Journal of the American College of Radiology : JACR
-
Review Practice Guideline
ACR Appropriateness Criteria® Suspected upper extremity deep vein thrombosis.
Upper-extremity venous thrombosis often presents as unilateral arm swelling. The differential diagnosis includes lesions compressing the veins and causing a functional venous obstruction, venous stenosis, an infection causing edema, obstruction of previously functioning lymphatics, or the absence of sufficient lymphatic channels to ensure effective drainage. The following recommendations are made with the understanding that venous disease, specifically venous thrombosis, is the primary diagnosis to be excluded or confirmed in a patient presenting with unilateral upper-extremity swelling. ⋯ The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
-
Practice Guideline
Factors associated with radiologists' adherence to Fleischner Society guidelines for management of pulmonary nodules.
In 2005, the Fleischner Society guidelines (FSG) for managing pulmonary nodules detected on CT scans were published. The aim of this study was to evaluate adherence to the FSG, adjusting for demographic and clinical variables that may contribute to adherence. ⋯ Pulmonary nodules are prevalent findings on chest and abdominal CT scans. Although most radiologists recommend follow-up imaging for these findings, recommendations for pulmonary nodules were consistent with the FSG in 34% of radiology reports. Nodule size demonstrated an association with guideline adherence, after adjusting for key variables.
-
An increasing portion of imaging studies are performed by nonradiologists, especially for modalities with the highest relative value units. The aim of this study was to examine the trends in neuroradiologic interpretation among radiologists, neurologists, neurosurgeons, and other specialists within the Medicare population. ⋯ There was marked growth (140%) in neuroradiologic studies between 1996 and 2010 in the Medicare patient population. Radiologists' share of the total neuroradiologic interpretations remained unchanged and constituted 93.5% in 2010. Radiology's market share has shown growth in the inpatient and hospital outpatient sectors but not the private office sector, where independent diagnostic testing facilities, multidisciplinary groups, and other specialists have seen increases.
-
The aim of this study was to assess the association of patient encounter complexity and the utilization of CT of the abdomen and pelvis (CTAP) in the emergency department (ED) setting. ⋯ Of patients undergoing CTAP in the ED setting, a very large majority (93.8%) are clinically complex. CT of the abdomen and pelvis is 5.95 times more likely to be utilized in higher than lower complexity ED patient encounters.