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.

Uterine carcinosarcoma: a primer for radiologists

OBJECTIVE

To provide a modern overview for radiologists of the unique radiological, pathological, and clinical features of uterine carcinosarcoma (UCS).

RESULTS

UCS is a unique gynecological malignancy that continues to present diagnostic and therapeutic challenges to the field of oncology. The classification and clinical understanding of this malignancy have evolved in recent years, yielding a modern conceptualization of a neoplastic entity that has been well studied but incompletely understood. As UCS causes a significant proportion of deaths secondary to uterine cancer, developing a familiarity with the imaging and clinical features of this entity is critical. In addition to summarizing the modern understanding of this tumor variant, an overview of the common imaging features of UCS will be presented. The role of radiological staging, imaging findings on presentation and follow-up imaging, and modern treatment paradigms will be discussed. Lastly, the current treatment paradigms and surveillance recommendations for UCS will be summarized.

CONCLUSION

Knowledge of the modern understanding of uterine carcinosarcoma, including its relevant imaging and clinical features, is critical for radiologists.

Effect of radiologist pregnancy on the performance of pediatric fluoroscopic studies: a survey of Society for Pediatric Radiology members

BACKGROUND

To our knowledge, the fluoroscopic practice patterns of pregnant diagnostic radiologists have not been documented.

OBJECTIVE

To describe the fluoroscopic practice patterns during pregnancy among members of the Society for Pediatric Radiology (SPR) and potential impact on career and professional relationships.

MATERIALS AND METHODS

After approval from the SPR, we sent all 1,847 SPR members an email link to an anonymous online survey that queried how pregnancy affects a practicing radiologist who performs fluoroscopy.

RESULTS

Of the 398 responses (65% female, 35% male), most female respondents (78%) reported having been pregnant while practicing radiology and the majority (85%) performed fluoroscopy during pregnancy. Most performed fluoroscopy during all three trimesters (first 78%, second 90%, third 87%) and the majority (81%) used double-lead. Forty-six percent indicated that their fluoroscopic responsibilities during pregnancy were stressful. Of those who opted to perform fewer fluoroscopy studies, 20% indicated that it impacted negatively on their career or professional relationships. After witnessing a pregnant co-worker perform fewer fluoroscopic studies, 11% (4% male; 16% female; P<0.05) of respondents observed a subsequent negative impact on the co-worker's career or professional relationships.

CONCLUSION

The majority of responding female SPR members had performed fluoroscopy during pregnancy and most performed fluoroscopy during their entire pregnancy with double-lead. Differences between self-reported adversity and observed adversity of performing less fluoroscopy during pregnancy speak to the lack of awareness of the issues, particularly among male colleagues. A clear policy with regard to performing fluoroscopy during pregnancy for all radiologists in every department is necessary.

Benefits of Independent Double Reading in Digital Mammography: A Theoretical Evaluation of All Possible Pairing Methodologies

RATIONALE AND OBJECTIVES

To establish the efficacy of pairing readers randomly and evaluate the merits of developing optimal pairing methodologies.

MATERIALS AND METHODS

Sensitivity, specificity, and proportion correct were computed for three different case sets that were independently read by 16 radiologists. Performance of radiologists as single readers was compared to expected double reading performance. We theoretically evaluated all possible pairing methodologies. Bootstrap resampling methods were used for statistical analyses.

RESULTS

Significant improvements in expected performance for double versus single reading (ie, delta performance) were shown for all performance measures and case-sets (p ≤ .003), with overall delta performance across all theoretically possible pairing schemes (n = 10,395) ranging between .05 and .08. Delta performance for the 20 best pairing schemes was significant (p < .001) and ranged between .07 and .10. Delta performance for 20 random pairing schemes was also significant (p ≤ .003) and ranged between .05 and .08. Delta performance for the 20 worst pairing schemes ranged between .03 and .06, reaching significance in delta proportion correct (p ≤ .021) for all three case-sets and in delta specificity for two case-sets (p ≤ .033) but not for a third case-set (p = .131), and not reaching significance in delta sensitivity for any of the three case-sets (.098 ≥ p ≥ .067).

CONCLUSION

Significant benefits accrue from double reading, and while random reader pairing achieves most double reading benefits, a strategic pairing approach may maximize the benefits of double reading.

Impact of the rise of artificial intelligence in radiology: What do radiologists think?

PURPOSE

The purpose of this study was to assess the perception, knowledge, wishes and expectations of a sample of French radiologists towards the rise of artificial intelligence (AI) in radiology.

MATERIAL AND METHOD

A general data protection regulation-compliant electronic survey was sent by e-mail to the 617 radiologists registered in the French departments of Nord and Pas-de-Calais (93 radiology residents and 524 senior radiologists), from both public and private institutions. The survey included 42 questions focusing on AI in radiology, and data were collected between January 16^th and January 31^st, 2019. The answers were analyzed together by a senior radiologist and a radiology resident.

RESULTS

A total of 70 radiology residents and 200 senior radiologists participated to the survey, which corresponded to a response rate of 43.8% (270/617). One hundred ninety-eight radiologists (198/270; 73.3%) estimated they had received insufficient previous information on AI. Two hundred and fifty-five respondents (255/270; 94.4%) would consider attending a generic continuous medical education in this field and 187 (187/270; 69.3%) a technically advanced training on AI. Two hundred and fourteen respondents (214/270; 79.3%) thought that AI will have a positive impact on their future practice. The highest expectations were the lowering of imaging-related medical errors (219/270; 81%), followed by the lowering of the interpretation time of each examination (201/270; 74.4%) and the increase in the time spent with patients (141/270; 52.2%).

CONCLUSION

While respondents had the feeling of receiving insufficient previous information on AI, they are willing to improve their knowledge and technical skills on this field. They share an optimistic view and think that AI will have a positive impact on their future practice. A lower risk of imaging-related medical errors and an increase in the time spent with patients are among their main expectations.

Stressors contributing to burnout amongst pediatric radiologists: results from a survey of the Society for Pediatric Radiology

BACKGROUND

A recent study showed a high prevalence of burnout in pediatric radiology.

OBJECTIVE

The purpose of this study is to evaluate potential stressors contributing to burnout in pediatric radiology.

MATERIALS AND METHODS

Society for Pediatric Radiology members received an invitation for an anonymous survey evaluating stressors contributing to burnout. Stressors evaluated included call burden, financial stress, work-life balance, health care evolution and job market changes, and radiology as a career choice. Additional questions regarding demographics were obtained.

RESULTS

The response rate was 460/1,453 (32%). The prevalence of emotional exhaustion was 66% (286/435), depersonalization was 61% (265/433) and perceived lack of personal accomplishment was 15% (67/436). In a backward selective logistic regression model, work-life imbalance and call burden were the only significant factors predicting higher emotional exhaustion (P<0.001). Using a similar model, work-life imbalance, call burden and decreased rate of reimbursement were significantly associated with higher probability of depersonalization (P=0.033, 0.0002 and 0.015, respectively). Emotional exhaustion and depersonalization were significantly associated with higher odds of a radiologist's wish to work in another medical specialty (P=0.011 and 0.002, respectively).

CONCLUSION

Key stressors contributing to burnout in pediatric radiology include work-life imbalance, pediatric call burden and a decreased rate of reimbursement. Burnout in pediatric radiology is a serious issue that needs to be addressed and prioritized on the individual and departmental/institutional levels and further investigated to develop effective interventions to mitigate it.

Creating high-quality radiology reports in foreign languages through multilingual structured reporting

OBJECTIVES

Globalization and migration are increasing the demand for reports in different languages. We aimed to examine if structured reports created by non-German-speaking radiologists with multilingual templates show significant differences in quality to structured reports and free-text reports by German native speakers.

METHODS

We used structured templates that allow radiologists to report in their mother tongue and then switch the report language to German or English automatically using proprietary software. German- and English-speaking radiology residents created structured reports in both German and English with these templates. Reports for three different exam types were created (intensive care chest x-ray, shoulder x-ray specifically for degenerative processes, and CT pulmonary angiogram for pulmonary embolism). The report quality of automatically translated German structured reports by English-speaking radiologists and German structured reports by German radiologists was then evaluated by German clinicians with a standardized questionnaire. The questionnaire was designed to assess attributes including content, comprehensibility, clinical consequences, and overall quality.

RESULTS

Structured reports by English-speaking radiologists that were automatically translated into German and German structured reports by German radiologists both received very high or high overall quality ratings in the majority of cases, showing no significant differences in quality. Likewise, no significant differences were observed between the two report types regarding comprehensibility and clinical consequences. Structured reports by German radiologists received significantly better ratings for overall quality and comprehensibility compared to free-text reports by German radiologists.

CONCLUSIONS

Multilingual structured reporting templates may serve as a feasible tool for creating high-quality radiology reports in foreign languages.

KEY POINTS

• Multilingualism in structured reporting templates can be a useful tool for creating high-quality radiology reports in foreign languages. • German reports created with multilingual structured reporting templates by English-speaking radiologists and German structured reports by German radiologists exhibit no significant differences in overall report quality. • Multilingual structured reporting templates can help radiologists overcome communication barriers and facilitate teleradiology.

Subspecialization in radiology: effects on the diagnostic spectrum of radiologists and report turnaround time in a Swiss university hospital

PURPOSE

To analyze the changes in the work profiles of radiologists and the reporting time after the implementation of professional subspecialization in the radiology department of a Swiss university hospital.

METHODS

In a retrospective analysis, the overall number of different radiologic examinations performed in the department of radiology of the largest Swiss university hospital was documented for 2014 and 2016 before and after the implementation of subspecialized reporting (subspecialities: abdominal, musculoskeletal, cardiothoracic, emergency, and pediatric imaging) in May 2015. For six selected radiologists, the number and types of reported examinations as well as the related radiology report turnaround times (RTATs) were analyzed in detail and compared between the two 1-year periods.

RESULTS

Overall, there was a significant increase of 10.3% in the total number of examinations performed in the whole department in 2016 compared with 2014. For four of the six radiologists, the range of different types of examinations significantly decreased with the introduction of subspecialized reporting (p < 0.05). Furthermore, there was a significant change in the subset of the ten most commonly reported types of examinations reported by each of the six radiologists. Mean overall RTATs significantly increased for five of the six radiologists (p < 0.05).

CONCLUSIONS

Implementation of subspecialized reporting led to a change in the structure and a decrease in the range of different examination types reported by each radiologist. Mean RTAT increased for most radiologists. Subspecialized reporting allows the individual radiologist to focus on a special field of professional competence but can result in longer overall RTAT.

Monitoring of fatigue in radiologists during prolonged image interpretation using fNIRS

PURPOSE

To determine whether functional near-infrared spectroscopy (fNIRS) allows monitoring fatigue in radiologists during prolonged image interpretation.

MATERIALS AND METHODS

Nine radiologists participated as subjects in the present study and continuously interpreted medical images and generated reports for cases for more than 4 h under real clinical work conditions. We measured changes in oxygenated hemoglobin concentrations [oxy-Hb] in the prefrontal cortex using 16-channel fNIRS (OEG16ME, Spectratech) every hour during the Stroop task to evaluate fatigue of radiologists and recorded fatigue scale (FS) as a behavior data.

RESULTS

Two subjects showed a subjective feeling of fatigue and an apparent decrease in brain activity after 4 h, so the experiment was completed in 4 h. The remaining seven subjects continued the experiment up to 5 h. FS decreased with time, and a significant reduction was observed between before and the end of image interpretation. Seven out of nine subjects showed a minimum [oxy-Hb] change at the end of prolonged image interpretation. The mean change of [oxy-Hb] at the end of all nine subjects was significantly less than the maximum during image interpretation.

CONCLUSION

fNIRS using the change of [oxy-Hb] may be useful for monitoring fatigue in radiologists during image interpretation.

Serum tumor markers and testicular germ cell tumors: a primer for radiologists

Serum tumor markers (STMs) play a critical role in the diagnosis, staging and follow-up of both seminomatous and nonseminomatous testicular germ cell neoplasms. Levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH), especially those measured after orchiectomy, also have implications for patient prognosis. Given that testicular germ cell tumors represent the most common solid tumor in men aged 20-34, radiologists must have familiarity with the clinical utilization and implications of these STMs. This article will review the classical patterns of STM elevation most commonly seen in pure seminomatous and nonseminomatous germ cell tumors while also providing case-based examples highlighting the importance of STM correlation with imaging. The role of STMs in clinical staging and disease surveillance will also be discussed.

Spectrum of lytic lesions of the skull: a pictorial essay

Abstract

Lytic lesions of the skull include a wide range of diseases, ranging from benign conditions such as arachnoid granulations or vascular lacunae, to aggressive malignant lesions such as lymphomas or metastases. An early and correct characterisation of the nature of the lesion is, therefore, crucial, in order to achieve a fast and appropriate treatment option. In this review, we present the radiological appearance of the most frequent lytic lesions of the skull, describing findings from different imaging modalities (plain X-rays, CT and MRI), with particular attention to diagnostic clues and differential diagnoses.

Teaching Points

• Osteolytic skull lesions may be challenging to diagnose.

• Association of different imaging techniques may aid image interpretation.

• Clinical information and extensive knowledge of possible differential diagnoses is essential.

• Some osteolytic tumours, although benign, may present as locally aggressive lesions.

• Malignant lesions require accurate staging, followed by variable treatment approaches.

Image quality and artifacts in automated breast ultrasonography

Three-dimensional automated breast ultrasonography (ABUS) has been approved for screening Epub ahead of print studies as an adjunct to mammography. ABUS provides proper orientation and documentation, resulting in better reproducibility. Optimal image quality is essential for a proper diagnosis, and high-quality images should be ensured when ABUS is used in clinical settings. Image quality in ABUS is highly dependent on the acquisition procedure. Artifacts can interfere with the visibility of abnormalities, reduce the overall image quality, and introduce clinical and technical problems. Nipple shadow and reverberation artifacts are some of the artifacts frequently encountered in ABUS. Radiologists should be familiar with proper image acquisition techniques and possible artifacts in order to acquire high-quality images.