Applying the American Association of Endodontists and American Academy of Oral and Maxillofacial Radiology guidelines for cone-beam computed tomography prescription: Impact on endodontic clinical decisions.

BACKGROUND: The American Association of Endodontists (AAE) and the American Academy of Oral and Maxillofacial Radiology (AAOMR) developed guidelines for the prescription of cone-beam computed tomographic (CBCT) imaging. The impact of appropriately prescribed CBCT imaging on endodontic diagnosis and treatment (Tx) decisions was examined. METHODS: The clinical databases at the School of Dentistry at the University of California, Los Angeles, Los Angeles, California, were queried to identify patients referred for CBCT imaging from the postgraduate endodontic clinic over a consecutive 36-month period. Primary and secondary indications for CBCT imaging were recorded. Pre-CBCT uncertainty in diagnosis, Tx of the teeth in question, and post-CBCT changes to the diagnosis and Tx plan were recorded. RESULTS: CBCT imaging was prescribed for 12% of patients. A total of 442 scans were prescribed to evaluate 526 teeth. Molars accounted for 51% of teeth examined. Overall, CBCT effected a change in periapical diagnosis (21%) and in the Tx plan (69%). The 5 most frequent primary indications for CBCT imaging were, in order, AAE-AAOMR recommendations 7, 9, 2, 12, and 6. The impact of these recommendations on Tx decisions varied from 48% through 93%. CONCLUSIONS: This study validates the use of the AAE-AAOMR guidelines for prescribing CBCT imaging for endodontic evaluations. CBCT imaging contributed predominantly to Tx decisions rather than diagnostic determinations. PRACTICAL IMPLICATIONS: This study validates AAE-AAOMR case selection guidelines for CBCT imaging and shows a positive impact of prescription imaging on endodontic decision making.

Increased Surveillance or Increased Scrutiny: Curbing Inappropriate Screening of Endometrial Cancer in Transgender Men.

Objective: The transgender male body is often considered a "black box" by even the most senior of attending physicians. Because of the stigma and fear associated with the utilization of Hormone Replacement Therapy (HRT) and the lack of clinical knowledge surrounding the subject, many transgender men will experience unnecessary testing for endometrial cancers. Materials and methods: This narrative review looked through publicly available PubMed and GoogleScholar articles on the topic of the use of pelvic ultrasounds in gynecological screening in transgendered males. 18,000 articles were filtered by relevance, date, clarity of the topic, and clinical recommendations. Of these articles 37 were included for discussion. Results: Of these 18,000 articles, only 37 were included for discussion. The resulting table, diagnostic tree, and discussion section are included within. Conclusion: Herein, the authors discuss the current understanding of the role of imaging in the diagnosis and treatment of gynecological cancers in transgendered men and how unnecessary imaging studies can be curbed for the benefit of the patient and the medical system at large.

Impact of a Health Information Technology-Enabled Appropriate Use Criterion on Utilization of Emergency Department CT for Renal Colic.

OBJECTIVE: The purpose of this study was to evaluate the impact of an appropriate use criterion (AUC) for renal colic based on local best practice, implemented as electronic clinical decision support (CDS), on the emergency department (ED) use of CT for patients with suspected nephrolithiasis. MATERIALS AND METHODS: This retrospective cohort study was performed in the EDs of a level I trauma center (study site) and local comparable hospital (control site). An AUC for patients younger than 50 years with a history of uncomplicated nephrolithiasis presenting with renal colic was developed by an interdisciplinary emergency medicine, emergency radiology, and urology team and embedded as CDS. AUC-consistent CT of ureter requests received no CDS alert. Otherwise, the orderer was alerted to consider a trial of symptomatic control or discharge without CT. A natural language processing tool mined ED notes for visits in September 2010-February 2012 (before AUC implementation) and April 2013-September 2014 (1 year after implementation) for concept unique identifiers of flank tenderness or renal or ureteral pain. Manual review excluded noneligible cases; the others were reviewed by a multidisciplinary team. Chi-square tests were used to assess for CT rate differences, the primary outcome. RESULTS: The final sample included 467 patients (194 study site) before and 306 (88 study site) after AUC implementation. The study site's CT of ureter rate decreased from 23.7% (46/194) to 14.8% (13/88) (p = 0.03) after implementation of the AUC. The rate at the control site remained unchanged, 49.8% (136/273) versus 48.2% (105/218) (p = 0.3). CONCLUSION: Implementing an AUC based on local best practice as CDS may effectively curb potential imaging overuse in a subset of ED patients with renal colic unlikely to have a complicated course or alternative dangerous diagnosis.

Why Physics in Medicine?

Despite its crucial role in the development of new medical imaging technologies, in clinical practice, physics has primarily been involved in the technical evaluation of technologies. However, this narrow role is no longer adequate. New trajectories in medicine call for a stronger role for physics in the clinic. The movement toward evidence-based, quantitative, and value-based medicine requires physicists to play a more integral role in delivering innovative precision care through the intentional clinical application of physical sciences. There are three aspects of this clinical role: technology assessment based on metrics as they relate to expected clinical performance, optimized use of technologies for patient-centered clinical outcomes, and retrospective analysis of imaging operations to ensure attainment of expectations in terms of quality and variability. These tasks fuel the drive toward high-quality, consistent practice of medical imaging that is patient centered, evidence based, and safe. While this particular article focuses on imaging, this trajectory and paradigm is equally applicable to the multitudes of the applications of physics in medicine.

Evidence-Based Cancer Imaging.

With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients.

Evidence-Based Cancer Imaging

With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients.

Ten commandments for effective clinical decision support for imaging: enabling evidence-based practice to improve quality and reduce waste.

OBJECTIVE: We describe best practices for effective imaging clinical decision support (CDS) derived from firsthand experience, extending the Ten Commandments for CDS published a decade ago. Our collective perspective is used to set expectations for providers, health systems, policy makers, payers, and health information technology developers. CONCLUSION: Highlighting unique attributes of effective imaging CDS will help radiologists to successfully lead and optimize the value of the substantial federal and local investments in health information technology in the United States.