Marc Willis, DO

View details for DOI 10.1016/j.jacr.2020.09.053

View details for PubMedID 33069677

View details for DOI 10.1016/j.jacr.2020.07.009

View details for PubMedID 32783896

Abstract

PURPOSE: The aim of this study was to determine whether participation in Radiology Support, Communication and Alignment Network (R-SCAN) results in a reduction of inappropriate imaging in a wide range of real-world clinical environments.METHODS: This quality improvement study used imaging data from 27 US academic and private practices that completed R-SCAN projects between January 25, 2015, and August 8, 2018. Each project consisted of baseline, educational (intervention), and posteducational phases. Baseline and posteducational imaging cases were rated as high, medium, or low value on the basis of validated ACR Appropriateness Criteria. Four cohorts were generated: a comprehensive cohort that included all eligible practices and three topic-specific cohorts that included practices that completed projects of specific Choosing Wisely topics (pulmonary embolism, adnexal cyst, and low back pain). Changes in the proportion of high-value cases after R-SCAN intervention were assessed for each cohort using generalized estimating equation logistic regression, and changes in the number of low-value cases were analyzed using Poisson regression.RESULTS: Use of R-SCAN in the comprehensive cohort resulted in a greater proportion of high-value imaging cases (from 57% to 79%; odds ratio, 2.69; 95% confidence interval, 1.50-4.86; P= .001) and 345 fewer low-value cases after intervention (incidence rate ratio, 0.45; 95% confidence interval, 0.29-0.70; P < .001). Similar changes in proportion of high-value cases and number of low-value cases were found for the pulmonary embolism, adnexal cyst, and low back pain cohorts.CONCLUSIONS: R-SCAN participation was associated with a reduced likelihood of inappropriate imaging and is thus a promising tool to enhance the quality of patient care and promote wise use of health care resources.

View details for DOI 10.1016/j.jacr.2020.02.011

View details for PubMedID 32371000

Abstract

As of January 2020, clinical decision support needs to be implemented across US health systems for advanced diagnostic imaging services. This article reviews the history, importance, and hurdles of clinical decision support and discusses a few pearls and pitfalls regarding its implementation.

View details for DOI 10.1016/j.jacr.2020.03.016

View details for PubMedID 32370997

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has reduced radiology volumes across the country as providers have decreased elective care to minimize the spread of infection and free up health care delivery system capacity. After the stay-at-home order was issued in our county, imaging volumes at our institution decreased to approximately 46% of baseline volumes, similar to the experience of other radiology practices. Given the substantial differences in severity and timing of the disease in different geographic regions, estimating resumption of radiology volumes will be one of the next major challenges for radiology practices. We hypothesize that there are six major variables that will likely predict radiology volumes: (1) severity of disease in the local region, including potential subsequent "waves" of infection; (2) lifting of government social distancing restrictions; (3) patient concern regarding risk of leaving home and entering imaging facilities; (4) management of pent-up demand for imaging delayed during the acute phase of the pandemic, including institutional capacity; (5) impact of the economic downturn on health insurance and ability to pay for imaging; and (6) radiology practice profile reflecting amount of elective imaging performed, including type of patients seen by the radiology practice such as emergency, inpatient, outpatient mix and subspecialty types. We encourage radiology practice leaders to use these and other relevant variables to plan for the coming weeks and to work collaboratively with local health system and governmental leaders to help ensure that needed patient care is restored as quickly as the environment will safely permit.

View details for DOI 10.1016/j.jacr.2020.05.026

View details for PubMedID 32505562

Abstract

The ACR recognizes that radiology practices are grappling with when and how to safely resume routine radiology care during the coronavirus disease 2019 (COVID-19) pandemic. Although it is unclear how long the pandemic will last, it may persist for many months. Throughout this time, it will be important to perform safe, comprehensive, and effective care for patients with and patients without COVID-19, recognizing that asymptomatic transmission is common with this disease. Local idiosyncrasies prevent a single prescriptive strategy. However, general considerations can be applied to most practice environments. A comprehensive strategy will include consideration of local COVID-19 statistics; availability of personal protective equipment (PPE); local, state, and federal government mandates; institutional regulatory guidance; local safety measures; health care worker availability; patient and health care worker risk factors; factors specific to the indication(s) for radiology care; and examination or procedure acuity. An accurate risk-benefit analysis of postponing versus performing a given routine radiology examination or procedure often is not possible due to many unknown and complex factors. However, this is the overriding principle: If the risk of illness or death to a health care worker or patient from health care-acquired COVID-19 is greater than the risk of illness or death from delaying radiology care, the care should be delayed; however, if the opposite is true, the radiology care should proceed in a timely fashion.

View details for DOI 10.1016/j.jacr.2020.05.001

View details for PubMedID 32442427

View details for PubMedCentralID PMC7201228

View details for DOI 10.1016/j.jacr.2016.08.030

View details for Web of Science ID 000398652400028

View details for PubMedID 27884631

View details for PubMedID 28284675

View details for DOI 10.1016/j.jacr.2016.09.040

View details for Web of Science ID 000389562000011

View details for PubMedID 27888947

View details for DOI 10.1016/j.jacr.2016.05.002

View details for Web of Science ID 000387638400013

View details for PubMedID 27319371

Abstract

The menisci play an important biomechanical role in axial load distribution of the knees by means of hoop strength, which is contingent on intact circumferentially oriented collagen fibers and meniscal root attachments. Disruption of the meniscal root attachments leads to altered biomechanics, resulting in progressive cartilage loss, osteoarthritis, and subchondral edema, with the potential for development of a subchondral insufficiency fracture. Identification of meniscal root tears at magnetic resonance (MR) imaging is crucial because new arthroscopic surgical techniques (transtibial pullout repair) have been developed to repair meniscal root tears and preserve the tibiofemoral cartilage of the knee. An MR imaging classification of posterior medial meniscal root ligament lesions has been recently described that is dedicated to the posterior root of the medial meniscus. An arthroscopic classification of meniscal root tears has been described that can be applied to the anterior and posterior roots of both the medial meniscus and the lateral meniscus. This arthroscopic classification includes type 1, partial stable root tears; type 2, complete radial root tears; type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the radiologist in the preoperative reporting of meniscal root tear types and the evaluation of the tibiofemoral cartilage. As more patients undergo arthroscopic repair of meniscal root tears, familiarity with the surgical technique and the postoperative radiographic and MR imaging appearance is important to adequately report the imaging findings. RSNA, 2016.

View details for DOI 10.1148/rg.2016160026

View details for Web of Science ID 000388438200012

View details for PubMedID 27726749

Abstract

To determine the reliability of measuring ulnar variance on lateral wrist radiographs and to compare this technique with previously described methods.Ulnar variance was measured in 100 normal wrist radiographs using the methods of perpendiculars, central reference point, and the lateral radiograph by 3 surgeons on 2 occasions. Intraobserver repeatability and agreement between raters and methods were assessed and compared.Intra- and interobserver reliability and agreement were both excellent using all 3 methods within a 1.0-mm cutoff. However, there was substantial pairwise disagreement in measures of ulnar variance between all 3 methods.This study demonstrates that, for measurement of ulnar variance, the methods of perpendiculars, central reference point, and lateral radiographic measurement each have clinically acceptable intraobserver repeatability and interobserver agreement. Despite their independent reliability, each method of radiographic determination of ulnar variance had considerable disagreement with the other methods, indicative of inherent inaccuracies in the techniques. The lateral radiograph uniquely allows for visualization of the amount of ulnar head protruding proximal or distal to the concave lunate facet and allows for a rapid estimation of pronosupination, which is known to affect ulnar variance.Determination of ulnar variance can be an important component of surgical decision making in various pathological conditions of the hand and wrist. Traditionally, it has been measured through methods using the posteroanterior wrist radiograph, but there are potential shortcomings with these methods, and use of the lateral radiograph may provide a more clinically relevant picture of ulnar variance. This study shows that measurement from the lateral radiograph provides similar reliability to previously accepted techniques.

View details for DOI 10.1016/j.jhsa.2014.03.024

View details for Web of Science ID 000337011000012

View details for PubMedID 24810937

Abstract

Medical physics instruction for diagnostic radiology residency at our institution has been redesigned with an interactive and image-based approach that encourages clinical application. The new medical physics curriculum spans the first 3 years of radiology residency and is integrated with the core didactic curriculum.Salient features include clinical medical physics conferences, fundamentals of medical physics lectures, practicums, online modules, journal club, and a final review before the American Board of Radiology core examination.

View details for DOI 10.2214/AJR.11.7356

View details for Web of Science ID 000308150000048

View details for PubMedID 22915405

Abstract

The upcoming ABR examination format for radiology residents is undergoing significant changes in 2013. This requires adaptation of the didactic curriculum for radiology residents entering in July 2010 to meet these changes. Physics will now be incorporated into the core (qualifying) examination during the third year of residency, instead of being tested as a separate examination that was often taken earlier in residency training in past years. In this article, the authors discuss the past, present, and future of medical physics instruction and outline a revised medical physics curriculum for radiology residents that has been internally approved for implementation at the authors' institution and has not been advocated by any society or by the ABR. Starting with this article, the authors hope to encourage a discussion of physics curriculum revision with other institutions.

View details for DOI 10.1016/j.jacr.2010.08.016

View details for Web of Science ID 000305361100012

View details for PubMedID 21211765