Communicating Nonroutine Radiologic Findings to the Ordering Physician: Will (Should) Information Technology–assisted Communication Replace Direct Voice Contact?

Pediatric musculoskeletal pathologies: are there differences in triage of diagnoses and preferences for communication between radiology and orthopedics?

OBJECTIVE

To define the clinical importance of various pediatric musculoskeletal diagnoses, determine preferred communication methods based on the acuity level of findings, and investigate differences between specialties utilizing the Delphi methodology.

METHODS

Radiologists, orthopedic surgeons, and sports-medicine pediatricians at a tertiary children's hospital were surveyed (n = 79) twice using REDCap (Research Electronic Data Capture). Surveys were conducted anonymously and at least 1 year apart, first eliciting all potentially non-routine findings and various communication methods (round 1), and later categorizing the acuity (emergent, urgent, or non-urgent) of different diagnosis categories and selecting the preferred communication method (verbal, written electronic messages, and report) and timeframe (round 2). Chi-square, Fisher's exact, and Kruskal-Wallis H tests were used to compare variables between specialties.

RESULTS

Round 1 produced 267 entries for non-routine findings (grouped into 19 diagnoses) and 71 for communication methods (grouped into 3 categories). Round 2 found no significant difference in the acuity assignments for the 19 predetermined diagnoses (p = 0.66) between the 3 specialties; however, there was reduced agreement for the top urgent diagnoses within and between specialties. Most pediatricians preferred written electronic messages. The preferred communication timeframe for urgent diagnoses was significantly different (< 2 h for pediatricians, < 4 h for radiologists, and < 8 h for surgeons; p = 0.003) between specialties whereas no difference was found for emergent (p = 1) and non-urgent diagnoses (p = 0.80).

CONCLUSION

Acuity assignment for the 19 pediatric-specific musculoskeletal diagnoses was not significantly different between specialties, but the preferred communication timeframe for urgent diagnoses was significantly different, ranging between 2 and 8 h.

Diagnosis in a snap: a pilot study using Snapchat in radiologic didactics

Purpose

To evaluate Snapchat, an image-based social media platform, as a tool for emergency radiologic didactics comparing image interpretation on mobile devices with conventional analysis on a classroom screen.

Materials and methods

Seven radiology residents (4 juniors, 3 seniors;4 males, 3 females; 28.4 years old, ± 1.7 years) were shown 5 emergent radiologic cases using Snapchat and 5 cases of similar content and duration on a classroom projector over 4 weeks. All images depicted diagnoses requiring immediate communication to ordering physicians. Performance was scored 0–2 (0 = complete miss, 1 = major finding, but missed the diagnosis, 2 = correct diagnosis) by two attending radiologists in consensus.

Results

All residents performed better on Snapchat each week. In weeks 1–4, juniors scored 21/40 (52.5%), 23/40 (57.5%), 19/40 (47.5%), and 18/40 (45%) points using Snapchat compared with 13/40 (32.5%), 23/40 (57.5%), 14/40 (35%), and 13/40 (32.5%), respectively, each week by projector, while seniors scored 19/30 (63.3%), 21/30 (70%), 27/30 (90%), and 21/30 (70%) on Snapchat versus 16/30 (53.3%), 19/30 (63.3%), 20/30 (66.7%), and 20/30 (66.7%) on projector. Four-week totals showed juniors scoring 81/160 (50.6%) on Snapchat and 63/160 (39.4%) by projector compared with seniors scoring 88/120 (73.3%) and 75/120 (62.5%), respectively. Performance on Snapchat was statistically, significantly better than via projector during weeks 1 and 3 (p values 0.0019 and 0.0031).

Conclusion

Radiology residents interpreting emergency cases via Snapchat showed higher accuracy compared with using a traditional classroom screen. This pilot study suggests that Snapchat may have a role in the digital radiologic classroom’s evolution.

Communicating Radiology Test Results: Are Our Phone Calls Excessive, Just Right, or Not Enough?

RATIONALE AND OBJECTIVES

This study aimed to determine the preferences of radiology and referring provider residents regarding direct communication of radiology test results.

METHODS

This Health Insurance Portability and Accountability Act-compliant quality improvement effort was exempt from institutional review board oversight. An anonymous survey was emailed to 44 radiology residents and 364 referring resident providers who routinely provide or receive direct communication of test results at our quaternary care medical center. The survey focused on the frequency, indication, clinical utility, and methods of direct communication of radiology results. Proportions were compared to chi-square or Fisher exact test.

RESULTS

The response rates were 86% (37 of 43) (radiology) and 41% (151 of 364) (referring providers). Approximately half of radiology residents (49% [18 of 37]) thought the frequency of direct verbal communication was excessive, and none (0 of 37) thought more communication was needed. In contrast, only 1.3% (2 of 151; P < .001) of referring providers felt the frequency was excessive, and 24% (36 of 151; P < .001) desired more. The majority (66% [100 of 151]) of referring providers felt phone calls from radiologists often or always added value beyond a timely radiology report, and 59% (44 of 74) felt it is the radiologist's responsibility to call about abnormal findings. Furthermore, 83% (125 of 151) of referring providers preferred to receive a phone call about non-emergent unexpected findings, although preferences varied for various example abnormalities. For outpatients with non-emergent unexpected findings, most providers (90% [64 of 71]) prefer written communication rather than a phone call.

CONCLUSIONS

Referring providers prefer direct communication of radiology results, even for non-urgent unexpected findings, whereas radiology residents prefer less direct communication and are more likely to consider radiologist-to-provider communication superfluous.

"Incidentalomas" on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations

The purpose of this article is to familiarize radiologists and clinicians with a subset of common and uncommon incidental findings on abdominal and pelvic computed tomography examinations, including hepatic, splenic, renal, adrenal, pancreatic, aortic/iliac arterial, gynecological, and a few other miscellaneous findings, with an emphasis on "incidentalomas" discovered in the emergency setting. In addition, we will review the complex problem of diagnosing such entities, and provide current management recommendations. Representative case examples, which we have encountered in our clinical practices, will be demonstrated.