1
|
Nguyen DL, Ren Y, Jones TM, Thomas SM, Lo JY, Grimm LJ, Gamagami E. Patient Characteristics Impact Performance of AI Algorithm in Interpreting Negative Screening Digital Breast Tomosynthesis Studies. Radiology 2024; 311:e232286. [PMID: 38771177 PMCID: PMC11140531 DOI: 10.1148/radiol.232286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/22/2024] [Accepted: 03/25/2024] [Indexed: 05/22/2024]
Abstract
Background Artificial intelligence (AI) is increasingly used to manage radiologists' workloads. The impact of patient characteristics on AI performance has not been well studied. Purpose To understand the impact of patient characteristics (race and ethnicity, age, and breast density) on the performance of an AI algorithm interpreting negative screening digital breast tomosynthesis (DBT) examinations. Materials and Methods This retrospective cohort study identified negative screening DBT examinations from an academic institution from January 1, 2016, to December 31, 2019. All examinations had 2 years of follow-up without a diagnosis of atypia or breast malignancy and were therefore considered true negatives. A subset of unique patients was randomly selected to provide a broad distribution of race and ethnicity. DBT studies in this final cohort were interpreted by a U.S. Food and Drug Administration-approved AI algorithm, which generated case scores (malignancy certainty) and risk scores (1-year subsequent malignancy risk) for each mammogram. Positive examinations were classified based on vendor-provided thresholds for both scores. Multivariable logistic regression was used to understand relationships between the scores and patient characteristics. Results A total of 4855 patients (median age, 54 years [IQR, 46-63 years]) were included: 27% (1316 of 4855) White, 26% (1261 of 4855) Black, 28% (1351 of 4855) Asian, and 19% (927 of 4855) Hispanic patients. False-positive case scores were significantly more likely in Black patients (odds ratio [OR] = 1.5 [95% CI: 1.2, 1.8]) and less likely in Asian patients (OR = 0.7 [95% CI: 0.5, 0.9]) compared with White patients, and more likely in older patients (71-80 years; OR = 1.9 [95% CI: 1.5, 2.5]) and less likely in younger patients (41-50 years; OR = 0.6 [95% CI: 0.5, 0.7]) compared with patients aged 51-60 years. False-positive risk scores were more likely in Black patients (OR = 1.5 [95% CI: 1.0, 2.0]), patients aged 61-70 years (OR = 3.5 [95% CI: 2.4, 5.1]), and patients with extremely dense breasts (OR = 2.8 [95% CI: 1.3, 5.8]) compared with White patients, patients aged 51-60 years, and patients with fatty density breasts, respectively. Conclusion Patient characteristics influenced the case and risk scores of a Food and Drug Administration-approved AI algorithm analyzing negative screening DBT examinations. © RSNA, 2024.
Collapse
Affiliation(s)
| | | | - Tyler M. Jones
- From the Department of Radiology, Duke University School of Medicine,
10 Duke Medicine Cir, Durham, NC 27710 (D.L.N., J.Y.L., L.J.G.); Pratt School of
Engineering (Y.R.) and Department of Biostatistics and Bioinformatics (T.M.J.,
S.M.T.), Duke University, Durham, NC; and iCAD, Nashua, NC (Y.R.)
| | - Samantha M. Thomas
- From the Department of Radiology, Duke University School of Medicine,
10 Duke Medicine Cir, Durham, NC 27710 (D.L.N., J.Y.L., L.J.G.); Pratt School of
Engineering (Y.R.) and Department of Biostatistics and Bioinformatics (T.M.J.,
S.M.T.), Duke University, Durham, NC; and iCAD, Nashua, NC (Y.R.)
| | - Joseph Y. Lo
- From the Department of Radiology, Duke University School of Medicine,
10 Duke Medicine Cir, Durham, NC 27710 (D.L.N., J.Y.L., L.J.G.); Pratt School of
Engineering (Y.R.) and Department of Biostatistics and Bioinformatics (T.M.J.,
S.M.T.), Duke University, Durham, NC; and iCAD, Nashua, NC (Y.R.)
| | - Lars J. Grimm
- From the Department of Radiology, Duke University School of Medicine,
10 Duke Medicine Cir, Durham, NC 27710 (D.L.N., J.Y.L., L.J.G.); Pratt School of
Engineering (Y.R.) and Department of Biostatistics and Bioinformatics (T.M.J.,
S.M.T.), Duke University, Durham, NC; and iCAD, Nashua, NC (Y.R.)
| | - Eileen Gamagami
- From the Department of Radiology, Duke University School of Medicine,
10 Duke Medicine Cir, Durham, NC 27710 (D.L.N., J.Y.L., L.J.G.); Pratt School of
Engineering (Y.R.) and Department of Biostatistics and Bioinformatics (T.M.J.,
S.M.T.), Duke University, Durham, NC; and iCAD, Nashua, NC (Y.R.)
| |
Collapse
|
2
|
Jackson T, Wahab RA, Bankston K, Mehta TS. Raising Cultural Awareness and Addressing Barriers to Breast Imaging Care for Black Women. JOURNAL OF BREAST IMAGING 2024; 6:72-79. [PMID: 38142231 DOI: 10.1093/jbi/wbad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 12/25/2023]
Abstract
Health care disparities, which are differences in the attainment of full health potential among population groups, have been documented across medical conditions, clinical settings, and diagnostic and treatment modalities. Deeply rooted health care disparities due to many factors have affected how Black women (BW) view medical care including screening mammography. This article explores health care disparities around breast cancer in BW and how patient distrust, provider biases, race, and social determinants of health continue to have negative effects on breast cancer outcomes in BW, despite medical advances in breast cancer detection and management. In addition, this article addresses the importance of culturally competent care for BW around breast cancer awareness, screening, and treatment, and offers strategies to address disparities and rebuild trust.
Collapse
Affiliation(s)
- Tatianie Jackson
- Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Karen Bankston
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Tejas S Mehta
- Department of Radiology, UMass Memorial Medical Center/UMass Chan Medical School, Worcester, MA, USA
| |
Collapse
|
3
|
Paluch J, Kohr J, Squires A, Loving V. Patient-centered Care and Integrated Practice Units: Embracing the Breast Care Continuum. JOURNAL OF BREAST IMAGING 2022; 4:413-422. [PMID: 38416987 DOI: 10.1093/jbi/wbac031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Indexed: 03/01/2024]
Abstract
Patient-centered care is a health care approach optimized for the needs of the patient. As patients have sought more autonomy in recent years, this model has been more frequently adopted. Breast radiologists aspiring to advance patient-centered care should seek greater ownership of the breast diagnostic imaging and intervention workflows, helping their patients navigate the complex breast care landscape with patients' preferences taken into account. Applying this approach to breast radiology will increase patient satisfaction and compliance while also limiting wasted health care dollars, unnecessary diagnostic delays, and overall confusion. Herein, the benefits of patient-centered breast radiology are discussed, and numerous suggestions and case examples are provided to help readers reshape their practice toward the priorities of their patients.
Collapse
Affiliation(s)
- Jeremy Paluch
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | - Jennifer Kohr
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | | | - Vilert Loving
- Banner MD Anderson Cancer Center, Division of Diagnostic Imaging, Gilbert, AZ, USA
| |
Collapse
|
4
|
Amornsiripanitch N, Chikarmane SA, Cochon LR, Khorasani R, Giess CS. Electronic Worklist Improves Timeliness of Screening Mammogram Interpretation in an Urban Underserved Population. Curr Probl Diagn Radiol 2021; 51:323-327. [PMID: 34266693 DOI: 10.1067/j.cpradiol.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the impact of an electronic workflow update on screening mammography turnaround time and time to diagnostic imaging for mammography performed on our urban mobile mammography van and at an urban community health center. METHOD Prior to 10/15/2019, screening exams for the mammography van and urban community health center were made available for interpretation to a single designated radiologist via a manually generated paper list. On 10/15/2019, screening exams were routed electronically onto PACS for any breast radiologist across our Network to interpret. Screening mammogram turnaround time (defined as time form image acquisition to report finalization), time to diagnostic imaging, and time to tissue sampling were collected for pre- and post-implementation periods (6/1-9/30/2019 and 11/1/2019-2/29/2020, respectively) and compared via student t-test and statistical process control analyses. RESULTS The number of screening exams in the pre- and post-implementation periods were 851 and 728 exams, respectively. Patients were predominately Black and/or African American (400/1579, 25%), non-English speaking (858/1579, 54%) and insured by Medicaid (751/1579, 48%). After implementation of the electronic workflow, turnaround time decreased from 101.0 to 36.4 hours (63.9%, P <0.001) and statistical process control analyses showed sustained decrease in mean turnaround time. However, mean time to diagnostic imaging and tissue sampling were unchanged after implementation (39 vs 45, days; P = 0.330 and 43 vs 59; P = 0.187, respectively). CONCLUSION Electronic workflow management can reduce screening mammography turnaround time for underserved populations, but additional efforts are warranted to improve time to imaging follow-up for abnormal screening mammograms.
Collapse
Affiliation(s)
| | | | - Laila R Cochon
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115
| | - Ramin Khorasani
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115
| | | |
Collapse
|
5
|
Burns J, Ciccarelli S, Mardakhaev E, Erdfarb A, Goldberg-Stein S, Bello JA. Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions. J Am Coll Radiol 2021; 18:1297-1309. [PMID: 33989534 DOI: 10.1016/j.jacr.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Handoffs are essential to achieving safe care transitions. In radiology practice, frequent transitions of care responsibility among clinicians, radiologists, and patients occur between moments of care such as determining protocol, imaging, interpreting, and consulting. Continuity of care is maintained across these transitions with handoffs, which are the process of communicating patient information and transferring decision-making responsibility. As a leading cause of medical error, handoffs are a major communication challenge that is exceedingly common in both diagnostic and interventional radiology practice. The frequency of handoffs in radiology underscores the importance of using evidence-based strategies to improve patient safety in the radiology department. In this article, reliability science principles and handoff improvement tools are adapted to provide radiology-focused strategies at individual, team, and organizational levels with the goal of minimizing handoff errors and improving care transitions.
Collapse
Affiliation(s)
- Judah Burns
- Chair, Montefiore Medical Center Peer Review Board; Program Director, Montefiore Medical Center Diagnostic Radiology Residency Program; Department of Radiology, Montefiore Medical Center, Bronx, New York.
| | | | | | - Amichai Erdfarb
- Director of Quality and Safety, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Shlomit Goldberg-Stein
- Director of Operational Improvement, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Jacqueline A Bello
- Vice Chair, Board of Chancellors, American College of Radiology; Section Chief of Neuroradiology, Montefiore Medical Center; Department of Radiology, Montefiore Medical Center, Bronx, New York
| |
Collapse
|
6
|
Patel MM, Parikh JR. Patient Diversity in Breast Imaging: Barriers and Potential Solutions. JOURNAL OF BREAST IMAGING 2021; 3:98-105. [PMID: 38424834 DOI: 10.1093/jbi/wbaa092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 03/02/2024]
Abstract
Recent reports have highlighted disparities in breast cancer care related to patient diversity. Breast radiologists represent the face of breast imaging and are key players in advocating for patients to reduce these disparities. Diversity-related barriers for breast imaging patients, as they journey from screening to survivorship, include impediments to access and quality of care, gaps in communication, and lack of knowledge in both providers and patients. Potential strategies for overcoming these specific barriers include "culturally tailored" nurse navigators, mobile mammography, improved communication, patient and provider education, and breast radiologist involvement in advocacy efforts promoting diversity. As current trends in recommendations and guidelines for breast imaging include more numerous and advanced imaging modalities, it is important to acknowledge and address diversity-related disparities.
Collapse
Affiliation(s)
- Miral M Patel
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| |
Collapse
|
7
|
Engaging patients and families in pediatric radiology. Pediatr Radiol 2020; 50:1492-1498. [PMID: 32935240 DOI: 10.1007/s00247-020-04742-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/17/2020] [Accepted: 05/22/2020] [Indexed: 10/23/2022]
Abstract
While patient and family-centered care (PFCC) is currently a hot topic in medicine, it has long been a specific focus of pediatrics. The concept of PFCC includes a change in culture where physicians and patients move away from paternalism and instead view patients and families as partners in care. Although there are many ways in which adult-focused radiologists can learn from pediatric radiologists as leaders in PFCC, there remain many opportunities for improvement for all radiologists.
Collapse
|
8
|
Nguyen DL, Oluyemi E, Myers KS, Harvey SC, Mullen LA, Ambinder EB. Impact of Telephone Communication on Patient Adherence With Follow-Up Recommendations After an Abnormal Screening Mammogram. J Am Coll Radiol 2020; 17:1139-1148. [DOI: 10.1016/j.jacr.2020.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
|
9
|
Impact of Improved Screening Mammography Recall Lay Letter Readability on Patient Follow-Up. J Am Coll Radiol 2020; 17:1429-1436. [PMID: 32738226 PMCID: PMC7390731 DOI: 10.1016/j.jacr.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE In the setting of abnormal results on screening mammography, the Mammography Quality Standards Act mandates that patients receive a mailed "recall" lay letter informing them to return for additional follow-up imaging. The language used in this letter should be "easily understood by a lay person." In February 2019, the authors' institution revised the language of its recall lay letter to the sixth grade reading level. The purpose of this study was to analyze the effect of improved readability on patient follow-up rates. METHODS In this retrospective study, data from all screening mammograms at a single institution with BI-RADS category 0 assessments excluding technical recalls between February 2018 to February 2019 (pre-intervention group) and February 2019 to February 2020 (post-intervention group) were reviewed. The primary outcome measure was the percentage of patients in each intervention group who returned for their diagnostic follow-up examination within 60 days (the standard recommended by the Centers for Disease Control and Prevention). Univariate and multivariate logistic regression was done to estimate odds ratios and 95% confidence intervals for follow-up within 60 days. RESULTS This study included 1,987 patients in the pre-intervention group and 2,211 patients in the post-intervention group. The patient follow-up rate within 60 days increased from 90.1% (1,790 of 1,987) in the pre-intervention group to 93.9% (2,076 of 2,211) in the post-intervention group (P < .001). When controlling for imaging site, patients in the post-intervention group had 1.96-fold increased odds of returning for a diagnostic follow-up examination within 60 days (95% confidence interval, 1.52-2.53). CONCLUSIONS Revising an institution's recall lay letter to a lower reading grade level significantly improved timely patient follow-up.
Collapse
|
10
|
Nguyen DL, Ambinder EB, Jones MK, Mullen LA, Harvey SC. Improving State-Mandated Breast Density Notifications. J Am Coll Radiol 2020; 17:384-390. [DOI: 10.1016/j.jacr.2019.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/13/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
|