Staff Profile

@article{pmid38086003,

title = {Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations},

author = {Mary Linton B Peters and Andrew Eckel and Claudia L Seguin and Barak Davidi and David H Howard and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1200/OP.23.00495},

issn = {2688-1535},

year  = {2024},

date = {2024-02-01},

urldate = {2024-02-01},

journal = {JCO Oncol Pract},

volume = {20},

issue = {2},

pages = {278-290},

abstract = {PURPOSE: We evaluated the potential cost-effectiveness of combined magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) screening for pancreatic ductal adenocarcinoma (PDAC) among populations at high risk for the disease.nnMETHODS: We used a microsimulation model of the natural history of PDAC to estimate the lifetime health benefits, costs, and cost-effectiveness of PDAC screening among populations with specific genetic risk factors for PDAC, including  and , , , Lynch syndrome, , , and . For each high-risk population, we simulated 29 screening strategies, defined by starting age and frequency. Screening included MRI with follow-up EUS in a subset of patients. Costs of tests were based on Medicare reimbursement for MRI, EUS, fine-needle aspiration biopsy, and pancreatectomy. Cancer-related cost by stage of disease and phase of treatment was based on the literature. For each high-risk population, we performed an incremental cost-effectiveness analysis, assuming a willingness-to-pay (WTP) threshold of $100,000 US dollars (USD) per quality-adjusted life year (QALY) gained.nnRESULTS: For men with relative risk (RR) 12.33 () and RR 28 (), annual screening was cost-effective, starting at age 55 and 40 years, respectively. For women, screening was only cost-effective for those with RR 28 (), with annual screening starting at age 45 years.nnCONCLUSION: Combined MRI/EUS screening may be a cost-effective approach for the highest-risk populations (among mutations considered, those with RR \>12). However, for those with moderate risk (RR, 5-12), screening would only be cost-effective at higher WTP thresholds (eg, $200K USD/QALY) or with once-only screening.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37406750c,

title = {Ultrasound Surveillance of Small, Incidentally Detected Gallbladder Polyps: Projected Benefits by Sex, Age, and Comorbidity Level},

author = {Claudia L Seguin and Barak Davidi and Mary Linton B Peters and Andrew Eckel and Mukesh G Harisinghani and Reece J Goiffon and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1016/j.jacr.2023.05.015},

issn = {1558-349X},

year  = {2023},

date = {2023-10-01},

urldate = {2023-10-01},

journal = {J Am Coll Radiol},

volume = {20},

number = {10},

pages = {1031-1041},

abstract = {OBJECTIVE: Incidentally detected gallbladder polyps are commonly encountered when performing upper abdominal ultrasound. Our purpose was to estimate the life expectancy (LE) benefit of ultrasound-based gallbladder surveillance in patients with small (6-7 to \<10 mm), incidentally detected gallbladder polyps, accounting for patient sex, age, and comorbidity level.nnMETHODS: We developed a decision-analytic Markov model to evaluate hypothetical cohorts of women and men with small gallbladder polyps, with varying age (66-80 years) and comorbidity level (none, mild, moderate, severe). Drawing from current evidence, in the base case, we assumed no increased risk of gallbladder cancer in patients with small gallbladder polyps. To estimate maximal possible LE gains from surveillance, we assumed perfect cancer control consequent to 5 years of surveillance. We varied key assumptions including cancer risk and test performance characteristics in sensitivity analysis.nnRESULTS: Projected LE gains from surveillance were \<3 days across most cohorts and scenarios evaluated. For 66- and 80-year-olds with no comorbidities, LE gains were 1.46 and 1.45 days, respectively, for women, and 0.67 and 0.75 days for men. With 10 years of surveillance, LE gains increased to 2.94 days for 66-year-old women with no comorbidities (men: 1.35 days). If we assumed a 10% increase in gallbladder cancer risk among individuals with polyps, LE gains increased slightly to 1.60 days for 66-year-old women with no comorbidities (men: 0.74 days). Results were sensitive to test performance and surgical mortality.nnDISCUSSION: Even under unrealistic, optimistic assumptions of cancer control, ultrasound surveillance of incidentally detected small gallbladder polyps provided limited benefit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37406750,

title = {Ultrasound Surveillance of Small Incidentally Detected Gallbladder Polyps: Projected Benefits by Sex, Age, and Comorbidity Level},

author = {Claudia L Seguin and Barak Davidi and Mary Linton B Peters and Andrew Eckel and Mukesh G Harisinghani and Reece J Goiffon and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1016/j.jacr.2023.05.015},

issn = {1558-349X},

year  = {2023},

date = {2023-07-01},

urldate = {2023-07-01},

journal = {J Am Coll Radiol},

volume = {S1546-1440},

issue = {23},

pages = {00475-1},

abstract = {OBJECTIVE: Incidentally detected gallbladder polyps are commonly encountered when performing upper abdominal ultrasound. Our purpose was to estimate the life expectancy (LE) benefit of ultrasound-based gallbladder surveillance in patients with small (6-7 to \<10 mm), incidentally detected gallbladder polyps, accounting for patient sex, age, and comorbidity level.nnMETHODS: We developed a decision-analytic Markov model to evaluate hypothetical cohorts of women and men with small gallbladder polyps, with varying age (66-80 years) and comorbidity level (none, mild, moderate, severe). Drawing from current evidence, in the base case, we assumed no increased risk of gallbladder cancer in patients with small gallbladder polyps. To estimate maximal possible LE gains from surveillance, we assumed perfect cancer control consequent to five years of surveillance. We varied key assumptions including cancer risk and test performance characteristics in sensitivity analysis.nnRESULTS: Projected LE gains from surveillance were \< 3 days across most cohorts and scenarios evaluated. For 66- and 80-year-olds with no comorbidities, LE gains were 1.46 and 1.45 days, respectively, for women, and 0.67 and 0.75 days for men. With ten years of surveillance, LE gains increased to 2.94 days for 66-year-old women with no comorbidities (men: 1.35 days). If we assumed a 10% increase in gallbladder cancer risk among individuals with polyps, LE gains increased slightly to 1.60 days for 66-year-old women with no comorbidities (men: 0.74 days). Results were sensitive to test performance and surgical mortality.nnDISCUSSION: Even under unrealistic, optimistic assumptions of cancer control, ultrasound surveillance of incidentally detected small gallbladder polyps provided limited benefit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{PETERS2022,

title = {‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Genetic testing to guide screening for pancreatic ductal adenocarcinoma: Results of a microsimulation model},

author = {Mary Linton B. Peters and Andrew Eckel and Anna Lietz and Claudia Seguin and Peter Mueller and Chin Hur and Pari V. Pandharipande},

url = {https://www.sciencedirect.com/science/article/pii/S1424390322001703},

doi = {https://doi.org/10.1016/j.pan.2022.05.003},

issn = {1424-3903},

year  = {2022},

date = {2022-09-22},

urldate = {2022-05-31},

journal = {Pancreatology},

volume = {22},

issue = {6},

pages = {760-769},

abstract = {Background 

First-degree relatives (FDRs) of patients with pancreatic ductal adenocarcinoma (PDAC) have elevated PDAC risk, partially due to germline genetic variants. We evaluated the potential effectiveness of genetic testing to target MRI-based screening among FDRs. 

Methods 

We used a microsimulation model of PDAC, calibrated to Surveillance, Epidemiology, and End Results (SEER) data, to estimate the potential life expectancy (LE) gain of screening for each of the following groups of FDRs: indviduals who test positive for each of eight variants associated with elevated PDAC risk (e.g., BRCA2, CDKN2A); individuals who test negative; and individuals who do not test. Screening was assumed to take place if LE gains were achievable. We simulated multiple screening approaches, defined by starting age and frequency. Sensitivity analysis evaluated changes in results given varying model assumptions. 

Results 

For women, 92% of mutation carriers had projected LE gains from screening for PDAC, if screening strategies (start age, frequency) were optimized. Among carriers, LE gains ranged from 0.1 days (ATM + women screened once at age 70) to 510 days (STK11+ women screened annually from age 40). For men, LE gains were projected for all mutation carriers, ranging from 0.2 days (BRCA1+ men screened once at age 70) to 620 days (STK11+ men screened annually from age 40). For men and women who did not undergo genetic testing, or for whom testing showed no variant, screening yielded small LE benefit (0\textendash2.1 days). 

Conclusions 

Genetic testing of FDRs can inform targeted PDAC screening by identifying which FDRs may benefit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Petranovic2022,

title = {Liquid Biopsy, Diagnostic Imaging, and Future Synergies.},

author = {Milena Petranovic and Sana Raoof and Subba R. Digumarthy and Amita Sharma and Jo-Anne O. Shepard and Justin F. Gainor and Pari V. Pandharipande},

url = {https://pubmed.ncbi.nlm.nih.gov/35152958/},

doi = {10.1016/j.jacr.2021.11.001},

issn = {1558-349X},

year  = {2022},

date = {2022-02-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {19},

issue = {2 Pt B},

pages = {336--343},

abstract = {Imaging plays an integral role in the initial diagnosis and longitudinal care of patients with cancer. Liquid biopsies, which most commonly involve genetic analysis of circulating free DNA, have emerged as important complementary tools in cancer care with the potential to interface with imaging at each step of the cancer care continuum. Here, the authors use non-small-cell lung cancer as a paradigm to elucidate factors driving the need for liquid biopsy in the spectrum of lung cancer care, demonstrate ways in which liquid biopsy has already changed standard clinical practice, and discuss anticipated synergies of liquid biopsy and imaging in screening and early detection and in monitoring of disease.},

keywords = {},

pubstate = {ppublish},

tppubtype = {article}

}

@article{Munden2021,

title = {Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee.},

author = {Reginald F Munden and William C Black and Thomas E Hartman and Heber MacMahon and Jane P Ko and Debra S Dyer and David Naidich and Santiago E Rossi and H Page McAdams and Eric M Goodman and Kathleen Brown and Michael Kent and Brett W Carter and Caroline Chiles and Ann N Leung and Phillip M Boiselle and Ella A Kazerooni and Lincoln L Berland and Pari Pandharipande},

url = {https://pubmed.ncbi.nlm.nih.gov/34246574/},

doi = {10.1016/j.jacr.2021.04.014},

issn = {1558-349X},

year  = {2021},

date = {2021-07-01},

journal = {Journal of the American College of Radiology : JACR},

abstract = {The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Thrall2021,

title = {Rethinking the Approach to Artificial Intelligence for Medical Image Analysis: The Case for Precision Diagnosis.},

author = {James H Thrall and David Fessell and Pari Pandharipande},

url = {https://pubmed.ncbi.nlm.nih.gov/33413896/},

doi = {10.1016/j.jacr.2020.07.010},

issn = {1558-349X},

year  = {2021},

date = {2021-01-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {18},

number = {1 Pt B},

pages = {174--179},

abstract = {To date, widely generalizable artificial intelligence (AI) programs for medical image analysis have not been demonstrated, including for mammography. Rather than pursuing a strategy of collecting ever-larger databases in the attempt to build generalizable programs, we suggest three possible avenues for exploring a precision medicine or precision imaging approach. First, it is now technologically feasible to collect hundreds of thousands of multi-institutional cases along with other patient data, allowing stratification of patients into subpopulations that have similar characteristics in the manner discussed by the National Research Council in its white paper on precision medicine. A family of AI programs could be developed across different examination types that are matched to specific patient subpopulations. Such stratification can help address bias, including racial or ethnic bias, by allowing unbiased data aggregation for creation of subpopulations. Second, for common examinations, larger institutions may be able to collect enough of their own data to train AI programs that reflect disease prevalence and variety in their respective unique patient subpopulations. Third, high- and low-probability subpopulations can be identified by application of AI programs, thereby allowing their triage off the radiology work list. This would reduce radiologists' workloads, providing more time for interpretation of the remaining examinations. For high-volume procedures, investigators should come together to define reference standards, collect data, and compare the merits of pursuing generalizability versus a precision medicine subpopulation-based strategy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Seguin2020,

title = {Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity Level.},

author = {Claudia Seguin and Anna Lietz and Jason D. Wright and Alexi Wright and Amy Knudsen and Pari Pandharipande},

url = {https://pubmed.ncbi.nlm.nih.gov/33096089/},

doi = {10.1016/j.jacr.2020.09.048},

issn = {1558-349X},

year  = {2021},

date = {2021-01-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {18},

number = {1 PT A},

pages = {10-18},

abstract = {The aim of this study was to estimate effects on life expectancy (LE) of imaging-based ovarian surveillance after detection of incidental postmenopausal ovarian cysts, under different assumptions of patient age, comorbidity level, and cancer risk and detection. A decision-analytic Markov model was developed to estimate LE benefits. Hypothetical cohorts of postmenopausal women with simple ovarian cysts were evaluated, with varied age (66-80 years) and comorbidity level (none, mild, moderate, severe). For each cohort, imaging "follow-up" (2 years) and "no-follow-up" strategies were compared. Consistent with current evidence, increased cancer risk in patients with cysts was not assumed; however, incident ovarian cancers could be detected during follow-up. To estimate theoretical maximal LE gains from follow-up, perfect ovarian cancer detection and treatment during follow-up were assumed. This and other key assumptions were varied in sensitivity analysis. Projected LE gains from follow-up were limited. For 66-, 70-, 75-, and 80-year-old women with no comorbidities, LE gains were 5.1, 5.1, 4.5, and 3.7 days; with severe comorbidities, they were 3.5, 3.2, 2.7, and 2.1 days. With sensitivity of 50% for cancer detection, they were 3.7 days for 66-year-old women with no comorbidities and 1.3 days for 80-year-old women with severe comorbidities. When cancer risk for women with cysts was assumed to be elevated (1.1 times average risk), LE gains increased only modestly (5.6 and 2.3 days for analogous cohorts). Even in the circumstance of perfect ovarian cancer detection and treatment, surveillance of postmenopausal women (≥66 years of age) with simple cysts affords limited benefits, particularly in women with advanced age and comorbidities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{ExpertPanel2020,

title = {ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer},

author = {Expert Panel GYN and OB Imaging and Caroline Reinhold and Yoshiko Ueno and Esma A Akin and Priyadarshani R Bhosale and Kika M Dudiak and Anuja Jhingran and Stella K Kang and Aoife Kilcoyne and Yulia Lakhman and Refky Nicola and Pari Pandharipande and Rajmohan Paspulati and Atul B Shinagare and William Small and Hebert Alberto Vargas and Bradford P Whitcomb and Phyllis Glanc},

url = {https://pubmed.ncbi.nlm.nih.gov/33153558/},

doi = {10.1016/j.jacr.2020.09.001},

issn = {1558-349X},

year  = {2020},

date = {2020-11-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {17},

pages = {S472--S486},

abstract = {To date, there is little consensus on the role of pelvic imaging in assessing local disease extent during initial staging in patients with endometrial carcinoma, with practices differing widely across centers. However, when pretreatment assessment of local tumor extent is indicated, MRI is the preferred imaging modality. Preoperative imaging of endometrial carcinoma can define the extent of disease and indicate the need for subspecialist referral in the presence of deep myometrial invasion, cervical extension, or suspected lymphadenopathy. If distant metastatic disease is clinically suspected, preoperative assessment with cross-sectional imaging or PET/CT may be performed. However, most patients with low-grade disease are at low risk of lymph node and distant metastases. Thus, this group may not require a routine pretreatment evaluation for distant metastases. Recurrence rates in patients with endometrial carcinoma are infrequent. Therefore, radiologic evaluation is typically used only to investigate suspicion of recurrent disease due to symptoms or physical examination and not for routine surveillance after treatment. 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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yuan2020,

title = {Diabetes, Weight Change, and Pancreatic Cancer Risk.},

author = {Chen Yuan and Ana Babic and Natalia Khalaf and Jonathan A. Nowak and Lauren K. Brais and Douglas A. Rubinson and Kimmie Ng and Andrew J. Aguirre and Pari Pandharipande and Charles S. Fuchs and Edward L. Giovannucci and Meir J. Stampfer and Michael H. Rosenthal and Chris Sander and Peter Kraft and Brian M. Wolpin},

url = {https://pubmed.ncbi.nlm.nih.gov/32789511/},

doi = {10.1001/jamaoncol.2020.2948},

issn = {2374-2445},

year  = {2020},

date = {2020-08-01},

journal = {JAMA oncology},

abstract = {Pancreatic cancer is the third-leading cause of cancer death in the United States; however, few high-risk groups have been identified to facilitate early diagnosis strategies. To evaluate the association of diabetes duration and recent weight change with subsequent risk of pancreatic cancer in the general population. This cohort study obtained data from female participants in the Nurses' Health Study and male participants in the Health Professionals Follow-Up Study, with repeated exposure assessments over 30 years. Incident cases of pancreatic cancer were identified from self-report or during follow-up of participant deaths. Deaths were ascertained through reports from the next of kin, the US Postal Service, or the National Death Index. Data collection was conducted from October 1, 2018, to December 31, 2018. Data analysis was performed from January 1, 2019, to June 30, 2019. Duration of physician-diagnosed diabetes and recent weight change. Hazard ratios (HRs) for subsequent development of pancreatic cancer. Of the 112 818 women (with a mean [SD] age of 59.4 [11.7] years) and 46 207 men (with a mean [SD] age of 64.7 [10.8] years) included in the analysis, 1116 incident cases of pancreatic cancers were identified. Compared with participants with no diabetes, those with recent-onset diabetes had an age-adjusted HR for pancreatic cancer of 2.97 (95% CI, 2.31-3.82) and those with long-standing diabetes had an age-adjusted HR of 2.16 (95% CI, 1.78-2.60). Compared with those with no weight loss, participants who reported a 1- to 4-lb weight loss had an age-adjusted HR for pancreatic cancer of 1.25 (95% CI, 1.03-1.52), those with a 5- to 8-lb weight loss had an age-adjusted HR of 1.33 (95% CI, 1.06-1.66), and those with more than an 8-lb weight loss had an age-adjusted HR of 1.92 (95% CI, 1.58-2.32). Participants with recent-onset diabetes accompanied by weight loss of 1 to 8 lb (91 incident cases per 100 000 person-years [95% CI, 55-151]; HR, 3.61 [95% CI, 2.14-6.10]) or more than 8 lb (164 incident cases per 100 000 person-years [95% CI, 114-238]; HR, 6.75 [95% CI, 4.55-10.00]) had a substantially increased risk for pancreatic cancer compared with those with neither exposure (16 incident cases per 100 000 person-years; 95% CI, 14-17). Incidence rates were even higher among participants with recent-onset diabetes and weight loss with a body mass index of less than 25 before weight loss (400 incident cases per 100 000 person-years) or whose weight loss was not intentional judging from increased physical activity or healthier dietary choices (334 incident cases per 100 000 person-years). This study demonstrates that recent-onset diabetes accompanied by weight loss is associated with a substantially increased risk for developing pancreatic cancer. Older age, previous healthy weight, and no intentional weight loss further elevate this risk.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ciprani2020,

title = {Risk of malignancy in small pancreatic cysts decreases over time.},

author = {D. Ciprani and M. Weniger and M. Qadan and T. Hank and N. K. Horick and J. M. Harrison and G. Marchegiani and S. Andrianello and Pari Pandharipande and C. R. Ferrone and K. D. Lillemoe and A. L. Warshaw and C. Bassi and R. Salvia and C. Fern\'{a}ndez-Del Castillo},

url = {https://pubmed.ncbi.nlm.nih.gov/32819844/},

doi = {10.1016/j.pan.2020.08.003},

issn = {1424-3911},

year  = {2020},

date = {2020-08-01},

journal = {Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]},

abstract = {Pancreatic cysts \<15 mm without worrisome features have practically no risk of malignancy at the time of diagnosis but this can change over time. Optimal duration of follow-up is a matter of debate. We evaluated predictors of malignancy and attempted to identify a time to safely discontinue surveillance. Bi-centric study utilizing prospectively collected databases of patients with pancreatic cysts measuring \<15 mm and without worrisome features who underwent surveillance at the Massachusetts General Hospital (1988-2017) and at the University of Verona Hospital Trust (2000-2016). The risk of malignant transformation was assessed using the Kaplan-Meier method and parametric survival models, and predictors of malignancy were evaluated using Cox regression. 806 patients were identified. Median follow-up was 58 months (6-347). Over time, 58 (7.2%) cysts were resected and of those, 11 had high grade dysplasia (HGD) or invasive cancer. Three additional patients had unresectable cancer for a total rate of malignancy of 1.7%. Predictors of development of malignancy included an increase in size ≥2.5 mm/year (HR = 29.54, 95% CI: 9.39-92.91, P \< 0.001) and the development of worrisome features (HR = 9.17, 95% CI: 2.99-28.1},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Atwi2020,

title = {Follow-up Recommendation Rates Associated With Spectral Detector Dual-Energy CT of the Abdomen and Pelvis: A Retrospective Comparison to Single-Energy CT.},

author = {Noah E Atwi and Carl F Sabottke and David M Pitre and David L Smith and Raman Danrad and Ekta Dharaiya and Avinash Kambadakone and Pari Pandharipande and Aran M Toshav},

url = {https://pubmed.ncbi.nlm.nih.gov/32032553/},

doi = {10.1016/j.jacr.2019.12.029},

issn = {1558-349X},

year  = {2020},

date = {2020-07-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {17},

pages = {940--950},

abstract = {Dual-energy CT image sets have many applications in abdominopelvic imaging but no demonstrated clinical effect. To determine the effect of dual-energy CT iodine maps on abdominopelvic imaging follow-up recommendation rates. Retrospective study of abdominopelvic CTs acquired from April 2017 through June 2018. CT reports were analyzed for radiologic follow-up recommendation and follow-up recommendation reason. Follow-up MRI reports were analyzed for benign or nonbenign diagnosis. CT scans with iodine maps (CTIMs) and conventional CT scans (CCTs) subgroups were compared using χ testing. In all, 3,221 abdominopelvic CT scans of 2,401 patients (1,326 men, 1,075 women, mean age 54.1 years) were analyzed; 1,423 were CTIMs and 1,798 were CCTs. Follow-up recommendation rates were not significantly different for CTIMs and CCTs (19.5% and 21.4%, respectively},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Pandharipande2020,

title = {Imaging-based Risk Scores for Treatment Selection in Early Pancreatic Cancer: A Step Forward for Tailored Treatment.},

author = {Pari Pandharipande and Mark A. Anderson},

url = {https://pubmed.ncbi.nlm.nih.gov/32692283/},

doi = {10.1148/radiol.2020202567},

issn = {1527-1315},

year  = {2020},

date = {2020-07-01},

urldate = {2020-07-01},

journal = {Radiology},

pages = {202567},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kim2020,

title = {Genetic and Circulating Biomarker Data Improve Risk Prediction for Pancreatic Cancer in the General Population.},

author = {Jihye Kim and Chen Yuan and Ana Babic and Ying Bao and Clary B. Clish and Michael N. Pollak and Laufey T. Amundadottir and Alison P. Klein and Rachael Z. Stolzenberg-Solomon and Pari Pandharipande and Lauren K. Brais and Marisa W. Welch and Kimmie Ng and Edward L. Giovannucci and Howard D. Sesso and JoAnn E. Manson and Meir J. Stampfer and Charles S. Fuchs and Brian M. Wolpin and Peter Kraft},

url = {https://www.ncbi.nlm.nih.gov/pubmed/32321713},

doi = {10.1158/1055-9965.EPI-19-1389},

issn = {1538-7755},

year  = {2020},

date = {2020-05-01},

journal = {Cancer epidemiology, biomarkers \& prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology},

volume = {29},

number = {5},

pages = {999-1008},

abstract = {Pancreatic cancer is the third leading cause of cancer death in the United States, and 80% of patients present with advanced, incurable disease. Risk markers for pancreatic cancer have been characterized, but combined models are not used clinically to identify individuals at high risk for the disease. Within a nested case-control study of 500 pancreatic cancer cases diagnosed after blood collection and 1,091 matched controls enrolled in four U.S. prospective cohorts, we characterized absolute risk models that included clinical factors (e.g., body mass index, history of diabetes), germline genetic polymorphisms, and circulating biomarkers. Model discrimination showed an area under ROC curve of 0.62 via cross-validation. Our final integrated model identified 3.7% of men and 2.6% of women who had at least 3 times greater than average risk in the ensuing 10 years. Individuals within the top risk percentile had a 4% risk of developing pancreatic cancer by age 80 years and 2% 10-year risk at age 70 years. Risk models that include established clinical, genetic, and circulating factors improved disease discrimination over models using clinical factors alone. Absolute risk models for pancreatic cancer may help identify individuals in the general population appropriate for disease interception.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bhayana2020,

title = {Abdominal Imaging Findings in COVID-19: Preliminary Observations.},

author = {Rajesh Bhayana and Avik Som and Matthew D. Li and Denston E. Carey and Mark A. Anderson and Michael A. Blake and Onofrio Catalano and Michael S. Gee and Peter F. Hahn and Mukesh Harisinghani and Aoife Kilcoyne and Susanna I. Lee and Amirkasra Mojtahed and Pari Pandharipande and Theodore T. Pierce and David A. Rosman and Sanjay Saini and Anthony E. Samir and Joseph F. Simeone and Debra A. Gervais and George Velmahos and Joseph Misdraji and Avinash Kambadakone},

url = {https://www.ncbi.nlm.nih.gov/pubmed/32391742},

doi = {10.1148/radiol.2020201908},

issn = {1527-1315},

year  = {2020},

date = {2020-05-01},

urldate = {2020-05-01},

journal = {Radiology},

pages = {201908},

abstract = {Background Angiotensin converting enzyme 2 (ACE2), a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury. Purpose To report abdominal imaging findings in patients with coronavirus disease 2019 (COVID-19). Materials and Methods In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from 3/27/2020 to 4/10/2020 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included. Abdominal imaging studies performed in these patients were reviewed and salient findings recorded. Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results 412 patients (average age 57 years; range 18-\>90 years; 241 men, 171 women) were evaluated. 224 abdominal imaging studies were performed (radiograph},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Patel2020,

title = {Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions.},

author = {Bhavik N Patel and Artem T Boltyenkov and Maria G Martinez and Domenico Mastrodicasa and Daniele Marin and R Brooke Jeffrey and Benjamin Chung and Pari Pandharipande and Avinash Kambadakone},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31894384},

doi = {10.1007/s00261-019-02380-x},

issn = {2366-0058},

year  = {2020},

date = {2020-01-01},

journal = {Abdominal radiology (New York)},

abstract = {To evaluate the cost-effectiveness of DECT versus multiphasic CT and MRI for characterizing small incidentally detected indeterminate renal lesions using a Markov Monte Carlo decision-analytic model. Incidental renal lesions are commonly encountered due to the increasing utilization of medical imaging and the increasing prevalence of renal lesions with age. Currently recommended imaging modalities to further characterize incidental indeterminate renal lesions have some inherent drawbacks. Single-phase DECT may overcome these limitations, but its cost-effectiveness remains uncertain. A decision-analytic (Markov) model was constructed to estimate life expectancy and lifetime costs for otherwise healthy 64-year-old patients with small (≤ 4 cm) incidentally detected, indeterminate renal lesions on routine imaging (e.g., ultrasound or single-phase CT). Three strategies for evaluating renal lesions for enhancement were compared: multiphase SECT (e.g., true unenhanced and nephrographic phase), multiphasic MRI, and single-phase DECT (nephrographic phase in dual-energy mode). The model incorporated modality-specific diagnostic test performance, incidence, and prevalence of incidental renal cell carcinomas (RCCs), effectiveness, costs, and health outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analysis were performed. In the base case analysis, expected mean costs per patient undergoing characterization of incidental renal lesions were $2567 for single-phase DECT, $3290 for multiphasic CT, and $3751 for multiphasic MRI. Associated quality-adjusted life-years were the highest for single-phase DECT at 0.962, for multiphasic MRI it was 0.940, and was the lowest for multiphasic CT at 0.925. Because of lower associated costs and higher effectiveness, the single-phase DECT strategy dominated the other two strategies. Single-phase DECT is potentially more cost-effective than multiphasic SECT and MRI for evaluating small incidentally detected indeterminate renal lesions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Tramontano2019a,

title = {Pancreatic cancer treatment costs, including patient liability, by phase of care and treatment modality, 2000-2013.},

author = {Angela Tramontano and Yufan Chen and Tina Watson and Andrew Eckel and Deirdre Sheehan and Mary Linton B. Peters and Pari Pandharipande and Chin Hur and Chung Yin Kong},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31804317},

doi = {10.1097/MD.0000000000018082},

issn = {1536-5964},

year  = {2019},

date = {2019-12-01},

journal = {Medicine},

volume = {98},

number = {49},

pages = {e18082},

abstract = {Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups. Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal- and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year. Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age. Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ferrone2019,

title = {Management implications of fluorodeoxyglucose positron emission tomography/magnetic resonance in untreated intrahepatic cholangiocarcinoma.},

author = {Cristina Ferrone and Lipika Goyal and Motaz Qadan and Debra Gervais and Dushyant V Sahani and Andrew X Zhu and Theodore S Hong and Lawrence S Blaszkowsky and Kenneth K Tanabe and Mark Vangel and Barbara J Amorim and Jennifer Y Wo and Umar Mahmood and Pari Pandharipande and Ciprian Catana and Virginia P Duenas and Yolanda Q Collazo and Lina G Canamaque and Liran Domachevsky and Hanna H Bernstine and David Groshar and Tiffany Tsing-Fang Shih and Yan Li and Ken Herrmann and Lale Umutlu and Bruce R Rosen and Onofrio A Catalano},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31705172},

doi = {10.1007/s00259-019-04558-3},

issn = {1619-7089},

year  = {2019},

date = {2019-11-01},

journal = {European journal of nuclear medicine and molecular imaging},

abstract = {Intrahepatic cholangiocarcinoma (ICC) is associated with a poor prognosis with surgical resection offering the best chance for long-term survival and potential cure. However, in up to 36% of patients who undergo surgery, more extensive disease is found at time of operation requiring cancellation of surgery. PET/MR is a novel hybrid technology that might improve local and whole-body staging in ICC patients, potentially influencing clinical management. This study was aimed to investigate the possible management implications of PET/MR, relative to conventional imaging, in patients affected by untreated intrahepatic cholangiocarcinoma. Retrospective review of the clinicopathologic features of 37 patients with iCCC, who underwent PET/MR between September 2015 and August 2018, was performed to investigate the management implications that PET/MR had exerted on the affected patients, relative to conventional imaging. Of the 37 patients enrolled, median age 63.5 years, 20 (54%) were female. The same day PET/CT was performed in 26 patients. All patients were iCCC-treatment-na"ive. Conventional imaging obtained as part of routine clinical care demonstrated early-stage resectable disease for 15 patients and advanced stage disease beyond the scope of surgical resection for 22. PET/MR modified the clinical management of 11/37 (29.7%) patients: for 5 patients (13.5%), the operation was cancelled due to identification of additional disease, while 4 "inoperable" patients (10.8%) underwent an operation. An additional 2 patients (5.4%) had a significant change in their operative plan based on PET/MR. When compared with standard imaging, PET/MR significantly influenced the treatment plan in 29.7% of patients with iCCC. 2018P001334.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Women’sImagingPanel2019,

title = {ACR Appropriateness Criteria® Gestational Trophoblastic Disease},

author = {Expert Panel Women’s Imaging Panel and Kika M Dudiak and Katherine E Maturen and Esma A Akin and Maria Bell and Priyadarshani R Bhosale and Stella K Kang and Aoife Kilcoyne and Yulia Lakhman and Refky Nicola and Pari Pandharipande and Rajmohan Paspulati and Caroline Reinhold and Stephanie Ricci and Atul B Shinagare and Hebert Alberto Vargas and Bradford P Whitcomb and Phyllis Glanc},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31685103},

doi = {10.1016/j.jacr.2019.05.015},

issn = {1558-349X},

year  = {2019},

date = {2019-11-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {16},

pages = {S348--S363},

abstract = {Gestational trophoblastic disease (GTD), a rare complication of pregnancy, includes both benign and malignant forms, the latter collectively referred to as gestational trophoblastic neoplasia (GTN). When metastatic, the lungs are the most common site of initial spread. Beta-human chorionic gonadotropin, elaborated to some extent by all forms of GTD, is useful in facilitating disease detection, diagnosis, monitoring treatment response, and follow-up. Imaging evaluation depends on whether GTD manifests in one of its benign forms or whether it has progressed to GTN. Transabdominal and transvaginal ultrasound with duplex Doppler evaluation of the pelvis are usually appropriate diagnostic procedures in either of these circumstances, and in posttreatment surveillance. The appropriateness of more extensive imaging remains dependent on a diagnosis of GTN and on other factors. The use of imaging to assess complications, typically hemorrhagic, should be guided by the location of clinical signs and symptoms. 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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Li2019,

title = {Deep learning-enabled system for rapid pneumothorax screening on chest CT.},

author = {Xiang Li and James H Thrall and Subba R Digumarthy and Mannudeep K Kalra and Pari Pandharipande and Bowen Zhang and Chayanin Nitiwarangkul and Ramandeep Singh and Ruhani Doda Khera and Quanzheng Li},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31585302},

doi = {10.1016/j.ejrad.2019.108692},

issn = {1872-7727},

year  = {2019},

date = {2019-09-01},

journal = {European journal of radiology},

volume = {120},

pages = {108692},

abstract = {Prompt diagnosis and quantitation of pneumothorax impact decisions pertaining to patient management. The purpose of our study was to develop and evaluate the accuracy of a deep learning (DL)-based image classification program for detection of pneumothorax on chest CT. In an IRB approved study, an eight-layer convolutional neural network (CNN) using constant-size (36*36 pixels) 2D image patches was trained on a set of 80 chest CTs, with (n = 50) and without (n = 30) pneumothorax. Image patches were classified based on their probability of representing pneumothorax with subsequent generation of 3D heat-maps. The heat maps were further defined to include 1) pneumothorax area size, 2) relative location of the region to the lung boundary, and 3) a shape descriptor based on regional anisotropy. A support vector machine (SVM) was trained for classification. We assessed performance of our program in a separate test dataset of 200 chest CT examinations, with (160/200, 75%) and without (40/200, 25%) pneumothorax. Data were analyzed to determine the accuracy, sensitivity, specificity. The subject-wise sensitivity was 100% (all 160/160 pneumothoraces detected) and specificity was 82.5% (33 true negative/40). False positive classifications were primarily related to emphysema and/or artifacts in the test images. This deep learning-based program demonstrated high accuracy for automatic detection of pneumothorax on chest CTs. By implementing it on a high-performance computing platform and integrating the domain knowledge of radiologists into the analytics framework, our method can be used to rapidly pre-screen large numbers of cases for presence of pneumothorax, a critical finding.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{PANDHARIPANDE2019,

title = {Identifying Barriers to Building a Diverse Physician Workforce: A National Survey of the ACR Membership},

author = {Pari Pandharipande and Nathaniel Mercaldo and Anna Lietz and Claudia L. Seguin and Chrishanae Neal and Curtiland Deville and Jay R. Parikh and Gelareh Sadigh and Karla A. Sepulveda and Katherine E. Maturen and Jan Cox and Swati Bansal and Katarzyna J. Macura and Karen Donelan},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31173744},

doi = {https://doi.org/10.1016/j.jacr.2019.05.008},

issn = {1546-1440},

year  = {2019},

date = {2019-08-01},

urldate = {2019-08-01},

journal = {Journal of the American College of Radiology},

volume = {16},

number = {8},

pages = {1091-1101},

abstract = {Purpose 

The aim of this study was to identify potential barriers to building a diverse workforce in radiology and radiation oncology by conducting a national survey of physicians in these fields and studying their reported career experiences. 

Methods 

An electronic survey of ACR members (February 27, 2018, to April 26, 2018) was conducted in which physicians’ attitudes about their work environment, relationships, and culture were queried. The aim was to determine if responses differed by gender or race/ethnicity. In total, 900 invitations were issued; women were oversampled with the goal of equal representation. Descriptive summaries (proportions of yes/no responses) were calculated per item, per subgroup of interest. Logistic regression analysis was used to identify significant associations between gender and item-specific responses; it was not used in the race/ethnicity analysis because of the small sizes of many subgroups. 

Results 

The response rate was 51.2% (461 of 900). In total, 51.0% of respondents identified as women (235 of 461); the 9.5% (44 of 461) who identified as black or African American, Hispanic, or American Indian or Alaska Native were considered underrepresented minorities. Respondents’ mean age was 40.2 ± 10.4 years. Subgroups varied most in their reporting of unfair or disrespectful treatment. Women were significantly more likely than men to report such treatment attributable to gender (50.6% vs. 5.4%; odds ratio, 18.00; 95% confidence interval, 9.29-34.86; P .001), and 27.9% of underrepresented minorities compared with 2.6% of white non-Hispanic respondents reported such treatment attributable to race/ethnicity. 

Conclusions 

Women and underrepresented minorities disproportionately experience unfair or disrespectful treatment in the workplace. Addressing this problem is likely to be critically important for improving workforce diversity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Choi2018,

title = {Neoadjuvant FOLFIRINOX for Patients with Borderline Resectable or Locally Advanced Pancreatic Cancer: Results of a Decision Analysis.},

author = {Jin Choi and Ryan D Nipp and Angela Tramontano and Ayman Ali and Tiannan Zhan and Pari Pandharipande and Emily Dowling and Cristina R Ferrone and Theodore S Hong and Deborah Schrag and Carlos Fernandez-Del Castillo and David P Ryan and Chung Yin Kong and Chin Hur},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30559125},

doi = {10.1634/theoncologist.2018-0114},

issn = {1549-490X},

year  = {2019},

date = {2019-07-01},

journal = {The Oncologist},

volume = {24},

number = {7},

pages = {945-954},

abstract = {The effectiveness and cost-effectiveness of using neoadjuvant FOLFIRINOX (nFOLFIRINOX) for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA PDAC) are unknown. Our objective was to determine whether nFOLFIRINOX is more effective or cost-effective for patients with BR/LA PDAC compared with upfront resection surgery and adjuvant gemcitabine plus capecitabine (GEM/CAPE) or gemcitabine monotherapy (GEM). We performed a decision-analysis to assess the value of nFOLFIRINOX versus GEM/CAPE or GEM using a mathematical simulation model. Model transition probabilities were estimated using published and institutional clinical data. Model outcomes included overall and disease-free survival, quality-adjusted life-years (QALYs), cost in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses explored the uncertainty of model assumptions. Model results found median overall survival (34.5/28.0/22.0 months) and disease-free survival (15.0/14.0/13.0 months) were better for nFOLFIRINOX compared with GEM/CAPE and GEM. nFOLFIRINOX was the optimal strategy on an efficiency frontier, resulting in an additional 0.35 life-years, or 0.30 QALYs, at a cost of $46,200/QALY gained compared with GEM/CAPE. Sensitivity analysis found that cancer recurrence and complete resection rates most affected model results, but were otherwise robust. Probabilistic sensitivity analyses found that nFOLFIRINOX was cost-effective 92.4% of the time at a willingness-to-pay threshold of $100,000/QALY. Our modeling analysis suggests that nFOLFIRINOX is preferable to upfront surgery for patients with BR/LA PDAC from both an effectiveness and cost-effectiveness standpoint. Additional clinical data that further define the long-term effectiveness of nFOLFIRINOX are needed to confirm our results. Increasingly, neoadjuvant FOLFIRINOX has been used for borderline resectable and locally advanced pancreatic cancer with the goal of rendering them resectable and decreasing risk of recurrence. Despite many efforts to show the benefits of neoadjuvant over adjuvant therapies, clinical evidence to guide this decision is largely lacking. Decision-analytic modeling can provide a methodologic platform that integrates the best available data to quantitatively explore clinical decisions by simulating a hypothetical clinical trial. This modeling analysis suggests that neoadjuvant FOLFIRINOX is preferable to upfront surgery and adjuvant therapies by various outcome metrics including quality-adjusted life years, overall survival, and incremental cost-effectiveness ratio.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Women’sImaging2019,

title = {ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms},

author = {Expert Panel Women’s Imaging: and Mostafa Atri and Abdullah Alabousi and Caroline Reinhold and Esma A Akin and Carol B Benson and Priyadarshani R Bhosale and Stella K Kang and Yulia Lakhman and Refky Nicola and Pari Pandharipande and Maitray D Patel and Gloria M Salazar and Thomas D Shipp and Lynn Simpson and Betsy L Sussman and Jennifer W Uyeda and Darci J Wall and Bradford P Whitcomb and Carolyn M Zelop and Phyllis Glanc},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31054761},

doi = {10.1016/j.jacr.2019.02.011},

issn = {1558-349X},

year  = {2019},

date = {2019-05-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {16},

pages = {S77--S93},

abstract = {There are approximately 9.1 pelvic surgeries performed for every histologically confirmed adnexal malignancy in the United States, compared to 2.3 surgeries per malignancy (in oncology centers) and 5.9 surgeries per malignancy (in other centers) in Europe. An important prognostic factor in the long-term survival in patients with ovarian malignancy is the initial management by a gynecological oncologist. With high accuracy of imaging for adnexal mass characterization and consequent appropriate triage to subspecialty referral, the better use of gynecologic oncology can improve treatment outcomes. Ultrasound, including transabdominal, transvaginal, and duplex ultrasound, combined with MRI with contrast can diagnose adnexal masses as benign with specific features (ie, functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, hydrosalpinx, peritoneal inclusion cyst, Tarlov cyst), malignant, or indeterminate. 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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kang2018,

title = {Navigating Uncertainty in the Management of Incidental Findings.},

author = {Stella K Kang and Lincoln L Berland and William W Mayo-Smith and Jenny K Hoang and Brian R Herts and Alec J Megibow and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30551999},

doi = {10.1016/j.jacr.2018.09.042},

issn = {1558-349X},

year  = {2019},

date = {2019-05-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {16},

number = {5},

pages = {700-708},

abstract = {The lack of prospective outcomes studies for many types of incidental findings limits our understanding of both their natural history and the potential efficacy of treatment. To support decision making for the management of incidental findings, major sources of uncertainty in management pathways can be mapped and analyzed using mathematical models. This process yields important insights into how uncertainty influences the best treatment decision. Here, we consider a classification scheme, grounded in decision science, which exposes various levels and types of uncertainty in the management of incidental findings and addresses (1) disease-related risks, which are considered in context of a patient's competing causes of mortality; (2) potential degrees of intervention; (3) strength of evidence; and (4) patients' treatment-related preferences. Herein we describe how categorizing uncertainty by the sources, issues, and locus can build a framework from which to improve the management of incidental findings. Accurate and comprehensive handling of uncertainty will improve the quality of related decision making and will help guide future research priorities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Weaver2019,

title = {Testing for Verification Bias in Reported Malignancy Risks for Side-Branch Intraductal Papillary Mucinous Neoplasms: A Simulation Modeling Approach.},

author = {Davis Weaver and Anna Lietz and Sarah Fletcher Mercaldo and Mary Linton B. Peters and Chin Hur and Chung Yin Kong and Brian M Wolpin and Alec J Megibow and Lincoln L Berland and Amy Knudsen and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30620679},

doi = {10.2214/AJR.18.20180},

issn = {1546-3141},

year  = {2019},

date = {2019-03-01},

urldate = {2019-03-01},

journal = {AJR. American journal of roentgenology},

volume = {212},

number = {3},

pages = {596-601},

abstract = {The objective of our study was to test for the possibility that published malignancy risks for side-branch intraductal papillary mucinous neoplasms (IPMNs) are overestimates, likely due to verification bias. We tested for possible verification bias using simulation modeling techniques. First, in age-defined hypothetical cohorts of 10 million persons, we projected the frequency of pancreatic ductal adenocarcinoma (PDAC) arising from side-branch IPMNs over 5 years using published estimates of their prevalence (4.4%) and rate of malignant transformation (1.9%). Second, we projected the total number of PDAC cases in corresponding cohorts over the same time horizon using national cancer registry data. For each cohort, we determined whether the percentage of all PDAC cases that arose from side-branch IPMNs (i.e., side-branch IPMN-associated PDAC cases) was clinically plausible using an upper limit of 10% to define plausibility, as estimated from the literature. Model assumptions and parameter uncertainty were evaluated in sensitivity analysis. Across all cohorts, percentages of side-branch IPMN-associated PDACs greatly exceeded 10%. In the base case (mean age = 55.7 years), 80% of PDAC cases arose from side-branch IPMNs (7877/9786). In the oldest cohort evaluated (mean age = 75 years), this estimate was 76% (14,227/18,714). In a secondary analysis, we found that if an upper limit threshold of 10% for side-branch IPMN-associated PDAC was imposed, the model-predicted rate of malignancy for side-branch IPMNs would be less than 0.24% over a 5-year time horizon, substantially lower than most literature-based estimates. Our results suggest that reported malignancy risks associated with side-branch IPMNs are likely to be overestimates and imply the presence of verification bias.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{10.1001/jamanetworkopen.2018.7621,

title = {Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States},

author = {Qiushi Chen and Marc R. Larochelle and Davis Weaver and Anna Lietz and Peter P. Mueller and Sarah Fletcher Mercaldo and Sarah E. Wakeman and Kenneth A. Freedberg and Tiana Raphel and Amy Knudsen and Pari Pandharipande and Jagpreet Chhatwal},

url = {https://dx.doi.org/10.1001/jamanetworkopen.2018.7621},

doi = {10.1001/jamanetworkopen.2018.7621},

issn = {2574-3805},

year  = {2019},

date = {2019-02-01},

journal = {JAMA Network Open},

volume = {2},

number = {2},

pages = {e187621-e187621},

abstract = {Deaths due to opioid overdose have tripled in the last decade. Efforts to curb this trend have focused on restricting the prescription opioid supply; however, the near-term effects of such efforts are unknown.To project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025.This system dynamics (mathematical) model of the US opioid epidemic projected outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025. The analysis was performed in 2018 by retrospectively calibrating the model from 2002 to 2015 data from the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention.Comparison of interventions that would lower the incidence of prescription opioid misuse from 2016 to 2025 based on historical trends (a 7.5% reduction per year) and 50% faster than historical trends (an 11.3% reduction per year), vs a circumstance in which the incidence of misuse remained constant after 2015.Opioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention.Under the status quo, the annual number of opioid overdose deaths is projected to increase from 33 100 in 2015 to 81 700 (95% uncertainty interval [UI], 63 600-101 700) in 2025 (a 147% increase from 2015). From 2016 to 2025, 700 400 (95% UI, 590 200-817 100) individuals in the United States are projected to die from opioid overdose, with 80% of the deaths attributable to illicit opioids. The number of individuals using illicit opioids is projected to increase by 61%\textemdashfrom 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%.This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{LeeLK2018,

title = {Repeat CT Performed Within One Month of CT Conducted in the Emergency Department for Abdominal Pain: A Secondary Analysis of Data From a Prospective Multicenter Study.},

author = {Leslie K Lee and Andrew T Reisner and William D Binder and Atif Zaheer and Martin L Gunn and Ken F Linnau and Chad M Miller and Maurice Herring and Angela Tramontano and Avinash Kambadakone and Onofrio A Catalano and Mukesh Harisinghani and Elkan F. Halpern and Karen Donelan and G. Scott Gazelle and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30512995},

doi = {10.2214/AJR.18.20060},

issn = {1546-3141},

year  = {2019},

date = {2019-02-01},

journal = {AJR. American journal of roentgenology},

volume = {212},

number = {2},

pages = {382-385},

abstract = {The purpose of this study is to determine both the frequency of repeat CT performed within 1 month after a patient visits the emergency department (ED) and undergoes CT evaluation for abdominal pain and the frequency of worsened or new CT-based diagnoses. Secondary analysis was performed on data collected during a prospective multicenter study. The parent study included patients who underwent CT in the ED for abdominal pain between 2012 and 2014, and these patients constituted the study group of the present analysis. The proportion of patients who underwent (in any setting) repeat abdominal CT within 1 month of the index CT examination was calculated. For each of these patients, results of the index and repeat CT scans were compared by an independent panel and categorized as follows: no change (group 1); same process, improved (group 2); same process, worse (group 3); or different process (group 4). The proportion of patients in groups 1 and 2 versus groups 3 and 4 was calculated, and patient and ED physician characteristics were compared. The parent study included 544 patients (246 of whom were men [45%]; mean patient age, 49.4 years). Of those 544 patients, 53 (10%; 95% CI, 7.5-13%) underwent repeat abdominal CT. Patients' CT comparisons were categorized as follows: group 1 for 43% of patients (23/53), group 2 for 26% (14/53), group 3 for 15% (8/53), and group 4 for 15% (8/53). New or worse findings were present in 30% of patients (16/53) (95% CI, 19-44%). When patients with findings in groups 1 and 2 were compared to patients with findings in groups 3 and 4, no significant difference was noted in patient age (p = 0.25) or sex (p = 0.76), the number of days between scans (p = 0.98), and the diagnostic confidence of the ED physician after the index CT scan was obtained (p = 0.33). Short-term, repeat abdominal CT was performed for 10% of patients who underwent CT in the ED for abdominal pain, and it yielded new or worse findings for 30% of those patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lietz2019,

title = {Potential survival benefits from optimized chemotherapy implementation in advanced ovarian cancer: Projections from a microsimulation model.},

author = {Anna Lietz and Davis Weaver and Alexander Melamed and Jose Alejandro Rauh-Hain and Jason D Wright and Alexi Wright and Amy Knudsen and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/31539415},

doi = {10.1371/journal.pone.0222828},

issn = {1932-6203},

year  = {2019},

date = {2019-01-01},

journal = {PloS one},

volume = {14},

pages = {e0222828},

abstract = {Ovarian cancer is often diagnosed in advanced stages, when survival is poor. Treatment advances have been made, but are inconsistently implemented. Our purpose was to project the maximum life expectancy gains that could be achieved in women with stage IIIC epithelial ovarian cancer if the implementation of available chemotherapy regimens could be optimized. We used a microsimulation model to estimate life expectancy benefits associated with "optimized" implementation of four post-operative chemotherapy options: standard intravenous chemotherapy; intraperitoneal + intravenous chemotherapy; bevacizumab + intravenous chemotherapy; and hyperthermic intraperitoneal chemotherapy + intravenous chemotherapy. Optimized implementation was defined as follows. Patients triaged to primary cytoreductive surgery received intraperitoneal + intravenous chemotherapy if optimally or completely cytoreduced, and bevacizumab + intravenous chemotherapy if suboptimally cytoreduced. Patients triaged to neoadjuvant chemotherapy received hyperthermic intraperitoneal chemotherapy at interval cytoreductive surgery if optimally or completely cytoreduced, and standard IV chemotherapy if suboptimally cytoreduced. Life expectancy associated with optimized implementation was compared with that of current utilization practices, estimated using published literature and the National Cancer Database. Effects of model uncertainty were evaluated in sensitivity analyses. Life expectancy associated with optimized implementation vs. current practice was 76.7 vs. 64.5 months (life expectancy gain = 12.2 months). Providing intraperitoneal + intravenous chemotherapy to all eligible patients was the largest driver of life expectancy gains, due to both the potential benefit conferred by intraperitoneal + intravenous chemotherapy and the proportion of eligible women who do not receive intraperitoneal + intravenous chemotherapy in current practice. Population-level life expectancy in stage IIIC epithelial ovarian cancer could be substantially improved through greater uptake of available chemotherapy regimens.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kang2019,

title = {Personalized Treatment for Small Renal Tumors: Decision Analysis of Competing Causes of Mortality.},

author = {Stella K Kang and William C Huang and Elena B Elkin and Pari Pandharipande and R Scott Braithwaite},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30644815},

doi = {10.1148/radiol.2018181114},

issn = {1527-1315},

year  = {2019},

date = {2019-01-01},

journal = {Radiology},

pages = {181114},

abstract = {Purpose To compare the effectiveness of personalized treatment for small (≤4 cm) renal tumors versus routine partial nephrectomy (PN), accounting for various competing causes of mortality. Materials and Methods A state-transition microsimulation model was constructed to compare life expectancy of management strategies for small renal tumors by using 1 000 000 simulations in the following ways: routine PN or personalized treatment involving percutaneous ablation for risk factors for worsening chronic kidney disease (CKD), and otherwise PN; biopsy, with triage of renal cell carcinoma (RCC) to PN or ablation depending on risk factors for worsening CKD; active surveillance for growth; and active surveillance when MRI findings are indicative of papillary RCC. Transition probabilities were incorporated from the literature. Effects of parameter variability were assessed in sensitivity analysis. Results In patients of all ages with normal renal function, routine PN yielded the longest life expectancy (eg, 0.67 years in 65-year-old men with nephrometry score [NS] of 4). Otherwise, personalized strategies extended life expectancy versus routine PN: in CKD stages 2 or 3a, moderate or high NS, and no comorbidities, MRI guidance for active surveillance extended life expectancy (eg, 2.60 years for MRI vs PN in CKD 3a, NS 10); and with Charlson comorbidity index of 1 or more, biopsy or active surveillance for growth extended life expectancy (eg, 2.70 years for surveillance for growth in CKD 3a, NS 10). CKD 3b was most effectively managed by using MRI to help predict papillary RCC for surveillance. Conclusion For patients with chronic kidney disease and small renal tumors, personalized treatment selection likely extends life expectancy. © RSNA, 2019 Online supplemental material is available for this article.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Wang2019,

title = {Barriers to Lung Cancer Screening Engagement from the Patient and Provider Perspective.},

author = {Gary X Wang and Travis P Baggett and Pari Pandharipande and Elyse R Park and Sanja Percac-Lima and Jo-Anne O Shepard and Florian J Fintelmann and Efren J Flores},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30620258},

doi = {10.1148/radiol.2018180212},

issn = {1527-1315},

year  = {2019},

date = {2019-01-01},

journal = {Radiology},

pages = {180212},

abstract = {Lung cancer remains the leading cause of cancer mortality in the United States. Lung cancer screening (LCS) with low-dose CT reduces mortality among high-risk current and former smokers and has been covered by public and private insurers without cost sharing since 2015. Patients and referring providers confront numerous barriers to participation in screening. To best serve in multidisciplinary efforts to expand LCS nationwide, radiologists must be knowledgeable of these challenges. A better understanding of the difficulties confronted by other stakeholders will help radiologists continue to collaboratively guide the growth of LCS programs in their communities. This article reviews barriers to participation in LCS for patients and referring providers, as well as possible solutions and interventions currently underway.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Criss2018a,

title = {Effect of PD-L1 testing on the cost-effectiveness and budget impact of pembrolizumab for advanced urothelial carcinoma of the bladder in the United States.},

author = {Steven Criss and Davis Weaver and Deirdre Sheehan and Richard J Lee and Pari Pandharipande and Chung Yin Kong},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30528699},

doi = {10.1016/j.urolonc.2018.11.016},

issn = {1873-2496},

year  = {2018},

date = {2018-12-01},

urldate = {2018-12-01},

journal = {Urologic oncology},

abstract = {Our purpose was to evaluate the effect of PD-L1 testing on the cost-effectiveness of pembrolizumab for second-line treatment of advanced urothelial carcinoma in the bladder from the U.S. societal perspective. We developed a microsimulation model to compare 3 treatment strategies: (1) treat all patients with standard-of-care chemotherapy, (2) treat all patients with pembrolizumab, and (3) treat patients with PD-L1-positive tumors at a ≥1% expression threshold with pembrolizumab, and all others with standard-of-care chemotherapy. Additionally, we performed a budget impact analysis based on the projected number of urothelial carcinoma patients eligible for second-line pembrolizumab treatment. Treating all patients with chemotherapy resulted in a mean cost of $17,232 and mean effect of 0.43 quality-adjusted life-years. The PD-L1 test strategy was the most efficient strategy, with an incremental cost-effectiveness ratio of $122,933/quality-adjusted life-year. Treating all patients with pembrolizumab resulted in an incremental cost-effectiveness ratio of $197,383/quality-adjusted life-year compared to the PD-L1 test strategy. The PD-L1 test strategy would produce an incremental budget impact of $14.9 million in the first year of use compared to chemotherapy, increasing to $16.5 million in the fifth year of use. Treating all patients with pembrolizumab would produce an incremental budget impact of $19.6 million compared to the PD-L1 test strategy in its first year of use, increasing to $20.9 million by year 5. Pembrolizumab was not cost-effective in either strategy based on a $100,000/quality-adjusted life-year willingness-to-pay threshold. Using PD-L1 testing to select for patients who may have better associated outcomes may improve the affordability of pembrolizumab.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Peters2018,

title = {Progression to pancreatic ductal adenocarcinoma from pancreatic intraepithelial neoplasia: Results of a simulation model.},

author = {Mary Linton B. Peters and Andrew Eckel and Peter P. Mueller and Angela Tramontano and Davis Weaver and Anna Lietz and Chin Hur and Chung Yin Kong and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30143405},

doi = {10.1016/j.pan.2018.07.009},

issn = {1424-3911},

year  = {2018},

date = {2018-12-01},

urldate = {2018-12-01},

journal = {Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]},

volume = {18},

number = {8},

pages = {928-934},

abstract = {To gain insight into the natural history and carcinogenesis pathway of Pancreatic Intraepithelial Neoplasia (PanIN) lesions by building a calibrated simulation model of PanIN progression to pancreatic ductal adenocarcinoma (PDAC) METHODS: We revised a previously validated simulation model of solid PDAC, calibrating the model to fit data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program and published literature on PanIN prevalence by age. We estimated the likelihood of progression from PanIN states (1, 2, and 3) to PDAC and the time between PanIN onset and PDAC (dwell time). We evaluated a hypothetical intervention to test for and treat PanIN 3 lesions to estimate the potential benefits from PanIN detection. We estimated the lifetime probability of progressing from PanIN 1 to PDAC to be 1.5% (men), 1.3% (women). Progression from PanIN 1 to PDAC took 33.6 years and 35.3 years, respectively, and from PanIN 3 to PDAC took 11.3 years and 12.3 years. A hypothetical test for PanIN 3 detection and treatment could provide a maximum, average life expectancy gain of 40 days. Our modeling analysis estimates PanINs have a relatively indolent course to PDAC, supporting the feasibility of potential future early detection strategies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Neal2018,

title = {Patient Navigation to Improve Cancer Screening in Underserved Populations: Reported Experiences, Opportunities, and Challenges},

author = {Chrishanae Neal and Davis Weaver and Tiana Raphel and Anna Lietz and Efren J Flores and Sanja Percac-Lima and Amy Knudsen and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29685346},

doi = {10.1016/j.jacr.2018.03.001},

issn = {1558-349X},

year  = {2018},

date = {2018-11-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {15},

number = {11},

pages = {1565-1572},

abstract = {Our goal is to define patient navigation for an imaging audience, present a focused selection of published experiences with navigation programs for breast and colorectal cancer screening, and expose principal barriers to the success of such programs. Despite numerous advances in the early detection of cancers, many patients still present with advanced disease. A disproportionate number are low-income minority patients who experience worse health outcomes than their white or more financially stable counterparts. Patient navigation, which aims to assist the medically underserved by overcoming specific barriers to care, may represent one solution to narrowing disparities. Related research suggests that in general, patient navigation programs that have addressed breast or colorectal cancer screening have been successful in improving screening rates and timeliness of follow-up care. However, although beneficial, navigation is expensive and may present an unmanageable financial burden for many health care centers. To overcome this challenge, navigation efforts will likely need to target those patients that are most likely to benefit. Further research to identify such patients will be critically important for improving the sustainability of navigation programs, and, in turn, for realizing the benefits of such programs in reducing cancer disparities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Royce2018,

title = {Comparative Effectiveness of Bladder-preserving Tri-modality Therapy Versus Radical Cystectomy for Muscle-invasive Bladder Cancer.},

author = {Trevor J Royce and Adam S Feldman and Matthew Mossanen and Joanna C Yang and William U Shipley and Pari Pandharipande and Jason A Efstathiou},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30482661},

doi = {10.1016/j.clgc.2018.09.023},

issn = {1938-0682},

year  = {2018},

date = {2018-10-01},

journal = {Clinical genitourinary cancer},

abstract = {There are limited randomized data comparing radical cystectomy (RC) with bladder-sparing tri-modality therapy (TMT) in the treatment of muscle-invasive bladder cancer (MIBC). Both strategies are thought to have similar survival outcomes with different morbidity profiles. We compare the effectiveness of TMT and RC using decision-analytic modeling and the endpoint of quality-adjusted life years (QALYs). Using a Markov model, we simulated the lifetime outcomes after TMT versus RC ± neoadjuvant chemotherapy for 67-year-old patients with clinical stage T2-T4aN0M0 MIBC. Model probabilities and utilities were extracted from the literature. The incremental effectiveness was reported in QALYs and sensitivity analyses were performed. For all patients with MIBC, although the model showed identical survival, TMT was the most effective strategy with an incremental gain of 0.59 QALYs over RC (7.83 vs. 7.24 QALYs, respectively). When limiting the model to favorable, contemporary cohorts in both the TMT and RC strategies, TMT remained more effective with an incremental gain of 1.61 QALYs (9.37 vs. 7.76 QALYs, respectively). One-way sensitivity analyses demonstrated the model was sensitive to the quality of life parameters (ie, the utilities) for RC and TMT. When testing the 95% confidence interval of the RC utility parameter the model demonstrated an incremental gain with TMT from -0.54 to 4.23 QALYs. Probabilistic sensitivity analysis demonstrated that TMT was more effective than RC for 63% of model iterations. This modeling study found that treatment of MIBC with organ-sparing TMT in appropriately-selected patients may result in a gain of QALYs relative to RC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Mehtsun2018,

title = {Are Staging Computed Tomography (CT) Scans of the Chest Necessary in Pancreatic Adenocarcinoma?},

author = {Winta Mehtsun and Fallon E Chipidza and Carlos Fern\'{a}ndez-Del Castillo and Katherine Hemingway and Zhi Ven Fong and David C Chang and Pari Pandharipande and Jeffrey W Clark and Jill Allen and Theodore S Hong and Jennifer Y Wo and Andrew L Warshaw and Keith D Lillemoe and Cristina R Ferrone},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30276641},

doi = {10.1245/s10434-018-6764-3},

issn = {1534-4681},

year  = {2018},

date = {2018-10-01},

urldate = {2018-10-01},

journal = {Annals of surgical oncology},

abstract = {There is no consensus on the use of chest imaging in pancreatic ductal adenocarcinoma (PDAC) patients. Among PDAC patients, we examined the use of chest computed tomography (CT) over time and determined whether the use of chest CT led to a survival difference or change in management via identification of indeterminate lung nodules (ILNs). Retrospective clinical data was collected for patients diagnosed with PDAC from 1998 to 2014. We examined the proportion of patients undergoing staging chest CT scan and those who had ILN, defined as ≥ 1 well-defined, noncalcified lung nodule(s) ≤ 1 cm in diameter. We determined time to overall survival (OS) using multivariate Cox regression. We also assessed changes in management of PDAC patients who later developed lung metastasis only. Of the 2710 patients diagnosed with PDAC, 632 (23%) had greater than one chest CT. Of those patients, 451 (71%) patients had ILNs, whereas 181 (29%) had no ILNs. There was no difference in median overall survival in patients without ILNs (16.4 [13.6, 19.0] months) versus those with ILN (14.8 [13.6, 15.8] month},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Johnson2018,

title = {New ACR Choosing Wisely Recommendations: Judicious Use of Multiphase Abdominal CT Protocols},

author = {Pamela T Johnson and Jacqueline A Bello and Mythreyi B Chatfield and Jonathan A Flug and Pari Pandharipande and Saurabh Rohatgi and Elliot K Fishman and Alec J Megibow},

url = {https://www.ncbi.nlm.nih.gov/pubmed/30219345},

doi = {10.1016/j.jacr.2018.07.026},

issn = {1558-349X},

year  = {2018},

date = {2018-09-01},

journal = {Journal of the American College of Radiology : JACR},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Choy2018,

title = {Current Applications and Future Impact of Machine Learning in Radiology.},

author = {Garry Choy and Omid Khalilzadeh and Mark Michalski and Synho Do and Anthony E Samir and Oleg S Pianykh and J Raymond Geis and Pari Pandharipande and James A Brink and Keith J Dreyer},

url = {https://www.ncbi.nlm.nih.gov/pubmed/29944078},

doi = {10.1148/radiol.2018171820},

issn = {1527-1315},

year  = {2018},

date = {2018-06-01},

journal = {Radiology},

pages = {171820},

abstract = {Recent advances and future perspectives of machine learning techniques offer promising applications in medical imaging. Machine learning has the potential to improve different steps of the radiology workflow including order scheduling and triage, clinical decision support systems, detection and interpretation of findings, postprocessing and dose estimation, examination quality control, and radiology reporting. In this article, the authors review examples of current applications of machine learning and artificial intelligence techniques in diagnostic radiology. In addition, the future impact and natural extension of these techniques in radiology practice are discussed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Munden2018,

title = {Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee.},

author = {Reginald F Munden and Brett W Carter and Caroline Chiles and Heber MacMahon and William C Black and Jane P Ko and H Page McAdams and Santiago E Rossi and Ann N Leung and Phillip M Boiselle and Michael S Kent and Kathleen Brown and Debra S Dyer and Thomas E Hartman and Eric M Goodman and David P Naidich and Ella A Kazerooni and Lincoln L Berland and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/29941240},

doi = {10.1016/j.jacr.2018.04.029},

issn = {1558-349X},

year  = {2018},

date = {2018-06-01},

journal = {Journal of the American College of Radiology : JACR},

abstract = {The ACR Incidental Findings Committee presents recommendations for managing incidentally detected mediastinal and cardiovascular findings found on CT. The Chest Subcommittee was composed of thoracic radiologists who developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address the most commonly encountered mediastinal and cardiovascular incidental findings and are not intended to be a comprehensive review of all incidental findings associated with these compartments. Our goal is to improve the quality of care by providing guidance on how to manage incidentally detected thoracic findings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{CLee2018,

title = {Identifying and Disseminating More Best Practices.},

author = {Christoph I Lee and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29787317},

doi = {10.2214/AJR.18.19997},

issn = {1546-3141},

year  = {2018},

date = {2018-06-01},

urldate = {2018-06-01},

journal = {AJR. American journal of roentgenology},

volume = {210},

pages = {1179--1180},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Weaver2018,

title = {Modeling treatment outcomes for patients with advanced ovarian cancer: Projected benefits of a test to optimize treatment selection.},

author = {Davis Weaver and Tiana Raphel and Alexander Melamed and Jose Alejandro Rauh-Hain and John O Schorge and Amy Knudsen and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29486993},

doi = {10.1016/j.ygyno.2018.02.007},

issn = {1095-6859},

year  = {2018},

date = {2018-05-01},

journal = {Gynecologic oncology},

volume = {149},

number = {2},

pages = {256-262},

abstract = {For patients with advanced stage epithelial ovarian cancer (EOC), substantial emphasis has been placed on diagnostic tests that can discern which of two treatment options - primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy followed by interval cytoreductive surgery (NACT+ICS) - optimizes patient-level outcomes. Our goal was to project potential life expectancy (LE) gains that could be achieved by use of such a test. We developed a microsimulation model to project LE for patients with stage IIIC EOC. We compared: a "standard-of-care" strategy, in which patients were triaged to PCS vs. NACT+ICS based on current clinical practice; and a "test" strategy, in which patients were triaged based on results of a hypothetical test. We identified those test performance characteristics for which the test strategy outperformed the standard-of-care strategy, from a LE standpoint. Effects of parameter uncertainty were evaluated in sensitivity analysis. Even with a perfect test, the LE gain was modest (LE with test vs. standard-of-care strategy=67.6 vs. 66.4months; LE gain=1.2months). In order to outperform the standard-of-care, the test had to have a high probability of correctly identifying "resectable" patients at PCS (i.e. those for whom complete or optimal cytoreduction would be possible); this test property was more important than correct triage of unresectable patients to NACT+ICS. Results were sensitive to the proportion of patients whose underlying disease was resectable at PCS. Diagnostic tests that are designed to triage patients with advanced stage EOC will likely have only a modest effect on LE.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Women’sImaging:2018-copy-1043255524,

title = {ACR Appropriateness Criteria® Staging and Follow-Up of Ovarian Cancer},

author = {Expert Panel Women’s Imaging: and Stella K Kang and Caroline Reinhold and Mostafa Atri and Carol B Benson and Priyadarshani R Bhosale and Anuja Jhingran and Yulia Lakhman and Katherine E Maturen and Refky Nicola and Pari Pandharipande and Gloria M Salazar and Thomas D Shipp and Lynn Simpson and William Small and Betsy L Sussman and Jennifer W Uyeda and Darci J Wall and Bradford P Whitcomb and Carolyn M Zelop and Phyllis Glanc},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29724422},

doi = {10.1016/j.jacr.2018.03.015},

issn = {1558-349X},

year  = {2018},

date = {2018-05-01},

urldate = {2018-05-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {15},

pages = {S198--S207},

abstract = {In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. 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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Raphel2018,

title = {Imaging Follow-up of Low-Risk Incidental Pancreas and Kidney Findings: Effects of Patient Age and Comorbidity on Projected Life Expectancy.},

author = {Tiana Raphel and Davis Weaver and Lincoln L Berland and Brian R Herts and Alec J Megibow and Amy Knudsen and Pari Pandharipande},

url = {https://www.ncbi.nlm.nih.gov/pubmed/29401040},

doi = {10.1148/radiol.2018171701},

issn = {1527-1315},

year  = {2018},

date = {2018-05-01},

urldate = {2018-05-01},

journal = {Radiology},

volume = {287},

number = {2},

pages = {504-514},

abstract = {Purpose To determine the effects of patient age and comorbidity level on life expectancy (LE) benefits associated with imaging follow-up of Bosniak IIF renal cysts and pancreatic side-branch (SB) intraductal papillary mucinous neoplasms (IPMNs). Materials and Methods A decision-analytic Markov model to evaluate LE benefits was developed. Hypothetical cohorts with varied age (60-80 years) and comorbidities (none, mild, moderate, or severe) were evaluated. For each finding, LE projections from two strategies were compared: imaging follow-up and no imaging follow-up. Under follow-up, it was assumed that cancers associated with the incidental finding were successfully treated before they spread. For patients without follow-up, mortality risks from Bosniak IIF cysts (renal cell carcinoma) and SBIPMNs (pancreatic ductal adenocarcinoma) were incorporated. Model assumptions and parameter uncertainty were evaluated in sensitivity analysis. Results In the youngest, healthiest cohorts (age, 60 years; no comorbidities), projected LE benefits from follow-up were as follows: Bosniak IIF cyst, 6.5 months (women) and 5.8 months (men); SBIPMN, 6.4 months (women) and 5.3 months (men). Follow-up of Bosniak IIF cysts in 60-year-old women with severe comorbidities yielded a LE benefit of 3.9 months; in 80-year-old women with no comorbidities, the benefit was 2.8 months, and with severe comorbidities the benefit was 1.5 months. Similar trends were observed in men and for SBIPMN. Results were sensitive to the performance of follow-up for cancer detection; malignancy risks; and stage at presentation of malignant, unfollowed Bosniak IIF cysts. Conclusion With progression of age and comorbidity level, follow-up of low-risk incidental findings yields increasingly limited benefits for patients. © RSNA, 2018 Online supplemental material is available for this article.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Nipp2018a,

title = {Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer.},

author = {Ryan Nipp and Angela Tramontano and Chung Yin Kong and Pari Pandharipande and Emily Dowling and Deborah Schrag and Chin Hur},

url = {https://www.ncbi.nlm.nih.gov/pubmed/29322643},

doi = {10.1002/cam4.1277},

issn = {2045-7634},

year  = {2018},

date = {2018-02-01},

journal = {Cancer medicine},

volume = {7},

pages = {525--535},

abstract = {Age, sex, and racial/ethnic disparities exist, but are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival and treatment disparities persist after adjusting for demographic and clinical characteristics. Our study included PDAC patients diagnosed between 1992 and 2011. We used Cox regression to compare survival across age, sex, and race/ethnicity within early-stage and late-stage cancer subgroups, adjusting for marital status, urban location, socioeconomics, SEER region, comorbidities, stage, lymph node status, tumor location, tumor grade, diagnosis year, and treatment received. We used logistic regression to compare differences in treatment received across age, sex, and race/ethnicity. Among 20,896 patients, 84% were White, 9% Black, 5% Asian, and 2% Hispanic. Median age was 75; 56% were female and 53% had late-stage cancer. Among early-stage patients in the adjusted Cox model, older patient subgroups had worse survival compared with ages 66-69 (HR \> 1.1, P \< 0.01 for groups \>69); no survival differences existed between sexes. Black (HR = 1.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Wang2018,

title = {The Effect of Computer-Assisted Reporting on Interreader Variability of Lumbar Spine MRI Degenerative Findings: Five Readers With 30 Disc Levels.},

author = {Benjamin Wang and Daniel I Rosenthal and Chun Xu and Pari Pandharipande and H. Benjamin Harvey and Tarik K Alkasab and Ambrose J Huang},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29467092},

doi = {10.1016/j.jacr.2017.12.020},

issn = {1558-349X},

year  = {2018},

date = {2018-02-01},

journal = {Journal of the American College of Radiology : JACR},

abstract = {The aim of this study was to assess differences in interreader variability among radiologists after the implementation of a computer-assisted reporting (CAR) tool for the interpretation of degenerative disc disease on lumbar spine MRI. Thirty lumbar spine MRI examinations were selected from the radiology database. Five fellowship-trained musculoskeletal radiologists evaluated each L4-L5 disc in a blinded fashion and reported the findings using a traditional free dictation approach. One month later, they reinterpreted the same discs using a web browser-based CAR tool in the same blinded fashion. The degrees of central canal stenosis, neural foraminal stenosis, and facet joint osteoarthritis; presence or absence of lateral recess stenosis; types of disc bulge or herniation; and herniation location using both methods were recorded. Percentage disagreement among the radiologists for each variable was calculated and compared using the Wilcoxon signed rank test. There was a statistically significant decrease among the five radiologists in percentage disagreement for neural foraminal stenosis (46% versus 35},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Pahade2018,

title = {What Patients Want to Know about Imaging Examinations: A Multiinstitutional U\.{S}. Survey in Adult and Pediatric Teaching Hospitals on Patient Preferences for Receiving Information before Radiologic Examinations.},

author = {Jay K Pahade and Andrew T Trout and Bin Zhang and Pradeep Bhambhvani and Victorine V Muse and Lisa R Delaney and Evan J Zucker and Pari Pandharipande and James A Brink and Marilyn J Goske},

doi = {10.1148/radiol.2017170592},

issn = {1527-1315},

year  = {2018},

date = {2018-02-01},

journal = {Radiology},

pages = {170592},

abstract = {Purpose To identify what information patients and parents or caregivers found useful before an imaging examination, from whom they preferred to receive information, and how those preferences related to patient-specific variables including demographics and prior radiologic examinations. Materials and Methods A 24-item survey was distributed at three pediatric and three adult hospitals between January and May 2015. The χ or Fisher exact test (categorical variables) and one-way analysis of variance or two-sample t test (continuous variables) were used for comparisons. Multivariate logistic regression was used to determine associations between responses and demographics. Results Of 1742 surveys, 1542 (89%) were returned (381 partial, 1161 completed). Mean respondent age was 46.2 years ± 16.8 (standard deviation), with respondents more frequently female (1025 of 1506, 68%) and Caucasian (1132 of 1504, 75%). Overall, 78% (1117 of 1438) reported receiving information about their examination most commonly from the ordering provider (824 of 1292, 64%), who was also the most preferred source (1005 of 1388, 72%). Scheduled magnetic resonance (MR) imaging or nuclear medicine examinations (P \< .001 vs other examination types) and increasing education (P = .008) were associated with higher rates of receiving information. Half of respondents (757 of 1452, 52%) sought information themselves. The highest importance scores for pre-examination information (Likert scale ≥4) was most frequently assigned to information on examination preparation and least frequently assigned to whether an alternative radiation-free examination could be used (74% vs 54%; P \< .001). Conclusion Delivery of pre-examination information for radiologic examinations is suboptimal, with half of all patients and caregivers seeking information on their own. Ordering providers are the predominant and preferred source of examination-related information, with respondents placing highest importance on information related to examination preparation. RSNA, 2018 Online supplemental material is available for this article.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Megibow2018,

title = {Author's Reply.},

author = {Alec J Megibow and Mark E Baker and Desiree E Morgan and Ihab R Kamel and Dushyant V Sahani and Elliot Newman and William R Brugge and Lincoln L Berland and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29483047},

doi = {10.1016/j.jacr.2018.01.012},

issn = {1558-349X},

year  = {2018},

date = {2018-02-01},

urldate = {2018-02-01},

journal = {Journal of the American College of Radiology : JACR},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Gore2017,

title = {Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee},

author = {Richard M Gore and Perry J Pickhardt and Koenraad J Mortele and Elliot K Fishman and Jeanne M Horowitz and Claus J Fimmel and Mark S Talamonti and Lincoln L Berland and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28927870},

doi = {10.1016/j.jacr.2017.07.018},

issn = {1558-349X},

year  = {2017},

date = {2017-11-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {14},

number = {11},

pages = {1429-1437},

abstract = {The ACR Committee on Incidental Findings presents recommendations for managing liver lesions that are incidentally detected on CT. These recommendations represent an update from the liver component of the ACR 2010 white paper on managing incidental findings in the pancreas, adrenal glands, kidneys, and liver. The Liver Subcommittee-which included five abdominal radiologists, one hepatologist, and one hepatobiliary surgeon-developed this algorithm. The recommendations draw from published evidence and expert opinion and were finalized by informal iterative consensus. Algorithm branches categorize liver lesions on the basis of patient characteristics and imaging features. They terminate with an assessment of benignity or a specific follow-up recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. The goal is to improve the quality of care by providing guidance on how to manage incidentally detected liver lesions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Women’sImaging:2017,

title = {ACR Appropriateness Criteria® Ovarian Cancer Screening},

author = {Pari Pandharipande and Kathryn Lowry and Caroline Reinhold and Mostafa Atri and Carol B Benson and Priyadarshani R Bhosale and Edward D Green and Stella K Kang and Yulia Lakhman and Katherine E Maturen and Refky Nicola and Gloria M Salazar and Thomas D Shipp and Lynn Simpson and Betsy L Sussman and Jennifer Uyeda and Darci J Wall and Bradford Whitcomb and Carolyn M Zelop and Phyllis Glanc},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29101987},

doi = {10.1016/j.jacr.2017.08.049},

issn = {1558-349X},

year  = {2017},

date = {2017-11-01},

urldate = {2017-11-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {14},

number = {11S},

pages = {S490--S499},

abstract = {There has been much interest in the identification of a successful ovarian cancer screening test, in particular, one that can detect ovarian cancer at an early stage and improve survival. We reviewed the currently available data from randomized and observational trials that examine the role of imaging for ovarian cancer screening in average-risk and high-risk women. We found insufficient evidence to recommend ovarian cancer screening, when considering the imaging modality (pelvic ultrasound) and population (average-risk postmenopausal women) for which there is the greatest available published evidence; randomized controlled trials have not demonstrated a mortality benefit in this setting. Screening high-risk women using pelvic ultrasound may be appropriate in some clinical situations; however, related data are limited because large, randomized trials have not been performed 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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Berland2017,

title = {Comment on "Time for Action: Striking Unexpected and Incidental From Our Lexicon"},

author = {Lincoln L Berland and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28982523},

doi = {10.1016/j.jacr.2017.06.013},

issn = {1558-349X},

year  = {2017},

date = {2017-10-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {14},

number = {10},

pages = {1266},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Halpern2017,

title = {Behind the Numbers: Sensitivity Analysis in Cost-Effectiveness Modeling},

author = {Elkan F. Halpern and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/28723291},

doi = {10.1148/radiol.2017170242},

issn = {1527-1315},

year  = {2017},

date = {2017-08-01},

journal = {Radiology},

volume = {284},

pages = {310--312},

keywords = {},

pubstate = {published},

tppubtype = {article}

}