Bio

Clinical Focus


  • Pediatric Radiology
  • Diagnostic Radiology

Academic Appointments


Administrative Appointments


  • Associate Chair of Performance Improvement, Department of Radiology (2013 - Present)

Professional Education


  • Board Certification: Pediatric Radiology, American Board of Radiology (2010)
  • Fellowship:University of Colorado School of Medicine (2008) CO
  • Board Certification: Diagnostic Radiology, American Board of Radiology (2007)
  • Residency:University of Colorado School of Medicine (2007) CO
  • Internship:University of Colorado Health Science Center (2003) CO
  • MBA, Yale University School of Management, CT (2002)
  • Medical Education:Yale University School of Medicine (2002) CT

Publications

Journal Articles


  • Guide to Effective Quality Improvement Reporting in Radiology. Radiology Larson, D. B., Duncan, J. R., Nagy, P. G., Kruskal, J. B. 2014: 131930

    Abstract

    Substantial societal investments in biomedical research are contributing to an explosion in knowledge that the health delivery system is struggling to effectively implement. Managing this complexity requires ingenuity, research and development, and dedicated resources. Many innovative solutions can be found in quality improvement (QI) activities, defined as the "systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of healthcare in particular settings." QI shares many similarities with biomedical research, but also differs in several important ways. Inclusion of QI in the peer-reviewed literature is needed to foster its advancement through the dissemination, testing, and refinement of theories, methods, and applications. QI methods and reporting standards are less mature in health care than those of biomedical research. A lack of widespread understanding and consensus regarding the purpose of publishing QI-related material also exists. In this document, guidance is provided in evaluating quality of QI-related material and in determining priority of submitted material for publication. © RSNA, 2014.

    View details for DOI 10.1148/radiol.14131930

    View details for PubMedID 24555635

  • Twiddler syndrome with a twist: a cause of vagal nerve stimulator lead fracture PEDIATRIC RADIOLOGY Trout, A. T., Larson, D. B., Mangano, F. T., Gonsalves, C. H. 2013; 43 (12): 1647-1651

    Abstract

    Twiddler syndrome is uncommon in children and most commonly described as causing lead retraction with implanted cardiac pacemakers and defibrillators. We report an uncommon case of a child repeatedly "twiddling" a vagal nerve stimulator to the point of lead fracture. The findings of Twiddler syndrome illustrated here apply to all implanted devices and show the complication of lead fracture in addition to the more commonly reported complication of lead retraction. This case highlights the need to be aware of the radiographic findings of this phenomenon in children with implanted vagal nerve stimulators due to the perceived increased risk of "twiddling" in pediatric and developmentally delayed patients.

    View details for DOI 10.1007/s00247-013-2736-8

    View details for Web of Science ID 000327425400014

    View details for PubMedID 23832019

  • Practice Policy and Quality Initiatives Quality Improvement and Confirmation Projects: Facilitating Rapid, Measurable Performance Improvement RADIOGRAPHICS Hawkins, C. M., Alsip, C. N., Pryor, R. M., Leach, A. D., Larson, D. B. 2013; 33 (7): E225-E235

    Abstract

    As radiology departments continue to increase in size and complexity, the process of improving and maintaining excellent performance is becoming increasingly challenging. In response, a systematic process for efficiently implementing and sustaining measurable improvement in our radiology department has been developed, which targets focused aspects of individual performance that contribute to overall departmental quality. Projects designed to achieve such improvements have been called quality improvement and confirmation (QuIC) projects. The QuIC project process involves a project champion, medical expert, technical expert, quality improvement technologist specialist, and appropriate leaders, managers, and support personnel. The project champion conducts a preliminary investigation and organizes team members, who define the desired performance through consensus, establish data collection and analysis procedures, and prepare to launch the project. Once launched, the QuIC project process follows an execution period that is divided into four phases: (a) project launch phase, (b) support phase, (c) transition phase, and (d) maintenance phase. The first three phases focus on education, group-level feedback, and individual feedback, respectively. Weekly audits are performed to track performance improvement. Data collection, analysis, and dissemination processes are automated to the extent possible. To date, four such projects have been successfully conducted. The QuIC project concept is an attempt to apply the principles of process improvement to the process of process improvement by enabling any member of a radiology department to efficiently and reliably spearhead a quality improvement project. We consider this to be a work in progress and continue to refine the process with the goal of eventually being able to conduct many projects simultaneously.

    View details for DOI 10.1148/rg.337135058

    View details for Web of Science ID 000327759900003

    View details for PubMedID 23988633

  • Emergency Department Computed Tomography Utilization in the United States and Canada ANNALS OF EMERGENCY MEDICINE Berdahl, C. T., Vermeulen, M. J., Larson, D. B., Schull, M. J. 2013; 62 (5): 486-494

    Abstract

    We compare secular trends in computed tomography (CT) utilization in emergency departments (EDs) in the United States and Ontario, Canada.Using a systematic survey in the US (The National Hospital Ambulatory Medical Care Survey) and administrative databases in Ontario, we performed a retrospective study of ED visits from 2003 to 2008. We calculated utilization overall, by visit characteristics, and for 5 clinical conditions in which CT is commonly indicated: abdominal pain, complex abdominal pain (abdominal pain, age ≥65 years, urgent to most urgent triage), admitted complex abdominal pain (abdominal pain, age ≥65 years, urgent to most urgent triage, and admitted to hospital), headache, and chest pain/shortness of breath. US data were weighted to produce national estimates.On-site CT was available for 97% (95% confidence interval [CI] 95% to 99%) of visits in the United States compared with 80% (95% CI 80% to 80%) in Ontario. Visits were more frequently triaged as higher acuity in the United States than in Ontario, with 15.1% (95% CI 13.9% to 16.4%) of US visits categorized as most urgent versus 11.8% (95% CI 11.8% to 11.8%) in Ontario. The proportion of all ED visits in which CT was performed was 11.4% (95% CI 10.8% to 12.0%) in the United States versus 5.9% (95% CI 5.9% to 5.9%) in Ontario. The proportion for children was 4.7% (95% CI 4.3% to 5.1%) in the United States versus 1.4% (95% CI 1.4% to 1.4%) in Ontario. The rate of visits involving CT per year increased faster from 2003 to 2008 in the United States (odds ratio 2.00; 95% CI 1.81 to 2.21) than Ontario (odds ratio 1.69; 95% CI 1.68 to 1.70). Over time, all subgroups experienced increases in CT rate except Ontario children younger than 10 years, who experienced a significant decrease. United States-Ontario differences in CT proportions were significant among patients presenting with headache, abdominal pain, chest pain/shortness of breath, and complex abdominal pain. Proportions for visits involving admitted complex abdominal pain in the two jurisdictions were indistinguishable: 45.8% in the United States (95% CI 39.9% to 51.7%) versus 44.7% (95% CI 44.4% to 45.0%) in Ontario.CT was more readily available in US EDs, and US clinicians used the technology more frequently than their colleagues in Ontario for nearly every category of patients, including children. CT utilization increased over time in both jurisdictions, but faster in the United States. Different demographic features between the two jurisdictions, including triage severity, frequency of hospitalization, and availability of CT scanners, likely account for at least some of the differences in CT utilization. Investigation of both clinical and nonclinical reasons for the differences in CT utilization between the United States and Canada would be a fruitful area for further research.

    View details for DOI 10.1016/j.annemergmed.2013.02.018

    View details for Web of Science ID 000326906200008

    View details for PubMedID 23683773

  • System for Verifiable CT Radiation Dose Optimization Based on Image Quality. Part II. Process Control System RADIOLOGY Larson, D. B., Malarik, R. J., Hall, S. M., Podberesky, D. J. 2013; 269 (1): 177-185

    Abstract

    To evaluate the effect of an automated computed tomography (CT) radiation dose optimization and process control system on the consistency of estimated image noise and size-specific dose estimates (SSDEs) of radiation in CT examinations of the chest, abdomen, and pelvis.This quality improvement project was determined not to constitute human subject research. An automated system was developed to analyze each examination immediately after completion, and to report individual axial-image-level and study-level summary data for patient size, image noise, and SSDE. The system acquired data for 4 months beginning October 1, 2011. Protocol changes were made by using parameters recommended by the prediction application, and 3 months of additional data were acquired. Preimplementation and postimplementation mean image noise and SSDE were compared by using unpaired t tests and F tests. Common-cause variation was differentiated from special-cause variation by using a statistical process control individual chart.A total of 817 CT examinations, 490 acquired before and 327 acquired after the initial protocol changes, were included in the study. Mean patient age and water-equivalent diameter were 12.0 years and 23.0 cm, respectively. The difference between actual and target noise increased from -1.4 to 0.3 HU (P < .01) and the standard deviation decreased from 3.9 to 1.6 HU (P < .01). Mean SSDE decreased from 11.9 to 7.5 mGy, a 37% reduction (P < .01). The process control chart identified several special causes of variation.Implementation of an automated CT radiation dose optimization system led to verifiable simultaneous decrease in image noise variation and SSDE. The automated nature of the system provides the opportunity for consistent CT radiation dose optimization on a broad scale.

    View details for DOI 10.1148/radiol.13122321

    View details for Web of Science ID 000325000700020

    View details for PubMedID 23784877

  • System for Verifiable CT Radiation Dose Optimization Based on Image Quality. Part I. Optimization Model RADIOLOGY Larson, D. B., Wang, L. L., Podberesky, D. J., Goske, M. J. 2013; 269 (1): 167-176

    Abstract

    To develop and validate a mathematical radiation dose optimization model for computed tomography (CT) of the chest, abdomen, and pelvis.This quality improvement project was determined not to constitute human subject research. A model for measuring water-equivalent diameter (DW) based on the topogram was developed and validated on each axial section in eight CT examinations of the chest, abdomen, and pelvis (500 images). A model for estimating image noise and size-specific dose estimates (SSDEs) using image and metadata was developed and validated in 16 examinations of anthropomorphic phantoms. A model to quantify radiologist image quality preferences was developed and applied to evaluations of 32 CT examinations of the abdomen and pelvis by 10 radiologists. The scanners' dose modulation algorithms were modeled and incorporated into an application capable of prediction of image noise and SSDE over a range of patient sizes. With use of the application, protocol techniques were recommended to achieve specific image noise targets. Comparisons were evaluated by using two-tailed nonpaired and paired t tests. Results: The mean difference between topogram- and axial-based DW estimates was -3.5% ± 2.2 (standard deviation). The mean difference between estimated and measured image noise and volume CT dose index on the anthropomorphic phantoms was -6.9% ± 5.5 and 0.8% ± 1.8, respectively. A three-dimensional radiologist image quality preference model was developed. For the prediction model validation studies, mean differences between predicted and actual effective tube current-time product, SSDE, and estimated image noise were -0.9% ± 9.3, -1.8% ± 10.6, and -0.5% ± 4.4, respectively.CT image quality and radiation dose can be mathematically predicted and optimized on the basis of patient size and radiologist-specific image noise target curves.

    View details for DOI 10.1148/radiol.13122320

    View details for Web of Science ID 000325000700019

    View details for PubMedID 23784878

  • Commentary: Masters of Radiology Panel Discussion-How Do We Maintain Control Over Imaging? AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Kazerooni, E. A., Norbash, A., Javitt, M. C., Beauchamp, N. J. 2013; 201 (1): 128-132

    View details for DOI 10.2214/AJR.13.10891

    View details for Web of Science ID 000320771900040

    View details for PubMedID 23789666

  • Diagnostic Reference Ranges for Pediatric Abdominal CT RADIOLOGY Goske, M. J., Strauss, K. J., Coombs, L. P., Mandel, K. E., Towbin, A. J., Larson, D. B., Callahan, M. J., Darge, K., Podberesky, D. J., Frush, D. P., Westra, S. J., Prince, J. S. 2013; 268 (1): 208-218

    Abstract

    To develop diagnostic reference ranges (DRRs) and a method for an individual practice to calculate site-specific reference doses for computed tomographic (CT) scans of the abdomen or abdomen and pelvis in children on the basis of body width (BW).This HIPAA-compliant multicenter retrospective study was approved by institutional review boards of participating institutions; informed consent was waived. In 939 pediatric patients, CT doses were reviewed in 499 (53%) male and 440 (47%) female patients (mean age, 10 years). Doses were from 954 scans obtained from September 1 to December 1, 2009, through Quality Improvement Registry for CT Scans in Children within the National Radiology Data Registry, American College of Radiology. Size-specific dose estimate (SSDE), a dose estimate based on BW, CT dose index, dose-length product, and effective dose were analyzed. BW measurement was obtained with electronic calipers from the axial image at the splenic vein level after completion of the CT scan. An adult-sized patient was defined as a patient with BW of 34 cm. An appropriate dose range for each DRR was developed by reviewing image quality on a subset of CT scans through comparison with a five-point visual reference scale with increments of added simulated quantum mottle and by determining DRR to establish lower and upper bounds for each range.For 954 scans, DRRs (SSDEs) were 5.8-12.0, 7.3-12.2, 7.6-13.4, 9.8-16.4, and 13.1-19.0 mGy for BWs less than 15, 15-19, 20-24, 25-29, and 30 cm or greater, respectively. The fractions of adult doses, adult SSDEs, used within the consortium for patients with BWs of 10, 14, 18, 22, 26, and 30 cm were 0.4, 0.5, 0.6, 0.7, 0.8, and 0.9, respectively.The concept of DRRs addresses the balance between the patient's risk (radiation dose) and benefit (diagnostic image quality). Calculation of reference doses as a function of BW for an individual practice provides a tool to help develop site-specific CT protocols that help manage pediatric patient radiation doses.

    View details for DOI 10.1148/radiol.13120730

    View details for Web of Science ID 000320761400023

    View details for PubMedID 23513245

  • Masters of Radiology Panel Discussion: Defining a Quality Dashboard for Radiology-What Are the Right Metrics? AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Kazerooni, E. A., Norbash, A., Crowe, J. K., Javitt, M. C., Beauchamp, N. J. 2013; 200 (4): 839-844

    View details for DOI 10.2214/AJR.12.10469

    View details for Web of Science ID 000316622100036

    View details for PubMedID 23521458

  • Improving Consistency in Radiology Reporting through the Use of Department-wide Standardized Structured Reporting RADIOLOGY Larson, D. B., Towbin, A. J., Pryor, R. M., Donnelly, L. F. 2013; 267 (1): 240-250

    Abstract

    To successfully develop a department-wide standardized structured reporting program and achieve widespread adoption throughout the radiology department.A structured reporting work group was formed in February 2010 to oversee development of standardized structured reports for a radiology department of 36 radiologists at a tertiary care children's hospital. The committee reached consensus on report organization and provided written guidelines and checklists for division representatives to aid in creation of the structured reports. Report drafts were reviewed by a subcommittee and revised until agreement was reached with the report author. Each report was vetted by all radiologists who would be using the report, and further revisions were made, as appropriate. Reports were then entered into the speech recognition system so that each report was associated with a procedure code or a group of codes from the radiology information system. This enabled automatic report population within the speech recognition system. The initiative was completed by September 2011. Quarterly audits were performed to evaluate for adherence to the standard report format and use of the normal report in cases in which the radiologist believed the study was normal. In August 2012, radiologists were surveyed as to their impressions of the structured reporting program.A total of 228 standardized structured reports were created within 2 years after initiation of the project, corresponding to 199,000 (94%) of 212,000 departmental studies by volume. By the end of the implementation period in September 2011, all 223 (100%) audited reports adhered to the standard report format and 80 (99%) of 81 reports adhered to the normal report. Radiologist feedback was largely favorable.Standardized department-wide structured reporting can be implemented in a radiology department, with a high rate of adoption by the radiologists.

    View details for DOI 10.1148/radiol.12121502

    View details for Web of Science ID 000316565000025

    View details for PubMedID 23329657

  • Practice Policy and Quality Initiatives Decreasing Variability in Turnaround Time for Radiographic Studies from the Emergency Department RADIOGRAPHICS Towbin, A. J., Iyer, S. B., Brown, J., Varadarajan, K., Perry, L. A., Larson, D. B. 2013; 33 (2): 361-371

    Abstract

    A study was performed to evaluate use of quality improvement techniques to decrease the variability in turnaround time (TAT) for radiology reports on emergency department (ED) radiographs. An interdepartmental improvement team applied multiple interventions. Statistical process control charts were used to evaluate for improvement in mean TAT for ED radiographs, percentage of ED radiographs read within 35 minutes, and standard deviation of the mean TAT. To determine if the changes in the radiology department had an effect on the ED, the average time from when an ED physician first met with the patient to the time when the final treatment decision was made was also measured. There was a significant improvement in mean TAT for ED radiographs (from 23.9 to 14.6 minutes), percentage of ED radiographs read within 35 minutes (from 82.2% to 92.9%), and standard deviation of the mean TAT (from 22.8 to 12.7). The mean time from when an ED physician first met with the patient to the time a final treatment decision was made decreased from 88.7 to 79.8 minutes. Quality improvement techniques were used to decrease mean TAT and the variability in TAT for ED radiographs. This change was associated with an improvement in ED throughput.

    View details for DOI 10.1148/rg.332125738

    View details for Web of Science ID 000315998700007

    View details for PubMedID 23479701

  • Standardization of Quality Initiative Reporting RADIOGRAPHICS Duncan, J. R., Larson, D. B., Kruskal, J. B. 2013; 33 (2): 373-374

    View details for DOI 10.1148/rg.332125034

    View details for Web of Science ID 000315998700008

    View details for PubMedID 23479702

  • Masters of Radiology Panel Discussion: Hyperefficient Radiology-Can We Maintain The Pace? AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Kazerooni, E. A., Norbash, A., Crowe, J. K., Javitt, M. C., Beauchamp, N. J., Mendelson, E. B. 2012; 199 (4): 838-843

    View details for DOI 10.2214/AJR.12.9648

    View details for Web of Science ID 000309117300036

    View details for PubMedID 22997376

  • Masters of Radiology Panel Discussion: The Future of the Radiology Job Market AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Kaye, A. D., Kazerooni, E. A., Norbash, A., Crowe, J. K., Javitt, M. C., Beauchamp, N. J., Mendelson, E. B. 2012; 199 (1): 127-132

    View details for DOI 10.2214/AJR.12.9019

    View details for Web of Science ID 000305804000040

    View details for PubMedID 22733903

  • Masters of Radiology Panel Discussion: Maintaining Maintenance of Certification in the Field of Radiology AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Kazerooni, E. A., Norbash, A., Crowe, J. K., Javitt, M. C., Beauchamp, N. J., Mendelson, E. B. 2012; 198 (4): 854-857

    View details for DOI 10.2214/AJR.11.8375

    View details for Web of Science ID 000302129000033

    View details for PubMedID 22451551

  • Masters of Radiology Panel Discussion: Women in Radiology-How Can We Encourage More Women to Join the Field and Become Leaders? AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Kaye, A. D., Kazerooni, E. A., Norbash, A., Crowe, J. K., Javitt, M. C., Beauchamp, N. J. 2012; 198 (1): 145-149

    View details for DOI 10.2214/AJR.11.8053

    View details for Web of Science ID 000298884100049

    View details for PubMedID 22194490

  • What Is the Role of the Radiologist in Holding Down Health Care Cost Growth? AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Beauchamp, N. J., Kaye, A., Larson, D. B., Norbash, A. 2011; 197 (4): 919-922

    View details for DOI 10.2214/AJR.11.7491

    View details for Web of Science ID 000295081000062

    View details for PubMedID 21940579

  • Changing Radiologists' Expectations: False Information versus Years of Experience RADIOLOGY Larson, D. B. 2011; 261 (1): 327-327

    View details for DOI 10.1148/radiol.11110794

    View details for Web of Science ID 000295039000039

    View details for PubMedID 21931145

  • Masters of Radiology Panel Discussion: Encouraging and Fostering Mentorship-How We Can Ensure That No Faculty Member Is Left Behind and That Leaders Do Not Fail AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Norbash, A., Javitt, M. C., Beauchamp, N. J., Monsees, B., Messinger, N. 2011; 197 (1): 149-153

    View details for DOI 10.2214/AJR.11.7090

    View details for Web of Science ID 000291991200036

    View details for PubMedID 21701023

  • Rethinking Peer Review: What Aviation Can Teach Radiology about Performance Improvement RADIOLOGY Larson, D. B., Nance, J. J. 2011; 259 (3): 626-632

    View details for DOI 10.1148/radiol.11102222

    View details for Web of Science ID 000290898100003

    View details for PubMedID 21602501

  • Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995-2008 RADIOLOGY Larson, D. B., Johnson, L. W., Schnell, B. M., Goske, M. J., Salisbury, S. R., Forman, H. P. 2011; 259 (3): 793-801

    Abstract

    To describe nationwide trends and factors associated with the use of computed tomography (CT) in children visiting emergency departments (EDs) in the United States between 1995 and 2008.This study was exempt from institutional review board oversight. Data from the 1995-2008 National Hospital Ambulatory Medical Care Survey were used to evaluate the number and percentage of visits associated with CT for patients younger than 18 years. A mean of 7375 visits were sampled each year. Data were subcategorized according to multiple patient and hospital characteristics. The Rao-Scott χ(2) test was performed to determine whether CT use was similar across subpopulations.From 1995 to 2008, the number of pediatric ED visits that included CT examination increased from 0.33 to 1.65 million, a fivefold increase, with a compound annual growth rate of 13.2%. The percentage of visits associated with CT increased from 1.2% to 5.9%, a 4.8-fold increase, with a compound annual growth rate of 12.8%. The number of visits associated with CT at pediatric-focused and non-pediatric-focused EDs increased from 14,895 and 316,133, respectively, in 1995 to 212,716 and 1,438,413, respectively, in 2008. By the end of the study period, top chief complaints among those undergoing CT included head injury, abdominal pain, and headache.Use of CT in children who visit the ED has increased substantially and occurs primarily at non-pediatric-focused facilities. This underscores the need for special attention to this vulnerable population to ensure that imaging is appropriately ordered, performed, and interpreted.

    View details for DOI 10.1148/radiol.11101939

    View details for Web of Science ID 000290898100019

    View details for PubMedID 21467249

  • Reliability of Renal Length Measurements Made With Ultrasound Compared With Measurements From Helical CT Multiplanar Reformat Images AMERICAN JOURNAL OF ROENTGENOLOGY Larson, D. B., Meyers, M. L., O'Hara, S. M. 2011; 196 (5): W592-W597

    Abstract

    The purpose of this article is to determine the reliability of sonographic renal length measurements compared with measurements obtained from helical CT multiplanar reformat images and compared with standard renal growth curves.A retrospective review was performed of 76 subjects who underwent both renal ultrasound and abdominal CT within 2 weeks of one another. Renal lengths were measured using oblique coronal reformat images of helically acquired CT data by two observers on two occasions. Intraobserver and interobserver error for these measurements were calculated. Ultrasound renal length measurements were compared with CT measurements. Measurement variation was compared with standard renal growth curves.The mean (± SD) of the absolute value of interobserver error of CT measurements was 0.9 ± 0.8 mm. Compared with CT, individual ultrasound measurements underestimated renal length by 1.5 ± 5.6 mm on average, with a 95% CI of -12.5 to 9.5 mm. When the maximum of three ultrasound renal length measurements was used, the SD was 4.7 mm, with a 95% CI of -8.2 to 10.1 mm of the reported renal length. This corresponds to greater or less than 3.3 years of normal renal growth.Lack of renal growth can be asserted only when renal length falls below the growth curve, taking into account the corresponding measurement error limits, which we found to be greater or less than 9.3 mm. If the follow-up measurement falls within these limits, one should not infer lack of appropriate renal growth, even if the renal length measurement decreases or remains unchanged for up to 3 years.

    View details for DOI 10.2214/AJR.10.5486

    View details for Web of Science ID 000289769000014

    View details for PubMedID 21512050

  • Masters of Radiology Panel Discussion: The Commoditization of Radiology AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Larson, D. B., Kaye, A. D., Kazerooni, E. A., Norbash, A., Crowe, J. K., Javitt, M. C., Beauchamp, N. J. 2011; 196 (4): 843-847

    View details for DOI 10.2214/AJR.10.6393

    View details for Web of Science ID 000288650600041

    View details for PubMedID 21427333

  • National Trends in CT Use in the Emergency Department: 1995-2007 RADIOLOGY Larson, D. B., Johnson, L. W., Schnell, B. M., Salisbury, S. R., Forman, H. P. 2011; 258 (1): 164-173

    Abstract

    To identify nationwide trends and factors associated with the use of computed tomography (CT) in the emergency department (ED).This study was exempt from institutional review board approval. Data from the 1995-2007 National Hospital Ambulatory Medical Care Survey were used to evaluate the numbers and percentages of ED visits associated with CT. A mean of 30 044 visits were sampled each year. Data were also subcategorized according to multiple patient and hospital characteristics. The Rao-Scott χ(2) test was performed to determine whether CT use was similar across subpopulations. Data were evaluated according to exponential and logistic growth models.From 1995 to 2007, the number of ED visits that included a CT examination increased from 2.7 million to 16.2 million, constituting a 5.9-fold increase and a compound annual growth rate of 16.0%. The percentage of visits associated with CT increased from 2.8% to 13.9%, constituting a 4.9-fold increase and a compound annual growth rate of 14.2%. The exponential growth model provided the best fit for the trend in CT use. CT use was greater in older patients, white patients, patients admitted to the hospital, and patients at facilities in metropolitan regions. By the end of the study period, the top chief complaints among those who underwent CT were abdominal pain, headache, and chest pain. The percentage of patient visits associated with CT for all evaluated chief complaints increased-most substantially among those who underwent CT for flank, abdominal, or chest pain.Use of CT has increased at a higher rate in the ED than in other settings. The overall use of CT had not begun to taper by 2007.

    View details for DOI 10.1148/radiol.10100640

    View details for Web of Science ID 000285574200019

    View details for PubMedID 21115875

  • Masters of Radiology Panel Discussion: Models for Health Care Performance in Radiology-How Do We Measure Our Productivity and Ourselves? AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Norbash, A., Beauchamp, N. J., Thrall, J. H., Larson, D. B., Kazerooni, E. A., Hricak, H., Monsees, B., Javitt, M. C., Crowe, J. K. 2011; 196 (1): 130-135

    View details for DOI 10.2214/AJR.10.5611

    View details for Web of Science ID 000286018800018

    View details for PubMedID 21178057

  • Masters of Radiology Panel Discussion: Who Is Accountable for the Appropriateness of Studies-The Radiologist, the Referring Physician, or Both? AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Beauchamp, N. J., Kazerooni, E. A., Larson, D. B., Javitt, M. C., Norbash, A. 2010; 195 (4): 968-973

    View details for DOI 10.2214/AJR.10.4997

    View details for Web of Science ID 000282033600026

    View details for PubMedID 20858826

  • Masters of Radiology Panel Discussion: Radiology Extenders-Challenges and Opportunities to Balance the Demands of Our Changing Work Environment AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Javitt, M. C., Monsees, B., Larson, D. B., Norbash, A., Kaye, A., Beauchamp, N. J., Messinger, N. 2010; 195 (1): 170-175

    View details for DOI 10.2214/AJR.10.4619

    View details for Web of Science ID 000278998200023

    View details for PubMedID 20566812

  • Masters of Radiology Panel Discussion: Role of Communication in Today's Radiologic Practices AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Javitt, M. C., Monsees, B., Crowe, J. K., Beauchamp, N. J., Larson, D. B., Kaye, A., Kazerooni, E. A., Norbash, A., Messinger, N., Hricak, H., Thrall, J. H. 2010; 194 (4): 1014-1017

    View details for DOI 10.2214/AJR.09.4060

    View details for Web of Science ID 000275863300023

    View details for PubMedID 20308504

  • Masters of Radiology Panel Discussion: Responding to Health Care Reform and Other Market Pressures AMERICAN JOURNAL OF ROENTGENOLOGY Forman, H. P., Crowe, J. K., Messinger, N., Javitt, M. C., Larson, D. B., Norbash, A., Kaye, A., Thrall, J. H., Hricak, H., Kazerooni, E. A. 2010; 194 (1): 173-177

    View details for DOI 10.2214/AJR.09.3715

    View details for Web of Science ID 000272990500024

    View details for PubMedID 20028920

  • RADPEER scoring white paper. Journal of the American College of Radiology Jackson, V. P., Cushing, T., Abujudeh, H. H., Borgstede, J. P., Chin, K. W., Grimes, C. K., Larson, D. B., Larson, P. A., Pyatt, R. S., Thorwarth, W. T. 2009; 6 (1): 21-25

    Abstract

    The ACR's RADPEER program began in 2002; the electronic version, e-RADPEER, was offered in 2005. To date, more than 10,000 radiologists and more than 800 groups are participating in the program. Since the inception of RADPEER, there have been continuing discussions regarding a number of issues, including the scoring system, the subspecialty-specific subcategorization of data collected for each imaging modality, and the validation of interfacility scoring consistency. This white paper reviews the task force discussions, the literature review, and the new recommended scoring process and lexicon for RADPEER.

    View details for DOI 10.1016/j.jacr.2008.06.011

    View details for PubMedID 19111267

  • My old Kentucky home, goodnight: Potential impact of planned changes in the radiology board certification process AMERICAN JOURNAL OF ROENTGENOLOGY Larson, D. B., Saket, D. D. 2008; 190 (5): 1149-1151

    View details for DOI 10.2214/AJR.07.3981

    View details for Web of Science ID 000255185100002

    View details for PubMedID 18430822

  • Informing parents about CT radiation exposure in children: It's OK to tell them AMERICAN JOURNAL OF ROENTGENOLOGY Larson, D. B., Rader, S. B., Forman, H. P., Fenton, L. Z. 2007; 189 (2): 271-275

    Abstract

    The purpose of our study was to determine how parents' understanding of and willingness to allow their children to undergo CT change after receiving information regarding radiation dose and risk.One hundred parents of children undergoing nonemergent CT studies at a tertiary-care children's hospital were surveyed before and after reading an informational handout describing radiation risk. Parental knowledge of whether CT uses radiation or increases lifetime risk of cancer was assessed, as was willingness to permit their child to undergo both a CT examination that their child's doctor recommended and one for which their doctor thought observation might be equally effective.Of the 100 parents who were surveyed, 66% believed CT uses radiation before reading the handout, versus 99% afterward (p < 0.01). Before reading the handout, 13% believed CT increases the lifetime risk of cancer, versus 86% afterward (p < 0.01). After reading the handout, parents became less willing to have their child undergo CT given a hypothetic situation in which their doctor believed that either CT or observation would be equally effective (p < 0.01), but their willingness to have their child undergo CT recommended by their doctor did not significantly change. After reading the handout, 62% of parents reported no change in level of concern. No parent refused or requested to defer CT after reading the handout.A brief informational handout can improve parental understanding of the potential increased risk of cancer related to pediatric CT without causing parents to refuse studies recommended by the referring physician.

    View details for DOI 10.2214/AJR.07.2248

    View details for Web of Science ID 000248624400006

    View details for PubMedID 17646450

  • Major changes in radiology residency program requirements are coming AMERICAN JOURNAL OF ROENTGENOLOGY Larson, D. B. 2007; 188 (1): 3-4

    View details for DOI 10.2214/AJR.07.6100

    View details for Web of Science ID 000245647900002

    View details for PubMedID 17179338

  • The AFIP and the tragedy of the commons. Journal of the American College of Radiology Larson, D. B. 2007; 4 (1): 8-10

    View details for PubMedID 17412218

  • Non-enhancing pilocytic astrocytoma of the spinal cord PEDIATRIC RADIOLOGY Larson, D. B., Hedlund, G. L. 2006; 36 (12): 1312-1315

    Abstract

    Pilocytic astrocytomas are among the most common intramedullary spinal cord tumors in the pediatric age group. The presence of contrast enhancement is a major factor used to distinguish these tumors from other spinal cord lesions. We present a case of histologically proved non-enhancing intramedullary spinal cord pilocytic astrocytoma in a 12-year-old girl. This case represents an exception to the conventional wisdom that pediatric spinal neoplasms enhance with administration of intravenous contrast material.

    View details for DOI 10.1007/s00247-006-0301-4

    View details for Web of Science ID 000242831000012

    View details for PubMedID 17021719

  • A comprehensive portrait of teleradiology in radiology practices: Results from the American College of Radiology's 1999 survey AMERICAN JOURNAL OF ROENTGENOLOGY Larson, D. B., Cypel, Y. S., Forman, H. P., Sunshine, J. H. 2005; 185 (1): 24-35

    Abstract

    This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared.In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses.Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs.Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.

    View details for Web of Science ID 000229951900005

    View details for PubMedID 15972394

  • Graduate medical education financing: its effect on radiologists at all career levels AMERICAN JOURNAL OF ROENTGENOLOGY Larson, D. B. 2004; 182 (4): A9-A10

    View details for Web of Science ID 000220382800001

    View details for PubMedID 15085869

  • MD/MBA programs in the United States: Evidence of a change in health care leadership ACADEMIC MEDICINE Larson, D. B., Chandler, M., Forman, H. P. 2003; 78 (3): 335-341

    Abstract

    Managerial sciences are playing an increasingly prominent role in the organization and delivery of health care. Despite popular media reports that a rising number of physicians are acquiring a background in this discipline through MD/MBA (medical and master of business administration) programs, no recent study has verified this. This study measured changes in the number and nature of the affiliations between management and medicine in the form of MD/MBA programs in the United States.Surveys of admission officers of 125 U.S. allopathic medical schools and of the overseers of each joint MD/MBA degree program were administered in May-October 2001. Main outcome measures included program growth, curriculum and degree requirements, application and admission requirements, and program leadership and organization.The number of MD/MBA programs grew from six to 33 between 1993 and 2001, and 17 more medical schools were considering establishing the joint-degree program. Ten, 15, and 20 programs produced 27, 42, and 61 graduates in 1999, 2000, and 2001, respectively, and over 100 students were expected to graduate per year when all 33 programs matured. Program structures and oversight indicate a spectrum of philosophies regarding the appropriate level of integration of the two degrees. MD/MBA programs apparently attempt to complement medical education with management education rather than the converse.The growth in the numbers of MD/MBA programs and participants indicates rising cooperation between medical and business schools and increasing interest in management education early in the careers of graduating physicians.

    View details for Web of Science ID 000181465500017

    View details for PubMedID 12634220

  • Technical skills for weight loss: Preliminary data from a randomized trial PREVENTIVE MEDICINE Katz, D. L., Chan, W., Gonzalez, M., Larson, D., Nawaz, H., Abdulrahman, M., Yeh, M. C. 2002; 34 (6): 608-615

    Abstract

    Optimal behavioral interventions for sustainable weight loss are uncertain. We therefore conducted a study among overweight/obese women comparing conventional dietary counseling of individuals (counseling-based intervention) to a novel, group-based skill-building intervention.Eighty subjects were randomly assigned to either the counseling-based or to the skill-building intervention. Outcomes included weight loss, dietitian hours per group and per unit weight loss, and dollars spent per group and per unit weight lost.Weight loss at 6 months (follow-up rate 61.3%) in the counseling-based group was 8.8 lb (P = 0.0001), and in the skill-building group was 3.8 lb (P = 0.01). A total of 160 dietitian hours were required for the counseling-based group, and 131 for the skilled-building group. The counseling-based group cost an average of $21 per pound lost, while the skill-building cost an average of $48 per pound lost (P = 0.16).At 6 months, individualized office-based counseling produced more weight loss than a skill-building approach and cost less than half as much per pound of weight loss. Longer-term follow-up is required to determine if, as hypothesized, the skill-building intervention produces more sustainable weight loss.

    View details for DOI 10.1006/pmed.2002.1025

    View details for Web of Science ID 000176029600007

    View details for PubMedID 12052021

  • Self-reported weight and height - Implications for obesity research AMERICAN JOURNAL OF PREVENTIVE MEDICINE Nawaz, H., Chan, W., Abdulrahman, M., Larson, D., Katz, D. L. 2001; 20 (4): 294-298

    Abstract

    Self-reported weight and height are under- and over-reported, respectively, in epidemiologic studies. This tendency, which may adversely affect study operations, has not been evaluated among subjects being enrolled into a weight-loss program.Self-reported weight, height, and body mass index (BMI) were compared to measured values in 97 overweight or obese (BMI>27.3) women being enrolled into a randomized, controlled trial of two behavioral interventions for weight loss. The effects of demographic factors, baseline weight, baseline height, and baseline BMI on weight and height reporting were assessed.There was a significant difference between measured and reported weight (mean difference=-3.75 lb, p=0.0001) and height (mean difference=+0.35 in., p=0.0007). The mean difference between measured and reported BMI was -1.14 kg/m(2) (p=0.0001). Unemployed, retired, or disabled women were more likely to under-report their BMI than employed women (p=0.001). Six percent of subjects who were initially considered eligible for the study on the basis of the self-report were eventually excluded from the study because they did not meet the inclusion criterion for BMI.Obese women who seek weight-loss assistance tend to under-report their weight and over-report their height, suggesting that self-reported data are likely to be inaccurate. Misreporting is apparently influenced by employment and disability and has the potential to complicate recruitment of subjects for research studies.

    View details for Web of Science ID 000168351400010

    View details for PubMedID 11331120

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