Implementation of a Software Distribution Intervention to Improve Workload Balance in an Academic Pediatric Radiology Department

In our pediatric radiology department, radiographs (XR) are the shared responsibility of the body section and interpreted in addition to modality or site-specific assignments. Given an unequal contribution amongst radiologists to the XR workload, a software solution was developed to distribute radiographs and improve workload balance. Metrics to evaluate the intervention's effectiveness were compared before and after the intervention. Data was retrieved from the radiology analytics platform, scheduling software, and the peer learning database. Metrics were compared 12 months pre (March 2018-February 2019) and 6 months post (March 2019-August 2019) intervention on non-holiday weekdays, 7 am-5 pm. To evaluate the intervention's effectiveness, variance between radiologists' contributions to XR volume was assessed using Levene's and Fisher's tests. Changes in turnaround times (TATs) and error rates pre- and post-intervention were evaluated as secondary metrics. Following the intervention, the average number of XR interpreted on target rotations increased by 8.9% (p = 0.011) while the departmental volume of radiographs increased only 4.5%. The variance between radiologists' daily XR contribution was 21.3% (p < 0.0001) higher prior to the intervention. Days where target rotations read fewer than 5 XR decreased from 17.8 to 1.1% (p < 0.0001) after the intervention. Days in which more than 75% of all XR had a TAT less than 60 min improved from 26.8 to 39.7% (p = 0.017) after the intervention. There was no statistically significant difference in error frequency (error rate 2.49% pre and 2.72% post, p = 0.636). In conclusion, the software intervention improved XR workload contribution with decreased variability. Despite increased volumes, there was an improvement in turnaround times with no effect on error rates.

Training opportunities of artificial intelligence (AI) in radiology: a systematic review

OBJECTIVES

The aim is to offer an overview of the existing training programs and critically examine them and suggest avenues for further development of AI training programs for radiologists.

METHODS

Deductive thematic analysis of 100 training programs offered in 2019 and 2020 (until June 30). We analyze the public data about the training programs based on their "contents," "target audience," "instructors and offering agents," and "legitimization strategies."

RESULTS

There are many AI training programs offered to radiologists, yet most of them (80%) are short, stand-alone sessions, which are not part of a longer-term learning trajectory. The training programs mainly (around 85%) focus on the basic concepts of AI and are offered in passive mode. Professional institutions and commercial companies are active in offering the programs (91%), though academic institutes are limitedly involved.

CONCLUSIONS

There is a need to further develop systematic training programs that are pedagogically integrated into radiology curriculum. Future training programs need to further focus on learning how to work with AI at work and be further specialized and customized to the contexts of radiology work.

KEY POINTS

• Most of AI training programs are short, stand-alone sessions, which focus on the basics of AI. • The content of training programs focuses on medical and technical topics; managerial, legal, and ethical topics are marginally addressed. • Professional institutions and commercial companies are active in offering AI training; academic institutes are limitedly involved.

Bridging the divide between medical school and clinical practice: identification of six key learning outcomes for an undergraduate preparatory course in radiology

BACKGROUND

There exists a significant divide between what is learnt in medical school and subsequently what is required to practice medicine effectively. Despite multiple strategies to remedy this discordance, the problem persists. Here, we describe the identification of a comprehensive set of learning outcomes for a preparation for practice course in radiology.

METHODS

Assessment of interns' readiness to interact with the radiology department was conducted using a national survey of both interns and radiologists. In parallel, group concept mapping (GCM) which involves a combination of qualitative and quantitative techniques was used to identify the shared understanding of participants from a diverse range of medical specialties regarding what topics should be included in an intern preparatory course for interacting with the radiology department.

RESULTS

The survey demonstrated that most interns and radiologists felt that undergraduate medical training did not prepare interns to interact with the radiology department. GCM identified six learning outcomes that should be targeted when designing a preparatory module: requesting investigations; clinical decision support; radiology department IT and communication; adverse reactions and risks; interpretation of radiology results and urgent imaging. The thematic clusters from the group concept mapping corroborated the deficiencies identified in the national survey.

CONCLUSION

We have identified six key learning outcomes that should be included in a preparation for practice module in radiology. Future courses targeting these thematic clusters may facilitate a smoother transition from theory to practice for newly graduated doctors.

Three-dimensional imaging and three-dimensional printing for plastic preparation of medical interventions

Three-dimensional (3D) imaging has been available for nearly four decades and is regarded as state of the art for visualization of anatomy and pathology and for procedure planning in many clinical fields. Together with 3D image reconstructions in the form of rendered virtual 3D models, it has helped to better perceive complex anatomic and pathologic relations, improved preprocedural measuring and sizing of implants, and nowadays enables even photorealistic quality. However, presentation on 2D displays limits the 3D experience. Novel 3D printing technologies can transfer virtual anatomic models into true 3D space and produce both patient-specific models and medical devices constructed by computer-aided design. Individualized anatomic models hold great potential for medical and patient education, research, device development and testing, procedure training, preoperative planning, and fabrication of individualized instruments and implants. Hand in hand with 3D imaging, medical 3D printing has started to revolutionize medicine in certain fields and new applications are developed and introduced regularly. The demand for medical 3D printing will likely continue to rise, as it is a promising tool for plastic preparation of medical interventions. However, there is ongoing debate on the appropriateness of medical 3D printing and further research on its efficiency is needed. As experts in 3D imaging, radiologists are not only capable of advising on adequate imaging parameters, but should also become adept in 3D printing to participate in on-site 3D printing facilities and randomized controlled trials on the topic, thus contributing to improving patient outcomes via personalized medicine through patient-specific preparation of medical interventions.

Automated quantitative MRI volumetry reports support diagnostic interpretation in dementia: a multi-rater, clinical accuracy study

Objectives

We examined whether providing a quantitative report (QReport) of regional brain volumes improves radiologists’ accuracy and confidence in detecting volume loss, and in differentiating Alzheimer’s disease (AD) and frontotemporal dementia (FTD), compared with visual assessment alone.

Methods

Our forced-choice multi-rater clinical accuracy study used MRI from 16 AD patients, 14 FTD patients, and 15 healthy controls; age range 52–81. Our QReport was presented to raters with regional grey matter volumes plotted as percentiles against data from a normative population (n = 461). Nine raters with varying radiological experience (3 each: consultants, registrars, ‘non-clinical image analysts’) assessed each case twice (with and without the QReport). Raters were blinded to clinical and demographic information; they classified scans as ‘normal’ or ‘abnormal’ and if ‘abnormal’ as ‘AD’ or ‘FTD’.

Results

The QReport improved sensitivity for detecting volume loss and AD across all raters combined (p = 0.015* and p = 0.002*, respectively). Only the consultant group’s accuracy increased significantly when using the QReport (p = 0.02*). Overall, raters’ agreement (Cohen’s κ) with the ‘gold standard’ was not significantly affected by the QReport; only the consultant group improved significantly (κ_s 0.41➔0.55, p = 0.04*). Cronbach’s alpha for interrater agreement improved from 0.886 to 0.925, corresponding to an improvement from ‘good’ to ‘excellent’.

Conclusion

Our QReport referencing single-subject results to normative data alongside visual assessment improved sensitivity, accuracy, and interrater agreement for detecting volume loss. The QReport was most effective in the consultants, suggesting that experience is needed to fully benefit from the additional information provided by quantitative analyses.

Key Points

• The use of quantitative report alongside routine visual MRI assessment improves sensitivity and accuracy for detecting volume loss and AD vs visual assessment alone.

• Consultant neuroradiologists’ assessment accuracy and agreement (kappa scores) significantly improved with the use of quantitative atrophy reports.

• First multi-rater radiological clinical evaluation of visual quantitative MRI atrophy report for use as a diagnostic aid in dementia.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-020-07455-8.

Evaluation of stress and anxiety caused by the coronavirus disease 2019 (COVID-19) pandemic in pediatric radiology

BACKGROUND

Work-related stress and burnout were documented to be high among pediatric radiologists prior to the coronavirus disease 2019 (COVID-19) pandemic. New challenges arose from the COVID-19 pandemic, potentially introducing new stressors and anxieties.

OBJECTIVE

To evaluate potential sources of stress and anxiety for pediatric radiology faculty during the early phase of the COVID-19 pandemic.

MATERIALS AND METHODS

We conducted a survey of attending physician members of the Society for Pediatric Radiology in North America from April 27, 2020, to May 22, 2020. The response rate was 21% (251/1,206). Survey questions included demographic information and questions regarding working remotely, personal protective equipment, redeployment, personal wellness, wellness resources and financial concerns. A psychometrician reviewed the questions to ensure minimal risk of misinterpretation.

RESULTS

Median age of respondents was 48 years (range 33-70 years) with median number of years in practice of 14 (range 1-45 years). Fifty-three percent of respondents were women and 46% were men. Because of an increase in remote work, 69% of respondents endorsed feeling more isolated from a lack of regular interaction with colleagues. Fifty-three percent of respondents indicated that it is challenging to work remotely while overseeing home schooling for children. In comparison to men, women reported overall higher work-related stress and anxiety (P=0.02), higher feelings of guilt from radiology staff (i.e. technologists and nurses) being more exposed to COVID-19 (P=0.02) and higher levels of stress providing for dependents (P=0.04). Most respondents thought that departmental leadership was effective and respondents were not concerned about meeting financial obligations or job loss.

CONCLUSION

The early phase of the COVID-19 pandemic caused additional stress and anxiety for pediatric radiology faculty and disproportionally affected women. Given the continuously evolving state of the COVID-19 pandemic, these results could aid in planning and implementation of future strategies to combat burnout in radiology. Specific attention should be directed to different stressors experienced by female versus male radiologists, especially in regard to dependent care.

Concordance between a neuroradiologist, a consultant radiologist and trained reporting radiographers interpreting MRI head examinations: An empirical study

INTRODUCTION

This study assessed agreement between MRI reporting radiographers and a consultant radiologist compared with an index neuroradiologist when reporting MRI head (brain/internal auditory meati [IAMs]) examinations. The effect on patient management of any discordant reports was also examined.

METHODS

Two trained MRI reporting radiographers (RRs), a consultant radiologist (CR) and an index neuroradiologist (INR) reported on a random sample of 210 MRI examinations. The radiographers reported during clinical practice and the radiologists in clinical practice conditions. Two independent consultant physicians (neuro-rehabilitation and neuropsychiatry) compared these reports with the index neuroradiologist report for agreement and the clinical importance of discrepant reports.

RESULTS

Overall observer agreement between the RRs and CR was comparable in relation to agreement with the INR: RR; 93/210 (44.3%); and the CR; 83/210 (39.4%) for all head MRI examinations (p = 0.32). For brain examinations the difference was similar: RR; 64/180 (35.6%); and CR; 54/190 (30.0%), p = 0.26. Agreement rates for the IAMs examinations were identical, 29/30 (97.7%). For all head MRI examinations (n = 210) there was a very small observed difference of <0.5% in mean agreement between the reporting radiographers and the consultant radiologist (p = 0.92) for examinations where a major disagreement would have been likely to have led to a change in patient management.

CONCLUSION

MRI reporting radiographers reported during clinical practice on MRI head examinations to a level of agreement comparable with a consultant radiologist.

IMPLICATIONS FOR PRACTICE

This is an area in which radiographers could provide additional reporting roles to the reporting service to increase capacity. Wider potential benefits include cost-effectiveness and role development/retention of radiographers.

Prediction of visceral pleural invasion in lung cancer on CT: deep learning model achieves a radiologist-level performance with adaptive sensitivity and specificity to clinical needs

OBJECTIVES

To develop and validate a preoperative CT-based deep learning model for the prediction of visceral pleural invasion (VPI) in early-stage lung cancer.

METHODS

In this retrospective study, dataset 1 (for training, tuning, and internal validation) included 676 patients with clinical stage IA lung adenocarcinomas resected between 2009 and 2015. Dataset 2 (for temporal validation) included 141 patients with clinical stage I adenocarcinomas resected between 2017 and 2018. A CT-based deep learning model was developed for the prediction of VPI and validated in terms of discrimination and calibration. An observer performance study and a multivariable regression analysis were performed.

RESULTS

The area under the receiver operating characteristic curve (AUC) of the model was 0.75 (95% CI, 0.67-0.84), which was comparable to those of board-certified radiologists (AUC, 0.73-0.79; all p > 0.05). The model had a higher standardized partial AUC for a specificity range of 90 to 100% than the radiologists (all p < 0.05). The high sensitivity cutoff (0.245) yielded a sensitivity of 93.8% and a specificity of 31.2%, and the high specificity cutoff (0.448) resulted in a sensitivity of 47.9% and a specificity of 86.0%. Two of the three radiologists provided highly sensitive (93.8% and 97.9%) but not specific (48.4% and 40.9%) diagnoses. The model showed good calibration (p > 0.05), and its output was an independent predictor for VPI (adjusted odds ratio, 1.07; 95% CI, 1.03-1.11; p < 0.001).

CONCLUSIONS

The deep learning model demonstrated a radiologist-level performance. The model could achieve either highly sensitive or highly specific diagnoses depending on clinical needs.

KEY POINTS

• The preoperative CT-based deep learning model demonstrated an expert-level diagnostic performance for the presence of visceral pleural invasion in early-stage lung cancer. • Radiologists had a tendency toward highly sensitive, but not specific diagnoses for the visceral pleural invasion.

To repeat or not to repeat: Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate during mobile chest radiography

INTRODUCTION

Radiologists and radiographers play a complementary role in providing an optimal image quality with decrease radiation dose and proper diagnosis during chest radiographs. We aim Investigate years of experience among radiologists and radiographers on perception of image quality and its impact on repeat rate when evaluating portable pediatric chest radiographs.

METHODS

IRB approved retrospective study consisted of randomly selected images (n = 131) of pediatric portable chest radiographs. Images were blindly assessed by four radiologists and four radiographers. Readers were asked to assess qualitative and quantitative image quality by rating: image quality, decision to repeat and image technique. All data was compared employing Pearson's Correlation, Visual grading characteristic (VGC) and Cohens' kappa analyses.

RESULTS

Image quality: Radiologists (88.4%) rated images as excellent significantly more than radiographers (11.6%), and radiographers (90.1%) as poor significantly more than radiologists (9.9%) (p < 0.05). Repeat: Radiologists (57%) decided not to repeat images significantly more than radiographers (43%) (p < 0.05). Image technique: Radiologists rated images as acceptable (65%) and excellent (97.7%) significantly more than radiographers (35% and 2.3% respectively) (p < 0.05), whereas radiographers (84%) assessed image technique as poor significantly more than radiologists (16%) (p < 0.05). VGC: radiographers had slightly better qualitative evaluation of image quality than radiologists. An association between image quality (p < 0.002) and repeat decision (p < 0.044) with years of experience was established when comparing years of experience with image assessment rubric, while no association was noted with image technique (p < 0.9).

CONCLUSION

Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate of portable pediatric chest radiographs. Interestingly, years of experience only seem to affect image technique and image quality assessment among radiologists.

IMPLICATIONS FOR PRACTICE

Continuous education of radiographers and close collaboration with radiologists is crucial to achieve optimal image quality and low radiation doses.

Minimum perceivable size difference: how well can radiologists visually detect a change in lung nodule size from CT images?

OBJECTIVE

The purpose of this study was to determine how well radiologists could visually detect a change in lung nodule size on the basis of visual image perception alone.

SUBJECTS AND METHODS

Under IRB approval, 109 standard chest CT image series were anonymized and exported from PACS. Nine hundred forty virtual lung nodule pairs (six baseline diameters, six relative volume differences, two nodule types-solid and ground glass-and 14 repeats) were digitally inserted into the chest CT image series (same location, different sizes between the pair). These digitally altered CT image pairs were shown to nine radiologists who were tasked to visually determine which image contained the larger nodule using a two-alternative forced-choice perception experimental design. These data were statistically analyzed using a generalized linear mixed effects model to determine how accurately the radiologists were able to correctly identify the larger nodule.

RESULTS

Nominal baseline nodule diameter, relative volume difference, and nodule type were found to be statistically significant factors (p < 0.001) in influencing the radiologists' accuracy. For solid (ground-glass) nodules, the baseline diameter needed to be at least 6.3 mm (13.2 mm) to be able to visually detect a 25% change in volume with 95 ± 1.4% accuracy. Accuracy was lowest for the nodules with the smallest baseline diameters and smallest relative volume differences. Additionally, accuracy was lower for ground-glass nodules compared to solid nodules.

CONCLUSIONS

Factors that impacted visual size assessment were baseline nodule diameter, relative volume difference, and solid versus non-solid nodule type, with larger and more solid lesions offering a more precise assessment of change.

KEY POINTS

• For solid nodules, radiologists could visually detect a 25% change in volume with 95% accuracy for nodules having greater than 6.3-mm baseline diameter. • For ground-glass nodules, radiologists could visually detect a 25% change in volume with 95% accuracy for nodules having greater than 13.2-mm baseline diameter. • Accuracy in detecting a change in nodule size began to stabilize around 90-100% for nodules with larger baseline diameters (> 8 mm for solid nodules, > 12 mm for ground-glass nodules) and larger relative volume differences (>15% for solid nodules, > 25% for ground-glass nodules).

Interobserver variability in quality assessment of magnetic resonance images

Background

The perceptual quality of magnetic resonance (MR) images influences diagnosis and may compromise the treatment. The purpose of this study was to evaluate how the image quality changes influence the interobserver variability of their assessment.

Methods

For the variability evaluation, a dataset containing distorted MRI images was prepared and then assessed by 31 experienced medical professionals (radiologists). Differences between observers were analyzed using the Fleiss’ kappa. However, since the kappa evaluates the agreement among radiologists taking into account aggregated decisions, a typically employed criterion of the image quality assessment (IQA) performance was used to provide a more thorough analysis. The IQA performance of radiologists was evaluated by comparing the Spearman correlation coefficients, ρ, between individual scores with the mean opinion scores (MOS) composed of the subjective opinions of the remaining professionals.

Results

The experiments show that there is a significant agreement among radiologists (κ=0.12; 95% confidence interval [CI]: 0.118, 0.121; P<0.001) on the quality of the assessed images. The resulted κ is strongly affected by the subjectivity of the assigned scores, separately presenting close scores. Therefore, the ρ was used to identify poor performance cases and to confirm the consistency of the majority of collected scores (ρ_mean = 0.5706). The results for interns (ρ_mean = 0.6868) supports the finding that the quality assessment of MR images can be successfully taught.

Conclusions

The agreement observed among radiologists from different imaging centers confirms the subjectivity of the perception of MR images. It was shown that the image content and severity of distortions affect the IQA. Furthermore, the study highlights the importance of the psychosomatic condition of the observers and their attitude.

Applications of artificial intelligence (AI) in diagnostic radiology: a technography study

Objectives

Why is there a major gap between the promises of AI and its applications in the domain of diagnostic radiology? To answer this question, we systematically review and critically analyze the AI applications in the radiology domain.

Methods

We systematically analyzed these applications based on their focal modality and anatomic region as well as their stage of development, technical infrastructure, and approval.

Results

We identified 269 AI applications in the diagnostic radiology domain, offered by 99 companies. We show that AI applications are primarily narrow in terms of tasks, modality, and anatomic region. A majority of the available AI functionalities focus on supporting the “perception” and “reasoning” in the radiology workflow.

Conclusions

Thereby, we contribute by (1) offering a systematic framework for analyzing and mapping the technological developments in the diagnostic radiology domain, (2) providing empirical evidence regarding the landscape of AI applications, and (3) offering insights into the current state of AI applications. Accordingly, we discuss the potential impacts of AI applications on the radiology work and we highlight future possibilities for developing these applications.

Key Points

• Many AI applications are introduced to the radiology domain and their number and diversity grow very fast.

• Most of the AI applications are narrow in terms of modality, body part, and pathology.

• A lot of applications focus on supporting “perception” and “reasoning” tasks.

Electronic supplementary material

The online version of this article (10.1007/s00330-020-07230-9) contains supplementary material, which is available to authorized users.

Incorporation of a computer-aided vessel-suppression system to detect lung nodules in CT images: effect on sensitivity and reading time in routine clinical settings

PURPOSE

To evaluate whether a computer-aided vessel-suppression system improves lung nodule detection in routine clinical settings.

MATERIALS AND METHODS

We used computer software that automatically suppresses pulmonary vessels on chest CT while preserving pulmonary nodules. Sixty-one chest CT images were included in our study. Three radiologists independently read either standard CT images alone or both computer-aided CT and standard CT images randomly to detect a pulmonary nodule ≥ 4 mm in diameter. After an interval of at least 15 days to avoid recall bias, the three radiologists interpreted the counterpart images of the same patients. The reference standard was decided by an expert panel. The primary endpoint was sensitivity. The secondary endpoint was interpretation time.

RESULTS

The average sensitivity improved with computer-aided CT (72% for standard CT vs. 84% for computer-aided CT, p = 0.02). There was no difference in the false-positive rate (21% for both standard CT and computer-aided CT, p = 0.98). Although the average reading time was 9.5% longer for computer-aided plus standard CT compared with standard CT alone, the difference was not significant (p = 0.11).

CONCLUSION

Vessel-suppressed CT images helped radiologists to improve the sensitivity of pulmonary nodule detection without compromising the false-positive rate.

Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons

OBJECTIVES

To assess the interobserver reliability (IOR) of the Tile classification system, and its potential influence on outcomes, for the interpretation of CT images of pelvic fractures by radiologists and surgeons.

METHODS

Retrospective data (1/2008-12/2016) from 238 patients with pelvic fractures were analyzed. Mean patient age was 44 years (SD 20); 66% were male. There were 54 Tile A, 82 Tile B, and 102 Tile C type injuries. The 30-day mortality rate was 15% (36/238). Six observers, three radiologists, and three surgeons with different levels of experience (attending/resident/intern) classified each fracture into one of the 26 second-order subcategories of the Tile classification. Weighted kappa coefficients were used to assess the IORs for the three main categories and nine first-order subcategories.

RESULTS

The overall IORs of the Tile system for the main categories and first-order subcategories were moderate (kappa = 0.44) and fair (kappa = 0.31), respectively. IOR was fair to moderate among radiologists, but only fair among surgeons. By level of training, IOR was moderate between attendings and between residents, whereas it was only fair between interns. IOR was moderate to substantial (kappa = 0.56-0.70) between the radiology attending and resident. Association of the Tile fracture type with 30-day mortality was present based on two out of six observer ratings.

CONCLUSIONS

The overall IOR of the Tile classification system is only fair to moderate, increases with the level of rater experience and is better among radiologists than surgeons. In the light of these findings, results from studies using this classification system must be interpreted cautiously.

KEY POINTS

• The overall interobserver reliability of the Tile pelvic fracture classification is only fair to moderate. • Interobserver reliability increases with observer experience and radiologists have higher kappa coefficients than surgeons. • Interobserver reliability has an impact on the association of the Tile classification system with mortality in two out of six cases.

Breast arterial calcifications as a biomarker of cardiovascular risk: radiologists' awareness, reporting, and action. A survey among the EUSOBI members

Objectives

To investigate the knowledge of radiologists on breast arterial calcifications (BAC) and attitude about BAC reporting, communication to women, and subsequent action.

Methods

An online survey was offered to EUSOBI members, with 17 questions focused on demographics, level of experience, clinical setting, awareness of BAC association with cardiovascular risk, mammographic reporting, modality of BAC assessment, and action habits. Descriptive statistics were used.

Results

Among 1084 EUSOBI members, 378 (34.9%) responded to the survey, 361/378 (95.5%) radiologists, 263 females (69.6%), 112 males (29.6%), and 3 (0.8%) who did not specify their gender. Of 378 respondents, 305 (80.7%) declared to be aware of BAC meaning in terms of cardiovascular risk and 234 (61.9%) to routinely include BAC in mammogram reports, when detected. Excluding one inconsistent answer, simple annotation of BAC presence was declared by 151/233 (64.8%), distinction between low versus extensive BAC burden by 59/233 (25.3%), and usage of an ordinal scale by 22/233 (9.5%) and of a cardinal scale by 1/233 (0.4%). Among these 233 radiologists reporting BAC, 106 (45.5%) declared to orally inform the woman and, in case of severe BAC burden, 103 (44.2%) to investigate cardiovascular history, and 92 (39.5%) to refer the woman to a cardiologist.

Conclusion

Among EUSOBI respondents, over 80% declared to be aware of BAC cardiovascular meaning and over 60% to include BAC in the report. Qualitative BAC assessment predominates. About 40% of respondents who report on BAC, in the case of severe BAC burden, investigate cardiovascular history and/or refer the woman to a cardiologist.

Key Points

• Of 1084 EUSOBI members, 378 (35%) participated: 81% of respondents are aware of breast arterial calcification (BAC) cardiovascular meaning and 62% include BAC in the mammogram report.

• Of those reporting BAC, description of presence was declared by 65%, low versus extensive burden distinction by 25%, usage of an ordinal scale by 10%, and of a cardinal scale by 0.4%; 46% inform the woman and, in case of severe BAC burden, 44% examine cardiovascular history, and 40% refer her to a cardiologist.

• European breast radiologists may be ready for large-scale studies to ascertain the role of BAC assessment in the comprehensive framework of female cardiovascular disease prevention.

Electronic supplementary material

The online version of this article (10.1007/s00330-020-07136-6) contains supplementary material, which is available to authorized users.

Involvement of radiologists in oncologic multidisciplinary team meetings: an international survey by the European Society of Oncologic Imaging

Objectives

Multidisciplinary tumour boards (MTBs) play an increasingly important role in managing cancer patients from diagnosis to treatment. However, many problems arise around the organisation of MTBs, both in terms of organisation-administration and time management. In this context, the European Society of Oncologic Imaging (ESOI) conducted a survey among its members, aimed at assessing the quality and amount of involvement of radiologists in MTBs, their role in it and related issues.

Methods

All members were invited to fill in a questionnaire consisting of 15 questions with both open and multiple-choice answers. Simple descriptive analyses and graphs were performed.

Results

A total of 292 ESOI members in full standing for the year 2018 joined the survey. Most respondents (89%) declared to attend MT-Bs, but only 114 respondents (43.9%) review over 70% of exams prior to MTB meetings, mainly due to lack of time due to a busy schedule for imaging and reporting (46.6%). Perceived benefits (i.e. surgical and histological feedback (86.9%), improved knowledge of cancer treatment (82.7%) and better interaction between radiologists and referring clinicians for discussing rare cases (56.9%)) and issues (i.e. attending MTB meetings during regular working hours (71.9%) and lack of accreditation with continuing medical education (CME) (85%)) are reported.

Conclusions

Despite the value and benefits of radiologists’ participation in MTBs, issues like improper preparation due to a busy schedule and no counterpart in CME accreditation require efforts to improve the role of radiologists for a better patient care.

Key Points

• Most radiologists attend multidisciplinary tumour boards, but less than half of them review images in advance, mostly due to time constraints.

• Feedback about radiological diagnoses, improved knowledge of cancer treatment and interaction with referring clinicians are perceived as major benefits.

• Concerns were expressed about scheduling multidisciplinary tumour boards during regular working hours and lack of accreditation with continuing medical education.

The Effect of Visual Hindsight Bias on Radiologist Perception

RATIONALE AND OBJECTIVES

To measure the effect of visual hindsight bias on radiologists' perception during chest radiograph pulmonary nodule detection.

MATERIALS AND METHODS

This was a prospective multi-observer study to assess the effect of hindsight bias on radiologists' perception. Sixteen radiologists were asked to interpret 15 postero-anterior chest images containing a solitary lung nodule each consisting of 25 incremental levels of blur. Participants were requested initially to detect the nodule by reducing the blur of the images (foresight). They were then asked to increase the blur until the identified nodule was undetectable (hindsight). Participants then repeated the experiment, after being informed of the potential effects of hindsight bias and asked to counteract these effects. Participants were divided into two groups (experienced and less experienced) and the nodules were given different conspicuity ratings to determine the effect of expertise and task difficulty. Eye tracking technology was also utilised to capture visual search.

RESULTS

Wilcoxon analysis demonstrated significant differences between foresight and hindsight values of the radiologists (p = 0.02). However, after being informed of hindsight bias, these differences were no longer significant (p = 0.97). Friedman analysis also determined overall significance in the hindsight ratios between nodule conspicuities for both phases (phase 1: p = 0.02; phase 2: p = 0.02). There was no significance difference between the experienced and less experienced groups.

CONCLUSION

This study demonstrated that radiologists exhibit hindsight bias but appeared to be able to compensate for this phenomenon once its effects were considered. Also, visual hindsight bias appears to be affected by task difficulty with a greater effect occurring with less conspicuous nodules.

Variability in the interpretation of grey-scale ultrasound features in assessing thyroid nodules: A systematic review and meta-analysis

PURPOSE

To investigate the interobserver agreement of different thyroid imaging report and data system (TI-RADS) and ultrasound (US) features.

METHODS

Two researchers independently searched PubMed, Embase and the Web of Science for relevant studies published between October 1972 and December 2018. Studies investigating interobserver agreement between different radiologists were included. The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) score tools were applied to assess the quality of the studies. The data for the inter-agreements of TI-RADS categories and ultrasound features were extracted, and combined with STATA 12.0 (StataCorp, College Station, TX) was used.

RESULTS

Seven studies including 927 patients were eligible for this meta-analysis. There was a moderate variability in the TI-RADS categories among radiologists (0.54; 95% CI: 0.49-0.58). Regarding the US features, the reliability of composition (0.61; 95% CI: 0.55-0.66) and calcification (0.71; 95% CI: 0.65-0.77) was good, the reliability of echogenicity (0.58; 95% CI: 0.51-0.64), shape (0.53; 95% CI: 0.45-0.62), margin (0.40; 95% CI: 0.32-0.48) and echogenic foci (0.43; 95% CI: 0.32-0.54) was moderate. Subgroup analyses showed that experience/training, the number of observers and the number of patients were the main factors influencing the variability.

CONCLUSIONS

The interobserver agreement for the TI-RADS categories was moderate. There remains potential for improvement, especially in terms of the echogenicity, shape, margin and echogenic foci, the precision of the description and the targeted training needed.

Generalist versus Abdominal Subspecialist Radiologist Interpretations of Abdominopelvic Computed Tomography Performed on Patients with Abdominal Pain and its Impact on the Therapeutic Approach

Introduction:

Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients.

Objective:

The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients’ therapeutic approach.

Methods:

The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8–12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required.

Results:

Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients’ mean age was 56 (27–93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented.

Conclusion:

Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment.

Bridging the Gap with Clinicians: The Issue of Underrecognition of Pathologists and Radiologists as Scientific Authors in Contemporary Medical Literature

The purpose of this study was to evaluate recognition of pathologists and radiologists as coauthors in case reports in the field of surgical oncology. The MEDLINE database was searched for all full free text case reports involving human material published from April 1, 2011 until March 31, 2016, using search terms: "case report" + "tumors" + "surgery" + "malignant". The search strategy identified a total of 1427 case reports of which 907 were included in this analysis. Of 807 articles with histopathological images and/or descriptions, 352 (43.6%) did not acknowledge or include the pathologist as a coauthor. Of 662 case reports with radiographic images and/or their description, 537 (81.1%) did not list the radiologist as coauthor nor acknowledge them. In case reports containing histopathological images, significantly more pathologists were either listed as coauthors or acknowledged compared to those who were not (Z = 5.128; p = 0.001). However, among case reports containing radiographic images, there were significantly less articles either listing radiologists as coauthors or acknowledging them compared to a larger proportion of articles in which radiologists were omitted (Z = - 22.646; p = 0.001). In conclusion, pathologists and radiologists are underrecognized as coauthors in surgical oncology case reports in spite of obvious proof of their contribution to manuscript preparation. When involved in research and publishing, all physicians should be aware of fair and honest collaboration with specialists in other clinical and non-clinical disciplines to better serve the scientific community.

Detection of emergent large vessel occlusion stroke with CT angiography is high across all levels of radiology training and grayscale viewing methods

OBJECTIVES

CT angiography (CTA) is essential in acute stroke to detect emergent large vessel occlusions (ELVO) and must be interpreted by radiologists with and without subspecialized training. Additionally, grayscale inversion has been suggested to improve diagnostic accuracy in other radiology applications. This study examines diagnostic performance in ELVO detection between neuroradiologists, non-neuroradiologists, and radiology residents using standard and grayscale inversion viewing methods.

METHODS

A random, counterbalanced experimental design was used, where 18 radiologists with varying experiences interpreted the same patient images with and without grayscale inversion. Confirmed positive and negative ELVO cases were randomly ordered using a balanced design. Sensitivity, specificity, positive and negative predictive values as well as confidence, subjective assessment of image quality, time to ELVO detection, and overall interpretation time were examined between grayscale inversion (on/off) by experience level using generalized mixed modeling assuming a binary, negative binomial, and binomial distributions, respectively.

RESULTS

All groups of radiologists had high sensitivity and specificity for ELVO detection (all > .94). Neuroradiologists were faster than non-neuroradiologists and residents in interpretation time, with a mean of 47 s to detect ELVO, as compared with 59 and 74 s, respectively. Residents were subjectively less confident than attending physicians. With respect to grayscale inversion, no differences were observed between groups with grayscale inversion vs. standard viewing for diagnostic performance (p = 0.30), detection time (p = .45), overall interpretation time (p = .97), and confidence (p = .20).

CONCLUSIONS

Diagnostic performance in ELVO detection with CTA was high across all levels of radiologist training level. Grayscale inversion offered no significant detection advantage.

KEY POINTS

• Stroke is an acute vascular syndrome that requires acute vascular imaging. • Proximal large vessel occlusions can be identified quickly and accurately by radiologists across all training levels. • Grayscale inversion demonstrated minimal detectable benefit in the detection of proximal large vessel occlusions.

Impact of artificial intelligence on radiology: a EuroAIM survey among members of the European Society of Radiology

We report the results of a survey conducted among ESR members in November and December 2018, asking for expectations about artificial intelligence (AI) in 5-10 years. Of 24,000 ESR members contacted, 675 (2.8%) completed the survey, 454 males (67%), 555 (82%) working at academic/public hospitals. AI impact was mostly expected (≥ 30% of responders) on breast, oncologic, thoracic, and neuro imaging, mainly involving mammography, computed tomography, and magnetic resonance. Responders foresee AI impact on: job opportunities (375/675, 56%), 218/375 (58%) expecting increase, 157/375 (42%) reduction; reporting workload (504/675, 75%), 256/504 (51%) expecting reduction, 248/504 (49%) increase; radiologist's profile, becoming more clinical (364/675, 54%) and more subspecialised (283/675, 42%). For 374/675 responders (55%) AI-only reports would be not accepted by patients, for 79/675 (12%) accepted, for 222/675 (33%) it is too early to answer. For 275/675 responders (41%) AI will make the radiologist-patient relation more interactive, for 140/675 (21%) more impersonal, for 259/675 (38%) unchanged. If AI allows time saving, radiologists should interact more with clinicians (437/675, 65%) and/or patients (322/675, 48%). For all responders, involvement in AI-projects is welcome, with different roles: supervision (434/675, 64%), task definition (359/675, 53%), image labelling (197/675, 29%). Of 675 responders, 321 (48%) do not currently use AI, 138 (20%) use AI, 205 (30%) are planning to do it. According to 277/675 responders (41%), radiologists will take responsibility for AI outcome, while 277/675 (41%) suggest shared responsibility with other professionals. To summarise, responders showed a general favourable attitude towards AI.

CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome

OBJECTIVE

The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma.

MATERIALS AND METHODS

Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively.

RESULTS

Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10.

CONCLUSION

This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients.

KEY POINTS

• CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.

Interpretive Performance and Inter-Observer Agreement on Digital Mammography Test Sets

Objective

To evaluate the interpretive performance and inter-observer agreement on digital mammographs among radiologists and to investigate whether radiologist characteristics affect performance and agreement.

Materials and Methods

The test sets consisted of full-field digital mammograms and contained 12 cancer cases among 1000 total cases. Twelve radiologists independently interpreted all mammograms. Performance indicators included the recall rate, cancer detection rate (CDR), positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and area under the receiver operating characteristic curve (AUC). Inter-radiologist agreement was measured. The reporting radiologist characteristics included number of years of experience interpreting mammography, fellowship training in breast imaging, and annual volume of mammography interpretation.

Results

The mean and range of interpretive performance were as follows: recall rate, 7.5% (3.3–10.2%); CDR, 10.6 (8.0–12.0 per 1000 examinations); PPV, 15.9% (8.8–33.3%); sensitivity, 88.2% (66.7–100%); specificity, 93.5% (90.6–97.8%); FPR, 6.5% (2.2–9.4%); and AUC, 0.93 (0.82–0.99). Radiologists who annually interpreted more than 3000 screening mammograms tended to exhibit higher CDRs and sensitivities than those who interpreted fewer than 3000 mammograms (p = 0.064). The inter-radiologist agreement showed a percent agreement of 77.2–88.8% and a kappa value of 0.27–0.34. Radiologist characteristics did not affect agreement.

Conclusion

The interpretative performance of the radiologists fulfilled the mammography screening goal of the American College of Radiology, although there was inter-observer variability. Radiologists who interpreted more than 3000 screening mammograms annually tended to perform better than radiologists who did not.