National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
151 to 175 of 548 Research Studies DisplayedShah NR, Eisman AS, Winchester DE
E-consult protocoling to improve the quality of cardiac stress tests.
Rarely appropriate cardiac stress tests remain prevalent in the range of 10% to 20% and unnecessarily prolong wait times. To address this ongoing problem, the investigators designed the EPIQ-Stress workflow, which included a structured electronic consult (“econsult”) with all outpatient stress test orders. In this study, the investigators assessed whether EPIQ-Stress implementation was associated with a reduction in rarely appropriate testing and in order-to-report wait times.
AHRQ-funded; HS022998.
Citation: Shah NR, Eisman AS, Winchester DE .
E-consult protocoling to improve the quality of cardiac stress tests.
JACC Cardiovasc Imaging 2021 Feb;14(2):512-14. doi: 10.1016/j.jcmg.2020.08.009..
Keywords: Telehealth, Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Zachrison KS, Natsui S, Luan Erfe BM
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
The objective of this study was to determine whether acute ischemic stroke (AIS) patients' language preference was associated with differences in time from symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DTI), and door-to-needle (DTN) time. The investigators concluded that consistent with prior reports examining disparities in care, a systems-based approach to acute stroke prevents differences in hospital-based metrics.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Natsui S, Luan Erfe BM .
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
Am J Emerg Med 2021 Feb;40:177-80. doi: 10.1016/j.ajem.2020.10.064..
Keywords: Stroke, Cardiovascular Conditions, Emergency Department, Cultural Competence, Diagnostic Safety and Quality
Shipe ME, Deppen SA, Sullivan S
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Granulomas caused by infectious lung diseases can present as indeterminate pulmonary nodules (IPN). This study aimed to validate an enzyme immunoassay (EIA) for histoplasma immunoglobulins G and M (IgG, IgM) for diagnosing benign IPN in areas with endemic histoplasmosis. The investigators concluded that this study confirmed that histoplasma EIA testing could be useful for diagnosing benign IPN in areas with endemic histoplasmosis in a population at high risk for lung cancer.
AHRQ-funded; HS026122.
Citation: Shipe ME, Deppen SA, Sullivan S .
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Ann Thorac Surg 2021 Feb;111(2):416-20. doi: 10.1016/j.athoracsur.2020.05.101..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Lacson R, Cochon L, Ching PR
Integrity of clinical information in radiology reports documenting pulmonary nodules.
Researchers sought to quantify the integrity, measured as completeness and concordance with a thoracic radiologist, of documenting pulmonary nodule characteristics in CT reports, and to assess impact on making follow-up recommendations. Their retrospective cohort study was performed at an academic medical center and natural language processing was used on radiology reports of CT scans of chest, abdomen, or spine to assess presence of pulmonary nodules. They found that essential pulmonary nodule characteristics were under-reported, potentially impacting recommendations for pulmonary nodule follow-up. They concluded that the lack of documentation of pulmonary nodule characteristics in radiology reports was common, with the potential for compromising patient care and clinical decision support tools.
AHRQ-funded; HS024722.
Citation: Lacson R, Cochon L, Ching PR .
Integrity of clinical information in radiology reports documenting pulmonary nodules.
J Am Med Inform Assoc 2021 Jan 15;28(1):80-85. doi: 10.1093/jamia/ocaa209..
Keywords: Imaging, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Zhou Y, Walter FM, Singh H
Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study.
In England, patients who meet National Institute for Health and Care Excellence (NICE) guideline criteria for suspected cancer should receive a specialist assessment within 14 days. In this study, the researchers examined how quickly bladder and kidney cancer patients who met fast-track referral criteria were actually diagnosed. The investigators found that more than a quarter of patients presenting with fast-track referral features did not achieve a timely diagnosis, suggesting inadequate guideline adherence for some patients.
AHRQ-funded; HS022087.
Citation: Zhou Y, Walter FM, Singh H .
Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study.
Cancers 2021 Jan 5;13(1). doi: 10.3390/cancers13010156..
Keywords: Cancer, Diagnostic Safety and Quality
Marin JR, Rodean J, Hall M
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
Researchers evaluated racial and ethnic differences in the performance of common ED imaging studies and examined patterns across diagnoses. In this study, which evaluated visits by nonhospitalized patients younger than 18 years in 44 US children's hospital EDs, they found that non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. They recommended further investigation to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Hall M .
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
JAMA Netw Open 2021 Jan 4(1):e2033710. doi: 10.1001/jamanetworkopen.2020.33710..
Keywords: Children/Adolescents, Hospitals, Emergency Department, Imaging, Racial and Ethnic Minorities, Disparities, Diagnostic Safety and Quality
Armstrong Armstrong, Irwin DJ, Leverenz JB
Biomarker use for dementia with Lewy body diagnosis: survey of US experts.
Researchers investigated clinical practice patterns of dementia with Lewy body (DLB) diagnostic criteria. An anonymous survey was sent to 38 center of excellence investigators inquiring about clinical use of diagnostic tests/biomarkers. They found that neuropsychological testing and MRI remained the most widely used diagnostic tests by DLB specialists. Other tests, particularly, indicative biomarkers, are used only selectively. They recommended research to validate existing potential DLB biomarkers, to develop new biomarkers, and to investigate mechanisms to improve DLB diagnosis.
Citation: Armstrong Armstrong, Irwin DJ, Leverenz JB .
Biomarker use for dementia with Lewy body diagnosis: survey of US experts.
Alzheimer Dis Assoc Disord 2021 Jan-Mar;35(1):55-61. doi: 10.1097/wad.0000000000000414..
Keywords: Dementia, Neurological Disorders, Diagnostic Safety and Quality
Rodriguez PJ, Roberts DA, Meisner J
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. In this study, the investigators aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence. The authors concluded that incorporating dual rapid diagnostic tests in antenatal care could be cost-saving across countries with varying HIV prevalence.
AHRQ-funded; HS013853.
Citation: Rodriguez PJ, Roberts DA, Meisner J .
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Lancet Glob Health 2021 Jan;9(1):e61-e71. doi: 10.1016/s2214-109x(20)30395-8..
Keywords: Human Immunodeficiency Virus (HIV), Infectious Diseases, Prevention, Pregnancy, Women, Diagnostic Safety and Quality, Healthcare Costs
Marshall TL, Ipsaro AJ, Le M
Increasing physician reporting of diagnostic learning opportunities.
This study investigated methods to improve physician reporting of diagnostic errors at the pediatric division of a hospital. In that pediatric hospital medicine (PHM) division only 1 diagnostic-related safety event was reported in the preceding 4 years. The authors aimed to improve attending physician reporting of suspected diagnostic errors from 0 to 2 per 100 PHM patient admissions within 6 months. The improvement team used the Model for Improvement and used the term diagnostic learning opportunity (DLO) with clinicians as opposed to diagnostic error to lessen the stigma. They developed an electronic reporting form and encouraged its use through reminders, scheduled reflection time, and monthly progress reports. Over the course of 13 weeks, there was an increase from 0 to 1.6 per patient admission reports files. Most events (66%) were true diagnostic errors.
AHRQ-funded; HS023827.
Citation: Marshall TL, Ipsaro AJ, Le M .
Increasing physician reporting of diagnostic learning opportunities.
Pediatrics 2021 Jan;147(1). doi: 10.1542/peds.2019-2400..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Hospitals, Quality Improvement, Quality of Care
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Shared Decision Making, Diagnostic Safety and Quality
Stone CA, Trubiano JA, Phillips EJ
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
Although 1% to 2% of the general population carries a cephalosporin allergy label (CAL), there is a lack of validated testing strategies and predictors of true allergy. The objective of this study was to identify cross-reactivity patterns and predictors of skin test positive (STP) in geographically disparate patients with a CAL. The investigators found that cephalosporin cross-reactivity was based on shared R1 groupings. Increasing time since the original reaction and the presence of a PAL with unknown cephalosporin tolerance predicted a lower likelihood of cephalosporin STP.
AHRQ-funded; HS026395.
Citation: Stone CA, Trubiano JA, Phillips EJ .
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
J Allergy Clin Immunol Pract 2021 Jan;9(1):435-44e13. doi: 10.1016/j.jaip.2020.07.056..
Keywords: Antibiotics, Medication, Adverse Drug Events (ADE), Adverse Events, Skin Conditions, Diagnostic Safety and Quality
Fraiman YS, Wojcik MH
The influence of social determinants of health on the genetic diagnostic odyssey: who remains undiagnosed, why, and to what effect?
This review article synthesizes the available evidence regarding population disparities in genetic testing for pediatric rare disease diagnosis and identifies gaps in care. The influence of social determinants of health is known, but this study’s goal is to examine the prevalence and nature of disparities in diagnostic testing. It synthesizes the available evidence regarding disparities, defining the need for further, prospective studies.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Wojcik MH .
The influence of social determinants of health on the genetic diagnostic odyssey: who remains undiagnosed, why, and to what effect?
Pediatr Res 2021 Jan;89(2):295-300. doi: 10.1038/s41390-020-01151-5..
Keywords: Children/Adolescents, Social Determinants of Health, Genetics, Diagnostic Safety and Quality, Screening, Disparities
Iribarren S, Lentz C, Sheinfil AZ
Using an HIV self-test kit to test a partner: attitudes and preferences among high-risk populations.
Researchers explored attitudes and preferences among HIV-negative men who have sex with men and HIV-negative transgender women using an HIV self-testing (HIVST) kit to test partners. They found that most preferred gum swab over fingerprick tests, but would prefer a blood test if it gave results for other sexually transmitted infections (STIs). They concluded that efforts to improve HIVST uptake should focus on incorporating testing for other STIs, reducing test kit size, and reducing cost.
AHRQ-funded; HS026383.
Citation: Iribarren S, Lentz C, Sheinfil AZ .
Using an HIV self-test kit to test a partner: attitudes and preferences among high-risk populations.
AIDS Behav 2020 Nov;24(11):3232-43. doi: 10.1007/s10461-020-02885-3..
Keywords: Human Immunodeficiency Virus (HIV), Diagnostic Safety and Quality, Infectious Diseases, Prevention
Ganguli I, Lupo C, Mainor AJ
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
This observational cohort study looked at the prevalence and cost of care cascades after routine tests considered low value in fee-for-service Medicare patients from January 2013 through March 2015 who had gone for an annual wellness visit (AWV). Among the 75,275 AWV recipients identified, 18.6% received at least 1 low-value test including an ECG, urinalysis, or thyrotropin tests. Patients who were younger, White, and lived in urban, high-income areas were most likely to receive those tests. The cost-cascade was considered notable but of modest cost.
AHRQ-funded; HS023812.
Citation: Ganguli I, Lupo C, Mainor AJ .
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
JAMA Netw Open 2020 Dec;3(12):e2029891. doi: 10.1001/jamanetworkopen.2020.29891..
Keywords: Elderly, Medicare, Healthcare Costs, Diagnostic Safety and Quality
Yankova LC, Neuman MI, Wang ME
Febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections.
In this study, the investigators aimed to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections (IBI). The investigators concluded that the sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count was suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI.
AHRQ-funded; HS026006.
Citation: Yankova LC, Neuman MI, Wang ME .
Febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections.
Hosp Pediatr 2020 Dec;10(12):1120-25. doi: 10.1542/hpeds.2020-000638..
Keywords: Newborns/Infants, Urinary Tract Infection (UTI), Diagnostic Safety and Quality
Sangal RB, Fodeh S, Taylor A
Identification of patients with nontraumatic intracranial hemorrhage using administrative claims data.
Nontraumatic intracranial hemorrhage (ICH) is a neurological emergency of research interest; however, unlike ischemic stroke, has not been well studied in large datasets due to the lack of an established administrative claims-based definition. In this study, the investigators aimed to evaluate both explicit diagnosis codes and machine learning methods to create a claims-based definition for this clinical phenotype.
AHRQ-funded; HS023554.
Citation: Sangal RB, Fodeh S, Taylor A .
Identification of patients with nontraumatic intracranial hemorrhage using administrative claims data.
J Stroke Cerebrovasc Dis 2020 Dec;29(12):105306. doi: 10.1016/j.jstrokecerebrovasdis.2020.105306..
Keywords: Cardiovascular Conditions, Neurological Disorders, Diagnostic Safety and Quality, Data
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Jordan Kempker A, Rudd KE, Wang HE
https://www.pubmed.ncbi.nlm.nih.gov/33009097
Sepsis epidemiology across the International Classification of Diseases, 9th Edition, to International Classification of Diseases, 10th Edition, chasm-a direct application of the Institute for Health Metrics and Evaluation case definition to hospital disc
The objective of this study was to describe the epidemiology of sepsis across the transition from the International Classification of Diseases (ICD), 9th Edition and ICD, 10th Edition, coding systems, evaluating estimates of two previously published ICD 10th Edition, coding strategies. The investigators concluded that The Institute for Health Metrics and Evaluation ICD, 10th Edition, coding strategy for identifying sepsis may capture a larger patient population within administrative datasets that are different from those identified with previously deployed ICD-based methods.
Citation: Jordan Kempker A, Rudd KE, Wang HE .
Sepsis epidemiology across the International Classification of Diseases, 9th Edition, to International Classification of Diseases, 10th Edition, chasm-a direct application of the Institute for Health Metrics and Evaluation case definition to hospital disc
Crit Care Med 2020 Dec;48(12):1881-84. doi: 10.1097/ccm.0000000000004577..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sepsis, Diagnostic Safety and Quality
Salmasian H, Blanchfield BB, Joyce K
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
Wrong-patient order entry (WPOE) errors have a high potential for harm; these errors are particularly frequent wherever workflows are complex and multitasking and interruptions are common, such as in the emergency department (ED). The purpose of this study was to evaluate whether the use of noninterruptive display of patient photographs in the banner of the electronic health record (EHR) is associated with a decreased rate of WPOE errors.
AHRQ-funded; HS024713.
Citation: Salmasian H, Blanchfield BB, Joyce K .
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
AMA Netw Open 2020 Nov 2;3(11):e2019652. doi: 10.1001/jamanetworkopen.2020.19652..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Diagnostic Safety and Quality
Yang J, Wang L, Phadke
Development and validation of a deep learning model for detection of allergic reactions using safety event reports across hospitals,
Although critical to patient safety, health care-related allergic reactions are challenging to identify and monitor. The purpose of this study was to develop a deep learning model to identify allergic reactions in the free-text narrative of hospital safety reports and evaluate its generalizability, efficiency, productivity, and interpretability. The investigators concluded that their study showed that a deep learning model could accurately and efficiently identify allergic reactions using free-text narratives written by a variety of health care professionals.
AHRQ-funded; HS025375.
Citation: Yang J, Wang L, Phadke .
Development and validation of a deep learning model for detection of allergic reactions using safety event reports across hospitals,
JAMA Netw Open 2020 Nov 2;3(11):e2022836. doi: 10.1001/jamanetworkopen.2020.22836..
Keywords: Diagnostic Safety and Quality, Health Information Technology (HIT), Patient Safety
Silverberg JI, Lei D, Yousaf M
Association of itch triggers with atopic dermatitis severity and course in adults.
Atopic dermatitis (AD) is associated with heterogeneous triggers of itch, which may affect AD course and severity. The objective of this study was to characterize the triggers of itch in adult AD. The investigators concluded that itch triggers were common and affected the course of AD. They noted that itch triggers are an important end point to assess in patients with AD.
AHRQ-funded; HS023011.
Citation: Silverberg JI, Lei D, Yousaf M .
Association of itch triggers with atopic dermatitis severity and course in adults.
Ann Allergy Asthma Immunol 2020 Nov;125(5):552-59.e2. doi: 10.1016/j.anai.2020.06.014..
Keywords: Skin Conditions, Diagnostic Safety and Quality
Dewan M, O'Halloran A, Kleinman M
eStablish and Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) electronic Delphi: development of a consensus framework for classifying and reviewing cardiac arrests within the PICU.
The authors sought to develop a consensus framework to guide the process of classifying and reviewing pediatric in-hospital cardiac arrest in the PICU. A multidisciplinary group of pediatric resuscitation experts generated a consensus-based framework to classify and review pediatric in-hospital cardiac arrest in the PICU. The authors recommended that future work focus on the application of this framework and further validation of these definitions and contributing factors for in-hospital cardiac arrest both within and outside the PICU.
AHRQ-funded; HS026975.
Citation: Dewan M, O'Halloran A, Kleinman M .
eStablish and Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) electronic Delphi: development of a consensus framework for classifying and reviewing cardiac arrests within the PICU.
Pediatr Crit Care Med 2020 Nov;21(11):992-99. doi: 10.1097/pcc.0000000000002488..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Fu Y, Ippolito JE, Ludwig DR
Technical note: automatic segmentation of CT images for ventral body composition analysis.
The authors developed a fully automatic body tissue decomposition procedure to segment three major compartments that are related to body composition analysis: subcutaneous adipose tissue, visceral adipose tissue, and muscle. They found that their proposed method enables fully automated quantification of three-dimensional ventral body composition metrics from computed tomography images.
Citation: Fu Y, Ippolito JE, Ludwig DR .
Technical note: automatic segmentation of CT images for ventral body composition analysis.
Med Phys 2020 Nov;47(11):5723-30. doi: 10.1002/mp.14465..
Keywords: Imaging, Diagnostic Safety and Quality
Rauscher GH, Tossas-Milligan K, Macarol T
Trends in attaining mammography quality benchmarks with repeated participation in a quality measurement program: going beyond the mammography quality standards act to address breast cancer disparities.
The Mammography Quality Standards Act requires that mammography facilities conduct audits, but there are no specifications on the metrics to be measured. In this study, the authors present trends from the first 5 years of data collection to examine whether continued participation in this quality improvement program was associated with an increase in the number of benchmarks met for breast cancer screening.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Tossas-Milligan K, Macarol T .
Trends in attaining mammography quality benchmarks with repeated participation in a quality measurement program: going beyond the mammography quality standards act to address breast cancer disparities.
J Am Coll Radiol 2020 Nov;17(11):1420-28. doi: 10.1016/j.jacr.2020.07.019..
Keywords: Cancer: Breast Cancer, Cancer, Women, Screening, Quality Measures, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Thomas MA, Olick-Gibson J, Fu Y
Using prediction models to evaluate magnetic resonance image guided radiation therapy plans.
Comprehensive analysis of daily, online adaptive plan quality and safety in magnetic resonance imaging (MRI) guided radiation therapy is critical to its widespread use. In this study the investigators describe using prediction models to evaluate magnetic resonance image guided radiation therapy plans. Artificial neural network models developed with offline plans created after simulation were used to analyze and compare online plans that were adapted and reoptimized in real time prior to treatment.
AHRQ-funded; HS022888.
Citation: Thomas MA, Olick-Gibson J, Fu Y .
Using prediction models to evaluate magnetic resonance image guided radiation therapy plans.
Phys Imaging Radiat Oncol 2020 Oct 28;16:99-102. doi: 10.1016/j.phro.2020.10.002..
Keywords: Imaging, Diagnostic Safety and Quality