Abstract:
Importance:The American College of Radiology (ACR) has recognized the importance of minimizing radiation doses used for lung cancer screening (LCS) computed tomography (CT). However, without standard protocols, doses could still be unnecessarily high, reducing screening margin of benefit. Objective:To characterize LCS CT radiation doses and identify factors explaining variation. Design, Setting, and Participants:We prospectively collected LCS examination dose metrics, from 2016 to 2017, at US institutions in the University of California, San Francisco International Dose Registry. Institution-level factors were collected through baseline survey. Mixed-effects linear and logistic regression models were estimated using forward variable selection. Results are presented as percentage excess dose and odds ratios (ORs) with 95% confidence intervals (CIs). The analysis was conducted between 2018 and 2019. Main Outcomes and Measures:Log-transformed measures of (1) mean volume CT dose index (CTDIvol, mGy), reflecting the average radiation dose per slice; (2) mean effective dose (ED, mSv), reflecting the total dose received and estimated future cancer risk; (3) proportion of CT scans using radiation doses above ACR benchmarks (CTDIvol >3 mGy, ED >1 mSv); and (4) proportion of CT scans using radiation doses above 75th percentile of registry doses (CTDIvol >2.7 mGy, ED >1.4 mSv). Results:Data were collected for 12 529 patients undergoing LCS CT scans performed at 72 institutions. Overall, 7232 participants (58%) were men, and the median age was 65 years (interquartile range [IQR], 60-70). Of 72 institutions, 15 (21%) had median CTDIvol and 47 (65%) had median ED above ACR guidelines. Institutions allowing any radiologists to establish protocols had 44% higher mean CTDIvol (mean dose difference [MDD], 44%; 95% CI, 19%-69%) and 27% higher mean ED (MDD, 27%; 95% CI, 5%-50%) vs those limiting who established protocols. Institutions allowing any radiologist to establish protocols had higher odds of examinations exceeding ACR CTDIvol guidelines (OR, 12.0; 95% CI, 2.0-71.4), and 75th percentile of registry CTDIvol (OR, 19.0; 95% CI, 1.9-186.7) or ED (OR, 8.5; 95% CI, 1.7-42.9). Having lead radiologists establish protocols resulted in lower odds of doses exceeding ACR ED guidelines (OR, 0.01; 95% CI, 0.001-0.1). Employing external vs internal medical physicists was associated with increased odds of exceeding ACR CTDIvol guidelines (OR, 6.1; 95% CI, 1.8-20.8). Having medical physicists establish protocols was associated with decreased odds of exceeding 75th percentile of registry CTDIvol (OR, 0.09; 95% CI, 0.01-0.59). Institutions reporting protocol updates as needed had 27% higher mean CTDIvol (MDD, 27%; 95% CI, 8%-45%). Conclusions and Relevance:Facilities varied in LCS CT radiation dose distributions. Institutions limiting protocol creation to lead radiologists and having internal medical physicists had lower doses.
journal_name
JAMA Intern Medjournal_title
JAMA internal medicineauthors
Demb J,Chu P,Yu S,Whitebird R,Solberg L,Miglioretti DL,Smith-Bindman Rdoi
10.1001/jamainternmed.2019.3893subject
Has Abstractpub_date
2019-09-23 00:00:00eissn
2168-6106issn
2168-6114pii
2751519pub_type
杂志文章abstract:IMPORTANCE:Older patients with diabetes mellitus receiving medical treatment whose blood pressure (BP) or blood glucose level are potentially dangerously low are rarely deintensified. Given the established risks of low blood pressure and blood glucose, this is a major opportunity to decrease medication harm. OBJECTIVE...
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abstract:Importance:Advanced age is associated with lower use of drug treatment to prevent fractures, but concerns about comorbidities and prognosis increase the complexity of managing osteoporosis in this age group. Objective:To determine the association of disease definition, number of comorbidities, and prognosis with 5-yea...
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更新日期:2019-06-17 00:00:00
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pub_type: 杂志文章
doi:10.1001/jamainternmed.2013.8972
更新日期:2013-09-23 00:00:00
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更新日期:2015-01-01 00:00:00
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pub_type: 杂志文章,多中心研究
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abstract:IMPORTANCE:The RAS/RAF/mitogen-activated protein kinase and extracellular signal-regulated kinase (ERK) kinase/ERK cascade plays a crucial role in melanoma cell proliferation and survival. Sildenafil citrate (Viagra) is a phosphodiesterase (PDE) 5A inhibitor commonly used for erectile dysfunction. Recent studies have s...
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pub_type: 杂志文章
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abstract:IMPORTANCE:General medicine rounds by attending physicians provide the foundation for patient care and education in teaching hospitals. However, the detailed activities of these rounds in the current era are not well characterized. OBJECTIVE:To describe the characteristics of attending rounds for internal medicine inp...
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pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2013.6041
更新日期:2013-06-24 00:00:00
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章,评审
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更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:A challenge in intensive obesity treatment is making care scalable. Little is known about whether the outcome of physician-directed weight loss treatment can be improved by adding mobile technology. METHODS:We conducted a 2-arm, 12-month study (October 1, 2007, through September 31, 2010). Seventy adults (b...
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pub_type: 杂志文章,随机对照试验
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更新日期:2020-10-01 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2014.4010
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists. METHODS:A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central ...
journal_title:JAMA internal medicine
pub_type: 杂志文章,meta分析
doi:10.1001/2013.jamainternmed.1001
更新日期:2013-01-28 00:00:00
abstract:Importance:Every day in the United States, more than 200 people are murdered or assaulted with a firearm. Little research has considered the role of interpersonal ties in the pathways through which gun violence spreads. Objective:To evaluate the extent to which the people who will become subjects of gun violence can b...
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pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.8245
更新日期:2017-03-01 00:00:00
abstract:IMPORTANCE:Estimating the US burden of methicillin-resistant Staphylococcus aureus (MRSA) infections is important for planning and tracking success of prevention strategies. OBJECTIVE:To describe updated national estimates and characteristics of health care- and community-associated invasive methicillin-resistant Stap...
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pub_type: 杂志文章
doi:10.1001/jamainternmed.2013.10423
更新日期:2013-11-25 00:00:00
abstract:Importance:Chronic kidney disease (CKD) is common in adults with heart failure and is associated with an increased risk of sudden cardiac death. Randomized trials of participants without CKD have demonstrated that implantable cardioverter defibrillators (ICDs) decrease the risk of arrhythmic death in selected patients ...
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pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.8462
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更新日期:2019-07-22 00:00:00
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doi:10.1001/jamainternmed.2018.7529
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pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2017.3958
更新日期:2017-10-01 00:00:00
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pub_type: 社论
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更新日期:2018-09-01 00:00:00
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更新日期:2018-01-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2018.2259
更新日期:2018-08-01 00:00:00
abstract:IMPORTANCE:Persons with type 2 diabetes mellitus (T2DM) are at increased risk for decline in cognitive function, reduced brain volume, and increased white matter lesions in the brain. Poor control of blood pressure (BP) and lipid levels are risk factors for T2DM-related cognitive decline, but the effect of intensive tr...
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pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamainternmed.2013.13656
更新日期:2014-03-01 00:00:00
abstract:Importance:Facing new financial incentives to reduce unnecessary spending, health care organizations may attempt to reduce wasteful care by influencing physician practices or selecting more cost-effective physicians. However, physicians' role in determining the use of low-value services has not been well described. Ob...
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pub_type: 杂志文章
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更新日期:2019-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2021-01-01 00:00:00
abstract:Importance:Diabetic retinopathy (DR) is the leading cause of blindness in adults of working age in the United States. In the Los Angeles County safety net, a nonvertically integrated system serving underinsured and uninsured patients, the prevalence of DR is approximately 50%, and owing to limited specialty care resour...
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pub_type: 杂志文章
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更新日期:2017-05-01 00:00:00