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Jubane M, Rennick AC, Villavicencio JJ, Ferreira de Souza F, Peters V, Jonczak E, Bialick S, Dhir A, Grossman J, Trent JC, D’Amato G, Rosenberg AE, Hornicek FJ, Yechieli RL, Subhawong T, Alessandrino F. Imaging-Based Disease Assessment and Management Recommendations: Impact of Multidisciplinary Sarcoma Tumor Board. Cancers (Basel) 2024; 16:2674. [PMID: 39123402 PMCID: PMC11311895 DOI: 10.3390/cancers16152674] [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: 06/19/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Multidisciplinary tumor boards (MTBs) facilitate decision-making among subspecialists in the care of oncology patients, but the mechanisms by which they enhance outcomes remain incompletely understood. Our aim was to measure the agreement between sarcoma MTBs and radiology reports' disease assessment and management recommendations. This single-center IRB-approved retrospective study evaluated cases presented at a weekly sarcoma MTB from 1 August 2020 to 31 July 2021. Cases without clinical notes, imaging studies, or radiology reports were excluded. The data collected included the patient's clinical status at the time of the MTB, the treatment response assessment by the MTB and radiologists (stable disease; partial response; complete response; progressive disease/recurrence), and the recommendations of the radiology reports and of the MTB. The agreement between the initial radiologist review and MTB on disease assessment and recommendations was analyzed using kappa statistics. In total, 283 cases met the inclusion criteria. Radiology reports provided recommendations in 34.3% of cases, which were adhered to by the ordering providers in 73.2% of cases. The agreement between MTBs and radiology reports was moderate in disease assessment (86.2% agreement; κ = 0.78; p < 0.0001) and negligible in recommendations (36% agreement; κ = 0.18; p < 0.0001). Radiologists were more likely to assign progressive disease/recurrence than MTBs (54.4% vs. 44.4%; p < 0.001) and to recommend short-term imaging follow-up more commonly than MTBs (46.4% vs. 21.7%; p < 0.001). At a tertiary care center, radiologists' isolated interpretations of imaging findings and management recommendations frequently differ from the MTB's consensus, reflecting the value of multidisciplinary discussions incorporating the patient's clinical status and the available treatment options into the final radiographic assessment.
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Affiliation(s)
- Maverick Jubane
- Department of Radiology, Jackson Memorial Hospital, Miami, FL 33136, USA
| | - Andrew C. Rennick
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Felipe Ferreira de Souza
- Department of Radiology, University of Miami, Miami, FL 33136, USA
- Department of Interventional Radiology, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Vanessa Peters
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Emily Jonczak
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Division of Medical Oncology, Department of Medicine, University of Miami, Miami, FL 33136, USA
| | - Steven Bialick
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Division of Medical Oncology, Department of Medicine, University of Miami, Miami, FL 33136, USA
| | - Aditi Dhir
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, University of Miami, Miami, FL 33136, USA
| | - Julie Grossman
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, FL 33136, USA
| | - Jonathan C. Trent
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Division of Medical Oncology, Department of Medicine, University of Miami, Miami, FL 33136, USA
| | - Gina D’Amato
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Division of Medical Oncology, Department of Medicine, University of Miami, Miami, FL 33136, USA
| | - Andrew E. Rosenberg
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Department of Pathology & Laboratory Medicine, University of Miami, Miami, FL 33136, USA
| | - Francis J. Hornicek
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Department of Orthopedics, University of Miami, Miami, FL 33136, USA
| | - Raphael L. Yechieli
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- Department of Radiation Oncology, University of Miami, Miami, FL 33136, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Francesco Alessandrino
- Department of Radiology, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
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Costa DN, Nguyen N, Garant A, Meng X, Courtney KD, Shah RB, Pedrosa I. The role of the radiologist in the prostate cancer multidisciplinary conference. Abdom Radiol (NY) 2024:10.1007/s00261-024-04433-2. [PMID: 38951230 DOI: 10.1007/s00261-024-04433-2] [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: 03/01/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
The broad range of disease aggressiveness together with imperfect screening, diagnostic, and treatment options in prostate cancer (PCa) makes medical decision-making complex. The primary goal of a multidisciplinary conference is to improve patient outcomes by combining evidence-based data and expert opinion to discuss optimal management, including for those patients with challenging presentations. The primary purpose of the genitourinary imaging specialist in the prostate cancer multidisciplinary conference is to use imaging findings to reduce uncertainty by answering clinical questions. In this review, we discuss the role and the opportunities for an imaging specialist to add value in the care of men with prostate cancer discussed at multidisciplinary conferences.
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Affiliation(s)
- Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Nghi Nguyen
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aurelie Garant
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kevin D Courtney
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rajal B Shah
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Stratchko LM, Rossebo AE, Kisting MA, Hinshaw JL, Mao L, Meyer CA, Robbins JB, Tuite MJ, Grist TM, Lee FT. Unreimbursed Costs of Multidisciplinary Conferences to a Radiology Department: A Prospective Analysis at an Academic Medical Center. J Am Coll Radiol 2024; 21:668-675. [PMID: 37922969 DOI: 10.1016/j.jacr.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Multidisciplinary conferences (MDCs) are important for clinical care but are unreimbursed and can be time-consuming for radiologists to prepare for and present. The purpose of this single-center, prospective, survey-based study is to measure the per-conference time and total time radiologists devote to MDCs at a single academic medical center. Secondary objectives are to determine the source of radiologist preparation time, and calculate the per conference and overall radiology departmental costs of MDC participation. METHODS A prospective survey was performed to capture all radiology preparation and presentation time for MDCs in a 3-month period, which was then annualized. Total cost was calculated on the basis of Association of Administrators in Academic Radiology survey data for nonchair academic radiologist compensation plus a 30% fringe-benefit rate. RESULTS The survey response rate was 86.9%. A total of 3,358 hours were devoted annually to MDCs, which represents time equivalent to 1.9 full-time equivalents or $1,155,152 in unreimbursed radiology departmental costs. Per-MDC total preparation and presentation time was 2.7 hours, at an annual cost of $46,440 for each weekly MDC. Radiologists used a combination of personal time (49.7%), academic time (42%), and/or clinical time (35.4%) to prepare for MDCs. Radiologists devoted a mean of 47.9 hours (1.2 weeks) of time per annum to MDCs. CONCLUSIONS Radiologist time devoted to MDCs at the survey institution was substantial, and preparation time was drawn disproportionately from personal and academic time, which may have negative implications for burnout, recruitment and retention, and academic productivity unless it is effectively mitigated.
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Affiliation(s)
- Lindsay M Stratchko
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Cristopher A Meyer
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael J Tuite
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
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Becker M. How to prepare for a bright future of radiology in Europe. Insights Imaging 2023; 14:168. [PMID: 37816908 PMCID: PMC10564684 DOI: 10.1186/s13244-023-01525-3] [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: 08/16/2023] [Accepted: 09/16/2023] [Indexed: 10/12/2023] Open
Abstract
Because artificial intelligence (AI)-powered algorithms allow automated image analysis in a growing number of diagnostic scenarios, some healthcare stakeholders have raised doubts about the future of the entire radiologic profession. Their view disregards not only the role of radiologists in the diagnostic service chain beyond reporting, but also the many multidisciplinary and patient-related consulting tasks for which radiologists are solicited. The time commitment for these non-reporting tasks is considerable but difficult to quantify and often impossible to fulfil considering the current mismatch between workload and workforce in many countries. Nonetheless, multidisciplinary, and patient-centred consulting activities could move up on radiologists' agendas as soon as AI-based tools can save time in daily routine. Although there are many reasons why AI will assist and not replace radiologists as imaging experts in the future, it is important to position the next generation of European radiologists in view of this expected trend. To ensure radiologists' personal professional recognition and fulfilment in multidisciplinary environments, the focus of training should go beyond diagnostic reporting, concentrating on clinical backgrounds, specific communication skills with referrers and patients, and integration of imaging findings with those of other disciplines. Close collaboration between the European Society of Radiology (ESR) and European national radiologic societies can help to achieve these goals. Although each adequate treatment begins with a correct diagnosis, many health politicians see radiologic procedures mainly as a cost factor. Radiologic research should, therefore, increasingly investigate the imaging impact on treatment and outcome rather than focusing mainly on technical improvements and diagnostic accuracy alone.Critical relevance statement Strategies are presented to prepare for a successful future of the radiologic profession in Europe, if AI-powered tools can alleviate the current reporting overload: engaging in multidisciplinary activities (clinical and integrative diagnostics), enhancing the value and recognition of radiologists' role through clinical expertise, focusing radiological research on the impact on diagnosis and outcome, and promoting patient-centred radiology by enhancing communication skills.Key points • AI-powered tools will not replace radiologists but hold promise to reduce the current reporting burden, enabling them to reinvest liberated time in multidisciplinary clinical and patient-related tasks.• The skills and resources for these tasks should be considered when recruiting and teaching the next generation of radiologists, when organising departments and planning staffing.• Communication skills will play an increasing role in both multidisciplinary activities and patient-centred radiology.• The value and importance of a correct and integrative diagnosis and the cost of an incorrect imaging diagnosis should be emphasised when discussing with non-medical stakeholders in healthcare.• The radiologic community in Europe should start now to prepare for a bright future of the profession for the benefit of patients and medical colleagues alike.
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Affiliation(s)
- Minerva Becker
- Unit of Head and Neck and Maxilofacial Radiology, Division of Radiology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret Gentil 4, Geneva 14, CH 1211, Switzerland.
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Komarraju A, Van Rilland EZ, Gebhardt MC, Anderson ME, Heincelman C, Wu JS. What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference? Clin Orthop Relat Res 2023; 481:2005-2013. [PMID: 36929904 PMCID: PMC10499106 DOI: 10.1097/corr.0000000000002626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/12/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Multidisciplinary orthopaedic oncology conferences are important in developing the treatment plan for patients with suspected orthopaedic bone and soft tissue tumors, involving physicians from several services. Past studies have shown the clinical value of these conferences; however, the impact of radiology input on the management plan and time cost for radiology to staff these conferences has not been fully studied. QUESTIONS/PURPOSES (1) Does radiology input at multidisciplinary conference help guide clinical management and improve clinician confidence? (2) What is the time cost of radiology input for a multidisciplinary conference? METHODS This prospective study was conducted from October 2020 to March 2022 at a tertiary academic center with a sarcoma center. A single data questionnaire for each patient was sent to one of three treating orthopaedic oncologists with 41, 19, and 5 years of experience after radiology discussion at a weekly multidisciplinary conference. A data questionnaire was completed by the treating orthopaedic oncologist for 48% (322 of 672) of patients, which refers to the proportion of those three oncologists' patients for which survey data were captured. A musculoskeletal radiology fellow and musculoskeletal fellowship-trained radiology attending physician provided radiology input at each multidisciplinary conference. The clinical plan (leave alone, follow-up imaging, follow-up clinically, recommend different imaging test, core needle biopsy, surgical excision or biopsy or fixation, or other) and change in clinical confidence before and after radiology input were documented. A second weekly data questionnaire was sent to the radiology fellow to estimate the time cost of radiology input for the multidisciplinary conference. RESULTS In 29% (93 of 322) of patients, there was a change in the clinical plan after radiology input. Biopsy was canceled in 30% (24 of 80) of patients for whom biopsy was initially planned, and surgical excision was canceled in 24% (17 of 72) of patients in whom surgical excision was initially planned. In 21% (68 of 322) of patients, there were unreported imaging findings that affected clinical management; 13% (43 of 322) of patients had a missed finding, and 8% (25 of 322) of patients had imaging findings that were interpreted incorrectly. For confidence in the final treatment plan, 78% (251 of 322) of patients had an increase in clinical confidence by their treating orthopaedic oncologist after the multidisciplinary conference. Radiology fellows and attendings spent a mean of 4.2 and 1.5 hours, respectively, reviewing and presenting at a multidisciplinary conference each week. The annual combined prorated time cost for the radiology attending and fellow was estimated at USD 24,310 based on national median salary data for attendings and internal salary data for fellows. CONCLUSION In a study taken at one tertiary-care oncology program, input from radiology attendings and fellows in the setting of a multidisciplinary conference helped to guide the final treatment plan, reduce procedures, and improve clinician confidence in the final treatment plan, at an annual time cost of USD 24,310. CLINICAL RELEVANCE Multidisciplinary orthopaedic oncology conferences can lead to changes in management plans, and the time cost to the radiologists should be budgeted for by the radiology department or parent institution.
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Affiliation(s)
- Aparna Komarraju
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Mark C. Gebhardt
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Megan E. Anderson
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carrie Heincelman
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jim S. Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ambinder EB, Calhoun BC. Risk-Associated Lesions of the Breast in Core Needle Biopsies: Current Approaches to Radiological-Pathological Correlation. Surg Pathol Clin 2022; 15:147-157. [PMID: 35236630 DOI: 10.1016/j.path.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Image-guided core needle biopsies (CNBs) of the breast frequently result in a diagnosis of a benign or atypical lesion associated with breast cancer risk. The subsequent clinical management of these patients is variable, reflecting a lack of consensus on criteria for selecting patients for clinical and radiological follow-up versus immediate surgical excision. In this review, the evidence from prospective studies of breast CNB with radiological-pathological correlation is evaluated and summarized. The data support an emerging consensus on the importance of radiologic-pathologic correlation in standardizing the selection of patients for active surveillance versus surgery.
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Affiliation(s)
- Emily B Ambinder
- Breast Imaging Division, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine
| | - Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 160 N. Medical Drive, Campus Box 7525, Chapel Hill, NC 27599, USA.
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