Does PACS improve diagnostic accuracy in chest radiograph interpretations in clinical practice?

Pediatric chest radiograph interpretation in a real-life setting

Chest radiography is a frequently used imaging modality in children. However, only fair to moderate inter-observer agreement has been reported between chest radiograph interpreters. Most studies were not performed in real-world clinical settings. Our aims were to examine the agreement between emergency department pediatricians and board-certified radiologists in a pediatric real-life setting and to identify clinical risk factors for the discrepancies. Included were children aged 3 months to 18 years who underwent chest radiography in the emergency department not during the regular hours of radiologist interpretation. Every case was reviewed by an expert panel. Inter-observer agreement between emergency department pediatricians and board-certified radiologists was assessed by Cohen's kappa; risk factors for disagreement were analyzed. Among 1373 cases, the level of agreement between emergency department pediatricians and board-certified radiologists was "moderate" (k = 0.505). For radiographs performed after midnight, agreement was only "fair" (k = 0.391). The expert panel identified clinically relevant disagreements in 260 (18.9%) of the radiographs. Over-treatment of antibiotics was identified in 121 (8.9%) of the cases and under-treatment in 79 (5.8%). In a multivariable logistic regression, the following parameters were found to be significantly associated with disagreements: neurological background (p = 0.046), fever (p = 0.001), dyspnea (p = 0.014), and radiographs performed after midnight (p = 0.007).

CONCLUSIONS

Moderate agreement was found between emergency department pediatricians and board-certified radiologists in interpreting chest radiographs. Neurological background, fever, dyspnea, and radiographs performed after midnight were identified as risk factors for disagreement. Implementing these findings could facilitate the use of radiologist expertise, save time and resources, and potentially improve patient care.

WHAT IS KNOWN

• Only fair to moderate inter-observer agreement has been reported between chest radiograph interpreters. • Most studies were not performed in real-world clinical settings. Clinical risk factors for disagreements have not been reported.

WHAT IS NEW

• In this study, which included 1373 cases at the emergency department, the level of agreement between interpreters was only "moderate." • The major clinical parameters associated with interpretation discrepancies were neurological background, fever, dyspnea, and interpretations conducted during the night shift.

Effect of picture archiving and communication system on diagnosis accuracy in CT and radiography examinations in emergency departments

INTRODUCTION

Picture archiving and communication system (PACS) affects the radiologists' and physicians' performance. We aimed to evaluate the effect of implementing PACS on the emergency department (ED) physicians' accuracy compared to a radiologist's diagnosis in Iran.

METHODS

We retrospectively collected data for three six-month periods before and after the implementation of PACS on CT scan and radiography examinations. We compared ED physicians' diagnoses of CT scan and radiography images with a radiologist's interpretations for the same images. We compared 374 CT scans and 346 radiography examinations before implementing PACS (July 2015 to December 2015); 507 CT scans and 480 radiography examinations immediately after PACS (July 2016 to December 2016); and 870 CT scans and 1137 radiography examinations one year after PACS (July 2017 to December 2017).

RESULTS

We found that diagnosis accuracy of ED physicians on CT scans increased from 75.9 % before implementing PACS to 84.4 % immediately after PACS and 94.9 % one year after PACS (p-value < 0.0001). Diagnosis accuracy for radiography images increased from 63.0 % before implementing PACS to 80.2 % immediately after PACS and 93.1 % one year after PACS (p-value < 0.0001).

CONCLUSION

Implementation of PACS technology increases ED physicians' diagnosis accuracy.

Challenges of Implementing Picture Archiving and Communication System in Multiple Hospitals: Perspectives of Involved Staff and Users

Today, despite the advantages of the PACS system, its implementation in some healthcare organizations faces many challenges. One of the important factors in the successful implementation of a PACS system is identifying and prioritizing the challenges from the perspectives of involved staff and user of this system. Therefore, the aim of this study was to determine and compare the challenges of implementing PACS from perspectives these users in educational hospitals. This study was conducted on all IT and medical equipment staff, and radiology residents (n = 140) in Kerman University of Medical Sciences (KUMS) and Shiraz University of Medical Sciences (SUMS) in 2016. The data were collected through two researcher-made questionnaires. Their validity was approved by radiologists, IT staff, and medical informatics specialists and their reliability through calculation of Cronbach's Alpha (0.969 and 0.795). We used Multivariate Analysis of Variance (MANOVA) to compare the scores given by three groups of participants in the challenges and Univariate Analysis of Variance (ANOVA) to compare the scores in two universities. The participants believed that technical challenges were more important than other challenges (x̄=3.74, SD = 0.7). IT experts (x̄=3.87, SD = 1) and radiology residents (x̄=3.95, SD = 0.9) gave the higher scores to the "shortage of high quality monitors" factor and medical equipment experts (x̄=4.26, SD = 0.87) to the "low speed of communication networks" factor among all technical challenges. The mean scores given to technical (x̄=76.1, SD = 13.5) and managerial (x̄=16, SD = 5.9) challenges in SUMS were more than the scores of the same challenges in KUMS (x̄=69.9, SD = 15.7) and (x̄=11.9, SD = 6.4) (p < 0.05). The technical challenges are the most common challenges to PACS implementation, and different universities experience different levels of technical challenges. Eliminating implementation challenges can reduce the risk of failure in the utilization process. Based on the results of this study, providing necessary infrastructures such as appropriate monitors and upgraded IT equipment can prevent many of the PACS implementation challenges.

Discussion of “Evidence-based Health Informatics: How Do We Know What We Know?”

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper “Evidence-based Health Informatics: How Do We Know What We Know?” written by Elske Ammenwerth [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Ammenwerth paper. In subsequent issues the discussion can continue through letters to the editor.

With these comments on the paper “Evidence-based Health Informatics: How do we know what we know?”, written by Elske Ammenwerth [1], the journal seeks to stimulate a broad discussion on the challenges of evaluating information processing and information technology in health care. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.