Radiology report turnaround: expectations and solutions

Backlogs in formal interpretation of radiology examinations: a pilot global survey

OBJECTIVE

Anecdotal reports from imaging facilities globally suggest growing radiology interpretation reporting delays. This pilot study's primary aim was to estimate the backlog of formal interpretation of imaging examinations.

METHODS

An online survey was distributed to radiologists globally to gather practice-specific characteristics, imaging volumes, and reporting for 3 types of examinations (brain/head CT scans, chest CT scans, and chest radiographs) at 4 time points: 7, 30, 90 days, and 6 months.

RESULTS

We received responses from 49 radiologists in 16 countries on six continents. Unreported examinations (backlog) were present in thirty of 44 (68%) facilities. Backlogs for brain/head CT, chest CT, and chest radiographs were present in, respectively, 48%, 50%, and 59% of facilities at 7 days and 20%, 23%, and 32% of facilities at 6 months. When present, the mean proportion of backlog (range) at 7 days was 17% (1 to 96) for brain/head CT, 18% (3 to 82) for chest CT, and 22% (1 to 99) for chest radiographs.

CONCLUSIONS

Our findings from this pilot study show a widespread global backlog in reporting common imaging examinations, and further research is needed on the issue and contributing factors.

Emergency triage of brain computed tomography via anomaly detection with a deep generative model

Triage is essential for the early diagnosis and reporting of neurologic emergencies. Herein, we report the development of an anomaly detection algorithm (ADA) with a deep generative model trained on brain computed tomography (CT) images of healthy individuals that reprioritizes radiology worklists and provides lesion attention maps for brain CT images with critical findings. In the internal and external validation datasets, the ADA achieved area under the curve values (95% confidence interval) of 0.85 (0.81–0.89) and 0.87 (0.85–0.89), respectively, for detecting emergency cases. In a clinical simulation test of an emergency cohort, the median wait time was significantly shorter post-ADA triage than pre-ADA triage by 294 s (422.5 s [interquartile range, IQR 299] to 70.5 s [IQR 168]), and the median radiology report turnaround time was significantly faster post-ADA triage than pre-ADA triage by 297.5 s (445.0 s [IQR 298] to 88.5 s [IQR 179]) (all p < 0.001).

The experiences of sonographers with regard to report writing and communicating their findings

BACKGROUND

Sonographers in South Africa are legally allowed to write their own reports; however, they often lack adequate training in providing a well-structured and coherent formal written report.

AIM

The aim of this study was to explore and describe how sonographers in the Gauteng province experience the responsibility of report writing and to develop recommendations that could assist sonographers in the execution of their duty.

SETTING

Focus group discussions (FGDs) with sonographers from private and public hospitals located in Gauteng province were conducted at neutral locations that were convenient for the sonographers.

METHODS

A qualitative phenomenological research design was used for this study. A two-stage sampling approach was employed to recruit information-rich sonographers to partake in this study. Purposeful sampling was used to select sonographers based on their first-hand experience of report writing, followed by snowball sampling which allowed the researcher access to new participants on the recommendation of previous sonographers. Thirteen female sonographers voluntarily participated in the study, and the FGDs continued until data saturation was reached. The views and opinions of the sonographers were analysed using content analysis.

RESULTS

Key findings of this study indicated that sonographers felt unprepared to describe ultrasound findings correctly in order to provide a coherent and well-structured formal written report.

CONCLUSION

Sonographers suggested the use of workshops or further training at higher educational institutions (HEIs) to support sonographers in their report-writing role.

CONTRIBUTION

The experiences identified by sonographers can assist HEIs to provide further training or workshops to support sonographers in communicating their findings effectively.

A Population-Level Summary of Health Care Utilization for the Management of Patellar Tendinopathy in the Military Health System

Patellar tendinopathy (PT) is a common nontraumatic orthopaedic disorder of the knee suffered by many service members. Understanding the make-up of usual care for PT at the system level can better frame current clinical gaps and areas that need improvement. Exercise therapy is recommended as a core treatment for PT, but it is unclear how often it is used as a part of usual care for PT within the Military Health System (MHS). The purpose of the study was to identify interventions used in the management of PT and the timing of these interventions. A secondary purpose was to determine if exercise therapy use was associated with reduced recurrence of knee pain. In total, 4,719 individuals aged 17 to 50 years in the MHS diagnosed with PT between 2010 and 2011 were included. Pharmacological and nonpharmacological interventions, visits to specialty providers, and imaging services were captured. Descriptive statistics were used to report the findings. Interventions were further categorized as being part of initial care (within the first 7 days), the initial episode of care (within the first 60 days), or the 2-year time period after diagnosis. Linear regression assessed the relationship between the number of exercise therapy visits in the initial episode of care and recurrences of knee pain. In total, 50.6% of this cohort had no more than one medical visit total for PT. Exercise therapy (18.2%) and nonsteroidal anti-inflammatory drugs (4.3%) were the two most used interventions in the initial episode of care. Radiographs were ordered for 23.1% of the cohort in the initial episode of care. The number of exercise therapy visits a patient received during the initial episode of care was not associated with recurrences of knee pain. Half of the individuals received no further care beyond an initial visit for the diagnosis of PT. Exercise therapy was the most common intervention used during the initial episode of care, but exercise therapy did not influence the recurrence of knee pain.

The relationship between knee radiographs and the timing of physical therapy in individuals with patellofemoral pain

BACKGROUND

Routine knee radiographs are discouraged for individuals with non-traumatic knee pain, but they are often still ordered despite limited evidence for their value in guiding treatment choices. Radiograph utilization may delay the use of physical therapy, which has been associated with improved outcomes and lower long-term costs.

OBJECTIVE

To examine the relationship between obtaining knee radiographs for patients with patellofemoral pain (PFP) and the timing of physical therapy, and the association between ordering radiographs for patients who use physical therapy and the likelihood of knee pain recurrence.

STUDY DESIGN

Retrospective cohort.

SETTING

United States Military Health System civilian and military clinics.

PATIENTS

23,332 individuals aged 18 to 50 diagnosed with PFP between 2010 and 2011 in the United States Military Health System who received physical therapy.

INTERVENTIONS

Physical therapy provided to individuals who did or did not receive an initial radiograph.

MAIN OUTCOME MEASURES

Timing of physical therapy and recurrence of knee pain were compared between groups (with and without initial radiographs).

RESULTS

If radiographs were used, the odds of initiating physical therapy (aOR = 0.78; 95% CI 0.64 to 0.94) within 30 days of the initial diagnosis were significantly lower. The mean days from diagnosis to initiating physical therapy was 12.1 (95% CI 9.1 to 16.1) if patients had radiographs versus 6.9 (95% CI 5.2 to 9.1) without. The odds of knee pain recurrence were no greater if radiographs were used (aOR = 1.01; 95% CI 0.83 to 1.22).

CONCLUSIONS

Receiving knee radiographs as part of initial care for PFP was associated with delayed initiation of physical therapy, but there was no association between early knee radiographs and recurrence of knee pain. Routine use of radiographs for PFP is not warranted, and can potentially delay appropriate treatment. This article is protected by copyright. All rights reserved.

A silver bullet? The role of radiology information system data mining in defining gunshot injury trends at a South African tertiary-level hospital

Background

South Africa (SA) has no national injury surveillance system, and hence, non-fatal gunshot injuries are not routinely recorded. Most firearm-related injuries require multi-detector computer tomography (MDCT) assessment at a tertiary-level facility. MDCT scanning for victims with gunshot injuries thus provide an indication of the societal burden of firearm trauma. The potential of the modern radiology information system (RIS) to serve as a robust research tool in such settings is not fully appreciated.

Objective

The aim of this study was to evaluate the use of institutional RIS data in defining MDCT scanning trends for gunshot victims presenting to a tertiary-level SA hospital.

Method

A single-institution, retrospective, comparative study was conducted at the Tygerberg Hospital (TBH) Trauma Unit for the years 2013 and 2018. Using data-mining software, customised RIS searches for information on all gunshot-related emergency computed tomography scans in the respective years were performed. Demographic, temporal, anatomical and scan-protocol trends were analysed by cross tabulation, Chi-squared and Fisher’s exact tests.

Results

Gunshot-related emergency MDCT scans increased by 62% (546 vs. 887) from 2013 to 2018. Lower-limb CT angiography was the commonest investigation in both periods. A higher proportion of victims in 2018 sustained thoracic injuries (12.5% vs. 19.8%; p < 0.01) and required imaging of more than two body parts (13.1% vs. 19.2%; p < 0.01).

Conclusion

By using RIS data to demonstrate the increasing gunshot-related MDCT workload in the review period, as well as a pattern of more complex and potentially life-threatening injury, this study highlights the burden of firearm trauma in the society and the potential role of the modern RIS as a robust research tool.

Subspecialized radiological reporting reduces radiology report turnaround time

Objectives

The objective of this study was to compare the radiology report turnaround time (RTAT) between decentralized/modality-based and centralized/subspecialized radiological reporting at a multi-center radiology enterprise.

Methods

RTAT values for MRI, CT, and conventional radiography were compared between decentralized/modality-based (04 September 2017–22 December 2017) and centralized/subspecialized radiology (03 September 2018–21 December 2018) reporting grouped into three subspecializations (body radiology, musculoskeletal radiology, and neuroradiology) at eleven sites of a multi-center radiology enterprise. For the objective of this investigation, hospitals were defined as major and minor hospitals. The Mann-Whitney U test served for statistical analyses.

Results

Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology resulted overall in a significant decrease of the RTAT: from 82 to 77 min for the first signature (p < 0.001), and 119 to 107 min and 295 to 238 min for the second signature (p < 0.001). Subgroup analyses demonstrate a significant decrease of the RTAT for MRI reports (e.g., second signature RTAT, 1051 to 401 min; p < 0.001) and conventional radiographs (e. g., second signature RTAT, 278 to 171 min; p < 0.001). The RTAT at major hospitals decreased from 288 to 245 min (second signature; p < 0.001) while the corresponding RTAT of minor hospitals decreased more remarkably, from 300 to 198 min (p < 0.001). However, the results were heterogenous; in some analyses, the RTAT even increased. The effect size analyses represent small effects.

Conclusions

Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology was associated with a significant decreased RTAT. Specifically, the RTAT for MRI reports and conventional radiographs was significantly reduced. A pronounced RTAT decrease was observed at minor hospitals.

Assessing the Training Costs and Work of Diagnostic Radiology Residents Using Key Performance Indicators - An Observational Study

RATIONALE AND OBJECTIVES

To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turn-around time (TAT) as the outcome measure.

MATERIALS AND METHODS

In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost allocation of faculty effort. The volume of cases reported in the 2015-16 academic year and median and interquartile range (IQR) TAT for a trainee preliminary (Complete to Prelim, C-P) or an attending final (Complete to Final, C-F) radiology report were measured and stratified by time of day and patient location. Wilcoxon rank-sum tests were used (significance, p values < 0.05).

RESULTS

The annual cost of a DR resident was $99,109, 34% greater than direct salary/benefits and 27% of the direct salary/benefits cost of an attending. The total per minute cost of rendering care was $4.36 with both trainee ($0.70/minute) and faculty ($3.66/minute). Residents participated in 139,084/235,417 (59%) imaging studies. The C-P TAT was 74 (IQR, 27-180) minutes compared to 51 (IQR, 18-129) minutes C-F TAT of faculty working alone and C-F TAT of 213 (IQR, 71-469) minutes with a resident (p < 0.001). The C-P TAT vs C-F TAT between 4 pm-9 am and weekends with residents is 44 (IQR, 18-119) minutes vs 60 (IQR, 18-179) minutes without.

CONCLUSION

The cost of training DR residents exceeds the salary and benefits allocated to their training. Residents increase the absolute professional labor cost of caring for a patient. Overall TAT is slower with residents but the care delivered by residents after-hours is faster.

Exploring the Role of Artificial Intelligence in an Emergency and Trauma Radiology Department

Emergency and trauma radiologists, emergency department’s physicians and nurses, researchers, departmental leaders, and health policymakers have attempted to discover efficient approaches to enhance the provision of quality patient care. There are increasing expectations for radiology practices to deliver a dedicated emergency radiology service providing 24/7/365 on-site attending radiologist coverage. Emergency radiologists (ERs) are pressed to meet the demand of increased imaging volume, provide accurate reports, maintain a lower proportion of discrepancy rate, and with a rapid report turnaround time of finalized reports. Thus, rendering the radiologists overburdened. The demand for an increased efficiency in providing quality care to acute patients has led to the emergence of artificial intelligence (AI) in the field. AI can be used to assist emergency and trauma radiologists deal with the ever-increasing imaging volume and workload, as AI methods have typically demonstrated a variety of applications in medical image analysis and interpretation, albeit most programs are in a training or validation phase. This article aims to offer an evidence-based discourse about the evolving role of artificial intelligence in assisting the imaging pathway in an emergency and trauma radiology department. We hope to generate a multidisciplinary discourse that addresses the technical processes, the challenges in the labour-intensive process of training, validation and testing of an algorithm, the need for emphasis on ethics, and how an emergency radiologist’s role is pivotal in the execution of AI-guided systems within the context of an emergency and trauma radiology department. This exploratory narrative serves the present-day health leadership’s information needs by proposing an AI supported and radiologist centered framework depicting the work flow within a department. It is suspected that the use of such a framework, if efficacious, could provide considerable benefits for patient safety and quality of care provided. Additionally, alleviating radiologist burnout and decreasing healthcare costs over time.

Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time of Trauma-Related Imaging Studies Being Finalized Within 48 Hours in an Emergency Radiology Department, Offering a Perspective from a Tertiary Care Hospital

OBJECTIVE

To offer an evidence-based account of the effect of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma-related radiographs finalized within 48 hours of exam completion, drawing data from an emergency radiology department of a tertiary care hospital in Vancouver, British Columbia.

MATERIALS AND METHODS

This was a retrospective chart review, where TATs of imaging studies for a sample of trauma patients, who had visited the emergency department of the Vancouver General Hospital between two time periods, January 1 to September 30, 2013, and January 1 to September 30, 2017, were noted.

RESULTS

In models adjusted for patient's age, sex, and seasonality, the 24/7/365 attending radiologist coverage was associated with an average of 19.1 (95% confidence interval [CI]: 18.7-19.4) hours of reduction in time from exam completion to report finalization by an attending radiologist. Approximately 11.3 (95% CI: 18.7-19.4) hours was due to reduction in time from exam completion to preliminary diagnosis of reports. When the impact of the increased number of radiology staff in 2017 was removed in the analysis, the overall TAT was reduced by 13.3 (95% CI: 13.0-13.6) hours and the time from exam completion to preliminary report was reduced by 7.8 (95% CI: 7.6-8.1) hours.

LIMITATION

Since we have used a simple random sample (SRS) for this research, this study does not describe the burden of reports that are finalized in the emergency and trauma radiology department during the given time periods.

CONCLUSION

Our pilot study demonstrates that the implementation of 24/7/365 attending radiology coverage significantly reduces TAT for finalized radiology reports of all modalities of trauma imaging studies in an emergency and trauma radiology department.

POLICY IMPLICATION

This research serves the contemporary health-care administration, policymaking information needs by providing the evidence for significantly reduced TAT of finalized radiology reports from a Canadian perspective.

Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time in an Emergency and Trauma Radiology Department

OBJECTIVE

To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department.

PATIENTS AND METHODS

This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to September 30, 2013, and (2) January 1, 2017, to January 30, 2018, and whose reports were read by an attending emergency and trauma radiologist was noted.

RESULTS

The 24/7/365 radiology coverage was associated with a significant reduction in TAT of computed tomography reports, and the time reduction was comparable between trauma and nontrauma cases. In adjusted models, the extension of radiology coverage was associated with an average of 7.83 hours reduction in overall TAT (95% confidence interval [CI]: 7.44-8.22) for reports related to trauma, in which 2.73 hours were due to reduction in completion to transcription time (TC; 95% CI: 2.53-2.93), and 5.10 hours were due to reduction in transcription to finalization time (TF; 95% CI: 4.75-5.44). For reports related to nontrauma cases, 24/7/365 coverage was associated with an average of 6.07 hours reduction in overall TAT (95% CI: 3.54-8.59), 2.91 hours reduction in TC (95% CI: 1.55-4.26), and 3.16 hours reduction in TF (95% CI: 0.90-5.42).

CONCLUSION

Our pilot study demonstrates that the implementation of on-site 24/7/365 attending emergency radiology coverage at a tertiary care center was associated with a reduced TAT for trauma and nontrauma patients imaging studies. Although the magnitude and precision of estimates were slightly higher for trauma cases as compared to nontrauma cases. Trauma examinations stand to benefit the most from 24/7/365 attending level radiology coverage.

An Important and Often Ignored Turnaround Time in Radiology - Clinician Turnaround Time: Implications for Musculoskeletal Radiology

Background:

There has been an increase in routine musculoskeletal (MSK) MRI studies performed on weekends.

Study Aims:

First, to assess whether radiologist interpretation of routine MSK MRI studies on weekends decreases the time to when the clinician reads the radiologist’s report compared to studies performed on the weekend but interpreted the following Monday. Second, to evaluate whether reports are more likely to be read by clinicians if the MRIs are interpreted by radiologists on weekends compared to the following Monday.

Methods:

A random sample of 1765 patients who underwent routine MSK MRIs from January 1, 2015 to December 31, 2016 was evaluated. The radiologist turnaround times (rTATs), clinician turnaround times (cTATs) and the provider turnaround time (pTAT) were calculated. The pTAT was the sum of the rTAT and the cTAT. Fisher’s exact tests were used to compare proportions. Wilcoxon Rank Sum tests were used to compare turnaround time metrics.

Results:

There was no difference in the pTAT for studies performed and interpreted on the weekends compared to those performed on the weekend but interpreted the following Monday (P = 0.750). However, clinicians were significantly less likely to read the reports interpreted on the weekend compared to studies interpreted on weekdays (P = 0.001).

Conclusion:

Routine MSK MRI studies performed on weekends can be interpreted by radiologists on the following weekday (Monday) without affecting the time at which the clinician reads the reports and these reports are more likely to be read by clinicians if the radiologist interprets the study on a weekday.

The Role of the Integrated Digital Radiology System in Assessing the Impact of Patient Load on Emergency Computed Tomography (CT) Efficiency

Time-critical management is of particular significance in the trauma and emergency setting, where intervals from patient arrival to diagnostic imaging and from imaging to radiology report are key determinants of outcome. This study, based in the Trauma and Emergency Unit of a large, tertiary-level African hospital with a fully digital radiology department, assessed the impact of increased workload on computerised tomography (CT) efficiency. Sequential, customised searches of the institutional radiology information system (RIS) were conducted to define two weekends in 2016 with the lowest and highest emergency CT workloads, respectively. The electronic RIS timestamps defining the intervals between key steps in the CT workflow were extracted and analysed for each weekend. With the exception of radiologist reporting time, workflow steps were significantly prolonged by increased workload. This study highlights the potential role of the integrated digital radiology system in enabling a detailed analysis of imaging workflow, thereby facilitating the identification and appropriate management of bottlenecks.

Speech recognition for clinical documentation from 1990 to 2018: a systematic review

OBJECTIVE

The study sought to review recent literature regarding use of speech recognition (SR) technology for clinical documentation and to understand the impact of SR on document accuracy, provider efficiency, institutional cost, and more.

MATERIALS AND METHODS

We searched 10 scientific and medical literature databases to find articles about clinician use of SR for documentation published between January 1, 1990, and October 15, 2018. We annotated included articles with their research topic(s), medical domain(s), and SR system(s) evaluated and analyzed the results.

RESULTS

One hundred twenty-two articles were included. Forty-eight (39.3%) involved the radiology department exclusively and 10 (8.2%) involved emergency medicine; 10 (8.2%) mentioned multiple departments. Forty-eight (39.3%) articles studied productivity; 20 (16.4%) studied the effect of SR on documentation time, with mixed findings. Decreased turnaround time was reported in all 19 (15.6%) studies in which it was evaluated. Twenty-nine (23.8%) studies conducted error analyses, though various evaluation metrics were used. Reported percentage of documents with errors ranged from 4.8% to 71%; reported word error rates ranged from 7.4% to 38.7%. Seven (5.7%) studies assessed documentation-associated costs; 5 reported decreases and 2 reported increases. Many studies (44.3%) used products by Nuance Communications. Other vendors included IBM (9.0%) and Philips (6.6%); 7 (5.7%) used self-developed systems.

CONCLUSION

Despite widespread use of SR for clinical documentation, research on this topic remains largely heterogeneous, often using different evaluation metrics with mixed findings. Further, that SR-assisted documentation has become increasingly common in clinical settings beyond radiology warrants further investigation of its use and effectiveness in these settings.

Recall of structured radiology reports is significantly superior to that of unstructured reports

OBJECTIVE

To measure recall of structured compared with unstructured radiology reports.

METHODS

Institutional review board approval was obtained. Four hypothetical radiology reports, two structured and two unstructured reports, were created for the purposes of this study by an experienced consultant radiologist. The reports, each followed immediately by a multiple-choice questionnaire listing possible diagnoses from the report, were distributed to the members of two national physician associations using a web-based survey tool. Based on the number of correct responses, correct critical findings and incorrect responses, rates per number of potential diagnoses were calculated for each individual and averaged. The paired sign test compared results between structured and unstructured reports.

RESULTS

148 respondents completed the survey, 126 (85.1%) of whom were physicians. The mean percentage of incorrect diagnoses was 4.5% for structured reports compared with 16.7% for unstructured reports (p < 0.001). The average rate of critical diagnosis recall was 82.7% for structured reports and 65.1% for unstructured reports (p < 0.001). The average percentage of all diagnoses detected for structured compared with unstructured reports was 64.3 and 59.0%, respectively (p = 0.007).

CONCLUSION

Recall of structured radiology reports is significantly superior to recall of unstructured reports immediately after reading the report. Advances in knowledge: A structured radiology report format can positively impact the referring clinician's ability to recall the critical findings with statistically significance.

Forecasting the demand for radiology services

Since the demand for health services is the key driver for virtually all of a health care organisation's financial and operational activities, it is imperative that health care managers invest the time and effort to develop appropriate and accessible forecasting models for their facility's services. In this article, we analyse and forecast the demand for radiology services at a large, tertiary hospital in Florida. We demonstrate that a comprehensive and accurate forecasting model can be constructed using well-known statistical techniques. We then use our model to illustrate how to provide decision support for radiology managers with respect to department staffing. The methodology we present is not limited to radiology services and we advocate for more routine and widespread use of demand forecasting throughout the health care delivery system.

Quality metrics currently used in academic radiology departments: results of the QUALMET survey

OBJECTIVE

We present the results of the 2015 quality metrics (QUALMET) survey, which was designed to assess the commonalities and variability of selected quality and productivity metrics currently employed by a large sample of academic radiology departments representing all regions in the USA.

METHODS

The survey of key radiology metrics was distributed in March-April of 2015 via personal e-mail to 112 academic radiology departments.

RESULTS

There was a 34.8% institutional response rate. We found that most academic departments of radiology commonly utilize metrics of hand hygiene, report turn around time (RTAT), relative value unit (RVU) productivity, patient satisfaction and participation in peer review. RTAT targets were found to vary widely. The implementation of radiology peer review and the variety of ways in which peer review results are used within academic radiology departments, the use of clinical decision support tools and requirements for radiologist participation in Maintenance of Certification also varied. Policies for hand hygiene and critical results communication were very similar across all institutions reporting, and most departments utilized some form of missed case/difficult case conference as part of their quality and safety programme, as well as some form of periodic radiologist performance reviews.

CONCLUSION

Results of the QUALMET survey suggest many similarities in tracking and utilization of the selected quality and productivity metrics included in our survey. Use of quality indicators is not a fully standardized process among academic radiology departments. Advances in knowledge: This article examines the current quality and productivity metrics in academic radiology.

Radiologic Professionalism in Modern Health Care

Modern radiology is at the forefront of technological progress in medicine, a position that often places unique challenges on its professional character. This article uses "Medical Professionalism in the New Millennium: A Physician Charter," a document published in 2002 and endorsed by several major radiology organizations, as a lens for exploring professional challenges in modern radiology. The three main tenets of the Charter emphasize patient welfare, patient autonomy, and the reduction of disparities in health care distribution. This article reviews the ways in which modern technology and financial structures potentially create stressors on professionalism in radiology, while highlighting the opportunities they provide for radiologists seeking to fulfill the professional goals articulated in the Charter. Picture archiving and communication systems (PACS) and voice recognition systems have transformed the speed of radiology and enhanced the ability of radiologists to improve patient care but also have brought new tensions to the workplace. Although teleradiology may improve global access to radiologists, it may also promote the commoditization of radiology, which diminishes the professional stature of radiologists. Social media and patient portals provide radiologists with new forums for interacting with the public and patients, potentially promoting patient welfare. However, patient privacy and autonomy are important considerations. Finally, modern financial structures provide radiologists with both entrepreneurial opportunities as well as the temptation for unprofessional conduct. Each of these advances carries the potential for professional growth while testing the professional stature of radiology. By considering the risks and benefits of emerging technologies in the modern radiology world, radiologists can chart an ethical and professional future path.

Temporal evaluation of computed tomographic scans at a Level 1 trauma department in a central South African hospital

Background: Time is a precious commodity, especially in the trauma setting, which requires continuous evaluation to ensure streamlined service delivery, quality patient care and employee efficiency.Objectives: The present study analyses the authors’ institution’s multi-detector computed tomography (MDCT) scan process as part of the imaging turnaround time of trauma patients. It is intended to serve as a baseline for the institution, to offer a comparison with institutions worldwide and to improve service delivery.Method: Relevant categorical data were collected from the trauma patient register and radiological information system (RIS) from 01 February 2013 to 31 January 2014. A population of 1107 trauma patients who received a MDCT scan was included in the study. Temporal data were analysed as a continuum with reference to triage priority, time of day, type of CT scan and admission status. Results: The median trauma arrival to MDCT scan time (TTS) and reporting turnaround time (RTAT) were 69 (39–126) and 86 (53–146) minutes respectively. TTS was subdivided into the time when the patient arrived at trauma to the radiology referral (TTRef) and submission of the radiology request, to the arrival at the MDCT (RefTS) location. TTRef was statistically significantly longer than RefTS (p < 0.0001). RTAT was subdivided into the arrival at the MDCT to the start of the radiology report (STR) and time taken to complete the report (RT). STR was statistically significantly longer than RT (p < 0.0001). Conclusion: The time to scan (TTS) was comparable to, but unfortunately the report turnaround time (RTAT) lagged behind, the findings of some first-world institutions.

Adherence of Academic Radiologists in a Non-English Speaking Imaging Center to the BI-RADS Standards of Reporting Breast MRI

Objectives:

To assess the adherence of academic radiologists in a university center to BI-RADS lexicon (BLA) and to evaluate the structural completeness of breast MRI reports.

Materials and Methods:

Breast MRI reports made during 2012 in a single academic center by six readers were scored for formal completeness (FS) including recording the MRI protocol, making relevant clinical correlation, and describing background enhancement; BLA including mass rather than lesion, describing lesion outline, enhancement characteristics, and dynamic curve; and also expressing the final conclusion using BLA, resulting in a maximal total score of 8. FS and BLA were correlated with reader characteristics including breast imaging background, years of academic experience, and number of breast MRIs reported yearly. Tests used for statistical analysis were the Mann–Whitney U test and analysis of variance (ANOVA).

Results:

Overall BLA was 38.9%. This percentage was 60.1% and 3.7% in radiologists with and without breast imaging background, respectively (P = 0.000). Mean FS among all readers was 3.81 ± 1.75. This score was 2.54 ± 1.1 for readers without breast imaging background and 4.6 ± 1.6 for the readers regularly involved in breast imaging (P = 0.000).

Conclusions:

Higher degree of BLA and higher mean FS were associated with radiologists regularly involved in breast imaging. No association was found with years of academic experience or number of breast MRIs interpreted yearly.

Factors that Influence Radiographers' Decisions to Pursue Postgraduate Education: An Exploratory Qualitative Study

BACKGROUND

Radiography has continued to expand since the discovery of x-rays with newer technologies and responsibilities for radiographers. Consequently, radiographers need to learn new skills in order to remain relevant in health care. Radiography currently needs a generation of radiographers who can also get engaged in research and advance the profession through evidence-based practices. Achieving this requires radiographers to be trained above the basic qualification, yet there are still few radiographers embarking on postgraduate education. The purpose of this study was to explore factors that influence radiographers' decisions to pursue postgraduate education, as well as explore ways of improving access to such education.

METHODS

An exploratory qualitative study was conducted with postgraduate radiography students at Cardiff University. Purposive convenience sampling was used to recruit participants. Data were collected using individual face-to-face interviews, which were then analyzed using thematic analysis and summarized into themes and subthemes.

RESULTS

There were nine participants interviewed, providing adequate data saturation. Of the nine, three were female and six were men. Eight of them were basic radiographers, whereas one was a senior radiographer. Radiographers were influenced by intrinsic and extrinsic factors when deciding to pursue postgraduate radiography education. Key intrinsic factors included desire for personal professional development, desire for new challenges, and search for satisfaction within the profession. Key extrinsic factors included requirements for continuous professional development, availability of funding, and search for improved remuneration. Key suggestions for improving access to postgraduate education were identified.

CONCLUSIONS

Both external and internal factors simultaneously influence radiographers' decisions to embark on postgraduate education, and all these factors need to be addressed in order to improve access to such education for radiographers.

Learning curve of speech recognition

Speech recognition (SR) speeds patient care processes by reducing report turnaround times. However, concerns have emerged about prolonged training and an added secretarial burden for radiologists. We assessed how much proofing radiologists who have years of experience with SR and radiologists new to SR must perform, and estimated how quickly the new users become as skilled as the experienced users. We studied SR log entries for 0.25 million reports from 154 radiologists and after careful exclusions, defined a group of 11 experienced radiologists and 71 radiologists new to SR (24,833 and 122,093 reports, respectively). Data were analyzed for sound file and report lengths, character-based error rates, and words unknown to the SR's dictionary. Experienced radiologists corrected 6 characters for each report and for new users, 11. Some users presented a very unfavorable learning curve, with error rates not declining as expected. New users' reports were longer, and data for the experienced users indicates that their reports, initially equally lengthy, shortened over a period of several years. For most radiologists, only minor corrections of dictated reports were necessary. While new users adopted SR quickly, with a subset outperforming experienced users from the start, identification of users struggling with SR will help facilitate troubleshooting and support.

Influence of radiology report format on reading time and comprehension

This study examined whether radiology report format influences reading time and comprehension of information. Three reports were reformatted to conventional free text, structured text organized by organ system, and hierarchical structured text organized by clinical significance. Five attending radiologists, five radiology residents, five internal medicine attendings, and five internal medicine residents read the reports and answered a series of questions about them. Reading was timed and participants reported reading preferences. For reading time, there was no significant effect for format, but there was for attending versus resident, and radiology versus internal medicine. For percent correct scores, there was no significant effect for report format or for attending versus resident, but there was for radiology versus internal medicine with the radiologists scoring better overall. Report format does not appear to impact viewing time or percent correct answers, but there are differences in both for specialty and level of experience. There were also differences between the four groups of participants with respect to what they focus on in a radiology report and how they read reports (skim versus read in detail). There may not be a "one-size-fits-all" radiology report format as individual preferences differ widely.

Achieving efficiency in crowded emergency departments: a research agenda

In 2011, Academic Emergency Medicine convened a consensus conference entitled "Interventions to Assure Quality in the Crowded Emergency Department." This article, a product of the breakout session on "interventions to safeguard efficiency of care," explores various elements of the research agenda on efficiency and quality in crowded emergency departments (EDs). The authors discuss four areas identified as critical to achieving progress in the research agenda for improving ED efficiency: 1) What measures can be used to understand and improve the efficiency and quality of interventions in the ED? 2) Which factors outside of the ED's control affect ED efficiency? 3) How do workforce factors affect ED efficiency? 4) How do ED design, patient flow structures, and use of technology affect efficiency? Filling these knowledge gaps is vital to identifying interventions that improve the delivery of emergency care in all EDs.

Email notification combined with off site signing substantially reduces resident approval to faculty verification time

RATIONALE AND OBJECTIVES

Attending radiologist signature time (AST) is a variable and modifiable component of overall report turnaround time. Delays in finalized reports have potential to undermine radiologists' value as consultants and adversely affect patient care. This study was performed to evaluate the impact of notebook computer distribution and daily automated e-mail notification on reducing AST.

MATERIALS AND METHODS

Two simultaneous interventions were initiated in the authors' radiology department in February 2010. These included the distribution of a notebook computer with preloaded software for each attending radiologist to sign radiology reports and daily automated e-mail notifications for unsigned reports. The digital dictation system archive and the radiology information system were queried for all radiology reports produced from January 2009 through August 2010. The time between resident approval and attending radiologist signature before and after the intervention was analyzed. Potential unintended "side effects" of the intervention were also studied.

RESULTS

Resident-authored reports were signed, on average, 2.53 hours sooner after the intervention. This represented a highly significant (P = .003) decrease in AST with all else held equal. Postintervention reports were authored by residents at the same rate (about 70%). An unintended "side effect" was that attending radiologists were less likely to make changes to resident-authored reports after the intervention.

CONCLUSIONS

E-mail notification combined with offsite signing can reduce AST substantially. Notebook computers with preloaded software streamline the process of accessing, editing, and signing reports. The observed decrease in AST reflects a positive change in the timeliness of report signature.

Voice recognition versus transcriptionist: error rates and productivity in MRI reporting

PURPOSE

Despite the frequent introduction of voice recognition (VR) into radiology departments, little evidence still exists about its impact on workflow, error rates and costs. We designed a study to compare typographical errors, turnaround times (TAT) from reported to verified and productivity for VR-generated reports versus transcriptionist-generated reports in MRI.

METHODS

Fifty MRI reports generated by VR and 50 finalized MRI reports generated by the transcriptionist, of two radiologists, were sampled retrospectively. Two hundred reports were scrutinised for typographical errors and the average TAT from dictated to final approval. To assess productivity, the average MRI reports per hour for one of the radiologists was calculated using data from extra weekend reporting sessions.

RESULTS

Forty-two % and 30% of the finalized VR reports for each of the radiologists investigated contained errors. Only 6% and 8% of the transcriptionist-generated reports contained errors. The average TAT for VR was 0 h, and for the transcriptionist reports TAT was 89 and 38.9 h. Productivity was calculated at 8.6 MRI reports per hour using VR and 13.3 MRI reports using the transcriptionist, representing a 55% increase in productivity.

CONCLUSION

Our results demonstrate that VR is not an effective method of generating reports for MRI. Ideally, we would have the report error rate and productivity of a transcriptionist and the TAT of VR.

Good practice for radiological reporting. Guidelines from the European Society of Radiology (ESR)

The views of the European Society of Radiology concerning what constitutes a good radiological report are outlined in this article. Some pertinent literature is reviewed.

Radiologist report turnaround time: impact of pay-for-performance measures

OBJECTIVE

Expedited finalized radiologist report turnaround times (RTAT) are considered an important quality care metric in medicine. This study was performed to evaluate the impact of a radiologist pay-for-performance (PFP) program on reducing RTAT.

MATERIALS AND METHODS

A radiologist PFP program was used to assess its impact on RTAT for all departmental reports from 11 subspecialty divisions. Study periods were 3 months before (baseline period) and immediately after (immediate period) the introduction of the program and 2 years later after the program had terminated (post period). Three RTAT components were evaluated for individual radiologists and for each radiology division: examination completion (C) to final signature (F), C to preliminary signature (P), and P to F.

RESULTS

Eighty-one radiologists met the inclusion criterion for the study and performed a final signature on 99,959 reports during the baseline period, 104,673 reports during the immediate period, and 91,379 reports during the post period. Mean C-F, C-P, and P-F for all reports decreased significantly from baseline to immediate to post period (p < 0.0001), with the largest effect on the P-F component. Similarly, divisional C-F, C-P, and P-F also significantly decreased (p < 0.0001) for all divisions except the C-F for nuclear and neurovascular radiology from baseline to immediate period and the C-P component from baseline to post period for cardiac radiology.

CONCLUSION

A radiologist PFP program appears to have a marked effect on expediting final report turnaround times, which continues after its termination.

Voice recognition software: effect on radiology report turnaround time at an academic medical center

OBJECTIVE

Previous studies have documented reductions in turnaround time after implementation of voice recognition software in the generation of radiology reports. Our preliminary observations suggested that improvement in report turnaround time varies among users. The purpose of this study was to analyze the effect of work habits and caseload on such variations.

SUBJECTS AND METHODS

Data were collected for 9 months before and after the implementation of voice recognition after a 6-month training period. Thirty faculty members were ranked according to their report turnaround time before and after implementation of voice recognition and according to their percentage reduction in report turnaround time. The report turnaround times before and after implementation of voice recognition for faculty were compared with the number of verified reports and work habit type.

RESULTS

The average report turnaround time for the department before implementation of voice recognition was 28 hours. After implementation of voice recognition, the average turnaround time was 12.7 hours, and the volume of verified reports increased 5% between the two study periods. The improvement in report turnaround time for individual faculty members ranged from -33% to +93%, and the rank order did not change significantly (Spearman coefficient, 0.58; p < 0.05). Faculty members' ranks in report turnaround time did not correlate significantly with volume rank before and after implementation of voice recognition (Spearman coefficients, 0.341 and 0.346; p > 0.05). Faculty members who had type 1 work habits, that is, reviewed, revised, and finalized reports at the time of image review, benefited the most from use of voice recognition.

CONCLUSION

Use of voice recognition software decreased report turnaround time for the department and for 28 of 30 individual faculty members. Improvement in report turnaround time does not correlate with workload but does correlate with work habits, suggesting human behavior may play a role in determining the outcome of adopting a productivity-enhancing technology.

Augmenting the impact of technology adoption with financial incentive to improve radiology report signature times

PURPOSE

Radiology report signature time (ST) can be a substantial component of total report turnaround time. Poor turnaround time resulting from lengthy ST can adversely affect patient care. The combination of technology adoption with financial incentive was evaluated to determine if ST improvement can be augmented and sustained.

METHODS

This prospective study was performed at a 751-bed, urban, tertiary care adult teaching hospital. Test-site imaging volume approximated 48,000 examinations per month. The radiology department has 100 trainees and 124 attending radiologists serving multiple institutions. Over a study period of 4 years and 4 months, three interventions focused on radiologist signature performance were implemented: 1) a notification paging application that alerted radiologists when reports were ready for signature, 2) a picture archiving and communications systems (PACS)-integrated speech recognition report generation system, and 3) a departmental financial incentive to reward radiologists semiannually for ST performance. Signature time was compared before and after the interventions. Wilcoxon and linear regression statistical analyses were used to assess the significance of trends.

RESULTS

Technology adoption (paging plus speech recognition) reduced median ST from >5 to <1 hour (P < .001) and 80th-percentile ST from >24 to 15 to 18 hours (P < .001). Subsequent addition of a financial incentive further improved 80th-percentile ST to 4 to 8 hours (P < .001). The gains in median and 80th-percentile ST were sustained over the final 31 months of the study period.

CONCLUSIONS

Technology interventions coupled with financial incentive can result in synergistic and sustainable improvement in radiologist report-signing behavior. The addition of a financial incentive leads to better performance than that achievable through technology alone.