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Yan TD, Jalal S, Harris A. Value-Based Radiology in Canada: Reducing Low-Value Care and Improving System Efficiency. Can Assoc Radiol J 2024:8465371241277110. [PMID: 39219178 DOI: 10.1177/08465371241277110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Radiology departments are increasingly tasked with managing growing demands on services including long waitlists for scanning and interventional procedures, human health resource shortages, equipment needs, and challenges incorporating advanced imaging solutions. The burden of system inefficiencies and the overuse of "low-value" imaging causes downstream impact on patients at the individual level, the economy and healthcare system at the societal level, and planetary health at an overarching level. Low value imaging includes those performed for an inappropriate clinical indication, with little to no value to the management of the patient, and resulting in healthcare resource waste; it is estimated that up to a quarter of advanced imaging studies in Canada meet this criterion. Strategies to reduce low-value imaging include the development and use of referral guidelines, use of appropriateness criteria, optimization of existing protocols, and integration of clinical decision support tools into the ordering provider's workflow. Additional means of optimizing system efficiency such as centralized intake models, improved access to electronic medical records and outside imaging, enhanced communication with patients and referrers, and the utilization of artificial intelligence will further increase the value of radiology provided to patients and care providers.
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Affiliation(s)
- Tyler D Yan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sabeena Jalal
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Alison Harris
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Hajalamin M, Awadalla A, Mukhtar M. Assessing, Advising, and Advancing the Filling Practices of the Radiology Request Form in Africa: A Systematic Review. Diagnostics (Basel) 2024; 14:1694. [PMID: 39125570 PMCID: PMC11311308 DOI: 10.3390/diagnostics14151694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Despite the increased use of diagnostic imaging in Africa, the completion of the Radiology Request Form (RRF) remains suboptimal, often relying on paper-based communication. To examine the practices surrounding RRF completion in the African continent, on 25 March 2024, we conducted a systematic review of peer-reviewed articles describing the practice in African settings. Non-African studies, studies involving non-human subjects, and articles examining the practice of the RRF for interventional usage were excluded. Our search involves PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, Google Scholar, and African Journals Online. The included studies were 3004, of which 30 met the inclusion criteria. These studies span eight countries and highlighted several shortcomings, including the usage of informal forms, unconventional abbreviations, illegibility, inaccuracy, and the lack of important fields from institutional forms, commonly the last menstrual period and the referrer's contact details. We also found widespread non-compliance in all RRF fields; half of the studies did not have an adequately filled form. Incomplete RRFs lead to delayed imaging, increased workloads for radiographers and radiologists, and potential misdiagnoses due to insufficient information. It will also impede the application of radiation protection principles. To address these challenges, empowering radiographers and radiologists and encouraging best practices is essential. Regular audits and educational initiatives aimed at clinicians are recommended. While transitioning to a paperless communication system might help, implementing nationwide quality improvement projects to standardise radiology request forms is currently more feasible.
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Affiliation(s)
| | - Almontasir Awadalla
- Beaumont Hospital, Beaumont Road, Beaumont, D09 V2N0 Dublin, Ireland; (A.A.); (M.M.)
| | - Mahmoud Mukhtar
- Beaumont Hospital, Beaumont Road, Beaumont, D09 V2N0 Dublin, Ireland; (A.A.); (M.M.)
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Andersen ER, Hofmann BM, Brandsæter IØ, Kjelle E. Reducing low-value imaging-A qualitative evaluation of a pilot intervention in Norway. J Eval Clin Pract 2024. [PMID: 39031620 DOI: 10.1111/jep.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/02/2024] [Indexed: 07/22/2024]
Abstract
RATIONAL Low-value radiological imaging threatens patient safety and efficient use of limited health resources. It is important to evaluate measures for reducing low-value utilisation, to learn and to improve. Accordingly, the objective of this study was to qualitatively evaluate a pilot intervention for reducing low-value imaging in Norway. METHODS Semi-structured interviews were conducted aimed at describing stakeholders' experience with a multicomponent pilot intervention consisting of a standardised procedure for referral assessment, a standardised return letter, and information about the value and possible risks of magnetic resonance imaging-examinations to the public. Data were analysed in line with qualitative content analysis with a deductive approach. RESULTS Seven healthcare providers were interviewed, including two radiologists, two radiographers, one manual therapist, one practice consultant and one general practitioner. Data analysis yielded four categories: (1) information and reception, (2) referral- and assessment processes, (3) suggestions for improvement and facilitation and (4) outcomes of the pilot intervention. CONCLUSIONS The pilot intervention was deemed acceptable, feasible, engaging and relevant. Specific training in the use of the new procedure was suggested to improve the intervention. The simple design, as well as the positive acceptance demonstrated and the few resources needed, make the pilot intervention and methodology highly relevant for other settings or when aiming to reduce the number of other low-value radiology examinations.
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Affiliation(s)
- Eivind Richter Andersen
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Ingrid Øfsti Brandsæter
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Elin Kjelle
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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Alami Idrissi Y, Virador GM, Singh RB, Rao D, Stone JA, Sandhu SJS. Imaging 3.0: A scoping review. Curr Probl Diagn Radiol 2024; 53:399-404. [PMID: 38242771 DOI: 10.1067/j.cpradiol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
We aim to provide a comprehensive summary of the current body of literature concerning the Imaging 3.0 initiative and its implications for patient care within the field of radiology. We offer a thorough analysis of the literature pertaining to the Imaging 3.0 initiative, emphasizing the practical application of the five pillars of the program, their cost-effectiveness, and their benefits in patient management. By doing so, we hope to illustrate the impact the Imaging 3.0 Initiative can have on the future of radiology and patient care.
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Affiliation(s)
- Yassine Alami Idrissi
- Hillman Cancer Center, University of Pittsburgh Medical Center, 5030 Centre avenue, Pittsburgh, PA 15213, United States.
| | - Gabriel M Virador
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, United States
| | - Rahul B Singh
- Department of Internal Medicine, New York City Health and Hospitals/South Brooklyn Health, Brooklyn, NY, United States
| | - Dinesh Rao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Jeffrey A Stone
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
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Äijö T, Elgort D, Becker M, Herzog R, Brown RKJ, Odry BL, Vianu R. Improving the Reliability of Peer Review Without a Gold Standard. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:489-503. [PMID: 38316666 PMCID: PMC11031531 DOI: 10.1007/s10278-024-00971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/29/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
Peer review plays a crucial role in accreditation and credentialing processes as it can identify outliers and foster a peer learning approach, facilitating error analysis and knowledge sharing. However, traditional peer review methods may fall short in effectively addressing the interpretive variability among reviewing and primary reading radiologists, hindering scalability and effectiveness. Reducing this variability is key to enhancing the reliability of results and instilling confidence in the review process. In this paper, we propose a novel statistical approach called "Bayesian Inter-Reviewer Agreement Rate" (BIRAR) that integrates radiologist variability. By doing so, BIRAR aims to enhance the accuracy and consistency of peer review assessments, providing physicians involved in quality improvement and peer learning programs with valuable and reliable insights. A computer simulation was designed to assign predefined interpretive error rates to hypothetical interpreting and peer-reviewing radiologists. The Monte Carlo simulation then sampled (100 samples per experiment) the data that would be generated by peer reviews. The performances of BIRAR and four other peer review methods for measuring interpretive error rates were then evaluated, including a method that uses a gold standard diagnosis. Application of the BIRAR method resulted in 93% and 79% higher relative accuracy and 43% and 66% lower relative variability, compared to "Single/Standard" and "Majority Panel" peer review methods, respectively. Accuracy was defined by the median difference of Monte Carlo simulations between measured and pre-defined "actual" interpretive error rates. Variability was defined by the 95% CI around the median difference of Monte Carlo simulations between measured and pre-defined "actual" interpretive error rates. BIRAR is a practical and scalable peer review method that produces more accurate and less variable assessments of interpretive quality by accounting for variability within the group's radiologists, implicitly applying a standard derived from the level of consensus within the group across various types of interpretive findings.
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Affiliation(s)
| | - Daniel Elgort
- Covera Health, New York, NY, USA
- Present Address: Aster Insights, Tampa, FL, USA
| | - Murray Becker
- Covera Health, New York, NY, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Richard K J Brown
- Department of Radiology, University of Michigan (Michigan Medicine), Ann Arbor, MI, USA
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Hofmann B, Håvik V, Andersen ER, Brandsæter IØ, Kjelle E. Low-value MRI of the knee in Norway: a register-based study to identify the proportion of potentially low-value MRIs and estimate the related costs. BMJ Open 2024; 14:e081860. [PMID: 38485174 PMCID: PMC10941154 DOI: 10.1136/bmjopen-2023-081860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES The objective of this study is to investigate the proportion of potentially low-value knee MRI in Norway and to provide an estimate of the related costs. DESIGN Register study based on conditional data extraction and analysis of data from Control and Reimbursement of Healthcare Claims registry in Norway. SETTING MRI in public specialist healthcare with universal health coverage (Norway). PARTICIPANTS 48 212 MRIs for 41 456 unique patients and 45 946 reimbursement claims. OUTCOME MEASURES Proportion of MRIs of the knee that (1) did not have a relevant tentative diagnosis prior to the knee MRI, (2) did not have a relevant alternative image of the knee before the MRI or (3) did not have a relevant code from the specialist care within 6 months after the MRI, and those that had combinations of 1, 2 and 3. Estimated costs for those that had combinations of 1, 2 and 3. RESULTS Very few patients (6.4%) had a relevant diagnosis code or prior imaging examination when having the MRI and only 14.6% got a knee-related diagnosis code from the specialist care within 6 months after the MRI. 21.8% of the patients had knee X-ray, CT or ultrasound within 6 months before the MRI. Between 58% and 85% of patients having knee MRIs in Norway have no relevant examinations or diagnoses six months prior to or after the MRI examination. These examinations are unlikely to benefit patients and they correspond to between 24 108 and 35 416 MRIs at a cost of €6.7-€9.8 million per year. CONCLUSION A substantial proportion of MRIs of the knee in Norway have no relevant examinations or diagnoses before or after the MRI and are potentially of low value. Reducing low-value MRIs could free resources for high-value imaging, reduce waiting times, improve the quality of care and increase patient safety and professional integrity.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Gjøvik, Norway
- Centre of Medical Ethics, University of Oslo, Norway, Oslo, Norway
| | - Vegard Håvik
- Department for Medical Reimbursement, Norwegian Directorate of Health, Oslo, Norway
| | - Eivind Richter Andersen
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Gjøvik, Norway
| | - Ingrid Øfsti Brandsæter
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Gjøvik, Norway
| | - Elin Kjelle
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Gjøvik, Norway
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Kwee TC, Kasalak Ö, Yakar D. Radiologist-patient communication of musculoskeletal ultrasonography results: a choice between added value and costs. Acta Radiol 2024; 65:267-272. [PMID: 34617452 DOI: 10.1177/02841851211044974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Literature on radiologist-patient communication of musculoskeletal ultrasonography (US) results is currently lacking. PURPOSE To investigate the patient's view on receiving the results from a radiologist after a musculoskeletal US examination, and the additional time required to provide such a service. MATERIAL AND METHODS This prospective study included 106 outpatients who underwent musculoskeletal US, and who were equally randomized to either receive or not receive the results from the radiologist directly after the examination. RESULTS In both randomization groups, all quality performance metrics (radiologist's friendliness, explanation, skill, concern for comfort, concern for patient questions/worries, overall rating of the examination, and likelihood of recommending the examination) received median scores of good/high to very good/very high. Patients who had received their US results from the radiologist rated the radiologist's explanation and concern for patient questions/worries as significantly higher (P = 0.009 and P = 0.002) than patients who had not. In both randomization groups, there were no significant differences between anxiety levels before and after the US examination (P = 0.222 and P = 1.000). Of the 48 responding patients, 46 (95.8%) rated a radiologist-patient discussion of US findings as important. US examinations with a radiologist-patient communication regarding US findings (median = 11.29 min) were significantly longer (P < 0.0001) than those without (median = 8.08 min). CONCLUSION Even without communicating musculoskeletal US results directly to patients, radiologists can still achieve high ratings from patients for their communication and empathy. Nevertheless, patient experience can be further enhanced if a radiologist adds this communication to the examination. However, this increases total examination time and therefore costs.
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Affiliation(s)
- Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ömer Kasalak
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Derya Yakar
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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O'Callaghan ME, Fawsitt R, Gao J, Broughan J, McCombe G, Phelan A, Quinlan D, Collins C, Stanley F, Cullen W. Irish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study. Ir J Med Sci 2024; 193:425-434. [PMID: 37354242 PMCID: PMC10808218 DOI: 10.1007/s11845-023-03419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors. AIMS Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative. METHODS A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs. RESULTS Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines. CONCLUSIONS GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.
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Affiliation(s)
- Michael Edmund O'Callaghan
- Irish College of General Practitioners (ICGP), Dublin, Ireland.
- School of Medicine, University of Limerick (UL), Dublin, Ireland.
| | - Ronan Fawsitt
- Ireland East Hospital Group (IEHG) GP Research Network, University College Dublin/Ireland, Dublin, Ireland
| | - Jiaran Gao
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | - John Broughan
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | - Geoff McCombe
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | - Amy Phelan
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | | | - Claire Collins
- Irish College of General Practitioners (ICGP), Dublin, Ireland
| | - Fintan Stanley
- Irish College of General Practitioners (ICGP), Dublin, Ireland
| | - Walter Cullen
- Ireland East Hospital Group (IEHG) GP Research Network, University College Dublin/Ireland, Dublin, Ireland
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
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Christensen EW, Pelzl CE, Rula EY, Nicola LP, Nicola GN. Prevalence of "One-Off Events" in Radiology: Implications for Radiology in Episode-Based Alternative Payment Models. Curr Probl Diagn Radiol 2024; 53:48-53. [PMID: 37704487 DOI: 10.1067/j.cpradiol.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE As reimbursement mechanisms become more value-based, there are questions about the applicability of these mechanisms for nonepisodic care, particularly care provided by nonpatient-facing specialists, for example, radiologists. Accordingly, this study examined the prevalence of nonepisodic care-one-off events-in diagnostic radiology. METHODS We conducted a multiyear (2015-2019) retrospective study of diagnostic imaging using a large commercial payer database including commercial insurance and Medicare Advantage. Using a 12-month evaluation period starting with the day of the initial imaging study/studies, we categorized imaging studies as one-off events if there were no additional studies (beyond the first day of the evaluation period) for the next 12 months in the same body region. We also evaluated an alternative, more stringent definition of a one-off event: the only imaging study during the 12-month evaluation period. We computed the percentage of one-off events overall and by body region. RESULTS We found that one-off events comprised 33.2%-45.8% of imaging studies depending on whether one-off events are defined as the only study in the evaluation period or imaging only on the first day of the evaluation period, respectively. This share varied widely by body region: highest for cardiac (80.9%-87.7%) and lower for chest (26.8%-35.2%). By place-of-service, the proportion was lowest for the inpatient (12.9%-29.1%) and long-term care settings (18.6%-30%). DISCUSSION Given the sizeable share of imaging studies categorized as one-off events, much of radiologists' workload falls outside of the framework of episodic measurement tools and value-based payment models.
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Affiliation(s)
- Eric W Christensen
- Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, Reston, VA; Health Services Management, University of Minnesota, St. Paul, MN
| | - Casey E Pelzl
- Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, Reston, VA.
| | | | - Lauren P Nicola
- Triad Radiology Associates, Winston-Salem, NC; American College of Radiology Board of Chancellors, Reston, VA
| | - Gregory N Nicola
- American College of Radiology Board of Chancellors, Reston, VA; Hackensack Radiology Group, PA, River Edge, NJ; American College of Radiology Commission on Economics, Reston, VA
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Luo S, Zhang Y, Wang P, Yang Z, Zheng J, Wang Z, Zhang J, Zhu J. The moderating role of resilience in the association between workload and depressive symptoms among radiology residents in China: results from a nationwide cross-sectional study. Eur Radiol 2024; 34:695-704. [PMID: 37566268 DOI: 10.1007/s00330-023-10021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES The current study aimed to explore the moderating role of psychological resilience in the association between workload and depressive symptoms among radiology residents during standardized residency training (SRT) in China. METHODS A nationwide cross-sectional online survey was conducted among radiology residents in China. Workload was measured by working hours per week and the frequency of frontline nightwork in the last month. Resilience was assessed by the 2-item Connor-Davidson Resilience Scale. Depressive symptoms were measured by the Depression Anxiety Stress Scales. The hierarchical regression and simple slope analyses were performed to examine the moderating effect of resilience. RESULTS Among 3666 radiology residents, the mean age was 27.3 years (SD = 2.6) and 58% were female. About 24.4% of the participants reported medium to severe depressive symptoms. The hierarchical regression showed that working hours (ba = 0.11, 95%CI: 0.08, 0.14) and having frontline nightwork more than once (ba = 1.22, 95%CI: 0.67, 1.78) were positively associated with depressive symptoms; the moderating effect of resilience was significant in the association of depressive symptoms with working hours (ba = - 0.02, 95%CI: - 0.03, - 0.01) and having frontline nightwork more than once (ba = - 0.28, 95%CI: - 0.49, - 0.07). The simple slope test showed the association between workload-related variables and depressive symptoms was only significant in those with a relatively lower level of resilience. CONCLUSIONS The study found that resilience was an important modifier buffering the positive association between workload and depressive symptoms among radiology residents in China. Future medical training programs are suggested to include effective intervention components to increase personal resilience. CLINICAL RELEVANCE STATEMENT Heavy workload in clinical setting may pose adverse effect on mental health and job performance of radiology residents. The study investigated whether psychological resilience would mitigate the association between workload and depressive symptoms among Chinese radiology residents. KEY POINTS • Radiology residents with a heavier workload presented a higher level of depressive symptoms in China. • Psychological resilience mitigated the positive association between workload and depressive symptoms. • The association between workload and depressive symptoms was only statistically significant in radiology residents with a relatively lower level of resilience.
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Affiliation(s)
- Sitong Luo
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yuhang Zhang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- Department of Radiology, Ningbo No.2 Hospital, 315000, Ningbo, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No.2 Hospital, 315000, Ningbo, China.
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
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11
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Hofmann B, Brandsaeter IØ, Kjelle E. Variations in wait times for imaging services: a register-based study of self-reported wait times for specific examinations in Norway. BMC Health Serv Res 2023; 23:1287. [PMID: 37996873 PMCID: PMC10666297 DOI: 10.1186/s12913-023-10284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND While the number of medical images has increased substantially, the demand has outpaced access, resulting in long wait times in many countries. Long wait times are a key problem for patient safety and quality of care as they can result in prolonged suffering, delayed diagnosis and treatment, as well as poorer prognosis and loss of lives. Surprisingly, little is known about wait times for imaging services. OBJECTIVE Investigate wait times for specific imaging services in Norway and to compare wait times with the total number of examinations and their development over time. METHODS Data from the wait time registry at the Norwegian Directorate of Health from 2018 to 2021 as well as data on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and in-patient data afforded by fourteen hospital trusts and hospitals in Norway were analysed. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics. RESULTS Wait times vary through the months of the year. Conventional X-ray (XR) had the shortest wait times (3.0-4.4 weeks), and Magnetic Resonance Imaging (MRI) and ultrasound (US) had the lengthiest (8.7-12.0 and 7.9-11.4 weeks respectively). The wait times were lengthiest during the summer and winter holidays. Variations in wait times were also found for specific examination types between Norway's four public health regions. In addition, there was variation over time within the health regions. The wait times with the private health providers were substantially lower than with the public health providers. From 2018 to 2021, the wait time for MRIs increased by 6.6%, while the number of examinations (per 10,000) increased by 8.6%. Those regions with the highest number of examinations per 1,000 inhabitants per year had the lowest wait times. CONCLUSION Wait times for diagnostic imaging procedures varied with time, region, and modality in Norway from 2018 to 2021. Long wait times may entail many negative consequences for patients, professionals, and the healthcare system. Reducing long wait times is an obvious way to improve the quality, safety, and efficiency of care.
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Affiliation(s)
- Bjørn Hofmann
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, PO Box 1130, Oslo, N-0318, Norway.
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | - Ingrid Øfsti Brandsaeter
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Elin Kjelle
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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12
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Jimenez YA, Lewis SJ. Infection prevention and control in the medical imaging environment: a scoping review. Insights Imaging 2023; 14:121. [PMID: 37450068 PMCID: PMC10348968 DOI: 10.1186/s13244-023-01470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/17/2023] [Indexed: 07/18/2023] Open
Abstract
Infection prevention and control (IPC) practices are key to preventing and controlling the spread of pathogens in medical imaging departments (MIDs). The objective of this scoping review was to synthesise information about current research in MID regarding IPC and to use the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify the work system factors ('persons', 'organisation', 'tools and technology', 'tasks' and 'environment') influencing the practice of IPC, in order to better understand challenges and facilitators that affect IPC in MID. Predefined search terms and medical subject headings relating to IPC in the medical imaging setting were used to search 3 databases. A total of 46 publications met the inclusion criteria, which combined, encompassed all five SEIPS domains influencing IPC. The literature supports the interrelated nature of the five SEIPS domains, and influence to one another. Hand hygiene was a major focus of publications. Mechanisms of infection in contrast-enhanced computed tomography were most reported, with human error, lack of education, and issues associated with devices and processes mechanisms found to influence IPC breaches. A systems approach, such as the SEIPS model, is useful for understanding barriers and hence opportunities for improvement of IPC in the medical imaging setting. Future studies should address individuals' decision-making processes in the medical imaging setting, and a greater focus should be placed into the procedural steps, education and tools used for contrast media administration. CRITICAL RELEVANCE STATEMENT: A systems approach, such as the Systems Engineering Initiative for Patient Safety model, is useful for understanding barriers and hence opportunities for improvement of IPC in the medical imaging setting. KEY POINTS: 1. IPC in the medical imaging setting would benefit from a systems approach. 2. The role of education and monitoring of IPC compliance requires further research. 3. Geographical location is a key variable in IPC research in medical imaging.
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Affiliation(s)
- Yobelli A Jimenez
- University of Sydney, Susan Wakil Health Building (D18), Western Avenue, Camperdown, NSW, 2006, Australia.
| | - Sarah J Lewis
- University of Sydney, Susan Wakil Health Building (D18), Western Avenue, Camperdown, NSW, 2006, Australia
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Malhotra A, Bajaj S, Garg T, Khunte M, Pahwa B, Wu X, Payabvash S, Mukherjee S, Gandhi D, Forman HP. American College of Radiology Appropriateness Criteria®: a bibliometric analysis of panel members. Insights Imaging 2023; 14:113. [PMID: 37395838 PMCID: PMC10317907 DOI: 10.1186/s13244-023-01456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/12/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE To assess the features of panel members involved in the writing of the ACR-AC and identify alignment with research output and topic-specific research publications. METHODS A cross-sectional analysis was performed on the research output of panel members of 34 ACR-AC documents published in 2021. For each author, we searched Medline to record total number of papers (P), total number of ACR-AC papers (C) and total number of previously published papers that are relevant to the ACR-AC topic (R). RESULTS Three hundred eighty-three different panel members constituted 602 panel positions for creating 34 ACR-AC in 2021 with a median panel size of 17 members. Sixty-eight (17.5%) of experts had been part of ≥10 previously published ACR-AC papers and 154 (40%) were members in ≥ 5 published ACR-AC papers. The median number of previously published papers relevant to the ACR-AC topic was 1 (IQR: 0-5). 44% of the panel members had no previously published paper relevant to the ACR-AC topic. The proportion of ACR-AC papers (C/P) was higher for authors with ≥ 5 ACR-AC papers (0.21) than authors with < 5 ACR-AC papers (0.11, p < 0.0001); however, proportion of relevant papers per topic (R/P) was higher for authors with < 5 ACR-AC papers (0.10) than authors with ≥ 5 ACR-AC papers (0.07). CONCLUSION The composition of the ACR Appropriateness Criteria panels reflects many members with little or no previously published literature on the topic of consideration. Similar pool of experts exists on multiple expert panels formulating imaging appropriateness guidelines. KEY POINTS There were 68 (17.5%) panel experts on ≥ 10 ACR-AC panels. Nearly 45% of the panel experts had zero median number of relevant papers. Fifteen panels (44%) had > 50% of members having zero relevant papers.
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Affiliation(s)
- Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA.
| | - Suryansh Bajaj
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Bhavya Pahwa
- University College of Medical Sciences, Delhi, India
| | - Xiao Wu
- Department of Radiology, University of California at San Francisco, San Francisco, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Suresh Mukherjee
- Radiology and Radiation Oncology, University of Illinois, Peoria, IL and Robert Wood Johnson Medical School, Newark, NJ, USA
| | - Dheeraj Gandhi
- Interventional Neuroradiology, Nuclear Medicine, Neurology and Neurosurgery, University of Maryland School of Medicine, Maryland, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
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Siewert B, Bruno MA, Fleishon HB, Hublall R, Slanetz PJ, Jankovic SN, Kotsenas AL, Schwartz ES, Pawley B, Mukherji SK, Bourland JD, Artunduaga M, Saif M, Poussaint TY, Scanlon MH, Kirsch J, Lexa FJ. Summary of the 2022 ACR Intersociety Meeting. J Am Coll Radiol 2023; 20:479-486. [PMID: 37121627 DOI: 10.1016/j.jacr.2023.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 05/02/2023]
Abstract
The ACR Intersociety Committee meeting of 2022 (ISC-2022) was convened around the theme of "Recovering From The Great Resignation, Moral Injury and Other Stressors: Rebuilding Radiology for a Robust Future." Representatives from 29 radiology organizations, including all radiology subspecialties, radiation oncology, and medical physics, as well as academic and private practice radiologists, met for 3 days in early August in Park City, Utah, to search for solutions to the most pressing problems facing the specialty of radiology in 2022. Of these, the mismatch between the clinical workload and the available radiologist workforce was foremost-as many other identifiable problems flowed downstream from this, including high job turnover, lack of time for teaching and research, radiologist burnout, and moral injury.
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Affiliation(s)
- Bettina Siewert
- Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Vice Chair of RSNA Quality Improvement Committee.
| | - Michael A Bruno
- Professor of Radiology and Professor of Medicine, Penn State University, University Park, Pennsylvania, and Department of Radiology, Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - Howard B Fleishon
- Associate Professor of Radiology, Department of Radiology and Imaging Sciences, Atlanta, Georgia; President, ACR
| | - Ronald Hublall
- Central Illinois Radiological Associates, East Peoria, Illinois
| | - Priscilla J Slanetz
- Professor of Radiology, Boston University Chobanian & Avedisian School of Medicine and Department of Radiology, Boston Medical Center, Boston, Massachusetts; President-Elect, AUR; Vice Chair of Academic Affairs in the Department of Radiology and Associate Program Director of the Diagnostic Radiology Residency, Boston Medical Center; Subspecialty Chair, ACR Appropriateness Criteria Breast Imaging Panels; Chair, Mentorship Committee, Society of Breast Imaging; Co-Chair, Fellowship Committee and Breast Imaging Committee of the Massachusetts Radiological Society
| | - Stephanie N Jankovic
- Department of Radiology, Oregon Health & Science University Hospital, Portland, Oregon
| | - Amy L Kotsenas
- Professor of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, and Department of Radiology, Mayo Clinic, Rochester, Minnesota; Board of Chancellors, ACR
| | - Erin S Schwartz
- Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Barbara Pawley
- Associate Professor of Radiology, University of Kentucky, Lexington, Kentucky, and Department of Radiology, UK Albert B. Chandler Hospital, Lexington, Kentucky; Immediate Past-President, American Association for Women Radiologists
| | | | - J Daniel Bourland
- Professor of Radiation Oncology, Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 2022 President, American Association of Physicists in Medicine, 2023 Chair, Board of Directors, American Association of Physicists in Medicine
| | - Maddy Artunduaga
- Assistant Professor of Radiology, Department of Radiology, Pediatric Radiology Division, UT Southwestern Medical Center, Dallas, Texas
| | - Manal Saif
- Department of Radiology, Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - Tina Y Poussaint
- Lionel W. Young Chair in Radiology, Professor of Radiology, Harvard Medical School, Boston, Massachusetts, and Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, 1st Past President, American Society of Neyruradiology
| | - Mary H Scanlon
- Clinical Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Pennsylvania, and Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, President, Association of Program Directors in Radiology
| | - Jacobo Kirsch
- Chair, Florida Region Imaging Institute, Cleveland Clinic Florida, Weston Hospital, Weston, Florida
| | - Frank J Lexa
- Professor and Vice Chair Faculty Affairs, Department of Radiology, University of Pittsburgh Medical Center International, Pittsburgh, Pennsylvania; Vice President, ACR; Chief Medical Officer, The Radiology Leadership Institute of the ACR
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15
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Brandsæter IØ, Andersen ER, Hofmann BM, Kjelle E. Drivers for low-value imaging: a qualitative study of stakeholders' perspectives in Norway. BMC Health Serv Res 2023; 23:295. [PMID: 36978092 PMCID: PMC10044073 DOI: 10.1186/s12913-023-09328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND One kind of overutilization of diagnostic imaging is low-value imaging, i.e., imaging that does not lead to altered clinical pathways or improved health outcomes. Despite having well-documented extension and consequences, low-value imaging is still widespread. The objective of this study was to identify the drivers for the use of low-value imaging in the Norwegian healthcare services. METHODS We conducted individual, semi-structured interviews among representatives from the health authorities, general practitioners, specialists working in hospitals, radiologists, radiographers, and managers of imaging departments. Data analysis was carried out in line with framework analysis consisting of five steps: Familiarization, indexing, charting, mapping, and interpretation. RESULTS The analysis included 27 participants and resulted in two themes. The stakeholders identified drivers in the healthcare system and in the interaction between radiologists, referrers, and patients. The identified drivers were categorized in sub-themes, such as organization, communication, competence, expectations, defensive medicine, roles and responsibilities, and referral quality and time constraints. The drivers interact with each other and may strengthen the effect of other drivers. CONCLUSIONS Several drivers for low-value imaging in Norway were identified at all levels of the healthcare system. The drivers work simultaneously and synergistically. To free resources for high-value imaging, drivers should be targeted by appropriate measures at several levels to reduce low-value imaging.
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Affiliation(s)
- Ingrid Øfsti Brandsæter
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology (NTNU), NTNU Gjøvik, PB 191, 2802, Gjøvik, Norway.
| | - Eivind Richter Andersen
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology (NTNU), NTNU Gjøvik, PB 191, 2802, Gjøvik, Norway
| | - Bjørn Morten Hofmann
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology (NTNU), NTNU Gjøvik, PB 191, 2802, Gjøvik, Norway
- Centre for Medical Ethics, University of Oslo, Blindern, PB 1130, 0318, Oslo, Norway
| | - Elin Kjelle
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology (NTNU), NTNU Gjøvik, PB 191, 2802, Gjøvik, Norway
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16
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Andersen ER, Brandsæter IØ, Hofmann BM, Kjelle E. The use of low-value imaging: the role of referral practice and access to imaging services in a representative area of Norway. Insights Imaging 2023; 14:29. [PMID: 36746848 PMCID: PMC9902580 DOI: 10.1186/s13244-023-01375-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Even though imaging is essential to modern medicine, some examinations are of low value as they do not lead to any change in the management of the patient. The Choosing Wisely (CW) campaign aims to reduce the use of such services. In the Norwegian version of CW, specific magnetic resonance imaging (MRI) of the head, lower back, and knee are amongst others identified as potential low-value examinations. However, referral practice and access to imaging may drive low-value utilisation. By using registry data from 2019 and descriptive analysis, this study aimed to examine the role of referral practice and access to imaging on the use of specific CW-examinations in one representative area in Norway. RESULTS A total of 237,554 examinations were performed by four public and two private imaging facilities located within the area. Forty-two percent (19,210/45,289) of all MRI examinations were related to CW. Private imaging centres performed most of the CW-imaging. A total of 3700 referrers were identified, and 2.3% were identified as "high-referrers," accounting for 33% of all CW-examinations. Referrers' experience did not influence imaging utilisation. A subset of referrers ("super-referrers," 0.5%) accounted for 10% of CW-examinations. Distance to service had no impact on the use of CW-examinations. CONCLUSIONS This study provides valuable insight into the use of imaging and referral practice in one representative area in Norway. A great variation in referral practice was observed. Therefore, targeting referrers with high referral rates may be a promising strategy for reducing the use of low-value imaging.
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Affiliation(s)
- Eivind Richter Andersen
- Department of Health Sciences in Gjøvik, The Norwegian University of Science and Technology (NTNU), P.O. Box 1, 2802, Gjøvik, Norway.
| | - Ingrid Øfsti Brandsæter
- grid.5947.f0000 0001 1516 2393Department of Health Sciences in Gjøvik, The Norwegian University of Science and Technology (NTNU), P.O. Box 1, 2802 Gjøvik, Norway
| | - Bjørn Morten Hofmann
- grid.5947.f0000 0001 1516 2393Department of Health Sciences in Gjøvik, The Norwegian University of Science and Technology (NTNU), P.O. Box 1, 2802 Gjøvik, Norway ,grid.5510.10000 0004 1936 8921Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Elin Kjelle
- grid.5947.f0000 0001 1516 2393Department of Health Sciences in Gjøvik, The Norwegian University of Science and Technology (NTNU), P.O. Box 1, 2802 Gjøvik, Norway
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17
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Brady AP, Uberoi R, Lee MJ, Müller-Hülsbeck S, Adam A. Leadership in Interventional Radiology - Fostering a Culture of Excellence. Can Assoc Radiol J 2023; 74:185-191. [PMID: 35471189 DOI: 10.1177/08465371221089249] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This invited article reviews the current status of Interventional Radiology (IR), in terms of its status as a speciality, and outlines the conditions needed for IR to function optimally within healthcare settings. Guidance is offered in terms of developing an IR department, ensuring high-quality practice, dealing with administrative and political challenges, dealing with industry and creating a legacy.
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Affiliation(s)
- Adrian P Brady
- 36860Mercy University Hospital and University College Cork, Cork, Ireland
| | - Raman Uberoi
- 6397Oxford University Hospitals Trust, Oxford, UK
| | - Michael J Lee
- 57978Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Andreas Adam
- Professor Emeritus of Interventional Radiology, 405987King's College London, London, UK
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18
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Wang P, Zhang J, Chen Y, He Y, Shen L, Jiang M, Yang Z, Zheng J, Wang Z, Zhu J. The satisfaction with radiology residency training in China: results of a nationwide survey. Insights Imaging 2022; 13:196. [PMID: 36520298 PMCID: PMC9753880 DOI: 10.1186/s13244-022-01329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND National data on the satisfaction of radiology residents enrolled in standardized residency training (SRT) are rather scarce in China. This study identified a set of potential factors concerning SRT satisfaction among radiology residents as well as the association between SRT satisfaction and post-competency and well-being. METHODS A total of 3666 radiology residents who were receiving SRT during 2020 in China were recruited across all 31 provinces. The cumulative odds logistic regression was used to examine the potential factors associated with SRT satisfaction as well as associations between satisfaction and well-being, burnout, professional identity and competency. RESULTS The prevalence of satisfaction with SRT was 68.6%. Participants who were male, worked in central China, aged more than 28 years old, had long working hours and claimed increased workload during the COVID-19 pandemic were more likely to be unsatisfied with the SRT program. Participants who were more satisfied with the radiation protection were more likely to report higher degree of SRT satisfaction (OR = 3.00, 95% CI 2.58-3.50). In addition, SRT satisfaction was positively associated with well-being, professional identity, competency and lower burnout. CONCLUSIONS Perceived satisfaction can be introduced into hospital management, as it may reflect the overall situation of the residents during residency training and influence radiologists' well-being, professional identification and competency. Appropriate measures should be taken to reduce the risk of radiation exposure, ensure employee safety (such as risk assessment system and paid time off), provide radiology residents with fair treatment and guarantee the time out of working for optimizing their professional ability.
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Affiliation(s)
- Peicheng Wang
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China
| | - Jingfeng Zhang
- grid.9227.e0000000119573309Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yanhua Chen
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China
| | - Yanrong He
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China
| | - Lijun Shen
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China
| | - Maoqing Jiang
- grid.9227.e0000000119573309Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhenghan Yang
- grid.24696.3f0000 0004 0369 153XDepartment of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- grid.9227.e0000000119573309Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhenchang Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiming Zhu
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China ,grid.12527.330000 0001 0662 3178Institute for Healthy China, Tsinghua University, Beijing, China
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Rohren SA, Kamel S, Khan ZA, Patel P, Ghannam S, Gopal A, Hsieh PH, Elsayes KM. A call to action; national survey of teaching radiology curriculum to medical students. J Clin Imaging Sci 2022; 12:57. [PMID: 36325497 PMCID: PMC9610045 DOI: 10.25259/jcis_36_2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/21/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives: Radiology and medical imaging are important yet often an underrepresented facet of medical education. Notably, there is concern among radiologists that students do not receive enough radiology exposure and that they struggle to interpret image findings on entering residency. Therefore, this survey aims to identify how medical students perceive the radiology curriculum and to determine gaps in delivery. Material and Methods: Students were recruited from United States (US) medical schools and given a 21-question survey assessing their perception of the radiology curriculum as well as asking about their confidence levels regarding medical imaging. The inclusion criteria were age >18 and enrolled in US medical school. The surveys were completed in April–July 2020 by students across the US. Objective parameters were measured as percentage correct, while subjective parameters used a 4-point Likert scale. Results: A total of 472 medical students across 31 medical schools completed the surveys with a response rate of 69%. Responses represented all class years within medical schools and showed equal distribution among the future career plans. Students responded that didactic lectures were the most common teaching method and that radiologists were their primary teachers during preclinical education. Students were unfamiliar with the American College of Radiology appropriateness criteria with 65% responding they had never heard of it and 33% reporting that they have heard of it but never used it. In assessing students’ perceptions of radiology education, 72% of students responded that they received too little, and 28% of students responded, “Just right.” <1% of students responded that there was “Too much” radiology in their curriculum. Conclusion: Radiologists are increasing their educational representation in medical school curricula. Despite this, radiology continues to be under-represented with students desiring more exposure to medical imaging. Integrating the student’s perceptions with existing curricula suggests that efforts should focus on increasing awareness of which studies are appropriate and teaching students how to systematically interpret an image.
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Affiliation(s)
- Scott Andrew Rohren
- School of Medicine, Baylor College of Medicine, Houston, Texas, United States,
| | - Serageldin Kamel
- Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas, United States,
| | - Zoha A. Khan
- School of Medicine, McGovern Medical School at UT Health, Houston, Texas, United States,
| | - Parth Patel
- School of Medicine, McGovern Medical School at UT Health, Houston, Texas, United States,
| | - Sammar Ghannam
- Department of Radiology, UT Health Science Center at San Antonio, San Antonio, Texas, United States,
| | - Akilan Gopal
- School of Medicine, University of Texas Southwestern, Dallas, Texas, United States,
| | - Peggy H. Hsieh
- Office of Educational Programs, McGovern Medical School, Houston, Texas, United States,
| | - Khaled M. Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, United States,
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Cabral Frade H, Wilson SE, Beckwith A, Powers WJ. Comparison of Outcomes of Ischemic Stroke Initially Imaged With Cranial Computed Tomography Alone vs Computed Tomography Plus Magnetic Resonance Imaging. JAMA Netw Open 2022; 5:e2219416. [PMID: 35862046 PMCID: PMC9305377 DOI: 10.1001/jamanetworkopen.2022.19416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Patients with acute ischemic stroke often undergo magnetic resonance imaging (MRI) in addition to computed tomography (CT), but its association with clinical outcomes is uncertain. OBJECTIVE To assess whether clinical outcomes of patients with acute ischemic stroke with initial CT alone were noninferior to those with additional MRI. DESIGN, SETTING, AND PARTICIPANTS A retrospective observational propensity score-matched cohort study of clinical outcomes at discharge and 1 year for patients hospitalized with acute ischemic stroke was conducted at an academic medical center between January 2015 and December 2017. Data collection from an electronic medical record system performed from May 2020 through January 2022 was not completely blinded. Noninferiority margins were based on the designs of previous randomized clinical trials of ischemic stroke treatments. Statistical analysis was performed in January 2022. Participants were adults hospitalized with acute ischemic stroke with admission diagnosis based on CT. Exclusion criteria were primarily missing data. From 508 eligible patients, all 123 cases with additional MRI were propensity-score matched to 123 controls without. EXPOSURE MRI after initial diagnosis. MAIN OUTCOMES AND MEASURES Death or dependence at hospital discharge (modified Rankin Scale score of 3-6) and stroke or death occurring in survivors within 1 year after discharge. RESULTS Among 246 participants, the median age was 68 years (IQR, 58-78.8 years) and 131 (53.0%) were men. Death or dependence at discharge occurred more often in patients with additional MRI (59 of 123 [48.0%]) than in those with CT alone (52 of 123 [42.3%]; absolute difference, 5.7%; 95% CI, -6.7% to 18.1%), meeting the -7.50% criterion for noninferiority. Stroke or death within 1 year after discharge determined for 225 of 235 (96%) survivors occurred more often in patients with additional MRI (22 of 113 [19.5%]) than in those with CT alone (14 of 112 [12.5%]; relative risk, 1.14; 95% CI, 0.86-1.50), meeting the 0.725 relative risk criterion for noninferiority. CONCLUSIONS AND RELEVANCE This propensity score-matched cohort study of patients hospitalized with acute ischemic stroke found that a diagnostic imaging strategy of initial CT alone was noninferior to initial CT plus additional MRI with regard to clinical outcomes at discharge and at 1 year. Further research is needed to determine which patients hospitalized with acute ischemic stroke benefit from MRI.
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Affiliation(s)
- Heitor Cabral Frade
- Department of Neurology, the University of Texas Medical Branch at Galveston
| | - Susan E. Wilson
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill
| | - Anne Beckwith
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill
| | - William J. Powers
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill
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The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR). Insights Imaging 2022; 13:100. [PMID: 35662384 PMCID: PMC9167391 DOI: 10.1186/s13244-022-01241-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Radiology as a specialty has been enormously successful since its beginnings, moving over time from an adjunct to clinical decision-making to a crucial component of multidisciplinary patient care. However, this increased centrality of radiology and reliance on our services carries within it dangers, prominent among them being the danger of our being viewed as deliverers of a commodity, and the risk of our becoming overwhelmed by increasing workload, unable to interact sufficiently with patients and referrers due to pressure of work. With this White Paper, the Board of Directors of the European Society of Radiology (ESR) seeks to briefly explain the position of the radiologist in the modern healthcare environment, considering our duties and contributions as doctors, protectors, communicators, innovators, scientists and teachers. This statement is intended to serve as a summary of the breadth of our responsibilities and roles, and to assist radiologists in countering misunderstanding of who we are and what we do.
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Andersen ER, Hofmann BM, Kjelle E. Reducing low-value radiological services in Norway -a qualitative multi-professional study on measures and facilitators for change. BMC Health Serv Res 2022; 22:678. [PMID: 35596215 PMCID: PMC9122550 DOI: 10.1186/s12913-022-08077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/11/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Overuse, underuse, and significant variation in the utilisation of radiological services are well documented in the literature. Several radiological examinations are identified as low-value examinations as they do not lead to a change in diagnosis or course of treatment. Even so, such examinations are frequently performed. Many measures for reducing low-value imaging have been carried out with variable outcomes. While there is little evidence as to why some measures work and others do not, adjusting to the context seems important for success. The objective of this study was to investigate which measures stakeholders consider appropriate for reducing the use of low-value imaging and what it takes to make them work. METHODS Semi-structured interviews were conducted among radiographers, radiologists, radiological department managers, hospital clinicians, general practitioners, and health government/authorities' representatives. The interview guide covered two broad areas: Experience with low-value services, and possible future measures deemed appropriate for reducing low-value services. Data were analysed in line with a qualitative framework analysis. RESULTS The analysis included information from 27 participants. All participants acknowledged that low-value imaging was a problem, but few had very specific suggestions on reducing this in practice. Suggested measures were to stop referrals from being sent, provide support in assessing referrals, or change the healthcare system. Identified facilitators were categorised as management and resources, evidence, and experienced value. In general, appropriate measures should be practical, well-founded, and valuable. CONCLUSIONS This study provides insight into various stakeholders' perceptions of suitable interventions to reduce low-value imaging. While many measures for reducing low-value imaging are available, contextual sensitivity is crucial to make them work.
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Affiliation(s)
- Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 1, N-2802, Gjøvik, Norway.
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 1, N-2802, Gjøvik, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 1, N-2802, Gjøvik, Norway
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23
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Kjelle E, Andersen ER, Krokeide AM, Soril LJJ, van Bodegom-Vos L, Clement FM, Hofmann BM. Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Arne Magnus Krokeide
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Lesley J J Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Leti van Bodegom-Vos
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fiona M Clement
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics, The University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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24
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Brady AP. Radiology's Contribution to Individual Healthcare and to Society - a Shift from Volume to Value. Can Assoc Radiol J 2022; 73:616-617. [PMID: 35442109 DOI: 10.1177/08465371221093276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Hill H, Mittal R, Merlin T. Evidence-based funding of new imaging applications and technologies by Medicare in Australia: How it happens and how it can be improved. J Med Imaging Radiat Oncol 2022; 66:215-224. [PMID: 35243777 PMCID: PMC9310840 DOI: 10.1111/1754-9485.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Medical Services Advisory Committee (MSAC) is responsible for the assessment of medical imaging tests proposed for public funding. A number of factors related to the clinical or cost effectiveness of an imaging service may impact on the funding decision. OBJECTIVE To determine what evidentiary and economic factors impact most on MSAC recommendations for the funding of imaging tests. METHODS Information was extracted on health technology assessments (HTAs) of medical imaging tests published on the MSAC website, with a funding decision between 2006 to July 2021. Imaging tests with diagnostic, staging or screening indications were eligible. Data were extracted in test-indication pairs and included data on evidence quality, quantity, consistency of findings, cost-effectiveness and financial impact. Multivariate logistic regression analysis was performed with adjustments for clustered data. RESULTS Overall, 42 imaging test applications to MSAC were included, representing 91 clinical indications. Most were diagnostic tests. The most common evidentiary concerns reported by MSAC were limited evidence (36%), low quality evidence (26%), and applicability of the data (22%). The reference standard for diagnostic accuracy was imperfect or not appropriate in 25% of the indications. In regression analyses, uncertainty about cost-effectiveness of an imaging service predicted most negative funding decisions. CONCLUSIONS The single biggest contributor to a negative funding decision by MSAC was uncertainty about the cost-effectiveness of the imaging service. This was likely driven by uncertainty regarding the impact on patient health. HTAs that are able to demonstrate the clinical utility of a new imaging service are more likely to publicly funded.
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Affiliation(s)
- Hayley Hill
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Ruchi Mittal
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Tracy Merlin
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
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Kwee TC, Yakar D, Pennings JP, Kasalak Ö. Value-based radiology cannot thrive without reforms and research. Eur Radiol 2022; 32:4337-4339. [PMID: 35149909 DOI: 10.1007/s00330-022-08583-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 12/22/2022]
Abstract
KEY POINTS • A value-based system aims to achieve improved patient-relevant outcomes without increasing costs.• Value-based radiology cannot thrive as long as volume dominates as the most important metric to reward clinical performance.• Reforms and research are needed to enable radiologists to practice value-based healthcare.
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Affiliation(s)
- Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Jan P Pennings
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Ömer Kasalak
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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27
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Hofmann B, Andersen ER, Kjelle E. What can we learn from the SARS-COV-2 pandemic about the value of specific radiological examinations? BMC Health Serv Res 2021; 21:1158. [PMID: 34702243 PMCID: PMC8546787 DOI: 10.1186/s12913-021-07190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The SARS-COV-2 pandemic provides a natural intervention to assess practical priority setting and internal evaluation of specific health services, such as radiological services. Norway makes an excellent case as it had a very low infection rate and very few cases of COVID-19. Accordingly, the objective of this study is to use the changes in performed outpatient radiological examinations during the first stages of the SARS-COV-2 pandemic to assess the practical evaluation of specific radiological examinations in Norway. METHODS Data was collected retrospectively from the Norwegian Health Economics Administration (HELFO) in the years 2015-2020. Data included the number of performed outpatient imaging examinations at public hospitals and private imaging centers in Norway and was divided in to three periods based on the level of restrictions on elective health services. Results were analyzed with descriptive statistics. RESULTS In the first period there was a 45% reduction in outpatient radiology compared to the same time period in 2015-2019 while in period 2 and 3 there was a 25 and 6% reduction respectively. The study identified a list of specific potential low-value radiological examinations. While some of these are covered by the Choosing Wisely campaign, others are not. CONCLUSION By studying the priority setting practice during the initial phases of the pandemic this study identifies a set of potential low value radiological examinations during the initial phases of the SARS-COV-2 pandemic. These examinations are candidates for closer assessments for health services quality improvement.
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Affiliation(s)
- Bjørn Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 191, N-2802, Gjøvik, Norway.
- Centre of Medical Ethics at the University of Oslo, Oslo, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 191, N-2802, Gjøvik, Norway
| | - Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 191, N-2802, Gjøvik, Norway
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28
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Kasalak Ö, Yakar D, Dierckx RAJO, Kwee TC. Radiologist-patient consultation of imaging findings after neck ultrasonography: An opportunity to practice value-based radiology. Clin Imaging 2021; 81:87-91. [PMID: 34655997 DOI: 10.1016/j.clinimag.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate how patients experience a radiologist-patient consultation of imaging findings directly after neck ultrasonography (US), and how much time this consumes. MATERIALS AND METHODS This prospective randomized study included 109 consecutive patients who underwent neck US, of whom 44 had a radiologist-patient consultation of US results directly after the examination, and 65 who had not. RESULTS The median ratings of all healthcare quality metrics (friendliness of the radiologist, explanation of the radiologist, skill of the radiologist, radiologist's concern for comfort during the examination, radiologist's concern for patient questions/worries, overall rating of the examination, and likelihood of recommending the examination) were either good/high or very good/very high, without any significant differences between both patient groups. Patients who did not discuss the US results with the radiologist, were significantly more worried during the examination (P = 0.040) and had significantly higher anxiety levels after completion of the US examination (P = 0.027) than patients who discussed the US results with the radiologist. Fifty-one out of 55 responding patients (92.7%) indicated a radiologist-patient consultation of US results to be important. The median duration of US examinations that included a radiologist-patient consultation of US results was 7.57 min (range: 5.15-12.10 min), while the median duration of US examinations without a radiologist-patient consultation of US results was 7.34 min (range: 3.45-14.32 min), without any significant difference (P = 0.637). CONCLUSION A radiologist-patient consultation of imaging findings after neck US decreases patient anxiety, is desired by most patients, and does not significantly prolong total examination time.
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Affiliation(s)
- Ömer Kasalak
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - Derya Yakar
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
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29
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Kjelle E, Andersen ER, Soril LJJ, van Bodegom-Vos L, Hofmann BM. Interventions to reduce low-value imaging - a systematic review of interventions and outcomes. BMC Health Serv Res 2021; 21:983. [PMID: 34537051 PMCID: PMC8449221 DOI: 10.1186/s12913-021-07004-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is estimated that 20-50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. METHODS An electronic database search was completed in Medline - Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. RESULTS The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. CONCLUSIONS Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
| | - Lesley J. J. Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6 Canada
| | - Leti van Bodegom-Vos
- Medical Decision making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
- Centre of Medical Ethics, University of Oslo, Postbox 1130, Blindern, 0318 Oslo, Norway
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30
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Abstract
We argue radiologists generate most of their value by serving as translators and communicators-linguists skilled in the languages of imaging. The disconnect between these core functions and how radiology practices are paid impedes our efforts to maximize value. We believe more investigation is needed to optimize the fidelity of our translations and the coherence, visibility, and actionability of our communications.
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Value-based radiology: what is the ESR doing, and what should we do in the future? Insights Imaging 2021; 12:108. [PMID: 34318401 PMCID: PMC8316510 DOI: 10.1186/s13244-021-01056-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 01/11/2023] Open
Abstract
Value-based radiology (VBR) is rapidly gaining ground as a means of considering the input of radiology practice into individual and societal healthcare, and represents a welcome move away from older metrics focused on counting studies performed, without consideration of whether these studies contributed positively to patient management or to society as a whole. Intrinsic to the process of considering whether radiology activity confers value is recognising the breadth of involvement of radiology in healthcare delivery; previous ESR and multi-society publications have explored this, and have sought to highlight the many ways in which our specialty contributes to patient welfare. This paper is intended to highlight some current ESR activities which already contribute substantially to value creation and delivery, and to outline a selection of practical steps which could be taken by the ESR in the future to enhance value. Patient summary Value-based radiology (VBR) is a conceptual means of looking at the benefits conferred on patients and on society as a whole by provision of radiology services, as opposed to older means of counting numbers of radiology studies performed, without consideration of whether or not those studies contributed overall value. VBR will become increasingly important in the future as a means of determining resources. The ESR has been a leader in advancing VBR concepts and educating radiologists about this novel way of looking at what we do. This paper is designed to highlight current ESR activities which contribute value to healthcare, and to consider other ways in which the ESR could potentially support value enhancement in the future.
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Brady AP, Bello JA, Derchi LE, Fuchsjäger M, Goergen S, Krestin GP, Lee EJY, Levin DC, Pressacco J, Rao VM, Slavotinek J, Visser JJ, Walker REA, Brink JA. Radiology in the Era of Value-Based Healthcare: A Multi Society Expert Statement From the ACR, CAR, ESR, IS3R, RANZCR, and RSNA. J Am Coll Radiol 2021; 18:877-883. [PMID: 33358108 DOI: 10.1016/j.jacr.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. METHODS, FINDINGS AND INTERPRETATION This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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Affiliation(s)
- Adrian P Brady
- Mercy University Hospital, Cork, Ireland; European Society of Radiology (ESR), Vienna, Austria.
| | - Jaqueline A Bello
- Montefiore Medical Center, New York, New York; American College of Radiology (ACR), Reston, Virginia
| | - Lorenzo E Derchi
- University of Genoa, Genoa, Italy; European Society of Radiology (ESR), Vienna, Austria
| | - Michael Fuchsjäger
- Medical University Graz, Graz, Austria; European Society of Radiology (ESR), Vienna, Austria
| | - Stacy Goergen
- Monash University, Melbourne, Australia; Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia
| | - Gabriel P Krestin
- Erasmus Medical Center, Rotterdam, the Netherlands; International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Emil J Y Lee
- Langley Memorial Hospital, Langley, Canada; Canadian Association of Radiologists (CAR), Ottawa, Canada
| | - David C Levin
- Thomas Jefferson University, Philadelphia, Pennsylvania; Radiological Society of North America (RSNA), Oak Brook, Illinois
| | - Josephine Pressacco
- McGill University, Montreal, Canada; Canadian Association of Radiologists (CAR), Ottawa, Canada
| | - Vijay M Rao
- Thomas Jefferson University, Philadelphia, Pennsylvania; Radiological Society of North America (RSNA), Oak Brook, Illinois
| | - John Slavotinek
- Flinders Medical Centre and Flinders University, Adelaide, Australia; Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia
| | - Jacob J Visser
- Erasmus Medical Center, Rotterdam, the Netherlands; International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Richard E A Walker
- University of Calgary, Calgary, Canada; Canadian Association of Radiologists (CAR), Ottawa, Canada
| | - James A Brink
- Harvard Medical School, Boston, Massachusetts; American College of Radiology (ACR), Reston, Virginia; International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
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33
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The vanishing radiologist-an unseen danger, and a danger of being unseen. Eur Radiol 2021; 31:5998-6000. [PMID: 33569618 DOI: 10.1007/s00330-021-07723-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/24/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
KEY POINTS • Radiology has developed into a central and important part of patient care.• A combination of technological developments, increasing workload and radiologists' behaviour run the risk of diminishing the visibility of radiologists to referrers and patientsRadiology has developed into a central and important part of patient care.• It is vital for the successful future of radiology that we remain conscious of the need to maintain visibility of who we are and what we contribute to patient care.
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Patient survey of value in relation to radiology: results from a survey of the European Society of Radiology (ESR) value-based radiology subcommittee. Insights Imaging 2021; 12:6. [PMID: 33411144 PMCID: PMC7790952 DOI: 10.1186/s13244-020-00943-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 01/02/2023] Open
Abstract
Rationale and methodology A survey of patients was carried out between January and June 2019, to better understand how patients interpret value in relation to radiology as a means to refining the concept of Value-Based Radiology (VBR) in Europe, ensure radiology’s value is properly weighted in Value-Based Health Care (VBH) metrics, and maximise the value of radiological services to patients. The survey was disseminated via various heads of radiology departments, ESR officers, patient organisations, and ESR website and social media channels. Results Responses were received from 400 patients from 22 countries. Whilst most expressed general satisfaction with the radiological services they received, certain aspects of the radiological services they received left room for improvement. Thirty-six percent of respondents reported that they were not satisfied with the information provided about the risks and benefits of procedures, and thirty-three percent reported not being satisfied with the availability of radiologists for consultation, potentially suggesting that some patients lack sufficient information to participate fully in treatment decisions. Patients were often unaware of what information they were entitled to receive. Over eighty percent of respondents were unfamiliar with the concepts of Value-Based Radiology and/or Value-Based Health Care. Conclusion In addition to procedural correctness (correct diagnosis, appropriate procedures performed), patients highly value information and communication with their radiologist (information provided about procedures, explanation of results, personal consultation). Lack of communication was found to be a cause of dissatisfaction in many cases. This could suggest a means of improving patient outcomes as measured by Value-Based Health Care metrics.
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35
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Brady AP, Bello JA, Derchi LE, Fuchsjäger M, Goergen S, Krestin GP, Lee EJY, Levin DC, Pressacco J, Rao VM, Slavotinek J, Visser JJ, Walker REA, Brink JA. Radiology in the Era of Value-Based Healthcare: A Multi-Society Expert Statement From the ACR, CAR, ESR, IS3R, RANZCR, and RSNA. Can Assoc Radiol J 2020; 72:208-214. [PMID: 33345576 DOI: 10.1177/0846537120982567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. METHODS, FINDINGS AND INTERPRETATION This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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Affiliation(s)
- Adrian P Brady
- 36860Mercy University Hospital, Cork, Ireland.,European Society of Radiology (ESR), Vienna, Austria
| | - Jaqueline A Bello
- Montefiore Medical Center, New York, USA.,American College of Radiology (ACR), Reston, VA, USA
| | - Lorenzo E Derchi
- European Society of Radiology (ESR), Vienna, Austria.,University of Genoa, Italy
| | - Michael Fuchsjäger
- European Society of Radiology (ESR), Vienna, Austria.,Medical University Graz, Austria
| | - Stacy Goergen
- Monash University, Melbourne, Victoria, Australia.,Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, New South Wales, Australia
| | - Gabriel P Krestin
- 6993Erasmus Medical Center, Rotterdam, the Netherlands.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Emil J Y Lee
- 60460Langley Memorial Hospital, British Columbia, Canada.,Canadian Association of Radiologists (CAR), Ottawa, Ontario, Canada
| | - David C Levin
- 6559Thomas Jefferson University, Philadelphia, PA, USA.,Radiological Society of North America (RSNA), Oak Brook, IL, USA
| | - Josephine Pressacco
- Canadian Association of Radiologists (CAR), Ottawa, Ontario, Canada.,5620McGill University, Montreal, Quebec, Canada
| | - Vijay M Rao
- 6559Thomas Jefferson University, Philadelphia, PA, USA.,Radiological Society of North America (RSNA), Oak Brook, IL, USA
| | - John Slavotinek
- Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, New South Wales, Australia.,14351Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Jacob J Visser
- 6993Erasmus Medical Center, Rotterdam, the Netherlands.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Richard E A Walker
- Canadian Association of Radiologists (CAR), Ottawa, Ontario, Canada.,2129University of Calgary, Alberta, Canada
| | - James A Brink
- American College of Radiology (ACR), Reston, VA, USA.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria.,1811Harvard Medical School, Boston, MA, USA
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Brady AP, Bello JA, Derchi LE, Fuchsjäger M, Goergen S, Krestin GP, Lee EJY, Levin DC, Pressacco J, Rao VM, Slavotinek J, Visser JJ, Walker REA, Brink JA. Radiology in the era of value-based healthcare: a multi-society expert statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNA. Insights Imaging 2020; 11:136. [PMID: 33345287 PMCID: PMC7750384 DOI: 10.1186/s13244-020-00941-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology’s central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the healthcare value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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Affiliation(s)
- Adrian P Brady
- Mercy University Hospital, Cork, Ireland. .,European Society of Radiology (ESR), Vienna, Austria.
| | - Jaqueline A Bello
- Montefiore Medical Center, New York, USA.,American College of Radiology (ACR), Reston, USA
| | - Lorenzo E Derchi
- University of Genoa, Genoa, Italy.,European Society of Radiology (ESR), Vienna, Austria
| | - Michael Fuchsjäger
- Medical University Graz, Graz, Austria.,European Society of Radiology (ESR), Vienna, Austria
| | - Stacy Goergen
- Monash University, Melbourne, Australia.,Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia
| | - Gabriel P Krestin
- Erasmus Medical Center, Rotterdam, The Netherlands.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Emil J Y Lee
- Langley Memorial Hospital, Langley, Canada.,Canadian Association of Radiologists (CAR), Ottawa, Canada
| | - David C Levin
- Thomas Jefferson University, Philadelphia, USA.,Radiological Society of North America (RSNA), Oak Brook, USA
| | - Josephine Pressacco
- McGill University, Montreal, Canada.,Canadian Association of Radiologists (CAR), Ottawa, Canada
| | - Vijay M Rao
- Thomas Jefferson University, Philadelphia, USA.,Radiological Society of North America (RSNA), Oak Brook, USA
| | - John Slavotinek
- Flinders Medical Centre and Flinders University, Adelaide, Australia.,Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia
| | - Jacob J Visser
- Erasmus Medical Center, Rotterdam, The Netherlands.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Richard E A Walker
- University of Calgary, Calgary, Canada.,Canadian Association of Radiologists (CAR), Ottawa, Canada
| | - James A Brink
- Harvard Medical School, Boston, USA.,American College of Radiology (ACR), Reston, USA.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
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Brady AP, Bello JA, Derchi LE, Fuchsjäger M, Goergen S, Krestin GP, Lee EJ, Levin DC, Pressacco J, Rao VM, Slavotinek J, Visser JJ, Walker RE, Brink JA. Radiology in the era of value-based healthcare: A multi-society expert statement from the ACR, CAR, ESR, IS3R, RANZCR and RSNA. J Med Imaging Radiat Oncol 2020; 65:60-66. [PMID: 33345440 DOI: 10.1111/1754-9485.13125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The value-based healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. METHODS, FINDINGS AND INTERPRETATION This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia and New Zealand, describes the place of radiology in VBH models and the healthcare value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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Affiliation(s)
- Adrian P Brady
- Mercy University Hospital, Cork, Ireland.,European Society of Radiology (ESR), Vienna, Austria
| | - Jaqueline A Bello
- Montefiore Medical Center, New York, New York, USA.,American College of Radiology (ACR), Reston, Virginia, USA
| | - Lorenzo E Derchi
- European Society of Radiology (ESR), Vienna, Austria.,University of Genoa, Genoa, Italy
| | - Michael Fuchsjäger
- European Society of Radiology (ESR), Vienna, Austria.,Medical University Graz, Graz, Austria
| | - Stacy Goergen
- Monash University, Melbourne, Victoria, Australia.,Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, New South Wales, Australia
| | - Gabriel P Krestin
- Erasmus Medical Center, Rotterdam, The Netherlands.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Emil Jy Lee
- Langley Memorial Hospital, Langley, British Columbia, Canada.,Canadian Association of Radiologists (CAR), Ottawa, Ontario, Canada
| | - David C Levin
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Radiological Society of North America (RSNA), Oak Brook, Illinois, USA
| | - Josephine Pressacco
- Canadian Association of Radiologists (CAR), Ottawa, Ontario, Canada.,McGill University, Montreal, Quebec, Canada
| | - Vijay M Rao
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Radiological Society of North America (RSNA), Oak Brook, Illinois, USA
| | - John Slavotinek
- Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, New South Wales, Australia.,Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Jacob J Visser
- Erasmus Medical Center, Rotterdam, The Netherlands.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria
| | - Richard Ea Walker
- Canadian Association of Radiologists (CAR), Ottawa, Ontario, Canada.,University of Calgary, Calgary, Alberta, Canada
| | - James A Brink
- American College of Radiology (ACR), Reston, Virginia, USA.,International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria.,Harvard Medical School, Boston, Massachusetts, USA
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Brady AP, Bello JA, Derchi LE, Fuchsjäger M, Goergen S, Krestin GP, Lee EJY, Levin DC, Pressacco J, Rao VM, Slavotinek J, Visser JJ, Walker REA, Brink JA. Radiology in the Era of Value-based Healthcare: A Multi-Society Expert Statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNA. Radiology 2020; 298:486-491. [PMID: 33346696 DOI: 10.1148/radiol.2020209027] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined. Published under a CC BY 4.0 license.
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Affiliation(s)
- Adrian P Brady
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L.†, V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Jaqueline A Bello
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Lorenzo E Derchi
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Michael Fuchsjäger
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Stacy Goergen
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Gabriel P Krestin
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Emil J Y Lee
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - David C Levin
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Josephine Pressacco
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Vijay M Rao
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - John Slavotinek
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Jacob J Visser
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - Richard E A Walker
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
| | - James A Brink
- From Mercy University Hospital, Grenville Place, Centre, Cork, T12 WE28, Ireland (A.P.B.); European Society of Radiology (ESR), Vienna, Austria (A.P.B., L.E.D., M.F.); Montefiore Medical Center, New York, NY (J. Bello); American College of Radiology (ACR), Reston, Va (J. Bello, J. Brink); University of Genoa, Genoa Italy (L.E.D.); Medical University Graz, Graz, Austria (M.F.); Monash University, Melbourne, Australia (S.G.); Royal Australian and New Zealand College of Radiologists (RANZCR), Sydney, Australia (S.G., J.S.); Erasmus Medical Center, Rotterdam, the Netherlands (G.P.K., J.J.V., J. Brink); International Society for Strategic Studies in Radiology (IS3R), Vienna, Austria (G.P.K., J.J.V.); Langley Memorial Hospital, Langley, Canada (E.J.Y.L.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Thomas Jefferson University, Philadelphia, Pa (D.C.L., V.M.R.); Radiological Society of North America (RSNA), Oak Brook, Ill (D.C.L., V.M.R.); McGill University, Montreal, Canada (J.P.); Canadian Association of Radiologists (CAR), Ottawa, Canada (E.J.Y.L., J.P., R.E.A.W.); Flinders Medical Centre and Flinders University, Adelaide, Australia (J.S.); University of Calgary, Calgary, Canada (R.E.A.W.); Harvard Medical School, Boston, Mass (J. Brink)
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