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Yoon SY, Lee KS, Bezuidenhout AF, Kruskal JB. Spectrum of Cognitive Biases in Diagnostic Radiology. Radiographics 2024; 44:e230059. [PMID: 38843094 DOI: 10.1148/rg.230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Cognitive biases are systematic thought processes involving the use of a filter of personal experiences and preferences arising from the tendency of the human brain to simplify information processing, especially when taking in vast amounts of data such as from imaging studies. These biases encompass a wide spectrum of thought processes and frequently overlap in their concepts, with multiple biases usually in operation when interpretive and perceptual errors occur in radiology. The authors review the gamut of cognitive biases that occur in radiology. These biases are organized according to their expected stage of occurrence while the radiologist reads and interprets an imaging study. In addition, the authors propose several additional cognitive biases that have not yet, to their knowledge, been defined in the radiologic literature but are applicable to diagnostic radiology. Case examples are used to illustrate potential biases and their impact, with emergency radiology serving as the clinical paradigm, given the associated high imaging volumes, wide diversity of imaging examinations, and rapid pace, which can further increase a radiologist's reliance on biases and heuristics. Potential strategies to recognize and overcome one's personal biases at each stage of image interpretation are also discussed. Awareness of such biases and their unintended effects on imaging interpretations and patient outcomes may help make radiologists cognizant of their own biases that can result in diagnostic errors. Identification of cognitive bias in departmental and systematic quality improvement practices may represent another tool to prevent diagnostic errors in radiology. ©RSNA, 2024 See the invited commentary by Larson in this issue.
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Affiliation(s)
- Se-Young Yoon
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Karen S Lee
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Abraham F Bezuidenhout
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Jonathan B Kruskal
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
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Parikh JR, Lexa F. Practical Strategies to Retain Radiologists. J Am Coll Radiol 2024; 21:963-968. [PMID: 38101499 PMCID: PMC11144110 DOI: 10.1016/j.jacr.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/12/2023] [Indexed: 12/17/2023]
Abstract
Since the great resignation associated with the coronavirus disease 2019 pandemic, radiology practices are now challenged with maintaining adequate radiology staffing requirements to cope with increasing clinical workload requirements. The authors describe practical strategies for radiology practice leaders to retain radiologists in the current challenging job market, while mitigating their burnout.
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Affiliation(s)
- Jay R Parikh
- Professor, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Frank Lexa
- Professor and Vice Chair, Faculty Affairs, Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Leithner D, Sala E, Neri E, Schlemmer HP, D'Anastasi M, Weber M, Avesani G, Caglic I, Caruso D, Gabelloni M, Goh V, Granata V, Kunz WG, Nougaret S, Russo L, Woitek R, Mayerhoefer ME. Perceptions of radiologists on structured reporting for cancer imaging-a survey by the European Society of Oncologic Imaging (ESOI). Eur Radiol 2024:10.1007/s00330-023-10397-6. [PMID: 38206405 DOI: 10.1007/s00330-023-10397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To assess radiologists' current use of, and opinions on, structured reporting (SR) in oncologic imaging, and to provide recommendations for a structured report template. MATERIALS AND METHODS An online survey with 28 questions was sent to European Society of Oncologic Imaging (ESOI) members. The questionnaire had four main parts: (1) participant information, e.g., country, workplace, experience, and current SR use; (2) SR design, e.g., numbers of sections and fields, and template use; (3) clinical impact of SR, e.g., on report quality and length, workload, and communication with clinicians; and (4) preferences for an oncology-focused structured CT report. Data analysis comprised descriptive statistics, chi-square tests, and Spearman correlation coefficients. RESULTS A total of 200 radiologists from 51 countries completed the survey: 57.0% currently utilized SR (57%), with a lower proportion within than outside of Europe (51.0 vs. 72.7%; p = 0.006). Among SR users, the majority observed markedly increased report quality (62.3%) and easier comparison to previous exams (53.5%), a slightly lower error rate (50.9%), and fewer calls/emails by clinicians (78.9%) due to SR. The perceived impact of SR on communication with clinicians (i.e., frequency of calls/emails) differed with radiologists' experience (p < 0.001), and experience also showed low but significant correlations with communication with clinicians (r = - 0.27, p = 0.003), report quality (r = 0.19, p = 0.043), and error rate (r = - 0.22, p = 0.016). Template use also affected the perceived impact of SR on report quality (p = 0.036). CONCLUSION Radiologists regard SR in oncologic imaging favorably, with perceived positive effects on report quality, error rate, comparison of serial exams, and communication with clinicians. CLINICAL RELEVANCE STATEMENT Radiologists believe that structured reporting in oncologic imaging improves report quality, decreases the error rate, and enables better communication with clinicians. Implementation of structured reporting in Europe is currently below the international level and needs society endorsement. KEY POINTS • The majority of oncologic imaging specialists (57% overall; 51% in Europe) use structured reporting in clinical practice. • The vast majority of oncologic imaging specialists use templates (92.1%), which are typically cancer-specific (76.2%). • Structured reporting is perceived to markedly improve report quality, communication with clinicians, and comparison to prior scans.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Universita Cattolica del Sacro Cuore, Rome, Italy
- Advanced Radiology Center, Fondazione Universitario Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | | | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Giacomo Avesani
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Vicky Goh
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS, Naples, Italy
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital LMU Munich, Munich, Germany
| | | | - Luca Russo
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Ramona Woitek
- Research Centre for Medical Image Analysis and Artificial Intelligence, Danube Private University, Krems, Austria
| | - Marius E Mayerhoefer
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
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Krueger D, Tanner SB, Szalat A, Malabanan A, Prout T, Lau A, Rosen HN, Shuhart C. DXA Reporting Updates: 2023 Official Positions of the International Society for Clinical Densitometry. J Clin Densitom 2024; 27:101437. [PMID: 38011777 DOI: 10.1016/j.jocd.2023.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Professional guidance and standards assist radiologic interpreters in generating high quality reports. Initially DXA reporting Official Positions were provided by the ISCD in 2003; however, as the field has progressed, some of the current recommendations require revision and updating. This manuscript details the research approach and provides updated DXA reporting guidance. METHODS Key Questions were proposed by ISCD established protocols and approved by the Position Development Conference Steering Committee. Literature related to each question was accumulated by searching PubMed, and existing guidelines from other organizations were extracted from websites. Modifications and additions to the ISCD Official Positions were determined by an expert panel after reviewing the Task Force proposals and position papers. RESULTS Since most DXA is now performed in radiology departments, an approach was endorsed that better aligns with standard radiologic reports. To achieve this, reporting elements were divided into required minimum or optional. Collectively, required components comprise a standard diagnostic report and are considered the minimum necessary to generate an acceptable report. Additional elements were retained and categorized as optional. These optional components were considered relevant but tailored to a consultative, clinically oriented report. Although this information is beneficial, not all interpreters have access to sufficient clinical information, or may not have the clinical expertise to expand beyond a diagnostic report. Consequently, these are not required for an acceptable report. CONCLUSION These updated ISCD positions conform with the DXA field's evolution over the past 20 years. Specifically, a basic diagnostic report better aligns with radiology standards, and additional elements (which are valued by treating clinicians) remain acceptable but are optional and not required. Additionally, reporting guidance for newer elements such as fracture risk assessment are incorporated. It is our expectation that these updated Official Positions will improve compliance with required standards and generate high quality DXA reports that are valuable to the recipient clinician and contribute to best patient care.
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Affiliation(s)
- Diane Krueger
- School of Medicine and Public Health, Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - S Bobo Tanner
- Department of Medicine, Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Auryan Szalat
- Osteoporosis Center, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alan Malabanan
- Bone Health Clinic, Boston Medical Center, Boston, MA, USA
| | - Tyler Prout
- Radiology Department, University of Wisconsin, Madison, WI, USA
| | - Adrian Lau
- Division of Endocrinology and Metabolism, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold N Rosen
- Osteoporosis Prevention and Treatment Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher Shuhart
- Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle, WA, USA
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Roshan MP, Garcia J, Cury AB, Lamy C, Souza F, Sidani C, Cury RC. Eye tracking validation: Improving radiologist reporting and interpretation. Eur J Radiol 2023; 168:111134. [PMID: 37806192 DOI: 10.1016/j.ejrad.2023.111134] [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: 07/31/2023] [Revised: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
RATIONALE AND OBJECTIVES This study aims to validate a new radiology reporting style using eye tracking to maximize radiologist interpretation time, increase accuracy, and minimize dictation time, ultimately providing a clinically relevant, concise, and accurate reporting style. MATERIALS AND METHODS The positive findings only dictation style using a podcast stand-alone microphone (n = 76) was compared with the standard check-list dictation style using a handheld microphone (n = 81). Experienced board-certified radiologists used each style for various imaging modalities. The number of voice recognition corrections per case was tracked. Eye-tracking glasses captured eye movement to document dictation, interpretation, and total examination times. This device also generated thermal heat maps for each style. The statistical difference between the two methods was assessed via descriptive analysis and inferential statistics. RESULTS Eye tracking revealed that the new positive findings dictation style led to a noteworthy shift in radiologists' visual attention, with reduced heat map overlaying the reporting software compared to the standard check-list style, indicating greater focus on medical images. Cases with at least one voice recognition correction significantly decreased using the positive findings dictation style versus the standard check-list style (5.26 % vs. 14.81 %; p = 0.0240). The positive findings dictation style significantly decreased average dictation time (16.54 s [s] vs. 29.39 s; p = 0.0003) without impacting interpretation time (70.90 s vs. 64.30 s; p = 0.7799) or total examination time (87.45 s vs. 93.69 s; p = 0.3756) compared to the standard style. CONCLUSION Positive findings only dictation style significantly decreased dictation time and enhanced accuracy without compromising total interpretation time.
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Affiliation(s)
- Mona P Roshan
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA.
| | - Jacklyn Garcia
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA.
| | - Ana B Cury
- Baptist Health of South Florida and Radiology Associates of South Florida, 8900 N Kendall Dr, Miami, FL 33176, USA.
| | - Chrisnel Lamy
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA.
| | - Frederico Souza
- Baptist Health of South Florida and Radiology Associates of South Florida, 8900 N Kendall Dr, Miami, FL 33176, USA.
| | - Charif Sidani
- Baptist Health of South Florida and Radiology Associates of South Florida, 8900 N Kendall Dr, Miami, FL 33176, USA.
| | - Ricardo C Cury
- Baptist Health of South Florida and Radiology Associates of South Florida, 8900 N Kendall Dr, Miami, FL 33176, USA.
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Gupta A, Gupta N, Kabra M, Kaur T, Gabra P, Khan MA, Jana M. Impact of Structured Reporting of Skeletal Survey in Skeletal Dysplasia: A Single Institution Experience. Indian J Radiol Imaging 2023; 33:144-149. [PMID: 37123575 PMCID: PMC10132863 DOI: 10.1055/s-0043-1762935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Abstract
Background Structured reporting has the advantages of reducing ambiguity in written radiology reports with greater uniformity and comparability of reports amongst different institutes. It has multiple facets: structured format, structured content, and standardized language. While structured reporting initiative has been used in various radiology subspecialties such as oncology, cardiothoracic, abdominal and interventional radiology; skeletal dysplasia is a domain that remains largely untouched by this concept.
Purpose To evaluate the impact of structured reporting in skeletal dysplasia.
Methods and Materials This was an ethically approved pragmatic clinical trial. A defined number (75) of clinically diagnosed and/or genetically confirmed skeletal dysplasia radiographs were evaluated by two radiologists (reader A and reader B) with 5-and 7-years' experience in general radiology, respectively. A pre-defined structured reporting format for skeletal dysplasia was used as an interventional tool. Both the readers interpreted the radiographs before and after the training session. In addition to diagnosis, diagnostic confidence was noted using a semiquantitative scale. Improvement in diagnostic accuracy and diagnostic confidence after training were assessed. McNemar's test was used to assess the statistical significance of difference in proportion of correct diagnoses in pre- and post-education phases. An interrater reliability analysis using the Kappa statistic was performed to determine interobserver agreement between readers both in pre- and post-education phases.
Results In the post-education phase, the proportion of accurate diagnosis improved from 48% (36/75) to 64% (48/75) for reader A, and from 44% (33/75) to 60% (45/75) for reader B as compared with the pre-education phase. Amongst the cases with a correct radiologic diagnosis, an increase in diagnostic confidence was noted in 18 cases for reader A, and 15 cases for reader B. In none of the cases, there was a reduction in diagnostic confidence after training. A McNemar's test determined that there was a statistically significant difference in the proportion of correct diagnoses in pre- and post-education phases, p < 0.001. The interobserver agreement between the readers was found to increase from Kappa = 0.33 (p = 0.004) using non-structured reporting in pre-education phase to Kappa = 0.46 (p < 0.001) using structured reporting in the post-education phase.
Conclusion A structured reporting of skeletal survey can improve accuracy and confidence in diagnosing skeletal dysplasia.
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Affiliation(s)
- Amit Gupta
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Gupta
- Department of Genetics, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tejinder Kaur
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pavan Gabra
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof A. Khan
- Department of Genetics, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Implementation of artificial intelligence in thoracic imaging-a what, how, and why guide from the European Society of Thoracic Imaging (ESTI). Eur Radiol 2023:10.1007/s00330-023-09409-2. [PMID: 36729173 PMCID: PMC9892666 DOI: 10.1007/s00330-023-09409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/29/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023]
Abstract
This statement from the European Society of Thoracic imaging (ESTI) explains and summarises the essentials for understanding and implementing Artificial intelligence (AI) in clinical practice in thoracic radiology departments. This document discusses the current AI scientific evidence in thoracic imaging, its potential clinical utility, implementation and costs, training requirements and validation, its' effect on the training of new radiologists, post-implementation issues, and medico-legal and ethical issues. All these issues have to be addressed and overcome, for AI to become implemented clinically in thoracic radiology. KEY POINTS: • Assessing the datasets used for training and validation of the AI system is essential. • A departmental strategy and business plan which includes continuing quality assurance of AI system and a sustainable financial plan is important for successful implementation. • Awareness of the negative effect on training of new radiologists is vital.
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A Systematic Review of Chest Imaging Findings in Long COVID Patients. J Pers Med 2023; 13:jpm13020282. [PMID: 36836515 PMCID: PMC9965323 DOI: 10.3390/jpm13020282] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Long COVID is the persistence of one or more COVID-19 symptoms after the initial viral infection, and there is evidence supporting its association with lung damage. In this systematic review, we provide an overview of lung imaging and its findings in long COVID patients. A PubMed search was performed on 29 September 2021, for English language studies in which lung imaging was performed in adults suffering from long COVID. Two independent researchers extracted the data. Our search identified 3130 articles, of which 31, representing the imaging findings of 342 long COVID patients, were retained. The most common imaging modality used was computed tomography (CT) (N = 249). A total of 29 different imaging findings were reported, which were broadly categorized into interstitial (fibrotic), pleural, airway, and other parenchymal abnormalities. A direct comparison between cases, in terms of residual lesions, was available for 148 patients, of whom 66 (44.6%) had normal CT findings. Although respiratory symptoms belong to the most common symptoms in long COVID patients, this is not necessarily linked to radiologically detectable lung damage. Therefore, more research is needed on the role of the various types of lung (and other organ) damage which may or may not occur in long COVID.
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Fasterholdt I, Naghavi-Behzad M, Rasmussen BSB, Kjølhede T, Skjøth MM, Hildebrandt MG, Kidholm K. Value assessment of artificial intelligence in medical imaging: a scoping review. BMC Med Imaging 2022; 22:187. [PMID: 36316665 PMCID: PMC9620604 DOI: 10.1186/s12880-022-00918-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is seen as one of the major disrupting forces in the future healthcare system. However, the assessment of the value of these new technologies is still unclear, and no agreed international health technology assessment-based guideline exists. This study provides an overview of the available literature in the value assessment of AI in the field of medical imaging. METHODS We performed a systematic scoping review of published studies between January 2016 and September 2020 using 10 databases (Medline, Scopus, ProQuest, Google Scholar, and six related databases of grey literature). Information about the context (country, clinical area, and type of study) and mentioned domains with specific outcomes and items were extracted. An existing domain classification, from a European assessment framework, was used as a point of departure, and extracted data were grouped into domains and content analysis of data was performed covering predetermined themes. RESULTS Seventy-nine studies were included out of 5890 identified articles. An additional seven studies were identified by searching reference lists, and the analysis was performed on 86 included studies. Eleven domains were identified: (1) health problem and current use of technology, (2) technology aspects, (3) safety assessment, (4) clinical effectiveness, (5) economics, (6) ethical analysis, (7) organisational aspects, (8) patients and social aspects, (9) legal aspects, (10) development of AI algorithm, performance metrics and validation, and (11) other aspects. The frequency of mentioning a domain varied from 20 to 78% within the included papers. Only 15/86 studies were actual assessments of AI technologies. The majority of data were statements from reviews or papers voicing future needs or challenges of AI research, i.e. not actual outcomes of evaluations. CONCLUSIONS This review regarding value assessment of AI in medical imaging yielded 86 studies including 11 identified domains. The domain classification based on European assessment framework proved useful and current analysis added one new domain. Included studies had a broad range of essential domains about addressing AI technologies highlighting the importance of domains related to legal and ethical aspects.
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Affiliation(s)
- Iben Fasterholdt
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark
| | - Mohammad Naghavi-Behzad
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Benjamin S. B. Rasmussen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Radiology, Odense University Hospital, Odense, Denmark ,grid.7143.10000 0004 0512 5013CAI-X – Centre for Clinical Artificial Intelligence, Odense University Hospital, Odense, Denmark
| | - Tue Kjølhede
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark
| | - Mette Maria Skjøth
- grid.7143.10000 0004 0512 5013Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Malene Grubbe Hildebrandt
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Kristian Kidholm
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark
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The natural language processing of radiology requests and reports of chest imaging: Comparing five transformer models’ multilabel classification and a proof-of-concept study. Health Informatics J 2022; 28:14604582221131198. [DOI: 10.1177/14604582221131198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Radiology requests and reports contain valuable information about diagnostic findings and indications, and transformer-based language models are promising for more accurate text classification. Methods In a retrospective study, 2256 radiologist-annotated radiology requests (8 classes) and reports (10 classes) were divided into training and testing datasets (90% and 10%, respectively) and used to train 32 models. Performance metrics were compared by model type (LSTM, Bertje, RobBERT, BERT-clinical, BERT-multilingual, BERT-base), text length, data prevalence, and training strategy. The best models were used to predict the remaining 40,873 cases’ categories of the datasets of requests and reports. Results The RobBERT model performed the best after 4000 training iterations, resulting in AUC values ranging from 0.808 [95% CI (0.757–0.859)] to 0.976 [95% CI (0.956–0.996)] for the requests and 0.746 [95% CI (0.689–0.802)] to 1.0 [95% CI (1.0–1.0)] for the reports. The AUC for the classification of normal reports was 0.95 [95% CI (0.922–0.979)]. The predicted data demonstrated variability of both diagnostic yield for various request classes and request patterns related to COVID-19 hospital admission data. Conclusion Transformer-based natural language processing is feasible for the multilabel classification of chest imaging request and report items. Diagnostic yield varies with the information in the requests.
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Interactive Multimedia Reporting Technical Considerations: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2022; 35:817-833. [PMID: 35962150 PMCID: PMC9485305 DOI: 10.1007/s10278-022-00658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 10/28/2022] Open
Abstract
Despite technological advances in the analysis of digital images for medical consultations, many health information systems lack the ability to correlate textual descriptions of image findings linked to the actual images. Images and reports often reside in separate silos in the medical record throughout the process of image viewing, report authoring, and report consumption. Forward-thinking centers and early adopters have created interactive reports with multimedia elements and embedded hyperlinks in reports that connect the narrative text with the related source images and measurements. Most of these solutions rely on proprietary single-vendor systems for viewing and reporting in the absence of any encompassing industry standards to facilitate interoperability with the electronic health record (EHR) and other systems. International standards have enabled the digitization of image acquisition, storage, viewing, and structured reporting. These provide the foundation to discuss enhanced reporting. Lessons learned in the digital transformation of radiology and pathology can serve as a basis for interactive multimedia reporting (IMR) across image-centric medical specialties. This paper describes the standard-based infrastructure and communications to fulfill recently defined clinical requirements through a consensus from an international workgroup of multidisciplinary medical specialists, informaticists, and industry participants. These efforts have led toward the development of an Integrating the Healthcare Enterprise (IHE) profile that will serve as a foundation for interoperable interactive multimedia reporting.
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White T, Aronson MD, Sternberg SB, Shafiq U, Berkowitz SJ, Benneyan J, Phillips RS, Schiff GD. Analysis of Radiology Report Recommendation Characteristics and Rate of Recommended Action Performance. JAMA Netw Open 2022; 5:e2222549. [PMID: 35867062 PMCID: PMC9308057 DOI: 10.1001/jamanetworkopen.2022.22549] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Following up on recommendations from radiologic findings is important for patient care, but frequently there are failures to carry out these recommendations. The lack of reliable systems to characterize and track completion of actionable radiology report recommendations poses an important patient safety challenge. OBJECTIVES To characterize actionable radiology recommendations and, using this taxonomy, track and understand rates of loop closure for radiology recommendations in a primary care setting. DESIGN, SETTING, AND PARTICIPANTS Radiology reports in a primary care clinic at a large academic center were redesigned to include actionable recommendations in a separate dedicated field. Manual review of all reports generated from imaging tests ordered between January 1 and December 31, 2018, by primary care physicians that contained actionable recommendations was performed. For this quality improvement study, a taxonomy system that conceptualized recommendations was developed based on 3 domains: (1) what is recommended (eg, repeat a test or perform a different test, specialty referral), (2) specified time frame in which to perform the recommended action, and (3) contingency language qualifying the recommendation. Using this framework, a 2-stage process was used to review patients' records to classify recommendations and determine loop closure rates and factors associated with failure to complete recommended actions. Data analysis was conducted from April to July 2021. MAIN OUTCOMES AND MEASURES Radiology recommendations, time frames, and contingencies. Rates of carrying out vs not closing the loop on these recommendations in the recommended time frame were assessed. RESULTS A total of 598 radiology reports were identified with structured recommendations: 462 for additional or future radiologic studies and 196 for nonradiologic actions (119 specialty referrals, 47 invasive procedures, and 43 other actions). The overall rate of completed actions (loop closure) within the recommended time frame was 87.4%, with 31 open loop cases rated by quality expert reviewers to pose substantial clinical risks. Factors associated with successful loop closure included (1) absence of accompanying contingency language, (2) shorter recommended time frames, and (3) evidence of direct radiologist communication with the ordering primary care physicians. A clinically significant lack of loop closure was found in approximately 5% of cases. CONCLUSIONS AND RELEVANCE The findings of this study suggest that creating structured radiology reports featuring a dedicated recommendations field permits the development of taxonomy to classify such recommendations and determine whether they were carried out. The lack of loop closure suggests the need for more reliable systems.
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Affiliation(s)
- Tiantian White
- Harvard Medical School, Boston, Massachusetts
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Mark D. Aronson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Scot B. Sternberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Umber Shafiq
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Seth J. Berkowitz
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - James Benneyan
- Healthcare Systems Engineering Institute, College of Engineering, Northeastern University, Boston, Massachusetts
| | - Russell S. Phillips
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Center for Primary Care, Boston, Massachusetts
| | - Gordon D. Schiff
- Harvard Medical School, Center for Primary Care, Boston, Massachusetts
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, Massachusetts
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13
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Talking Points: Enhancing Communication Between Radiologists and Patients. Acad Radiol 2022; 29:888-896. [PMID: 33846062 DOI: 10.1016/j.acra.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022]
Abstract
Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.
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14
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Pool FJ, Ferris N, Siwach P, Siemienowicz M. Structured Reporting in Radiology: what do radiologists think and does RANZCR have a role in implementation. J Med Imaging Radiat Oncol 2022; 66:193-201. [PMID: 35243789 DOI: 10.1111/1754-9485.13362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Royal Australian and New Zealand College of Radiologists (RANZCR) established a working group to explore how the college should engage with the future development of structured radiology reporting in our region, particularly in the context of a broader move to digital healthcare. Phase 1 of the project surveyed college members and affiliated interest groups about how they are using structured reporting currently and might like it to evolve. METHODS Member and interest group questionnaires were based on previously published studies and posted to the Survey Monkey platform. Responses were analysed descriptively. RESULTS There were 114 members and 58 affiliated group responses. There is clearest support for RANZCR developing guidelines around structured report quality, for improvements in report content, particularly tailoring to clinical context and study parameters, and for improved integration of structured reporting and RIS/PACS systems. CONCLUSIONS Phase 2 of the structured reporting working group project will aim to develop guidelines for structured report quality and processes through which RANZCR can implement them.
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Affiliation(s)
- Felicity J Pool
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Nicholas Ferris
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia
| | | | - Miranda Siemienowicz
- Radiology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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15
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Tadavarthi Y, Makeeva V, Wagstaff W, Zhan H, Podlasek A, Bhatia N, Heilbrun M, Krupinski E, Safdar N, Banerjee I, Gichoya J, Trivedi H. Overview of Noninterpretive Artificial Intelligence Models for Safety, Quality, Workflow, and Education Applications in Radiology Practice. Radiol Artif Intell 2022; 4:e210114. [PMID: 35391770 DOI: 10.1148/ryai.210114] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/17/2021] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Abstract
Artificial intelligence has become a ubiquitous term in radiology over the past several years, and much attention has been given to applications that aid radiologists in the detection of abnormalities and diagnosis of diseases. However, there are many potential applications related to radiologic image quality, safety, and workflow improvements that present equal, if not greater, value propositions to radiology practices, insurance companies, and hospital systems. This review focuses on six major categories for artificial intelligence applications: study selection and protocoling, image acquisition, worklist prioritization, study reporting, business applications, and resident education. All of these categories can substantially affect different aspects of radiology practices and workflows. Each of these categories has different value propositions in terms of whether they could be used to increase efficiency, improve patient safety, increase revenue, or save costs. Each application is covered in depth in the context of both current and future areas of work. Keywords: Use of AI in Education, Application Domain, Supervised Learning, Safety © RSNA, 2022.
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Affiliation(s)
- Yasasvi Tadavarthi
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Valeria Makeeva
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - William Wagstaff
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Henry Zhan
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Anna Podlasek
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Neil Bhatia
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Marta Heilbrun
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Elizabeth Krupinski
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Nabile Safdar
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Imon Banerjee
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Judy Gichoya
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
| | - Hari Trivedi
- Department of Medicine, Medical College of Georgia, Augusta, Ga (Y.T.); Department of Radiology and Imaging Sciences (V.M., W.W., H.Z., M.H., E.K., N.S., J.G., H.T.), School of Medicine (N.B.), and Department of Biomedical Informatics (I.B.), Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322; and Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK (A.P.)
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16
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Lee JK, Bermel R, Bullen J, Ruggieri P, Jones SE. Structured Reporting in Multiple Sclerosis Reduces Interpretation Time. Acad Radiol 2021; 28:1733-1738. [PMID: 32868172 DOI: 10.1016/j.acra.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/01/2023]
Abstract
RATIONALE AND OBJECTIVES Previous studies have reported mixed results regarding whether the use of structured reporting (SR) leads to a change in interpretation times. The objective of this study was to quantify any change in interpretation times after the implementation of SR for multiple sclerosis (MS) follow-up magnetic resonance imaging (MRI) of the brain. MATERIALS AND METHODS Interpretation times before and after the transition to MS MRI SR were compared over a 5-year period. To control for changing practice patterns, a control group of non-MS (intracranial masses) reports not using SR was also assessed. In a secondary analysis, interpretation times for 2D and 3D MRI MS protocols after the initiation of SR were compared to determine whether increased image number with the 3D protocol affected interpretation times. RESULTS Mean and median interpretation times before the initiation of SR for MS MRI were 11.0 and 8.0 minutes versus 8.5 and 6.0 minutes after the implementation of SR (p < 0.001). Although non-MS MRI interpretation times also decreased, an interaction analysis demonstrated that the decrease in MS interpretation times was significantly higher (p < 0.001). Mean and median interpretation times using 3D protocols were slighter increased compared to interpretation times with 2D protocols (p = 0.036). CONCLUSION After the implementation of SR for MS follow-up MRI at our institution, interpretation times significantly decreased despite the increased number of images with some of the examinations due to the adoption of 3D protocols. The adoption of SR for MS MRI follow-up scans may improve radiologist efficiency.
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Affiliation(s)
- Jonathan K Lee
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.
| | - Robert Bermel
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Bullen
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Paul Ruggieri
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Stephen E Jones
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
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17
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Assadsangabi R, Maralani P, Chen AF, Loevner LA, Mohan S. Common blind spots and interpretive errors of neck imaging. Clin Imaging 2021; 82:29-37. [PMID: 34773810 DOI: 10.1016/j.clinimag.2021.10.019] [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: 06/23/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Complex anatomy and a wide spectrum of diseases in the head and neck predispose interpretation of neck imaging to cognitive pitfalls and perceptual errors. Extra attention to common blind spots in the neck and familiarity with common interpretive challenges could aid radiologists in preventing these diagnostic errors.
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Affiliation(s)
- Reza Assadsangabi
- Department of Radiology, Division of Neuroradiology, University of California-Davis, Sacramento, CA, USA.
| | - Pejman Maralani
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony F Chen
- Department of Radiology, Division of Neuroradiology, University of California-Davis, Sacramento, CA, USA
| | - Laurie A Loevner
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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18
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Boon GJAM, Jairam PM, Groot GMC, van Rooden CJ, Ende-Verhaar YM, Beenen LFM, Kroft LJM, Bogaard HJ, Huisman MV, Symersky P, Vonk Noordegraaf A, Meijboom LJ, Klok FA. Identification of chronic thromboembolic pulmonary hypertension on CTPAs performed for diagnosing acute pulmonary embolism depending on level of expertise. Eur J Intern Med 2021; 93:64-70. [PMID: 34294517 DOI: 10.1016/j.ejim.2021.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Expert reading often reveals radiological signs of chronic thromboembolic pulmonary hypertension (CTEPH) or chronic PE on computed tomography pulmonary angiography (CTPA) performed at the time of acute pulmonary embolism (PE) presentation preceding CTEPH. Little is known about the accuracy and reproducibility of CTPA reading by radiologists in training in this setting. OBJECTIVES To evaluate 1) whether signs of CTEPH or chronic PE are routinely reported on CTPA for suspected PE; and 2) whether CTEPH-non-expert readers achieve comparable predictive accuracy to CTEPH-expert radiologists after dedicated instruction. METHODS Original reports of CTPAs demonstrating acute PE in 50 patients whom ultimately developed CTEPH, and those of 50 PE who did not, were screened for documented signs of CTEPH. All scans were re-assessed by three CTEPH-expert readers and two CTEPH-non-expert readers (blinded and independently) for predefined signs and overall presence of CTEPH. RESULTS Signs of chronic PE were mentioned in the original reports of 14/50 cases (28%), while CTEPH-expert radiologists had recognized 44/50 (88%). Using a standardized definition (≥3 predefined radiological signs), moderate-to-good agreement was reached between CTEPH-non-expert readers and the experts' consensus (k-statistics 0.46; 0.61) at slightly lower sensitivities. The CTEPH-non-expert readers had moderate agreement on the presence of CTEPH (κ-statistic 0.38), but both correctly identified most cases (80% and 88%, respectively). CONCLUSIONS Concomitant signs of CTEPH were poorly documented in daily practice, while most CTEPH patients were identified by CTEPH-non-expert readers after dedicated instruction. These findings underline the feasibility of achieving earlier CTEPH diagnosis by assessing CTPAs more attentively.
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Affiliation(s)
- Gudula J A M Boon
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | - Pushpa M Jairam
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerie M C Groot
- Department of Radiology, Medical Center Gelderse Vallei, Ede, the Netherlands
| | | | - Yvonne M Ende-Verhaar
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Ludo F M Beenen
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Petr Symersky
- Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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Steinkamp J, Cook TS. Basic Artificial Intelligence Techniques: Natural Language Processing of Radiology Reports. Radiol Clin North Am 2021; 59:919-931. [PMID: 34689877 DOI: 10.1016/j.rcl.2021.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Natural language processing (NLP) is a subfield of computer science and linguistics that can be applied to extract meaningful information from radiology reports. Symbolic NLP is rule based and well suited to problems that can be explicitly defined by a set of rules. Statistical NLP is better situated to problems that cannot be well defined and requires annotated or labeled examples from which machine learning algorithms can infer the rules. Both symbolic and statistical NLP have found success in a variety of radiology use cases. More recently, deep learning approaches, including transformers, have gained traction and demonstrated good performance.
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Affiliation(s)
- Jackson Steinkamp
- Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Tessa S Cook
- Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 1 Silverstein Radiology, Philadelphia, PA 19104, USA.
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20
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Structured Reporting of Lung Cancer Staging: A Consensus Proposal. Diagnostics (Basel) 2021; 11:diagnostics11091569. [PMID: 34573911 PMCID: PMC8465460 DOI: 10.3390/diagnostics11091569] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Structured reporting (SR) in radiology is becoming necessary and has recently been recognized by major scientific societies. This study aimed to build CT-based structured reports for lung cancer during the staging phase, in order to improve communication between radiologists, members of the multidisciplinary team and patients. Materials and Methods: A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A modified Delphi exercise was used to build the structural report and to assess the level of agreement for all the report sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to perform a quality analysis according to the average inter-item correlation. Results: The final SR version was built by including 16 items in the “Patient Clinical Data” section, 4 items in the “Clinical Evaluation” section, 8 items in the “Exam Technique” section, 22 items in the “Report” section, and 5 items in the “Conclusion” section. Overall, 55 items were included in the final version of the SR. The overall mean of the scores of the experts and the sum of scores for the structured report were 4.5 (range 1–5) and 631 (mean value 67.54, STD 7.53), respectively, in the first round. The items of the structured report with higher accordance in the first round were primary lesion features, lymph nodes, metastasis and conclusions. The overall mean of the scores of the experts and the sum of scores for staging in the structured report were 4.7 (range 4–5) and 807 (mean value 70.11, STD 4.81), respectively, in the second round. The Cronbach’s alpha (Cα) correlation coefficient was 0.89 in the first round and 0.92 in the second round for staging in the structured report. Conclusions: The wide implementation of SR is critical for providing referring physicians and patients with the best quality of service, and for providing researchers with the best quality of data in the context of the big data exploitation of the available clinical data. Implementation is complex, requiring mature technology to successfully address pending user-friendliness, organizational and interoperability challenges.
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21
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M Cunha G, Fowler KJ, Roudenko A, Taouli B, Fung AW, Elsayes KM, Marks RM, Cruite I, Horvat N, Chernyak V, Sirlin CB, Tang A. How to Use LI-RADS to Report Liver CT and MRI Observations. Radiographics 2021; 41:1352-1367. [PMID: 34297631 DOI: 10.1148/rg.2021200205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Primary liver cancer is the fourth leading cause of cancer-related deaths worldwide, with hepatocellular carcinoma (HCC) comprising the vast majority of primary liver malignancies. Imaging plays a central role in HCC diagnosis and management. As a result, the content and structure of radiology reports are of utmost importance in guiding clinical management. The Liver Imaging Reporting and Data System (LI-RADS) provides guidance for standardized reporting of liver observations in patients who are at risk for HCC. LI-RADS standardized reporting intends to inform patient treatment and facilitate multidisciplinary communication and decisions, taking into consideration individual clinical factors. Depending on the context, observations may be reported individually, in aggregate, or as a combination of both. LI-RADS provides two templates for reporting liver observations: in a single continuous paragraph or in a structured format with keywords and imaging findings. The authors clarify terminology that is pertinent to reporting, highlight the benefits of structured reports, discuss the applicability of LI-RADS for liver CT and MRI, review the elements of a standardized LI-RADS report, provide guidance on the description of LI-RADS observations exemplified with two case-based reporting templates, illustrate relevant imaging findings and components to be included when reporting specific clinical scenarios, and discuss future directions. An invited commentary by Yano is available online. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Guilherme M Cunha
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Kathryn J Fowler
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Alexandra Roudenko
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Bachir Taouli
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Alice W Fung
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Khaled M Elsayes
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Robert M Marks
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Irene Cruite
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Natally Horvat
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Victoria Chernyak
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - Claude B Sirlin
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
| | - An Tang
- From the Department of Radiology, University of California San Diego, Liver Imaging Group, La Jolla, Calif (G.M.C., K.J.F., C.B.S.). The complete list of author affiliations is at the end of this article
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Chen J, Wu Z, Liu Y, Wang L, Li T, Dong Y, Qin Q, Ding S. Prevalence, Association Relation, and Dynamic Evolution Analysis of Critical Values in Health Checkup in China: A Retrospective Study. Front Public Health 2021; 9:630356. [PMID: 34368036 PMCID: PMC8339420 DOI: 10.3389/fpubh.2021.630356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/16/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: The critical values in health checkup play a key role in preventing chronic diseases and different types of cancer. This study aimed to analyze the prevalence, association relation, and dynamic evolution of critical values in health checkups at a large physical examination center in China. Methods: Herein, we chose 33,639 samples of physical examiners from January 2017 to December 2019. After strict exclusion processes, combined with the critical values in health checkup reporting data, 4,721 participants with at least one critical value were included. We first defined a critical value list for laboratory test, imaging, cervical cancer screening, electrocardiogram, and health checkup informed on site, and then performed a cross-sectional study to analyze the distribution and significance of critical values of 4,721 participants from different views and the association relation of 628 participants with more than one critical value and a retrospective cohort study to analyze the incidence and dynamic evolution of critical values based on 2,813 participants attending the physical examination from 2017 to 2019. Results: A total of 4,721 participants were included in the retrospective study. The prevalence of 10 critical values from 33,639 participants was over 0.6%. The critical values of obesity, hypertension, Glucose_T, Liver_T, Kidney_T, Lipid_T, Urine_T, and Head_CT were significantly increased in men (P < 0.05), whereas the results were the opposite for the Blood_T and Thyroid_US (P < 0.01). The prevalence trend of critical values increased along with age, where the prevalence of men was higher than that of women under 60 years old (P < 0.01), while the prevalence of women increased by four times and exceeded the prevalence of men above 70 years old. Association relation analysis identified 16 and 6 effective rules for men and women, respectively, where the critical values of Urine_T and Glucose_T played the central roles. Furthermore, a retrospective dynamic evolution analysis found that the incidence of new critical values was about 10%, the incidence of persistent critical values was about 50%, and that most of the effective evolution paths tended to no critical values for men and women. Conclusion: In conclusion, this study provides a new perspective to explore the population health status using the critical value reporting data in a physical examination center, which can assist in decision-making by health management at the population level and in the prevention and treatment of various types of cancer and chronic diseases at the individual level.
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Affiliation(s)
- Jingfeng Chen
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuoqing Wu
- Institute of Systems Engineering, Dalian University of Technology, Dalian, China
| | - Yanan Liu
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Wang
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tiantian Li
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihan Dong
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Qin
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Suying Ding
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Burns J, Ciccarelli S, Mardakhaev E, Erdfarb A, Goldberg-Stein S, Bello JA. Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions. J Am Coll Radiol 2021; 18:1297-1309. [PMID: 33989534 DOI: 10.1016/j.jacr.2021.04.007] [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: 01/01/2021] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Handoffs are essential to achieving safe care transitions. In radiology practice, frequent transitions of care responsibility among clinicians, radiologists, and patients occur between moments of care such as determining protocol, imaging, interpreting, and consulting. Continuity of care is maintained across these transitions with handoffs, which are the process of communicating patient information and transferring decision-making responsibility. As a leading cause of medical error, handoffs are a major communication challenge that is exceedingly common in both diagnostic and interventional radiology practice. The frequency of handoffs in radiology underscores the importance of using evidence-based strategies to improve patient safety in the radiology department. In this article, reliability science principles and handoff improvement tools are adapted to provide radiology-focused strategies at individual, team, and organizational levels with the goal of minimizing handoff errors and improving care transitions.
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Affiliation(s)
- Judah Burns
- Chair, Montefiore Medical Center Peer Review Board; Program Director, Montefiore Medical Center Diagnostic Radiology Residency Program; Department of Radiology, Montefiore Medical Center, Bronx, New York.
| | | | | | - Amichai Erdfarb
- Director of Quality and Safety, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Shlomit Goldberg-Stein
- Director of Operational Improvement, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Jacqueline A Bello
- Vice Chair, Board of Chancellors, American College of Radiology; Section Chief of Neuroradiology, Montefiore Medical Center; Department of Radiology, Montefiore Medical Center, Bronx, New York
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Granata V, Caruso D, Grassi R, Cappabianca S, Reginelli A, Rizzati R, Masselli G, Golfieri R, Rengo M, Regge D, Lo Re G, Pradella S, Fusco R, Faggioni L, Laghi A, Miele V, Neri E, Coppola F. Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal. Cancers (Basel) 2021; 13:cancers13092135. [PMID: 33925250 PMCID: PMC8125446 DOI: 10.3390/cancers13092135] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Structured reporting in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making. Abstract Background: Structured reporting (SR) in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. The aim of this study was to build MRI-based structured reports for rectal cancer (RC) staging and restaging in order to provide clinicians all critical tumor information. Materials and Methods: A panel of radiologist experts in abdominal imaging, called the members of the Italian Society of Medical and Interventional Radiology, was established. The modified Delphi process was used to build the SR and to assess the level of agreement in all sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess the internal consistency of each section and to measure the quality analysis according to the average inter-item correlation. The intraclass correlation coefficient (ICC) was also evaluated. Results: After the second Delphi round of the SR RC staging, the panelists’ single scores and sum of scores were 3.8 (range 2–4) and 169, and the SR RC restaging panelists’ single scores and sum of scores were 3.7 (range 2–4) and 148, respectively. The Cα correlation coefficient was 0.79 for SR staging and 0.81 for SR restaging. The ICCs for the SR RC staging and restaging were 0.78 (p < 0.01) and 0.82 (p < 0.01), respectively. The final SR version was built and included 53 items for RC staging and 50 items for RC restaging. Conclusions: The final version of the structured reports of MRI-based RC staging and restaging should be a helpful and promising tool for clinicians in managing cancer patients properly. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy; (V.G.); (R.F.)
| | - Damiano Caruso
- Department of Medical-Surgical and Translational Medicine-Radiology Unit, Sapienza University of Rome, 00185 Rome, Italy; (D.C.); (M.R.); (A.L.)
| | - Roberto Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80127 Naples, Italy; (R.G.); (S.C.); (A.R.)
- SIRM Foundation, Italian Society of Medical and Interventional Radiology, 20122 Milan, Italy
| | - Salvatore Cappabianca
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80127 Naples, Italy; (R.G.); (S.C.); (A.R.)
| | - Alfonso Reginelli
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80127 Naples, Italy; (R.G.); (S.C.); (A.R.)
| | - Roberto Rizzati
- Division of Radiology, SS.ma Annunziata Hospital, Azienda USL di Ferrara, 44121 Ferrara, Italy;
| | - Gabriele Masselli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy;
| | - Rita Golfieri
- Division of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.G.); (F.C.)
| | - Marco Rengo
- Department of Medical-Surgical and Translational Medicine-Radiology Unit, Sapienza University of Rome, 00185 Rome, Italy; (D.C.); (M.R.); (A.L.)
| | - Daniele Regge
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy;
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy
| | - Giuseppe Lo Re
- Section of Radiological Sciences, DIBIMED, University of Palermo, 90127 Palermo, Italy;
| | - Silvia Pradella
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50139 Florence, Italy; (S.P.); (V.M.)
| | - Roberta Fusco
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy; (V.G.); (R.F.)
| | - Lorenzo Faggioni
- Department of Translational Research, University of Pisa, 56126 Pisa, Italy;
| | - Andrea Laghi
- Department of Medical-Surgical and Translational Medicine-Radiology Unit, Sapienza University of Rome, 00185 Rome, Italy; (D.C.); (M.R.); (A.L.)
| | - Vittorio Miele
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50139 Florence, Italy; (S.P.); (V.M.)
| | - Emanuele Neri
- SIRM Foundation, Italian Society of Medical and Interventional Radiology, 20122 Milan, Italy
- Department of Translational Research, University of Pisa, 56126 Pisa, Italy;
- Correspondence: ; Tel.: +39-050-997313 or +39-050-992913
| | - Francesca Coppola
- Division of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.G.); (F.C.)
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Granata V, Coppola F, Grassi R, Fusco R, Tafuto S, Izzo F, Reginelli A, Maggialetti N, Buccicardi D, Frittoli B, Rengo M, Bortolotto C, Prost R, Lacasella GV, Montella M, Ciaghi E, Bellifemine F, De Muzio F, Danti G, Grazzini G, De Filippo M, Cappabianca S, Barresi C, Iafrate F, Stoppino LP, Laghi A, Grassi R, Brunese L, Neri E, Miele V, Faggioni L. Structured Reporting of Computed Tomography in the Staging of Neuroendocrine Neoplasms: A Delphi Consensus Proposal. Front Endocrinol (Lausanne) 2021; 12:748944. [PMID: 34917023 PMCID: PMC8670531 DOI: 10.3389/fendo.2021.748944] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/12/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports in Neuroendocrine Neoplasms during the staging phase in order to improve communication between the radiologist and members of multidisciplinary teams. MATERIALS AND METHODS A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A Modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. Cronbach's alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. RESULTS The final SR version was built by including n=16 items in the "Patient Clinical Data" section, n=13 items in the "Clinical Evaluation" section, n=8 items in the "Imaging Protocol" section, and n=17 items in the "Report" section. Overall, 54 items were included in the final version of the SR. Both in the first and second round, all sections received more than a good rating: a mean value of 4.7 and range of 4.2-5.0 in the first round and a mean value 4.9 and range of 4.9-5 in the second round. In the first round, the Cα correlation coefficient was a poor 0.57: the overall mean score of the experts and the sum of scores for the structured report were 4.7 (range 1-5) and 728 (mean value 52.00 and standard deviation 2.83), respectively. In the second round, the Cα correlation coefficient was a good 0.82: the overall mean score of the experts and the sum of scores for the structured report were 4.9 (range 4-5) and 760 (mean value 54.29 and standard deviation 1.64), respectively. CONCLUSIONS The present SR, based on a multi-round consensus-building Delphi exercise following in-depth discussion between expert radiologists in gastro-enteric and oncological imaging, derived from a multidisciplinary agreement between a radiologist, medical oncologist and surgeon in order to obtain the most appropriate communication tool for referring physicians.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Roberta Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, Naples, Italy
| | | | - Salvatore Tafuto
- Medical Oncology Unit, Istituto Nazionale Tumori IRCCS ‘Fondazione G. Pascale’, Naples, Italy
| | - Francesco Izzo
- Department of Surgery, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Naples, Italy
| | - Alfonso Reginelli
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, Naples, Italy
| | | | | | - Barbara Frittoli
- Department of Radiology, Ospedali Civili, Hospital of Brescia, University of Brescia, Brescia, Italy
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Latina, Italy
| | - Chandra Bortolotto
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Pavia, Italy
| | - Roberto Prost
- Radiology Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Giorgia Viola Lacasella
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, Naples, Italy
| | - Marco Montella
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, Naples, Italy
| | | | | | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Ginevra Danti
- Division of Radiology, “Azienda Ospedaliera Universitaria Careggi”, Florence, Italy
- *Correspondence: Ginevra Danti,
| | - Giulia Grazzini
- Division of Radiology, “Azienda Ospedaliera Universitaria Careggi”, Florence, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Salvatore Cappabianca
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, Naples, Italy
| | - Carmelo Barresi
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Franco Iafrate
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome-Sant’Andrea University Hospital, Rome, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Emanuele Neri
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Division of Radiology, “Azienda Ospedaliera Universitaria Careggi”, Florence, Italy
| | - Lorenzo Faggioni
- Department of Translational Research, University of Pisa, Pisa, Italy
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Balthazar P, Joshi H, Heilbrun ME. Reporting on Renal Masses, Recommendations for Terminology, and Sample Templates. Radiol Clin North Am 2020; 58:925-933. [PMID: 32792124 DOI: 10.1016/j.rcl.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Given the incidence of small renal masses, from benign cysts to malignancy, most radiologists encounter these lesions multiple times during their career. Radiologists have an opportunity to provide critical data that will further refine the understanding of the impact of these masses on patient outcomes. This article summarizes and describes recent updates and understanding of the critical observations and descriptors of renal masses. The templates and glossary of terms presented in this review article facilitate the radiology reporting of such data elements, giving radiologists the opportunity to improve diagnostic accuracy and influence management of small renal masses.
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Affiliation(s)
- Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, Northeast, Atlanta, GA 30322, USA. https://twitter.com/PBalthazarMD
| | - Hena Joshi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, Northeast, Atlanta, GA 30322, USA. https://twitter.com/hjoshimd
| | - Marta E Heilbrun
- Department of Radiology and Imaging Sciences, Emory University Healthcare, 1364 Clifton Road, Northeast, Suite CG24, Atlanta, GA 30322, USA.
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27
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Neri E, Coppola F, Larici AR, Sverzellati N, Mazzei MA, Sacco P, Dalpiaz G, Feragalli B, Miele V, Grassi R. Structured reporting of chest CT in COVID-19 pneumonia: a consensus proposal. Insights Imaging 2020; 11:92. [PMID: 32785803 PMCID: PMC7422456 DOI: 10.1186/s13244-020-00901-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The need of a standardized reporting scheme and language, in imaging of COVID-19 pneumonia, has been welcomed by major scientific societies. The aim of the study was to build the reporting scheme of chest CT in COVID-19 pneumonia. METHODS A team of experts, of the Italian Society of Medical and Interventional Radiology (SIRM), has been recruited to compose a consensus panel. They used a modified Delphi process to build a reporting scheme and expressed a level of agreement for each section of the report. To measure the internal consistency of the panelist ratings for each section of the report, a quality analysis based on the average inter-item correlation was performed with Cronbach's alpha (Cα) correlation coefficient. RESULTS The overall mean score of the experts and the sum of score were 3.1 (std.dev. ± 0.11) and 122 in the second round, and improved to 3.75 (std.dev. ± 0.40) and 154 in the third round. The Cronbach's alpha (Cα) correlation coefficient was 0.741 (acceptable) in the second round and improved to 0.789 in the third round. The final report was built in the management of radiology report template (MRRT) and includes n = 4 items in the procedure information, n = 5 items in the clinical information, n = 16 in the findings, and n = 3 in the impression, with overall 28 items. CONCLUSIONS The proposed structured report could be of help both for expert radiologists and for the less experienced who are faced with the management of these patients. The structured report is conceived as a guideline, to recommend the key items/findings of chest CT in COVID-19 pneumonia.
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Affiliation(s)
- E Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, Università degli Studi di Pisa, Radiodiagnostica 3, Via Roma 67 -, 56126, Pisa, SD, Italy.
| | - F Coppola
- Malpighi Radiology Unit, Department of Diagnostic and Preventive Medicine, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - A R Larici
- Section of Radiology, Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart Rome Campus, "Agostino Gemelli" University Polyclinic Foundation IRCCS, Roma, Italy
| | - N Sverzellati
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - M A Mazzei
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - P Sacco
- Diagnostic Imaging Unit, Department of Medical, Surgical and Neuro Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - G Dalpiaz
- Department of Radiology, Bellaria Carlo Alberto Pizzardi Hospital, Bologna, Italy
| | - B Feragalli
- Department of Medical, Oral and Biotechnological Sciences, University G. d'Annunzio Chieti-Pescara, Chieti, Italy
| | - V Miele
- Department of Radiology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - R Grassi
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania Luigi Vanvitelli, Naples, Italy
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Loving VA, Valencia EM, Patel B, Johnston BS. The Role of Cognitive Bias in Breast Radiology Diagnostic and Judgment Errors. JOURNAL OF BREAST IMAGING 2020; 2:382-389. [PMID: 38424956 DOI: 10.1093/jbi/wbaa023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Indexed: 03/02/2024]
Abstract
Cognitive bias is an unavoidable aspect of human decision-making. In breast radiology, these biases contribute to missed or erroneous diagnoses and mistaken judgments. This article introduces breast radiologists to eight cognitive biases commonly encountered in breast radiology: anchoring, availability, commission, confirmation, gambler's fallacy, omission, satisfaction of search, and outcome. In addition to illustrative cases, this article offers suggestions for radiologists to better recognize and counteract these biases at the individual level and at the organizational level.
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Mortani Barbosa EJ, Kelly K. Statistical modeling can determine what factors are predictive of appropriate follow-up in patients presenting with incidental pulmonary nodules on CT. Eur J Radiol 2020; 128:109062. [PMID: 32422551 DOI: 10.1016/j.ejrad.2020.109062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess the performance of statistical modeling in predicting follow-up adherence of incidentally detected pulmonary nodules (IPN) on CT, based on patient variables (PV), radiology report related variables (RRRV) and physician-patient communication variables (PPCV). METHODS 200 patients with IPN on CT were retrospectively identified and randomly selected. PV (age, gender, smoking status, ethnicity), RRRV (nodule size, patient context, whether follow-up recommendations were provided) and PPCV (whether referring physician documented IPN and ordered follow-up on the electronic medical record) were recorded. Primary outcome was whether patients received appropriate follow-up within +/- 1 month of the recommended time frame. Statistical methods included logistic regression and machine learning (K-nearest neighbors and support vector machine). RESULTS Adherence was low, with or without recommendations provided in the radiology report (23.4 %-27.4 %). Whether the referring physician ordered follow-up was the dominant predictor of adherence in all models. The following variables were statistically significant predictors of whether referring physician ordered follow-up: recommendations provided in the radiology report, smoking status, patient context and nodule size (FDR logworth of respectively 21.18, 11.66, 2.35, 1.63, p < 0.05). Prediction accuracy varied from 72 % (PV) to 93 % (PPCV, all variables). CONCLUSION PPCV are the most important predictors of adherence. Amongst all variables, patient context, smoking status, nodule size, and whether the radiologist provided follow-up recommendations in the report were all statistically significant predictors of patient follow-up adherence, supporting the utility of statistical modeling for analytics, quality assurance and optimization of outcomes related to IPN.
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Affiliation(s)
| | - Kate Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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30
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Allen B, Cook TS, Bello JA. Quality and Data Science. J Am Coll Radiol 2019; 16:1237-1238. [DOI: 10.1016/j.jacr.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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