Clinical evaluation of malignancy diagnosis of rare thyroid carcinomas by an artificial intelligent automatic diagnosis system

PURPOSE

To evaluate the application value of a generally trained artificial intelligence (AI) automatic diagnosis system in the malignancy diagnosis of rare thyroid carcinomas, such as follicular thyroid carcinoma, medullary thyroid carcinoma, primary thyroid lymphoma and anaplastic thyroid carcinoma and compare the diagnostic performance with radiologists of different experience levels.

METHODS

We retrospectively studied 342 patients with 378 thyroid nodules that included 196 rare malignant nodules by using postoperative pathology as the gold standard, and compared the diagnostic performances of three radiologists (one junior, one mid-level, one senior) and that of AI automatic diagnosis system.

RESULTS

The accuracy of the AI system in malignancy diagnosis was 0.825, which was significantly higher than that of all three radiologists and higher than the best radiologist in this study by a margin of 0.097 with P-value of 2.252 × 10^-16. The mid-level radiologist and senior radiologist had higher sensitivity (0.857 and 0.959) than that of the AI system (0.847) at the cost of having much lower specificity (0.533, 0.478 versus 0.802). The junior radiologist showed relatively balanced sensitivity and specificity (0.816 and 0.549) but both were lower than that of the AI system.

CONCLUSIONS

The generally trained AI automatic diagnosis system showed high accuracy in the differential diagnosis of begin nodules and rare malignancy nodules. It may assist radiologists for screening of rare malignancy nodules that even senior radiologists are not acquainted with.

Can a chest HRCT-based crash course on COVID-19 cases make inexperienced thoracic radiologists readily available to face the next pandemic?

OBJECTIVE

To test the inter-reader agreement in assessing lung disease extent, HRCT signs, and Radiological Society of North America (RSNA) categorization between a chest-devoted radiologist (CR) and two HRCT-naïve radiology residents (RR1 and RR2) after the latter attended a COVID-19-based chest high-resolution computed tomography (HRCT) "crash course".

METHODS

The course was built by retrospective inclusion of 150 patients who underwent HRCT for COVID-19 pneumonia between November 2020 and January 2021. During a first 10-days-long "training phase", RR1 and RR2 read a pool of 100/150 HRCTs, receiving day-by-day access to CR reports as feedback. In the subsequent 2-days-long "test phase", they were asked to report 50/150 HRCTs with no feedback. Test phase reports of RR1/RR2 were then compared with CR using unweighted or linearly-weighted Cohen's kappa (k) statistic and intraclass correlation coefficient (ICC).

RESULTS

We observed almost perfect agreement in assessing disease extent between RR1-CR (k = 0.83, p < 0.001) and RR2-CR (k = 0.88, p < 0.001). The agreement between RR1-CR and RR2-CR on consolidation, crazy paving pattern, organizing pneumonia (OP) pattern, and pulmonary artery (PA) diameter was substantial (k = 0.65 and k = 0.68), moderate (k = 0.42 and k = 0.51), slight (k = 0.10 and k = 0.20), and good-to-excellent (ICC = 0.87 and ICC = 0.91), respectively. The agreement in providing RSNA categorization was moderate for R1 versus CR (k = 0.56) and substantial for R2 versus CR (k = 0.67).

CONCLUSION

HRCT-naïve readers showed an acceptable overall agreement with CR, supporting the hypothesis that a crash course can be a tool to readily make non-subspecialty radiologists available to cooperate in reading high burden of HRCT examinations during a pandemic/epidemic.

Attitudes and perceptions of radiologists towards online (virtual) oncologic multidisciplinary team meetings during the COVID-19 pandemic-a survey of the European Society of Oncologic Imaging (ESOI)

OBJECTIVES

To explore radiologists' opinions regarding the shift from in-person oncologic multidisciplinary team meetings (MDTMs) to online MDTMs. To assess the perceived impact of online MDTMs, and to evaluate clinical and technical aspects of online meetings.

METHODS

An online questionnaire including 24 questions was e-mailed to all European Society of Oncologic Imaging (ESOI) members. Questions targeted the structure and efficacy of online MDTMs, including benefits and limitations.

RESULTS

A total of 204 radiologists responded to the survey. Responses were evaluated using descriptive statistical analysis. The majority (157/204; 77%) reported a shift to online MDTMs at the start of the pandemic. For the most part, this transition had a positive effect on maintaining and improving attendance. The majority of participants reported that online MDTMs provide the same clinical standard as in-person meetings, and that interdisciplinary discussion and review of imaging data were not hindered. Seventy three of 204 (35.8%) participants favour reverting to in-person MDTs, once safe to do so, while 7/204 (3.4%) prefer a continuation of online MDTMs. The majority (124/204, 60.8%) prefer a combination of physical and online MDTMs.

CONCLUSIONS

Online MDTMs are a viable alternative to in-person meetings enabling continued timely high-quality provision of care with maintained coordination between specialties. They were accepted by the majority of surveyed radiologists who also favoured their continuation after the pandemic, preferably in combination with in-person meetings. An awareness of communication issues particular to online meetings is important. Training, improved software, and availability of support are essential to overcome technical and IT difficulties reported by participants.

KEY POINTS

• Majority of surveyed radiologists reported shift from in-person to online oncologic MDT meetings during the COVID-19 pandemic. • The shift to online MDTMs was feasible and generally accepted by the radiologists surveyed with the majority reporting that online MDTMs provide the same clinical standard as in-person meetings. • Most would favour the return to in-person MDTMs but would also accept the continued use of online MDTMs following the end of the current pandemic.

Algorithmic transparency and interpretability measures improve radiologists' performance in BI-RADS 4 classification

OBJECTIVE

To evaluate the perception of different types of AI-based assistance and the interaction of radiologists with the algorithm's predictions and certainty measures.

METHODS

In this retrospective observer study, four radiologists were asked to classify Breast Imaging-Reporting and Data System 4 (BI-RADS4) lesions (n = 101 benign, n = 99 malignant). The effect of different types of AI-based assistance (occlusion-based interpretability map, classification, and certainty) on the radiologists' performance (sensitivity, specificity, questionnaire) were measured. The influence of the Big Five personality traits was analyzed using the Pearson correlation.

RESULTS

Diagnostic accuracy was significantly improved by AI-based assistance (an increase of 2.8% ± 2.3%, 95 %-CI 1.5 to 4.0 %, p = 0.045) and trust in the algorithm was generated primarily by the certainty of the prediction (100% of participants). Different human-AI interactions were observed ranging from nearly no interaction to humanization of the algorithm. High scores in neuroticism were correlated with higher persuasibility (Pearson's r = 0.98, p = 0.02), while higher consciousness and change of accuracy showed an inverse correlation (Pearson's r = -0.96, p = 0.04).

CONCLUSION

Trust in the algorithm's performance was mostly dependent on the certainty of the predictions in combination with a plausible heatmap. Human-AI interaction varied widely and was influenced by personality traits.

KEY POINTS

• AI-based assistance significantly improved the diagnostic accuracy of radiologists in classifying BI-RADS 4 mammography lesions. • Trust in the algorithm's performance was mostly dependent on the certainty of the prediction in combination with a reasonable heatmap. • Personality traits seem to influence human-AI collaboration. Radiologists with specific personality traits were more likely to change their classification according to the algorithm's prediction than others.

Professional practice and awareness of child abuse among radiologists and radiologic technologists: results from Saudi Arabia

BACKGROUND

The knowledge, awareness and professionalism of health care providers in the field of child protection are crucial in identifying and reporting suspected child abuse. Radiologic technologists and radiologists play a vital role in the diagnosis of suspected physical child abuse.

OBJECTIVE

To assess current practice, knowledge and awareness of child abuse among radiologic technologists and radiologists in Saudi Arabia.

MATERIALS AND METHODS

We distributed an internet-based questionnaire to radiologic technologists and radiologists working in Saudi Arabia via national radiology societies and social media channels over a 6-week period (27 October to 8 December 2021). Survey questions covered knowledge regarding child abuse, professional practice in radiology departments in Saudi Arabia in cases of suspected physical abuse (SPA), and knowledge of the national legislation and reporting and acting procedures in child abuse.

RESULTS

A total of 315 respondents (224 radiologic technologists and 91 radiologists) participated in this study. The median score for knowledge of abuse was higher amongst radiologists (4.8) than radiologic technologists (4.0); P < 0.001. In total, 210 (93.8%) radiologic technologists and 61 (67.0%) radiologists reported that there was no protocol (i.e. skeletal survey) at their hospital for imaging children with SPA. Most radiologic technologists had no training in paediatric radiology (165/224, 73.7%) and most radiologists had received no training in evaluating imaging performed for SPA (73/91, 80.2%). More than half of respondents - 131 (58.5%) radiologic technologists and 44 (48.4%) radiologists - were not familiar with the reporting and acting procedures at their hospitals in cases of child abuse.

CONCLUSION

Although radiologic technologists and radiologists in Saudi Arabia have good knowledge and awareness of child abuse in general, they lack specific knowledge of the reporting and acting procedures at their hospitals in cases of suspected child abuse. National imaging guidelines and training courses are needed to develop appropriate skills in the recognition, imaging and reporting of SPA in infants and young children in Saudi Arabia.

The changing concept of radiographer's role in UAE: An analysis of radiologists' opinions and acceptance

INTRODUCTION

The role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE.

AIM

This study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles.

METHODS

Data was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol.

RESULTS

A total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development.

CONCLUSION

Radiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training.

IMPLICATIONS FOR PRACTICE

Guidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions.

Experience and results after the implementation of a radiology day unit in a reference hospital

Background

Interventional radiological procedures have significantly increased in recent years. Most of them are minimally invasive and require a short hospitalization, mainly done in other non-radiological units nowadays. Limited bed availability and high occupancy rates in these units create longer waiting lists and cancellations. The aim of this retrospective study is to assess the creation and functioning of a Radiology Day Unit (RDU) and evaluating its outcomes. For this purpose, data about interventional procedures and its complications, incidents, patient safety, quality and satisfaction rates were collected from May 2018 to December 2020, and posteriorly analyzed to evaluate its implementation.

Results

During the assessed period, 3841 patients were admitted into the RDU, with a net increase of 13% and 26% in the second and third year, respectively. Procedures performed by the Abdominal Radiology section were the most frequent (76–85%) followed by Interventional Vascular Radiology and Thoracic Radiology. Complication rates were low (1.5%) and most of them were self-limited and managed in the own department. Waiting lists were significantly reduced, from 2 months to 1 week in case of procedures performed by the Abdominal Radiology section. Patient satisfaction was higher than 80% in all the items evaluated with a global satisfaction of 93%.

Conclusion

The RDU in our hospital has become a vital section for the management and post-procedure caring of patients undergoing interventional procedures in the Radiology Service with low complication rates and overall high levels of quality and patient safety, allowing the reduction of waiting lists and occupancy rates.

AI-CAD for differentiating lesions presenting as calcifications only on mammography: outcome analysis incorporating the ACR BI-RADS descriptors for calcifications

OBJECTIVES

To evaluate how AI-CAD triages calcifications and to compare its performance to an experienced breast radiologist.

METHODS

Among routine mammography performed between June 2016 and May 2018, 535 lesions detected as calcifications only on mammography in 500 women (mean age, 48.8 years) that were additionally interpreted with additional magnification views were included in this study. One dedicated breast radiologist retrospectively reviewed the magnification mammograms to assess morphology, distribution, and final assessment category according to ACR BI-RADS. AI-CAD analyzed routine mammograms providing AI-CAD marks and corresponding AI-CAD scores (ranging from 0 to 100%), for which values ≥ 10% were considered positive. Ground truth in terms of malignancy or benignity was confirmed with a histopathologic diagnosis or at least 1 year of imaging follow - up.

RESULTS

Of the 535 calcifications, 215 (40.2%) were malignant. Calcifications with positive AI-CAD scores showed significantly higher PPVs compared to calcifications with negative scores for all morphology (all p < 0.05). PPVs were significantly higher in calcifications with positive AI-CAD scores compared to those with negative scores for BI-RADS 3, 4a, or 4b assessments (all p < 0.05). AI-CAD and the experienced radiologist did not show significant difference in diagnostic performance; sensitivity 92.1% vs 95.4% (p = 0.125), specificity 71.9% vs 72.5% (p = 0.842), and accuracy 80.0% vs 81.7% (p = 0.413).

CONCLUSION

Among calcifications with same morphology or BI-RADS assessment, those with positive AI-CAD scores had significantly higher PPVs. AI-CAD showed similar diagnostic performances to the experienced radiologist for calcifications detected on mammography.

KEY POINTS

• Among calcifications with same morphology or BI-RADS assessment, those with positive AI-CAD scores had significantly higher PPVs. • AI-CAD showed similar diagnostic performance to an experienced radiologist in assessing lesions detected as calcifications only on mammography. • Among malignant calcifications, calcifications with positive AI-CAD scores showed higher rates of invasive cancers than calcifications with negative scores (all p > 0.05).

The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR)

Radiology as a specialty has been enormously successful since its beginnings, moving over time from an adjunct to clinical decision-making to a crucial component of multidisciplinary patient care. However, this increased centrality of radiology and reliance on our services carries within it dangers, prominent among them being the danger of our being viewed as deliverers of a commodity, and the risk of our becoming overwhelmed by increasing workload, unable to interact sufficiently with patients and referrers due to pressure of work. With this White Paper, the Board of Directors of the European Society of Radiology (ESR) seeks to briefly explain the position of the radiologist in the modern healthcare environment, considering our duties and contributions as doctors, protectors, communicators, innovators, scientists and teachers. This statement is intended to serve as a summary of the breadth of our responsibilities and roles, and to assist radiologists in countering misunderstanding of who we are and what we do.

Using Occlusion-Based Saliency Maps to Explain an Artificial Intelligence Tool in Lung Cancer Screening: Agreement Between Radiologists, Labels, and Visual Prompts

Occlusion-based saliency maps (OBSMs) are one of the approaches for interpreting decision-making process of an artificial intelligence (AI) system. This study explores the agreement among text responses from a cohort of radiologists to describe diagnostically relevant areas on low-dose CT (LDCT) images. It also explores if radiologists’ descriptions of cases misclassified by the AI provide a rationale for ruling out the AI’s output. The OBSM indicating the importance of different pixels on the final decision made by an AI were generated for 10 benign cases (3 misclassified by the AI tool as malignant) and 10 malignant cases (2 misclassified by the AI tool as benign). Thirty-six radiologists were asked to use radiological vocabulary, typical to reporting LDCT scans, to describe the mapped regions of interest (ROI). The radiologists’ annotations were then grouped by using a clustering-based technique. Topics were extracted from the annotations and for each ROI, a percentage of annotations containing each topic were found. Radiologists annotated 17 and 24 unique ROIs on benign and malignant cases, respectively. Agreement on the main label (e.g., “vessel,” “nodule”) by radiologists was only seen in only in 12% of all areas (5/41 ROI). Topic analyses identified six descriptors which are commonly associated with a lower malignancy likelihood. Eight common topics related to a higher malignancy likelihood were also determined. Occlusion-based saliency maps were used to explain an AI decision-making process to radiologists, who in turn have provided insight into the level of agreement between the AI’s decision and radiological lexicon.

Visual expertise modulates baseline brain activity: a preliminary resting-state fMRI study using expertise model of radiologists

Background

visual expertise and experience modulate evoked brain activity in response to training-related stimuli. However, few studies have considered how the visual experience is represented in the resting state brain activity. This study tried to investigate the way visual experience, i.e., visual recognition expertise, modulates baseline brain neuronal activity in the resting state using the model of radiologists.

Methods

The amplitude of low-frequency (< 0.08 Hz) fluctuation (ALFF) was used as the metric of baseline brain activity and a visual expertise model of radiologists to investigated this question. The visual recognition skill enables them to accurately identify pathological information in medical images. After the behavior measurement, a cohort group of radiology interns (n = 22) and a group of matched layperson (n = 22) were selected for inclusion in the study. The resting state functional magnetic resonance imaging (fMRI) scans were performed for all of the subjects.

Results

Higher ALFF in the right fusiform gyrus and the left orbitofrontal cortex were observed, and the ALFF in the fusiform gyrus was correlated with the intern radiologists’ behavioral expertise(all results corrected for multiple comparisons).

Conclusions

Visual experience modulates the baseline brain activity in both high-level visual cortex and high-order cognitive cortex, indicating the engagement of both top-down and bottom-up facilitation. We provide a novel perspective to how visual experience modulated cortical brain activity by introducing the resting state changes. Also, we propose that our current study may provide novel ideas for the development of new training protocols in medical school.

Role of the radiologist in the diagnosis and management of the two forms of hepatic echinococcosis

Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged (drainage, stenting, or Puncture, aspiration, injection, and reaspiration (PAIR)). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.

What radiologists need to know about patients' expectations: P.A.T.I.E.N.T.S C.A.R.E.R.S A.I.M.S

The Patient Advisory Group (PAG) of the European Society of Radiology aims to highlight, in this short paper, patients’ expectations from the radiological community and support workers, throughout the patient’s medical imaging journey for completion of diagnostic or interventional examinations. In order to maintain constant awareness of patients’ expectations, key expectations have been summarised in an easy-to-remember mnemonic: PATIENTS CARERS AIMS.

Due to disparate healthcare systems and medical imaging services in Europe, not all patient expectations can be systematically met, but healthcare providers should be mindful, when setting up new operational procedures, of the need to focus on patient-centred needs and care. At times when new or improved technology is being introduced, such as artificial intelligence applications, telemedicine, robotisation of interventional procedures and digitised records, the impact on radiologist–patient communication and interactions should be considered.

Adoption of a diagnostic certainty scale in abdominal imaging: 2-year experience at an academic institution

PURPOSE

Assess use of a diagnostic certainty scale (CS) for abdominal imaging reports and identify factors associated with greater adoption.

METHODS

This retrospective, Institutional Review Board-exempt study was conducted at an academic health system. Abdominal radiology reports containing diagnostic certainty phrases (DCPs) generated 4/1/2019-3/31/2021 were identified by a natural language processing tool. Reports containing DCPs were subdivided into those with/without a CS inserted at the end. Primary outcome was monthly CS use rate in reports containing DCPs. Secondary outcomes were assessment of factors associated with CS use, and usage of recommended DCPs over time. Chi-square test was used to compare proportions; univariable and multivariable regression assessed impact of other variables.

RESULTS

DCPs were used in 81,281/124,501 reports (65.3%). One-month post-implementation, 82/2310 (3.6%) of reports with DCPs contained the CS, increasing to 1862/4644 (40.1%) by study completion (p < 0.001). Multivariable analysis demonstrated reports containing recommended DCPs were more likely to have the CS (Odds Ratio [OR] 4.5; p < 0.001). Using CT as a reference, CS use was lower for ultrasound (OR 0.73; p < 0.001) and X-ray (OR 0.38; p < 0.001). There was substantial inter-radiologist variation in CS use (OR 0.01-26.3, multiple p values).

CONCLUSION

DCPs are very common in abdominal imaging reports and can be further clarified with CS use. Although voluntary CS adoption increased 13-fold over 2 years, > 50% of reports with DCPs lacked the CS at study's end. More stringent interventions, including embedding the scale in report templates, are likely needed to reduce inter-radiologist variation and decrease ambiguity in conveying diagnostic certainty to referring providers and patients.

MRI-assessed tumor-free distance to serosa predicts deep myometrial invasion and poor outcome in endometrial cancer

OBJECTIVES

To explore the diagnostic accuracy of preoperative magnetic resonance imaging (MRI)-derived tumor measurements for the prediction of histopathological deep (≥ 50%) myometrial invasion (pDMI) and prognostication in endometrial cancer (EC).

METHODS

Preoperative pelvic MRI of 357 included patients with histologically confirmed EC were read independently by three radiologists blinded to clinical information. The radiologists recorded imaging findings (T1 post-contrast sequence) suggesting deep (≥ 50%) myometrial invasion (iDMI) and measured anteroposterior tumor diameter (APD), depth of myometrial tumor invasion (DOI) and tumor-free distance to serosa (iTFD). Receiver operating characteristic (ROC) curves for the prediction of pDMI were plotted for the different MRI measurements. The predictive and prognostic value of the MRI measurements was analyzed using logistic regression and Cox proportional hazard model.

RESULTS

iTFD yielded highest area under the ROC curve (AUC) for the prediction of pDMI with an AUC of 0.82, whereas DOI, APD and iDMI yielded AUCs of 0.74, 0.81 and 0.74, respectively. Multivariate analysis for predicting pDMI yielded highest predictive value of iTFD <  6 mm with OR of 5.8 (p < 0.001) and lower figures for DOI ≥ 5 mm (OR = 2.8, p = 0.01), APD ≥ 17 mm (OR = 2.8, p < 0.001) and iDMI (OR = 1.1, p = 0.82). Patients with iTFD < 6 mm also had significantly reduced progression-free survival with hazard ratio of 2.4 (p < 0.001).

CONCLUSION

For predicting pDMI, iTFD yielded best diagnostic performance and iTFD < 6 mm outperformed other cutoff-based imaging markers and conventional subjective assessment of deep myometrial invasion (iDMI) for diagnosing pDMI. Thus, iTFD at MRI represents a promising preoperative imaging biomarker that may aid in predicting pDMI and high-risk disease in EC.

Evaluation of quality of renal tract ultrasound scans and reports performed in children with first urinary tract infection

PURPOSE

To determine the quality of renal tract ultrasound (US) imaging records performed in children for evaluation of urinary tract infection (UTI) by multiple professionals with different levels of experience in a dedicated academic children's hospital.

METHODS

Retrospective analysis of US images and reports for children ≤ 13-years with first presentation of a UTI. 9 Operators (6 consultant radiologists and 3 sonographers) were anonymised and the adequacy of their US images and reports were evaluated for the following categories; Image acquisition, Image labelling, Metric labelling, and Final reporting. The frequency of the reporting quality of the elements assessed was compared between radiologists and sonographers using Chi-square or fisher exact test.

RESULTS

Renal tract US studies for 100 children (20 males, 80 females) with first UTI episode were assessed. Mean age was 4.5 ± 3.4 years. 54% of the studies were performed by sonographers and 46% by radiologists. Kidneys and pre-micturition bladder scans were acquired in more than 96% of exams by both sonographers and radiologists. Kidney image and metric labelling was adequate in almost all exams (98-100%) with the exception of plane labelling which was not routinely done by US operators (less than 3%). Sonographers performed consistently better than radiologists in post-micturition bladder scanning, pre- and post-micturition bladder labelling and renal length reporting (p<0.05). Least to be recorded by US operators (both radiologists and sonographers) were doppler scan acquisitions (less than 3%), bladder wall thickness labelling (less than 3%), and renal calculi reporting (less than 1%).

CONCLUSION

The inconsistency of the reporting quality between the different elements assessed highlights the difference in US training and experience received by sonographers and radiologists. A pro-forma structured reporting template may ensure US operators provide consistent, thorough and good quality ultrasound images and reports.

Magnitude and Determinants of Computer Vision Syndrome Among Radiologists in Saudi Arabia: A National Survey

RATIONALE AND OBJECTIVES

To assess the magnitude and determinants of computer vision syndrome (CVS) among radiologists in Saudi Arabia using a reliable and validated survey instrument.

MATERIALS AND METHODS

This nationwide cross-sectional web-based survey took place in April 2021 and included all radiologists and radiology residents residing practicing in Saudi Arabia. We used the reliable and validated CVS questionnaire. Univariate and multivariate analyses were carried out using nonparametric methods. The CVS score was correlated with different demographic- and health-related variables. The Mann-Whitney U test and Kruskal-Wallis test were used to determine if there was a statistically significant difference between subgroups.

RESULTS

The survey was completed by 416 participants. The prevalence of CVS was 65.4% (95% CI: 60.8-70.0). The median CVS score was 7.5 (interquartile range: 4.0; 12.0). Mild CVS was observed in 188 participants (69.1%), moderate CVS was observed in 69 (25.4%), and severe CVS was observed in 15 (5.5%). The most common symptoms perceived by participants were headache (72.1%), dryness (70.7%), burning (63.7%), blurred vision (56.3%), and increased sensitivity to light (55.5%). Multinomial regression analysis suggested that female sex (p < 0.001), work as a general radiologist (p = 0.05), and the use of eyeglasses (p = 0.001) were significant predictors of CVS.

CONCLUSION

The prevalence of CVS among radiologists in our study was high. Local and international societies need to establish and implement legislative and preventive measures to ensure the safety and ocular and visual health of radiologists.

An investigation of radiographers' and radiologists' perceptions and attitudes in Kuwait towards extending radiographers' role in mammography

INTRODUCTION

Kuwait has a shortage of radiologists, especially in mammography, resulting in increased workload and longer waiting times for women receiving imaging investigations. This study looked at how radiographers and radiologists perceived radiographers' role extension (RE) in mammography, and whether this could reduce radiologist workload, thereby improving patient service and waiting times.

METHODS

A single case study design with 10 radiographers (mammographers) and 10 radiologists was undertaken across multiple sites: hospitals, screening clinics and specialist centres in Kuwait. Data included individual semi-structured interviews, documentary analysis and field notes. Perceptions were examined under a theoretical framework, Abbotts' System of Professions.

RESULTS

Two main themes were identified, firstly in examining the current role of radiographers in mammography and areas of interest for extending role, this highlighted insufficient knowledge of the concept. The second focused on in-depth understanding of drivers and barriers to RE in mammography, both groups opposed radiographers performing extended tasks without radiologist supervision.

CONCLUSION

Radiologists and radiographers' attitudes were influenced by concepts of professional identity and professional identity formation. Insufficient professional knowledge negatively affected the radiographers' readiness to undertake RE in mammography. Radiologists are reluctant to blur boundaries, enabling them to maintain and control jurisdiction of their own profession and that of radiographers, thereby, as discussed in Abbott's theory, limiting impact on workload or waiting times.

IMPLICATIONS FOR PRACTICE

Whilst RE is limited, to improve workload and patient waiting times, setting up an educational programme for radiographers specialising in mammography would be an important step to extending the radiographers' role. The study highlighted a need to educate radiographers to undertake breast ultrasound and amend policy to introduce training programmes for radiographers. Radiographer rotation across the various radiographic modalities negatively affected radiographers' performance, placing well-trained radiographers permanently within the mammography department should improve experience and overall skills.

Education of Radiologists in Healthcare Disparities

Disparities exist in access to a multitude of screening and diagnostic imaging examinations and procedures. To address these disparities within radiology, emphasis so far has been placed upon diversifying the workforce and formally educating trainees on healthcare disparities. Currently, there is no organized and nationally accepted educational program or content for practicing radiologists specific to diversity and healthcare disparity. This void can be addressed by providing an educational curriculum framework for practicing radiologists based on three key factors: individual efforts, calling for institutional change, and national collaboration. Individual efforts should focus on acknowledging the existence of disparities, understanding the contribution of one's implicit bias in perpetuating disparities, understanding and highlighting issues related to insurance coverage of radiology examinations, and participating in radiology political action committees. These efforts can be facilitated by a consolidated web-based training program for practicing radiologists. To pave the way for meaningful systemic change, the implementation of institutional change like that initiated by the Culture of Safety movement in 2002 is needed. A national collaborative effort initiated by radiology organizations to empower radiologists and recognize positive changes would further provide support. SUMMARY: A three-pronged educational framework combining individual radiologist education, institutional change, and national collaboration will enable radiologists to play a role in addressing imaging-related disparities in healthcare.