Publications by authors named "Dennis Toy"

10 Publications

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Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City.

Radiol Cardiothorac Imaging 2020 Dec 17;2(6):e200464. Epub 2020 Dec 17.

Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A).

Background: Coronavirus disease 2019 (COVID-19) affects vulnerable populations (VP) adversely.

Purpose: To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantage) and determine if a particular subgroup has worse outcomes from COVID-19.

Materials/methods: Of 4110 patients who underwent COVID-19 testing from March 3-April 4, 2020 at NewYork-Presbyterian Hospital (NYP) health system, we included 1121 COVID-19 positive adults (mean age 59±18 years, 59% male) from two academic hospitals and evaluated imaging utilization rates and outcomes, including mortality.

Results: Of 897 (80%) VP, there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantage patients. Imaging was performed in 88% of patients and mostly portable/bedside studies, with 87% of patients receiving chest radiographs. There were 83% hospital admissions, 25% ICU admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intubation requirement, longer hospital stays, and >4-fold increase in mortality compared to non-elderlies (adjusted hazard ratio[aHR] 4.79, p<0.001). Self-reported minorities had fewer ICU admissions (p=0.03) and reduced hazard for mortality (aHR 0.53, p=0.004; complete case analysis: aHR 0.39, p<0.001 excluding "not reported"; sensitivity analysis: aHR 0.61, p=0.005 "not reported" classified as minorities) with similar imaging utilization, compared to non-minorities. SES disadvantage patients had similar imaging utilization and outcomes as compared to their counterparts.

Conclusions: In a predominantly hospitalized New York City cohort, elderly patients are at highest mortality risk. Racial/ethnic minorities and SES disadvantage patients fare better or similarly to their counterparts, highlighting the critical role of access to inpatient medical care during the COVID-19 pandemic.
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http://dx.doi.org/10.1148/ryct.2020200464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751279PMC
December 2020

Central paradiaphragmatic middle lobe involvement in nonspecific interstitial pneumonia.

Eur Radiol 2021 Feb 23. Epub 2021 Feb 23.

Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA.

Objectives: Nonspecific interstitial pneumonia (NSIP) lacks specific diagnostic guidelines or criteria for imaging diagnosis, and the need for more reliable computed tomography (CT) characterization remains. We hypothesized that central paradiaphragmatic middle lobe (ML) involvement is present in most patients with NSIP. The purpose of this study was to evaluate the prevalence of ML involvement and thus to assess its potential as a unique feature of NSIP.

Methods: We conducted a retrospective CT-imaging review of 40 patients with biopsy-proven (7/40, 18%) or clinically established (33/40, 82%) NSIP. Three subspecialty-trained thoracic radiologists reviewed CTs for ML involvement both independently and in consensus, and additional CT findings previously described in NSIP independently.

Results: ML involvement was present in most cases (70%, 28/40, independent review, 78%, 31/40, consensus reading), with substantial agreement among all three readers (κ = 0.65). Fibrosis was present in almost all cases (93%, 37/40). Subpleural sparing occurred in one-third of patients (30%, 12/40). Homogeneity (48%, 19/40), central bronchiectasis (45%, 18/40), and peripheral bronchiectasis (53%, 21/40) were present in about half of patients. Apart from substantial inter-reader agreement on fibrosis (κ = 0.65), the above-mentioned imaging characteristics had fair to slight universal agreement (κ = 0.07-0.30).

Conclusions: Central paradiaphragmatic ML ground glass attenuation superimposed on reticulation and traction bronchiectasis occurs in most patients with NSIP, with high interobserver agreement.

Key Points: • Central paradiaphragmatic middle lobe ground glass attenuation superimposed on reticulation and traction bronchiectasis is common in nonspecific interstitial pneumonia (NSIP). • This finding occurs more frequently than subpleural sparing and has a better interobserver agreement.
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http://dx.doi.org/10.1007/s00330-021-07741-zDOI Listing
February 2021

Thoracic Manifestations of Rheumatoid Arthritis.

Radiographics 2021 Jan-Feb;41(1):32-55

From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065.

Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. RSNA, 2021.
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http://dx.doi.org/10.1148/rg.2021200091DOI Listing
January 2021

Preparation for the ABR Core Exam: Resident Study Habits and the Value of Case Conferences.

J Am Coll Radiol 2021 Apr 23;18(4):615-619. Epub 2020 Nov 23.

Director of Radiology, Denver Health, Denver, Colorado; Vice Chair, Department of Radiology, University of Colorado, Denver, Colorado.

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http://dx.doi.org/10.1016/j.jacr.2020.10.019DOI Listing
April 2021

The importance of imaging - Perspectives from redeployment.

Clin Imaging 2021 Jan 13;69:380-383. Epub 2020 Oct 13.

New York Presbyterian Hospital - Weill Cornell, Department of Radiology, 520 East 70(th) Street, Starr 8A-37, New York, NY 10021, United States of America. Electronic address:

As the coronavirus disease 2019 (COVID-19) pandemic strains the healthcare system, radiology residents across the United States have become a vital part of the redeployed workforce. Through a series of four cases of COVID-19 patients encountered on the wards, we highlight the insight and unique set of skills redeployed radiology residents possess that are essential to patient care during this crisis. By increasing visibility through active participation on the clinical team, we demonstrate the fundamental role radiology has in the greater field of medicine.
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http://dx.doi.org/10.1016/j.clinimag.2020.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550887PMC
January 2021

A Case-Based Review of Vaping-Induced Injury-Pulmonary Toxicity and Beyond.

Curr Probl Diagn Radiol 2021 May-Jun;50(3):401-409. Epub 2020 Jun 26.

Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY. Electronic address:

The last 10 years has seen a steady rise in the use of electronic cigarettes ("e-cigarettes" or ECIGs) or "vape pens." Though initially developed to assist with smoking cessation, use among adolescents has been particularly high. A concomitant rise in ECIG-related injuries disproportionately affecting young patients has been recognized. This unique case series highlights both pulmonary and extra-pulmonary ECIG-induced injuries including vape tip ingestion, maxillofacial fractures after vape pen explosion, myocarditis, and several different manifestations of vaping-associated lung injury. Becoming familiar with expected imaging findings in the wide array of ECIG-induced complications will help radiologists recognize these findings, recommend further imaging as needed, facilitate early diagnosis by help referring clinicians elicit the relevant history from patients, and expedite appropriate treatment.
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http://dx.doi.org/10.1067/j.cpradiol.2020.06.003DOI Listing
June 2020

Imaging & other potential predictors of deterioration in COVID-19.

Am J Emerg Med 2020 07 28;38(7):1547.e1-1547.e4. Epub 2020 Apr 28.

Department of Radiology, Weill Cornell Medical Center, 525 East 68(th) Street, New York, NY 10065, United States of America.

This case report describes a young patient with COVID-19 who is initially diagnosed with CT chest imaging. Upon admission to the hospital, his clinical condition deteriorates requiring ventilatory support. We explore the value of imaging and other potential predictors of deterioration.
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http://dx.doi.org/10.1016/j.ajem.2020.04.075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195283PMC
July 2020

Pre and Post Procedure Imaging of the Watchman® Device with Cardiac Computed Tomography Angiography.

Curr Treat Options Cardiovasc Med 2019 Sep 14;21(10):61. Epub 2019 Sep 14.

Denver Health, Department of Radiology, University of Colorado, 777 Bannock St. MC0024, Denver, CO, 80204, USA.

Purpose Of Review: Left atrial appendage occlusion with the Watchman® device requires pre and post procedure imaging. Currently, transesophageal echocardiography is the recommended modality, though cardiac computed tomography angiography may be an acceptable alternative.

Recent Findings: Cardiac computed tomography angiography can be used to safely and accurately predict Watchman® device sizing. It can also be used to detect post procedure complications similar to, or better than, transesophageal echocardiography. Cardiac computed tomography angiography is a viable alternative imaging modality for pre and post procedure evaluation for the Watchman device.
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http://dx.doi.org/10.1007/s11936-019-0767-7DOI Listing
September 2019

Radiology Research Funding: Current State and Future Opportunities.

Acad Radiol 2018 01 1;25(1):26-39. Epub 2017 Sep 1.

Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia.

Funding for research has become increasingly difficult to obtain in an environment of decreasing clinical revenue, increasing research costs, and growing competition for federal and nonfederal funding sources. This paper identifies critical requirements to build and sustain a successful radiology research program (eg, key personnel and leadership, research training and mentorship, infrastructure, institutional and departmental funding or support), reviews the current state of available funding for radiology (including federal, nonfederal, philanthropy, crowdfunding, and industry), and describes promising opportunities for future funding (eg, health services, comparative effectiveness, and patient-centered outcomes research). The funding climate, especially at the federal level, changes periodically, so it is important to have radiology-specific organizations such as the American College of Radiology and the Academy of Radiology Research serving as our key advocates. Key to obtaining any funding, no matter what the source, is a well-formulated grant proposal, so a review of opportunities specifically available to radiologists to develop and hone their grant-writing skills is provided. Effective and sustained funding for radiology research has the potential to cultivate young researchers, bolster quality research, and enhance health care. Those interested in pursuing research need to be aware of the ever-changing funding landscape, research priority areas, and the resources available to them to succeed. To succeed, radiology researchers need to think about diversification and flexibility in their interests, developing multidisciplinary and multi-institutional projects, and engaging a broader base of stakeholders that includes patients.
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http://dx.doi.org/10.1016/j.acra.2017.07.013DOI Listing
January 2018

Effect of Massed Versus Interleaved Teaching Method on Performance of Students in Radiology.

J Am Coll Radiol 2016 Aug 26;13(8):979-84. Epub 2016 May 26.

Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut.

Purpose: Radiology instruction is based on the principle that grouped (or massed) repetition of an intellectual activity leads to expertise. The aim of this study was to test the hypothesis that the spaced (or interleaved) method of teaching chest x-ray interpretation is more effective than the massed method.

Methods: After institutional review board approval was obtained, 40 first- and second-year medical students were randomized into two groups matched by age, gender, and education experience. Both groups saw six examples of 12 common chest radiographic patterns, one grouped, the other scrambled randomly without repeating strings. After a distraction, participants took a multiple-choice test consisting of two cases in each radiographic pattern, one previously shown, one new. Results were analyzed using two-tailed Student's t test of proportion.

Results: Comparing interleaved and massed groups, the average overall score was 57% versus 43% (P = .03), the recollection score was 61% versus 47% (P = .03), and the induction score was 53% versus 40% (P = 0.10), respectively. Comparing second- and first-year students, average scores were 67% and 39%, respectively (P < .01). First-year students in the interleaved and massed groups scored 55% and 36% (P = .02) in recall and 40% and 28% (P = .10) in induction. Second-year students in the interleaved and massed groups scored 71% and 63% (P = .36) in recall and 74% and 59% (P = .03) in induction.

Conclusions: The interleaved method of instruction leads to better results than the massed method across all levels of education. A higher level of medical education improves performance independent of method of instruction.
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http://dx.doi.org/10.1016/j.jacr.2016.03.031DOI Listing
August 2016