVANCES IN KNOWLEDGE This cohort study shows that approximately 1 in 5 symptomatic patients undergoing a brachial plexus MRI had a clinically important incidental findings, which required further investigation or treatment. This information can be used to inform patients consenting to clinical or research imaging.
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Affiliation(s)
- Antonia R Perumal
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | | | - Rayna K Bhogal
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | | | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - James J Rankine
- Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, UK
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Lynch JA, Goldenberg AJ, Garrison NA, Brothers KB. Analogies in Genomics Policymaking: Debates and Drawbacks. Am J Hum Genet 2020; 107:797-801. [PMID: 33157006 DOI: 10.1016/j.ajhg.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022] Open
Abstract
The analogy between genomics and imaging has been an important touchstone in the debate on how secondary findings should be handled in both clinical and research genomics contexts. However, a critical eye is needed to understand whether an analogy like this one provides an adequate basis for policymaking in genomics. Genomics and imaging are undoubtedly similar in certain ways, but whether that similarity is adequate to justify adopting identical policies is a task that requires further analysis. This is highlighted by the fact that secondary findings are produced in other domains of medicine and public health, such as newborn screening programs, routine laboratory panels, and antibiotic sensitivity testing, and that the practices for handling secondary findings in each of these areas are different. These examples demonstrate that medicine has no single comprehensive policy or set of practices for managing secondary findings. Analogies to imaging, newborn screening, routine testing panels, and antibiotic sensitivity testing all lead to different policy options for genomics. In this piece we argue that analogies are a powerful way of driving policy discussions by rendering two different areas of medical practice similar, but an overdependence on a single analogy risks limiting policy discussions in potentially deleterious ways.
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Affiliation(s)
- John A Lynch
- Department of Communication, University of Cincinnati, Cincinnati, OH 45221, USA.
| | - Aaron J Goldenberg
- Department of Bioethics & Medical Humanities, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Nanibaa' A Garrison
- Institute for Society and Genetics, University of California, Los Angeles, CA 90095, USA; Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA; Institute for Bioethics, Health Policy and Law, University of Louisville, Louisville, KY 40202, USA.
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Chen G, Xue Y, Wei J, Duan Q. The undiagnosed potential clinically significant incidental findings of neck CTA: A large retrospective single-center study. Medicine (Baltimore) 2020; 99:e22440. [PMID: 33120738 PMCID: PMC7581090 DOI: 10.1097/md.0000000000022440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To assess the prevalence and missed reporting rate of potential clinically-significant incidental findings (IFs) in the neck CTA scans.All consecutive patients undergoing neck CTA imaging, from January 1, 2017 to December 31, 2018, were retrospectively evaluated by a radiologist for the presence of incidental findings in the upper chest, lower head and neck regions. These incidental findings were subsequently classified into 3 categories in terms of clinical significance: Type I, highly significant, Type II, moderately significant; and Type III, mildly or not significant. Type I and Type II IFs were determined as potential clinically significant ones and were retrospectively analyzed by another 2 radiologists in consensus. The undiagnosed findings were designated as those that were not reported by the initial radiologists. The differences in the rate of unreported potential clinically significant IFs were compared between the chest group and head or neck group.A total of 376 potential clinically significant IFs were detected in 1,698 (91.19%) patients, of which 175 IFs were classified as highly significant findings (Type I), and 201 (53.46%) as moderately significant findings (Type II). The most common potential clinically significant findings included thyroid nodules (n = 88, 23.40%), pulmonary nodules (n = 56, 14.89%), sinus disease (n = 39, 10.37%), intracranial or cervical artery aneurysms (n = 30, 7.98%), enlarged lymph nodes (n = 24, 6.38%), and pulmonary embolism (n = 19, 5.05%). In addition, 184 (48.94%) of them were not mentioned in the initial report. The highest incidence of missed potential clinical findings were pulmonary embolism and pathologic fractures and erosions (100% for both). The unreported rate of the chest group was significantly higher than that of the head or neck one, regardless of Type I, Type II or all potential clinically significant IFs (χ = 32.151, χ = 31.211, χ = 65.286, respectively; P < .001 for all).Important clinically significant incidental findings are commonly found in a proportion of patients undergoing neck CTA, in which nearly half of these patients have had potential clinically significant IFs not diagnosed in the initial report. Therefore, radiologists should beware of the importance of and the necessity to identify incidental findings in neck CTA scans.
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Affiliation(s)
- Guangliang Chen
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Jin Wei
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Qing Duan
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
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96
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Badizadegan K, Vanlandingham DM, Hampton W, Thompson KM. Value of biopsy in a cohort of children with high-titer celiac serologies: observation of dynamic policy differences between Europe and North America. BMC Health Serv Res 2020; 20:962. [PMID: 33081760 PMCID: PMC7576777 DOI: 10.1186/s12913-020-05815-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background Healthcare systems implement change at different rates because of differences in incentives, organizational processes, key influencers, and management styles. A comparable set of forces may play out at the national and international levels as demonstrated in significant differences in the diagnostic management of pediatric Celiac Disease (CD) between European and North American practitioners. Methods We use retrospective clinical cohorts of 27,868 serum tissue transglutaminase (tTG) immunoglobulin A levels and 7907 upper gastrointestinal endoscopy pathology reports to create a dataset of 793 pathology reports with matching tTG results between July 1 of 2014 and July 1 of 2018. We use this dataset to characterize histopathological findings in the duodenum, stomach and esophagus of patients as a function of serum tTG levels. In addition, we use the dataset to estimate the local and national cost of endoscopies performed in patients with serum tTG levels greater than 10 times the upper limit of normal. Results Using evidence from a US tertiary care center, we show that in the cohort of pediatric patients with high pre-test probability of CD as determined by serum tTG levels, biopsy provides no additional diagnostic value for CD, and that it counter-intuitively introduces diagnostic uncertainty in a number of patients. We estimate that using the European diagnostic algorithms could avoid between 4891 and 7738 pediatric endoscopies per year in the US for evaluation of CD. Conclusions This study considers the North American and European management guidelines for the diagnosis of pediatric CD and highlights the slow adoption in North America of evidence-based algorithms developed and applied in Europe for triage of endoscopy and biopsy. We suggest that system dynamics influences that help maintain the status quo in North America include a variety of social and economic factors in addition to medical evidence. This work contributes to the growing body of evidence that the dynamics that largely favor maintaining status quo management policies in a variety of systems extend to clinical medicine and potentially influence clinical decisions at the level of individual patients and the population. Supplementary information Supplementary information accompanies this paper at 10.1186/s12913-020-05815-0.
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Affiliation(s)
| | - David M Vanlandingham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Wesley Hampton
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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97
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Faget C, Millet I, Sebbane M, Thuret R, Verheyden C, Curros-Doyon F, Molinari N, Taourel P. Imaging strategies for patients with suspicion of uncomplicated colic pain: diagnostic accuracy and management assessment. Eur Radiol 2020; 31:2983-2993. [PMID: 33051735 DOI: 10.1007/s00330-020-07264-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Compare different imaging scenarios in the diagnosis of uncomplicated renal colic due to urolithiasis (URCU). MATERIALS AND METHODS A total of 206 prospectively included patients had been admitted with suspected URCU and had undergone abdominal plain film (APF), US and unenhanced CT after clinical STONE score evaluation. CT was the reference standard. We assessed sensitivity (Se), specificity (Spe) and Youden index for colic pain diagnosis, percentage of patients managed by urologic treatment with stone identified, percentage of alternative diagnoses (AD) and exposure to radiation, according to single imaging approaches, strategies driven by patient characteristics and conditional imaging strategies after APF and US. RESULTS One hundred (48.5%) patients had a final diagnosis of URCU and 19 underwent urologic treatment. The conditional strategy, i.e. CT in patients who had no stone identified at US, had a perfect sensitivity and specificity. This enabled diagnosis of all stones requiring urology management while decreasing the number of CT exams by 22%. The strategy whereby CT was used when there was neither direct or indirect APF + US finding of colic pain nor alternative diagnoses in patients with a STONE score ≥ 10 had a sensitivity of 0.95 and a specificity of 0.99, identified 84% of stones managed by urologic treatment and decreased the number of CT examinations by 76%. CONCLUSION In patients with clinical findings consistent with URCU, the use of ultrasound as first-line imaging modality, with CT restricted to patients with negative US and a STONE score ≥ 10, led to a sensitivity and specificity of above 95%, identified 84% of stones requiring urological management and reduced the number of CT scans needed by fourfold. KEY POINTS • For diagnosis, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, provides both a sensitivity and specificity superior or equal to 95% and reduces the number of CT scans necessary by fourfold. • For management, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, maintains a 84% stone identification rate in urology-treated patients.
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Affiliation(s)
- Claire Faget
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Ingrid Millet
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Mustapha Sebbane
- Department of Emergency, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France
| | - Rodolphe Thuret
- Department of Urology and Renal Transplantation, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France
| | - Cécile Verheyden
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Fernanda Curros-Doyon
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Nicolas Molinari
- Department of Biostatistics and Medical Information, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France
| | - Patrice Taourel
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
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98
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Walls AC, Din RS, Okhovat JP, Chansky PB, Micheletti RG, Mostaghimi A. Low utility of radiologic imaging in evaluating cutaneous small-vessel vasculitis: A multi-institutional retrospective study. J Am Acad Dermatol 2020; 84:1197-1199. [PMID: 33011319 DOI: 10.1016/j.jaad.2020.09.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew C Walls
- Department of Dermatology, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts
| | - Ryan S Din
- Department of Dermatology, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts
| | - Jean-Phillip Okhovat
- Department of Dermatology, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Peter B Chansky
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arash Mostaghimi
- Department of Dermatology, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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99
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Saw JTS, Imeri NN, Aldridge ES, Buntine PG. Predictive values of haematuria and hydronephrosis in suspected renal colic: An emergency department retrospective audit. Emerg Med Australas 2020; 32:573-577. [DOI: 10.1111/1742-6723.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/21/2019] [Accepted: 12/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Paul G Buntine
- Eastern Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
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100
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Nartker MS, Alaoui-Soce A, Wolfe JM. Visual search errors are persistent in a laboratory analog of the incidental finding problem. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2020; 5:32. [PMID: 32728864 PMCID: PMC7391453 DOI: 10.1186/s41235-020-00235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/11/2020] [Indexed: 11/18/2022]
Abstract
When radiologists search for a specific target (e.g., lung cancer), they are also asked to report any other clinically significant “incidental findings” (e.g., pneumonia). These incidental findings are missed at an undesirably high rate. In an effort to understand and reduce these errors, Wolfe et al. (Cognitive Research: Principles and Implications 2:35, 2017) developed “mixed hybrid search” as a model system for incidental findings. In this task, non-expert observers memorize six targets: half of these targets are specific images (analogous to the suspected diagnosis in the clinical task). The other half are broader, categorically defined targets, like “animals” or “cars” (analogous to the less well-specified incidental findings). In subsequent search through displays for any instances of any of the targets, observers miss about one third of the categorical targets, mimicking the incidental finding problem. In the present paper, we attempted to reduce the number of errors in the mixed hybrid search task with the goal of finding methods that could be deployed in a clinical setting. In Experiments 1a and 1b, we reminded observers about the categorical targets by inserting non-search trials in which categorical targets were clearly marked. In Experiment 2, observers responded twice on each trial: once to confirm the presence or absence of the specific targets, and once to confirm the presence or absence of the categorical targets. In Experiment 3, observers were required to confirm the presence or absence of every target on every trial using a checklist procedure. Only Experiment 3 produced a marked decline in categorical target errors, but at the cost of a substantial increase in response time.
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Affiliation(s)
- Makaela S Nartker
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD, USA.
| | - Abla Alaoui-Soce
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Jeremy M Wolfe
- Visual Attention Laboratory, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Department of Ophthalmology and Radiology, Harvard Medical School, Boston, MA, USA
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