Scholars@Duke
Robert Saunders

Robert Saunders

Principal, Duke-Margolis Ctr Hlth Policy
Duke-Margolis Institute for Health Policy
100 Fuqua Drive, Box 90120, Durham, NC 27708
1201 Pennsylvania Avenue, Suite 500, Washington, DC 20004

Selected Publications

Improving Cardiovascular Drug and Device Development and Evidence Through Patient-Centered Research and Clinical Trials: A Call to Action From the Value in Healthcare Initiative's Partnering With Regulators Learning Collaborative.

Journal Article Circ Cardiovasc Qual Outcomes · July 2020 The pipeline of new cardiovascular drugs is relatively limited compared with many other clinical areas. Challenges causing lagging drug innovation include the duration and expense of cardiovascular clinical trials needed for regulatory evaluation and appro ... Full text Link to item Cite

Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative.

Journal Article Circ Cardiovasc Qual Outcomes · July 2020 Stroke is one of the leading causes of morbidity and mortality in the United States. While age-adjusted stroke mortality was falling, it has leveled off in recent years due in part to advances in medical technology, health care options, and population heal ... Full text Link to item Cite

Streamlining and Reimagining Prior Authorization Under Value-Based Contracts: A Call to Action From the Value in Healthcare Initiative's Prior Authorization Learning Collaborative.

Journal Article Circulation. Cardiovascular quality and outcomes · July 2020 Utilization management strategies, including prior authorization, are commonly used to facilitate safe and guideline-adherent provision of new, individualized, and potentially costly cardiovascular therapies. However, as currently deployed, these approache ... Full text Cite

Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative.

Journal Article Circulation. Cardiovascular quality and outcomes · May 2020 Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in impr ... Full text Cite

Medicaid and CHIP Child Health Beneficiary Incentives: Program Landscape and Stakeholder Insights.

Journal Article Pediatrics · August 2019 OBJECTIVES: To describe the landscape of Medicaid and the Children's Health Insurance Program beneficiary incentive programs for child health and garner key stakeholder insights on incentive program rationale, child and family engagement, and program evalu ... Full text Link to item Cite

The Need for Practical and Accurate Measures of Value for Radiology.

Journal Article J Am Coll Radiol · June 2019 Radiologists play a critical role in helping the health care system achieve greater value. Unfortunately, today radiology is often judged by simple "checkbox" metrics, which neither directly reflect the value radiologists provide nor the outcomes they help ... Full text Link to item Cite

ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities.

Journal Article Health Aff (Millwood) · June 2019 Care for people living with serious illness is suboptimal for many reasons, including underpayment for key services (such as care coordination and social supports) in fee-for-service reimbursement. Accountable care organizations (ACOs) have potential to im ... Full text Link to item Cite

Why Do Accountable Care Organizations Leave The Medicare Shared Savings Program?

Journal Article Health affairs (Project Hope) · May 2019 The ability of accountable care organizations (ACOs) to continue reducing costs and improving quality depends on understanding what affects their survival. We examined such factors for survival in the Medicare Shared Savings Program (MSSP) of 624 ACOs betw ... Full text Cite

Engaging Beneficiaries In Medicaid Programs That Incentivize Health-Promoting Behaviors.

Journal Article Health Aff (Millwood) · March 2019 Medicaid programs are increasingly adopting incentive programs to improve health behaviors among beneficiaries. There is limited evidence on what incentives are being offered to Medicaid beneficiaries, how programs are engaging beneficiaries, and how progr ... Full text Link to item Cite

Getting More Performance from Performance Measurement

Journal Article New England Journal of Medicine · December 4, 2014 Full text Cite

Dual-energy contrast-enhanced breast tomosynthesis: optimization of beam quality for dose and image quality.

Journal Article Phys Med Biol · October 7, 2011 Dual-energy contrast-enhanced breast tomosynthesis is a promising technique to obtain three-dimensional functional information from the breast with high resolution and speed. To optimize this new method, this study searched for the beam quality that maximi ... Full text Link to item Cite

An anthropomorphic breast model for breast imaging simulation and optimization.

Journal Article Acad Radiol · May 2011 RATIONALE AND OBJECTIVES: Optimization studies for x-ray-based breast imaging systems using computer simulation can greatly benefit from a phantom capable of modeling varying anatomical variability across different patients. This study aimed to develop a t ... Full text Link to item Cite

Can compression be reduced for breast tomosynthesis? Monte carlo study on mass and microcalcification conspicuity in tomosynthesis.

Journal Article Radiology · June 2009 PURPOSE: To assess, in a voxelized anthropomorphic breast phantom, how the conspicuity of breast masses and microcalcifications may be affected by applying reduced breast compression in tomosynthesis. MATERIALS AND METHODS: A breast tomosynthesis system wa ... Full text Link to item Cite

Towards optimized acquisition scheme for multiprojection correlation imaging of breast cancer.

Journal Article Acad Radiol · April 2009 RATIONALE AND OBJECTIVES: Correlation imaging (CI) is a form of multiprojection imaging in which multiple images of a patient are acquired from slightly different angles. Information from these images is combined to make the final diagnosis. A critical fac ... Full text Link to item Cite

Mass detection on mammograms: influence of signal shape uncertainty on human and model observers.

Journal Article J Opt Soc Am A Opt Image Sci Vis · February 2009 We studied the influence of signal variability on human and model observers for detection tasks with realistic simulated masses superimposed on real patient mammographic backgrounds and synthesized mammographic backgrounds (clustered lumpy backgrounds, CLB ... Full text Link to item Cite

Micro-CT imaging of breast tumors in rodents using a liposomal, nanoparticle contrast agent.

Journal Article Int J Nanomedicine · 2009 A long circulating liposomal, nanoscale blood pool agent encapsulating traditional iodinated contrast agent (65 mg I/mL) was used for micro-computed tomography (CT) imaging of rats implanted with R3230AC mammary carcinoma. Three-dimensional vascular archit ... Open Access Link to item Cite

The effect of breast compression on mass conspicuity in digital mammography.

Journal Article Med Phys · October 2008 This study analyzed how the inherent quality of diagnostic information in digital mammography could be affected by breast compression. A digital mammography system was modeled using a Monte Carlo algorithm based on the Penelope program, which has been succ ... Full text Link to item Cite

Knowledge transfer across breast cancer screening modalities: A pilot study using an information-theoretic CADe system for mass detection

Conference Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) · September 9, 2008 We have performed a series of experiments to assess whether a featureless, knowledge-based CADe system that relies on information theoretic principles is capable of transferring knowledge across cases acquired with different imaging modalities. Typical fea ... Full text Cite

Assessment of low energies and slice depth in the quantification of breast tomosynthesis

Conference Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) · September 9, 2008 This study attempts to assess the quantitative potential of breast tomosynthesis imaging. Tomosynthesis might be a feasible replacement for digital mammography, so it is worthwhile to consider whether it can be quantitative like computed tomography (CT), w ... Full text Cite

Mass detection on mammograms: Signal variations and performance changes for human and model observers

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · June 18, 2008 We studied the influence of signal variability on human and model observer performances for a detection task with mammographic backgrounds and computer generated clustered lumpy backgrounds (CLB). We used synthetic yet realistic masses and backgrounds that ... Full text Cite

Optimized acquisition scheme for multi-projection correlation imaging of breast cancer

Conference Progress in Biomedical Optics and Imaging - Proceedings of SPIE · June 2, 2008 We are reporting the optimized acquisition scheme of multi-projection breast Correlation Imaging (CI) technique, which was pioneered in our lab at Duke University. CI is similar to tomosynthesis in its image acquisition scheme. However, instead of analyzin ... Full text Cite

Computer aided detection of breast masses in tomosynthesis reconstructed volumes using information-theoretic similarity measures

Conference Progress in Biomedical Optics and Imaging - Proceedings of SPIE · June 2, 2008 The purpose of this project is to study two Computer Aided Detection (CADe) systems for breast masses for digital tomosynthesis using reconstructed slices. This study used eighty human subject cases collected as part of on-going clinical trials at Duke Uni ... Full text Cite

Utility of a prototype liposomal contrast agent for x-ray imaging of breast cancer: A proof of concept using micro-CT in small animals

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · May 14, 2008 Imaging tumor angiogenesis in small animals is extremely challenging due to the size of the tumor vessels. Consequently, both dedicated small animal imaging systems and specialized intravascular contrast agents are required. The goal of this study was to i ... Full text Cite

Optimization of dual energy contrast enhanced breast tomosynthesis for improved mammographic lesion detection and diagnosis

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · May 14, 2008 Dual-energy contrast-enhanced breast tomosynthesis has been proposed as a technique to improve the detection of early-stage cancer in young, high-risk women. This study focused on optimizing this technique using computer simulations. The computer simulatio ... Full text Cite

Toward quantification of breast tomosynthesis imaging

Conference Progress in Biomedical Optics and Imaging - Proceedings of SPIE · May 14, 2008 Due to the high prevalence of breast cancer among women, much is being done to detect breast cancer earlier and more accurately. In current clinical practice, the most widely-used mode of breast imaging is mammography. Its main advantages are high sensitiv ... Full text Cite

A mathematical model platform for optimizing a multiprojection breast imaging system.

Journal Article Med Phys · April 2008 Multiprojection imaging is a technique in which a plurality of digital radiographic images of the same patient are acquired within a short interval of time from slightly different angles. Information from each image is combined to determine the final diagn ... Full text Link to item Cite

Initial human subject results for breast Bi-plane correlation imaging technique

Conference Progress in Biomedical Optics and Imaging - Proceedings of SPIE · October 18, 2007 Computer aided detection (CADe) systems often present multiple false-positives per image in projection mammography due to overlapping anatomy. To reduce the number of such false-positives, we propose performing CADe on image pairs acquired using a bi-plane ... Full text Cite

Does image quality matter? Impact of resolution and noise on mammographic task performance.

Journal Article Med Phys · October 2007 The purpose of this study was to examine the effects of different resolution and noise levels on task performance in digital mammography. This study created an image set with images at three different resolution levels, corresponding to three digital displ ... Full text Link to item Cite

Effect of dose reduction on the detection of mammographic lesions: a mathematical observer model analysis.

Journal Article Med Phys · August 2007 The effect of reduction in dose levels normally used in mammographic screening procedures on the detection of breast lesions were analyzed. Four types of breast lesions were simulated and inserted into clinically-acquired digital mammograms. Dose reduction ... Full text Link to item Cite

Digital mammography: effects of reduced radiation dose on diagnostic performance.

Journal Article Radiology · May 2007 PURPOSE: To experimentally determine the relationship between radiation dose and observer accuracy in the detection and discrimination of simulated lesions for digital mammography. MATERIALS AND METHODS: This HIPAA-compliant study received institutional re ... Full text Link to item Cite

Improving mammographic decision accuracy by incorporating observer ratings with interpretation time.

Journal Article Br J Radiol · December 2006 Mammography is currently the most established technique for the early detection of breast cancer. However, mammography would benefit from further improvements as it does produce some errors, such as not finding all early-stage cancers. The objectives of th ... Full text Link to item Cite

Invited paper: Displaying your health: An overview of medical display research

Journal Article Proceedings of the Third Americas Display Engineering and Applications Conference, ADEAC 2006 · December 1, 2006 Medical imaging has been moving from analog technologies (such as x-ray film) to digital ones in recent years. The quality of a digital image depends on the quality of the detector equipment used to capture the image, image processing applied to the image, ... Cite

Comparison of LCD and CRT displays based on efficacy for digital mammography.

Journal Article Acad Radiol · November 2006 RATIONALE AND OBJECTIVES: To compare two display technologies, cathode ray tube (CRT) and liquid crystal display (LCD), in terms of diagnostic accuracy for several common clinical tasks in digital mammography. MATERIALS AND METHODS: Simulated masses and mi ... Full text Link to item Cite

Simulation of mammographic lesions.

Journal Article Acad Radiol · July 2006 RATIONALE AND OBJECTIVES: This study presents a method for generating breast masses and microcalcifications in mammography via simulation. This simulation method allows for the creation of large image datasets with particular lesions, which may serve as a ... Full text Link to item Cite

A Monte Carlo investigation on the impact of scattered radiation on mammographic resolution and noise

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · June 30, 2006 Scattered radiation plays a significant role in mammographic imaging, with scatter fractions over 50% for larger, denser breasts. For screen-film systems, scatter primarily affects the image contrast, reducing the conspicuity of subtle lesions. While digit ... Full text Cite

Analyzing the Effect of dose reduction on the detection of mammographic lesions using mathematical observer models

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · June 22, 2006 The purpose of this study was to determine the effect of dose reduction on the detectability of breast lesions in mammograms. Mammograms with dose levels corresponding to 50% and 25% of the original clinically-relevant exposure levels were simulated. Detec ... Full text Cite

Resolution and noise measurements of five CRT and LCD medical displays.

Journal Article Med Phys · February 2006 The performance of soft-copy displays plays a significant role in the overall image quality of a digital radiographic system. In this work, we discuss methods to characterize the resolution and noise of both cathode ray tube (CRT) and liquid crystal displa ... Full text Link to item Cite

TH‐C‐330A‐02: Does Image Quality Impact Mammographic Accuracy?

Conference Medical Physics · January 1, 2006 Purpose: To assess the impact of resolution and noise on observer performance in detecting and classifying breast masses and microcalcifications in x‐ray mammography. Method and Materials: Simulated breast masses and microcalcifications were inserted into ... Full text Cite

Effect of display resolution on the detection of mammographie lesions

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · September 19, 2005 For diagnosis of breast cancer by mammography, the mammograms must be viewed by a radiologist. The purpose of this study was to determine the effect of display resolution on the specific clinical task of detection of breast lesions by a human observer. Usi ... Full text Cite

Detector evaluation of a prototype amorphous selenium-based full field digital mammography system

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · August 25, 2005 This study evaluated the physical performance of a selenium-based direct full-field digital mammography prototype detector (Siemens Mammomat Novation DR), including the pixel value vs. exposure linearity, the modulation transfer function (MTF), the normali ... Full text Cite

Physical characterization of a prototype selenium-based full field digital mammography detector.

Journal Article Med Phys · February 2005 The purpose of this study was to measure experimentally the physical performance of a prototype mammographic imager based on a direct detection, flat-panel array design employing an amorphous selenium converter with 70 microm pixels. The system was charact ... Full text Link to item Cite

Characterization of breast masses for simulation purposes

Journal Article Progress in Biomedical Optics and Imaging - Proceedings of SPIE · December 1, 2004 Simulation of radiographic lesions is an important prerequisite for several research applications in medical imaging, including hardware and software design and optimization. For mammography, breast masses are an important class of lesions to be considered ... Full text Cite

Fundamental imaging characteristics of a slot-scan digital chest radiographic system.

Journal Article Med Phys · September 2004 Our purpose in this study was to evaluate the fundamental image quality characteristics of a new slot-scan digital chest radiography system (ThoraScan, Delft Imaging Systems/Nucletron, Veenendaal, The Netherlands). The linearity of the system was measured ... Full text Link to item Cite

Impact of resolution and noise characteristics of digital radiographic detectors on the detectability of lung nodules.

Journal Article Med Phys · June 2004 One of the unanswered questions in digital radiography is the connection between physical image quality metrics and clinical detection performance. In this paper, we examine the impact of two physical metrics, resolution and noise, on the detectability of ... Full text Link to item Cite

A method for modifying the image quality parameters of digital radiographic images.

Journal Article Med Phys · November 2003 A new computer simulation approach is presented that is capable of modeling several varieties of digital radiographic systems by their image quality characteristics. In this approach, the resolution and noise characteristics of ideal supersampled input ima ... Full text Link to item Cite

Impact of resolution and noise characteristics of digital radiographic detectors on the detectability of lung nodules

Journal Article Proceedings of SPIE - The International Society for Optical Engineering · September 15, 2003 The current system performance metrics for Digital Radiographic detectors describe physical parameters, such as resolution (Modulation Transfer Function), noise (Noise Power Spectrum) and efficiency (Detective Quantum Efficiency). However, little has been ... Full text Cite