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Wollek A, Hyska S, Sedlmeyr T, Haitzer P, Rueckel J, Sabel BO, Ingrisch M, Lasser T. German CheXpert Chest X-ray Radiology Report Labeler. ROFO-FORTSCHR RONTG 2024; 196:956-965. [PMID: 38295825 DOI: 10.1055/a-2234-8268] [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: 08/17/2024]
Abstract
PURPOSE The aim of this study was to develop an algorithm to automatically extract annotations from German thoracic radiology reports to train deep learning-based chest X-ray classification models. MATERIALS AND METHODS An automatic label extraction model for German thoracic radiology reports was designed based on the CheXpert architecture. The algorithm can extract labels for twelve common chest pathologies, the presence of support devices, and "no finding". For iterative improvements and to generate a ground truth, a web-based multi-reader annotation interface was created. With the proposed annotation interface, a radiologist annotated 1086 retrospectively collected radiology reports from 2020-2021 (data set 1). The effect of automatically extracted labels on chest radiograph classification performance was evaluated on an additional, in-house pneumothorax data set (data set 2), containing 6434 chest radiographs with corresponding reports, by comparing a DenseNet-121 model trained on extracted labels from the associated reports, image-based pneumothorax labels, and publicly available data, respectively. RESULTS Comparing automated to manual labeling on data set 1: "mention extraction" class-wise F1 scores ranged from 0.8 to 0.995, the "negation detection" F1 scores from 0.624 to 0.981, and F1 scores for "uncertainty detection" from 0.353 to 0.725. Extracted pneumothorax labels on data set 2 had a sensitivity of 0.997 [95 % CI: 0.994, 0.999] and specificity of 0.991 [95 % CI: 0.988, 0.994]. The model trained on publicly available data achieved an area under the receiver operating curve (AUC) for pneumothorax classification of 0.728 [95 % CI: 0.694, 0.760], while the models trained on automatically extracted labels and on manual annotations achieved values of 0.858 [95 % CI: 0.832, 0.882] and 0.934 [95 % CI: 0.918, 0.949], respectively. CONCLUSION Automatic label extraction from German thoracic radiology reports is a promising substitute for manual labeling. By reducing the time required for data annotation, larger training data sets can be created, resulting in improved overall modeling performance. Our results demonstrated that a pneumothorax classifier trained on automatically extracted labels strongly outperformed the model trained on publicly available data, without the need for additional annotation time and performed competitively compared to manually labeled data. KEY POINTS · An algorithm for automatic German thoracic radiology report annotation was developed.. · Automatic label extraction is a promising substitute for manual labeling.. · The classifier trained on extracted labels outperformed the model trained on publicly available data.. ZITIERWEISE · Wollek A, Hyska S, Sedlmeyr T et al. German CheXpert Chest X-ray Radiology Report Labeler. Fortschr Röntgenstr 2024; 196: 956 - 965.
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Affiliation(s)
- Alessandro Wollek
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching b. München, Germany
- School of Computation, Information and Technology, Technical University of Munich, Garching b. München, Germany
| | - Sardi Hyska
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Thomas Sedlmeyr
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching b. München, Germany
- School of Computation, Information and Technology, Technical University of Munich, Garching b. München, Germany
| | - Philip Haitzer
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching b. München, Germany
- School of Computation, Information and Technology, Technical University of Munich, Garching b. München, Germany
| | - Johannes Rueckel
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, München, Germany
- Institute of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Bastian O Sabel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Germany, München, Germany
| | - Michael Ingrisch
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Tobias Lasser
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching b. München, Germany
- School of Computation, Information and Technology, Technical University of Munich, Garching b. München, Germany
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Núñez L, Ferreira C, Mojtahed A, Lamb H, Cappio S, Husainy MA, Dennis A, Pansini M. Assessing the performance of AI-assisted technicians in liver segmentation, Couinaud division, and lesion detection: a pilot study. Abdom Radiol (NY) 2024:10.1007/s00261-024-04507-1. [PMID: 39123052 DOI: 10.1007/s00261-024-04507-1] [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: 04/15/2024] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND In patients with primary and secondary liver cancer, the number and sizes of lesions, their locations within the Couinaud segments, and the volume and health status of the future liver remnant are key for informing treatment planning. Currently this is performed manually, generally by trained radiologists, who are seeing an inexorable growth in their workload. Integrating artificial intelligence (AI) and non-radiologist personnel into the workflow potentially addresses the increasing workload without sacrificing accuracy. This study evaluated the accuracy of non-radiologist technicians in liver cancer imaging compared with radiologists, both assisted by AI. METHODS Non-contrast T1-weighted MRI data from 18 colorectal liver metastasis patients were analyzed using an AI-enabled decision support tool that enables non-radiology trained technicians to perform key liver measurements. Three non-radiologist, experienced operators and three radiologists performed whole liver segmentation, Couinaud segment segmentation, and the detection and measurements of lesions aided by AI-generated delineations. Agreement between radiologists and non-radiologists was assessed using the intraclass correlation coefficient (ICC). Two additional radiologists adjudicated any lesion detection discrepancies. RESULTS Whole liver volume showed high levels of agreement between the non-radiologist and radiologist groups (ICC = 0.99). The Couinaud segment volumetry ICC range was 0.77-0.96. Both groups identified the same 41 lesions. As well, the non-radiologist group identified seven more structures which were also confirmed as lesions by the adjudicators. Lesion diameter categorization agreement was 90%, Couinaud localization 91.9%. Within-group variability was comparable for lesion measurements. CONCLUSION With AI assistance, non-radiologist experienced operators showed good agreement with radiologists for quantifying whole liver volume, Couinaud segment volume, and the detection and measurement of lesions in patients with known liver cancer. This AI-assisted non-radiologist approach has potential to reduce the stress on radiologists without compromising accuracy.
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Affiliation(s)
- Luis Núñez
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK.
| | - Carlos Ferreira
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Amirkasra Mojtahed
- Division of Abdominal Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Hildo Lamb
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Stefano Cappio
- Clinica Di Radiologia EOC, Istituto Di Imaging Della Svizzera Italiana (IIMSI), Lugano, Switzerland
| | - Mohammad Ali Husainy
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrea Dennis
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Michele Pansini
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Clinica Di Radiologia EOC, Istituto Di Imaging Della Svizzera Italiana (IIMSI), Lugano, Switzerland
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Jiam NT, Podury A, Quesnel AM, Handzel O. Worldwide differences in surgeon intraoperative practices for cochlear implantation. Cochlear Implants Int 2024:1-8. [PMID: 38935802 DOI: 10.1080/14670100.2024.2367309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To characterize practice patterns of intraoperative imaging and/or functional confirmation of cochlear implant electrode location worldwide. METHODS A cross-sectional survey of otolaryngologists performing cochlear implantation was conducted between March 1 and May 6, 2023. Participants were recruited worldwide using an international otologic society membership email list and at professional meetings. Ninety-seven of the 125 invited participants (78%) completed the survey. Participants were categorized by continent. RESULTS North American surgeons use intraoperative X-rays more frequently than surgeons in Europe and Asia (p < 0.001). Otolaryngologists in Europe and Asia more frequently use no intraoperative imaging (p = 0.02). There is no regional difference between the intraoperative use of electrophysiologic instruments. European and Asian surgeons implant MED-EL devices (p = 0.012) more frequently than North American surgeons, who more frequently use Cochlear Corporation devices (p = 0.003). MED-EL use is related to less frequent intraoperative X-ray use (p = 0.02). Advanced Bionics use is related to more frequent intraoperative CT use (p = 0.03). No significant association existed between years of practice, number of cochlear implantation surgeries performed yearly, volume of pediatric CI practice, and use of intraoperative tools. CONCLUSION Intraoperative practice for radiologic and functional verification of cochlear implant electrode positioning varies worldwide. Practice guidelines may help establish a standard of care for cochlear implantation.
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Affiliation(s)
- Nicole T Jiam
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology-Head & Neck Surgery, University of California - San Francisco, San Francisco, CA, USA
| | - Archana Podury
- Department of Otolaryngology, University of California - San Diego, San Diego, CA, USA
| | - Alicia M Quesnel
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Ophir Handzel
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology-Head & Neck Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Wollek A, Willem T, Ingrisch M, Sabel B, Lasser T. Out-of-distribution detection with in-distribution voting using the medical example of chest x-ray classification. Med Phys 2024; 51:2721-2732. [PMID: 37831587 DOI: 10.1002/mp.16790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/03/2023] [Accepted: 09/17/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Deep learning models are being applied to more and more use cases with astonishing success stories, but how do they perform in the real world? Models are typically tested on specific cleaned data sets, but when deployed in the real world, the model will encounter unexpected, out-of-distribution (OOD) data. PURPOSE To investigate the impact of OOD radiographs on existing chest x-ray classification models and to increase their robustness against OOD data. METHODS The study employed the commonly used chest x-ray classification model, CheXnet, trained on the chest x-ray 14 data set, and tested its robustness against OOD data using three public radiography data sets: IRMA, Bone Age, and MURA, and the ImageNet data set. To detect OOD data for multi-label classification, we proposed in-distribution voting (IDV). The OOD detection performance is measured across data sets using the area under the receiver operating characteristic curve (AUC) analysis and compared with Mahalanobis-based OOD detection, MaxLogit, MaxEnergy, self-supervised OOD detection (SS OOD), and CutMix. RESULTS Without additional OOD detection, the chest x-ray classifier failed to discard any OOD images, with an AUC of 0.5. The proposed IDV approach trained on ID (chest x-ray 14) and OOD data (IRMA and ImageNet) achieved, on average, 0.999 OOD AUC across the three data sets, surpassing all other OOD detection methods. Mahalanobis-based OOD detection achieved an average OOD detection AUC of 0.982. IDV trained solely with a few thousand ImageNet images had an AUC 0.913, which was considerably higher than MaxLogit (0.726), MaxEnergy (0.724), SS OOD (0.476), and CutMix (0.376). CONCLUSIONS The performance of all tested OOD detection methods did not translate well to radiography data sets, except Mahalanobis-based OOD detection and the proposed IDV method. Consequently, training solely on ID data led to incorrect classification of OOD images as ID, resulting in increased false positive rates. IDV substantially improved the model's ID classification performance, even when trained with data that will not occur in the intended use case or test set (ImageNet), without additional inference overhead or performance decrease in the target classification. The corresponding code is available at https://gitlab.lrz.de/IP/a-knee-cannot-have-lung-disease.
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Affiliation(s)
- Alessandro Wollek
- Munich Institute of Biomedical Engineering and the School of Computation, Information, and Technology, Technical University of Munich, Munich, Germany
| | - Theresa Willem
- Institute for History and Ethics in Medicine and Munich School of Technology in Society, Technical University of Munich, Munich, Germany
| | - Michael Ingrisch
- Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Munich, Germany
| | - Bastian Sabel
- Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Munich, Germany
| | - Tobias Lasser
- Munich Institute of Biomedical Engineering and the School of Computation, Information, and Technology, Technical University of Munich, Munich, Germany
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Ko CH, Chien LN, Chiu YT, Hsu HH, Wong HF, Chan WP. Demands for medical imaging and workforce Size: A nationwide population-based Study, 2000-2020. Eur J Radiol 2024; 172:111330. [PMID: 38290203 DOI: 10.1016/j.ejrad.2024.111330] [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: 07/13/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE The aim of this study was to investigate associations between workforce and workload among radiologists in Taiwan. MATERIALS AND METHODS Data for the period 2000-2020 describing the demand for imaging services and radiologists have been obtained from databases and statistical reports of the Ministry of Health and Welfare. The future demand for radiologists was based on Taiwanese people aged 40 and over. RESULTS The workforce of Taiwan's radiologists has increased by 6 % annually over the past 20 years (from 450 to 993), performing 2125, 3202 and 3620 monthly examinations (mainly conventional radiography and CT) in medical centers, regional hospitals and district hospitals. Between 2000 and 2020, the use of CT and MRI increased by more than 3.5 times. Demand for interventional radiology also increased by 1.77 times, 2.25 times, and 5 times, respectively. To maintain this volume of services in 2040, at least 1168 radiologists are needed, about 1.18 times more in 2020. CONCLUSION Taiwan has 2.4 to 2.9 times fewer radiologists than the United States and 3 times fewer than Europe, while the annual workload is approximately 2 to 3.4 times greater than that of the United States and 1.4 to 2.5 times greater than that of the United Kingdom. This report may serve as a reference for policy makers who address the challenges of the growing workload among radiologists in countries of similar situations.
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Affiliation(s)
- Chih-Hsiang Ko
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Li-Nien Chien
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
| | - Yu-Ting Chiu
- School of Health Care Administration, College of Management, Taipei Medical University, New Taipei City 235, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan
| | - Ho-Fai Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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Santomartino SM, Kung J, Yi PH. Systematic review of artificial intelligence development and evaluation for MRI diagnosis of knee ligament or meniscus tears. Skeletal Radiol 2024; 53:445-454. [PMID: 37584757 DOI: 10.1007/s00256-023-04416-2] [Citation(s) in RCA: 4] [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: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to summarize the results of original research studies evaluating the characteristics and performance of deep learning models for detection of knee ligament and meniscus tears on MRI. MATERIALS AND METHODS We searched PubMed for studies published as of February 2, 2022 for original studies evaluating development and evaluation of deep learning models for MRI diagnosis of knee ligament or meniscus tears. We summarized study details according to multiple criteria including baseline article details, model creation, deep learning details, and model evaluation. RESULTS 19 studies were included with radiology departments leading the publications in deep learning development and implementation for detecting knee injuries via MRI. Among the studies, there was a lack of standard reporting and inconsistently described development details. However, all included studies reported consistently high model performance that significantly supplemented human reader performance. CONCLUSION From our review, we found radiology departments have been leading deep learning development for injury detection on knee MRIs. Although studies inconsistently described DL model development details, all reported high model performance, indicating great promise for DL in knee MRI analysis.
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Affiliation(s)
- Samantha M Santomartino
- Drexel University College of Medicine, Philadelphia, PA, USA
- University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Justin Kung
- Department of Orthopaedic Surgery, University of South Carolina, Columbia, SC, USA
| | - Paul H Yi
- University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, University of Maryland School of Medicine, Baltimore, MD, USA.
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore Street First Floor Rm. 1172, Baltimore, MD, 21201, USA.
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Chiaradonna S, Jevtić P, Lanchier N. Framework for cyber risk loss distribution of hospital infrastructure: Bond percolation on mixed random graphs approach. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:2450-2485. [PMID: 37038249 DOI: 10.1111/risa.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Networks like those of healthcare infrastructure have been a primary target of cyberattacks for over a decade. From just a single cyberattack, a healthcare facility would expect to see millions of dollars in losses from legal fines, business interruption, and loss of revenue. As more medical devices become interconnected, more cyber vulnerabilities emerge, resulting in more potential exploitation that may disrupt patient care and give rise to catastrophic financial losses. In this paper, we propose a structural model of an aggregate loss distribution across multiple cyberattacks on a prototypical hospital network. Modeled as a mixed random graph, the hospital network consists of various patient-monitoring devices and medical imaging equipment as random nodes to account for the variable occupancy of patient rooms and availability of imaging equipment that are connected by bidirectional edges to fixed hospital and radiological information systems. Our framework accounts for the documented cyber vulnerabilities of a hospital's trusted internal network of its major medical assets. To our knowledge, there exist no other models of an aggregate loss distribution for cyber risk in this setting. We contextualize the problem in the probabilistic graph-theoretical framework using a percolation model and combinatorial techniques to compute the mean and variance of the loss distribution for a mixed random network with associated random costs that can be useful for healthcare administrators and cybersecurity professionals to improve cybersecurity management strategies. By characterizing this distribution, we allow for the further utility of pricing cyber risk.
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Affiliation(s)
- Stefano Chiaradonna
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, Arizona, USA
| | - Petar Jevtić
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, Arizona, USA
| | - Nicolas Lanchier
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, Arizona, USA
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Lee WJ, Shah Y, Ku A, Patel N, Salvador M. Evaluating Health Disparities in Radiology Practices in New Jersey: Exploring Radiologist Geographical Distribution. Cureus 2023; 15:e43474. [PMID: 37583547 PMCID: PMC10425128 DOI: 10.7759/cureus.43474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE This study aimed to determine if a disproportionate number of radiologists practice in high-income versus low-income counties in New Jersey (NJ), identify which vulnerable populations are most in need of more radiologists, and discuss how these relative differences can ultimately influence health outcomes. METHODS The NJ Health Care Profile, a database overseen and maintained by the Division of Consumer Affairs, was queried for all actively practicing radiologists within the state of NJ. These results were grouped into diagnostic and interventional radiologists followed by further stratification of physicians based on the counties where they currently practice. The median household income and population size of each county for 2021 were obtained from the US Census database. The ratio of the population size of each county over the number of radiologists in that county was used as a surrogate marker for disparities in patient care within the state and was compared between counties grouped by levels of income. RESULTS Of the 1,186 board-certified radiologists actively practicing within the state of NJ, 86% are solely diagnostic radiologists and 14% are interventional radiologists. About 44% of radiologists practice within counties that are within the top one-third of median household income in NJ, 25% practice within counties in the middle one-third, and 31% practice within counties in the bottom one-third. CONCLUSIONS There is a disproportionate number of radiologists practicing in high-income counties as opposed to lower-income counties. A contradiction to this trend was noted in three low-income counties: Essex, Camden, and Atlantic County, all of which exhibited low numbers of individuals per radiologist that rivaled those of higher-income counties. This finding is a concrete measure of successful radiologist recruitment efforts within these counties during the past few years to combat the increased prevalence of disease and associated complications that historically marginalized communities tend to disproportionately exhibit. Other low-income counties should look to what Essex, Camden, and Atlantic County have done to increase radiologist recruitment to levels that rival those of high-income areas.
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Affiliation(s)
- William J Lee
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
| | - Yash Shah
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
| | - Albert Ku
- Radiology, Drexel University College of Medicine, Philadelphia, USA
| | - Nidhi Patel
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
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Haque MIU, Dubey AK, Danciu I, Justice AC, Ovchinnikova OS, Hinkle JD. Effect of image resolution on automated classification of chest X-rays. J Med Imaging (Bellingham) 2023; 10:044503. [PMID: 37547812 PMCID: PMC10403240 DOI: 10.1117/1.jmi.10.4.044503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Deep learning (DL) models have received much attention lately for their ability to achieve expert-level performance on the accurate automated analysis of chest X-rays (CXRs). Recently available public CXR datasets include high resolution images, but state-of-the-art models are trained on reduced size images due to limitations on graphics processing unit memory and training time. As computing hardware continues to advance, it has become feasible to train deep convolutional neural networks on high-resolution images without sacrificing detail by downscaling. This study examines the effect of increased resolution on CXR classification performance. Approach We used the publicly available MIMIC-CXR-JPG dataset, comprising 377,110 high resolution CXR images for this study. We applied image downscaling from native resolution to 2048 × 2048 pixels , 1024 × 1024 pixels , 512 × 512 pixels , and 256 × 256 pixels and then we used the DenseNet121 and EfficientNet-B4 DL models to evaluate clinical task performance using these four downscaled image resolutions. Results We find that while some clinical findings are more reliably labeled using high resolutions, many other findings are actually labeled better using downscaled inputs. We qualitatively verify that tasks requiring a large receptive field are better suited to downscaled low resolution input images, by inspecting effective receptive fields and class activation maps of trained models. Finally, we show that stacking an ensemble across resolutions outperforms each individual learner at all input resolutions while providing interpretable scale weights, indicating that diverse information is extracted across resolutions. Conclusions This study suggests that instead of focusing solely on the finest image resolutions, multi-scale features should be emphasized for information extraction from high-resolution CXRs.
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Affiliation(s)
- Md Inzamam Ul Haque
- University of Tennessee, The Bredesen Center, Knoxville, Tennessee, United States
| | - Abhishek K. Dubey
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Oak Ridge, Tennessee, United States
| | - Ioana Danciu
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Oak Ridge, Tennessee, United States
| | - Amy C. Justice
- VA Connecticut Healthcare, West Haven, Connecticut, United States
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, West Haven, Connecticut, United States
- Yale School of Medicine, Department of Medicine, New Haven, Connecticut, United States
- Yale University, School of Public Health, New Haven, Connecticut, United States
| | - Olga S. Ovchinnikova
- University of Tennessee, The Bredesen Center, Knoxville, Tennessee, United States
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Oak Ridge, Tennessee, United States
- University of Tennessee, Materials Science and Engineering, Knoxville, Tennessee, United States
| | - Jacob D. Hinkle
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Oak Ridge, Tennessee, United States
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Ahmad HK, Milne MR, Buchlak QD, Ektas N, Sanderson G, Chamtie H, Karunasena S, Chiang J, Holt X, Tang CHM, Seah JCY, Bottrell G, Esmaili N, Brotchie P, Jones C. Machine Learning Augmented Interpretation of Chest X-rays: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13040743. [PMID: 36832231 PMCID: PMC9955112 DOI: 10.3390/diagnostics13040743] [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: 01/19/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Limitations of the chest X-ray (CXR) have resulted in attempts to create machine learning systems to assist clinicians and improve interpretation accuracy. An understanding of the capabilities and limitations of modern machine learning systems is necessary for clinicians as these tools begin to permeate practice. This systematic review aimed to provide an overview of machine learning applications designed to facilitate CXR interpretation. A systematic search strategy was executed to identify research into machine learning algorithms capable of detecting >2 radiographic findings on CXRs published between January 2020 and September 2022. Model details and study characteristics, including risk of bias and quality, were summarized. Initially, 2248 articles were retrieved, with 46 included in the final review. Published models demonstrated strong standalone performance and were typically as accurate, or more accurate, than radiologists or non-radiologist clinicians. Multiple studies demonstrated an improvement in the clinical finding classification performance of clinicians when models acted as a diagnostic assistance device. Device performance was compared with that of clinicians in 30% of studies, while effects on clinical perception and diagnosis were evaluated in 19%. Only one study was prospectively run. On average, 128,662 images were used to train and validate models. Most classified less than eight clinical findings, while the three most comprehensive models classified 54, 72, and 124 findings. This review suggests that machine learning devices designed to facilitate CXR interpretation perform strongly, improve the detection performance of clinicians, and improve the efficiency of radiology workflow. Several limitations were identified, and clinician involvement and expertise will be key to driving the safe implementation of quality CXR machine learning systems.
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Affiliation(s)
- Hassan K. Ahmad
- Annalise.ai, Sydney, NSW 2000, Australia
- Department of Emergency Medicine, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Correspondence:
| | | | - Quinlan D. Buchlak
- Annalise.ai, Sydney, NSW 2000, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, NSW 2007, Australia
- Department of Neurosurgery, Monash Health, Melbourne, VIC 3168, Australia
| | | | | | | | | | - Jason Chiang
- Annalise.ai, Sydney, NSW 2000, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC 3010, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW 2006, Australia
| | | | | | - Jarrel C. Y. Seah
- Annalise.ai, Sydney, NSW 2000, Australia
- Department of Radiology, Alfred Health, Melbourne, VIC 3004, Australia
| | | | - Nazanin Esmaili
- School of Medicine, University of Notre Dame Australia, Sydney, NSW 2007, Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Peter Brotchie
- Annalise.ai, Sydney, NSW 2000, Australia
- Department of Radiology, St Vincent’s Health Australia, Melbourne, VIC 3065, Australia
| | - Catherine Jones
- Annalise.ai, Sydney, NSW 2000, Australia
- I-MED Radiology Network, Brisbane, QLD 4006, Australia
- School of Public and Preventive Health, Monash University, Clayton, VIC 3800, Australia
- Department of Clinical Imaging Science, University of Sydney, Sydney, NSW 2006, Australia
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11
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Findeiss LK, Everett C, Azene E, Biggs K, Ignacio E, Matsumoto AH, Kay D, Kutsenko O, Liu R, Padha V, Soulez G, Swan T. Interventional Radiology Workforce Shortages Affecting Small and Rural Practices: A Report of the SIR/ACR Joint Task Force on Recruitment and Retention of Interventional Radiologists to Small and Rural Practices. J Am Coll Radiol 2022; 19:1322-1335. [PMID: 36216708 DOI: 10.1016/j.jacr.2022.08.004] [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: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 12/04/2022]
Abstract
Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists. Lack of access to interventional radiologic services results in a failure to meet the needs of patients, hospitals, and other community stakeholders. Acknowledging this challenge, the ACR's Commission on General, Small, Emergency and/or Rural Practice and Commission on Interventional and Cardiovascular Imaging and the Society of Interventional Radiology partnered to establish a joint task force to study this issue and identify strategies the ACR and the Society of Interventional Radiology should take to improve small and rural practice recruitment and retention of interventional radiologists. This report describes the deliberations and recommendations of the task force.
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Affiliation(s)
- Laura K Findeiss
- Chief of Radiology, Grady Health System, Emory University School of Medicine, Atlanta, Georgia.
| | - Catherine Everett
- Managing Partner, Coastal Radiology, New Bern, North Carolina; Member-at-Large, ACR Board of Chancellors; Associate Chief Medical Officer, Practice Analytics, RadPartners, El Segundo, California; and Secretary, American Association for Women Radiologists. https://twitter.com/cjeverett
| | - Ezana Azene
- Chair, Commission on Cancer, Gundersen Health System, La Crosse, Wisconsin. https://twitter.com/AceneMD
| | - Kelly Biggs
- Chief of Radiology, James E. VanZandt VA Medical Center, State College, Pennsylvania
| | - Elizabeth Ignacio
- Hawaii Pacific Health, Kahului, Hawaii; and Member, ACR Council Steering Committee. https://twitter.com/ElizabethAnnig1
| | - Alan H Matsumoto
- Chair and Theodore E. Keats Professor of Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, and Virginia; Vice Chair, ACR Board of Chancellors
| | - Dennis Kay
- System Chair, Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Oleksandra Kutsenko
- Miami Cardiac and Vascular Institute, Miami, Florida. https://twitter.com/kutsenkoMD
| | - Ray Liu
- Massachusetts General Hospital, Boston, Massachusetts; and Vice President, Massachusetts General Brigham Global Advisory. https://twitter.com/rwliu
| | - Vivek Padha
- Chief of Radiology West Virginia University, Martinsburg, West Virginia
| | - Gilles Soulez
- Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Director of the Imaging and Engineering Research Axis, CHUM Research Center; and President, Canadian Association of Radiologists
| | - Tim Swan
- Marshfield Clinic Health System, Marshfield, Wisconsin; and Member-at-Large, ACR Board of Chancellors. https://twitter.com/TimSwanMD
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Rammuni Silva RS, Fernando P. Effective Utilization of Multiple Convolutional Neural Networks for Chest X-Ray Classification. SN COMPUTER SCIENCE 2022; 3:492. [PMID: 36188757 PMCID: PMC9514177 DOI: 10.1007/s42979-022-01390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
Out of the numerous types of Medical Imaging modalities available, radiography stands out a bit more than others due to its capabilities of diagnosing diseases and conditions, including life-threatening conditions. Its affordability is another main reason for its prevalence. Chest Radiography holds even higher importance, as it focuses a critical area of the human body. However, interpreting a Chest Radiography image can be challenging and usually done by an experienced Radiologist for accurate results. There are two main issues related to this. One is that in some countries, experienced Radiologists are scarce. The other issue is that the inevitability of human errors in diagnoses. Researchers attempt to use Artificial Intelligence to address these two issues. Most of the existing work incorporates Convolutional Neural Networks for this purpose. This paper presents a novel way of parallelizing multiple architectures of Convolutional Neural Networks focusing on Chest X-ray classification. The paper further presents a comprehensive evaluation of the existing architectures with the parallelized results of them using our method. We used four large-scale datasets, including a non-medical one, for the evaluation of our models. We managed to achieve better accuracy for 9 out 13 and 11 out of 14 labels on our two main evaluation datasets. The paper concludes by presenting the limitations and future improvements possible for the system.
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13
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Khurana A, Patel B, Sharpe R. Geographic Variations in Growth of Radiologists and Medicare Enrollees From 2012 to 2019. J Am Coll Radiol 2022; 19:1006-1014. [PMID: 35961410 DOI: 10.1016/j.jacr.2022.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Analyze changes in the number of Medicare-serving radiologists and Medicare enrollees nationwide and by geographic region and state from 2012 to 2019 to understand variations in allocation of imaging health care services over the past decade. METHODS The number of radiologists submitting claims to Medicare was extracted from the CMS Physician and Other Supplier Public Use File Database. The number of Medicare enrollees by state was obtained from the Kaiser Family Foundation. National-, regional-, and state-level changes in rates of growth of radiologists, Medicare enrollees, and radiologists per 100,000 Medicare enrollees from 2012 to 2019 were tabulated. RESULTS The overall number of radiologists per 100,000 Medicare enrollees was 79.7 in 2012, increasing to 79.9 in 2019. In 2012, the number of radiologists per 100,000 enrollees was lower than the national average in the South (66.9; 16% lower) and Midwest (79.1; 0.7% lower) and higher in the Northeast (98.3; 23% higher) and West (88.8; 11% higher). In 2019, the number of radiologists per 100,000 enrollees was lower than the national average in the South (69.8; 12% lower) only and was higher in the Midwest (81.4; 1.9% higher), Northeast (99.3; 24% higher), and West (80.2; 0.4% higher). By state, there was a 4.2-fold variation in the number of radiologists per 100,000 Medicare enrollees, ranging from 38.8 in Wyoming to 161.4 in Minnesota (200.5 in Washington, DC). DISCUSSION The growth of Medicare-serving radiologists and Medicare enrollees was stable nationally and demonstrated tremendous variations by US region and state. These variations bring to light potential implications for patient access to care and distribution of health care resources.
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Affiliation(s)
- Aditya Khurana
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota.
| | - Bhavika Patel
- Associate Chair of Research, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Richard Sharpe
- Division Chair of Breast Imaging, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
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Mkhize N, Tiwari R, Chikte U, Pitcher R. Temporal Trends in the South African Diagnostic Radiology Workforce (2002-2019). Cureus 2022; 14:e27148. [PMID: 36004036 PMCID: PMC9392860 DOI: 10.7759/cureus.27148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background To facilitate imaging resource planning and address key health targets of the United Nations (UN) 2030 Sustainable Development Goals, accurate data are required on imaging personnel at the country level. Such data are currently limited. Objectives This study aims to analyze trends in the number, geographical distribution, and demographics of South African (SA) diagnostic imaging personnel between 2002 and 2019. Method A retrospective analysis of the Health Professions Council of South Africa (HPCSA) database of imaging personnel from 2002 to 2019 was done. The total number of personnel and personnel per million people were calculated for the country and for each professional group (radiologist, diagnostic radiographer, and sonographer) by calendar year, province, and demographic profile. Population data were provided by Statistics SA. Results The total imaging personnel, number per million people, and national population increased by 283% (3,095 versus 8,753), 119% (68 versus 149/106), and 29% (45.45 versus 58.77/106), respectively. Diagnostic radiographers constituted more than 80% of the workforce throughout the review period, increasing by 185% (2,540 versus 7,242). Sonographers, the smallest cohort, recorded the highest (49 versus 503; 906%) and radiologists (506 versus 1,007; 99%) the lowest proportional growth. Although radiologists showed persistent male predominance, the male proportion decreased from 82% to 69%, while that of females increased from 18% to 31%. The average annual percentage increase in female radiologists (14%) was more than three times that of males (4%). Diagnostic radiographers showed female predominance, but the proportion decreased from 90% to 83%, while that of males increased from 10% to 17%. Sonographers showed overwhelming female predominance (94% versus 92%). The average annual percentage increase in male diagnostic radiographers (21%) was more than double that of females (9%). In 2002, 48% (n = 1,475) of imaging personnel identified as White, and 15% (n = 467) identified as Black African. By 2019, those identifying as White and Black African were 36% (n = 3,122) and 35% (n = 3,045), respectively. The Western Cape Province (WCP) maintained the highest overall number of imaging personnel per million people (165 versus 233/106) and Limpopo the lowest (12 versus 54/106). However, Limpopo recorded the highest proportional growth in imaging personnel/106 people (368%) and the WCP the lowest (41%). The differential between the best- and least-resourced provinces thus decreased from 14:1 in 2002 to 4:1 in 2019. Conclusion In the review period, the SA imaging workforce has shown substantial expansion and transformation and has assumed a more equitable distribution.
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15
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Yield of pelvic CT in emergency department patients undergoing CT torso for generalized or multiple complaints. Emerg Radiol 2022; 29:937-946. [PMID: 35788933 DOI: 10.1007/s10140-022-02073-x] [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: 03/31/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the utility of pelvic computed tomography (CT) in emergency department (ED) patients undergoing chest CT angiogram (CTA) for chest pain or suspected pulmonary embolism (PE) followed by abdominopelvic CT in the same session for additional multisystem or generalized complaints. METHODS This retrospective study included consecutive adult ED patients from January 2017 to December 2019 who underwent CTA for suspected PE followed by portovenous abdominopelvic CT for multisystem or generalized complaints. Patient demographics, vitals, laboratory values, exam indication, malignancy history, and recent surgery/intervention were recorded. CT reports were reviewed for acute chest, abdomen, and/or pelvic pathology. RESULTS There were 400 patients with 243 (61%) women and mean age of 59.8 years. Acute pelvic findings were seen in 11% (45/400). In 53% (24/45) of these, pelvic pathology could be diagnosed based on the abdominal portion of the CT. Five percent (21/400) of patients demonstrated isolated acute pelvic findings with 86% of these (18/21) clinically suspected prior to imaging. Acute pelvic pathology was associated with female gender (p = 0.015) and elevated white blood cell count (WBC) (p = 0.03). Specific pelvic CT indications and female gender were significantly associated with (p = 0.02 each) and independent predictors of isolated acute pelvic pathology. CONCLUSION In ED patients undergoing chest CTA for chest pain or suspected PE combined with abdominopelvic CT, the presence of acute pelvic-related pathology not visualized on abdominal CT is low. For this ED patient cohort, pelvic CT may not be necessary in men with normal WBC and a low pre-imaging clinical suspicion for acute pelvic pathology.
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16
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Overview of Artificial Intelligence in Medicine. Artif Intell Med 2022. [DOI: 10.1007/978-981-19-1223-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Nationwide Analysis of Integrated and Independent Interventional Radiology Residency Websites During the COVID-19 Pandemic. Acad Radiol 2021; 28:1304-1312. [PMID: 33994076 DOI: 10.1016/j.acra.2021.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To analyze current interventional radiology residency program websites based on validated criteria and highlight areas for improvement during the COVID-19 pandemic. MATERIALS AND METHODS ACGME-accredited interventional radiology residency programs were identified from the Society of Interventional Radiology (SIR) public database, including 91 independent and 89 integrated programs. Program Webpages were then evaluated during September and October 2020 based on the presence of 48 criteria, organized into seven main categories including visibility & communication, program information, curriculum information, faculty description, research, recruitment, and salary and benefits. Programs were also evaluated based on region and research ranking. Additionally, 166 programs with accreditation for Early Specialization in Interventional Radiology (ESIR) were assessed for the presence or absence of ESIR pathway acknowledgement on program webpages. RESULTS The online search yielded information on all integrated programs (89/89, 100%) and 74 independent programs (74/91, 80.3%). For the ESIR programs, the online search for accreditation acknowledgement yielded 108 programs (108/166, 65%) approved for this pathway. Only seven of the 89 integrated programs met at least 75% of the criteria. Of the 91 independent programs, only one met at least 75% of the criteria. On average, integrated programs met more criteria (25, 52%) than independent programs (17, 36%). When comparing programs based on national rank, the visibility & communication category met more criteria on average than the lower ranked programs (integrated =73% vs. 64%, p = 0.01), (independent = 73% vs. 45%, p = 0.01). When comparing programs regionally, statistical significance was found only in the research category (p = 0.01). When comparing the integrated programs with the independent programs for averages in the 7 categories and the total criteria, statistical significance was found in all categories except facility description: visibility & communication (67.5% vs. 53. 7%, p = 0.01), program information (75.7% vs. 58%, p = 0.01), curriculum information (54.8% vs. 31.4, p = 0.01), research (42.5% vs. 27.5%, p = 0.01), recruitment (42.6% vs. 26.8%, p = 0.01), salary & benefits (47.8% vs. 26.8%, p = 0.01), and total criteria (52% vs. 35.8%, p = 0.01. CONCLUSION IR residency programs across the country are proficient in providing curricular, and logistical information online. However, improvement is needed in providing nonacademic highlights unique to programs that can aid in maximizing applicant match and compatibility. The information provided by online resources has the potential to influence residency applicant's program ranking and chosen pathway, particularly during the COVID19 pandemic.
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Santavicca S, Duszak R, Nicola GN, Golding LP, Rosenkrantz AB, Wernz C, Hughes DR. Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations. J Am Coll Radiol 2021; 18:1332-1341. [PMID: 34022135 DOI: 10.1016/j.jacr.2021.04.020] [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: 02/26/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to temporally characterize radiologist participation in Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). METHODS Using CMS Physician and Other Supplier Public Use Files, ACO provider-level Research Identifiable Files, and Shared Savings Program ACO Public-Use Files for 2013 through 2018, characteristics of radiologist ACO participation were assessed over time. RESULTS Between 2013 and 2018, the percentage of Medicare-participating radiologists affiliated with MSSP ACOs increased from 10.4% to 34.9%. During that time, the share of large ACOs (>20,000 beneficiaries) with participating radiologists averaged 87.0%, and the shares of medium ACOs (10,000-20,000) and small ACOs (<10,000) with participating radiologists rose from 62.5% to 66.0% and from 26.3% to 51.6%, respectively. The number of physicians in MSSP ACOs with radiologists was substantially larger than those without radiologists (mean range across years, 573-945 versus 107-179). Primary care physicians constituted a larger percentage of the physician population for ACOs without radiologists (average across years, 66.3% versus 38.5%), and ACOs with radiologists had a higher rate of specialist representation (56.0% versus 33.7%). Beneficiary age, race, and sex demographics were similar among radiologist-participating versus nonparticipating ACOs. CONCLUSIONS In recent years, radiologist participation in MSSP ACOs has increased substantially. ACOs with radiologist participation are large and more diverse in their physician specialty composition. Nonparticipating radiologists should prepare accordingly.
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Affiliation(s)
- Stefan Santavicca
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia.
| | - Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Gregory N Nicola
- Finance Chair and Board Member at Hackensack Meridian Health Partners Clinically Integrated Network; Executive leadership position at Hackensack Radiology Group, River Edge, New Jersey
| | - Lauren Parks Golding
- Executive Committee Chair, and Clinical Operations Chair, Triad Radiology Associates, Winston Salem, North Carolina
| | - Andrew B Rosenkrantz
- Professor of Radiology and Urology, Director of Prostate Imaging, Director of Health Policy, and Section Chief of Abdominal Imaging, Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Christian Wernz
- Department of Data Science, University of Virginia Health System, Charlottesville, Virginia
| | - Danny R Hughes
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; Professor, School of Economics, Georgia Institute of Technology, Director, Health Economics and Analytics Lab (HEAL), Atlanta, Georgia
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19
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Direct communication between radiologists and patients improves the quality of imaging reports. Eur Radiol 2021; 31:8725-8732. [PMID: 33909134 DOI: 10.1007/s00330-021-07933-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We investigate in what percentage of cases and to what extent radiological reports change when radiologists directly communicate with patients after imaging examinations. METHODS One hundred twenty-two consecutive outpatients undergoing MRI examinations at a single center were prospectively included. Radiological reports of the patients were drafted by two radiologists in consensus using only the clinical information that was made available by the referring physicians. Thereafter, one radiologist talked directly with the patient and recorded the duration of the conversation. Afterwards, the additional information from the patient was used to reevaluate the imaging studies in consensus. The radiologists determined whether the radiological report changed based on additional information and, if yes, to what extent. The degree of change was graded on a 4-point Likert scale (1, non-relevant findings, to 4, highly relevant findings). RESULTS Following direct communication (duration 170.9 ± 53.9 s), the radiological reports of 52 patients (42.6%) were changed. Of the 52 patients, the degree of change was classified as grade 1 for 8 patients (15.4 %), grade 2 for 27 patients (51.9%), grade 3 for 13 patients (25%), and grade 4 for 4 patients (7.7%). The reasons leading to changes were missing clinical information in 50 cases (96.2%) and the lack of additional external imaging in 2 cases (3.8%). CONCLUSIONS Radiologists should be aware that a lack of accurate information from the clinician can lead to incorrect radiological reports or diagnosis. Radiologists should communicate directly with patients, especially when the provided information is unclear, as it may significantly alter the radiological report. KEY POINTS • Direct communication between radiologists and patients for an average of 170's resulted in a change in the radiological reports of 52 patients (42.6%). • Of the 42.6% of cases where the reports were changed, the alterations were highly relevant (grades 3 and 4) in 32.7%, indicating major changes with significant impact towards patient management.
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Garg T, Bajaj S, Dayan MJ, Makary MS, Smirniotopoulos JB, Silk M, Ahmed O, Wadhwa V. Temporal and geospatial variations among the interventional radiology physician workforce in the United States. Clin Imaging 2021; 78:105-109. [PMID: 33773445 DOI: 10.1016/j.clinimag.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/27/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the temporal trends and state-wide geospatial variations in Vascular and Interventional Radiology (VIR) workforce in the United States. METHODS The State Physician Workforce Data from the AAMC website was accessed for years 2015, 2017, and 2019. The variables collected for each state included total number of active physicians, total number of physicians per specialty and total number of female physicians in VIR. Comparative data was obtained for vascular surgery (VS), diagnostic radiology (DR), and radiation oncology (RO). The annual growth rate for total physicians and sub-analysis of female physicians in each state was computed for each specialty. RESULTS From 2015 to 2019, the total number of active physicians in the United States grew by 1.8% per year. Growth of active physicians in VIR grew by 8.3%, DR 0.06%, VS 4.4%, and RO 1.9% per year. Colorado and Minnesota had the highest growth rate for VIR physicians (15%). VIR physicians per 100,000 people increased from 0.84 (2015) to 1.10 (2019) in the US. In comparison, VS physicians increased from 0.99 (2015) to 1.14 (2019), DR physicians decreased from 8.61 (2015) to 8.43 (2019), and RO physicians grew from 1.48 (2015) to 1.56 (2019). Women represented 6.8% of the VIR workforce in the US in 2019 and increased by a rate of 16% annually in the US from 2015 to 2019. In comparison, the number of women in VS has grown by 21%, DR by 2%, and RO by 2.4% during the same period. The state of Maryland has the highest proportion of women in VIR at 18%. CONCLUSION The number of VIR physicians is increasing at a higher rate than the national overall physician growth, and while female VIR physicians makeup a small fraction of the VIR workforce, their numbers have increased at a faster rate than overall VIR physicians.
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Affiliation(s)
- Tushar Garg
- Division of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai 400012, India
| | - Suryansh Bajaj
- Division of Interventional Radiology, Maulana Azad Medical College, New Delhi 110002, India
| | - Michael J Dayan
- Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York 10065, USA
| | - Mina S Makary
- Division of Interventional Radiology, Ohio State University, Columbus, OH, USA
| | - John B Smirniotopoulos
- Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York 10065, USA
| | - Mikhail Silk
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York 10065, USA
| | - Osman Ahmed
- Division of Interventional Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Vibhor Wadhwa
- Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York 10065, USA.
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21
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Zhang J, Han X, Yang Z, Wang Z, Zheng J, Yang Z, Zhu J. Radiology residency training in China: results from the first retrospective nationwide survey. Insights Imaging 2021; 12:25. [PMID: 33595737 PMCID: PMC7889775 DOI: 10.1186/s13244-021-00970-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives This was the first study to systematically landscape and examine China’s nationwide standardized residency training in radiology. Methods In this retrospective cross-sectional study, we used data from the 2019 national survey of the first two cohorts of 3679 radiology residents who completed training in 2017 and 2018 across all 31 provinces in China. A total of 1163 (32%) residents participated in the survey. Multivariable logistic regression was used to examine the implementation frequency of 24 identified training tasks (categorized into six competencies) by region, demographics, and other residency information. Results Among the 1163 respondents, 592 (51%) were trained in the more developed eastern region. Of the 24 identified training tasks, 15 were implemented significantly differently across regions, while the frequency of the most frequently conducted tasks (e.g., CT, MR, and radiograph interpretation and reporting) was consistent. The top 10 tasks all fell into the patient care and medical knowledge competency domains, while other competencies tended to be neglected. We found region and marital status were the most influential factors of training task implementation frequencies. Respondents trained in the northeast and the west were more likely to report, for instance, radiological examination recommendation (OR = 1.91, 95%CI = 1.27–2.88), as “very frequent.” Married respondents were more likely to report first-line night shift as “very frequent” (OR = 1.71, 95%CI = 1.29–2.26). Conclusions Despite the fast-win achievements of developing a national radiology residency training program, there is a gap to train quality and homogeneous radiologists across regions. Future improvement should be more tailored to residents’ personal characteristics and emphasize some “soft” competencies (e.g., communication skills).
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Xinxin Han
- School of Medicine, Tsinghua University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zimo Yang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
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22
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Kuo PC, Tsai CC, López DM, Karargyris A, Pollard TJ, Johnson AEW, Celi LA. Recalibration of deep learning models for abnormality detection in smartphone-captured chest radiograph. NPJ Digit Med 2021; 4:25. [PMID: 33589700 PMCID: PMC7884693 DOI: 10.1038/s41746-021-00393-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/11/2021] [Indexed: 12/22/2022] Open
Abstract
Image-based teleconsultation using smartphones has become increasingly popular. In parallel, deep learning algorithms have been developed to detect radiological findings in chest X-rays (CXRs). However, the feasibility of using smartphones to automate this process has yet to be evaluated. This study developed a recalibration method to build deep learning models to detect radiological findings on CXR photographs. Two publicly available databases (MIMIC-CXR and CheXpert) were used to build the models, and four derivative datasets containing 6453 CXR photographs were collected to evaluate model performance. After recalibration, the model achieved areas under the receiver operating characteristic curve of 0.80 (95% confidence interval: 0.78-0.82), 0.88 (0.86-0.90), 0.81 (0.79-0.84), 0.79 (0.77-0.81), 0.84 (0.80-0.88), and 0.90 (0.88-0.92), respectively, for detecting cardiomegaly, edema, consolidation, atelectasis, pneumothorax, and pleural effusion. The recalibration strategy, respectively, recovered 84.9%, 83.5%, 53.2%, 57.8%, 69.9%, and 83.0% of performance losses of the uncalibrated model. We conclude that the recalibration method can transfer models from digital CXRs to CXR photographs, which is expected to help physicians' clinical works.
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Affiliation(s)
- Po-Chih Kuo
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Cheng Che Tsai
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Diego M López
- Telematics Department, University of Cauca, Popayán, Cauca, Colombia
| | | | - Tom J Pollard
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Alistair E W Johnson
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Pulmonary Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Saleem HN, Sheikh UU, Khalid SA. Classification of Chest Diseases from X-ray Images on the CheXpert Dataset. LECTURE NOTES IN ELECTRICAL ENGINEERING 2021:837-850. [DOI: 10.1007/978-981-16-0749-3_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Biloglav Z, Medaković P, Vrkić D, Brkljačić B, Padjen I, Ćurić J, Žuvela F, Ivanac G. Geographical and Temporal Distribution of Radiologists, Computed Tomography and Magnetic Resonance Scanners in Croatia. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060295. [PMID: 34807799 PMCID: PMC8613895 DOI: 10.1177/00469580211060295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The aim of the study was to analyse the temporal and geographic distribution of radiologists, computed tomography and magnetic resonance scanners in Croatia. In this observational study we estimated radiologists’ number per 100,000 population for 1997, 2006, and 2017 and compared private and public CT and MR scanners between 2011 and 2018. We analyzed the availability of radiologists and scanners, and the relationship between the radiological workforce and economic strength among counties. The workforce increased significantly from 1997 to 2017 and was associated with economic strength categories in 2017. In 2018, there were more CT scanners in the public sector, while MR scanners were distributed evenly. In 2011, there was similar distribution of CT and MR between sectors, while in 2018 there were significantly more public CT scanners. Counties with a medical school had significantly more radiologists and MR scanners. The high-to-low ratios per CT and MR were 11 and 8.2, suggesting inequality of health care. Croatia significantly increased its radiological workforce; however, cross-county inequality remained. Counties with higher economic strength and medical schools have better availability of radiologists and equipment. To ensure the sustainable activity of the health care system, a precise estimate of supply and demand of radiology services is needed.
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Affiliation(s)
- Zrinka Biloglav
- Department of Medical Statistics, Epidemiology and Medical Informatics, School of Public Health Andrija Štampar, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Petar Medaković
- Department of Radiology, Special Hospital Agram, Zagreb, Croatia
| | - Dina Vrkić
- Central Medical Library, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Boris Brkljačić
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Padjen
- University of Zagreb School of Medicine, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Josip Ćurić
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, Croatia
| | - Franko Žuvela
- Department of Radiology, General Hospital Varaždin, Varaždin, Croatia
| | - Gordana Ivanac
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, Croatia
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25
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Meeting the Need for IR Training in Kenya. J Vasc Interv Radiol 2020; 31:1929-1932.e1. [PMID: 32951971 DOI: 10.1016/j.jvir.2020.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/19/2020] [Accepted: 03/31/2020] [Indexed: 11/24/2022] Open
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Rosenkrantz AB, Fleishon HB, Friedberg EB, Duszak R. Practice Characteristics of the United States General Radiologist Workforce: Most Generalists Work as Multispecialists. Acad Radiol 2020; 27:715-719. [PMID: 32234273 DOI: 10.1016/j.acra.2020.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES While subspecialty radiologists' practice patterns have received recent attention, little is known about the practice patterns of general radiologists. We aim to characterize this group (which represents most US radiologists). MATERIALS AND METHODS US radiologists' individual work efforts were assessed using the 2017 Medicare Provider and Other Supplier Public Use File and a previously validated wRVU-weighted claims-based classification system. Using prior criteria, radiologists without >50% work efforts in a single subspecialty were deemed generalists. For this study, a >25% subspecialty work effort threshold was deemed a subspecialty "focus area," and generalists with ≥2 subspecialty focus areas were deemed "multispecialists." Practice characteristics were summarized using various parameters. RESULTS Among 12,438 radiologists meeting existing claims-based criteria to be deemed generalists, 85.0% had ≥2 subspecialty focus areas of >25% work effort (i.e., multispecialists), 14.6% had one focus area, and 0.4% had no focus area. The fraction of generalists meeting multispecialist criteria was similar across radiologists' years in practice (range 84.7% to 85.4%), academic vs. nonacademic status (84.9% to 86.6%), and practice size (83.3% to 87.0%). Although general radiologist multispecialization varied geographically, a majority were multispecialists in all states (range 57.6% in VT to 93.9% in WY) and percentages were not associated with state-level population density (r = 0.013; p = 0.926). CONCLUSION The large majority of US general radiologists practice as multispecialists, and nearly all have at least one subspecialty focus area. The predominance of general radiologists' multispecialty focus across various practice types and locations supports their role in facilitating patient access to a range of radiologist subspecialties.
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Johnson AEW, Pollard TJ, Berkowitz SJ, Greenbaum NR, Lungren MP, Deng CY, Mark RG, Horng S. MIMIC-CXR, a de-identified publicly available database of chest radiographs with free-text reports. Sci Data 2019; 6:317. [PMID: 31831740 PMCID: PMC6908718 DOI: 10.1038/s41597-019-0322-0] [Citation(s) in RCA: 291] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022] Open
Abstract
Chest radiography is an extremely powerful imaging modality, allowing for a detailed inspection of a patient's chest, but requires specialized training for proper interpretation. With the advent of high performance general purpose computer vision algorithms, the accurate automated analysis of chest radiographs is becoming increasingly of interest to researchers. Here we describe MIMIC-CXR, a large dataset of 227,835 imaging studies for 65,379 patients presenting to the Beth Israel Deaconess Medical Center Emergency Department between 2011-2016. Each imaging study can contain one or more images, usually a frontal view and a lateral view. A total of 377,110 images are available in the dataset. Studies are made available with a semi-structured free-text radiology report that describes the radiological findings of the images, written by a practicing radiologist contemporaneously during routine clinical care. All images and reports have been de-identified to protect patient privacy. The dataset is made freely available to facilitate and encourage a wide range of research in computer vision, natural language processing, and clinical data mining.
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Affiliation(s)
- Alistair E W Johnson
- Institute of Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Tom J Pollard
- Institute of Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Seth J Berkowitz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nathaniel R Greenbaum
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Chih-Ying Deng
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Roger G Mark
- Institute of Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Steven Horng
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Laage Gaupp FM, Solomon N, Rukundo I, Naif AA, Mbuguje EM, Gonchigar A, Xing M, Prologo JD, Silin DD, Minja FJ. Tanzania IR Initiative: Training the First Generation of Interventional Radiologists. J Vasc Interv Radiol 2019; 30:2036-2040. [DOI: 10.1016/j.jvir.2019.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 07/23/2019] [Accepted: 08/04/2019] [Indexed: 10/25/2022] Open
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Kapoor N, Gaviola G, Wang A, Babatunde VD, Khorasani R. Quantifying and Characterizing Trainee Participation in a Major Academic Radiology Department. Curr Probl Diagn Radiol 2019; 48:436-440. [DOI: 10.1067/j.cpradiol.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
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Evaluation of an AI-Based Detection Software for Acute Findings in Abdominal Computed Tomography Scans: Toward an Automated Work List Prioritization of Routine CT Examinations. Invest Radiol 2019; 54:55-59. [PMID: 30199417 DOI: 10.1097/rli.0000000000000509] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to test the diagnostic performance of a deep learning-based triage system for the detection of acute findings in abdominal computed tomography (CT) examinations. MATERIALS AND METHODS Using a RIS/PACS (Radiology Information System/Picture Archiving and Communication System) search engine, we obtained 100 consecutive abdominal CTs with at least one of the following findings: free-gas, free-fluid, or fat-stranding and 100 control cases with absence of these findings. The CT data were analyzed using a convolutional neural network algorithm previously trained for detection of these findings on an independent sample. The validation of the results was performed on a Web-based feedback system by a radiologist with 1 year of experience in abdominal imaging without prior knowledge of image findings through both visual confirmation and comparison with the clinically approved, written report as the standard of reference. All cases were included in the final analysis, except those in which the whole dataset could not be processed by the detection software. Measures of diagnostic accuracy were then calculated. RESULTS A total of 194 cases were included in the analysis, 6 excluded because of technical problems during the extraction of the DICOM datasets from the local PACS. Overall, the algorithm achieved a 93% sensitivity (91/98, 7 false-negative) and 97% specificity (93/96, 3 false-positive) in the detection of acute abdominal findings. Intra-abdominal free gas was detected with a 92% sensitivity (54/59) and 93% specificity (39/42), free fluid with a 85% sensitivity (68/80) and 95% specificity (20/21), and fat stranding with a 81% sensitivity (42/50) and 98% specificity (48/49). False-positive results were due to streak artifacts, partial volume effects, and a misidentification of a diverticulum (each n = 1). CONCLUSIONS The algorithm's autonomous detection of acute pathological abdominal findings demonstrated a high diagnostic performance, enabling guidance of the radiology workflow toward prioritization of abdominal CT examinations with acute conditions.
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Affiliation(s)
- Yoav Mintz
- Department of General Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Ronit Brodie
- Department of General Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
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Access to Interventional Radiology Services in Small Hospitals and Rural Communities: An ACR Membership Intercommission Survey. J Am Coll Radiol 2019; 16:185-193. [DOI: 10.1016/j.jacr.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/22/2022]
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33
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Jutras M, Khosa F. The Physician Payment Sunshine Act: Evaluating Industrial Payments in Radiology. Acad Radiol 2019; 26:86-92. [PMID: 29958777 DOI: 10.1016/j.acra.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES The characterization of payments made to physicians by pharmaceutical companies, device manufacturers, and group purchasing organizations is crucial for assessing potential conflicts of interest and their impact on practice patterns. This study examines the compensation received by general radiologists (GR) in the United States, as well as radiologists in the following five subspecialties: body imaging, neuroradiology, pediatric radiology, nuclear radiology and radiological physics, and vascular and interventional radiology. MATERIALS AND METHODS Data were extracted from the Open Payments database for radiology subspecialists in the United States who received installments in calendar year 2015 from pharmaceutical and device manufacturing companies. RESULTS In 2015, a total of $43,685,052 was paid in 65,507 payments (mean $667/payment; median $32/payment) to radiologists, including 9826 GR, 362 body imaging radiologists, 479 neuroradiologists, 127 pediatric radiologists, 175 physicians in nuclear radiology and radiological physics, and 1584 vascular and interventional radiologists. Payments were unequally distributed across these six major subspecialties of radiology (p < 0.01), with GR receiving the largest number of total payments (44,695), and neuroradiologists receiving significantly higher median payments than any other subspecialty ($80 vs $32 for all radiologists; p < 0.01). Medtronic Neurovascular was the single largest payer to all radiologists combined. CONCLUSION Commercial entities make substantial payments to radiologists, with a significant variation in payments made to the different radiology subspecialties. While the largest number of total payments was made to GGR, the highest median payments were made to neuroradiologists, and significant dispersion in these payments was seen across different geographic regions. The impact of these payments on practice patterns remains to be elucidated.
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Rosenkrantz AB, Friedberg EB, Prologo JD, Everett C, Duszak R. Generalist versus Subspecialist Workforce Characteristics of Invasive Procedures Performed by Radiologists. Radiology 2018; 289:140-147. [DOI: 10.1148/radiol.2018180761] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew B. Rosenkrantz
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - Eric B. Friedberg
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - J. David Prologo
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - Catherine Everett
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - Richard Duszak
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
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Heller SL, Charlie A, Babb JS, Moy L, Gao Y. Trends in breast imaging: an analysis of 21 years of formal scientific abstracts at the Radiological Society of North America. Clin Imaging 2018; 49:1-6. [DOI: 10.1016/j.clinimag.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
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36
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Rosenkrantz AB, Wang W, Hughes DR, Duszak R. A County-Level Analysis of the US Radiologist Workforce: Physician Supply and Subspecialty Characteristics. J Am Coll Radiol 2018; 15:601-606. [DOI: 10.1016/j.jacr.2017.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/02/2017] [Indexed: 12/01/2022]
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37
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Rosenkrantz AB, Wang W, Hughes DR, Duszak R. Generalist versus Subspecialist Characteristics of the U.S. Radiologist Workforce. Radiology 2018; 286:929-937. [DOI: 10.1148/radiol.2017171684] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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38
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Current Clinical Practice Patterns of Self-Identified Interventional Radiologists. AJR Am J Roentgenol 2018. [DOI: 10.2214/ajr.17.18592] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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39
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Kumamaru KK, Machitori A, Koba R, Ijichi S, Nakajima Y, Aoki S. Global and Japanese regional variations in radiologist potential workload for computed tomography and magnetic resonance imaging examinations. Jpn J Radiol 2018; 36:273-281. [PMID: 29453512 DOI: 10.1007/s11604-018-0724-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/05/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To investigate the global variation in radiologist potential workload for CT and MRI examinations, and the regional variation in potential workload and extent of radiologists' involvement in CT and MRI examinations in Japan. METHODS "Radiologist potential workload" was defined as the annual number of CT plus MRI examinations divided by the total number of diagnostic radiologists. The extent of radiologists' involvement was measured as the proportion of CT and MRI examinations to which "Added-fees for Radiological Managements on Imaging-studies (ARMIs)" were applied among eligible examinations. Maximum variation was computed as the ratio of the highest-to-lowest values among the countries or Japanese prefectures. RESULTS The radiologist potential workload in Japan was 2.78-4.17 times higher than those in other countries. A maximum prefecture-to-prefecture variation was 3.88. The average percentage of CT plus MRI examinations with ARMI applied was 43.3%, with a maximum prefecture-to-prefecture variation of 3.97. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement. CONCLUSIONS Japan had a far greater radiologist potential workload compared with other countries, with a large regional variation among prefectures. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement in CT and MRI examinations.
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Affiliation(s)
- Kanako K Kumamaru
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Akihiro Machitori
- Department of Radiology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
| | - Ritsuko Koba
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.,GE Healthcare Japan Corporation, 4-7-127 Asahigaoka, Hino-shi, Tokyo, 191-8503, Japan
| | - Shinpei Ijichi
- GE Healthcare Japan Corporation, 4-7-127 Asahigaoka, Hino-shi, Tokyo, 191-8503, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shigeki Aoki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Shaw LJ, Blankstein R, Jacobs JE, Leipsic JA, Kwong RY, Taqueti VR, Beanlands RSB, Mieres JH, Flamm SD, Gerber TC, Spertus J, Di Carli MF. Defining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2017; 10:e000017. [PMID: 29242239 PMCID: PMC5926771 DOI: 10.1161/hci.0000000000000017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care. Our proposed statement may serve as the foundation for integrating these quality indicators into establishing designations of quality laboratory practices and developing standards for value-based payment reform for imaging services. We also include recommendations for future clinical research to fulfill quality aims within cardiovascular imaging, including clinical hypotheses of improving patient outcomes, the importance of health status as an end point, and deferred testing options. Future research should evolve to define novel methods optimized for the role of cardiovascular imaging for detecting disease and guiding treatment and to demonstrate the role of cardiovascular imaging in facilitating healthcare quality.
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Private Practice Radiologist Subspecialty Classification Using Medicare Claims. J Am Coll Radiol 2017; 14:1419-1425. [DOI: 10.1016/j.jacr.2017.04.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/21/2022]
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Reading efficiency can be improved by minor modification of assigned duties; a pilot study on a small team of general radiologists. Jpn J Radiol 2017; 35:262-268. [DOI: 10.1007/s11604-017-0629-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
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