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Background In the present study, we retrospectively evaluated the use of tomographic imaging in adult cancer patients to clarify how recent growth plateaus in the use of tomographic imaging in the United States might have affected oncologic imaging during the same period. Methods At a U.S. academic cancer centre, 12,059 patients with dates of death from January 2000 through December 2014 were identified. Imaging was restricted to brain and body computed tomography (CT), brain and body magnetic resonance (MR), and body positron-emission tomography (PET) with and without superimposed CT. Trends during the staging (1 year after diagnosis), monitoring (18-6 months before death), and end-of-life (final 6 months before death) phases were analyzed. Results Comparing the 2005-2009 with the 2010-2014 period, mean intensity of PET imaging increased 21% during staging (p = 0.0000) and 27% during end of life (p = 0.0019). In the monitoring phase, mean intensity for CT brain, CT body, and MR body imaging decreased by 26% (p = 0.0133), 11% (p = 0.0118), and 26% (p = 0.0008), respectively. Aggregate mean intensity of imaging increased in the 13%-27% range every 3 months from 18 months before death to death, reaching 1.43 images in the final 3 months of life. Patients diagnosed in the final 18 months of life had an average of 1 additional image during both the 3 months after diagnosis (p = 0.0000) and the final 3 months before death (p = 0.0000). Conclusions Imaging increased as temporal proximity to death decreased, and patients diagnosed near death received more staging imaging, suggesting that imaging guidelines should consider imaging intensity within the context of treatment phase. Despite the development, by multiple organizations, of appropriateness criteria to reduce imaging utilization, aggregate per-patient imaging showed insignificant changes. Simultaneous fluctuations in the intensity of imaging by modality suggest recent changes in the modalities preferred by providers. [ABSTRACT FROM AUTHOR]

Background: Recent radiologist compensation and clinical productivity trends have not been well characterized, especially across academic versus nonacademic practice settings., Purpose: To assess recent trends in in financial compensation and clinical productivity between academic and nonacademic settings in diagnostic radiology (DR) and interventional radiology (IR)., Materials and Methods: We studied deidentified data from the Medical Group Management Association for both DR and IR physicians in academic and nonacademic practices from 2014 to 2023. Median, 25th and 75th percentiles, and mean values were analyzed for compensation, collections, and work relative value units (wRVUs). Compensation and productivity data were compared by radiology subspecialty (DR versus IR), practice type (academic versus nonacademic provider), geographical region of the United States, and practice size. Trends in absolute changes were analyzed with linear regression., Results: The Medical Group Management Association Survey data for 2023 included responses for 3,769 radiologists (2,883 in DR and 886 in IR). In 2023, nonacademic radiologists had greater total median compensation than academic faculty in both DR (by 27%) and IR (by 32%). From 2014 to 2023, median compensation increased faster for academic DR physicians (3.2% annually) than for nonacademic DR physicians (1.9% annually). In 2023, DR physicians produced greater median wRVUs than IR physicians (by 53% for nonacademic and 46% for academic radiologists) with higher collections, but IR physicians had higher compensation (by 16% in nonacademic and 10% in academic settings). Over the last decade, IR physician compensation increased by 3.9% and 3.4% annually for nonacademic and academic IR physicians, respectively, whereas median wRVUs trended downward (by -1.5% for nonacademic and -2.4% for academic physicians) with declining collections (by -4.4% annually for nonacademic and -2.1% for academic physicians)., Conclusion: Over the last decade, the salary gap between academic and nonacademic radiologists has narrowed. Physician compensation has increased at a faster pace in IR, despite relatively lower clinical productivity and declining collections., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The field of patient engagement in radiology is evolving and offers ample opportunities for neuroradiologists to become involved. The patient journey can serve as a model that inspires patient engagement initiatives. The patient journey in radiology may be viewed in 5 stages: 1) awareness that an imaging test is needed, 2) considering having a specific imaging test, 3) access to imaging, 4) imaging service delivery, and 5) ongoing care. Here, we describe patient engagement opportunities based on literature review and paired with case studies by practicing neuroradiologists., (© 2024 by American Journal of Neuroradiology.)

Background and Purpose: Approaches to management of intracranial aneurysms are inconsistent, in part due to apprehension relating to potential malpractice claims. The purpose of this article was to review the causes of action underlying medical malpractice lawsuits related to the diagnosis and management of intracranial aneurysms and to identify the factors associated and their outcomes., Materials and Methods: We consulted 2 large legal databases in the United States to search for cases in which there were jury awards and settlements related to the diagnosis and management of patients with intracranial aneurysms in the United States. Files were screened to include only those cases in which the cause of action involved negligence in the diagnosis and management of a patient with an intracranial aneurysm., Results: Between 2000 and 2020, two hundred eighty-seven published case summaries were identified, of which 133 were eligible for inclusion in the analysis. Radiologists constituted 16% of 159 physicians sued in these lawsuits. Failure to diagnose was the most common medical malpractice claim referenced (100/133 cases), with the most common subgroups being "failure to include cerebral aneurysm as a differential and thus perform adequate work-up" (30 cases), and "failure to correctly interpret aneurysm evidence on CT or MR imaging" (16 cases). Only 6 of these 16 cases were adjudicated at trial, with 2 decided in favor of the plaintiff (awarded $4,000,000 and $43,000,000, respectively)., Conclusions: Incorrect interpretation of imaging is relatively infrequent as a cause of malpractice litigation compared with failure to diagnose aneurysms in the clinical setting by neurosurgeons, emergency physicians, and primary care providers., (© 2023 by American Journal of Neuroradiology.)

Objective: This observational study explores the association between palliative care (PC) involvement and high-cost imaging utilisation for patients with cancer patients during the last 3 months of life., Methods: Adult patients with cancer who died between 1 January 2012 and 31 May 2015 were identified. Referral to PC, intensity of PC service use, and non-emergent oncological imaging utilisation were determined. Associations between PC utilisation and proportion of patients imaged and mean number of studies per patient (mean imaging intensity (MII)) were assessed for the last 3 months and the last month of life. Similar analyses were performed for randomly matched case-control pairs (n = 197). Finally, the association between intensity of PC involvement and imaging utilisation was assessed., Results: 3784 patients were included, with 3523 (93%) never referred to PC and 261 (7%) seen by PC, largely before the last month of life (61%). Similar proportions of patients with and without PC referral were imaged during the last 3 months, while a greater proportion of patients with PC referral were imaged in the last month of life. PC involvement was not associated with significantly different MII during either time frame. In the matched-pairs analysis, a greater proportion of patients previously referred to PC received imaging in the period between the first PC encounter and death, and in the last month of life. MII remained similar between PC and non-PC groups. Finally, intensity of PC services was similar for imaged and non-imaged patients in the final 3 months and 1 month of life. During these time periods, increased PC intensity was not associated with decreased MII., Conclusions: PC involvement in end-of-life oncological care was not associated with decreased use of non-emergent, high-cost imaging. The role of advanced imaging in the PC setting requires further investigation., Competing Interests: Competing interests: SZP reports grants from the Alafi Family Foundation, Stupski Foundation, and Hellman Family Foundation during the conduct of the study. DS reports financial reimbursements from the American College of Radiology, American Society of Neuroradiology, National Quality Forum, Centers for Medicare and Medicaid Services, Health Services Advisory Group, Sutter Medical Group, and Radiological Associates Medical Group outside the submitted work; and DS receives financial reimbursement for serving as an expert witness and a medical consultant for several legal cases., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Care gaps occur when radiology follow-up recommendations are poorly communicated or not completed, resulting in missed or delayed diagnosis potentially leading to worse patient outcomes. This ACR-led initiative assembled a technical expert panel (TEP) to advise development of quality measures intended to improve communication and drive increased completion rates for radiology follow-up recommendations., Materials and Methods: A multistakeholder TEP was assembled to advise the development of quality measures. The project scope, limited to noncritical actionable incidental findings (AIFs), encourages practices to develop and implement systems ensuring appropriate communication and follow-up to completion., Results: A suite of nine measures were developed: four outcome measures include closing the loop on completion of radiology follow-up recommendations for nonemergent AIFs (with pulmonary nodule and abdominal aortic aneurysm use cases) and overall cancer diagnoses. Five process measures address communication and tracking of AIFs: inclusion of available evidence or guidelines informing the recommendation, communication of AIFs to the practice managing ongoing care, identifying when AIFs have been communicated to the patient, and employing tracking and reminder systems for AIFs., Conclusion: This ACR-led initiative developed a measure set intended to improve patient outcomes by ensuring that AIFs are appropriately communicated and followed up. The intent of these measures is to focus improvement on specific areas in which gaps in communication and AIF follow-up may occur, prompting systems to devote resources that will identify and implement solutions to improve patient care., (Copyright © 2022 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare non-physician healthcare professional and radiologists' survey responses regarding attitudes and current practices, policies, and procedures related to the follow-up of nonemergent actionable incidental findings (AIF)., Materials and Methods: The American College of Radiology (ACR) developed a survey with input from a technical expert panel (TEP). Survey items were developed by TEP members, refined by an ACR market research expert, and were examined for face and construct validity. The survey was distributed among ACR membership and various medical professional organizations. Responses from non-physician responders and radiologists were analyzed and compared using descriptive statistics., Results: The analysis included 375 responses, 247 from radiologists and 128 from non-physicians. All respondent groups stated that radiology follow-up recommendations are evidence-based. Both respondent groups indicated that there is up to moderate risk associated with AIF follow-up. Both respondent groups similarly favored that the accountability for communicating AIF lies first with the ordering provider, followed by primary care providers, then the patient, and lastly an automated process that is managed by a staff member and/or the radiologist. All respondent groups indicated that tracking processes were more commonly funded by the healthcare system than through the radiology budget., Conclusion: There is alignment between non-physicians and radiologists regarding the implementation of tracking systems that assure completion of radiology follow-up recommendations. Building tracking systems represents an opportunity for multi-disciplinary collaboration to address care transition communication and process gaps., (Copyright © 2021 Elsevier Inc. All rights reserved.)

To develop a method for calculating rates of testing for breast cancer recurrence in patients who have already undergone initial treatment for breast cancer, we calculated rates in a cohort of Medicare breast cancer patients and an age-matched noncancer cohort. We first used only tests with claims including diagnosis codes indicating invasive breast cancer and then used all tests regardless of diagnosis code. For each method, we calculated testing rates in the breast cancer cohort above the background rate in the noncancer population. The two methods provided similar estimates of testing prevalence and frequency, with exception of prevalence of CT., (© 2019 Wiley Periodicals, Inc.)

Objective: High-quality screening mammography has been shown to substantially reduce mortality from breast cancer. Recall rate is a principal performance metric for screening mammography because it directly relates to the rate of false-positive examinations. This study aims to compare the recall rate derived using two sources-the claims-based Hospital Compare (HC) dataset from the Centers for Medicare & Medicaid Services versus the National Mammography Database (NMD) from the American College of Radiology-to understand the implications in pay-for-performance and quality improvement activities., Materials and Methods: This study retrospectively compared the recall rate reported by NMD facilities with that reported in the HC dataset. Site matching was performed by facility name and zip code, followed by manual verification. Scatterplots, correlations, a paired t test, and Bland-Altman analysis were performed to assess association between the two measures., Results: During the period from October 1 to December 1, 2016, 92 facilities were unambiguously matched using 2014-2015 records in both datasets. The recall rates were positively correlated (r = 0.428, p < 0.001), but the mean HC recall rate (8.5% ± 2.86% [SD]) was significantly (p < 0.001) lower than the mean NMD recall rate (10.6% ± 3.90%)., Conclusion: The NMD and HC are two commonly used datasets for measuring screening mammography recall rate. Although recall rates are correlated at the individual facility level, there are important differences that have implications for quality improvement and pay-for-performance.

Background: The objective of this study was to examine the presence and magnitude of US geographic variation in use rates of both recommended and high-cost imaging in young patients with early-stage breast cancer during the 18 month period after surgical treatment of their primary tumor. Methods: Using the Truven Health MarketScan Commercial Database, a descriptive analysis was conducted of geographic variation in annual rates of dedicated breast imaging and high-cost body imaging of 36,045 women aged 18 to 64 years treated with surgery for invasive unilateral breast cancer between 2010 and 2012. Multivariate hierarchical analysis examined the relationship between likelihood of imaging and patient characteristics, with metropolitan statistical area (MSA) serving as a random effect. Patient characteristics included age group, BRCA1 /2 carrier status, family history of breast cancer, combination of breast surgery type and radiation therapy, drug therapy, and payer type. All MSAs in the United States were included, with areas outside MSAs within a given state aggregated into a single area for analytic purposes. Results: Descriptive analysis of rates of imaging use and intensity within MSA regions revealed wide geographic variation, irrespective of treatment cohort or age group. Increased probability of recommended postoperative dedicated breast imaging was primarily associated with age and treatment including both surgery and radiation therapy, followed by MSA region (odds ratio, 1.42). Increased probability of PET use-a high-cost imaging modality for which postoperative routine use is not recommended in the absence of specific clinical findings-was primarily associated with surgery type followed by MSA region (odds ratio, 1.82). Conclusions: In patients with breast cancer treated for low-risk disease, geography has effects on the rates of posttreatment imaging, suggesting that some patients are not receiving beneficial dedicated breast imaging, and high-cost nonbreast imaging may not be targeted to those groups most likely to benefit., (Copyright © 2018 by the National Comprehensive Cancer Network.)

A major outcome of the current health care reform process is the move away from unrestricted fee-for-service payment models toward those that are based on the delivery of better patient value and outcomes. The authors' purpose, therefore, is to critically evaluate and define those components of the overall imaging enterprise that deliver meaningful value to both patients and referrers and to determine how these components might be measured and quantified. These metrics might then be used to lobby providers and payers for sustainable payment solutions for radiologists and radiology services. The authors evaluated radiology operations and services using the framework of the imaging value chain, which divides radiology service into a number of discrete value-added activities, which ultimately deliver the primary product, most often the actionable report for diagnostic imaging or an effective outcome for interventional radiology. These value activities include scheduling and imaging appropriateness and stewardship, patient preparation, protocol design, modality operations, reporting, report communication, and clinical follow-up (eg, mammography reminder letters). Two further categories are hospital or health care organization citizenship and examination outcome. Each is discussed in turn, with specific activities highlighted., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Bundled or episode payments are among the most heavily emphasized approaches to aligning incentives and promoting care coordination, efficiency, and accountability in health care redesign. Bundled or episode payments price a market basket of services for an entire episode of care with both a clearly defined trigger and termination. Because the radiologist is "ancillary" in many bundles, the specialty is often unaware of the phenomenon. This is likely to change rapidly. Radiology is pivotal in high-prevalence, high-impact care areas such as low back pain and stroke that are focuses of widely used system performance metrics. More important, radiology is central to the diagnosis and management of a wide range of important diagnostic issues in areas such as breast cancer, pulmonary nodules, and incidental findings. Three models of bundled care will probably involve radiology intimately in the near future. Pure radiology bundles might be constructed for breast cancer screening and diagnosis, and these could be priced on the basis of guideline-based best-practice frequencies of care events such as recall and biopsy. Clinical bundles, for example low back pain, could be priced on the basis of optimal imaging frequencies. Finally, pricing of imaging studies might include evidence-based frequencies of follow-up imaging for incidental findings., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)