Donald G Mitchell

Publications (7)0 Total impact

• Article: ACR Appropriateness Criteria® First Trimester Bleeding.

  Barton F Lane, Jade J Wong-You-Cheong, Marcia C Javitt, Phyllis Glanc, Douglas L Brown, Theodore Dubinsky, Mukesh G Harisinghani, Robert D Harris, Nadia J Khati, Donald G Mitchell, Pari V Pandharipande, Harpreet K Pannu, Anne E Podrasky, Thomas D Shipp, Cary Lynn Siegel, Lynn Simpson, Darci J Wall, Carolyn M Zelop
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  ABSTRACT: Vaginal bleeding is not uncommon in the first trimester of pregnancy. Ultrasound is the foremost modality for evaluating normal development of the gestational sac and embryo and for discriminating the causes of bleeding. While correlation with quantitative βHCG and clinical presentation is essential, sonographic criteria permit diagnosis of failed pregnancies, ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. The American College of Radiology Appropriateness Criteria guidelines have been updated to incorporate recent data. A failed pregnancy may be diagnosed when there is absence of cardiac activity in an embryo exceeding 7 mm in crown rump length or absence of an embryo when the mean sac diameter exceeds 25 mm. In a stable patient with no intrauterine pregnancy and normal adnexae, close monitoring is advised. The diagnosis of ectopic pregnancy should be based on positive findings rather than on the absence of an intrauterine sac above a threshold level of βHCG. Following abortion, ultrasound can discriminate retained products of conception from clot and arteriovenous fistulae. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
  Ultrasound quarterly 05/2013;
• Article: ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass.

  Marcia C Javitt, Phyllis Glanc, Douglas L Brown, Theodore Dubinsky, Mukesh G Harisinghani, Nadia J Khati, Young Bae Kim, Donald G Mitchell, Pari V Pandharipande, Harpreet K Pannu, Ann E Podrasky, Henry D Royal, Thomas D Shipp, Cary Lynn Siegel, Lynn Simpson, Darci J Wall, Jade J Wong-You-Cheong, Carolyn M Zelop
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  ABSTRACT: Adnexal masses are a common problem clinically and imaging-wise, and transvaginal US (TVUS) is the first-line imaging modality for assessing them in the vast majority of patients. The findings of US, however, should be correlated with the history and laboratory tests, as well as any patient symptoms. Simple cysts are uniformly benign, and most warrant no further interrogation or treatment. Complex cysts carry more significant implications, and usually engender serial ultrasound(s), with a minority of cases warranting a pelvic MRI.Morphological analysis of adnexal masses with gray-scale US can help narrow the differential diagnosis. Spectral Doppler analysis has not proven useful in most well-performed studies. However, the use of color Doppler sonography adds significant contributions to differentiating between benign and malignant masses and is recommended in all cases of complex masses. Malignant masses generally demonstrate neovascularity, with abnormal branching vessel morphology. Optimal sonographic evaluation is achieved by using a combination of gray-scale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
  Ultrasound quarterly 01/2013;
• Article: ACR Appropriateness Criteria® pretreatment planning of invasive cancer of the cervix.

  Cary Lynn Siegel, Rochelle F Andreotti, Higinia Rosa Cardenes, Douglas L Brown, David K Gaffney, Neil S Horowitz, Marcia C Javitt, Susanna I Lee, Donald G Mitchell, David H Moore, Gautam G Rao, Henry D Royal, William Small, Mahesh A Varia, Catheryn M Yashar
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  ABSTRACT: The prognosis of cervical cancer is linked to lymph node involvement, and this is predicted clinically and pathologically by the stage of the disease, as well as the volume and grade of the tumor. Staging of cervical cancer based on International Federation of Gynecology and Obstetrics (FIGO) staging uses physical examination, cystoscopy, proctoscopy, intravenous urography, and barium enema. It does not include CT or MRI. Evaluation of the parametrium is limited in FIGO staging, and lymph node metastasis, an important prognostic factor, is not included in FIGO staging. The most important role for imaging is to distinguish stages Ia, Ib, and IIa disease treated with surgery from advanced disease treated with radiation therapy with or without chemotherapy. This article reviews the current role of imaging in pretreatment planning of invasive cervical cancer. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
  Journal of the American College of Radiology: JACR 06/2012; 9(6):395-402.
• Article: ACR Appropriateness Criteria® Multiple gestations.

  Sandra O DeJesus Allison, Marcia C Javitt, Phyllis Glanc, Rochelle F Andreotti, Genevieve L Bennett, Douglas L Brown, Theodore Dubinsky, Mukesh G Harisinghani, Robert D Harris, Donald G Mitchell, Pari V Pandharipande, Harpreet K Pannu, Ann E Podrasky, Thomas D Shipp, Cary Lynn Siegel, Lynn Simpson, Jade J Wong-You-Cheong, Carolyn M Zelop
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  ABSTRACT: Multiple gestations are high-risk compared with singleton pregnancies. Prematurity and intrauterine growth restrictions are the major sources of morbidity and mortality common to all twin gestations. Monochorionic twins are at a higher risk for twin-twin transfusion, fetal growth restriction, congenital anomalies, vasa previa, velamentous insertion of the umbilical cord and fetal death. Therefore, determination of multiple gestation, amnionicity and chorionicity in the first trimester is important. Follow up examinations to evaluate fetal well-being include assessment of fetal growth and amniotic fluid volume, umbilical artery Doppler, nonstress test and biophysical profile. To date, there is a paucity of literature regarding imaging schedules for follow-up. At the very least, antepartum testing in multiple gestations is recommended in all situations in which surveillance would ordinarily be performed in a singleton pregnancy.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.
  Ultrasound quarterly 06/2012; 28(2):149-55.
• Article: ACR Appropriateness Criteria® assessment of gravid cervix.

  Phyllis Glanc, Rochelle F Andreotti, Susanna I Lee, Sandra O Dejesus Allison, Genevieve L Bennett, Douglas L Brown, Theodore Dubinsky, Marcia C Javitt, Donald G Mitchell, Ann E Podrasky, Thomas D Shipp, Cary Lynn Siegel, Jade J Wong-You-Cheong, Carolyn M Zelop
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  ABSTRACT: It is well recognized that preterm birth is the leading cause of perinatal mortality and morbidity. There is a significant association between cervix length and preterm birth risk. Most authorities consider a cervical length <3 cm as the lower limit of normal. A cervical length >3 cm has a high negative predictive value for delivery less than 34 weeks. A cervical length of <15 mm is moderately predictive (∼ 70%) of preterm birth within 48 hours. Cervical length is normally distributed and should remain relatively constant until the third trimester. Transabdominal US is the least reliable method of cervical length assessment. The most reliable method of documenting cervical length is transvaginal ultrasound (TVUS). Transperineal US is an alternative for imaging if TVUS is contraindicated, such as with premature rupture of membranes. However, the resolution is decreased compared to TVUS. Short cervix length is the single most important predictive finding for premature delivery. This observation should prompt consultation for high risk obstetrical care and consideration of other management options such as cerclage or activity restriction.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.
  Ultrasound quarterly 12/2011; 27(4):275-80.
• Article: ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group.

  Rochelle F Andreotti, Susanna I Lee, Sandra O Dejesus Allison, Genevieve L Bennett, Douglas L Brown, Theodore Dubinsky, Phyllis Glanc, Marcia C Javitt, Donald G Mitchell, Ann E Podrasky, Thomas D Shipp, Cary Lynn Siegel, Jade J Wong-You-Cheong, Carolyn M Zelop
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  ABSTRACT: Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
  Ultrasound quarterly 09/2011; 27(3):205-10.
• Article: ACR appropriateness criteria(®) on abnormal vaginal bleeding.

  Genevieve L Bennett, Rochelle F Andreotti, Susanna I Lee, Sandra O Dejesus Allison, Douglas L Brown, Theodore Dubinsky, Phyllis Glanc, Donald G Mitchell, Ann E Podrasky, Thomas D Shipp, Cary Lynn Siegel, Jade J Wong-You-Cheong, Carolyn M Zelop
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  ABSTRACT: In evaluating a woman with abnormal vaginal bleeding, imaging cannot replace definitive histologic diagnosis but often plays an important role in screening, characterization of structural abnormalities, and directing appropriate patient care. Transvaginal ultrasound (TVUS) is generally the initial imaging modality of choice, with endometrial thickness a well-established predictor of endometrial disease in postmenopausal women. Endometrial thickness measurements of ≤5 mm and ≤4 mm have been advocated as appropriate upper threshold values to reasonably exclude endometrial carcinoma in postmenopausal women with vaginal bleeding; however, the best upper threshold endometrial thickness in the asymptomatic postmenopausal patient remains a subject of debate. Endometrial thickness in a premenopausal patient is a less reliable indicator of endometrial pathology since this may vary widely depending on the phase of menstrual cycle, and an upper threshold value for normal has not been well-established. Transabdominal ultrasound is generally an adjunct to TVUS and is most helpful when TVUS is not feasible or there is poor visualization of the endometrium. Hysterosonography may also allow for better delineation of both the endometrium and focal abnormalities in the endometrial cavity, leading to hysteroscopically directed biopsy or resection. Color and pulsed Doppler may provide additional characterization of a focal endometrial abnormality by demonstrating vascularity. MRI may also serve as an important problem-solving tool if the endometrium cannot be visualized on TVUS and hysterosonography is not possible, as well as for pretreatment planning of patients with suspected endometrial carcinoma. CT is generally not warranted for the evaluation of patients with abnormal bleeding, and an abnormal endometrium incidentally detected on CT should be further evaluated with TVUS.
  Journal of the American College of Radiology: JACR 07/2011; 8(7):460-8.