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Doğan K, Selçuk T, Alkan A. An Enhanced Mask R-CNN Approach for Pulmonary Embolism Detection and Segmentation. Diagnostics (Basel) 2024; 14:1102. [PMID: 38893629 PMCID: PMC11171979 DOI: 10.3390/diagnostics14111102] [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: 04/25/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Pulmonary embolism (PE) refers to the occlusion of pulmonary arteries by blood clots, posing a mortality risk of approximately 30%. The detection of pulmonary embolism within segmental arteries presents greater challenges compared with larger arteries and is frequently overlooked. In this study, we developed a computational method to automatically identify pulmonary embolism within segmental arteries using computed tomography (CT) images. The system architecture incorporates an enhanced Mask R-CNN deep neural network trained on PE-containing images. This network accurately localizes pulmonary embolisms in CT images and effectively delineates their boundaries. This study involved creating a local data set and evaluating the model predictions against pulmonary embolisms manually identified by expert radiologists. The sensitivity, specificity, accuracy, Dice coefficient, and Jaccard index values were obtained as 96.2%, 93.4%, 96.%, 0.95, and 0.89, respectively. The enhanced Mask R-CNN model outperformed the traditional Mask R-CNN and U-Net models. This study underscores the influence of Mask R-CNN's loss function on model performance, providing a basis for the potential improvement of Mask R-CNN models for object detection and segmentation tasks in CT images.
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Affiliation(s)
- Kâmil Doğan
- Department of Radiology, Kahramanmaras Sutcu Imam University, 46050 Onikişubat, Turkey;
| | - Turab Selçuk
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, 46050 Onikişubat, Turkey;
| | - Ahmet Alkan
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, 46050 Onikişubat, Turkey;
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Grenier PA, Ayobi A, Quenet S, Tassy M, Marx M, Chow DS, Weinberg BD, Chang PD, Chaibi Y. Deep Learning-Based Algorithm for Automatic Detection of Pulmonary Embolism in Chest CT Angiograms. Diagnostics (Basel) 2023; 13:diagnostics13071324. [PMID: 37046542 PMCID: PMC10093638 DOI: 10.3390/diagnostics13071324] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Purpose: Since the prompt recognition of acute pulmonary embolism (PE) and the immediate initiation of treatment can significantly reduce the risk of death, we developed a deep learning (DL)-based application aimed to automatically detect PEs on chest computed tomography angiograms (CTAs) and alert radiologists for an urgent interpretation. Convolutional neural networks (CNNs) were used to design the application. The associated algorithm used a hybrid 3D/2D UNet topology. The training phase was performed on datasets adequately distributed in terms of vendors, patient age, slice thickness, and kVp. The objective of this study was to validate the performance of the algorithm in detecting suspected PEs on CTAs. Methods: The validation dataset included 387 anonymized real-world chest CTAs from multiple clinical sites (228 U.S. cities). The data were acquired on 41 different scanner models from five different scanner makers. The ground truth (presence or absence of PE on CTA images) was established by three independent U.S. board-certified radiologists. Results: The algorithm correctly identified 170 of 186 exams positive for PE (sensitivity 91.4% [95% CI: 86.4–95.0%]) and 184 of 201 exams negative for PE (specificity 91.5% [95% CI: 86.8–95.0%]), leading to an accuracy of 91.5%. False negative cases were either chronic PEs or PEs at the limit of subsegmental arteries and close to partial volume effect artifacts. Most of the false positive findings were due to contrast agent-related fluid artifacts, pulmonary veins, and lymph nodes. Conclusions: The DL-based algorithm has a high degree of diagnostic accuracy with balanced sensitivity and specificity for the detection of PE on CTAs.
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Affiliation(s)
- Philippe A. Grenier
- Department of Clinical Research and Innovation, Foch Hospital Suresnes, Versailles Saint Quentin University, 78000 Versailles, France
| | | | | | | | | | - Daniel S. Chow
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Brent D. Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Peter D. Chang
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
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Ajmera P, Kharat A, Seth J, Rathi S, Pant R, Gawali M, Kulkarni V, Maramraju R, Kedia I, Botchu R, Khaladkar S. A deep learning approach for automated diagnosis of pulmonary embolism on computed tomographic pulmonary angiography. BMC Med Imaging 2022; 22:195. [DOI: 10.1186/s12880-022-00916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Computed tomographic pulmonary angiography (CTPA) is the diagnostic standard for confirming pulmonary embolism (PE). Since PE is a life-threatening condition, early diagnosis and treatment are critical to avoid PE-associated morbidity and mortality. However, PE remains subject to misdiagnosis.
Methods
We retrospectively identified 251 CTPAs performed at a tertiary care hospital between January 2018 to January 2021. The scans were classified as positive (n = 55) and negative (n = 196) for PE based on the annotations made by board-certified radiologists. A fully anonymized CT slice served as input for the detection of PE by the 2D segmentation model comprising U-Net architecture with Xception encoder. The diagnostic performance of the model was calculated at both the scan and the slice levels.
Results
The model correctly identified 44 out of 55 scans as positive for PE and 146 out of 196 scans as negative for PE with a sensitivity of 0.80 [95% CI 0.68, 0.89], a specificity of 0.74 [95% CI 0.68, 0.80], and an accuracy of 0.76 [95% CI 0.70, 0.81]. On slice level, 4817 out of 5183 slices were marked as positive for the presence of emboli with a specificity of 0.89 [95% CI 0.88, 0.89], a sensitivity of 0.93 [95% CI 0.92, 0.94], and an accuracy of 0.89 [95% CI 0.887, 0.890]. The model also achieved an AUROC of 0.85 [0.78, 0.90] and 0.94 [0.936, 0.941] at scan level and slice level, respectively for the detection of PE.
Conclusion
The development of an AI model and its use for the identification of pulmonary embolism will support healthcare workers by reducing the rate of missed findings and minimizing the time required to screen the scans.
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Soffer S, Klang E, Shimon O, Barash Y, Cahan N, Greenspana H, Konen E. Deep learning for pulmonary embolism detection on computed tomography pulmonary angiogram: a systematic review and meta-analysis. Sci Rep 2021; 11:15814. [PMID: 34349191 PMCID: PMC8338977 DOI: 10.1038/s41598-021-95249-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/07/2021] [Indexed: 12/22/2022] Open
Abstract
Computed tomographic pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis. However, this diagnosis is susceptible to misdiagnosis. In this study, we aimed to perform a systematic review of current literature applying deep learning for the diagnosis of PE on CTPA. MEDLINE/PUBMED were searched for studies that reported on the accuracy of deep learning algorithms for PE on CTPA. The risk of bias was evaluated using the QUADAS-2 tool. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curves were plotted. Seven studies met our inclusion criteria. A total of 36,847 CTPA studies were analyzed. All studies were retrospective. Five studies provided enough data to calculate summary estimates. The pooled sensitivity and specificity for PE detection were 0.88 (95% CI 0.803-0.927) and 0.86 (95% CI 0.756-0.924), respectively. Most studies had a high risk of bias. Our study suggests that deep learning models can detect PE on CTPA with satisfactory sensitivity and an acceptable number of false positive cases. Yet, these are only preliminary retrospective works, indicating the need for future research to determine the clinical impact of automated PE detection on patient care. Deep learning models are gradually being implemented in hospital systems, and it is important to understand the strengths and limitations of these algorithms.
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Affiliation(s)
- Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
- Ben-Gurion University of the Negev, Be'er Sheva, Israel.
- Deep Vision Lab, The Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Eyal Klang
- Deep Vision Lab, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Mount Sinai, New York, NY, USA
- Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel
| | - Orit Shimon
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yiftach Barash
- Deep Vision Lab, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Noa Cahan
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - Hayit Greenspana
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Huang SC, Kothari T, Banerjee I, Chute C, Ball RL, Borus N, Huang A, Patel BN, Rajpurkar P, Irvin J, Dunnmon J, Bledsoe J, Shpanskaya K, Dhaliwal A, Zamanian R, Ng AY, Lungren MP. PENet-a scalable deep-learning model for automated diagnosis of pulmonary embolism using volumetric CT imaging. NPJ Digit Med 2020; 3:61. [PMID: 32352039 PMCID: PMC7181770 DOI: 10.1038/s41746-020-0266-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/20/2020] [Indexed: 01/17/2023] Open
Abstract
Pulmonary embolism (PE) is a life-threatening clinical problem and computed tomography pulmonary angiography (CTPA) is the gold standard for diagnosis. Prompt diagnosis and immediate treatment are critical to avoid high morbidity and mortality rates, yet PE remains among the diagnoses most frequently missed or delayed. In this study, we developed a deep learning model-PENet, to automatically detect PE on volumetric CTPA scans as an end-to-end solution for this purpose. The PENet is a 77-layer 3D convolutional neural network (CNN) pretrained on the Kinetics-600 dataset and fine-tuned on a retrospective CTPA dataset collected from a single academic institution. The PENet model performance was evaluated in detecting PE on data from two different institutions: one as a hold-out dataset from the same institution as the training data and a second collected from an external institution to evaluate model generalizability to an unrelated population dataset. PENet achieved an AUROC of 0.84 [0.82-0.87] on detecting PE on the hold out internal test set and 0.85 [0.81-0.88] on external dataset. PENet also outperformed current state-of-the-art 3D CNN models. The results represent successful application of an end-to-end 3D CNN model for the complex task of PE diagnosis without requiring computationally intensive and time consuming preprocessing and demonstrates sustained performance on data from an external institution. Our model could be applied as a triage tool to automatically identify clinically important PEs allowing for prioritization for diagnostic radiology interpretation and improved care pathways via more efficient diagnosis.
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Affiliation(s)
- Shih-Cheng Huang
- Department of Biomedical Data Science, Stanford University, Stanford, CA USA
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
| | - Tanay Kothari
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Imon Banerjee
- Department of Biomedical Data Science, Stanford University, Stanford, CA USA
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Biomedical Informatics, Emory University, Atlanta, GA USA
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Chris Chute
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Robyn L. Ball
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
| | - Norah Borus
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Andrew Huang
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Bhavik N. Patel
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Pranav Rajpurkar
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Jeremy Irvin
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Jared Dunnmon
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Joseph Bledsoe
- Department of Emergency Medicine, Intermountain Medical Center, Salt Lake Valley, UT USA
| | | | - Abhay Dhaliwal
- Michigan State University, College of Human Medicine, East Lansing, MI USA
| | - Roham Zamanian
- Department of Pulmonary Critical Care Medicine, Stanford University, Stanford, CA USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford University, Stanford, CA USA
| | - Andrew Y. Ng
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Matthew P. Lungren
- Department of Biomedical Data Science, Stanford University, Stanford, CA USA
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Radiology, Stanford University, Stanford, CA USA
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6
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Lauritzen PM, Andersen JG, Stokke MV, Tennstrand AL, Aamodt R, Heggelund T, Dahl FA, Sandbæk G, Hurlen P, Gulbrandsen P. Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports. BMJ Qual Saf 2016; 25:595-603. [PMID: 27013638 PMCID: PMC4975845 DOI: 10.1136/bmjqs-2015-004536] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/21/2016] [Indexed: 11/25/2022]
Abstract
Background Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Consultant radiologists in Norwegian hospitals frequently request second reads by colleagues in real time. Our objective was to estimate the frequency of clinically important changes to radiology reports produced by these prospectively obtained double readings. Methods We retrospectively compared the preliminary and final reports from 1071 consecutive double-read abdominal CT examinations of surgical patients at five public hospitals in Norway. Experienced gastrointestinal surgeons rated the clinical importance of changes from the preliminary to final report. The severity of the radiological findings in clinically important changes was classified as increased, unchanged or decreased. Results Changes were classified as clinically important in 146 of 1071 reports (14%). Changes to 3 reports (0.3%) were critical (demanding immediate action), 35 (3%) were major (implying a change in treatment) and 108 (10%) were intermediate (requiring further investigations). The severity of the radiological findings was increased in 118 (81%) of the clinically important changes. Important changes were made less frequently when abdominal radiologists were first readers, more frequently when they were second readers, and more frequently to urgent examinations. Conclusion A 14% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and a targeted selection of urgent cases and radiologists reading outside their specialty may increase the yield of discrepant cases.
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Affiliation(s)
- Peter Mæhre Lauritzen
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Jack Gunnar Andersen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | | | - Rolf Aamodt
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Thomas Heggelund
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Fredrik A Dahl
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Gunnar Sandbæk
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petter Hurlen
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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7
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Lindgren EA, Patel MD, Wu Q, Melikian J, Hara AK. The clinical impact of subspecialized radiologist reinterpretation of abdominal imaging studies, with analysis of the types and relative frequency of interpretation discrepancies. ACTA ACUST UNITED AC 2015; 39:1119-26. [PMID: 24748211 DOI: 10.1007/s00261-014-0140-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The primary objective of this study was to determine the clinical impact and value of abdominal imaging reinterpretations by subspecialized abdominal imagers. METHODS Secondary interpretations for computed tomography (CT), magnetic resonance (MR), and ultrasound (US) abdominal studies performed outside our institution over a 7-month period were retrospectively compared to the primary (outside) interpretation, with interpretive differences recorded. Clinical notes, pathology and subsequent imaging determined ground truth diagnosis and the clinical impact of any interpretive discrepancies were graded as having high, medium, or little/no clinical impact. Interpretive comparisons were scored into categories: (1) no difference; (2) incidental findings of no clinical impact; (3) finding not reported; (4) significance of finding undercalled; (5) significance of finding overcalled; (6) finding misinterpreted; and (7) multiple discrepancy types in one report. RESULTS 398 report comparisons were reviewed on 380 patients. There were 300 CT, 60 MR, and 38 US examinations. The primary report had 5.0% (20/398) high clinical impact interpretive discrepancies and 7.5% (30/398) medium clinical impact discrepancies. The subspecialized secondary report had no high clinical impact discrepancies and 8/398 (2.0%) medium clinical impact discrepancies. In order of frequency, high and medium impact discrepancies in the primary report consisted of 50% overcalls, 26% unreported findings, 18% undercalls, 4% misinterpretations, and 2% multiple discrepancies. CONCLUSIONS Subspecialty review of abdominal imaging exams can provide clinical benefit. Half of the discrepancies in this series of abdominal reinterpretations were due to overcalls.
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Interobserver Agreement between On-Call Radiology Resident and General Radiologist Interpretations of CT Pulmonary Angiograms and CT Venograms. PLoS One 2015; 10:e0126116. [PMID: 25938666 PMCID: PMC4418836 DOI: 10.1371/journal.pone.0126116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/29/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate the interobserver agreement (IOA) between the initial radiology resident and the final staff radiologist reports of combined computed tomographic pulmonary angiograms (CTPA) and computed tomographic venograms (CTV) performed during on-call hours. Materials and Methods Approval by the institutional review board was obtained. Six-hundred and ninety-six consecutive studies (CTPA or CTPA with CTV) performed during on-call hours and interpreted by 30 residents were identified. Radiology residents’ reports were compared to the final staff reports. Three tests outcomes were considered (positive, P; negative, N; indeterminate, I). Discordant cases were reviews by a chest radiologist. Results CTPAs were reported by staff radiologists as positive for pulmonary embolism (PE) in 18% (126/694), with a kappa of 0.81 (95% CI 0.77-0.86) with 3 outcomes (P, N, I), and a kappa of 0.89 (95% CI 0.85-0.94) with 2 outcomes (P, N). Regarding PE location, good concordance was observed for positive studies, with a kappa of 0.86 (95% CI 0.78 – 0.95). CTVs were reported as positive by staff radiologists in 8.5% (33/388), with a kappa of 0.66 (95% CI 0.55-0.77) with 3 outcomes (P, N, I), and a kappa of 0.89 (95% CI 0.8-1.0) with 2 outcomes (P, N). The IOA between residents and staff radiologists increased with increasing residency year level for CTPAs, but did not for CTVs. Conclusions Very good and good IOA were observed between resident and staff radiologist interpretations for CTPA and CTV, respectively, with tendency towards improved IOA as residency level of training increased for CTPA, but not for CTV.
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Dell CM, Deloney LA, Jambhekar K, Brandon H. Preserving the educational value of call in a diagnostic radiology residency program. J Am Coll Radiol 2014; 11:68-73. [PMID: 24387964 DOI: 10.1016/j.jacr.2013.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Our study was designed to determine residents' opinions of the advantages, disadvantages and educational value of a traditional "Tandem Call" (TC) model as compared to night float (NF). Because TC is more representative of adult learning principles and constructivist theory, we hypothesized that resident satisfaction and educational outcomes would demonstrate a preference for, and the educational efficacy of, the TC model. METHODS We surveyed all residents in a university-based radiology residency on their opinions of TC and its educational value. Aggregate data from annual Graduate Medical Education Committee institutional surveys (2008-2012) and annual radiology alumni surveys (2009-2012) were reviewed as measures of satisfaction with TC. Performance on the ABR oral exam was a proxy for educational outcome. Quality data for the year of study and prior years in which TC was in effect were reviewed as a measure of patient safety. RESULTS The great majority of respondents attributed confidence/competence on call and added value to their education directly to TC. A majority believed that teamwork required for TC facilitated more positive relationships among residents and more peer teaching. Most said that they would not prefer NF. Almost all believed indirect supervision with attending backup aided in developing confidence in performance. Quality data confirmed a low number of discrepancies between preliminary resident and final attending reads. CONCLUSIONS TC provides a more consistent call experience throughout residency than NF. TC is valued by residents, facilitates retrieval-based learning and development of independence and efficiency, and parallels essential elements of team-based learning. Quality data suggests that lack of 24-hour attending supervision is not detrimental to patient safety.
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Affiliation(s)
- Carol M Dell
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Linda A Deloney
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kedar Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hicks Brandon
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Joshi R, Wu K, Kaicker J, Choudur H. Reliability of on-call radiology residents' interpretation of 64-slice CT pulmonary angiography for the detection of pulmonary embolism. Acta Radiol 2014; 55:682-90. [PMID: 24092761 DOI: 10.1177/0284185113506135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Computed tomography (CT) angiography for pulmonary embolism (PE) is the present standard for diagnosing PE. In many teaching hospitals, radiology residents are the first to review the case and to make an initial interpretation of the images. Accurate diagnosis of PE is crucial, especially in the emergency care setting. PURPOSE To evaluate the discrepancies between resident and staff interpretations of 64-slice CT angiogram for PE. MATERIAL AND METHODS Discrepancies between the preliminary reports by the on-call radiology resident were compared to the final report by the staff radiologist in 215 consecutive cases of 64-slice CT angiogram performed for PE, from May 2005 to March 2008. RESULTS Discrepancies were noted in 25 of the 215 studies (11.6%). These residents' discrepancies consisted of three false-positive, four false-negative, and 18 equivocal cases. There was a decrease in the discrepancy rate from the second year to the fifth year of training by approximately 60%. CONCLUSION The rate of discrepancy fell steeply between the second and fifth year of the residents training from 18.5% to 6.9%. Our study suggests that it is reasonable to have on-call radiology residents perform the preliminary interpretations of 64-slice CT for PE studies.
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Affiliation(s)
- Rohit Joshi
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - Ke Wu
- Department of Medical Imaging, Michael G Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jatin Kaicker
- Department of Medical Imaging, Michael G Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Hema Choudur
- Department of Medical Imaging, Michael G Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
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11
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Wu MZ, McInnes MDF, Macdonald DB, Kielar AZ, Duigenan S. CT in adults: systematic review and meta-analysis of interpretation discrepancy rates. Radiology 2013; 270:717-35. [PMID: 24475832 DOI: 10.1148/radiol.13131114] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To use meta-analysis to determine the discrepancy rate when interpreting computed tomography (CT) studies performed in adult patients and to determine whether discrepancy rate differs on the basis of body region or level of radiologist training. MATERIALS AND METHODS MEDLINE and EMBASE were searched from 1946 to June 2012 by using the combination "radiology AND (error OR peer review)." Two reviewers independently selected studies that met the inclusion criteria and extracted study data. Total and major discrepancy rates were investigated with a random-effects meta-analysis, and subgroups were compared by using the χ(2) Q statistic. Subgroup analyses were performed on the basis of the level of training of the initial radiologist and the body system scanned. RESULTS Fifty-eight studies met the inclusion criteria (388 123 CT examinations). The pooled total discrepancy rate was 7.7% (95% confidence interval [CI]: 5.6%, 10.3%), and the major discrepancy rate was 2.4% (95% CI: 1.7%, 3.2%). The pooled major discrepancy rate was comparable for staff (2.9%; 95% CI: 1.2%, 6.7%) and residents (2.2%; 95% CI: 1.7%, 2.9%) (Q = 0.92, P = .633). The pooled major discrepancy rates for head CT (0.8%; 95% CI: 0.4%, 1.6%) and spine CT (0.7%; 95% CI: 0.2%, 2.7%) were lower than those for chest CT (2.8%; 95% CI: 1.5%, 5.4%) and abdominal CT (2.6%; 95% CI: 1.0%, 6.7%) (Q = 8.28, P = .041). Lack of blinding of the reference radiologist to the initial report was associated with a lower major discrepancy rate (2.0%; 95% CI: 1.4%, 2.7%; 43 studies) than when blinding was present (12.1%; 95% CI: 4.4%, 29.4%; five studies) (Q = 10.65, P = .001). CONCLUSION Potentially useful reference ranges were identified in the subgroup analyses on the basis of body region scanned at adult CT. However, considerable heterogeneity that is only partially explained by subgroup analysis signifies that further research is necessary--particularly regarding the question of blinding of the reference radiologist.
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Affiliation(s)
- Mark Z Wu
- From the Department of Medical Imaging, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (M.Z.W., M.D.F.M.); and Department of Medical Imaging, the Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (D.B.M., A.Z.K., S.D.)
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12
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Abstract
Pulmonary embolism (PE) remains one of the most challenging medical diseases in the emergency department. PE is a potentially life threatening diagnosis that is seen in patients with chest pain and/or dyspnea but can span the clinical spectrum of medical presentations. In addition, it does not have any particular clinical feature, laboratory test, or diagnostic modality that can independently and confidently exclude its possibility. This article offers a review of PE in the emergency department. It emphasizes the appropriate determination of pretest probability, the approach to diagnosis and management, and special considerations related to pregnancy and radiation exposure.
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Affiliation(s)
- David W Ouellette
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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Incremental value of CT venography combined with pulmonary CT angiography for the detection of thromboembolic disease: systematic review and meta-analysis. AJR Am J Roentgenol 2011; 196:1065-72. [PMID: 21512072 DOI: 10.2214/ajr.10.4745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of our study was to assess the incremental role of CT venography (CTV) combined with pulmonary CT angiography (CTA) in detecting venous thromboembolic disease with a systematic review and meta-analysis of the literature. MATERIALS AND METHODS MEDLINE, Embase, and Web of Science were searched for relevant original articles published from January 1, 1995, to December 31, 2009. A random-effects model was used to obtain the incremental value of CTV in detecting thromboembolic disease. RESULTS Twenty-four studies, which included 17,373 patients, met our inclusion criteria. A meta-analysis showed that CTV increased detection rates of venous thromboembolic disease by identifying an additional 3% of cases (95% CI, 2-4%) of isolated deep venous thrombosis (DVT). A subgroup analysis of a high-risk group did not show any difference in the detection of isolated DVT. CONCLUSION The addition of CTV results in the increased detection of thromboembolic disease. CTV combined with pulmonary CTA has a promising role as a quick and efficient test for venous thromboembolism.
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Xiong L, Trout AT, Bailey JE, Brown RK, Kelly AM. Comparison of Discrepancy Rates in Resident and Faculty Interpretations of On-Call PE CT and V/Q Scans: Is One Study More Reliable During Off Hours? J Am Coll Radiol 2011; 8:415-21. [DOI: 10.1016/j.jacr.2010.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 12/10/2010] [Indexed: 11/27/2022]
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Effect of work hours, caseload, shift type, and experience on resident call performance. Acad Radiol 2010; 17:921-7. [PMID: 20540912 DOI: 10.1016/j.acra.2010.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 03/03/2010] [Accepted: 03/07/2010] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the independent effects of multiple variables on resident call performance. MATERIALS AND METHODS Independent radiology resident "on call" cross-sectional imaging interpretation quality assurance (QA) data obtained during a 171-day period at a single tertiary care Level 1 trauma teaching institution was reviewed. Clinically significant resident-faculty discrepancies were compared among three different call types: traditional single-day overnight call (OC, 15 hours/night after 9 daytime hours on weekdays), 7-night nightfloat (NF, 9 hours/night), and weekend day call (WD, 10 hours/day). Logistic regression analyses were performed to evaluate associations. RESULTS There were 119 (0.89%) clinically significant resident-faculty discordances from 13,424 cross-sectional interpretations: 56 (0.79%) from 7102 interpretations on 172 OC shifts, 39 (0.85%) from 4567 interpretations on 165 NF shifts, and 24 (1.4%) from 1755 interpretations on 49 WD shifts. Individual residents (n = 20) had a mean discrepancy rate of 0.9% (0.45%-1.9%). Overall, 102 (26.2%) of the shifts had at least one discordance. The following were associated with significantly (P < .001) increased discrepancy rates: junior vs. senior residents (odds ratio [OR] = 1.3 [1.2-1.4]), OC vs. NF (OR = 1.5 [1.3-1.6], WD vs. NF (OR = 1.4 [1.2-1.6]), weekend vs. weekday (OR = 1.3 [1.2-1.4]), and increasing cases/hour (OR = 1.6 [1.5-1.7]). Weekend OC shifts had a higher discrepancy rate (OR 1.3[1.2-1.5], P < .001) than weekday OC shifts despite a shorter workday (15 vs. 24 hours). CONCLUSION Increasing caseload, junior residents, and weekends are associated with a significantly higher discrepancy rate. OC is associated with a significantly higher discrepancy rate than NF. Measured discrepancy rates are low, regardless of call type.
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Bierry G, Roy C, Buy X, Kellner F, Jlassi H, Gangi A. [ECG-gated chest CT angiography: value for atypical chest pain evaluation]. JOURNAL DE RADIOLOGIE 2009; 90:825-831. [PMID: 19752788 DOI: 10.1016/s0221-0363(09)73214-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The aim of this study was to evaluate ECG-gated whole chest CTA as a routine triage tool for patients with acute chest pain. MATERIAL AND METHODS Whole chest CTA with retrospective ECG-gating was performed in 30 patients with acute atypical chest pain. The ten main segments of the coronary arteries, the pulmonary arteries, the aorta, and the myocardium (function, morphology) were independently analyzed by a resident and two senior radiologists. The inter-observer agreement between resident and senior radiologists was calculated. A final diagnosis was determined by consensus. RESULTS Thirty patients were included. The coronary artery segments, myocardium and pulmonary arteries were considered analyzable in 84%, 90% and 97% of cases respectively. A final diagnosis for the cause of pain was retained in 19 patients: significant coronary artery stenosis (5), pulmonary embolus (5), aortic dissection (1), hypokinetic cardiomyopathy (2), lung parenchymal abnormalities (5), and hiatus hernia (1). Inter-observer agreement ranged from 0.76 to 1 between senior radiologists and from 0.76 to 1 between resident and senior radiologists. The average time of image interpretation ranged from 14 to 15 minutes. CONCLUSION ECG-gated whole chest CT angiography appears as a promising tool for the evaluation of acute chest pain. Combined evaluation of appearance and function of the myocardium can reveal additional interesting information.
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Affiliation(s)
- G Bierry
- Service de Radiologie B, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex
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van Beek EJR. Should lung scan be abandoned for pulmonary embolism diagnosis in the age of multislice spiral CT? Yes. Intern Emerg Med 2009; 4:189-91. [PMID: 19377852 DOI: 10.1007/s11739-009-0252-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 03/24/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Edwin J R van Beek
- Department of Radiology, Carver College of Medicine, C-751 GH, 200 Hawkins Drive, Iowa City, IA 52242-1077, USA.
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