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Fuglsig JMDCES, Reis INRD, Yeung AWK, Bornstein MM, Spin-Neto R. The current role and future potential of digital diagnostic imaging in implant dentistry: A scoping review. Clin Oral Implants Res 2024; 35:793-809. [PMID: 37990981 DOI: 10.1111/clr.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Diagnostic imaging is crucial for implant dentistry. This review provides an up-to-date perspective on the application of digital diagnostic imaging in implant dentistry. METHODS Electronic searches were conducted in PubMed focusing on the question 'when (and why) do we need diagnostic imaging in implant dentistry?' The search results were summarised to identify different applications of digital diagnostic imaging in implant dentistry. RESULTS The most used imaging modalities in implant dentistry include intraoral periapical radiographs, panoramic views and cone beam computed tomography (CBCT). These are dependent on acquisition standardisation to optimise image quality. Particularly for CBCT, other technical parameters (i.e., tube current, tube voltage, field-of-view, voxel size) are relevant minimising the occurrence of artefacts. There is a growing interest in digital workflows, integrating diagnostic imaging and automation. Artificial intelligence (AI) has been incorporated into these workflows and is expected to play a significant role in the future of implant dentistry. Preliminary evidence supports the use of ionising-radiation-free imaging modalities (e.g., MRI and ultrasound) that can add value in terms of soft tissue visualisation. CONCLUSIONS Digital diagnostic imaging is the sine qua non in implant dentistry. Image acquisition protocols must be tailored to the patient's needs and clinical indication, considering the trade-off between radiation exposure and needed information. growing evidence supporting the benefits of digital workflows, from planning to execution, and the future of implant dentistry will likely involve a synergy between human expertise and AI-driven intelligence. Transiting into ionising-radiation-free imaging modalities is feasible, but these must be further developed before clinical implementation.
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Affiliation(s)
| | | | - Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Rubens Spin-Neto
- Section for Oral Radiology and Endodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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2
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Nuno FMTF, Gradim AC, da Costa Dias AA, Polónia DF. Value-Based Healthcare and Radiology: How can Value be Measured? JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221128075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of value-based healthcare (VBH) emerges as a response to traditional models of healthcare system management. More specifically, in radiology, the transition from volume to value has been discussed by its main associations, having as the main concern regarding the role of the specialty in a more integrated healthcare context. Through a qualitative study, this work aims to analyse and evaluate how this new concept can be implemented in radiology by identifying obstacles and mapping the technical and procedural improvements necessary for its correct implementation in the national context of healthcare provision. Through interviews with different elements of the healthcare sector (from doctors to industry partners and researchers), it was possible to draw a set of metrics for measuring the value of radiology, alongside the implementation of a VBH strategy. As the main conclusion, the implementation of a strategic agenda for the creation of value in radiology at the national level should be based on the reduction of variability and the identification of best practices in terms of adequacy, quality, safety and efficiency, aiming to satisfy the needs of requesting doctors and patients.
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Affiliation(s)
| | - Adriana Coutinho Gradim
- Department of Economics, Management, Industrial Engineering and Tourism, Campus Universitário de Santiago, Aveiro, Portugal
| | - Ana Alexandra da Costa Dias
- Department of Economics, Management, Industrial Engineering and Tourism, Campus Universitário de Santiago, Aveiro, Portugal
- GovCOPP (Governance, Competitiveness and Public Policies) Research Group, Campus Universitário de Santiago, Aveiro, Portugal
| | - Daniel Ferreira Polónia
- Department of Economics, Management, Industrial Engineering and Tourism, Campus Universitário de Santiago, Aveiro, Portugal
- GovCOPP (Governance, Competitiveness and Public Policies) Research Group, Campus Universitário de Santiago, Aveiro, Portugal
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3
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Jalilianhasanpour R, Huntley JH, Alvin MD, Hause S, Ali N, Urrutia V, Ghazi Sherbaf F, Johnson PT, Yousem DM, Yedavalli V. Value of acute neurovascular imaging in patients with suspected transient ischemic attack. Eur J Radiol 2022; 154:110427. [DOI: 10.1016/j.ejrad.2022.110427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
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Bruno MA, Fotos JS, Pitot M, Franceschi AM, Neutze JA, Willis MH, Wasserman E, Snyder BL, Cruciata G, Stuckey HL, Wintermark M. Factors Driving Resistance to Clinical Decision Support: Finding Inspiration in Radiology 3.0. J Am Coll Radiol 2022; 19:366-376. [DOI: 10.1016/j.jacr.2021.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
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Consul N, Camacho DR, Sam KQ, Berenji A, Diaz-Marchan PJ. The DIRRECT Radiology Residency Educational Pathway: A Focus on Clinical Consultancy- Radiology In Training. Radiology 2022; 302:E1-E3. [PMID: 34726533 DOI: 10.1148/radiol.2021210532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nikita Consul
- From the Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030 (N.C., D.R.C., A.B., P.J.D.M.); and Department of Breast Imaging, Radiology Partners, Houston, Tex (K.Q.S.)
| | - Diego R Camacho
- From the Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030 (N.C., D.R.C., A.B., P.J.D.M.); and Department of Breast Imaging, Radiology Partners, Houston, Tex (K.Q.S.)
| | - Kenny Q Sam
- From the Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030 (N.C., D.R.C., A.B., P.J.D.M.); and Department of Breast Imaging, Radiology Partners, Houston, Tex (K.Q.S.)
| | - Ashkan Berenji
- From the Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030 (N.C., D.R.C., A.B., P.J.D.M.); and Department of Breast Imaging, Radiology Partners, Houston, Tex (K.Q.S.)
| | - Pedro J Diaz-Marchan
- From the Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030 (N.C., D.R.C., A.B., P.J.D.M.); and Department of Breast Imaging, Radiology Partners, Houston, Tex (K.Q.S.)
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Communication - a lost art? Pediatr Radiol 2022; 52:613-615. [PMID: 34173851 PMCID: PMC8233635 DOI: 10.1007/s00247-021-05133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/02/2022]
Abstract
The field of radiology has benefited greatly from the technological boom that has brought greater precision, efficiency and utilization amid an exponential growth in medical science. The downside is that the same technology that has allowed the field to grow is contributing to an erosion of interpersonal communication and connection with patients and referring physicians. Remote reading has displaced us from the communal reading room, where much interaction and teaching used to take place. The "invisible" radiologist must transcend these barriers in order to preserve and strengthen the role of radiology in medical care. With modest adaptation, radiologists can regain their identity as consultants, where they have the greatest chance to show their value and thwart the drive toward commoditization.
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Goldman-Yassen AE, Strauss SB, Vlismas PP, Jagannath AD, Yuan M, Farinhas JM, Burns J, Bello JA. Face-to-Face: Resident-led Radiology Medicine Rounds Facilitate Evidence-based Processes for Clinical Decision Support. Curr Probl Diagn Radiol 2021; 50:580-584. [DOI: 10.1067/j.cpradiol.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/09/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
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Yacoub JH, Swanson CE, Jay AK, Cooper C, Spies J, Krishnan P. The Radiology Virtual Reading Room: During and Beyond the COVID-19 Pandemic. J Digit Imaging 2021; 34:308-319. [PMID: 33620622 PMCID: PMC7901504 DOI: 10.1007/s10278-021-00427-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic has disrupted the radiology reading room with a potentially lasting impact. This disruption could introduce the risk of obviating the need for the reading room, which would be detrimental to many of the roles of radiology that occur in and around the reading room. This disruption could also create the opportunity for accelerated evolution of the reading room to meet the strategic needs of radiology and health care through thoughtful re-design of the virtual reading room. In this article, we overview the impact of the COVID-19 pandemic on radiology in our institution and across the country, specifically on the dynamics of the radiology reading room. We introduce the concept of the virtual reading room, which is a redesigned alternative to the physical reading room that can serve the diverse needs of radiology and healthcare during and beyond the pandemic.
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Affiliation(s)
- Joseph H Yacoub
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA.
| | - Carl E Swanson
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Ann K Jay
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Cirrelda Cooper
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - James Spies
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Pranay Krishnan
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
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Beheshtian E, Pakpoor J, Huntley JH, Sahraian S, Urrutia V, Khan MK, Idowu O, Yousem DM. Vascular imaging in the initial evaluation of embolic stroke source. Clin Imaging 2020; 68:278-282. [PMID: 32916508 DOI: 10.1016/j.clinimag.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE During acute ischemic stroke evaluations, neurovascular imaging is commonly performed to localize the source of a thromboembolus and to identify vascular stenoses. In this study, we aimed to analyze 1) the usefulness of intracranial and/or cervical CTA and MRA and carotid doppler ultrasound (DUS) for identifying the stroke source and 2) the incidence of vascular stenoses across stroke etiologies. METHODS We retrospectively reviewed intracranial and/or cervical CTA, DUS and MRA studies to identify the source of the acute stroke by Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria for 200 consecutive patients admitted with a stroke to our tertiary hospital. Stroke etiologies were ascertained and the rates of intracranial and cervical vascular stenoses were stratified by stroke type. RESULTS Of 200 patients, the most probable sources of stroke were small vessel disease (29%), cardioembolic (26.0%) and atheroembolic (23.5%). Across all groups, 27.5% of patients had ≥70% stenosis on neurovascular imaging. The rate of ≥70% vascular stenosis in the neck was 6.9% and 5.8% in the small vessel and cardioembolic categories, respectively. CONCLUSIONS The TOAST etiologies of strokes were nearly equally distributed. Neurovascular imaging was of high utility for identifying large vessel intracranial stenoses in patients presenting with acute stroke across all etiologies, although neck CTA/MRA had a lower rate of positive studies with cardiogenic and small vessel strokes. These findings have implications on the use of CTA/MRA in acute stroke work-up.
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Affiliation(s)
- Elham Beheshtian
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA.
| | - Jina Pakpoor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA
| | - Joseph H Huntley
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA; Eastern Virginia Medical School, Norfolk, VA, USA
| | - Sadaf Sahraian
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Victor Urrutia
- Department of Neurology, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Majid K Khan
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Oluwatoyin Idowu
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - David M Yousem
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA
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Rosenkrantz AB, Fleishon HB, Friedberg EB, Duszak R. Practice Characteristics of the United States General Radiologist Workforce: Most Generalists Work as Multispecialists. Acad Radiol 2020; 27:715-719. [PMID: 32234273 DOI: 10.1016/j.acra.2020.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES While subspecialty radiologists' practice patterns have received recent attention, little is known about the practice patterns of general radiologists. We aim to characterize this group (which represents most US radiologists). MATERIALS AND METHODS US radiologists' individual work efforts were assessed using the 2017 Medicare Provider and Other Supplier Public Use File and a previously validated wRVU-weighted claims-based classification system. Using prior criteria, radiologists without >50% work efforts in a single subspecialty were deemed generalists. For this study, a >25% subspecialty work effort threshold was deemed a subspecialty "focus area," and generalists with ≥2 subspecialty focus areas were deemed "multispecialists." Practice characteristics were summarized using various parameters. RESULTS Among 12,438 radiologists meeting existing claims-based criteria to be deemed generalists, 85.0% had ≥2 subspecialty focus areas of >25% work effort (i.e., multispecialists), 14.6% had one focus area, and 0.4% had no focus area. The fraction of generalists meeting multispecialist criteria was similar across radiologists' years in practice (range 84.7% to 85.4%), academic vs. nonacademic status (84.9% to 86.6%), and practice size (83.3% to 87.0%). Although general radiologist multispecialization varied geographically, a majority were multispecialists in all states (range 57.6% in VT to 93.9% in WY) and percentages were not associated with state-level population density (r = 0.013; p = 0.926). CONCLUSION The large majority of US general radiologists practice as multispecialists, and nearly all have at least one subspecialty focus area. The predominance of general radiologists' multispecialty focus across various practice types and locations supports their role in facilitating patient access to a range of radiologist subspecialties.
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Gutzeit A, Fischmann A, Forstner R, Goette R, Herzog B, Kurtz C, Hebler C, Ladinger A, Froehlich JM, Blautzik J, Kolokythas O, Matoori S, Kos S, Reischauer C, Schefer H, Dubsky P, Gampenrieder SP, Hergan K, Gaissmaier W, Koh DM, Meissnitzer M. "I was seen by a radiologist, but unfortunately I can't remember the name and I still have questions. What should I do?" Radiologists should give thoughts to improve service professionalism and patient esteem. Cancer Imaging 2020; 20:18. [PMID: 32054513 PMCID: PMC7020583 DOI: 10.1186/s40644-020-0292-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background The aim of the study is to investigate how well patients remember the radiologist’s name after a radiological examination, and whether giving the patient a business card improves the patient’s perception of the radiologist’s professionalism and esteem. Methods In this prospective and randomized two-centre study, a total of 141 patients with BI-RADS 1 and 2 scores were included. After screening examination comprising mammography and ultrasound by a radiologist, 71 patients received a business card (group 1), while 70 received no business card (group 2). Following the examination, patients were questioned about their experiences. Results The patients in group 1 could remember the name of the radiologist in 85% of cases. The patients in group 2, in contrast, could only remember the name in 7% of cases (p < 0.001). 90% of the patients in group 1 believed it was very important that they are able to contact the radiologist at a later time, whereas only 76% of patients in group 2 felt that this was a very important service (p < 0.025). A total of 87% of the patients in group 1 indicated that they would contact the radiologist if they had any questions whereas 73% of the patients in group 2 would like to contact the radiologist but were not able to do so, because they could not remember the name (p < 0.001). All questions were analysed with a Cochran-Mantel-Haenszel (CMH) test that took study centre as stratification into account. In some cases, two categories were collapsed to avoid zero cell counts. Conclusions Using business cards significantly increased the recall of the radiologist’s name and could be an important tool in improving the relationships between patients and radiologists and enhancing service professionalism. Trial registration We have a general approval from our ethics committee. The patients have given their consent to this study.
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Affiliation(s)
- Andreas Gutzeit
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria. .,Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 1-5 / 10, 8093, Zurich, Switzerland. .,Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland.
| | - Arne Fischmann
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Rosemarie Forstner
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Romana Goette
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Bernhard Herzog
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Claudia Kurtz
- Institute of Radiology and Nuclear Medicine, Kantonsspital Luzern, Lucerne, Switzerland
| | - Chantal Hebler
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Andrea Ladinger
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Johannes M Froehlich
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Janusch Blautzik
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Orpheus Kolokythas
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98190, USA
| | - Simon Matoori
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria.,Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Sebastian Kos
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Carolin Reischauer
- Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Radiology, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland
| | - Hubert Schefer
- Department of Oncology, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Peter Dubsky
- Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Simon Peter Gampenrieder
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, P.O. Box 43, D-78457, Konstanz, Germany
| | - Dow-Mu Koh
- Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK
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Aldemir E, Gezer NS, Tohumoglu G, Barış M, Kavur AE, Dicle O, Selver MA. Reversible 3D compression of segmented medical volumes: usability analysis for teleradiology and storage. Med Phys 2020; 47:1727-1737. [PMID: 31994208 DOI: 10.1002/mp.14053] [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: 07/30/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND DICOM standard does not have modules that provide the possibilities of two-dimensional Presentation States to three-dimensional (3D). Once the final 3D rendering is obtained, only video/image exporting or snapshots can be used. To increase the utility of 3D Presentation States in clinical practice and teleradiology, the storing and transferring the segmentation results, obtained after tedious procedures, can be very effective. PURPOSE To propose a strategy for preserving interaction and mobility of visualizations for teleradiology by storing and transferring only binary segmented data, which is effectively compressed by modern adaptive and context-based reversible methods. MATERIAL AND METHODS A diverse set of segmented data, which include four abdominal organs (liver, spleen, right, and left kidneys) from 20 T1-DUAL and 20 T2-SPIR MRI, liver from 20 CT, and abdominal aorta with aneurysms (AAA) from 19 computed tomography-angiography datasets, are collected. Each organ is segmented manually by expert physicians, and binary volumes are created. The well-established reversible binary compression methods PNG, JPEG-LS, JPEG-XR, CCITT-G4, LZW, JBIG2, and ZIP are applied to medical datasets. Recently proposed context-based (3D-RLE) and adaptive (ABIC) algorithms are also employed. The performance assessment has been presented in terms of the compression ratio that is a universal compression metric. RESULTS Reversible compression of binary volumes results with substantial decreases in file size such as 254 to 2.14 MB for CT-AAA, 56.7 to 0.3 MB for CT-liver. Moreover, compared to the performance of well-established methods (i.e., mean 76.14%), CR is observed to be increased significantly for all segmented organs from both CT and MRI datasets when ABIC (95.49%) and 3D-RLE (94.98%) are utilized. The hypothesis is that morphological coherence of scanning procedure and adaptation between the segmented organs, that is, bi-level images, contributes to compression performance. Although the performance of well-established techniques is satisfactory, the sensitivity of ABIC to modality type and the advantage of 3D-RLE when the spatial coherence between the adjacent slices are high results with up to 10 times more CR performance. CONCLUSION Adaptive and context-based compression strategies allow effective storage and transfer of segmented binary data, which can be used to re-produce visualizations for better teleradiology practices preserving all interaction mechanisms.
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Affiliation(s)
- Erdoğan Aldemir
- The Graduate School of Natural and Applied Sciences, Dokuz Eylül University, Kuruçeşme Mahallesi, DEÜ Tinaztepe Campus No: 22, 35390, Buca, İzmir, Turkey
| | - Naciye Sinem Gezer
- Dokuz Eylül University Medical School, Department of Radiology, İnciraltı Mahallesi, Mithatpaşa Street, İnciraltı Campus, No:1606, 35340, Narlıdere/İzmir, Turkey
| | - Gulay Tohumoglu
- Electrical and Electronics Engineering Department, Dokuz Eylül University, Kuruçeşme Mahallesi, DEÜ Kaynaklar Campus No: 22, 35090, Buca, İzmir, Turkey
| | - Mustafa Barış
- Dokuz Eylül University Medical School, Department of Radiology, İnciraltı Mahallesi, Mithatpaşa Street, İnciraltı Campus, No:1606, 35340, Narlıdere/İzmir, Turkey
| | - A Emre Kavur
- The Graduate School of Natural and Applied Sciences, Dokuz Eylül University, Kuruçeşme Mahallesi, DEÜ Tinaztepe Campus No: 22, 35390, Buca, İzmir, Turkey
| | - Oguz Dicle
- Dokuz Eylül University Medical School, Department of Radiology, İnciraltı Mahallesi, Mithatpaşa Street, İnciraltı Campus, No:1606, 35340, Narlıdere/İzmir, Turkey
| | - M Alper Selver
- Electrical and Electronics Engineering Department, Dokuz Eylül University, Kuruçeşme Mahallesi, DEÜ Kaynaklar Campus No: 22, 35090, Buca, İzmir, Turkey
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Seghers VJ, Desai NK, Masand PM, Nasir S, Foster TL, Indiero DA, Johnson TD, Huisman TAGM. After the initial COVID-19 surge: a phased radiology departmental re-opening plan. Pediatr Radiol 2020; 50:1551-1559. [PMID: 32827259 PMCID: PMC7442886 DOI: 10.1007/s00247-020-04792-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/05/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Victor J. Seghers
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA ,Department of Radiology, Baylor College of Medicine, Houston, TX USA
| | - Nilesh K. Desai
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA ,Department of Radiology, Baylor College of Medicine, Houston, TX USA
| | - Prakash M. Masand
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA ,Department of Radiology, Baylor College of Medicine, Houston, TX USA
| | - Sadia Nasir
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA
| | - Traci L. Foster
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA
| | - Dennis A. Indiero
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA
| | - Trent D. Johnson
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA
| | - Thierry A. G. M. Huisman
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030 USA ,Department of Radiology, Baylor College of Medicine, Houston, TX USA
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Otero HJ, Degnan AJ, Kadom N, Neumann PJ, Lavelle TA. Cost-Effectiveness Analysis in Pediatric Imaging: The Evidence (or Lack Thereof) Thus Far. J Am Coll Radiol 2019; 17:452-461. [PMID: 31790678 DOI: 10.1016/j.jacr.2019.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review all published cost-effectiveness analyses (CEAs) of imaging technologies in children. METHODS We identified all CEAs involving fetal and pediatric imaging included in a publicly available repository of CEAs published since 1976. Information on publication characteristics, methods, costs, quality of life weights, and incremental cost-effectiveness ratios (ICERs) was recorded for each article. RESULTS Of 480 diagnostic CEAs, only 10 focused on fetal and pediatric imaging. The 10 studies reported 43 quality of life weights based on previously published adult data (n = 20, 46.5%); pregnant women perspective (n = 11, 25.6%), and treating physician perspective (n = 12, 27.9%). None of the studies elicited quality of life weights from children nor took into consideration the postnatal impact of disease on family's quality of life. All studies used a health care payer perspective without incorporating patients' incurred cost such as loss wages or travel related cost. Of 37 ICERs, 7 (18.9%) were cost saving and 6 (16.2%) were more expensive and less effective. The remaining ICERs ranged from $1,400 per quality-adjusted life-year (MRI versus ultrasound in newborns with moderate risk of occult spinal dysraphism) to $10,000,000 per quality-adjusted life-year (CT versus no imaging in children at low risk for craniosynostosis). CONCLUSION There is a striking paucity of cost-effectiveness studies evaluating imaging technologies in children. Existing studies do not incorporate the patient and family perspectives regarding utilities (eg, impact of child's disease on families' quality of life) or cost (eg, loss wages, travel, time off). Future studies should elicit and incorporate the impact of disease on families to better reflect real-world scenarios.
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Affiliation(s)
- Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta (Egleston), Atlanta, Georgia
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Gillman J, Wu SE, Rowland J, Scanlon M, Chen PH. Comparison of In-Person and Digital Radiology Resident Consultation Services. J Am Coll Radiol 2019; 16:972-975. [DOI: 10.1016/j.jacr.2018.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/09/2018] [Accepted: 11/22/2018] [Indexed: 11/15/2022]
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Griffith B, Kadom N, Straus CM. Radiology Education in the 21st Century: Threats and Opportunities. J Am Coll Radiol 2019; 16:1482-1487. [PMID: 31092349 DOI: 10.1016/j.jacr.2019.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Over the past 25 years, radiology has seen tremendous growth in interpretive demands, including increasing imaging volumes and shorter turnaround times, as well as increased noninterpretive demands often targeting value-adding opportunities. These mounting pressures have led to increased burnout among radiologists nationwide and, in the academic setting, have begun to threaten the core educational mission. Despite these threats, radiology has also proven itself over the years to be a leader when it comes to innovation, and as such, no other field is better suited to confront these challenges with innovative solutions. This article explores the impact these workload trends have had on radiology education and educators, as well as opportunities to confront these challenges.
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Affiliation(s)
- Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, Michigan.
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta-Egleston, Atlanta, Georgia
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Abstract
The health care industry has seen many changes in recent years. Gradually, the traditional volume-based fee-for-service health care system is being replaced by the patient-centered, value-based, pay-for-performance model. In response to this, the American College of Radiology has developed an initiative coined Imaging 3.0: a blueprint to help guide our profession through this transition in health care delivery. Radiologists are an integral part of the health care system, and they greatly affect patient care; however, we have progressively become less visible as a specialty. It is time that we, as radiologists, broaden our role in patient care. As breast radiologists, we are uniquely qualified to usher in this new era of medicine. We have the skill set to provide comprehensive breast care. We are actively involved in early breast cancer detection, pre-imaging patient-care decisions, imaging work-ups, diagnosis, care coordination, treatment, and follow-up. We have set the gold standard for concise structured reporting and follow-up recommendations with the American College of Radiology Breast Imaging Reporting and Data System lexicon, which offers value to our clinician colleagues. Our broad knowledge and role in breast conditions, patient relationships, and other noninterpretive skills offers personalized care and expertise that allows for the best, safest, most cost-effective, and efficient service for the patient and health care industry. Our comprehensive care provides direct interaction and education, decreases radiation exposure, and saves patients time and money. It also benefits the health care industry by improving throughput, reducing waste, and eliminating inefficiencies in the system. As breast radiologists, we are uniquely qualified to usher in this new era of radiology.
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Affiliation(s)
- Daniel W Dahl
- Baylor College of Medicine, Department of Radiology, Houston, TX
| | - Phan T Huynh
- Baylor College of Medicine, Department of Radiology, Houston, TX
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DiPiro PJ, Tirumani SH, Ramaiya NH. Perception of Breast Oncologists and Physician Extenders on Imaging Consultation Service at a Tertiary Cancer Institute. Curr Probl Diagn Radiol 2018; 48:452-455. [PMID: 30086986 DOI: 10.1067/j.cpradiol.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/05/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the perception and ease of utilization of the imaging consultation service by different types of referring clinicians and physician extenders within the breast oncology disease center at our tertiary cancer institute using a survey-based questionnaire. METHODS An institutional review board-exempted survey was created using a freely available online survey software and questionnaire tool. The survey was sent to 83 clinicians associated with the breast oncology disease center at our tertiary cancer center through an institutional e-mail list. The survey included 2 questions about demographics and 8 statements regarding various aspects of the consultation service scored on a 5-point Likert-type scale. "1'' being "agree completely," "3" being "neutral/neither agree nor disagree," and "5" being "disagree completely." The survey was sent online and was answered anonymously. Responses were tallied and analyzed. RESULTS A total of 56 responses (67%) were received. The weighted average of each Likert item ranged from 1.07 to 1.58. Highest positive concordance (95%) pertained to the access to the consult radiologist having a positive impact on patient care. The least concordant statement (78%), though still strong (with weighted average of 1.58% and 78% of respondents agreeing or agreeing completely) pertained to the role of direct consultation with radiologist in clinical management. Although there was variability of agreement to all statements (including responders feeling neutral), there was no one that disagreed with any of the Likert items. The mean Likert score for all the statements together was 1.23 (range: 1.07-1.58). CONCLUSION Presence of dedicated oncologic imaging consultation service is perceived positively by the breast oncology team at our tertiary cancer center.
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Affiliation(s)
- Pamela J DiPiro
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Gutzeit A, Heiland R, Sudarski S, Froehlich JM, Hergan K, Meissnitzer M, Kos S, Bertke P, Kolokythas O, Koh DM. Direct communication between radiologists and patients following imaging examinations. Should radiologists rethink their patient care? Eur Radiol 2018; 29:224-231. [PMID: 29943178 DOI: 10.1007/s00330-018-5503-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/26/2018] [Accepted: 04/18/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate patients' perception of the radiology service when the radiologist communicates the findings to patients. METHODS After routine MRI, patients in group 1 (n = 101) were given the opportunity to discuss the findings with the radiologist. Patients in group 2 (n = 101) left the radiology department without any personal communication. Subsequently, by means of a questionnaire designed by an expert psychologist, both groups were asked regarding their anxiety, emotional attachment to the institute and subjective assessment of competence. RESULTS Overall 76 % of all patients were concerned about their imaging findings without significant difference between both groups (p = 0.179). Significantly more patients in group 1 (81%) versus group 2 (14%; p < 0.001) perceived the opportunity to discuss their imaging findings with a radiologist to be a characteristic of a good radiology consultation. A larger number of patients in group 1 experienced significantly higher bonding and only wanted in the future to be examined in the department with communication (p = 0.001) (93%/75%). Significantly more patients in group 1 regarded the radiology department they attended as being more competent (mean score 4.72/4.09, p < 0.001). CONCLUSION Direct communication of imaging findings from radiologists to patients after an MRI examination leads to increased confidence in the radiology service and higher bonding between the patient and radiologist. Radiologists who refrain from direct communication have a lower bonding to patients and are assessed to have lower competence from the patient's point of view. KEY POINTS • Communication between radiologists and patients leads to an increased bonding affinity. • Direct communication leads to increased patient confidence in the radiology service. • Patients perceived discussion with a radiologist of high value.
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Affiliation(s)
- Andreas Gutzeit
- Department of Radiology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland.
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 1-5 / 10, 8093, Zurich, Switzerland.
| | - Regine Heiland
- elbdialog GbR; Schulz von Thun Institute, Institute for Communication, Hamburg, Germany
| | - Sonja Sudarski
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Johannes M Froehlich
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 1-5 / 10, 8093, Zurich, Switzerland
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Matthias Meissnitzer
- Department of Radiology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Sebastian Kos
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Peter Bertke
- Department of Internal Medicine, Hirslanden Klinik St. Anna, St. Anna-Strasse 31, 6006, Lucerne, Switzerland
| | - Orpheus Kolokythas
- Department of Radiology, University Washington, 1959 NE Pacific St., Seattle, WA, 98190, USA
| | - Dow M Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
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20
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Klobuka AJ, Lee J, Buranosky R, Heller M. When the Reading Room Meets the Team Room: Resident Perspectives From Radiology and Internal Medicine on the Effect of Personal Communication After Implementing a Resident-Led Radiology Rounds. Curr Probl Diagn Radiol 2018; 48:312-322. [PMID: 29628404 DOI: 10.1067/j.cpradiol.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Current radiology and internal medicine (IM) residents have trained to varying degrees depending on program in the post picture archiving and communication systems implementation era and thus have largely missed out on the benefits of in-person, 2-way communication between radiologists and consulting clinicians. The purpose of this study is to broadly explore resident perspectives from these groups on the desire for personal contact between radiologists and referring physicians and the effect of improved contact on clinical practice. MATERIALS AND METHODS A radiology rounds was implemented in which radiology residents travel to the IM teaching service teams to discuss their inpatients and review ordered imaging biweekly. Surveys were given to both cohorts following 9 months of implementation. RESULTS A total of 23/49 diagnostic radiology (DR) and 72/197 IM residents responded. In all, 83% of DR and 96% of IM residents desired more personal contact between radiologists and clinicians. Of all, 92% of DR residents agree that contact with referring clinicians changes their approach to a study, 96% of IM residents agree that personal contact with a radiologist has changed patient management in a way that they otherwise would not have done having simply read a report, 85% of DR residents report that more clinician contact will improve resource use, and 96% report that it will improve care quality. Furthermore, 99% of IM residents report that increased access to a radiologist would make selecting the most appropriate imaging study easier in various clinical scenarios. A majority of IM residents prefer radiology reports that provide specific next-step recommendations and that include arrows/key-image series. CONCLUSION We conclude that the newest generation of physicians is already attuned to the value of a radiologist who plays an active, in-person role in the clinical decision-making process.
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Affiliation(s)
- Andrew J Klobuka
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - John Lee
- Drexel University College of Medicine, Pittsburgh, PA
| | - Raquel Buranosky
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Matthew Heller
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Nguyen Q, Mehta SV, Fang J, Sheiman R, Kane R, Ahmed M, Sarwar A, Siewert B, Brook OR. Thirty-day emergency room visits and hospital admissions after outpatient non-vascular image-guided procedures. Abdom Radiol (NY) 2017; 42:2538-2543. [PMID: 28466184 DOI: 10.1007/s00261-017-1153-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the rate of post-procedure emergency department (ED) visits and hospital admissions following outpatient non-vascular image-guided interventions performed under moderate sedation and to identify common and preventable causes of emergency department visits and hospital admissions. MATERIALS AND METHODS Institutional review board approval was acquired for this HIPAA-compliant retrospective study with waiver of informed consent. 1426 consecutive patients undergoing 1512 outpatient image-guided procedures under moderate sedation from November 2012 to August 2014 were included. The average patient age was 57.2 ± 15.2 years, and 602 (42%) patients were women. Major procedure categories included ultrasound-guided liver biopsies, ultrasound-guided kidney biopsies, and CT-guided lung biopsies/fiducial placement. Procedure details and medical follow-up within and after 30 days of the procedure were analyzed. RESULTS A total of 168 (11.8%) patients were admitted to the hospital within 30 days of the procedure, with 29 of the admissions (17.3% of total admissions and 1.9% of total procedures) being procedure related. The most common procedure-related complication that required admission was hemorrhage (10/29, 34.5% of procedure-related admissions, 6.0% of total admissions, and 0.7% of total procedures), followed by pneumothorax (9/29, 31%, 5.4%, 0.6%), infection (4/29, 13.8%, 2.4%, 0.3%), and pain (3/29, 10.3%, 1.8%, 0.2%). Eighteen (62.1%) procedure-related admissions were immediately indicated. Thirty patients visited the ED and were subsequently discharged without admission with eight of the visits being procedure related (8/1512, 0.5%). All the procedure-related ED visits were due to pain. There were two deaths (2/1512, 0.1%) related to procedures, one from a thromboembolic event and another from post-biopsy hemorrhage. CONCLUSION Outpatient non-vascular image-guided procedures result in a 30-day 1.9% hospital admission, 30-day 0.5% emergency room visit, and 30-day 0.1% mortality rate.
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Affiliation(s)
- Quang Nguyen
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Sahil V Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jieming Fang
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Robert Sheiman
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Robert Kane
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Ammar Sarwar
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
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Salama GR, Sullivan C, Holzwanger D, Giambrone AE, Min RJ, Hentel KD. Improving Care and Education Through a Radiology Resident-driven Clinical Consultation Service. Acad Radiol 2017; 24:1175-1181. [PMID: 28392029 DOI: 10.1016/j.acra.2017.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/13/2017] [Accepted: 01/30/2017] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVE As health care moves toward bundled payment systems and merit-based incentive models, increasing awareness of the value of the radiologist is essential. A resident-driven clinical imaging rounds (CIR) program initiated at our institution allows radiologists to actively and directly participate in the team-based medical model. A retrospective review of survey data evaluated the qualitative and quantitative effects of CIR on clinical management, communication, and education of referring providers and radiology residents. MATERIALS AND METHODS The initial 10 months of a resident-organized CIR were evaluated in a retrospective study. Twenty radiology residents and 150 internal medicine physicians and medical students participated in imaging rounds. An anonymous survey of participants was performed and results were analyzed. RESULTS Eighty-five percent of radiology resident participants completed the survey (N = 17). Approximately 30% of internal medicine participants completed the survey (N = 45). There was an overwhelming positive review of imaging rounds, with a large majority of all groups agreeing that imaging rounds improve education, communication, and patient care. CONCLUSIONS Resident-driven imaging rounds provide a valuable opportunity to improve communication, education, and patient care. We have created a CIR with a sustainable workflow that allows direct and regularly scheduled imaging-medicine consultation valued by both radiologists and internal medicine physicians, improving the quality of patient care and providing education to our radiology residents in value-based care.
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Abstract
The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines "value" as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists' diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities. Main Messages • Value-based healthcare defines value as patient's outcome over costs. • The VBH framework disregards the diagnosis as an outcome. • VBH considers diagnosis only if wrong or a cause of complications. • A correct diagnosis is the first outcome that matters to patients. • Metrics to measure radiologists' impacts on patient outcomes are key. • The value provided by radiology is multifaceted, going beyond exam volumes.
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Maximizing Value Through Innovations in Radiologist-Driven Communications in Breast Imaging. AJR Am J Roentgenol 2017; 209:1001-1005. [PMID: 28726506 DOI: 10.2214/ajr.17.18410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purposes of this article are to provide an overview of current and emerging practices in radiologist communications with both referring physicians and patients across the breast cancer care continuum; to highlight areas in which radiologist-driven communications can improve value in breast cancer screening, diagnosis, and treatment; and describe how the integrative reporting and consultative practices of breast imagers can serve as models of higher-value patient-centered care in other radiology subspecialties. CONCLUSION The traditional radiology report will eventually no longer be viewed as the sole consultation by radiologists but instead act as a starting point for more detailed communications between radiologists and both patients and physicians. The value-creating practices of breast imagers can be used as a road map for similar practices across other radiologic specialties, similar to the use of BI-RADS as a road map for structured breast imaging reporting.
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DiPiro PJ, Krajewski KM, Giardino AA, Braschi-Amirfarzan M, Ramaiya NH. Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting. Korean J Radiol 2017; 18:18-27. [PMID: 28096715 PMCID: PMC5240488 DOI: 10.3348/kjr.2017.18.1.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/11/2016] [Indexed: 11/30/2022] Open
Abstract
The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.
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Affiliation(s)
- Pamela J DiPiro
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Katherine M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Angela A Giardino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Marta Braschi-Amirfarzan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
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Rosenkrantz AB, Sherwin J, Prithiani CP, Ostrow D, Recht MP. Technology-Assisted Virtual Consultation for Medical Imaging. J Am Coll Radiol 2016; 13:995-1002. [DOI: 10.1016/j.jacr.2016.02.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
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28
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Mayo RC, Parikh JR. Breast Imaging: The Face of Imaging 3.0. J Am Coll Radiol 2016; 13:1003-7. [DOI: 10.1016/j.jacr.2016.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/09/2016] [Indexed: 01/17/2023]
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29
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The Value of Imaging Part II: Value beyond Image Interpretation. Acad Radiol 2016; 23:23-9. [PMID: 26683509 DOI: 10.1016/j.acra.2015.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/09/2015] [Accepted: 09/20/2015] [Indexed: 12/21/2022]
Abstract
Although image interpretation is an essential part of radiologists' value, there are other ways in which we contribute to patient care. Part II of the value of imaging series reviews current initiatives that demonstrate value beyond the image interpretation. Standardizing processes, reducing the radiation dose of our examinations, clarifying written reports, improving communications with patients and providers, and promoting appropriate imaging through decision support are all ways we can provide safer, more consistent, and higher quality care. As payers and policy makers push to drive value, research that demonstrates the value of these endeavors, or lack thereof, will become increasingly sought after and supported.
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Arleo EK, Bluth E, Francavilla M, Straus CM, Reddy S, Recht M. Surveying Fourth-Year Medical Students Regarding the Choice of Diagnostic Radiology as a Specialty. J Am Coll Radiol 2015; 13:188-95. [PMID: 26499162 DOI: 10.1016/j.jacr.2015.08.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/05/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to survey fourth-year medical students, both those choosing and those not choosing diagnostic radiology as their specialty, regarding factors influencing their choice of specialty and their perceptions of radiology. METHODS A voluntary anonymous online survey hyperlink was sent to 141 US medical schools for distribution to fourth-year students. Topics included demographics, radiology education, specialty choice and influencing factors, and opinions of radiology. RESULTS A representative sampling (7%) of 2015 fourth-year medical students (n = 1,219; 51% men, 49% women) participated: 7% were applying in radiology and 93% were not. For respondents applying in radiology, the most important factor was intellectual challenge. For respondents applying in nonradiology specialties, degree of patient contact was the most important factor in the decision not to choose radiology; job market was not listed as a top-three factor. Women were less likely than men to apply in radiology (P < .001), with radiology selected by 11.8% of men (56 of 476) and only 2.8% of women (13 of 459). Respondents self-identifying as Asian had a significantly higher (P = .015) likelihood of selecting radiology (19 of 156 [12.2%]) than all other races combined (44 of 723 [6.1%]). Respondents at medical schools with required dedicated medical imaging rotations were more likely to choose radiology as a specialty, but most schools still do not require the clerkship (82%). CONCLUSIONS The reasons fourth-year medical students choose, or do not choose, diagnostic radiology as a specialty are multifactorial, but noncontrollable factors, such as the job market, proved less compelling than controllable factors, such as taking a radiology rotation.
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Affiliation(s)
| | - Edward Bluth
- Ochsner Clinic Foundation, New Orleans, Louisiana
| | | | | | - Sravanthi Reddy
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Michael Recht
- Department of Radiology, New York University Langone Medical Center, New York, New York
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Raji CA, Eyre H, Wei SH, Bredesen DE, Moylan S, Law M, Small G, Thompson PM, Friedlander RM, Silverman DH, Baune BT, Hoang TA, Salamon N, Toga AW, Vernooij MW. Hot Topics in Research: Preventive Neuroradiology in Brain Aging and Cognitive Decline. AJNR Am J Neuroradiol 2015; 36:1803-9. [PMID: 26045577 DOI: 10.3174/ajnr.a4409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/23/2015] [Indexed: 01/26/2023]
Abstract
Preventive neuroradiology is a new concept supported by growing literature. The main rationale of preventive neuroradiology is the application of multimodal brain imaging toward early and subclinical detection of brain disease and subsequent preventive actions through identification of modifiable risk factors. An insightful example of this is in the area of age-related cognitive decline, mild cognitive impairment, and dementia with potentially modifiable risk factors such as obesity, diet, sleep, hypertension, diabetes, depression, supplementation, smoking, and physical activity. In studying this link between lifestyle and cognitive decline, brain imaging markers may be instrumental as quantitative measures or even indicators of early disease. The purpose of this article is to provide an overview of the major studies reflecting how lifestyle factors affect the brain and cognition aging. In this hot topics review, we will specifically focus on obesity and physical activity.
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Affiliation(s)
- C A Raji
- From the Departments of Radiology (C.A.R., S.H.W., T.A.H., N.S.)
| | - H Eyre
- Psychiatry (H.E., G.S.) Discipline of Psychiatry (H.E., B.T.B.), University of Adelaide, Adelaide, South Australia, Australia
| | - S H Wei
- From the Departments of Radiology (C.A.R., S.H.W., T.A.H., N.S.)
| | | | - S Moylan
- School of Medicine (S.M.), Deakin University, Geelong, Victoria, Australia
| | - M Law
- Department of Radiology (M.L.)
| | | | - P M Thompson
- Laboratory of Neuroimaging (P.M.T., A.W.T.), University of Southern California, Los Angeles, California
| | - R M Friedlander
- Department of Neurosurgery (R.M.F.), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - D H Silverman
- Nuclear Medicine (D.H.S.), University of California at Los Angeles Medical Center, University of California at Los Angeles, Los Angeles, California
| | - B T Baune
- Discipline of Psychiatry (H.E., B.T.B.), University of Adelaide, Adelaide, South Australia, Australia
| | - T A Hoang
- From the Departments of Radiology (C.A.R., S.H.W., T.A.H., N.S.)
| | - N Salamon
- From the Departments of Radiology (C.A.R., S.H.W., T.A.H., N.S.)
| | - A W Toga
- Laboratory of Neuroimaging (P.M.T., A.W.T.), University of Southern California, Los Angeles, California
| | - M W Vernooij
- Departments of Radiology and Epidemiology (M.W.V.), Erasmus University Medical Center, Rotterdam, the Netherlands
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Rosenkrantz AB, Johnson E, Sanger JJ. Use of a web-based image reporting and tracking system for assessing abdominal imaging examination quality issues in a single practice. ACTA ACUST UNITED AC 2015; 40:3354-8. [PMID: 26182885 DOI: 10.1007/s00261-015-0502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article presents our local experience in the implementation of a real-time web-based system for reporting and tracking quality issues relating to abdominal imaging examinations. This system allows radiologists to electronically submit examination quality issues during clinical readouts. The submitted information is e-mailed to a designate for the given modality for further follow-up; the designate may subsequently enter text describing their response or action taken, which is e-mailed back to the radiologist. Review of 558 entries over a 6-year period demonstrated documentation of a broad range of examination quality issues, including specific issues relating to protocol deviation, post-processing errors, positioning errors, artifacts, and IT concerns. The most common issues varied among US, CT, MRI, radiography, and fluoroscopy. In addition, the most common issues resulting in a patient recall for repeat imaging (generally related to protocol deviation in MRI and US) were identified. In addition to submitting quality problems, radiologists also commonly used the tool to provide recognition of a well-performed examination. An electronic log of actions taken in response to radiologists' submissions indicated that both positive and negative feedback were commonly communicated to the performing technologist. Information generated using the tool can be used to guide subsequent quality improvement initiatives within a practice, including continued protocol standardization as well as education of technologists in the optimization of abdominal imaging examinations.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA.
| | - Evan Johnson
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
| | - Joseph J Sanger
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
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Becker M, Goldszal A, Detal J, Gronlund-Jacob J, Epstein R. Managing a Multisite Academic–Private Radiology Practice Reading Environment: Impact of IT Downtimes on Enterprise Efficiency. J Am Coll Radiol 2015; 12:630-7. [DOI: 10.1016/j.jacr.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/03/2014] [Indexed: 11/29/2022]
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Meehan TM, Harvey HB, Duszak R, Meyers PM, McGinty G, Nicola GN, Hirsch JA. Accountable Care Organizations: what they mean for the country and for neurointerventionalists. J Neurointerv Surg 2015; 8:654-7. [DOI: 10.1136/neurintsurg-2015-011809] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 11/04/2022]
Abstract
The Affordable Care Act is celebrating its fifth anniversary and remains one of the most significant attempts to reform healthcare in US history. Prior to the federal legislation, Accountable Care Organizations had largely been part of an academic discussion about how to control rising healthcare costs, but have since become a fixture in our national healthcare landscape. A fundamental shift is underway in the relationship between healthcare delivery and payment models. Some elements of Accountable Care Organizations may remain unfamiliar to most healthcare providers, including neurointerventional specialists. In this paper we review the fundamental concepts behind and the current forms of Accountable Care Organizations, and discuss the challenges and opportunities they present for neurointerventionalists.
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