Efren J. Flores

Efren J. Flores
Massachusetts General Hospital | MGH · Department of Radiology

MD

About

112
Publications
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1,354
Citations

Publications

Publications (112)
Article
Background RSNA COVID-19 chest CT consensus guidelines are widely used, but their true positive rate for COVID-19 pneumonia has not been assessed among vaccinated patients. Purpose To assess true positive rate of RSNA typical chest CT findings of COVID-19 among fully vaccinated subjects with PCR-confirmed COVID-19 infection compared with unvaccinat...
Article
Objective: While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential...
Article
Purpose Health care–related cost concerns and financial toxicity are increasingly recognized barriers along the breast cancer care continuum. The purpose of this study was to evaluate the association between patient-reported cost concerns and screening mammography utilization. Methods Survey participants aged 40 to 74 years from the 2018 National...
Article
BACKGROUND Despite progress in noninvasive means for visualizing and characterizing carotid plaque morphology, current clinical practice and AHA/ASA guidelines do not employ any plaque characteristics in deciding whether a patient should undergo carotid endarterectomy. Our objective is to evaluate the utility of dual‐energy computed tomography imag...
Article
Purpose To assess radiology representation, multimedia content, and multilingual content of United States lung cancer screening (LCS) program websites. Materials and methods We identified the websites of US LCS programs with the Google internet search engine using the search terms lung cancer screening, low-dose CT screening, and lung screening. W...
Article
Purpose: CT colonography (CTC) is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). Prior studies suggest that CTC utilization remains low. However, there are few studies evaluating recent CTC utilization and predictors of CTC utilization. Our purpose was to estimate recent nationwide CTC utilization and evaluat...
Article
Full-text available
The COVID-19 pandemic has necessitated a rapid shift to web-based or blended design models for both ongoing and future clinical research activities. Research conducted virtually not only has the potential to increase the patient-centeredness of clinical research but may also further widen existing disparities in research participation among underre...
Article
This commentary responds to a case about a Latino grocery worker who begins experiencing symptoms but is reluctant to be tested for SARS-CoV-2 and be treated for COVID-19 out of fear of losing his livelihood. The case reveals key weaknesses in US health care system capacity to mount evidence-based responses to mitigate, if not contain, spread of a...
Article
Purpose The aim of this study was to assess for sociodemographic factors associated with the use of an online patient portal to self-schedule screening mammography (SM) compared with the traditional scheduling pathway (phone call and referral system). Methods A retrospective study was conducted at an urban quaternary care academic medical center w...
Preprint
BACKGROUND A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials (TTTs) offer evidence-based cessation resources but suffer from low accrual rates. Digital outreach through clinician-delivered videos may improve recruitment efforts. However, understanding of how best to frame trial information and promote participatio...
Article
Background: A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited. Objective: This study aims to identify the message frames that were most effect...
Article
RATIONALE Over the past decade, technological advances have provided new tools for radiologists. However,the effect of these technological advances on radiologist workload and detecting pathologies needs to be assessed. OBJECTIVE The purpose of this study is to assess the workload, including non-interpretative tasks, associated with CT Angiogram (...
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Full-text available
Background Missed appointments can have an adverse impact on health outcomes by delaying appropriate imaging, which can be critical in influencing treatment decisions.Objective To assess for socioeconomic and imaging exam factors associated with missed appointments among children scheduled for diagnostic imaging.Materials and methodsWe retrospectiv...
Article
Background Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a ‘teachable moment’ to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support in Stopping Tobacco) trial, which will identi...
Article
Background To address disparities in lung cancer screening (LCS) that may exclude large numbers of high-risk African American smokers, revised U.S. Preventive Services Task Force (USPSTF) recommendations lowered LCS eligibility thresholds. However, there are limited recent data about the impact of newly revised guidelines on disparities in LCS elig...
Article
Purpose Individuals with serious mental illness (SMI) experience disparities in lung cancer mortality. Using a two-phase, mixed-methods approach, we developed a person-centered lung cancer screening (LCS) educational intervention (phase 1) for individuals with SMI (schizophrenia and bipolar disorder) and evaluated acceptability, feasibility, and ch...
Article
Background: The goal of this study is to assess the value of point-of-care virtual consultations in radiology. Methods: We conducted an institutional review board-approved feasibility study of video-based radiology consultations in an internal medicine primary care clinic at a quaternary academic medical center. The study included 3 primary care...
Article
Background Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted re...
Preprint
UNSTRUCTURED The COVID-19 pandemic has necessitated a rapid shift to web-based or blended design models for both ongoing and future clinical research activities. Research conducted virtually not only has the potential to increase the patient-centeredness of clinical research but may also further widen existing disparities in research participation...
Preprint
Full-text available
Objectives: To assess the diagnostic performance of lung point-of-care ultrasound (POCUS) compared to either a positive nucleic acid test (NAT) or a COVID-19-typical pattern on computed tomography (CT) and to evaluate opportunities to simplify a POCUS algorithm. Methods: Hospital-admitted adult inpatients with (1) either confirmed or suspected COVI...
Article
Purpose Coronavirus disease 2019 and the publicly documented deaths of countless black individuals have highlighted the need to confront systemic racism, address racial/ethnic disparities, and improve diversity and inclusion in radiology. Several radiology departments have begun to create diversity, equity, and inclusion (DEI) committees to systema...
Article
The COVID-19 pandemic has led to delays in cancer diagnosis, in part due to postponement of cancer screening. We used Google Trends data to assess public attention to cancer screening during the first peak of the COVID-19 pandemic. Search volume for terms related to established cancer screening tests ("colonoscopy," "mammogram," "lung cancer screen...
Article
Purpose The purpose of this study was to evaluate the readability of breast cancer online patient educational materials (OPEM) written in Spanish and to compare to equivalent English-language OPEM. Methods The breast cancer–related terms cáncer de seno (breast cancer), detección de cáncer de seno (breast cancer screening), and biopsia de seno (bre...
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Full-text available
Background and purpose: Severe respiratory distress in patients with COVID-19 has been associated with higher rate of neurologic manifestations. Our aim was to investigate whether the severity of chest imaging findings among patients with coronavirus disease 2019 (COVID-19) correlates with the risk of acute neuroimaging findings. Materials and me...
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Full-text available
BACKGROUND Disproportionally high rates of COVID-19 have been noted among communities with limited English proficiency (LEP), resulting in an unmet need for improved multilingual care and interpreter services. To enhance multilingual care, we created a freely available web app (RadTranslate™) that provides multilingual radiology exam instructions....
Article
Objective We aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screening interventions. Methods Adult participants from the 2015 National Health Interview Survey were included. Among patient...
Article
Background: In randomized controlled trials, lung cancer screening with low-dose chest computed tomography (LCS) has been reported to reduce lung cancer mortality. Although initial studies suggested that only approximately 5% of eligible patients have undergone LCS, recent studies have indicated that use of LCS may be increasing nationwide. The ob...
Article
Background: RSNA expert consensus guidelines provide a framework for reporting CT findings related to COVID-19, but have had limited multireader validation. Purpose: To assess the performance of the RSNA guidelines and quantify interobserver variability in application of the guidelines in patients undergoing chest CT for suspected COVID-19 pneum...
Article
Purpose: It is unclear if patients and providers have started to knowingly request lung cancer screening (LCS) outside US guidelines and insurance coverage for risk factors besides a history of heavy smoking. The authors analyzed their institution's best practices advisory (BPA) clinical decision support system to determine whether providers knowi...
Article
On September 20 of 2017, Hurricane Maria made landfall in Puerto Rico as a strong category 4 hurricane with destructive winds and flooding. Everyone suffered in the aftermath of the hurricane due to overwhelming destruction and lack of available resources. For medical students, these conditions were intensified due to their duty as first responders...
Article
Objective To identify factors associated with delayed adherence to follow-up in lung cancer screening. Methods Utilizing a data warehouse and lung cancer screening registry, variables were collected from a referred sample of 3110 unique participants with follow-up CT during the study period (1 January 2016 to 17 October 2018). Adherence was define...
Article
Purpose The aim of this study was to assess the differences in timeliness to MRI appointments and missed MRI appointment rates before and after the implementation of a rideshare program. Methods Retrospective analysis of a rideshare program was performed 9 months after implementation to compare the effects before and after implementation. Variable...
Article
Rationale and Objectives While affiliated imaging centers play an important role in healthcare systems, little is known of how their operations are impacted by the COVID-19 pandemic. Our goal was to investigate imaging volume trends during the pandemic at our large academic hospital compared to the affiliated imaging centers. Materials and Methods...
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Full-text available
Background: Disease severity on chest radiographs (CXR) has been associated with higher risk of disease progression and adverse outcomes from COVID-19. Few studies have evaluated COVID-19-related racial/ethnic disparities in radiology. Purpose: To evaluate whether Non-White minority patients hospitalized with confirmed COVID-19 infection presented...
Article
Purpose: The purpose of this article was to report the utility of computed tomography (CT) for detecting unsuspected cases of Coronavirus disease 2019 (COVID-19) and the utility of the Radiological Society of North America (RSNA)/Society of Thoracic Radiology (STR)/American College of Radiology (ACR) consensus guidelines for COVID-19 reporting. M...
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Full-text available
Purpose: To investigate pulmonary vascular abnormalities at CT pulmonary angiography (CT-PE) in patients with coronavirus disease 2019 (COVID-19) pneumonia. Materials and methods: In this retrospective study, 48 patients with reverse-transcription polymerase chain reaction-confirmed COVID-19 infection who had undergone CT-PE between March 23 and...
Article
Purpose To determine the variability in out-of-pocket costs of lung cancer screening (LCS) for uninsured patients and assess accessibility of this information by telephone or Internet. Methods LCS centers from the ACR’s LCS database were randomly selected. Centers were called between July and August 2019 to determine out-of-pocket cost. Telephone...
Article
Purpose Millions of patients undergo CT imaging examinations every year. These encounters may represent opportunities to improve colorectal cancer (CRC) screening rates among patients who have not received recommended CRC screening. Using a nationally representative cross-sectional survey, our purpose was to estimate the proportion of patients who...
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Full-text available
Importance The internet is an important source of medical information for many patients and may have a key role in the education of patients about lung cancer screening (LCS). Although most LCS programs in the United States have informational websites, the accuracy, completeness, and readability of these websites have not previously been studied....
Article
Objective: Tobacco use is the leading cause of preventable mortality in the United States. Screening mammography (SM) visits present opportunities for radiology practices to reduce tobacco-related morbidity and mortality. Our study evaluates implementation of a program that provides tobacco cessation service referrals and screens for lung cancer s...
Article
Initial studies suggest that women living in U.S. territories may experience barriers to appropriate breast cancer diagnosis and treatment. Our purpose was to evaluate mammography screening engagement in U.S. territories compared with U.S. states. Women aged 50-74 years in the 2016 Behavioral Risk Factor Surveillance System survey without personal...
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Full-text available
Lung cancer is a leading cause of cancer death in Latinos. In a telephone survey, we assessed perceptions about lung cancer and awareness of, interest in, and barriers to lung screening among older current and former smokers. We compared Latino and non-Latino responses adjusting for age, sex, education, and smoking status using logistic regression...
Article
OBJECTIVE. The purpose of this article is to assess the "reversed halo" sign in patients with septic pulmonary embolism (PE) due to IV substance use disorder. MATERIALS AND METHODS. A retrospective analysis was performed of chest CT scans obtained between 2007 and 2017 that had findings of septic PE associated with IV substance use disorder. Inclus...
Article
A 27-year-old homeless woman was evaluated at this hospital because of a suicide attempt. Three weeks before admission, she began to use intranasal heroin daily. While she was in the hospital, pain developed after dislocation of both the right and left elbows. Management decisions were made.
Article
Purpose: To compare image quality and radiation doses for chest DECT acquired with dual-source and rapid-kV switching techniques. Materials and methods: Our institutional Review Board approved retrospective study included 97 patients (54 men, 43 women; 63 ± 14 years) who underwent contrast-enhanced chest DECT with both single source, rapid kV-sw...
Article
Full-text available
Objective: Individuals with schizophrenia experience increased lung cancer mortality and decreased access to cancer screening and tobacco cessation treatment. To promote screening among individuals with schizophrenia, it is necessary to investigate the proportion who meet screening criteria and examine smoking behaviors, cancer risk perception, an...
Article
Full-text available
Purpose Recent advances in cancer treatment have resulted in greatly improved survival, and yet many patients in the USA have not benefited due to poor access to healthcare and difficulty accessing timely care across the cancer care continuum. Recognizing these issues and the need to facilitate discussions on how to improve navigation services for...
Article
-:Purpose: Millions of women undergo mammography screening each year, presenting an opportunity for radiologists to identify women eligible for lung cancer screening with low-dose chest CT (LCS) and smoking cessation counseling. The purpose of our study was to estimate the proportion of women eligible for LCS and tobacco cessation counseling among...
Article
-Purpose: To assess temporal trends and utilization patterns of diagnostic imaging performed for substance use disorder (SUD)-related indications in an academic radiology emergency department (ED). -Methods: Retrospective analyses of ED imaging examinations acquired from 2005 to 2015 were performed. Imaging examinations performed for suspected SUD...
Article
Purpose To determine the diagnostic accuracy and time savings of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol for detecting choledocholithiasis in patients visiting the emergency department (ED) for suspected biliary obstruction. Methods and materials This retrospective study evaluated adult patients (ages 18+ years...
Article
Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking...
Article
Disparities in outcomes exist for breast, colon, and lung cancer among diverse populations, particularly racial and ethnic underrepresented minorities (URMs) and individuals from lower socioeconomic status. For example, blacks experience mortality rates up to about 42% higher than whites for these cancers. Furthermore, although overall death rates...
Article
The US health care system is in the midst of incredible transformation. High-value, high-quality health care is the ultimate goal. Guided by the Institute of Medicine report “Crossing the Quality Chasm,” the focus is to deliver care that is safe, efficient, effective, timely, patient centered, and equitable. Equity is the principle that quality of...
Article
Purpose One in five US women report that they have been victims of intimate partner violence (IPV) during their lifetime. With millions of women presenting for mammography every year, breast imaging centers may represent ideal venues to identify women at risk for IPV and refer them to appropriate support services. Our purpose was to evaluate implem...
Article
-Purpose: Regular contact with a primary care physician (PCP) is associated with increased participation in screening mammography. Older studies suggested that PCP interaction may have a smaller effect on screening mammography uptake among racial and ethnic minorities compared with whites, but there is limited contemporary evidence about the effect...
Article
Lung cancer remains the leading cause of cancer mortality in the United States. Lung cancer screening (LCS) with low-dose CT reduces mortality among high-risk current and former smokers and has been covered by public and private insurers without cost sharing since 2015. Patients and referring providers confront numerous barriers to participation in...
Article
Objective: The aim of this study was to determine the association between the presence of chronic medical disease and mammography screening adherence. Materials and Methods: We performed a retrospective study on women between the ages of 50 and 64 who received screening mammography in 2005 and had at least 8 years of follow-up. Demographic and cli...
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Full-text available
Objective: To determine whether dual-energy computed tomography (DECT) of the chest can be performed at a reduced radiation dose, with an emphasis on images generated with post-processing techniques. Materials and Methods: In 21 patients undergoing DECT of the chest in a dual-source scanner, an additional image series was acquired at a reduced rad...
Article
-Purpose: As health care payment systems transition from fee-for-service to bundled payments, there is an increasing opportunity for radiologists to collaborate to improve population-based health care outcomes. Our purpose was to estimate the extent to which patients engaged in mammography underwent other additional imaging- and non-imaging-based p...
Article
Purpose: Radiography has a low sensitivity for the detection of fractures related to the talonavicular and calcaneocuboid articulations, also known as Chopart fractures. The purpose of this study is to determine the sensitivity of radiographs for detecting additional foot and ankle fractures related to Chopart fracture using CT or MRI as the refer...
Article
Our goal is to define patient navigation for an imaging audience, present a focused selection of published experiences with navigation programs for breast and colorectal cancer screening, and expose principal barriers to the success of such programs. Despite numerous advances in the early detection of cancers, many patients still present with advan...
Article
Numerous benign and malignant tracheal diseases may affect the trachea primarily and secondarily. While the posterior anterior (PA) and lateral chest radiograph is the conventional study for initial evaluation of the trachea and central airways, findings may not always be apparent on conventional radiographs, and further evaluation with cross secti...
Article
Purpose: The aim of this study was to investigate the impact of wait days (WDs) on missed outpatient MRI appointments across different demographic and socioeconomic factors. Methods: An institutional review board-approved retrospective study was conducted among adult patients scheduled for outpatient MRI during a 12-month period. Scheduling data...