The Effect of Clinical History on Diagnostic Imaging Interpretation - A Systematic Review

Can clinicians identify community-acquired pneumonia on ultralow-dose CT? A diagnostic accuracy study

BACKGROUND

Without increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians' assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist's assessments as reference standard.

METHODS

This was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations.

RESULTS

All clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians' CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77-88), specificity = 70% (95%CI: 59-81), positive predictive value = 80% (95%CI: 74-84), negative predictive value = 78% (95%CI: 73-82).

CONCLUSION

This study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy.

Abbreviated MRI in the evaluation of dizziness: report turnaround times and impact on length of stay compared to CT, CTA, and conventional MRI

PURPOSE

Neuroimaging is often used in the emergency department (ED) to evaluate for posterior circulation strokes in patients with dizziness, commonly with CT/CTA due to speed and availability. Although MRI offers more sensitive evaluation, it is less commonly used, in part due to slower turnaround times. We assess the potential for abbreviated MRI to improve reporting times and impact on length of stay (LOS) compared to conventional MRI (as well as CT/CTA) in the evaluation of acute dizziness.

MATERIALS AND METHODS

We performed a retrospective analysis of length of stay via LASSO regression for patients presenting to the ED with dizziness and discharged directly from the ED over 4 years (1/1/2018-12/31/2021), controlling for numerous patient-level and logistical factors. We additionally assessed turnaround time between order and final report for various imaging modalities.

RESULTS

14,204 patients were included in our analysis. Turnaround time for abbreviated MRI was significantly lower than for conventional MRI (4.40 h vs. 6.14 h, p < 0.001) with decreased impact on LOS (0.58 h vs. 2.02 h). Abbreviated MRI studies had longer turnaround time (4.40 h vs. 1.41 h, p < 0.001) and was associated with greater impact on ED LOS than non-contrast CT head (0.58 h vs. 0.00 h), however there was no significant difference in turnaround time compared to CTA head and neck (4.40 h vs. 3.86 h, p = 0.06) with similar effect on LOS (0.58 h vs. 0.53 h). Ordering both CTA and conventional MRI was associated with a greater-than-linear increase in LOS (additional 0.37 h); the same trend was not seen combining CTA and abbreviated MRI (additional 0.00 h).

CONCLUSIONS

In the acute settings where MRI is available, abbreviated MRI protocols may improve turnaround times and LOS compared to conventional MRI protocols. Since recent guidelines recommend MRI over CT in the evaluation of dizziness, implementation of abbreviated MRI protocols has the potential to facilitate rapid access to preferred imaging, while minimizing impact on ED workflows.

Practical Strategies to Retain Radiologists

Since the great resignation associated with the coronavirus disease 2019 pandemic, radiology practices are now challenged with maintaining adequate radiology staffing requirements to cope with increasing clinical workload requirements. The authors describe practical strategies for radiology practice leaders to retain radiologists in the current challenging job market, while mitigating their burnout.

Navigating Challenges in Teleradiology Implementation: A Case Study from Saudi Arabia's Healthcare System

Background and Aims

Teleradiology is the practice of interpreting medical images acquired in an off-site location. Teleradiology has been utilized widely around the world to address the needs for subspecialty coverage, workload balancing, and as a solution for understaffing. This study aims to assess the perceptions of teleradiology among radiologists in Saudi Arabia, investigate any challenges they might face, and explore strategies that would help mitigate those challenges.

Methods

A cross-sectional study using a self-administered electronic questionnaire was conducted to collect responses from radiologists practicing or having practiced teleradiology in Saudi Arabia. The questionnaire was conducted from January to June 2023, and 105 responses were included in the analysis. The responses were analyzed using chi-squared testing to investigate factors affecting the radiologists' perceptions.

Results

The most common challenges for teleradiology were access to patients' health records, access to prior imaging exams, and concerns about image quality assurance. Around 74% of participants perceived teleradiology to be beneficial for geographic, after-hour, and subspecialties coverage. Teleradiology was also perceived to help reduce the turn-around time of radiology interpretations. Better communication with referring physicians and technologists was seen as a way to help improve teleradiology services.

Conclusion

The findings suggest that the perception of teleradiology's challenges and benefits may not be influenced by experience, workplace, or subspecialty. Emphasis should be placed on the importance of quality assurance of images acquired remotely. Addressing the concerns and challenges related to access to patients' health records is also crucial to ensuring the successful implementation of teleradiology in the country.

Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports

INTRODUCTION

Timely recognition of dysplastic hip morphology is critical to facilitate appropriate management before significant joint damage has developed. It is likely that radiologist under reporting contributes to delays in diagnosis. This study aimed to assess how often adult hip dysplasia goes undetected in radiological reports and to identify clinical and radiological variables that impact the likelihood of detection of dysplasia by radiologists.

METHODS

Referral details and radiology reports of patients who underwent periacetabular osteotomy by a single surgeon for symptomatic hip dysplasia between 1 January 2016 and 30 June 2020 were reviewed. Four assessors measured the lateral centre edge angle from the pelvic radiograph performed at time of referral. Film quality and other radiographic parameters were also assessed.

RESULTS

Sixty-eight patients were included, 84% were female and the median age was 28.1 years. Dysplasia was not documented in the radiology report in 49% of cases. Dysplasia was more likely to be reported with no history of injury, an aspherical femoral head, lower lateral centre edge angle, higher acetabular index, increased femoral head shaft angle, higher femoro-epiphyseal acetabular roof index, or if there was disruption of Shenton's line, with the first three variables being independent predictors of radiologist detection.

CONCLUSION

Hip dysplasia should be considered in all adolescents/young adults presenting with hip pain. Causes of radiologist under reporting are likely multifactorial. Clinical information can cause cognitive biases and result in selective looking. A systematic approach to pelvis radiographs should include assessment of acetabular coverage and active search for evidence of femoral head migration.

Classification of Musculoskeletal Radiograph Requisition Appropriateness Using Machine Learning

Objective: Poor quality imaging requisitions lower report quality and impede good patient care. Manual control of such requisitions is time consuming and can be a source of friction with referring physicians. The purpose of this study was to determine if poor quality requisitions could be identified automatically using machine learning and natural language processing techniques in order to allow for more efficient workflow. Methods: Exam indications from 50 000 musculoskeletal radiograph requisitions were manually classified, reviewed and deemed 'appropriate' or 'inappropriate' by two staff radiologists based on ACR appropriateness criteria. The requisitions were divided into training and test groups (80/20 split). The training set was pre-processed, converted to a bag-of-words model and used to train a Multinomial Naïve Bayes classifier which was then applied to the test set. Results: Out of 50 000 requisitions, 12 253 (24.5%) were deemed to contain an inappropriate indication. A Naive Bayes model correctly classified requisitions with an accuracy of 98%. In the test set, 107 of 7561 (1.4%) appropriate requisitions were incorrectly flagged and 92 of 2439 (3.8%) inappropriate requisitions were not flagged. Conclusions: Accurate automated identification of inappropriate indications on musculoskeletal requisitions is feasible using machine learning and natural language processing.

The effect of clinical history on diagnostic performance of endodontic cone-beam CT interpretation

AIM

To assess the effect of clinical history on the interpretation of endodontic disease in dental cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

A reader performance study of an image test-set was undertaken using a factorial, free-response, crossover design, accounting for the independent variables: case type, case severity, reader type, and reading modality. Twenty-three readers interpreted 60 CBCT images twice over two reading sessions using a balanced design, once with access to clinical history and once without, where 30 in each session included history. Lesion localisations, specificity, false-positive marks and the weighted alternative free-response receiver operating characteristic (wAFROC1) figure of merit were calculated.

RESULTS

Clinical history had no significant effect on specificity and false-positive rates in non-diseased cases (p>0.05), but improved lesion localisation in subtle and obvious diseased cases (p<0.01). wAFROC1 values were higher with clinical history for subtle (0.58 versus 0.48; p<0.001) and obvious (0.77 versus 0.71; p=0.006) diseased categories. No associations were observed between clinical history and both readers' years of experience and reading volume in the non-diseased categories. Readers with fewer (p=0.03) and moderate (p=0.008) years of experience and low (p=0.002) CBCT reading volume demonstrated better lesion localisation in subtle diseased cases when clinical history was available.

CONCLUSIONS

Clinical history improved the interpretation of CBCT images with disease without affecting the interpretation of images without disease. Less and moderately experienced readers and low-volume readers benefitted more from availability of clinical history.