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Yasrab M, Thakker S, Wright MJ, Ahmed T, He J, Wolfgang CL, Chu LC, Weiss MJ, Kawamoto S, Johnson PT, Fishman EK, Javed AA. Factors associated with radiological misstaging of pancreatic ductal adenocarcinoma: A retrospective observational study. Curr Probl Diagn Radiol 2024:S0363-0188(24)00047-1. [PMID: 38522966 DOI: 10.1067/j.cpradiol.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Accurate staging of disease is vital in determining appropriate care for patients with pancreatic ductal adenocarcinoma (PDAC). It has been shown that the quality of scans and the experience of a radiologist can impact computed tomography (CT) based assessment of disease. The aim of the current study was to evaluate the impact of the rereading of outside hospital (OH) CT by an expert radiologist and a repeat pancreatic protocol CT (PPCT) on staging of disease. METHODS Patients evaluated at the our institute's pancreatic multidisciplinary clinic (2006 to 2014) with OH scan and repeat PPCT performed within 30 days were included. In-house radiologists staged disease using OH scans and repeat PPCT, and factors associated with misstaging were determined. RESULTS The study included 100 patients, with a median time between OH scan and PPCT of 19 days (IQR: 13-23 days.) Stage migration was mostly accounted for by upstaging of disease (58.8 % to 83.3 %) in all comparison groups. When OH scans were rereviewed, 21.5 % of the misstaging was due to missed metastases, however, when rereads were compared to the PPCT, occult metastases accounted for the majority of misstaged patients (62.5 %). Potential factors associated with misstaging were primarily related to imaging technique. CONCLUSION A repeat PPCT results in increased detection of metastatic disease that rereviews of OH scans may otherwise miss. Accessible insurance coverage for repeat PPCT imaging even within 30 days of an OH scan could help optimize delivery of care and alleviate burdens associated with misstaging.
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Affiliation(s)
- Mohammad Yasrab
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sameer Thakker
- Department of Surgery, New York University Langone Hospital, NYU Langone Health, New York City, NY, USA
| | - Michael J Wright
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taha Ahmed
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher L Wolfgang
- Department of Surgery, New York University Langone Hospital, NYU Langone Health, New York City, NY, USA
| | - Linda C Chu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Weiss
- Department of Surgery, Northwell Health, Lake Success, NY, USA
| | - Satomi Kawamoto
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela T Johnson
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ammar A Javed
- Department of Surgery, New York University Langone Hospital, NYU Langone Health, New York City, NY, USA.
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Malik RF, Sun KJ, Azadi JR, Lau BD, Whelton S, Arbab-Zadeh A, Wilson RF, Johnson PT. Opportunistic Screening for Coronary Artery Disease: An Untapped Population Health Resource. J Am Coll Radiol 2024:S1546-1440(24)00197-2. [PMID: 38382860 DOI: 10.1016/j.jacr.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in the United States. At-risk asymptomatic adults are eligible for screening with electrocardiogram-gated coronary artery calcium (CAC) CT, which aids in risk stratification and management decision-making. Incidental CAC (iCAC) is easily quantified on chest CT in patients imaged for noncardiac indications; however, radiologists do not routinely report the finding. OBJECTIVE To determine the clinical significance of CAC identified incidentally on routine chest CT performed for noncardiac indications. DESIGN An informationist developed search strategies in MEDLINE, Embase, and SCOPUS, and two reviewers independently screened results at both the abstract and full text levels. Data extracted from eligible articles included age, rate of iCAC identification, radiologist reporting frequency, impact on downstream medical management, and association of iCAC with patient outcomes. RESULTS From 359 unique citations, 83 research publications met inclusion criteria. The percentage of patients with iCAC ranged from 9% to 100%. Thirty-one investigations measured association(s) between iCAC and cardiovascular morbidity and mortality, and 29 identified significant correlations, including nonfatal myocardial infarction, fatal myocardial infarction, major adverse cardiovascular event, cardiovascular death, and all-cause death. iCAC was present in 20% to 100% of the patients in these cohorts, but when present, iCAC was reported by radiologists in only 31% to 44% of cases. Between 18% and 77% of patients with iCAC were not on preventive medications in studies that reported these data. Seven studies measured the effect of reporting on guideline directed medical therapy, and 5 (71%) reported an increase in medication prescriptions after diagnosis of iCAC, with one confirming reductions in low-density lipoprotein levels. Twelve investigations reported good concordance between CAC grade on noncardiac CT and Agatston score on electrocardiogram-gated cardiac CT, and 10 demonstrated that artificial intelligence tools can reliably calculate an Agatston score on noncardiac CT. CONCLUSION A body of evidence demonstrates that patients with iCAC on routine chest CT are at risk for cardiovascular disease events and death, but they are often undiagnosed. Uniform reporting of iCAC in the chest CT impression represents an opportunity for radiology to contribute to early identification of high-risk individuals and potentially reduce morbidity and mortality. AI tools have been validated to calculate Agatston score on routine chest CT and hold the best potential for facilitating broad adoption.
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Affiliation(s)
- Rubab F Malik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristie J Sun
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javad R Azadi
- Assistant Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Assistant Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seamus Whelton
- Associate Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Armin Arbab-Zadeh
- Director of Cardiac CT, Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Renee F Wilson
- Evidence Based Practice Center, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Pamela T Johnson
- Vice President of Care Transformation, Vice Chair of Quality and Safety in Radiology, Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ibad HA, Ghotbi E, Kasaeian A, Levin AS, Jones LC, Anzai Y, Soltanolkotabi M, Kapoor N, Johnson PT, Demehri S. Screening for Asymptomatic Osteonecrosis of the Hip in Systemic Lupus Erythematous: A Systematic Review and Meta-Analysis of MRI-Based Prevalence. Diagnostics (Basel) 2024; 14:279. [PMID: 38337795 PMCID: PMC10855524 DOI: 10.3390/diagnostics14030279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Objective. This paper aims to estimate asymptomatic hip osteonecrosis prevalence in SLE patients using MRI examination and to determine the prevalence among higher risk subpopulations. Materials and Methods. PubMed, Embase, Cochrane, and SCOPUS were searched from inception to May 9th, 2023. Studies on patients who were clinically diagnosed with systemic lupus erythematosus without reported symptoms attributable to hip osteonecrosis were included. Two independent reviewers extracted data and assessed the risk of bias. Data collected from each study include the study year, the number of hips screened, the number of hips with osteonecrosis, demographics, laboratory data, medications, follow-up time, radiological protocols, and MRI-based osteonecrosis detection and grading criteria. Results. Eleven eligible studies including 503 participants (15-35 years old; 74-100% female) with SLE were identified. Significant risk of bias was determined in one study. The overall prevalence of osteonecrosis of the hip was found to be 14% (184/1006 hip joints, 95% confidence interval: 7-22%, number needed to scan: 7.1). SLE patients who received corticosteroid treatment had a higher prevalence of asymptomatic hip osteonecrosis (18%) compared to non-corticosteroid users (0%, p-value < 0.01). Additionally, meta-regression results revealed that daily corticosteroid dose was associated with increased prevalence of asymptomatic osteonecrosis (0.5%/milligram, p-value < 0.01). Conclusions. The high prevalence of asymptomatic hip osteonecrosis in SLE patients raises concerns about the timeliness of interventions. The limitations of this study include a relatively low number of identified studies; and one study lacked full-text availability.
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Affiliation(s)
- Hamza A. Ibad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Elena Ghotbi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Arta Kasaeian
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Adam S. Levin
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Lynne C. Jones
- Center for Osteonecrosis Research and Education, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (Y.A.)
| | - Maryam Soltanolkotabi
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (Y.A.)
| | - Neena Kapoor
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Pamela T. Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Shadpour Demehri
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Murphy J, Malik R, Lau B, Conway SJ, Johnson PT. Refocusing the Lens: Adding Downstream Value to the Radiology Quality Equation. J Am Coll Radiol 2024; 21:88-92. [PMID: 37690537 DOI: 10.1016/j.jacr.2023.06.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Jacob Murphy
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rubab Malik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn Lau
- Department of Radiology & Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah J Conway
- Chief Medical Officer, Johns Hopkins Clinical Alliance, Baltimore, Maryland; Assistant Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela T Johnson
- Vice President of Care Transformation, Johns Hopkins Health System, Baltimore, Maryland; Vice Chair of Quality, Safety and Value, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Malik RF, Berry R, Lau BD, Busireddy KR, Patel P, Patel SH, Fishman EK, Bivalacqua TJ, Johnson PT, Sedaghat F. Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis. Tomography 2023; 9:1734-1744. [PMID: 37736991 PMCID: PMC10514844 DOI: 10.3390/tomography9050138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Bladder cancer is the sixth most common malignancy in the United States (US). Despite its high prevalence and the significant potential benefits of early detection, no reliable, cost-effective screening algorithm exists for asymptomatic patients at risk. Nonetheless, reports of incidentally identified early bladder cancer on CT/MRI scans performed for other indications are emerging in the literature. This represents a new opportunity for early detection, with over 80 million CT scans performed in the US yearly, 40% of which are abdominopelvic CTs. This investigation aims to define the imaging features of early bladder cancer, with the mission of facilitating early diagnosis. METHODS Following IRB approval with a waiver of informed consent, a retrospective review was performed, identifying 624 patients with non-muscle-invasive bladder cancer diagnosed at Johns Hopkins Hospital between 2000 and 2019. Of these patients, 99 patients underwent pelvic CT within the 5 years preceding pathologic diagnosis. These imaging studies were reviewed retrospectively to evaluate for the presence and features of any focal bladder wall abnormality. RESULTS Median age at the time of pathologic diagnosis was 70 years (range: 51-88 years), and 82% (81/99) of patients were male. A total of 226 CT studies were reviewed. The number of studies per patient ranged from 1 to 33. Median time interval between all available imaging and pathologic diagnosis was 14 months. A total of 62% (141/226) of the scans reviewed were performed for indications other than suspected urinary tract cancer (UTC). A bladder wall mass was visualized in 67% (66/99) of patients and on 35% (78/226) of scans performed before diagnosis. The majority (84%, 67/80) of masses were intraluminal. Mean transverse long- and short-axis measurements were 24 mm and 17 mm, respectively, with long dimension measurements ranging between 5 and 59 mm. CONCLUSIONS Early bladder cancer was visualized on CT preceding pathologic diagnosis in more than 2/3 of patients, and the majority of scans were performed for indications other than suspected urinary tract cancer/UTC symptoms. These results suggest that cross-sectional imaging performed for other indications can serve as a resource for opportunistic bladder cancer screening, particularly in high-risk patients.
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Affiliation(s)
- Rubab F. Malik
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Renu Berry
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Brandyn D. Lau
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Kiran R. Busireddy
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Prasan Patel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Sunil H. Patel
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.H.P.)
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Trinity J. Bivalacqua
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.H.P.)
| | - Pamela T. Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
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Rowe SP, Fishman EK, Chu LC, Johnson PT, Cameron JL. An Approach to Leadership in Academic Medicine: Lessons Learned From the Experience of Dr. John L. Cameron. Curr Probl Diagn Radiol 2023; 52:313-314. [PMID: 37438230 DOI: 10.1067/j.cpradiol.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/20/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Dr. John L. Cameron was appointed the chair of surgery at Johns Hopkins in 1984. He subsequently built the largest group of clinician-scientists anywhere in the world who were focused on pancreatic cancer. MATERIALS AND METHODS Trainees were selected over the decades to join the group based on characteristics including self-confidence, a sense of humor, a collegial and congenial personality, and a strong previous track record. Resume items such as prior leadership positions, academic achievements, and participation in team sports can all prove to be important predictors for future success. RESULTS Many of the trainees that were molded by that group have perpetuated its ideals by pursuing academic careers. Dr Cameron's approach can be distilled to 3 key points: work hard and lead by example, make diamonds by applying the right amount of pressure, and serve your people and give the impression that you are working for your trainees and junior people. CONCLUSIONS With those leadership principles, it should still be possible to build successful academic programs, despite the significant challenges that have arisen.
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Affiliation(s)
- Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Linda C Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John L Cameron
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD
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Johnson PT, Conway SJ, Berkowitz SA, Arbab-Zadeh A, Riley LH, Gilotra N, Mathioudakis NN, Feldman L, Pahwa AK. Transforming Health Care from Volume to Value: A Health System Implementation Road Map. Am J Med 2023; 136:763-767. [PMID: 37156348 PMCID: PMC10526882 DOI: 10.1016/j.amjmed.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Pamela T Johnson
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD; Office of Medical Affairs, Johns Hopkins Health System, Baltimore, MD.
| | - Sarah J Conway
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Scott A Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Armin Arbab-Zadeh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lee H Riley
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nisha Gilotra
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Leonard Feldman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amit K Pahwa
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Jalilianhasanpour R, Huntley JH, Alvin MD, Hause S, Ali N, Urrutia V, Ghazi Sherbaf F, Johnson PT, Yousem DM, Yedavalli V. Value of acute neurovascular imaging in patients with suspected transient ischemic attack. Eur J Radiol 2022; 154:110427. [DOI: 10.1016/j.ejrad.2022.110427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
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Nathan J, Lexa FJ, Friedberg E, Johnson PT, Rosenkrantz AB, Shah G. Did They Really Just Say That? The Academic Perspective. J Am Coll Radiol 2022:S1546-1440(22)00572-5. [PMID: 35985632 DOI: 10.1016/j.jacr.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer Nathan
- Staff Neuroradiologist, Andrews Air Force Base, Washington, DC.
| | - Frank J Lexa
- Chief Medical Officer, The Radiology Leadership Institute of the American College of Radiology, Wynnewood, Pennsylvania
| | - Eric Friedberg
- Associate Professor, Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, and Member, Board of Directors, ACCME
| | - Pamela T Johnson
- Vice President of Care Transformation, Johns Hopkins Health System; Vice Chair of Quality & Safety, Russell H. Morgan Department of Radiology; and Professor of Radiology, Oncology & Urology, Johns Hopkins Health System, Baltimore, Maryland
| | - Andrew B Rosenkrantz
- Professor, Radiology and Urology, and Section Chief, Abdominal Imaging, New York University Grossman School of Medicine, New York, New York, and is Editor-in-Chief, American Journal of Roentgenology
| | - Gaurang Shah
- Associate Chair and Professor, Radiology; Director, Medical Student Education, Neuroradiology; and Director, Clinical Functional MRI Service, Neuroradiology Division, University of Michigan Health System, Ann Arbor, Michigan
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Berry R, Busireddy K, Chu LC, Johnson PT, Fishman EK. The good, the bad, and the ugly: uncommon CT appearances of pheochromocytoma. Abdom Radiol (NY) 2022; 47:1406-1413. [PMID: 35212806 DOI: 10.1007/s00261-022-03447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
Pheochromocytoma is a neuroendocrine tumor arising in the adrenal medulla with varied imaging appearances and associated risk of serious cardiovascular complications if left undiagnosed and untreated. It is discovered incidentally in up to 70% of cases due to the increase in use of CT in clinical practice. Biopsy can have life-threatening consequences, so imaging is crucial for diagnosis and surgical planning. The purpose of this review is to demonstrate unusual CT appearances of pheochromocytoma and enhance diagnostic confidence in cases discovered incidentally. High level of suspicion for pheochromocytoma based on CT findings, along with urinary metanephrine levels, can obviate the need for additional expensive imaging.
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Affiliation(s)
- Renu Berry
- Russell H Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School Medicine, Baltimore, MD, 21287, USA.
- Johns Hopkins University School Medicine, 601 N. Caroline Street, Room JHOC 3140B, Baltimore, MD, 21287, USA.
| | - Kiran Busireddy
- Russell H Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School Medicine, Baltimore, MD, 21287, USA
| | - Linda C Chu
- Russell H Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School Medicine, Baltimore, MD, 21287, USA
| | - Pamela T Johnson
- Russell H Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School Medicine, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Russell H Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School Medicine, Baltimore, MD, 21287, USA
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Johnson PT, Lau B, Conway SJ, Riley L, Hill P. Evidence-Based, Prior Authorization in the Electronic Health Record: A Better Path Forward. J Am Coll Radiol 2022; 19:652-654. [DOI: 10.1016/j.jacr.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/29/2022] [Accepted: 02/19/2022] [Indexed: 11/16/2022]
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Prasanna S, Premnath N, Angraal S, Sedhom R, Khera R, Parsons H, Hussaini S, Johnson PT, Lou E, Beg MS, Subbiah IM, Rao P, Gupta A. Sentiment analysis of tweets on prior authorization. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
322 Background: Natural language processing (NLP) algorithms can be leveraged to better understand prevailing themes in healthcare conversations. Sentiment analysis, an NLP technique to analyze and interpret sentiments from text, has been validated on Twitter in tracking natural disasters and disease outbreaks. To establish its role in healthcare discourse, we sought to explore the feasibility and accuracy of sentiment analysis on Twitter posts (‘’tweets’’) related to prior authorizations (PAs), a common occurrence in oncology built to curb payer-concerns about costs of cancer care, but which can obstruct timely and appropriate care and increase administrative burden and clinician frustration. Methods: We identified tweets related to PAs between 03/09/2021-04/29/2021 using pre-specified keywords [e.g., #priorauth etc.] and used Twarc, a command-line tool and Python library for archiving Twitter JavaScript Object Notation data. We performed sentiment analysis using two NLP models: (1) TextBlob (trained on movie reviews); and (2) VADER (trained on social media). These models provide results as polarity, a score between 0-1, and a sentiment as ‘’positive’’ (>0), ‘’neutral’’ (exactly 0), or ‘’negative’’ (<0). We (AG, NP) manually reviewed all tweets to give the ground truth (human interpretation of reality) including a notation for sarcasm since models are not trained to detect sarcasm. We calculated the precision (positive predictive value), recall (sensitivity), and the F1-Score (measure of accuracy, range 0-1, 0=failure, 1=perfect) for the models vs. the ground truth. Results: After preprocessing, 964 tweets (mean 137/ week) met our inclusion criteria for sentiment analysis. The two existing NLP models labeled 42.4%- 43.3% tweets as positive, as compared to the ground truth (5.6% tweets positive). F-1 scores of models across labels ranged from 0.18-0.54. We noted sarcasm in 2.8% of tweets. Detailed results in Table. Conclusions: We demonstrate the feasibility of performing sentiment analysis on a topic of high interest within clinical oncology and the deficiency of existing NLP models to capture sentiment within oncologic Twitter discourse. Ongoing iterations of this work further train these models through better identification of the tweeter (patient vs. health care worker) and other analytics from shared content.[Table: see text]
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Affiliation(s)
- Shivika Prasanna
- University of Missouri Department of Electrical Engineering and Computer Science, Columbia, MO
| | | | - Suveen Angraal
- University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | - Syed Hussaini
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | - Emil Lou
- University of Minnesota School of Medicine, Minneapolis, MN
| | | | | | - Praveen Rao
- University of Missouri, Columbia, Dept. of Electrical Engineering & Computer Science, Columbia, MO
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Johnson PT, Anzai Y. Radiology at the Helm of Value-Based Care Transformation: From Stewardship to Leadership. J Am Coll Radiol 2021; 18:1226-1228. [PMID: 34358461 DOI: 10.1016/j.jacr.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Pamela T Johnson
- Vice President of Care Transformation, Johns Hopkins Health System; Vice Chair of Quality, Safety and Value in Radiology, Johns Hopkins Medicine; Professor of Radiology, Oncology and Urology, Johns Hopkins University School of Medicine; Co-Founder and Co-Director, High Value Practice Academic Alliance; Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | - Yoshimi Anzai
- Associate Chief Medical Quality Officer, University of Utah HealthCare; Professor of Radiology, Co-director, High Value Practice Academic Alliance Radiology Collaborative; Department of Radiology and Imaging Services, University of Utah, Salt Lake City, Utah
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14
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England RW, Sheikhbahaei S, Solomon AJ, Arbab-Zadeh A, Solnes LB, Bronner J, Johnson PT. When More Is Better: Underused Advanced Imaging Exams That Can Improve Outcomes and Reduce Cost of Care. Am J Med 2021; 134:848-853.e1. [PMID: 33819488 DOI: 10.1016/j.amjmed.2021.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
Appropriate use of resources is a tenet of care transformation efforts, with a national campaign to reduce low-value imaging. The next level of performance improvement is to bolster evidence-based screening, imaging surveillance, and diagnostic innovation, which can avert more costly, higher-risk elements of unnecessary care like emergent interventions. Clinical scenarios in which underused advanced imaging can improve outcomes and reduce total cost of care are reviewed, including abdominal aortic aneurysm surveillance, coronary artery disease diagnosis, and renal mass characterization. Reliable abdominal aortic aneurysm surveillance imaging reduces emergency surgery and can be driven by radiologists incorporating best practice standardized recommendations in imaging interpretations. Coronary computed tomography angiography in patients with stable and unstable chest pain can reduce downstream resource use while improving outcomes. Preoperative 99mTc-sestamibi single-photon emission computed tomography (SPECT) reliably distinguishes oncocytoma from renal cell carcinoma to obviate unnecessary nephrectomy. As technological advances in diagnostic, molecular, and interventional radiology improve our ability to detect and cure disease, analyses of cost effectiveness will be critical to radiology leadership and sustainability in the transition to a value-based reimbursement model.
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Affiliation(s)
| | | | | | - Armin Arbab-Zadeh
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Jay Bronner
- Radiology Partners Research Institute, El Segundo, Calif
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15
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Ellenbogen MI, Prichett L, Johnson PT, Brotman DJ. Development of a Simple Index to Measure Overuse of Diagnostic Testing at the Hospital Level Using Administrative Data. J Hosp Med 2021; 16:77-83. [PMID: 33496661 PMCID: PMC7850599 DOI: 10.12788/jhm.3547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We developed a diagnostic overuse index that identifies hospitals with high levels of diagnostic intensity by comparing negative diagnostic testing rates for common diagnoses. METHODS We prospectively identified candidate overuse metrics, each defined by the percentage of patients with a particular diagnosis who underwent a potentially unnecessary diagnostic test. We used data from seven states participating in the State Inpatient Databases. Candidate metrics were tested for temporal stability and internal consistency. Using mixed-effects ordinal regression and adjusting for regional and hospital characteristics, we compared results of our index with three Dartmouth health service area-level utilization metrics and three Medicare county-level cost metrics. RESULTS The index was comprised of five metrics with good temporal stability and internal consistency. It correlated with five of the six prespecified overuse measures. Among the Dartmouth metrics, our index correlated most closely with physician reimbursement, with an odds ratio of 2.02 (95% CI, 1.11-3.66) of being in a higher tertile of the overuse index when comparing tertiles 3 and 1 of this Dartmouth metric. Among the Medicare county-level metrics, our index correlated most closely with standardized costs of procedures per capita, with an odds ratio of 2.03 (95% CI, 1.21-3.39) of being in a higher overuse index tertile when comparing tertiles 3 and 1 of this metric. CONCLUSIONS We developed a novel overuse index that is preliminary in nature. This index is derived from readily available administrative data and shows some promise for measuring overuse of diagnostic testing at the hospital level.
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Affiliation(s)
- Michael I Ellenbogen
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Corresponding Author: Michael I. Ellenbogen, MD; ; Telephone: 443-287-4362
| | - Laura Prichett
- Biostatistics, Epidemiology, and Data Management (BEAD) Core, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Pamela T Johnson
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Daniel J Brotman
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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16
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Lee MH, Verde F, Johnson PT, Fishman EK. Unsuspected COVID-19 pneumonia suggests need for higher level of personal protective equipment usage during routine radiologic examinations: Two case reports. Radiol Case Rep 2021; 16:221-223. [PMID: 33250953 PMCID: PMC7680087 DOI: 10.1016/j.radcr.2020.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022] Open
Abstract
Two case reports demonstrating the need for enhanced usage of personal protective equipment of face shield, respirator, gloves, and gown during routine radiologic evaluation who may screen negative for COVID-19 and or atypical COVID-19 symptoms. First case is of a 42-year-old woman undergoing preoperative evaluation for endometrial cancer in the outpatient setting. The second case is of a 49-year-old woman presenting with abdominal pain, nausea, and vomiting for abdominal CT imaging from the emergency department. Both cases demonstrate typical lung imaging finding of COVID-19. These cases highlight the need for additional precautions in the outpatient and emergency setting even for patients in whom COVID-19 infection is not suspected.
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Affiliation(s)
- Megan H Lee
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3235-A, Baltimore, MD 21287, USA
| | - Franco Verde
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3235-A, Baltimore, MD 21287, USA
| | - Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3235-A, Baltimore, MD 21287, USA
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 3235-A, Baltimore, MD 21287, USA
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17
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Haj-Mirzaian A, Eng J, Khorasani R, Raja AS, Levin AS, Smith SE, Johnson PT, Demehri S. Use of Advanced Imaging for Radiographically Occult Hip Fracture in Elderly Patients: A Systematic Review and Meta-Analysis. Radiology 2020; 296:521-531. [PMID: 32633673 DOI: 10.1148/radiol.2020192167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The overall rate of hip fractures not identified on radiographs but that require surgery (ie, surgical hip fractures) remains unclear in elderly patients who are suspected to have such fractures based on clinical findings. Moreover, the importance of advanced imaging in these patients has not been comprehensively assessed. Purpose To estimate the frequency of radiographically occult hip fracture in elderly patients, to define the higher-risk subpopulation, and to determine the diagnostic performance of CT and bone scanning in the detection of occult fractures by using MRI as the reference standard. Materials and Methods A literature search was performed to identify English-language observational studies published from inception to September 27, 2018. Studies were included if patients were clinically suspected to have hip fracture but there was no radiographic evidence of surgical hip fracture (including absence of any definite fracture or only presence of isolated greater trochanter [GT] fracture). The rate of surgical hip fracture was reported in each study in which MRI was used as the reference standard. The pooled rate of occult fracture, diagnostic performance of CT and bone scanning, and strength of evidence (SOE) were assessed. Results Thirty-five studies were identified (2992 patients; mean age, 76.8 years ± 6.0 [standard deviation]; 66% female). The frequency of radiographically occult surgical hip fracture was 39% (1110 of 2835 patients; 95% confidence interval [CI]: 35%, 43%) in studies of patients with no definite radiographic fracture and 92% (134 of 157 patients; 95% CI: 83%, 98%) in studies of patients with radiographic evidence of isolated GT fracture (moderate SOE). The frequency of occult fracture was higher in patients aged at least 80 years (44%, 529 of 1184), those with an equivocal radiographic report (58%, 71 of 126), and those with a history of trauma (41%, 977 of 2370) (moderate SOE). CT and bone scanning yielded comparable diagnostic performance in the detection of radiographically occult hip fracture (P = .67), with a sensitivity of 79% and 87%, respectively (low SOE). Conclusion Elderly patients with acute hip pain and negative or equivocal findings at initial radiography have a high frequency of occult hip fractures. Therefore, the performance of advanced imaging (preferably MRI) may be clinically appropriate in all such patients. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Arya Haj-Mirzaian
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - John Eng
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Ramin Khorasani
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Ali S Raja
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Adam S Levin
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Stacy E Smith
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Pamela T Johnson
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
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18
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Adenaw N, Wen J, Pahwa AK, Sheth S, Johnson PT. Decreasing Duplicative Imaging: Inpatient and Emergency Medicine Abdominal Ultrasound Within 72 Hours of Abdominal CT. J Am Coll Radiol 2020; 17:590-596. [PMID: 32247697 DOI: 10.1016/j.jacr.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this project was to reduce abdominal ultrasound examinations in patients who had undergone abdominal CT within 72 hours previously. METHODS A best practice advisory (BPA) was created in the electronic medical record to advise against the use of abdominal ultrasound in adult inpatients and emergency department patients who had undergone abdominal CT within the preceding 72 hours. Acceptable acknowledgment reasons to proceed with the order were made available if providers chose to override. Frequency of BPA firing and subsequent ordering behavior were evaluated 6 months after integration of the BPA into the electronic medical record. Chart review was conducted for 100 patients whose orders were placed through an override of the alert to determine if the ultrasound study added value and for all patients whose ultrasound studies were canceled to confirm that patient care was not compromised by omitting the ultrasound study. RESULTS In the first 6 months, a total of 614 inpatient and emergency department abdominal ultrasound orders triggered the BPA. A total of 16% of orders (n = 96) were canceled by the provider after the BPA, reflecting 518 overrides. The majority of retained orders were to evaluate the gallbladder (44% [227 of 518]). Chart review confirmed utility for gallbladder imaging and that the canceled ultrasound examinations would not have contributed value to patients' care. CONCLUSIONS A recently performed abdominal CT scan may obviate the need for inpatient and emergency department abdominal ultrasound, particularly in the setting of hospital-acquired acute kidney injury. A BPA resulted in only 16% of orders' being canceled, whereas chart review revealed a much larger opportunity to avoid duplicative imaging.
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Affiliation(s)
- Nebiyu Adenaw
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Wen
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amit K Pahwa
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheila Sheth
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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19
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Ghodasara N, Liddell R, Fishman EK, Johnson PT. High-Value Multidetector CT Angiography of the Superior Mesenteric Artery: What Emergency Medicine Physicians and Interventional Radiologists Need to Know. Radiographics 2020; 39:559-577. [PMID: 30844348 DOI: 10.1148/rg.2019180131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The superior mesenteric artery (SMA) provides vital blood supply to the midgut, and an acute abnormality can rapidly precipitate bowel ischemia and infarction and lead to morbidity and mortality. Vascular diseases that acutely compromise the SMA threaten its tributaries and include occlusion, dissection, aneurysm rupture, pseudoaneurysm, vasculitis, and SMA branch hemorrhage into the bowel. Emergency medicine physicians rely on the radiologist to identify SMA abnormalities, to characterize them, and to detail findings that guide the appropriate triage of these patients. As such, radiologists must be cognizant of the features that influence patient treatment to assist vascular surgeons and interventional radiologists in decision making. Some patients can be treated medically, while clinical and radiographic findings may suggest the need for interventional or surgical repair of the artery. In the latter case, multidetector CT findings aid in determining which of the various surgical and endovascular treatment options is optimal, and both vascular and gastrointestinal sequelae of acute SMA abnormalities contribute to these determinations. The authors review acute life-threatening conditions involving the SMA including acute occlusion, dissection, aneurysm, pseudoaneurysm, and hemorrhage and discuss the vascular and gastrointestinal multidetector CT findings in each of these conditions that help to guide surgical and interventional management. ©RSNA, 2019.
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Affiliation(s)
- Nevil Ghodasara
- From the Divisions of Body CT (N.G., E.K.F., P.T.J.) and Interventional Radiology (R.L.), Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Hospital, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Robert Liddell
- From the Divisions of Body CT (N.G., E.K.F., P.T.J.) and Interventional Radiology (R.L.), Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Hospital, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Elliot K Fishman
- From the Divisions of Body CT (N.G., E.K.F., P.T.J.) and Interventional Radiology (R.L.), Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Hospital, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Pamela T Johnson
- From the Divisions of Body CT (N.G., E.K.F., P.T.J.) and Interventional Radiology (R.L.), Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Hospital, 601 N Caroline St, Room 4223, Baltimore, MD 21287
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20
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Varghese A, Fader A, Wilbur M, Salimian K, Azadi JR, Johnson PT, Stone R. Peritoneal tuberculosis: the great mimicker. Int J Gynecol Cancer 2020; 30:546-550. [PMID: 32156716 DOI: 10.1136/ijgc-2020-001291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aaron Varghese
- Gynecology and Obstetrics, Gynecologic Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amanda Fader
- Gynecology and Obstetrics, Gynecologic Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - MaryAnn Wilbur
- Gynecology and Obstetrics, Gynecologic Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kevan Salimian
- Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Javad R Azadi
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pamela T Johnson
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rebecca Stone
- Gynecology and Obstetrics, Gynecologic Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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21
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Larkin M, Fishman EK, Johnson PT. The Next Topic for Digital Tech Publishing-Your Health and Wellness. J Am Coll Radiol 2020; 17:1071-1072. [PMID: 32035875 DOI: 10.1016/j.jacr.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Mark Larkin
- Executive Vice President and General Manager of the CNET Media Group at CBS Interactive, San Francisco, California
| | - Elliot K Fishman
- Professor, Johns Hopkins Medicine, Department of Radiology and Radiological Science, Department of Oncology and Department of Surgery. He serves as Director of Diagnostic Imaging and Body CT at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela T Johnson
- Professor of Radiology, Oncology and Urology, Johns Hopkins Medicine; Vice Chair of Quality and Safety in Radiology, Johns Hopkins Medicine; Vice President of Care Transformation for the Johns Hopkins Health System; Sheldon B. Bearman M.D. Professor of Radiology, Johns Hopkins Medicine, Baltimore, Maryland.
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22
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Polotsky M, Vadvala HV, Fishman EK, Johnson PT. Duodenal emergencies: utility of multidetector CT with 2D multiplanar reconstructions for challenging but critical diagnoses. Emerg Radiol 2019; 27:195-203. [PMID: 31836955 DOI: 10.1007/s10140-019-01735-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/27/2019] [Indexed: 01/07/2023]
Abstract
Duodenal pathology is an infrequent cause of acute abdominal pain for which patients present to the emergency department. Critical pathology on multidetector CT (MDCT) may be overlooked if the radiologist does not carefully evaluate the duodenum as part of the search pattern. Optimal MDCT protocols include intravenous contrast with multiplanar reconstructions (MPRs). A variety of etiologies ranging from infection to malignancy can involve the duodenum, for which interrogation with MPRs is most helpful given the anatomy and complex relationship with surrounding structures. The purpose of this review article is to highlight the importance of CT acquisition with multiplanar reconstructions and review the spectrum of emergent duodenal pathology, with the goal of ensuring accurate and timely diagnosis to best guide patient management.
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Affiliation(s)
- Mikhael Polotsky
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Harshna V Vadvala
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Pamela T Johnson
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
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23
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Hentel KD, Menard A, Mongan J, Durack JC, Johnson PT, Raja AS, Khorasani R. What Physicians and Health Organizations Should Know About Mandated Imaging Appropriate Use Criteria. Ann Intern Med 2019; 170:880-885. [PMID: 31181572 DOI: 10.7326/m19-0287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Appropriate Use Criteria Program, enacted by the Centers for Medicare & Medicaid Services in response to the Protecting Access to Medicare Act of 2014 (PAMA), aims to reduce inappropriate and unnecessary imaging by mandating use of clinical decision support (CDS) by all providers who order advanced imaging examinations (magnetic resonance imaging; computed tomography; and nuclear medicine studies, including positron emission tomography). Beginning 1 January 2020, documentation of an interaction with a certified CDS system using approved appropriate use criteria will be required on all Medicare claims for advanced imaging in all emergency department patients and outpatients as a prerequisite for payment. The Appropriate Use Criteria Program will initially cover 8 priority clinical areas, including several (such as headache and low back pain) commonly encountered by internal medicine providers. All providers and organizations that order and provide advanced imaging must understand program requirements and their options for compliance strategies. Substantial resources and planning will be needed to comply with PAMA regulations and avoid unintended negative consequences on workflow and payments. However, robust evidence supporting the desired outcome of reducing inappropriate use of advanced imaging is lacking.
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Affiliation(s)
| | - Andrew Menard
- Johns Hopkins Medicine, Baltimore, Maryland (A.M., P.T.J.)
| | - John Mongan
- University of California, San Francisco, San Francisco, California (J.M.)
| | - Jeremy C Durack
- Memorial Sloan Kettering Cancer Center, New York, New York (J.C.D.)
| | | | - Ali S Raja
- Massachusetts General Hospital, Boston, Massachusetts (A.S.R.)
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24
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Johnson PT, Raja A, Khorasani R. Solutions to Reduce Unnecessary Imaging. JAMA 2019; 321:2242. [PMID: 31184733 DOI: 10.1001/jama.2019.4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pamela T Johnson
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Raja
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
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25
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Johnson PT, Pahwa A, Brotman DJ. New frontiers in High-Value Care Education and Innovation: When Less is Not More. J Hosp Med 2019; 14:323-324. [PMID: 30986179 DOI: 10.12788/jhm.3186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/04/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Pamela T Johnson
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amit Pahwa
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel J Brotman
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Deitte LA, McGinty GB, Canon CL, Omary RA, Johnson PT, Slanetz PJ. Shifting From Mentorship to Sponsorship—A Game Changer! J Am Coll Radiol 2019; 16:498-500. [DOI: 10.1016/j.jacr.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
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Powell K, Fishman EK, Horton KM, Johnson PT, Rowe SP. What Health Care Can Learn From Self-Driving Vehicles. J Am Coll Radiol 2019; 16:261-263. [DOI: 10.1016/j.jacr.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
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Verde F, Hawasli H, Johnson PT, Fishman EK. Gastric volvulus: unraveling the diagnosis with MPRs. Emerg Radiol 2019; 26:221-225. [DOI: 10.1007/s10140-019-01669-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
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Jobs R, Fishman EK, Horton K, Johnson PT. Rethinking the Paradigm in Medical Research and Discovery. J Am Coll Radiol 2019; 16:891-893. [PMID: 30598417 DOI: 10.1016/j.jacr.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Reed Jobs
- Health Care Initiatives, Emerson Collective, Palo Alto, California
| | | | - Karen Horton
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
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Abstract
3D computed tomography (CT) visualizations of volumetric data have become an important aspect of diagnostic imaging. The utility of 3D CT has been well described for the imaging of a number of renal pathologies. Recently, a new 3D visualization technique known as cinematic rendering (CR) has become available and provides photorealistic images derived from standard CT acquisitions by use of a complex global lighting model. Herein, we describe a number of normal variant and pathologic conditions of the kidney visualized with CR. We provide comparisons of findings with CR to traditional methods of 3D imaging and comment on the potential applications of this new method of 3D CT rendering.
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Affiliation(s)
- Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA.
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA.
| | - Alexa R Meyer
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Michael A Gorin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
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Thomas RB, Johnson PT, Fishman EK. Social Media for Global Education: Pearls and Pitfalls of Using Facebook, Twitter, and Instagram. J Am Coll Radiol 2018; 15:1513-1516. [DOI: 10.1016/j.jacr.2018.01.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 10/17/2022]
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Johnson PT, Bello JA, Chatfield MB, Flug JA, Pandharipande PV, Rohatgi S, Fishman EK, Megibow AJ. New ACR Choosing Wisely Recommendations: Judicious Use of Multiphase Abdominal CT Protocols. J Am Coll Radiol 2018; 16:56-60. [PMID: 30219345 DOI: 10.1016/j.jacr.2018.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | - Jacqueline A Bello
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | - Saurabh Rohatgi
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
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Fishman EK, Johnson PT. Guidance for Graduating Residents and Fellows: Finding Joy in Medicine on the Road Not Taken. J Am Coll Radiol 2018; 16:106-107. [PMID: 30158083 DOI: 10.1016/j.jacr.2018.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
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Abstract
Assessment of residents is optimally performed through processes and platforms that provide daily feedback, which can be immediately acted on. Given the documentation required by the Accreditation Council for Graduate Medical Education (ACGME), effective data management, integration, and presentation are crucial to ease the burden of manual documentation and increase the timeliness of actionable information. To this end, the authors modeled the learning activities of residents using the Experience Application Programming Interface (xAPI) framework, which is a standard framework for the learning community. On the basis of the xAPI framework and using open-source software to extend their existing infrastructure, the authors developed a Web-based dashboard that provides residents with a more holistic view of their educational experience. The dashboard was designed around the ACGME radiology milestones and provides real-time feedback to residents using various assessment metrics derived from multiple data sources. The purpose of this article is to describe the dashboard's architecture and components, the design and technical considerations, and the lessons learned in implementing the dashboard. ©RSNA, 2018.
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Affiliation(s)
- Ashimiyu B Durojaiye
- From the Department of Radiology, Johns Hopkins Medicine, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Elizabeth Snyder
- From the Department of Radiology, Johns Hopkins Medicine, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Michael Cohen
- From the Department of Radiology, Johns Hopkins Medicine, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Paul Nagy
- From the Department of Radiology, Johns Hopkins Medicine, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Kelvin Hong
- From the Department of Radiology, Johns Hopkins Medicine, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Pamela T Johnson
- From the Department of Radiology, Johns Hopkins Medicine, 601 N Caroline St, Room 4223, Baltimore, MD 21287
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Affiliation(s)
- Pamela T. Johnson
- From the Department of Radiology, Johns Hopkins Hospital, 601 N Caroline St, Room 4223, Baltimore, MD 21287
| | - Elliot K. Fishman
- From the Department of Radiology, Johns Hopkins Hospital, 601 N Caroline St, Room 4223, Baltimore, MD 21287
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Abstract
Health care spending in the United States has increased to unprecedented levels, and these costs have broken medical providers' promise to do no harm. Medical debt is the leading contributor to U.S. personal bankruptcy, more than 50% of household foreclosures are secondary to medical debt and illness, and patients are choosing to avoid necessary care because of its cost. Evidence that the health care delivery model is contributing to patient hardship is a call to action for the profession to transition to a high-value model, one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients. As such, value improvement work is being done at academic medical centers across the country. To promote measurable improvements in practice on a national scale, academic institutions need to align efforts and create a new model for collaboration, one that transcends cross-institutional competition, specialty divisions, and geographical constraints. Academic institutions are particularly accountable because of the importance of research and education in driving this transition. Investigations that elucidate effective implementation methodologies and evaluate safety outcomes data can facilitate transformation. Engaging trainees in quality improvement initiatives will instill high-value care into their practice. This article charges academic institutions to go beyond dissemination of best practice guidelines and demonstrate accountability for high-value quality improvement implementation. By effectively transitioning to a high-value health care system, medical providers will convincingly demonstrate that patients are their most important priority.
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Affiliation(s)
- Pamela T Johnson
- P.T. Johnson is director, Appropriate Imaging, physician lead, Johns Hopkins Health System High Value Care Committee, vice chair, Quality and Safety, program director, Radiology Residency, and associate professor, Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland. M.D. Alvin is a second-year diagnostic radiology resident, Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland. R.C. Ziegelstein is vice dean for education, Johns Hopkins University School of Medicine, and professor, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK. Instagram as a Vehicle for Education: What Radiology Educators Need to Know. Acad Radiol 2018; 25:819-822. [PMID: 29751861 DOI: 10.1016/j.acra.2018.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
Since its inception in 2010, Instagram has rapidly grown into one of the world's largest social media forums, with over 700 million registered users. In the field of medicine, Instagram has been used for professional development and is also being added to the armamentarium of social media vehicles for education. Utilization of Instagram for medical education lags behind Facebook and Twitter, as many educators may not recognize the potential role. The purpose of this manuscript is to describe unique features of Instagram that are not found on Facebook and Twitter, with the aim of facilitating use of Instagram for radiology education.
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Snyder E, Solnes L, Horton KM, Johnson PT. Precision Radiology Residency Training: Special Distinction Tracks for Noninterpretative Professional Development. Acad Radiol 2018; 25:714-718. [PMID: 29751858 DOI: 10.1016/j.acra.2017.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles. MATERIALS AND METHODS Since the 2015-2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care. Each track is longitudinal, with a set of requirements throughout the residents' training necessary to achieve certification at graduation. RESULTS To date nine residents have participated in the programs, including two who received distinction in two separate tracks. Residents in each of the tracks have implemented successful initiatives related to the focus area. As such, these tracks enrich training by ensuring that residents make meaningful contributions to the department and institution during their training and disseminate successful initiatives through presentation at national meetings and publications. CONCLUSION The duration of a radiology residency and resources available in an academic center provide opportunities for residency program directors to advance residents' skills in important noninterpretative components of radiology practice. Regardless of whether residents pursue academic medicine or private practice, these skills are necessary for graduates to become valuable members of a radiology practice and serve as national leaders in the field of radiology.
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Affiliation(s)
- Elizabeth Snyder
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842
| | - Lilja Solnes
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842
| | - Karen M Horton
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842
| | - Pamela T Johnson
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842.
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Kim DC, Herskovits EH, Johnson PT. Science to Practice: IT Solutions to Drive Standardized Report Recommendations for Abdominal Aortic Aneurysm Surveillance. J Am Coll Radiol 2018; 15:865-869. [DOI: 10.1016/j.jacr.2018.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 12/11/2022]
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40
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Childers BC, Cater SW, Horton KM, Fishman EK, Johnson PT. CT Evaluation of Acute Enteritis and Colitis: Is It Infectious, Inflammatory, or Ischemic? Radiographics 2018. [DOI: 10.1148/rg.2015150125.pres] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Snepar J, Fishman EK, Horton KM, Johnson PT, Rowe SP. Launching a Successful Startup: An Entrepreneur's Field Guide. J Am Coll Radiol 2018; 15:1521-1522. [PMID: 29784625 DOI: 10.1016/j.jacr.2018.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen M Horton
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Greenberg P, Johnson MB, Fishman EK, Johnson PT. Understanding the Rapidly Changing Business Landscape: A Primer for Medical Personnel. J Am Coll Radiol 2018; 15:928-930. [PMID: 29729980 DOI: 10.1016/j.jacr.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Elliot K Fishman
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
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43
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Rowe SP, Gorin MA, Allaf ME, Johnson PT, Fishman EK. Photorealistic 3-Dimensional Cinematic Rendering of Clear Cell Renal Cell Carcinoma From Volumetric Computed Tomography Data. Urology 2018; 115:e3-e5. [DOI: 10.1016/j.urology.2018.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 12/19/2022]
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44
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Johnson PT, Fishman EK. Enhancing Image Quality in the Era of Radiation Dose Reduction: Postprocessing Techniques for Body CT. J Am Coll Radiol 2018; 15:486-488. [DOI: 10.1016/j.jacr.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Rowe SP, Zimmerman SL, Johnson PT, Fishman EK. Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering. Emerg Radiol 2018; 25:449-453. [DOI: 10.1007/s10140-018-1594-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/21/2018] [Indexed: 12/19/2022]
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46
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Rowe SP, Johnson PT, Fishman EK. Cinematic rendering of cardiac CT volumetric data: Principles and initial observations. J Cardiovasc Comput Tomogr 2018; 12:56-59. [DOI: 10.1016/j.jcct.2017.11.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/30/2017] [Indexed: 12/29/2022]
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47
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Johnson PT, Thomas RB, Fishman EK. Facebook Live: A Free Real-Time Interactive Information Platform. J Am Coll Radiol 2018; 15:201-204. [DOI: 10.1016/j.jacr.2017.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022]
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48
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Abstract
Three-dimensional (3D) CT with volume rendering and maximum intensity projection is an integral component of CT interpretation for diagnosis and treatment planning of vascular pathology. Cinematic rendering is a new rendering algorithm that incorporates a more advanced lighting model than that used for volume rendering, to create photorealistic 3D CT images. The post-processing tool is not yet widely available and its ultimate clinical utility has yet to be assessed in well-designed studies. Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient-centred care. In this pictorial essay, a series of complex cardiovascular cases are presented to demonstrate the enhanced display capabilities associated with cinematic rendering, and the utility to guide patient management and understanding is discussed.
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Affiliation(s)
- Steven P Rowe
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Pamela T Johnson
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
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49
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Spear T, Horton KM, Fishman EK, Johnson PT. Transforming the Health Care Experience: Doctors, Nurses, Patients, and Beyond. J Am Coll Radiol 2017; 14:1369-1371.e1. [PMID: 28427908 DOI: 10.1016/j.jacr.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Karen M Horton
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pamela T Johnson
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland.
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50
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Johnson PT, Schneider R, Lugo-Fagundo C, Johnson MB, Fishman EK. MDCT Angiography With 3D Rendering: A Novel Cinematic Rendering Algorithm for Enhanced Anatomic Detail. AJR Am J Roentgenol 2017; 209:309-312. [DOI: 10.2214/ajr.17.17903] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pamela T. Johnson
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
| | - Robert Schneider
- Department of Diagnostic Imaging, Siemens Healthcare, Erlangen, Germany
| | - Carolina Lugo-Fagundo
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
| | - Michael B. Johnson
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
| | - Elliot K. Fishman
- Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N Caroline St, Rm 4223, Baltimore, MD 21287
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