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Magudia K, Arleo EK, Porter KK, Ng TSC. A Practical Guide for Paid Family and Medical Leave in Radiology, From the AJR Special Series on DEI. AJR Am J Roentgenol 2023; 221:575-581. [PMID: 37195791 DOI: 10.2214/ajr.23.29327] [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] [Indexed: 05/18/2023]
Abstract
Paid family and medical leave (FML) has significant benefits to organizations, including improvements in employee recruitment and retention, workplace culture, and employee morale and productivity, and is supported by evidence for overall cost savings. Furthermore, paid FML related to childbirth has significant benefits to individuals and families, including but not limited to improved maternal and infant health outcomes and improved breastfeeding initiation and duration. In the case of nonchildbearing parental leave, paid FML is associated with more equitable long-term division of household labor and childcare. Paid FML is increasingly being recognized as an important issue in medicine, as evidenced by the recent passage of policies by national societies and governing bodies, including the American Board of Medical Specialties, American Board of Radiology, Accreditation Council for Graduate Medical Education (ACGME), American College of Radiology, and American Medical Association. Implementation of paid FML requires adherence to federal, state, and local laws as well as institutional requirements. Specific requirements pertain to trainees from national governing bodies, such as the ACGME and medical specialty boards. Flexibility, work coverage, culture, and finances are additional considerations for ensuring an optimal paid FML policy that accounts for concerns of all impacted individuals.
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Affiliation(s)
- Kirti Magudia
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Elizabeth K Arleo
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY
| | | | - Thomas S C Ng
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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Arif-Tiwari H, Porter KK, Kamel IR, Bashir MR, Fung A, Kaplan DE, McGuire BM, Russo GK, Smith EN, Solnes LB, Thakrar KH, Vij A, Wahab SA, Wardrop RM, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Abnormal Liver Function Tests. J Am Coll Radiol 2023; 20:S302-S314. [PMID: 38040457 DOI: 10.1016/j.jacr.2023.08.023] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Liver function tests are commonly obtained in symptomatic and asymptomatic patients. Various overlapping lab patterns can be seen due to derangement of hepatocytes and bile ducts function. Imaging tests are pursued to identify underlying etiology and guide management based on the lab results. Liver function tests may reveal mild, moderate, or severe hepatocellular predominance and can be seen in alcoholic and nonalcoholic liver disease, acute hepatitis, and acute liver injury due to other causes. Cholestatic pattern with elevated alkaline phosphatase with or without elevated γ-glutamyl transpeptidase can be seen with various causes of obstructive biliopathy. Acute or subacute cholestasis with conjugated or unconjugated hyperbilirubinemia can be seen due to prehepatic, intrahepatic, or posthepatic causes. We discuss the initial and complementary imaging modalities to be used in clinical scenarios presenting with abnormal liver function tests. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona.
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alice Fung
- Oregon Health & Science University, Portland, Oregon
| | - David E Kaplan
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; American Association for the Study of Liver Diseases
| | - Brendan M McGuire
- University of Alabama at Birmingham, Birmingham, Alabama, Primary care physician
| | | | - Elainea N Smith
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Lilja Bjork Solnes
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Abhinav Vij
- New York University Langone Medical Center, New York, New York
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Richard M Wardrop
- Cleveland Clinic, Cleveland, Ohio; American College of Physicians, Hospital Medicine
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Borhani A, Porter KK, Umair M, Chu LC, Mathai SC, Kolb TM, Damico RL, Hassoun PM, Kamel IR, Zimmerman SL. Quantifying 4D flow cardiovascular magnetic resonance vortices in patients with pulmonary hypertension: A pilot study. Pulm Circ 2023; 13:e12298. [PMID: 37859803 PMCID: PMC10583650 DOI: 10.1002/pul2.12298] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
In this 4D flow cardiovascular magnetic resonance (CMR) study, vortical blood flow in the main pulmonary artery (MPA) is quantified using circulation (ᴦ), a metric used in fluid dynamics to quantify the rotational components of flow. Circulation (ᴦ) is a 4D flow CMR metric that quantifies the vortical blood flow pattern in the MPA of patients with pulmonary hypertension (PH), distinguishes them from healthy controls, and shows high correlation with invasive markers of PH severity.
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Affiliation(s)
- Ali Borhani
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kristin K. Porter
- Department of RadiologyUniversity of Alabama at Birmingham School of MedicineBirminghamAlabamaUSA
| | - Muhammad Umair
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Linda C. Chu
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Rachel L. Damico
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ihab R. Kamel
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Stefan L. Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Russo GK, Zaheer A, Kamel IR, Porter KK, Archer-Arroyo K, Bashir MR, Cash BD, Fung A, McCrary M, McGuire BM, Shih RD, Stowers J, Thakrar KH, Vij A, Wahab SA, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Upper Quadrant Pain: 2022 Update. J Am Coll Radiol 2023; 20:S211-S223. [PMID: 37236744 DOI: 10.1016/j.jacr.2023.02.011] [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: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Acute right upper quadrant pain is one of the most common presenting symptoms in hospital emergency departments, as well as outpatient settings. Although gallstone-related acute cholecystitis is a leading consideration in diagnosis, a myriad of extrabiliary sources including hepatic, pancreatic, gastroduodenal, and musculoskeletal should also be considered. This document focuses on the diagnostic accuracy of imaging studies performed specifically to evaluate acute right upper quadrant pain, with biliary etiologies including acute cholecystitis and its complications being the most common. An additional consideration of extrabiliary sources such as acute pancreatitis, peptic ulcer disease, ascending cholangitis, liver abscess, hepatitis, and painful liver neoplasms remain a diagnostic consideration in the right clinical setting. The use of radiographs, ultrasound, nuclear medicine, CT, and MRI for these indications are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin K Porter
- Panel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama; Council Steering Committee, ACR
| | | | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Alice Fung
- Oregon Health & Science University, Portland, Oregon; Liver Reporting & Data System Technique Working Group
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Brendan M McGuire
- University of Alabama at Birmingham, Birmingham, Alabama; Primary care physician
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - John Stowers
- Oregon Health & Science University, Portland, Oregon; American College of Surgeons
| | | | - Abhinav Vij
- New York University Langone Medical Center, New York, New York
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Arleo EK, Porter KK, Magudia K, Englander M, Deitte LA. American College of Radiology Paid Family/Medical Leave Policy: A Call to Action for the House of Medicine. J Womens Health (Larchmt) 2023; 32:255-259. [PMID: 36634250 DOI: 10.1089/jwh.2022.0442] [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] [Indexed: 01/14/2023] Open
Abstract
The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that "diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed." The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.
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Affiliation(s)
- Elizabeth Kagan Arleo
- New York-Presbyterian/Weill Cornell Medical Center, Weill Cornell Imaging, New York, New York, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama Medical Center, Birmingham, Alabama, USA
| | - Kirti Magudia
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Lori A Deitte
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Karandikar A, Solberg A, Fung A, Lee AY, Farooq A, Taylor AC, Oliveira A, Narayan A, Senter A, Majid A, Tong A, McGrath AL, Malik A, Brown AL, Roberts A, Fleischer A, Vettiyil B, Zigmund B, Park B, Curran B, Henry C, Jaimes C, Connolly C, Robson C, Meltzer CC, Phillips CH, Dove C, Glastonbury C, Pomeranz C, Kirsch CFE, Burgan CM, Scher C, Tomblinson C, Fuss C, Santillan C, Daye D, Brown DB, Young DJ, Kopans D, Vargas D, Martin D, Thompson D, Jordan DW, Shatzkes D, Sun D, Mastrodicasa D, Smith E, Korngold E, Dibble EH, Arleo EK, Hecht EM, Morris E, Maltin EP, Cooke EA, Schwartz ES, Lehrman E, Sodagari F, Shah F, Doo FX, Rigiroli F, Vilanilam GK, Landinez G, Kim GGY, Rahbar H, Choi H, Bandesha H, Ojeda-Fournier H, Ikuta I, Dragojevic I, Schroeder JLT, Ivanidze J, Katzen JT, Chiang J, Nguyen J, Robinson JD, Broder JC, Kemp J, Weaver JS, Conyers JM, Robbins JB, Leschied JR, Wen J, Park J, Mongan J, Perchik J, Barbero JPM, Jacob J, Ledbetter K, Macura KJ, Maturen KE, Frederick-Dyer K, Dodelzon K, Cort K, Kisling K, Babagbemi K, McGill KC, Chang KJ, Feigin K, Winsor KS, Seifert K, Patel K, Porter KK, Foley KM, Patel-Lippmann K, McIntosh LJ, Padilla L, Groner L, Harry LM, Ladd LM, Wang L, Spalluto LB, Mahesh M, Marx MV, Sugi MD, Sammer MBK, Sun M, Barkovich MJ, Miller MJ, Vella M, Davis MA, Englander MJ, Durst M, Oumano M, Wood MJ, McBee MP, Fischbein NJ, Kovalchuk N, Lall N, Eclov N, Madhuripan N, Ariaratnam NS, Vincoff NS, Kothary N, Yahyavi-Firouz-Abadi N, Brook OR, Glenn OA, Woodard PK, Mazaheri P, Rhyner P, Eby PR, Raghu P, Gerson RF, Patel R, Gutierrez RL, Gebhard R, Andreotti RF, Masum R, Woods R, Mandava S, Harrington SG, Parikh S, Chu S, Arora SS, Meyers SM, Prabhu S, Shams S, Pittman S, Patel SN, Payne S, Hetts SW, Hijaz TA, Chapman T, Loehfelm TW, Juang T, Clark TJ, Potigailo V, Shah V, Planz V, Kalia V, DeMartini W, Dillon WP, Gupta Y, Koethe Y, Hartley-Blossom Z, Wang ZJ, McGinty G, Haramati A, Allen LM, Germaine P. Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade. Clin Imaging 2023; 93:117-121. [PMID: 36064645 DOI: 10.1016/j.clinimag.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Alice Fung
- Oregon Health & Science University (OHSU), United States of America
| | - Amie Y Lee
- University of California, San Francisco, United States of America
| | | | - Amy C Taylor
- University of Virginia, Charlottesville, VA, United States of America
| | | | - Anand Narayan
- University of Wisconsin Hospitals and Clinics, Madison, WI, United States of America
| | | | | | | | | | | | | | - Anne Roberts
- University of California San Diego, United States of America
| | | | | | - Beth Zigmund
- Larner College of Medicine at University of Vermont, United States of America
| | - Brian Park
- Oregon Health & Science University (OHSU), United States of America
| | - Bruce Curran
- Virginia Commonwealth University Health System, United States of America
| | - Cameron Henry
- Vanderbilt University Medical Center, United States of America
| | - Camilo Jaimes
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Cara Connolly
- Vanderbilt University Medical Center, United States of America
| | - Caroline Robson
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Carolyn C Meltzer
- Keck School of Medicine of the University of Southern California, United States of America
| | | | - Christine Dove
- Vanderbilt University Medical Center, United States of America
| | | | | | | | | | - Courtney Scher
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Cristina Fuss
- Oregon Health & Science University (OHSU), United States of America
| | | | - Dania Daye
- Massachusetts General Hospital/Harvard Medical School, United States of America
| | - Daniel B Brown
- Vanderbilt University Medical Center, United States of America
| | - Daniel J Young
- Oregon Health & Science University (OHSU), United States of America
| | | | | | - Dann Martin
- Vanderbilt University Medical Center, United States of America
| | | | - David W Jordan
- University Hospitals Cleveland Medical Center & Case Western Reserve University, United States of America
| | | | - Derek Sun
- University of California, San Francisco, United States of America
| | | | | | - Elena Korngold
- Oregon Health & Science University (OHSU), United States of America
| | - Elizabeth H Dibble
- The Warren Alpert Medical School of Brown University, United States of America
| | | | | | | | | | - Erin A Cooke
- Vanderbilt University Medical Center, United States of America
| | - Erin Simon Schwartz
- Perelman School of Medicine, University of Pennsylvania, United States of America
| | | | - Faezeh Sodagari
- Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Faisal Shah
- Radiology Partners, United States of America
| | | | | | - George K Vilanilam
- Dept of Radiology, University of Arkansas for Medical Sciences, United States of America
| | - Gina Landinez
- University of California, San Francisco, United States of America
| | | | - Habib Rahbar
- University of Washington, United States of America
| | - Hailey Choi
- University of California, San Francisco, United States of America
| | | | | | - Ichiro Ikuta
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | | | | | | | - Jason Chiang
- Ronald Reagan UCLA Medical Center, United States of America
| | - Jeffers Nguyen
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | - Jennifer C Broder
- Lahey Hospital and Medical Center, Burlington, MA, United States of America
| | - Jennifer Kemp
- University of Colorado School of Medicine, United States of America
| | | | | | - Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, United States of America
| | | | - Jessica Wen
- Stanford University, United States of America
| | - Jocelyn Park
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | | | - Jordan Perchik
- University of Alabama at Birmingham, United States of America
| | | | - Jubin Jacob
- St Lawrence Radiology, United States of America
| | | | | | | | | | | | | | - Kelly Kisling
- University of California San Diego, United States of America
| | | | | | | | | | | | - Kimberly Seifert
- Stanford University School of Medicine, United States of America
| | - Kirang Patel
- University of Texas Southwestern Medical Center, United States of America
| | - Kristin K Porter
- University of Alabama at Birmingham Hospital, United States of America
| | | | | | | | - Laura Padilla
- University of California San Diego, United States of America
| | | | - Lauren M Harry
- Indiana University School of Medicine, United States of America
| | - Lauren M Ladd
- Indiana University School of Medicine, United States of America
| | - Lisa Wang
- Oregon Health & Science University (OHSU), United States of America
| | - Lucy B Spalluto
- Vanderbilt University Medical Center, United States of America
| | - M Mahesh
- Johns Hopkins University School of Medicine, United States of America
| | | | - Mark D Sugi
- University of California, San Francisco, United States of America
| | | | - Maryellen Sun
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | | | | | - Maya Vella
- University of California, San Francisco, United States of America
| | | | | | | | - Michael Oumano
- Rhode Island Hospital (Brown University), Providence, RI, United States of America
| | - Monica J Wood
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | - Morgan P McBee
- Medical University of South Carolina, United States of America
| | | | | | - Neil Lall
- Emory University, Atlanta, GA, United States of America
| | - Neville Eclov
- Duke University, Durham, NC, United States of America
| | | | | | - Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Nishita Kothary
- Stanford University School of Medicine, United States of America
| | | | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Orit A Glenn
- University of California, San Francisco, United States of America
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America
| | | | - Peter R Eby
- Virginia Mason Franciscan Health, United States of America
| | - Preethi Raghu
- University of California, San Francisco, United States of America
| | - Rachel F Gerson
- Northwest Radiologists, Inc, PS, Bellingham, WA, United States of America
| | - Rina Patel
- University of California, San Francisco, United States of America
| | | | - Robyn Gebhard
- The Ohio State University, Columbus, OH, United States of America
| | | | - Rukya Masum
- The Ohio State University, Columbus, OH, United States of America
| | - Ryan Woods
- University of Wisconsin School of Medicine and Public Health, United States of America
| | - Sabala Mandava
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Samir Parikh
- Henry Ford Health, Jackson, MI, United States of America
| | - Sammy Chu
- University of Washington (Seattle, WA), United States of America
| | | | - Sandra M Meyers
- University of California San Diego, United States of America
| | - Sanjay Prabhu
- Boston Children's Hospital, United States of America
| | | | - Sarah Pittman
- Stanford University School of Medicine, United States of America
| | | | | | - Steven W Hetts
- University of California, San Francisco, United States of America
| | - Tarek A Hijaz
- Northwestern Memorial Hospital/Feinberg School of Medicine of Northwestern University, Chicago, IL, United States of America
| | - Teresa Chapman
- University of Washington (Seattle, WA), United States of America
| | - Thomas W Loehfelm
- University of California, Davis, Sacramento, CA, United States of America
| | | | | | | | - Vinil Shah
- University of California, San Francisco, United States of America
| | - Virginia Planz
- Vanderbilt University Medical Center, United States of America
| | - Vivek Kalia
- Texas Scottish Rite for Children Hospital, United States of America
| | - Wendy DeMartini
- Stanford University School of Medicine, United States of America
| | - William P Dillon
- University of California, San Francisco, United States of America
| | - Yasha Gupta
- Memorial Sloan Kettering Cancer Center, United States of America
| | - Yilun Koethe
- Oregon Health & Science University (OHSU), United States of America
| | | | - Zhen Jane Wang
- University of California, San Francisco, United States of America
| | | | - Adina Haramati
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Laveil M Allen
- Vanderbilt University Medical Center, United States of America
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7
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Udayakumar N, Smith E, Boone A, Porter KK. A Common Path: Magnetic Resonance Imaging of Müllerian and Wolffian Duct Anomalies. Curr Urol Rep 2023; 24:1-9. [PMID: 36595101 DOI: 10.1007/s11934-022-01138-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the pathway of Mullerian and Wolffian duct development, anomalies that result from disruptions to this pathway, and the characteristics on advanced imaging that identify them. RECENT FINDINGS In-office evaluation for reproductive anomalies is usually inadequate for the diagnosis of congenital reproductive anomalies. Magnetic resonance imaging (MRI) has usurped invasive diagnostic methods including laparoscopy, hysteroscopy, and vasography as the new gold standard. Because of its superior soft-tissue delineation and the availability of advanced functional sequences, MRI offers a sophisticated method of distinguishing reproductive anomalies from one another, characterizing the degree of defect severity, and evaluating for concomitant urogenital anomalies non-invasively and without radiation exposure to the patient. Congenital anomalies of the Mullerian and Wolffian duct can be incredibly nuanced, requiring prompt and accurate diagnosis for management of infertility. Definitive diagnosis should be made early with MRI.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Elainea Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Boone
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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8
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Raptis CA, Goldstein A, Henry TS, Porter KK, Catenacci D, Kelly AM, Kuzniewski CT, Lai AR, Lee E, Long JM, Martin MD, Morris MF, Sandler KL, Sirajuddin A, Surasi DS, Wallace GW, Kamel IR, Donnelly EF. ACR Appropriateness Criteria® Staging and Follow-Up of Esophageal Cancer. J Am Coll Radiol 2022; 19:S462-S472. [PMID: 36436970 DOI: 10.1016/j.jacr.2022.09.008] [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: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document provides recommendations regarding the role of imaging in the staging and follow-up of esophageal cancer. For initial clinical staging, locoregional extent and nodal disease are typically assessed with esophagogastroduodenoscopy and esophageal ultrasound. FDG-PET/CT or CT of the chest and abdomen is usually appropriate for use in initial clinical staging as they provide additional information regarding distant nodal and metastatic disease. The detection of metastatic disease is critical in the initial evaluation of patients with esophageal cancer because it will direct patients to a treatment pathway centered on palliative radiation rather than surgery. For imaging during treatment, particularly neoadjuvant chemotherapy, FDG-PET/CT is usually appropriate, because some studies have found that it can provide information regarding primary lesion response, but more importantly it can be used to detect metastases that have developed since the induction of treatment. For patients who have completed treatment, FDG-PET/CT or CT of the chest and abdomen is usually appropriate for evaluating the presence and extent of metastases in patients with no suspected or known recurrence and in those with a suspected or known recurrence. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Alan Goldstein
- Division Chief, Abdominal Imaging, Director of CT Colonography, UMass Medical School, Worcester, Massachusetts
| | - Travis S Henry
- Panel Chair; Division Chief of Cardiothoracic Imaging, Duke University, Durham, North Carolina; Co-Director, ACR Education Center HRCT Course
| | - Kristin K Porter
- Panel Chair, University of Alabama Medical Center, Birmingham, Alabama; ACR Council Steering Committee
| | - Daniel Catenacci
- The University of Chicago, Chicago, Illinois; American Society of Clinical Oncology
| | - Aine Marie Kelly
- Assistant Program Director Radiology Residency, Emory University Hospital, Atlanta, Georgia
| | | | - Andrew R Lai
- Hospitalist; University of California San Francisco (UCSF), San Francisco, California; Former Director of the UCSF Hospitalist Procedure Service; Former Director of the UCSF Division of Hospital Medicine's Case Review Committee; Former Director of Procedures/Quality Improvement Rotation for the UCSF Internal Medicine Residency
| | - Elizabeth Lee
- Director, M1 Radiology Education, University of Michigan Medical School; Associate Program Director, Diagnostic Radiology, Michigan Medicine; Director of Residency Education Cardiothoracic Division, Michigan Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jason M Long
- Director of Robotic Thoracic Surgery, Director of Lung Cancer Screening, University of North Carolina Hospital, Chapel Hill, North Carolina; The Society of Thoracic Surgeons
| | - Maria D Martin
- Director, Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael F Morris
- Director of Cardiac CT and MRI, University of Arizona College of Medicine, Phoenix, Arizona
| | - Kim L Sandler
- Co-Director Vanderbilt Lung Screening Program, Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair, Thoracic Committee, ECOG-ACRIN; Co-Chair, Lung Screening 2.0 Steering Committee
| | | | - Devaki Shilpa Surasi
- Patient Safety and Quality Officer, Department of Nuclear Medicine, Chair-Elect, Junior Faculty Committee, The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Ihab R Kamel
- Specialty Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edwin F Donnelly
- Specialty Chair; Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Gupta K, Perchik JD, Fang AM, Porter KK, Rais-Bahrami S. Augmenting prostate magnetic resonance imaging reporting to incorporate diagnostic recommendations based upon clinical risk calculators. World J Radiol 2022; 14:249-255. [PMID: 36160831 PMCID: PMC9453318 DOI: 10.4329/wjr.v14.i8.249] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/27/2022] [Accepted: 07/25/2022] [Indexed: 02/08/2023] Open
Abstract
Risk calculators have offered a viable tool for clinicians to stratify patients at risk of prostate cancer (PCa) and to mitigate the low sensitivity and specificity of screening prostate specific antigen (PSA). While initially based on clinical and demographic data, incorporation of multiparametric magnetic resonance imaging (MRI) and the validated prostate imaging reporting and data system suspicion scoring system has standardized and improved risk stratification beyond the use of PSA and patient parameters alone. Biopsy-naïve patients with lower risk profiles for harboring clinically significant PCa are often subjected to uncomfortable, invasive, and potentially unnecessary prostate biopsy procedures. Incorporating risk calculator data into prostate MRI reports can broaden the role of radiologists, improve communication with clinicians primarily managing these patients, and help guide clinical care in directing the screening, detection, and risk stratification of PCa.
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Affiliation(s)
- Karisma Gupta
- Department of Radiology, University of Washington, Seattle, WA 98195, United States
| | - Jordan D Perchik
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Andrew M Fang
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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Arleo EK, Porter KK. Paid family/medical leave in radiology: The time is really now. Clin Imaging 2022; 85:120-122. [PMID: 35341682 DOI: 10.1016/j.clinimag.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Elizabeth Kagan Arleo
- New York-Presbyterian Hospital/Weill Cornell Medical Center, Department of Radiology, 425 East 61st Street, 9th floor, New York, NY 10065, United States of America.
| | - Kristin K Porter
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America.
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11
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Bass RZ, Woodard SA, Colvin SD, Zarzour JG, Porter KK, Canon CL. Childbearing in radiology training and early career: Challenges, opportunities, and finding the best time for you. Clin Imaging 2022; 86:67-70. [PMID: 35344778 DOI: 10.1016/j.clinimag.2022.03.015] [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: 01/17/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
For many women, radiology residency occurs during the childbearing years and they often question when is the best time to have children. Anxiety regarding fertility and pregnancy-related complications contribute to early career burnout in women physicians and many have fertility regrets. Supporting radiologists in training and early in their career as they navigate pregnancy and childbearing is critical to achieving a diverse workforce and leadership. Herein, we explore career-related challenges of childbearing and highlight opportunities for radiologists in residency, fellowship, and early in their career, so that they can make an informed childbearing decision.
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Affiliation(s)
- Rachel Z Bass
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Stefanie A Woodard
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Stephanie D Colvin
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
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Harrington SG, Wood M, Porter KK, Gupta Y, Esfahani SA, Daye D, Kilcoyne A, Donelan K, Narayan AK. Promoting Lactation Support: Challenges and Solutions to Supporting Breastfeeding Radiologists. Acad Radiol 2022; 29:175-180. [PMID: 33293255 DOI: 10.1016/j.acra.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals. MATERIALS AND METHODS A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption. RESULTS 50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (p = 0.028). No other factors were statistically significant (p > 0.05). CONCLUSION Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.
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13
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Galgano SJ, Norton JC, Porter KK, West JT, Rais-Bahrami S. Imaging for the Initial Staging and Post-Treatment Surveillance of Penile Squamous Cell Carcinoma. Diagnostics (Basel) 2022; 12:diagnostics12010170. [PMID: 35054337 PMCID: PMC8774300 DOI: 10.3390/diagnostics12010170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
Although relatively rare in the United States, penile squamous cell carcinoma is encountered worldwide at a higher rate. Initial diagnosis is often made on clinical exam, as almost all of these lesions are externally visible and amenable to biopsy. In distinction to other types of malignancies, penile cancer relies heavily on clinical nodal staging of the inguinal lymph node chains. As with all cancers, imaging plays a role in the initial staging, restaging, and surveillance of these patients. The aim of this manuscript is to highlight the applications, advantages, and limitations of different imaging modalities in the evaluation of penile cancer, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography.
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Affiliation(s)
- Samuel J. Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (S.J.G.); (K.K.P.); (J.T.W.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - John C. Norton
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Kristin K. Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (S.J.G.); (K.K.P.); (J.T.W.)
| | - Janelle T. West
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (S.J.G.); (K.K.P.); (J.T.W.)
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (S.J.G.); (K.K.P.); (J.T.W.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
- Correspondence:
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14
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Singhal A, Porter KK, Sorace AG, Kennedy KK, Canon CL. Navigating parental leave as a leader in radiology: Commentary on challenges and strategies. Clin Imaging 2021; 82:58-62. [PMID: 34773813 DOI: 10.1016/j.clinimag.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/02/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/03/2022]
Abstract
Navigating parental leave can be challenging in all fields of medicine, but it can be especially challenging for leaders balancing clinical, research, and administrative duties. As women take on more leadership roles, we have the opportunity to better define the current challenges and identify potential strategies for navigating successful parental leave while balancing the demands of leadership. This manuscript provides a commentary on the challenges and strategies for navigating parental leave in leadership positions in radiology, an important topic for shaping how parental leave is both viewed and valued in the future. Specifically, we highlight challenges and strategies for administrative responsibilities, reporting personnel, emails, microaggressions, research, empowerment, and prioritization.
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Affiliation(s)
- Aparna Singhal
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
| | - Anna G Sorace
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
| | - Kierstin K Kennedy
- UAB Hospital Medicine, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA.
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
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15
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Vij A, Zaheer A, Kamel IR, Porter KK, Arif-Tiwari H, Bashir MR, Fung A, Goldstein A, Herr KD, Kamaya A, Kobi M, Landler MP, Russo GK, Thakrar KH, Turturro MA, Wahab SA, Wardrop RM, Wright CL, Yang X, Carucci LR. ACR Appropriateness Criteria® Epigastric Pain. J Am Coll Radiol 2021; 18:S330-S339. [PMID: 34794592 DOI: 10.1016/j.jacr.2021.08.006] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022]
Abstract
Epigastric pain can have multiple etiologies including myocardial infarction, pancreatitis, acute aortic syndromes, gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia. This document focuses on the scenarios in which epigastric pain is accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis, which raise suspicion for gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, or hiatal hernia. Although endoscopy may be the test of choice for diagnosing these entities, patients may present with nonspecific or overlapping symptoms, necessitating the use of imaging prior to or instead of endoscopy. The utility of fluoroscopic imaging, CT, MRI, and FDG-PET for these indications are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Abhinav Vij
- New York University Langone Medical Center, New York, New York; and UT Southwestern Medical Center, Dallas, Texas.
| | - Atif Zaheer
- Johns Hopkins Hospital, Baltimore, Maryland; Chair, Disease Focus Panel for Pancreatitis, Society of Abdominal Radiology; and Associate Editor, Journal Abdominal Radiology
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin K Porter
- Panel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama; and Board of Directors/President (2021), American Association for Women in Radiology
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Mustafa R Bashir
- Associate Vice-Chair for Research, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Alice Fung
- Oregon Health & Science University, Portland, Oregon
| | - Alan Goldstein
- Division Chief, Abdominal Imaging, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California; and President-Elect (2020-2021) and President (2021-2022), Society of Radiologists in Ultrasound
| | | | - Matthew P Landler
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Primary care physician
| | | | | | - Michael A Turturro
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; American College of Emergency Physicians
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Richard M Wardrop
- The University of Mississippi Medical Center, Jackson, Mississippi; American College of Physicians; Member, American Board of Internal Medicine; Internal Medicine Specialty Board; and Program Director, Cleveland Clinic
| | - Chadwick L Wright
- The Ohio State University Wexner Medical Center, Columbus, Ohio; Board of Directors, American Board of Science in Nuclear Medicine (ABSNM); and Board of Directors, American College of Nuclear Medicine (ACNM)
| | - Xihua Yang
- Phoenix Indian Medical Center, Phoenix, Arizona; American College of Surgeons; and Volunteer Board Member, Franklin Pierce PA School
| | - Laura R Carucci
- Specialty Chair; and Director, CT and MRI, and Section Chief, Abdominal Imaging, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Abstract
With PET/MRI, the strengths of PET and MRI are combined to allow simultaneous image acquisition and near-perfect image coregistration. MRI is increasingly being used for staging and restaging of abdominopelvic oncologic lesions, including prostate, hepatobiliary, pancreatic, neuroendocrine, cervical, and rectal cancers. Fluorine 18-fluorodeoxyglucose PET/CT has long been considered a cornerstone of oncologic imaging, and the development of multiple targeted radiotracers has led to increased research on and use of these agents in clinical practice. Thus, simultaneously performed PET/MRI enables the acquisition of complementary imaging information, with distinct advantages over PET/CT and MR image acquisitions. The authors provide an overview of PET/MRI, including descriptions of the major differences between PET/MRI and PET/CT, as well as case examples and treatment protocols for patients with commonly encountered malignancies in the abdomen and pelvis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Samuel J Galgano
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Carli E Calderone
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Charlies Xie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Elainea N Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Kristin K Porter
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Jonathan E McConathy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
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Fang AM, Burns ZR, Nocera AP, Cardan RA, Nix JW, Porter KK, McDonald AM, Rais-Bahrami S. Stereotactic body radiation therapy with simultaneous integrated boost for prostate cancer: does MRI-targeted biopsy alter the boost field? Can J Urol 2021; 28:10817-10823. [PMID: 34657654] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION We aim to investigate if the addition of MRI-US fusion biopsy (FB) can aid in radiation planning and alter the boost field in cases of stereotactic body radiation therapy (SBRT) for prostate cancer with a simultaneous integrated boost (SIB) to a magnetic resonance imaging (MRI)-defined intraprostatic lesion. MATERIALS AND METHODS Patients undergoing SBRT with SIB for biopsy-proven prostatic adenocarcinoma and a pre-radiation MRI were retrospectively reviewed. 36.25 Gy in 5 fractions was delivered to entire prostate along with SIB of 40 Gy to an MRI-defined intraprostatic lesion. Demographic, radiation planning details, and post-procedural outcomes were compared between patients undergoing systematic transrectal ultrasound (TRUS) biopsy followed by MRI to those undergoing an MRI followed by a FB prior to radiation planning. RESULTS Forty-three patients underwent systematic TRUS biopsy followed by MRI and 46 patients underwent FB prior to radiation planning. Patients undergoing systematic TRUS biopsy had a smaller prostate volume when compared to the FB cohort (37.58 ± 13.78 versus 50.28 ± 26.76 cc, p = 0.007). No differences in prostate planning target volume (PTVprostate) and boost volume (PTVboost) were noted, but those undergoing TRUS biopsy prior to MRI had a higher integrated boost volume density (IBVD = PTVboost/total prostate volume) (0.16 ± 0.09 versus 0.13 ± 0.06, p = 0.045). No differences were observed in genitourinary or gastrointestinal toxicity rates. CONCLUSIONS Compared to systematic TRUS biopsy, implementation of prebiopsy prostate MRI and FB allows for safe and feasible SBRT in patients with significantly larger prostate volumes without increasing SIB cancer-directed treatment volumes, oncologic outcomes, quality of life measures, or treatment-related toxicities.
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Affiliation(s)
- Andrew M Fang
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zachary R Burns
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alexander P Nocera
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rex A Cardan
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew M McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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DeBenedectis CM, Schmitt C, Porter KK, Rumack C. American Association for Women in Radiology. Clin Imaging 2021; 80:353-358. [PMID: 34507267 DOI: 10.1016/j.clinimag.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/01/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022]
Abstract
For the past 40 years the American Association for Women in Radiology (AAWR) has continued to support efforts to achieve its founding goals of improving the visibility of women in radiology, advancing the professional and academic standing of women in radiology, and identifying and addressing issues faced by women in radiology. In the past 5 years, the AAWR has made great strides to support women in radiology through amplifying the voices of women heard at the American College of Radiology (ACR) Annual Meeting, initiating the AAWR Research & Education Capital Campaign, establishing the fellows of the AAWR, and advocating for practicing radiologists and trainee parental leave. The many accomplishments of the AAWR over the past 40 years and the committed future work of the AAWR ensure the voices of women in radiology are heard and the needs of women in radiology are recognized.
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Affiliation(s)
- Carolynn M DeBenedectis
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - Chelsea Schmitt
- USF Health Morsani College of Medicine, Department of Internal Medicine, 17 Davis Blvd, Suite 308, Tampa, FL 33606, United States of America
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, JTN 374, 619 19th St S, Birmingham, AL 35249-6830, United States of America.
| | - Carol Rumack
- University of Colorado School of Medicine, Graduate Medical Education, Building 500, Room 4223, 13001 E. 17th Place, Mail Stop C 293, Aurora, CO 80045, United States of America.
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19
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Galgano SJ, McDonald AM, Rais-Bahrami S, Porter KK, Choudhary G, Burgan C, Bhambhvani P, Nix JW, Morgan DE, Li Y, Thomas JV, McConathy J. Utility of 18F-Fluciclovine PET/MRI for Staging Newly Diagnosed High-Risk Prostate Cancer and Evaluating Response to Initial Androgen Deprivation Therapy: A Prospective Single-Arm Pilot Study. AJR Am J Roentgenol 2021; 217:720-729. [PMID: 33052718 PMCID: PMC9170127 DOI: 10.2214/ajr.20.24509] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND. Despite advances in prostate cancer treatment, rates of biochemical recurrence remain high, relating to lack of detection of small-volume metastatic disease using conventional imaging for initial staging. OBJECTIVE. The purpose of this study was to assess the potential use of 18F-fluciclovine PET/MRI for initial staging of high-risk prostate cancer and evaluating response to androgen deprivation therapy (ADT). METHODS. This prospective clinical trial enrolled 14 men with newly diagnosed high-risk prostate cancer and negative or equivocal conventional staging imaging for metastatic disease between January 2018 and February 2019. All patients underwent pretreatment 18F-fluciclovine PET/MRI including multiparametric prostate MRI; 12 underwent 18F-fluciclovine PET/MRI after surgery or between ADT and radiotherapy. Confidence in identification of the primary intraprostatic lesion and nodal metastases was independently rated on a 0-3 Likert scale by three readers with nuclear medicine experience for 18F-fluciclovine PET/MRI and three readers with abdominal imaging experience for MRI alone. Findings scored as 2 or 3 by at least two readers of a given modality were considered positive. A single reader measured SUVmean, SUVmax, and volume of the MRI-defined intraprostatic lesion and SUVmax of suspicious lymph nodes on PET before and after initiation of ADT. Changes in SUV were analyzed using nonparametric Wilcox-on signed-rank tests. RESULTS. The biopsy-proven lesion in the prostate gland was accurately identified in all 14 patients on both MRI and 18F-fluciclovine PET/MRI. Suspected nodal metastases were detected in three patients on MRI and seven patients on 18F-fluciclovine PET/MRI. After ADT, all patients showed decreased activity within the intraprostatic lesion and/or all suspicious lymph nodes. The primary lesion SUVmean was 4.5 ± 1.1 (range, 2.7-6.5) before treatment and 2.4 ± 1.1 (range, 0.0-3.6) after initiation of ADT (p = .008). For suspicious lymph nodes, the pretreatment SUVmax was 5.5 ± 3.7 (range, 2.8-12.7) and the post-treatment SUVmax was 2.8 ± 1.4 (range, 1.4-5.5) (p = .03). CONCLUSION.18F-labeled fluciclovine PET/MRI shows potential utility in initial staging of high-risk prostate cancer and in evaluating response to ADT. CLINICAL IMPACT. Given the FDA approval and widespread availability of 18F-fluciclovine, the findings could have an impact in the immediate future in guiding initial management of patients with prostate cancer. TRIAL REGISTRATION. ClinicalTrials.gov NCT03264456.
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Affiliation(s)
- Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew M McDonald
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
| | - Gagandeep Choudhary
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
| | - Constantine Burgan
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
| | - Pradeep Bhambhvani
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
| | - Jeffrey W Nix
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
| | - Yufeng Li
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
| | - Jonathan McConathy
- Department of Radiology, University of Alabama at Birmingham, 619 19 St S, JT N325, Birmingham, AL 35249
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
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Porter KK, Arleo EK, Spalluto LB, McGinty G, Hess CP. A lactation credit model to support breastfeeding in radiology: The new gold standard to support "liquid gold". Clin Imaging 2021; 80:16-18. [PMID: 34218079 DOI: 10.1016/j.clinimag.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
Breastfeeding has medical and economic benefits and providing an environment supportive of breastfeeding should be a priority in radiology to promote diversity, equity and inclusion. Most breastfeeding radiologists do not meet their breastfeeding goals and inadequate time for pumping is the most commonly cited barrier. The UCSF lactation credit model sets the standard for breastfeeding support in medicine by providing protected time without productivity penalties and it should be adapted and implemented across radiology practices to more fully support breastfeeding radiologists and radiation oncologists.
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Affiliation(s)
- Kristin K Porter
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America.
| | - Elizabeth Kagan Arleo
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
| | - Lucy B Spalluto
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
| | - Geraldine McGinty
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
| | - Christopher P Hess
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
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Magudia K, Ng TSC, Campbell SR, Balthazar P, Dibble EH, Hassanzadeh CJ, Lall N, Merfeld EC, Esfahani SA, Jimenez RB, Fields EC, Lightfoote JB, Ackerman SJ, Jeans EB, Englander MJ, DeBenedectis CM, Porter KK, Spalluto LB, Deitte LA, Jagsi R, Arleo EK. Family and Medical Leave for Diagnostic Radiology, Interventional Radiology, and Radiation Oncology Residents in the United States: A Policy Opportunity. Radiology 2021; 300:31-35. [PMID: 33847521 DOI: 10.1148/radiol.2021210798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kirti Magudia
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Thomas S C Ng
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Shauna R Campbell
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Patricia Balthazar
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Elizabeth H Dibble
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Comron J Hassanzadeh
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Neil Lall
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Emily C Merfeld
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Shadi A Esfahani
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Rachel B Jimenez
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Emma C Fields
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Johnson B Lightfoote
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Susan J Ackerman
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Elizabeth B Jeans
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Meridith J Englander
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Carolynn M DeBenedectis
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Kristin K Porter
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Lucy B Spalluto
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Lori A Deitte
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Reshma Jagsi
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
| | - Elizabeth Kagan Arleo
- From the Department of Radiology and Biomedical Imaging, University of California, 1700 4th St, Byers Hall, Suite 102, San Francisco, CA 94158 (K.M.); Departments of Radiology (T.S.C.N., P.B., S.A.E.) and Radiation Oncology (R.B.J.), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (S.R.C.); Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI (E.H.D.); Department of Radiation Oncology, Washington University School of Medicine, St Louis, Mo (C.J.H.); Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (N.L.); Department of Radiology, Emory University, Atlanta, Ga (N.L.); Department of Human Oncology, University of Wisconsin School of Medicine, Madison, Wis (E.C.M.); Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Va (E.C.F.); Department of Radiology, Pomona Valley Hospital Medical Center, Pomona, Calif (J.B.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charlestown, SC (S.J.A.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minn (E.B.J.); Department of Radiology, Albany Medical College, Albany, NY (M.J.E.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (C.M.D.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (K.K.P.); Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tenn (L.B.S., L.A.D.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Mich (R.J.); and Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY (E.K.A.)
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22
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Porter KK, Oates ME. Authentic gold: Celebrating the life and career of Cheri L. Canon, MD, FACR, FAAWR. Clin Imaging 2021; 74:174-177. [PMID: 33422391 DOI: 10.1016/j.clinimag.2020.12.014] [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: 11/25/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Since 1927, the American College of Radiology (ACR) has awarded Gold Medals to up to four individuals each year in recognition of their distinguished and extraordinary service to the ACR or to the discipline of radiology (American College of Radiology, n.d. [1]). As of 2019, only 10 of 194 Gold Medalists have been women. In May 2021, Dr. Cheri L. Canon will become the eleventh woman in ACR history to receive this prestigious award. Contemporaneously, in November 2020, she received the highest honor bestowed by the American Association for Women in Radiology (AAWR), the Marie Sklodowska-Curie Award, presented annually to an individual who has made outstanding contributions to the advancement of women in radiology or radiation oncology (American Association for Women in Radiology, n.d. [2]). Herein we celebrate Dr. Canon's remarkable life and impressive career achievements, and learn important lessons from her shared wisdom.
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Affiliation(s)
- Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - M Elizabeth Oates
- Department of Radiology, University of Kentucky, Lexington, KY, United States of America
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23
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Wolfman DJ, Porter KK, Johnson DL, Parikh JR. Unsustainable: COVID-19 Demands Increased Support for Radiologists. Clin Imaging 2020; 73:18-19. [PMID: 33254029 DOI: 10.1016/j.clinimag.2020.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/15/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022]
Abstract
Life is sometimes described as a complex tapestry and progress is not linear, but twisted like stitches, contributing to the final fabric. When tension arises, the most recent stitches unravel first. The COVID-19 pandemic is pulling back the thread of humanity's progress. Those disproportionately affected by the pandemic's tension are those whose progress is most recent and, therefore most tenuous, including women in medicine. The profession of radiology, recently acknowledged by practice leaders as experiencing burnout as a very significant problem (Parikh et al., 2020 [1]), is rapidly facing an untenable situation.
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Affiliation(s)
- Darcy J Wolfman
- Department of Radiology, Johns Hopkins School of Medicine, 5255 Loughboro Rd, NW, Washingon, DC 20016, United States of America.
| | - Kristin K Porter
- MR Modality Chief, University of Alabama at Birmingham, Department of Radiology, Abdominal Imaging Section, JTN 374, 619 19th St S, Birmingham, AL 35249-6830, United States of America.
| | - Dianne L Johnson
- MBB Radiology/RadPartners, Breast Imaging Section, Jacksonville, FL, United States of America.
| | - Jay R Parikh
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, United States of America.
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24
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Abstract
PURPOSE OF REVIEW Multiparametric MRI (mpMRI), composed of T2WI, DWI, and DCE sequences, is effective in identifying prostate cancer (PCa), but length and cost preclude its application as a PCa screening tool. Here we review abbreviated MRI protocols that shorten or omit conventional mpMRI components to reduce scan time and expense without forgoing diagnostic accuracy. RECENT FINDINGS The DCE sequence, which plays a limited diagnostic role in PI-RADS, is eliminated in variations of the biparametric MRI (bpMRI). T2WI, the lengthiest sequence, is truncated by only acquiring the axial plane or utilizing 3D acquisition with subsequent 2D reconstruction. DW-EPISMS further accelerates DWI acquisition. The fastest protocol described to date consists of just DW-EPISMS and axial-only 2D T2WI and runs less than 5 min. Abbreviated protocols can mitigate scan expense and increase scan access, allowing prostate MRI to become an efficient PCa screening tool.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, 1720 2nd Ave S, Birmingham, AL, 35249, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street S, JT N374, Birmingham, AL, 35249, USA.
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25
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Chernyak V, Horowitz JM, Kamel IR, Arif-Tiwari H, Bashir MR, Cash BD, Farrell J, Goldstein A, Grajo JR, Gupta S, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Liver Lesion-Initial Characterization. J Am Coll Radiol 2020; 17:S429-S446. [PMID: 33153555 DOI: 10.1016/j.jacr.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association
| | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | - Samir Gupta
- Rush University Medical Center, Chicago, Illinois; American College of Surgeons
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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26
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Kennedy J, Perchik JD, Porter KK. Systematic Review of Transgender-Related Research in Radiology Over a Decade: There Is Work to Be Done. J Am Coll Radiol 2020; 18:93-102. [PMID: 33007310 DOI: 10.1016/j.jacr.2020.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/06/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The ACR has established that diversity and inclusion are central to its mission of excellence in the radiologic professions; therefore, radiologists have a responsibility to serve the imaging needs of the transgender community. To understand radiologists' current knowledge of transgender topics, the authors performed a systematic review of publications from radiology journals. METHODS A lexicon of 14 transgender-related terms was created and expanded through a PubMed keyword search. From the 129 journals from the radiology, nuclear medicine, and medical imaging category of Journal Citation Reports, 106 journals met the inclusion criteria, including English translation and Scopus data for the study period. Using the Scopus advanced search feature, articles with titles, abstracts, Medical Subject Headings terms, or key words including 1 of 14 transgender terms were identified and analyzed. RESULTS Of the more than 200,000 articles published by the 106 journals from January 2008 to July 2019, 29 relevant articles were identified. Only 14 of the 106 journals published any transgender-related topics. The volume of articles has increased over time. The largest proportion of articles was published under the "general radiology" subsection, with the majority of these being editorials (6 of 10). Most of the original research was published under "neuroradiology" (7 of 13). Use of nonpreferred language, such as "transsexual" and "natal sex" was present through 2019. CONCLUSIONS Publication on transgender-related topics was uncommon among radiology journals. It is important to encourage further research and publication on transgender topics, as well as use of respectful, accepted language in radiology journals.
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Affiliation(s)
- Jasper Kennedy
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jordan D Perchik
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kristin K Porter
- Chief of MRI, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; President-Elect, American Association for Women in Radiology, Reston, Virginia.
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27
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Hindman NM, Arif-Tiwari H, Kamel IR, Al-Refaie WB, Bartel TB, Cash BD, Chernyak V, Goldstein A, Grajo JR, Horowitz JM, Kamaya A, McNamara MM, Porter KK, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria ® Jaundice. J Am Coll Radiol 2020; 16:S126-S140. [PMID: 31054739 DOI: 10.1016/j.jacr.2019.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
Jaundice is the end result of myriad causes, which makes the role of imaging in this setting particularly challenging. In the United States, the most common causes of all types of jaundice fall into four categories including hepatitis, alcoholic liver disease, blockage of the common bile duct by a gallstone or tumor, and toxic reaction to a drug or medicinal herb. Clinically, differentiating between the various potential etiologies of jaundice requires a detailed history, targeted physical examination, and pertinent laboratory studies, the results of which allow the physician to categorize the type of jaundice into mechanical or nonmechanical causes. Imaging modalities used to evaluate the jaundiced patient (all etiologies) include abdominal ultrasound (US), CT, MR cholangiopancreatography, endoscopic retrograde cholangiopancreatography and endoscopic US. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia; American College of Surgeons
| | | | - Brooks D Cash
- University of Texas McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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28
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Colvin SD, Cason DE, Galgano SJ, Triche BL, Gordetsky J, Rais-Bahrami S, Porter KK. Fusion of high B-value diffusion-weighted and T2-weighted MR images increases sensitivity for identification of extraprostatic disease in prostate cancer. Clin Imaging 2020; 68:202-209. [PMID: 32892105 DOI: 10.1016/j.clinimag.2020.08.022] [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: 05/09/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate whether fusion of high b-value diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) increases radiologists' ability to detect pathologic features responsible for upstaging in prostate cancer patients prior to radical prostatectomy (RP). BASIC PROCEDURES This was a retrospective study including 103 patients who underwent RP and a prostate MRI performed at 3T. High b-value DWI and T2WI were fused and interpreted by three radiologists with different degrees of experience. Prior to and after fusion, readers answered questionnaires about cancer presence, extraprostatic extension (EPE), seminal vesicle (SV) invasion, lymph node (LN) involvement, and reader confidence. Pathology reports served as the reference standard. MAIN FINDINGS High b-value DWI-T2WI fusion increased sensitivity for detection of EPE from 65.6% to 77.4% (p < 0.05), SV invasion from 40.5% to 48.8% (p < 0.05), and LN metastasis by 23.8% to 44.4% (p < 0.05). Readers' confidence significantly improved with the use of fusion imaging. Across all readers, confidence of cancer detection increased by 12.5% (p < 0.05), EPE by 14.7% (p < 0.05), SV invasion by 8.1% (p < 0.05), and LN metastasis by 2.5% (p < 0.05) using Wilcoxon signed rank test. PRINCIPAL CONCLUSIONS Fusion overlay of high b-value DWI and T2WI increases sensitivity for detection of extraprostatic disease resulting in upstaging at the time of RP.
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Affiliation(s)
- Stephanie D Colvin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Daniel E Cason
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Benjamin L Triche
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Soroush Rais-Bahrami
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
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29
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Magudia K, Smith E, Harrington SG, Porter KK, Arleo EK, Jagsi R, Spalluto LB. Carpe Diem: An opportunity for the ABR to support its trainees with family-friendly policies. Clin Imaging 2020; 69:148-149. [PMID: 32731107 PMCID: PMC7335233 DOI: 10.1016/j.clinimag.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Kirti Magudia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States of America
| | - Elainea Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America. https://twitter.com/elainea_smith
| | - Samantha G Harrington
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America. https://twitter.com/samgharrington
| | - Kristin K Porter
- American Association for Women in Radiology (AAWR), United States of America; Diversity and Inclusion Committee, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America. https://twitter.com/KPorterUAB
| | - Elizabeth Kagan Arleo
- American Association for Women in Radiology (AAWR), United States of America; Clinical Imaging, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Imaging, New York, NY, United States of America
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Lucy B Spalluto
- American Association for Women in Radiology (AAWR), United States of America; Office of Diversity and Inclusion, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America; Veterans Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America.
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Fábrega-Foster K, Kamel IR, Horowitz JM, Arif-Tiwari H, Bashir MR, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Scheiman JM, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Pancreatic Cyst. J Am Coll Radiol 2020; 17:S198-S206. [PMID: 32370963 DOI: 10.1016/j.jacr.2020.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 02/07/2023]
Abstract
Incidental pancreatic cysts are increasingly detected on imaging studies performed for unrelated indications and may be incompletely characterized on these studies. Adequate morphological characterization is critical due to the small risk of malignant degeneration associated with neoplastic pancreatic cysts, as well as the risk of associated pancreatic adenocarcinoma. For all pancreatic cysts, both size and morphology determine management. Specifically, imaging detection of features, such as pancreatic ductal communication and presence or absence of worrisome features or high-risk stigmata, have important management implications. The recommendations in this publication determine the appropriate initial imaging study to further evaluate a pancreatic cyst that was incidentally detected on a nondedicated imaging study. The recommendations are designed to maximize the yield of diagnostic information in order to better risk-stratify pancreatic cysts and assist in guiding future management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | | | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | - James M Scheiman
- University of Virginia Health System, Charlottesville, Virginia; American Gastroenterological Association
| | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Bashir MR, Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Chronic Liver Disease. J Am Coll Radiol 2020; 17:S70-S80. [PMID: 32370979 DOI: 10.1016/j.jacr.2020.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
The liver fibrosis stage is the most important clinical determinate of morbidity and mortality in patients with chronic liver diseases. With newer therapies, liver fibrosis can be stabilized and possibly reversed, thus accurate diagnosis and staging of liver fibrosis are clinically important. Ultrasound, CT, and conventional MRI can be used to establish the diagnosis of advanced fibrosis/cirrhosis but have limited utility for assessing earlier stages of fibrosis. Elastography-based ultrasound and MRI techniques are more useful for assessment of precirrhotic hepatic fibrosis. In patients with advanced fibrosis at risk for hepatocellular carcinoma (HCC), ultrasound is the surveillance modality recommended by international guidelines in nearly all circumstances. However, in patients in whom ultrasound does not assess the liver well, including those with severe steatosis or obesity, multiphase CT or MRI may have a role in surveillance for HCC. Both multiphase CT and MRI can be used for continued surveillance in patients with a history of HCC, and contrast-enhanced ultrasound may have an emerging role in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Sumeet K Asrani
- Baylor University Medical Center, Dallas, Texas; American Association for the Study of Liver Diseases
| | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Abstract
Acute pancreatitis (AP) is the most common gastrointestinal disease resulting in hospitalization in the United States with reports of over 270,000 hospitalizations and costs up to 2.6 billion dollars per year. AP is highly variable in disease course and outcome. Established in 1992, the original Atlanta classification system aimed to categorize the wide spectrum of AP by creating consensus-based terminology for AP types, severity, and complications. Though the original system standardized terminology, certain terms and definitions (i.e. pancreatic abscess) were unclear and often misused. The 2012 revised Atlanta classification (RAC) system updated terms, clarified definitions, and incorporated the medical community's improved understanding of the physiology of AP. The resulting RAC effectively defined the morphologic types of pancreatitis, provided a more standardized system for disease severity grading, further classified the local retroperitoneal complications, and established objective measures to describe this highly variable but common disease. This review provides an update on the recent literature evaluating the RAC, discusses both the strengths and shortcomings of the RAC system (including problematic interobserver agreement), and considers improvements for future classification systems.
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Affiliation(s)
| | - Elainea N Smith
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, 35294, USA
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, 35294, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, 35294, USA.
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Glaser ZA, Gordetsky JB, Bae S, Nix JW, Porter KK, Rais-Bahrami S. Evaluation of MSKCC Preprostatectomy nomogram in men who undergo MRI-targeted prostate biopsy prior to radical prostatectomy. Urol Oncol 2019; 37:970-975. [DOI: 10.1016/j.urolonc.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/07/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
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Porter KK, Zaheer A, Kamel IR, Horowitz JM, Arif-Tiwari H, Bartel TB, Bashir MR, Camacho MA, Cash BD, Chernyak V, Goldstein A, Grajo JR, Gupta S, Hindman NM, Kamaya A, McNamara MM, Carucci LR. ACR Appropriateness Criteria® Acute Pancreatitis. J Am Coll Radiol 2019; 16:S316-S330. [DOI: 10.1016/j.jacr.2019.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/19/2022]
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Triche BL, Nelson JT, McGill NS, Porter KK, Sanyal R, Tessler FN, McConathy JE, Gauntt DM, Yester MV, Singh SP. Recognizing and Minimizing Artifacts at CT, MRI, US, and Molecular Imaging. Radiographics 2019; 39:1017-1018. [DOI: 10.1148/rg.2019180022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin L. Triche
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - John T. Nelson
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Noah S. McGill
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Kristin K. Porter
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Rupan Sanyal
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Franklin N. Tessler
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Jonathan E. McConathy
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - David M. Gauntt
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Michael V. Yester
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Satinder P. Singh
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
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Glaser ZA, Gordetsky J, Bae S, Nix J, Porter KK, Rais-Bahrami S. Validation of MSKCC pre-prostatectomy nomogram in men who undergo MRI-targeted prostate biopsy prior to radical prostatectomy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.14] [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
14 Background: The Memorial Sloan Kettering Cancer Center (MSKCC) Pre-Prostatectomy nomogram is a widely used resource using clinical factors to predict the likelihood of adverse pathology at radical prostatectomy. The increasing adoption of magnetic resonance imaging (MRI) and MRI-targeted biopsy (TB) permits optimized detection of clinically-significant cancer over systematic biopsy sampling alone. We aim to validate the prognostic utility of the MSKCC Pre-Prostatectomy nomogram with TB pathology results. Methods: Men who underwent systematic extended-sextant prostate biopsy (SB) followed by MRI TB who later underwent radical prostatectomy at our institution were included. Patient information was entered into the MSKCC Pre-Prostatectomy nomogram using five biopsy reporting schemes (SB alone, TB alone reported each of two ways (individual core (IC) technique or aggregate cores (AG) technique combining cores from a single MRI targeted lesion), and SB with TB combined with TB reported by both IC and AG methods. The likelihood of extracapsular extension (EPE), lymph node involvement (LNI), and seminal vesicle invasion (SVI) as predicted by the nomogram for each biopsy reporting schema were compared to radical prostatectomy pathology. Results: We identified 63 men from January 2014 to November 2017. On ROC analysis, IC-TB, AG-TB, SB plus IC-TB, and SB plus AG-TB exhibited similar, if not improved, AUC compared to SB alone in predicting EPE (0.671, 0.674, 0.658, and 0.6613 versus 0.6085). For LNI, superior AUC was observed for AG-TB (0.647) compared to IC-TB (0.571) and SB alone (0.524) Equivocal SVI prediction was observed for SB plus IC-TB compared to SB alone (0.727 versus 0.733). Conclusions: Using TB pathology results either alone or combined with SB pathology results for the MSKCC Pre-Prostatectomy nomogram appears comparable, if not improved, in prognosticating adverse pathologic features on radical prostatectomy compared to using SB core data alone from which the nomogram was developed.
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Affiliation(s)
| | | | - Sejong Bae
- University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL
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Gordetsky JB, Ullman D, Schultz L, Porter KK, del Carmen Rodriguez Pena M, Calderone CE, Nix JW, Ullman M, Bae S, Rais-Bahrami S. Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection. Hum Pathol 2019; 83:159-165. [DOI: 10.1016/j.humpath.2018.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 11/27/2022]
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Affiliation(s)
- Elainea Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Veterans Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Porter KK, Bass RZ, Morgan DE, Canon CL, Zarzour JG. Creating a Culture to Support Radiology Resident Mothers. J Am Coll Radiol 2018; 15:1765-1767. [DOI: 10.1016/j.jacr.2018.07.001] [Citation(s) in RCA: 6] [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: 05/18/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
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Gennaro KH, Porter KK, Gordetsky JB, Galgano SJ, Rais-Bahrami S. Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification. Diagnostics (Basel) 2018; 8:diagnostics8040080. [PMID: 30513602 PMCID: PMC6316045 DOI: 10.3390/diagnostics8040080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.
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Affiliation(s)
- Kyle H Gennaro
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Calderone CE, Tuck BC, Gray SH, Porter KK, Rais-Bahrami S. The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus. Echocardiography 2018; 35:2047-2055. [DOI: 10.1111/echo.14187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Carli E. Calderone
- Department of Urology; University of Alabama at Birmingham; Birmingham Alabama
| | - Benjamin C. Tuck
- Department of Anesthesiology; University of Alabama at Birmingham; Birmingham Alabama
| | - Stephen H. Gray
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Kristin K. Porter
- Department of Radiology; University of Alabama at Birmingham; Birmingham Alabama
| | - Soroush Rais-Bahrami
- Department of Urology; University of Alabama at Birmingham; Birmingham Alabama
- Department of Radiology; University of Alabama at Birmingham; Birmingham Alabama
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Yarlagadda VK, Lai WS, Gordetsky JB, Porter KK, Nix JW, Thomas JV, Rais-Bahrami S. MRI/US fusion-guided prostate biopsy allows for equivalent cancer detection with significantly fewer needle cores in biopsy-naive men. ACTA ACUST UNITED AC 2018; 24:115-120. [PMID: 29770762 DOI: 10.5152/dir.2018.17422] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate the efficiency and cancer detection of magnetic resonance imaging (MRI) / ultrasonography (US) fusion-guided prostate biopsy in a cohort of biopsy-naive men compared with standard-of-care systematic extended sextant transrectal ultrasonography (TRUS)-guided biopsy. METHODS From 2014 to 2016, 72 biopsy-naive men referred for initial prostate cancer evaluation who underwent MRI of the prostate were prospectively evaluated. Retrospective review was performed on 69 patients with lesions suspicious for malignancy who underwent MRI/US fusion-guided biopsy in addition to systematic extended sextant biopsy. Biometric, imaging, and pathology data from both the MRI-targeted biopsies and systematic biopsies were analyzed and compared. RESULTS There were no significant differences in overall prostate cancer detection when comparing MRI-targeted biopsies to standard systematic biopsies (P = 0.39). Furthermore, there were no significant differences in the distribution of severity of cancers based on grade groups in cases with cancer detection (P = 0.68). However, significantly fewer needle cores were taken during the MRI/US fusion-guided biopsy compared with systematic biopsy (63% less cores sampled, P < 0.001) CONCLUSION: In biopsy-naive men, MRI/US fusion-guided prostate biopsy offers equal prostate cancer detection compared with systematic TRUS-guided biopsy with significantly fewer tissue cores using the targeted technique. This approach can potentially reduce morbidity in the future if used instead of systematic biopsy without sacrificing the ability to detect prostate cancer, particularly in cases with higher grade disease.
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Affiliation(s)
- Vidhush K Yarlagadda
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Win Shun Lai
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Glaser ZA, Porter KK, Thomas JV, Gordetsky JB, Rais-Bahrami S. MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence. Transl Androl Urol 2018; 7:S411-S419. [PMID: 30363494 PMCID: PMC6178314 DOI: 10.21037/tau.2018.03.21] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Baumgartner EM, Porter KK, Nix JW, Rais-Bahrami S, Gordetsky JB. Detection of extraprostatic disease and seminal vesicle invasion in patients undergoing magnetic resonance imaging-targeted prostate biopsies. Transl Androl Urol 2018; 7:S392-S396. [PMID: 30363466 PMCID: PMC6178323 DOI: 10.21037/tau.2018.03.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Finding incidental extraprostatic extension (EPE) or seminal vesicle invasion (SVI) by prostate cancer (PCa) is rare on standard prostate biopsy. We evaluated the clinical-pathologic features associated with EPE and SVI on multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided targeted biopsy (TB). Methods A retrospective review was performed from 2014-2017, selecting patients who had undergone TB. Clinical, pathologic, and radiologic features were evaluated. Results Five out of 333 (1.5%) patients who had PCa detected on TB had EPE and/or SVI. The average age and prostate-specific antigen (PSA) was 71 years and 17 ng/mL, respectively. The average number of cores taken on TB was 4.2. Two patients had a prior negative SB and two patients had a prior positive SB, one of which underwent radiation therapy. All patients had a PIRADSv2 suspicion score of 4 or 5. Four out of five (80%) patients underwent both SB and concurrent TB, of which 3/4 (75%) had EPE identified only on TB. One out of four (25%) patients also had both EPE and SVI, identified only on TB. One patient underwent only TB for MRI suspicion of SVI, which was pathologically confirmed on TB. On TB, one patient had Grade Group 3, two patients had Grade Group 4, and two patients had Grade Group 5 PCa. Perineural invasion (PNI) was present in 4/5 (80%) patients on TB. Conclusions Based on our small series, we hypothesize that MRI/US fusion TB outperforms SB in the identification of EPE and SVI. However, given the small sample size and the overall rarity of these pathologic findings on prostate biopsy, further validation is needed.
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Affiliation(s)
- Erin M Baumgartner
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Zghaib T, Shahid A, Pozzessere C, Porter KK, Chu LC, Eng J, Calkins H, Kamel IR, Nazarian S, Zimmerman SL. Validation of contrast-enhanced time-resolved magnetic resonance angiography in pre-ablation planning in patients with atrial fibrillation: comparison with traditional technique. Int J Cardiovasc Imaging 2018; 34:1451-1458. [PMID: 29663178 DOI: 10.1007/s10554-018-1355-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/05/2018] [Accepted: 04/11/2018] [Indexed: 12/13/2022]
Abstract
Bolus timing is critical to optimal magnetic resonance angiography (MRA) acquisitions but can be challenging in some patients. Our purpose was to evaluate whether contrast-enhanced time-resolved magnetic resonance angiography (TR-MRA), a dynamic multiphase sequence that does not rely on bolus timing, is a viable alternative method to conventional 3D fast-long angle shot contrast-enhanced magnetic resonance angiography (CE-MRA). Coronal subtracted conventional CE-MRA images in 50 consecutive patients presenting for pre-atrial fibrillation ablation pulmonary venous (PV) mapping were compared with 50 TR-MRA images performed in 50 subsequent patients. The TR-MRA protocol was modified to optimize spatial resolution with slightly reduced temporal resolution (6.1 s scan time). Three experienced readers evaluated each scan's image quality and relative left atrial (LA) opacification based on a 4-point scale and diagnostic PV visualization in a binary fashion. Additionally, LA signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and PV dimensions were measured for both techniques. TR-MRA had significantly higher overall image quality (3.10 ± 0.69 vs. 2.42 ± 0.69, p < 0.0001), and LA opacification scores (3.33 ± 0.70 vs. 2.15 ± 1.13, p < 0.0001) compared to CE-MRA. The proportion of diagnostically visualized pulmonary veins was 137/150 (91%) in the CE-MRA group vs. 147/150 (98%) with TR-MRA (p = 0.010). Both SNR and CNR were higher with TR-MRA vs. CE-MRA (277.9 ± 48.9 vs. 106.8 ± 41, p = 0.002 and 100.3 ± 41.7 vs. 70.7 ± 48.0, p = 0.002, respectively). Inter-reader variance of individual PV measurements for each of the MR techniques ranged between 0.62 and 1.47 mm and the ICC for vein measurements was higher with TR-MRA (range: 0.62-0.81) compared to CE-MRA (range: 0.47-0.64). TR-MRA, modified to maximize spatial resolution, offers an alternative method for performing high quality MRA examinations in patients with AF. TR-MRA offers greater overall image quality, PV visualization, and similarly reproducible PV measurements compared to traditional CE-MRA, without the challenges of proper bolus timing.
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Affiliation(s)
- Tarek Zghaib
- Division of Cardiology, Johns Hopkins Medicine, 600 N Wolfe St, Carnegie 592, Baltimore, MD, 21287, USA.
| | - Adeel Shahid
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Chiara Pozzessere
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, USA
| | - Linda C Chu
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - John Eng
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Medicine, 600 N Wolfe St, Carnegie 592, Baltimore, MD, 21287, USA
| | - Ihab R Kamel
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Saman Nazarian
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Stefan L Zimmerman
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
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Abstract
Liver lesions are often incidentally detected on ultrasound examination and may be incompletely characterized, requiring further imaging. Contrast-enhanced ultrasound (CEUS) was recently approved by the Food and Drug Administration in the United States for liver lesion characterization. CEUS has the ability to characterize focal liver lesions and has been shown to be superior to color Doppler and power Doppler ultrasound in the detection of tumor vascularity. Differentiating benign from malignant liver lesions is essential to characterizing liver lesions. The CEUS imaging characteristics of benign liver lesions are reviewed, including hepatic cysts, hemangiomas, focal fat, focal nodular hyperplasia, hepatocellular adenomas, abscesses, and traumatic lesions.
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Affiliation(s)
- Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 338, Birmingham, AL, 35294, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 338, Birmingham, AL, 35294, USA
| | - Hisham Tchelepi
- Department of Radiology, University of Southern California, Los Angeles, USA
| | - Michelle L Robbin
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 338, Birmingham, AL, 35294, USA
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Galgano SJ, Glaser ZA, Porter KK, Rais-Bahrami S. Role of Prostate MRI in the Setting of Active Surveillance for Prostate Cancer. Advances in Experimental Medicine and Biology 2018; 1096:49-67. [DOI: 10.1007/978-3-319-99286-0_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Glaser ZA, Gordetsky JB, Porter KK, Varambally S, Rais-Bahrami S. Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance. Front Oncol 2017; 7:256. [PMID: 29164056 PMCID: PMC5670116 DOI: 10.3389/fonc.2017.00256] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/12/2017] [Indexed: 01/04/2023] Open
Abstract
Background Active surveillance (AS) is a widely adopted strategy to monitor men with low-risk, localized prostate cancer (PCa). Current AS inclusion criteria may misclassify as many as one in four patients. The advent of multiparametric magnetic resonance imaging (mpMRI) and novel PCa biomarkers may offer improved risk stratification. We performed a review of recently published literature to characterize emerging evidence in support of these novel modalities. Methods An English literature search was conducted on PubMed for available original investigations on localized PCa, AS, imaging, and biomarkers published within the past 3 years. Our Boolean criteria included the following terms: PCa, AS, imaging, biomarker, genetic, genomic, prospective, retrospective, and comparative. The bibliographies and diagnostic modalities of the identified studies were used to expand our search. Results Our review identified 222 original studies. Our expanded search yielded 244 studies. Among these, 70 met our inclusion criteria. Evidence suggests mpMRI offers improved detection of clinically significant PCa, and MRI-fusion technology enhances the sensitivity of surveillance biopsies. Multiple studies demonstrate the promise of commercially available screening assays for prediction of AS failure, and several novel biomarkers show promise in this setting. Conclusion In the era of AS for men with low-risk PCa, improved strategies for proper stratification are needed. mpMRI has dramatically enhanced the detection of clinically significant PCa. The advent of novel biomarkers for prediction of aggressive disease and AS failure has shown some initial promise, but further validation is warranted.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
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Hutsler JJ, Lee DG, Porter KK. Comparative analysis of cortical layering and supragranular layer enlargement in rodent carnivore and primate species. Brain Res 2005; 1052:71-81. [PMID: 16018988 DOI: 10.1016/j.brainres.2005.06.015] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [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: 01/13/2005] [Revised: 05/31/2005] [Accepted: 06/05/2005] [Indexed: 11/17/2022]
Abstract
The mammalian cerebral cortex is composed of individual layers characterized by the cell types they contain and their afferent and efferent connections. The current study examined the raw, and size-normalized, laminar thicknesses in three cortical regions (somatosensory, motor, and premotor) of fourteen species from three orders of mammals: primates, carnivores, and rodents. The proportional size of the pyramidal cell layers (supra- and infragranular) varied between orders but was similar within orders despite wide variance in absolute cortical thickness. Further, supragranular layer thickness was largest in primates (46 +/- 3 percent), followed by carnivores (36 +/- 3 percent), and then rodents (19 +/- 4 percent), suggesting a distinct difference in the proportion of cortex devoted to corticocortical connectivity across these orders. Although measures of supragranular layer thickness are highly correlated with measures of overall brain size, such associations are not present when independent contrasts are used to control for phylogenetic inertia. Interestingly, neurogenesis time span remains strongly associated with supragranular layer thickness despite size normalization and controlling for phylogenetic inertia. Such layering differences between orders, and similarities amongst species within an order, suggest that supragranular layer expansion may have occurred early in mammalian evolution and may be related to ontogenetic variables such as neurogenesis time span rather than measures of overall size.
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Affiliation(s)
- Jeffrey J Hutsler
- Department of Psychology, 525 E. University Ave., University of Michigan, Ann Arbor, MI 48109-1109, USA.
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