Pragmatic Trial of Strategies for Surveillance of Patients with Pulmonary Nodules (Watch the Spot):
In collaboration with the University of California Davis, Kaiser Permanente, and health institutions across the country, RORL is participating in an unblinded, prospective, pragmatic, cluster-randomized, comparative effectiveness trial examining more intensive versus less intensive CT surveillance of patients with small pulmonary nodules. The aim is to create a surveillance strategy that will maximize earlier diagnosis for patients with cancer, while minimizing the harms of repeated ionizing radiation. This work is funded by the Patient-Centered Outcomes Research Institute (PCORI).
SYstems Research in Misuse, Overuse, and Underuse of INTerventions (SYRMOUNT)
Part of a broader, department-wide research program, this work aims to address inequities in breast cancer care among women and vulnerable communities by studying the overuse, underuse, or misuse of medical imaging. This program made possible by residual class settlement funds in the matter of April Krueger v. Wyeth, Inc., Case No. 03-cv-2496 (US District Court, SD of Calif.)
Projects in this portfolio include:
CAncer Risk from ImagiNG (CARING) – The aim of this retrospective study is to quantify the risk of cancer associated with exposure to medical imaging with a particular focus on breast cancer. The study will identify three cohorts of patients in California, Ontario, Canada, and Queensland, Australia, and we will follow these patients over time to assess each’s cumulative radiation exposure from imaging. We will capture each patient’s cancer risk factors and other clinical information, and cancer diagnoses will be confirmed via linkages with the respective local cancer registries.
Reducing the doses used for CT and positron emission tomography CT (PET-CT) in California – The purpose of this project is two-fold: to assemble data on radiation doses used for PET-CT and describe factors associated with high doses for each exam type; and to implement a quality improvement project to lower radiation doses at imaging facilities in California.
Cancer therapies, duration of treatment, and imaging surveillance for early detection of recurrent disease: study of practice patterns, disparities, and optimum use of care – This project seeks to understand practice patterns related to breast cancer diagnosis, treatment, and imaging surveillance at UCSF and Zuckerberg San Francisco General Hospital, with special attention to variation by race and ethnicity and other social determinants of health. In short, we will determine the use and duration of specific treatments and how surveillance with CT imaging influences the duration of treatment. As a starting place, we are developing AI tools to characterize the reason for imaging and results of imaging – a crucial first step towards automating the determination of what surveillance was done and the outcomes of such exams.