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Aslaner MA, Kadı G, Kesen S, Kılıç ACK, Coşkun Ö, Bildik F, Keleş A, Demircan A, Kılıç HK, Şişik B, Korkak ÖF, Çelik GK, Arslan V, Oskay A, Can Ö, Baykan N, Yaş SC, Yazla M, Yaka E, Efgan MG, İmamoğlu M, Ak A, Koca A, Çalışkan F, Yadigaroğlu M, Eroğlu SE, İbze S, Yaman M, Taş M, Ardıç Ş, Kozacı N, Çevik Y, Sabak M, Aygün A, Koşargelir M, Aslan YE, Altuntaş G, Acar N, İlhan B. A nationwide analysis of emergency medicine residents' CT interpretation in trauma: The Tract-EM study. Am J Emerg Med 2024; 85:123-129. [PMID: 39255684 DOI: 10.1016/j.ajem.2024.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/06/2024] [Accepted: 08/24/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVE To evaluate the accuracy and determine the factors influencing trauma CT interpretation proficiency among emergency medicine (EM) residents in Turkey through the TraCT-EM study (Interpretation of Trauma CT by EMergency Physicians). METHODS This nationwide, multicenter, cross-sectional study was conducted in 29 academic emergency departments (EDs) from April 2023 to March 2024. A total of 401 senior EM residents participated in the study, each interpreting a standardized set of 42 trauma CT series (cranial, maxillofacial, and cervical) derived from seven patients. Interpretation accuracy was assessed, and factors predicting interpretation failure were analyzed using univariate and multivariate regression models. RESULTS The median accuracy rate of residents was 64.9 %, with higher accuracy in normal CT findings. Using the Angoff method, 14 % of residents scored below the passing threshold. Factors associated with interpretation failure included shorter interpretation times (OR, 0.97; 95 % CI, 0.95-0.99), lower self-confidence in detecting serious pathologies (OR, 2.50; 95 % CI, 1.42-4.42), reliance on in-hospital radiology department reports (OR, 3.45; 95 % CI, 1.47-8.05), and receiving final radiology reports for CT scans (OR, 3.30; 95 % CI, 1.67-6.52), and lack of in-department training programs (OR, 2.51; 95 % CI, 1.34-4.70). CONCLUSION The TraCT-EM study highlighted a 65 % accuracy rate for senior EM residents in trauma CT interpretation, with specific predictors of failure identified. These findings suggest a need for tailored radiology education strategies to enhance training and competency in trauma CT interpretation for EM residents. Further optimization of educational programs could address these gaps, ultimately improving patient outcomes in trauma care.
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Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye.
| | - Gültekin Kadı
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye.
| | - Sevcihan Kesen
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | | | - Özlem Coşkun
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Fikret Bildik
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ayfer Keleş
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ahmet Demircan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Hüseyin Koray Kılıç
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Burak Şişik
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ömer Faruk Korkak
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | | | - Volkan Arslan
- Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Alten Oskay
- Department of Emergency Medicine, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Özge Can
- Department of Emergency Medicine, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Necmi Baykan
- Clinic of Emergency Medicine, Kayseri City Hospital, Kayseri, Türkiye
| | - Secdegül Coşkun Yaş
- Clinic of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Merve Yazla
- Clinic of Emergency Medicine, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Elif Yaka
- Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Mehmet Göktuğ Efgan
- Department of Emergency Medicine, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Türkiye
| | - Melih İmamoğlu
- Department of Emergency Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Ahmet Ak
- Department of Emergency Medicine, Selçuk University Faculty of Medicine, Konya, Türkiye
| | - Ayça Koca
- Department of Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Fatih Çalışkan
- Department of Emergency Medicine, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Metin Yadigaroğlu
- Department of Emergency Medicine, Samsun University Faculty of Medicine, Samsun, Türkiye
| | - Serkan Emre Eroğlu
- Department of Emergency Medicine, University of Health Sciences, Umraniye Health Practice and Research Center, İstanbul, Türkiye
| | - Süleyman İbze
- Department of Emergency Medicine, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Mahmut Yaman
- Department of Emergency Medicine, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
| | - Mahmut Taş
- Clinic of Emergency Medicine, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
| | - Şenol Ardıç
- Department of Emergency Medicine, Trabzon Kanuni Training and Research Hospital, Trabzon, Türkiye
| | - Nalan Kozacı
- Department of Emergency Medicine, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya, Türkiye
| | - Yunsur Çevik
- Clinic of Emergency Medicine, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Mustafa Sabak
- Department of Emergency Medicine, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Ali Aygün
- Department of Emergency Medicine, Ordu University Faculty of Medicine, Ordu, Türkiye
| | - Mehmet Koşargelir
- Clinic of Emergency Medicine, Haydarpaşa Numune Training and Research Hospital, İstanbul, Türkiye
| | - Yusuf Ertuğrul Aslan
- Department of Emergency Medicine, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Gürkan Altuntaş
- Department of Emergency Medicine, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
| | - Nurdan Acar
- Department of Emergency Medicine, Eskişehir Osmangazi University School of Medicine, Eskişehir, Türkiye
| | - Buğra İlhan
- Department of Emergency Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Türkiye
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Vendrell JF, Frandon J, Boussat B, Cotton F, Ferretti G, Sans N, Tasu JP, Beregi JP, Larbi A. Double Reading of Outsourced CT/MR Radiology Reports: Retrospective Analysis. J Patient Saf 2021; 17:e1267-e1271. [PMID: 30531236 DOI: 10.1097/pts.0000000000000525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Our objective was to determine disagreement rates in radiological reports provided by using a double-reading protocol in a national teleradiology company. METHODS From January 2015 to July 2016, 134169 radiological exams from 36 French centers, benefited outsourced interpretations by certified radiologists, in both regular and after-hours activities. Of these, 2040 CT and MR-scans (1.5%) were subjected to a second opinion by other radiologists in the field of their anatomical specialty (cerebral, thoracic, abdominal-pelvic, and osteoarticular). A five-point agreement scale graded from 0 to 4 was assigned for each exam. Disagreements were considered as minor if no clinical consequence for patient (scores 1 and 2) and major if potential clinical consequence (score 3 and 4). Independent radiologists performed a retrospective analysis and a stratified statistical analysis. RESULTS Double reading was performed on CT-scans (n = 934/2040, 45.8%) and MR-scans (n = 1106/2040, 54.2%) performed in regular (80.1%) and after-hours activities (19.9%). Disagreement scores occurred in 437 exams (21.4%), including major disagreements in 59 (2.9%). Among these, 48/754 were assigned by the thoracic second reader (6.4%), 6/70 by the abdominal-pelvic second reader (8.6%), 3/901 by the osteoarticular second reader (0.3%), and 2/315 by the cerebral second reader (0.6%), with statistical significant difference. No additional disagreement rate was observed in regular and after-hours activities (P = 0.63). CONCLUSIONS Double-reading of outsourced CT and MRI interpretations yielded 21.4% disagreement rate, with potential clinical consequence for patient in 2,9% of the cases. These results are in accordance with those previously reported and suggests that quality assurance of outsourced interpretations is needed.
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Affiliation(s)
| | - Julien Frandon
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
| | - Bastien Boussat
- Quality of care unit, Grenoble Alpes University Hospital, TIMC UMR 5525 CNRS, Grenoble Alpes University, France
| | - François Cotton
- Department of Radiology, Université de Lyon 1, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite Cedex, CREATIS INSA - 502, 69621 Villeurbanne Cedex, France
| | - Gilbert Ferretti
- Department of Medical Informatics, Centre Hospitalier et Universitaire de Grenoble, Hôpital Nord, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Nicolas Sans
- Department of Radiology, Centre Hospitalier et Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Jean-Pierre Tasu
- Department of radiology, Centre Hospitalier et Universitaire de Poitiers, Hôpital de la Milétrie, 2 Rue de la Milétrie, 86021 Poitiers cedex, France
| | - Jean-Paul Beregi
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
| | - Ahmed Larbi
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
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Ajrawat P, Young Shin D, Dryan D, Khan M, Ravi B, Veillette C, Leroux T. The Use of Telehealth for Orthopedic Consultations and Assessments: A Systematic Review. Orthopedics 2021; 44:198-206. [PMID: 34292815 DOI: 10.3928/01477447-20210621-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) pandemic, tele-health for orthopedic care is expanding rapidly. The authors sought to identify the evidence describing the effectiveness, barriers, and clinical applications of telehealth for orthopedic assessments and consultations. MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched from inception to March 2020. Forty-seven studies were included, with the most common conditions evaluated being trauma related and the primary modality being videoconferencing. Available literature supports the use of telehealth for orthopedic consultations and assessments because it yields moderate-to-high patient and provider satisfaction, accurate examinations, cost-effectiveness, and reduced wait times. Most commonly reported concerns were professional liability, network security, and technical issues. Given the COVID-19 pandemic, rapid implementation and uptake of virtual assessment for patient care has occurred. The current evidence suggests that telehealth is capable of providing prompt access to quality, cost-efficient orthopedic consultations and assessments. [Orthopedics. 2021;44(4):198--206.].
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Yılmaz AO, Baykal N. A novel approach to optimize workflow in grid-based teleradiology applications. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 123:159-169. [PMID: 26521122 DOI: 10.1016/j.cmpb.2015.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/22/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE This study proposes an infrastructure with a reporting workflow optimization algorithm (RWOA) in order to interconnect facilities, reporting units and radiologists on a single access interface, to increase the efficiency of the reporting process by decreasing the medical report turnaround time and to increase the quality of medical reports by determining the optimum match between the inspection and radiologist in terms of subspecialty, workload and response time. METHODS Workflow centric network architecture with an enhanced caching, querying and retrieving mechanism is implemented by seamlessly integrating Grid Agent and Grid Manager to conventional digital radiology systems. The inspection and radiologist attributes are modelled using a hierarchical ontology structure. Attribute preferences rated by radiologists and technical experts are formed into reciprocal matrixes and weights for entities are calculated utilizing Analytic Hierarchy Process (AHP). The assignment alternatives are processed by relation-based semantic matching (RBSM) and Integer Linear Programming (ILP). RESULTS The results are evaluated based on both real case applications and simulated process data in terms of subspecialty, response time and workload success rates. Results obtained using simulated data are compared with the outcomes obtained by applying Round Robin, Shortest Queue and Random distribution policies. The proposed algorithm is also applied to a real case teleradiology application process data where medical reporting workflow was performed based on manual assignments by the chief radiologist for 6225 inspections. CONCLUSIONS RBSM gives the highest subspecialty success rate and integrating ILP with RBSM ratings as RWOA provides a better response time and workload distribution success rate. RWOA based image delivery also prevents bandwidth, storage or hardware related stuck and latencies. When compared with a real case teleradiology application where inspection assignments were performed manually, the proposed solution was found to increase the experience success rate by 13.25%, workload success rate by 63.76% and response time success rate by 120%. The total response time in the real case application data was improved by 22.39%.
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Affiliation(s)
- Ayhan Ozan Yılmaz
- Department of Medical Informatics, Informatics Institute, Middle East Technical University, Ankara, Turkey.
| | - Nazife Baykal
- Department of Medical Informatics, Informatics Institute, Middle East Technical University, Ankara, Turkey.
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