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Becker AS, Das JP, Woo S, Elnajjar P, Chaim J, Erinjeri JP, Hricak H, Vargas HA. Programmatic Implementation of a Custom Subspecialized Oncologic Imaging Workflow Manager at a Tertiary Cancer Center. JCO Clin Cancer Inform 2022; 6:e2200066. [PMID: 36084275 PMCID: PMC9848557 DOI: 10.1200/cci.22.00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate whether a custom programmatic workflow manager reduces reporting turnaround times (TATs) from a body oncologic imaging workflow at a tertiary cancer center. METHODS A custom software program was developed and implemented in the programming language R. Other aspects of the workflow were left unchanged. TATs were measured over a 12-month period (June-May). The same prior 12-month period served as a historical control. Median TATs of magnetic resonance imaging (MRI) and computed tomography (CT) examinations were compared with a Wilcoxon test. A chi-square test was used to compare the numbers of examinations reported within 24 hours and after 72 hours as well as the proportions of examinations assigned according to individual radiologist preferences. RESULTS For all MRI and CT examinations (124,507 in 2019/2020 and 138,601 in 2020/2021), the median TAT decreased from 4 (interquartile range: 1-22 hours) to 3 hours (1-17 hours). Reports completed within 24 hours increased from 78% (124,127) to 89% (138,601). For MRI, TAT decreased from 22 (5-49 hours) to 8 hours (2-21 hours), and reports completed within 24 hours increased from 55% (14,211) to 80% (23,744). For CT, TAT decreased from 3 (1-19 hours) to 2 hours (1-13 hours), and reports completed within 24 hours increased from 84% (82,342) to 92% (99,922). Delayed reports (with a TAT > 72 hours) decreased from 17.0% (4,176) to 2.2% (649) for MRI and from 2.5% (2,500) to 0.7% (745) for CT. All differences were statistically significant (P < .001). CONCLUSION The custom workflow management software program significantly decreased MRI and CT report TATs.
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Affiliation(s)
- Anton S. Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeeban P. Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pierre Elnajjar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joshua Chaim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P. Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Msaouel P, Goswami S, Thall PF, Wang X, Yuan Y, Jonasch E, Gao J, Campbell MT, Shah AY, Corn PG, Tam AL, Ahrar K, Rao P, Sircar K, Cohen L, Basu S, Duan F, Jindal S, Zhang Y, Chen H, Yadav SS, Shazer R, Der-Torossian H, Allison JP, Sharma P, Tannir NM. A phase 1-2 trial of sitravatinib and nivolumab in clear cell renal cell carcinoma following progression on antiangiogenic therapy. Sci Transl Med 2022; 14:eabm6420. [PMID: 35442707 DOI: 10.1126/scitranslmed.abm6420] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The accumulation of immune-suppressive myeloid cells is a critical determinant of resistance to anti-programmed death-1 (PD-1) therapy in advanced clear cell renal cell carcinoma (ccRCC). In preclinical models, the tyrosine kinase inhibitor sitravatinib enhanced responses to anti-PD-1 therapy by modulating immune-suppressive myeloid cells. We conducted a phase 1-2 trial to choose an optimal sitravatinib dose combined with a fixed dose of nivolumab in 42 immunotherapy-naïve patients with ccRCC refractory to prior antiangiogenic therapies. The combination demonstrated no unexpected toxicities and achieved an objective response rate of 35.7% and a median progression-free survival of 11.7 months, with 80.1% of patients alive after a median follow-up of 18.7 months. Baseline peripheral blood neutrophil-to-lymphocyte ratio correlated with response to sitravatinib and nivolumab. Patients with liver metastases showed durable responses comparable to patients without liver metastases. In addition, correlative studies demonstrated reduction of immune-suppressive myeloid cells in the periphery and tumor microenvironment following sitravatinib treatment. This study provides a rationally designed combinatorial strategy to improve outcomes of anti-PD-1 therapy in advanced ccRCC.
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Affiliation(s)
- Pavlos Msaouel
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,David H. Koch Center for Applied Research of Genitourinary Cancers, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sangeeta Goswami
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Peter F Thall
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xuemei Wang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jianjun Gao
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,David H. Koch Center for Applied Research of Genitourinary Cancers, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Amishi Yogesh Shah
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Paul Gettys Corn
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alda L Tam
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kamran Ahrar
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Priya Rao
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kanishka Sircar
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sreyashi Basu
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Fei Duan
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sonali Jindal
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yuwei Zhang
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hong Chen
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shalini S Yadav
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | - James P Allison
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Padmanee Sharma
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Zabel AOJ, Leschka S, Wildermuth S, Hodler J, Dietrich TJ. Subspecialized radiological reporting reduces radiology report turnaround time. Insights Imaging 2020; 11:114. [PMID: 33123830 PMCID: PMC7596149 DOI: 10.1186/s13244-020-00917-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives The objective of this study was to compare the radiology report turnaround time (RTAT) between decentralized/modality-based and centralized/subspecialized radiological reporting at a multi-center radiology enterprise. Methods RTAT values for MRI, CT, and conventional radiography were compared between decentralized/modality-based (04 September 2017–22 December 2017) and centralized/subspecialized radiology (03 September 2018–21 December 2018) reporting grouped into three subspecializations (body radiology, musculoskeletal radiology, and neuroradiology) at eleven sites of a multi-center radiology enterprise. For the objective of this investigation, hospitals were defined as major and minor hospitals. The Mann-Whitney U test served for statistical analyses. Results Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology resulted overall in a significant decrease of the RTAT: from 82 to 77 min for the first signature (p < 0.001), and 119 to 107 min and 295 to 238 min for the second signature (p < 0.001). Subgroup analyses demonstrate a significant decrease of the RTAT for MRI reports (e.g., second signature RTAT, 1051 to 401 min; p < 0.001) and conventional radiographs (e. g., second signature RTAT, 278 to 171 min; p < 0.001). The RTAT at major hospitals decreased from 288 to 245 min (second signature; p < 0.001) while the corresponding RTAT of minor hospitals decreased more remarkably, from 300 to 198 min (p < 0.001). However, the results were heterogenous; in some analyses, the RTAT even increased. The effect size analyses represent small effects. Conclusions Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology was associated with a significant decreased RTAT. Specifically, the RTAT for MRI reports and conventional radiographs was significantly reduced. A pronounced RTAT decrease was observed at minor hospitals.
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Affiliation(s)
- Andreas Otto Josef Zabel
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland. .,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland.
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
| | - Juerg Hodler
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland.,Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Rämistrasse 100, 8091, Zürich, CH, Switzerland
| | - Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
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