BACKGROUND: Molecular imaging, particularly PET, has advanced the diagnosis and management of disease by visualizing biologic processes at a cellular and molecular level. PET imaging of the brain, spine, and head/neck, summarized under the umbrella term neuro-PET, enables noninvasive diagnosis and monitoring of diseases such as dementia, epilepsy, cancer, movement, or autoimmune disorders. The increasing prevalence of these conditions, as well as new treatment options necessitating response assessment, are expected to escalate neuro-PET imaging volumes, with projections for an increase in the need for specialized imaging services. This increasing clinical need highlights existing workforce shortages and underscores the need for neuroradiologists to acquire proficiency in molecular imaging. This expanded role seeks to address the growing demand. To this end, we propose a rigorous, structured, patient-centered, and collaborative framework for expanding neuroradiologists? training and practice to include neuro-PET interpretation. METHODS: This American Society of Neuroradiology consensus statement outlines competency recommendations, training pathways, and implementation strategies to incorporate neuro-PET into neuroradiology practice. This approach is based on existing guidelines and was informed by survey data from neuroradiologists and molecular imaging subspecialists revealing current practice patterns and training needs. For neuroradiology fellows, structured training encompasses hands-on neuro-PET imaging experience, understanding the biologic and molecular basis of radiopharmaceuticals used in neuro-PET, and integrating molecular insights with anatomic data. Neuroradiologists beyond fellowship can undertake practice-based curriculum involving supervised case interpretation, standardized reader training courses, continuing medical education (CME), and peer review. KEY MESSAGE: Neuroradiologists, with their in-depth expertise of central nervous system structure and function, are well positioned to meld molecular imaging data with traditional anatomic findings. They can achieve competency and should be granted practice privileges in interpreting neuro-PET studies through a comprehensive combination of structured training, hands-on clinical experience, and documented CME hours.

Radiology strongly impacts patient care. However, radiologists' potential to promote high-value care has long been underappreciated, partly related to difficulties in establishing their role in driving patient-oriented outcomes (e.g., reduced morbidity and mortality; improved quality of life). Recognizing this gap, the American College of Radiology convened the Relevance and Impact Committee to develop a framework for measuring radiologists' impact. The committee proposed two foundational concepts: diagnostic imaging provenance (the lineage underlying a diagnosis being established) and relevance (the manner in which a diagnosis relates to upstream reasons for examinations and downstream decision-making). The committee applied these concepts to develop the medical imaging life cycle framework as a patient and practitioner centric feedback loop whereby each examination serves as a potential care inflection point and pertinent positive and negative findings alter patient trajectories. Advances in data science, including large-scale EHR-driven analyses and generative artificial intelligence, now aid tracking of such relationships, helping to operationalize a longstanding vision of linking imaging to outcomes. This Perspective explores these core concepts and terminology underlying measurement of radiology's impact and seeks to provide a roadmap for their implementation within modern healthcare systems. Such application will promote radiologists' recognition as proximal agents of clinically impactful high-value care.

BACKGROUND: Beginning in 2006, neuroradiologists became increasingly aware of the risk of nephrogenic system fibrosis (NSF) when patients with chronic kidney disease (CKD) received gadolinium-based contrast agents (GBCAs) in conjunction with MRI scans. Radiology practices began withholding GBCAs from MRI patients with substantial CKD and instated a variety of safety measures to ensure that these individuals did not inadvertently receive GBCAs. As a result, the worldwide incidence of NSF was dramatically reduced. Since that time, a wealth of research on NSF and its etiology has found few unconfounded cases associated with those GBCAs categorized as group II agents by the American College of Radiology. METHODS: In 2023 and 2024, members of the American Society of Neuroradiology (ASNR) Standards and Guidelines Committee reviewed new research evidence on GBCA safety and its relevance to current MRI contrast administration guidelines for patients with CKD. This focused on systematic reviews and meta-analyses conducted during the past 5 years. Upon consideration of this literature, recommendations for the administration of GBCAs to patients with CKD were formulated. KEY MESSAGE: For neuroimaging applications, the ASNR recommends that group II GBCAs no longer be withheld in patients with CKD when these agents are medically indicated for diagnosis. Moreover, if group II GBCAs are exclusively used in an MRI practice, other safety measures, such as checking renal function or querying patients about CKD, can be discontinued.

Background The impact of intersectionality on academic radiology physician compensation is not well known. Purpose The aim of this study was to assess impact of intersectionality on academic radiology financial compensation, based on rank, gender and race/ethnicity in US medical schools. Methods Data were collected from the AAMC Faculty Salary Survey, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for radiology faculty with MD or equivalent degree in diagnostic radiology (DR) as well as interventional radiology (IR) was collected for 2023, stratified by rank, gender, and race/ethnicity. Results The AAMC Faculty Salary Survey data for 2023 included responses for 683 IR (138 women, 545 men) and 2431 DR (862 women, 1569 men) faculty. Men had a higher median compensation than women at all ranks, for both IR and DR, except DR instructors. The gender pay gap was greater in IR faculty compared to DR faculty of the same rank. All intersectional groups among IR faculty reported a lower median compensation compared to White men of the same rank. All intersectional groups among DR faculty, except Asian Men, had a lower median compensation than White men of the same rank. Among IR faculty, Asian women assistant professors faced the greatest disparity in median compensation, down to $75 K (15%) lower than White men. Among DR faculty, Black/African American women assistant professors faced the greatest disparity on median compensation, down to $48 K (10.5%) lower than White men. Conclusion The study results raise important concerns about impact of intersectionality on faculty compensation in radiology which needs further study and should be addressed as part of broader drive to increase diversity, equity, and inclusion in academic radiology.

Social determinants of health (SDOH) are conditions influencing individuals' health based on their environment of birth, living, working, and aging. Addressing SDOH is crucial for promoting health equity and reducing health outcome disparities. For conditions such as stroke and cancer screening where imaging is central to diagnosis and management, access to high-quality medical imaging is necessary. This article applies a previously described structural framework characterizing the impact of SDOH on patients who require imaging for their clinical indications. SDOH factors can be broadly categorized into five sectors: economic stability, education access and quality, neighborhood and built environment, social and community context, and health care access and quality. As patients navigate the health care system, they experience barriers at each step, which are significantly influenced by SDOH factors. Marginalized communities are prone to disparities due to the inability to complete the required diagnostic or screening imaging work-up. This article highlights SDOH that disproportionately affect marginalized communities, using stroke and cancer as examples of disease processes where imaging is needed for care. Potential strategies to mitigate these disparities include dedicating resources for clinical care coordinators, transportation, language assistance, and financial hardship subsidies. Last, various national and international health initiatives are tackling SDOH and fostering health equity.

Background and purposeTraumatic brain injury (TBI) is a major source of health loss and disability worldwide. Accurate and timely diagnosis of TBI is critical for appropriate treatment and management of the condition. Neuroimaging plays a crucial role in the diagnosis and characterization of TBI. Computed tomography (CT) is the first-line diagnostic imaging modality typically utilized in patients with suspected acute mild, moderate and severe TBI. Radiology reports play a crucial role in the diagnostic process, providing critical information about the location and extent of brain injury, as well as factors that could prevent secondary injury. However, the complexity and variability of radiology reports can make it challenging for healthcare providers to extract the necessary information for diagnosis and treatment planning.Methods/results/conclusionIn this article, we report the efforts of an international group of TBI imaging experts to develop a clinical radiology report template for CT scans obtained in patients suspected of TBI and consisting of fourteen different subdivisions (CT technique, mechanism of injury or clinical history, presence of scalp injuries, fractures, potential vascular injuries, potential injuries involving the extra-axial spaces, brain parenchymal injuries, potential injuries involving the cerebrospinal fluid spaces and the ventricular system, mass effect, secondary injuries, prior or coexisting pathology).

Artificial intelligence (AI) holds promise for helping patients access new and individualized health care pathways while increasing efficiencies for health care practitioners. Radiology has been at the forefront of this technology in medicine; many radiology practices are implementing and trialing AI-focused products. AI also holds great promise for reducing health disparities and promoting health equity. Radiology is ideally positioned to help reduce disparities given its central and critical role in patient care. The purposes of this article are to discuss the potential benefits and pitfalls of deploying AI algorithms in radiology, specifically highlighting the impact of AI on health equity; to explore ways to mitigate drivers of inequity; and to enhance pathways for creating better health care for all individuals, centering on a practical framework that helps radiologists address health equity during deployment of new tools.

Homelessness is a major social determinant of health. We studied the clinical and economic profile of homeless young adults hospitalized with stroke. We studied the National Inpatient Sample database (2002-2017) to evaluate trends of stroke hospitalization, clinical outcomes, and health expenditure in homeless vs non-homeless young adults (<45 years). We identified 3134 homeless individuals out of 648,944 young adults. Homeless patients were more likely to be men, Black adults and had a higher prevalence of cardiometabolic risk factors and psychiatric disorders than non-homeless adults. Both homeless and non-homeless adults had a similar prevalence of ischemic and hemorrhagic stroke. Between 2002 and 2017, hospitalization rates per million increased for both non-homeless (295.8-416.8) and homeless adults (0.5-3.6) (P ≤ 0.01). Between 2003 and 2017, the decline in in-hospital mortality was limited to non-homeless adults (11%-9%), while it has increased in homeless adults (3%-11%) (P < 0.01). The prevalence of acute myocardial infarction (6.8% vs 3.3%, P < 0.01), and acute kidney injury (13.1% vs 9.4%, P < 0.01) was also higher in homeless vs. non-homeless adults. The length of stay and inflation-adjusted care cost were comparable between both study groups. Finally, a higher proportion of homeless patients left the hospital against medical advice than non-homeless adults. Homeless young stroke patients had significant comorbidities, increased hospitalization rates, and adverse clinical outcomes. Therefore, public health interventions should focus on multidisciplinary care to reduce health care disparities among young homeless adults.

In the fall of 2021, several experts in this space delivered a Webinar hosted by the American Society of Neuroradiology (ASNR) Diversity and Inclusion Committee, focused on expanding the understanding of bias in artificial intelligence, with a health equity lens, and provided key concepts for neuroradiologists to approach the evaluation of these tools. In this perspective, we distill key parts of this discussion, including understanding why this topic is important to neuroradiologists and lending insight on how neuroradiologists can develop a framework to assess health equity-related bias in artificial intelligence tools. In addition, we provide examples of clinical workflow implementation of these tools so that we can begin to see how artificial intelligence tools will impact discourse on equitable radiologic care. As continuous learners, we must be engaged in new and rapidly evolving technologies that emerge in our field. The Diversity and Inclusion Committee of the ASNR has addressed this subject matter through its programming content revolving around health equity in neuroradiologic advances.

BACKGROUND:The exponential growth in CT utilization in emergency department (ED) until 2008 raised concerns regarding cost and radiation exposure. Head CT was one of the commonest studies. This led to mitigating efforts such as appropriate use guidelines, policy and payment reforms. The impact of these efforts is not fully understood. In addition, disparities in outcomes of acute conditions presenting to the ED is well known however recent trends in imaging utilization patterns and disparities are not well understood. In this study, we describe nationwide trends and disparities associated with head CT in ED settings between 2007 and 2014.METHODS:We analyzed 2007-2017 National Hospital Ambulatory Medical Care Survey (NHAMCS) with the primary goal to assess the rate and patterns of head CT imaging in ED.RESULTS:There were an estimated 117 million in 2007 and 139 million ED visits in 2017. There was a 4% increase in the any CT use in 2017 compared to 2007. No significant change in head CT utilization rate was seen. The 2007 head CT rate was 6.7% (95% CI: 6.1-7.3) compared to 7.7% (95% CI: 6.8-8.6) in 2017. Trauma, Headache and Dizziness are the top three indications for head CT use in the ED respectively. On adjusted analyses, significantly higher head CT utilization was seen in elderly, (age>65 yrs) and significantly lower utilization rate was seen in Non-Hispanic Black and Medicaid patients, and patients in rural locations.CONCLUSIONS:Previously reported exponential growth of CT use in ED is no longer seen. In particular, there was no significant change in ED head CT use between 2007 and 2017. Headache and Dizziness remain commonly used indications despite limited utility in most clinical scenarios, indicating continued need for appropriate use of imaging. There is significantly lower CT utilization in Non-Hispanic Black, Medicaid patients and those in rural locations, suggesting disparities in diagnostic work-up in marginalized and rural populations. This underscores the need for standardizing care regardless of race, insurance status and location.

As an organization, the American Society of Neuroradiology (ASNR) is committed to a welcoming environment for all and encourages a culture of bystander allyship, positive mentorship, and professional modeling.[1][1] Central to achieving this welcoming environment is the need to acknowledge, respect

Objective To evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA.Methods Publicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM.Results The Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%–200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%–100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%–66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state.Conclusions There are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.

AbstractObjectivesTo evaluate COVID-19 infection and mortality in ethnic and racial sub-groups across all states in the United States.MethodsPublicly available data from “The COVID Tracking Project at The Atlantic” was accessed between 09/09/2020 and 09/14/2020. For each state and the District of Columbia, % infection, % death, % population proportion for subgroups of race (African American (AA), Asian, American Indian or Alaska Native, (AI/AN) and White), and ethnicity (Hispanic/Latino, and non-Hispanic), were recorded. Absolute and relative excess infection (AEI and REI) and mortality (AEM and REM) were computed as absolute and relative difference between % infection or % mortality and % population proportion for each state. Median (IQR) REI is provided below.ResultsThe Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median REI 158%, [IQR: 100% to 200%]). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median REI, 50% [IQR 25% to 100%]). The AA population had the most disproportionate mortality with a median of 46% higher mortality than % population proportion, (median REM 46% [IQR, 18% to 66%]). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian population with ≥100% excess infections than % population proportion seen in 35 states for Hispanic, 14 states for AA, 9 states for AIAN, and 7 states for Asian populations. There was no disproportionate impact in the white population in any state.ConclusionsRacial/ethnic minorities (AA, Hispanic, AIAN and Asian populations) are disproportionately affected by COVID 19 infection and mortality across the nation. These findings underscore the potential role of social determinants of health in explaining the disparate impact of SARS-CoV-2 on vulnerable demographic groups, as well as the opportunity to improve outcomes in chronically marginalized populations.

SUMMARY: The appropriate imaging of patients with headache presents a number of important and vexing challenges for clinicians. Despite a number of guidelines and studies demonstrating a lack of cost-effectiveness, clinicians continue to image patients with chronic nonfocal headaches, and the trend toward imaging is increasing. The reasons are complex and include the fear of missing a clinically significant lesion and litigation, habitual and standard of care practices, lack of tort reform, regulatory penalties and potential impact on one’s professional reputation, patient pressures, and financial motivation. Regulatory and legislative reforms are needed to encourage best practices without fear of professional sanctions when following the guidelines. The value of negative findings on imaging tests requires better understanding because they appear to provide some measure of societal value. Clinical decision support tools and machine intelligence may offer additional guidance and improve quality and cost-efficient management of this challenging patient population.

Credits awarded for this enduring activity are designated “SA-CME” by the American Board of Radiology (ABR) and qualify toward fulfilling requirements for Maintenance of Certification (MOC) Part II: Lifelong Learning and Self-assessment. To access the SA-CME activity visit https://cortex.acr.org/Presenters/CaseScript/CaseView?CDId=XyenS8iFNlY%3d.

PURPOSE:To evaluate the economic impact and diagnostic utility of computed tomography (CT) in the management of emergency department (ED) patients presenting with headache and nonfocal physical examinations.METHODS AND MATERIALS:Computerized medical records from 2 major community hospitals were retrospectively reviewed of patients presenting with headache over a 2.5-year period (2003-2006). A model was developed to assess test outcomes, CT result costs, and average institutional costs of the ED visit. The binomial probabilistic distribution of expected maximum cases was also calculated.RESULTS:Of the 5510 patient records queried, 882 (16%) met the above criteria. Two hundred eighty-one patients demonstrated positive CT findings (31.8%), but only 9 (1.02%) demonstrated clinically significant results (requiring a change in management). Most positive studies were incidental, including old infarcts, chronic ischemic changes, encephalomalacia, and sinusitis. The average cost of the head CT exam and ED visit was $764 (2006 dollars). This was approximately 3 times the cost of a routine outpatient visit (plus CT) for headache ($253). The incremental cost per clinically significant case detected in the ED was $50078. The calculated expected maximum number of clinically significant positive cases was almost 50% lower than what was actually detected.CONCLUSION:Our results indicate that emergent CT imaging of nonfocal headache yields a low percentage of positive clinically significant results, and has limited cost efficacy. Since the use of CT for imaging patients with headache in the ED is widespread, the economic implications are considerable. Health policy reforms are indicated to better direct utilization in these patients.

Acute low back pain with or without radiculopathy is one of the most common health problems in the United States, with high annual costs of evaluation and treatment, not including lost productivity. Multiple reports show that uncomplicated acute low back pain or radiculopathy is a benign, self-limited condition that does not warrant any imaging studies. Guidelines for recognition of patients with more complicated status can be used to identify those who require further evaluation for suspicion of more serious problems and contribute to appropriate imaging utilization.

PURPOSE:To determine the clinical importance and relative value of reinterpreting brain CT imaging studies by subspecialty experts regarding changes in clinical management.METHODS:Computerized records were queried at two institutions during the years 2002-2003 for both primary interpretation by board-certified nonneuroradiologists and secondary interpretation by three neuroradiologists. A total of 1,081 cases were reviewed. Each case was initially interpreted as an emergent or urgent study. The reinterpreted studies were scored as concordant or discordant by the subspecialty experts. The discordant studies were then categorized as a "major discordance" if there was a change in clinical management, or as a "minor discordance" if there was no impact or change in clinical management.RESULTS:Of the 1,081 studies reviewed, 14 studies were identified as discordant (1.3%). Of those discordant studies, four were categorized as major discrepancies necessitating a change in clinical management (0.4 %). Ten were categorized as minor discrepancies (0.9%). There were no permanent adverse outcomes with respect to morbidity and mortality as a result of any discrepancy.CONCLUSION:The vast majority of interpreted head CT cases read by board-certified general radiologists do not result in discordant interpretations as verified by subspecialty experts. Discordant interpretations did not result in changes in clinical management in most cases. Double reading of head CTs by subspecialty experts appears to be an inefficient method of substantially improving imaging health quality outcomes.