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Tay YX, Foley S, Killeen R, Ong MEH, Chen RC, Chan LP, Mak MS, McNulty JP. Impact and effect of imaging referral guidelines on patients and radiology services: a systematic review. Eur Radiol 2024:10.1007/s00330-024-10938-7. [PMID: 39002059 DOI: 10.1007/s00330-024-10938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/10/2024] [Accepted: 06/11/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES The objective of this systematic review was to offer a comprehensive overview and explore the associated outcomes from imaging referral guidelines on various key stakeholders, such as patients and radiologists. MATERIALS AND METHODS An electronic database search was conducted in Medline, Embase and Web of Science to retrieve citations published between 2013 and 2023. The search was constructed using medical subject headings and keywords. Only full-text articles and reviews written in English were included. The quality of the included papers was assessed using the mixed methods appraisal tool. A narrative synthesis was undertaken for the selected articles. RESULTS The search yielded 4384 records. Following the abstract, full-text screening, and removal of duplication, 31 studies of varying levels of quality were included in the final analysis. Imaging referral guidelines from the American College of Radiology were most commonly used. Clinical decision support systems were the most evaluated mode of intervention, either integrated or standalone. Interventions showed reduced patient radiation doses and waiting times for imaging. There was a general reduction in radiology workload and utilisation of diagnostic imaging. Low-value imaging utilisation decreased with an increase in the appropriateness of imaging referrals and ratings and cost savings. Clinical effectiveness was maintained during the intervention period without notable adverse consequences. CONCLUSION Using evidence-based imaging referral guidelines improves the quality of healthcare and outcomes while reducing healthcare costs. Imaging referral guidelines are one essential component of improving the value of radiology in the healthcare system. CLINICAL RELEVANCE STATEMENT There is a need for broader dissemination of imaging referral guidelines to healthcare providers globally in tandem with the harmonisation of the application of these guidelines to improve the overall value of radiology within the healthcare system. KEY POINTS The application of imaging referral guidelines has an impact and effect on patients, radiologists, and health policymakers. The adoption of imaging referral guidelines in clinical practice can impact healthcare costs and improve healthcare quality and outcomes. Implementing imaging referral guidelines contributes to the attainment of value-based radiology.
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Affiliation(s)
- Yi Xiang Tay
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland.
- Radiography Department, Allied Health Division, Singapore General Hospital, Singapore, Singapore.
| | - Shane Foley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Ronan Killeen
- St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Marcus E H Ong
- Department of Emergency Medicine, Division of Medicine, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Robert Chun Chen
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Neuroradiology, Division of Radiological Sciences, Singapore General Hospital, Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Lai Peng Chan
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital, Singapore, Singapore
| | - May San Mak
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital, Singapore, Singapore
| | - Jonathan P McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
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2
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Lin DJ, Doshi AM, Fritz J, Recht MP. Designing Clinical MRI for Enhanced Workflow and Value. J Magn Reson Imaging 2024; 60:29-39. [PMID: 37795927 DOI: 10.1002/jmri.29038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
MRI is an expensive and traditionally time-intensive modality in imaging. With the paradigm shift toward value-based healthcare, radiology departments must examine the entire MRI process cycle to identify opportunities to optimize efficiency and enhance value for patients. Digital tools such as "frictionless scheduling" prioritize patient preference and convenience, thereby delivering patient-centered care. Recent advances in conventional and deep learning-based accelerated image reconstruction methods have reduced image acquisition time to such a degree that so-called nongradient time now constitutes a major percentage of total room time. For this reason, architectural design strategies that reconfigure patient preparation processes and decrease the turnaround time between scans can substantially impact overall throughput while also improving patient comfort and privacy. Real-time informatics tools that provide an enterprise-wide overview of MRI workflow and Picture Archiving and Communication System (PACS)-integrated instant messaging can complement these efforts by offering transparent, situational data and facilitating communication between radiology team members. Finally, long-term investment in training, recruiting, and retaining a highly skilled technologist workforce is essential for building a pipeline and team of technologists committed to excellence. Here, we highlight various opportunities for optimizing MRI workflow and enhancing value by offering many of our own on-the-ground experiences and conclude by anticipating some of the future directions for process improvement and innovation in clinical MR imaging. EVIDENCE LEVEL: N/A TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Dana J Lin
- Department of Radiology, NYU Grossman School of Medicine/NYU Langone Health, New York, New York, USA
| | - Ankur M Doshi
- Department of Radiology, NYU Grossman School of Medicine/NYU Langone Health, New York, New York, USA
| | - Jan Fritz
- Department of Radiology, NYU Grossman School of Medicine/NYU Langone Health, New York, New York, USA
| | - Michael P Recht
- Department of Radiology, NYU Grossman School of Medicine/NYU Langone Health, New York, New York, USA
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3
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Kjelle E, Brandsæter IØ, Andersen ER, Hofmann BM. Cost of Low-Value Imaging Worldwide: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:485-501. [PMID: 38427217 PMCID: PMC11178636 DOI: 10.1007/s40258-024-00876-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Imaging with low or no benefit for the patient undermines the quality of care and amounts to vast opportunity costs. More than 3.6 billion imaging examinations are performed annually, and about 20-50% of these are of low value. This study aimed to synthesize knowledge of the costs of low-value imaging worldwide. METHODS This systematic review was based on the PRISMA statement. The database search was developed in Medline and further adapted to Embase-Ovid, Cochrane Library, and Scopus. Primary empirical studies assessing the costs of low-value diagnostic imaging were included if published between 2012 and March 2022. Studies designed as randomized controlled trials, non-randomized trials, cohort studies, cross-sectional studies, descriptive studies, cost analysis, cost-effectiveness analysis, and mixed-methods studies were eligible. The analysis was descriptive. RESULTS Of 5,567 records identified, 106 were included. Most of the studies included were conducted in the USA (n = 76), and a hospital or medical center was the most common setting (n = 82). Thirty-eight of the included studies calculated the costs of multiple imaging modalities; in studies with only one imaging modality included, conventional radiography was the most common (n = 32). Aggregated costs for low-value examinations amounts to billions of dollars per year globally. Initiatives to reduce low-value imaging may reduce costs by up to 95% without harming patients. CONCLUSIONS This study is the first systematic review of the cost of low-value imaging worldwide, documenting a high potential for cost reduction. Given the universal challenges with resource allocation, the large amount used for low-value imaging represents a vast opportunity cost and offers great potential to improve the quality and efficiency of care.
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Affiliation(s)
- Elin Kjelle
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Ingrid Øfsti Brandsæter
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Eivind Richter Andersen
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Bjørn Morten Hofmann
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics at the University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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4
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Kjelle E, Andersen ER, Brandsæter IØ, Hofmann BM. Norwegian general practitioners' and radiologists' perspectives on the referral, justification, and unnecessary imaging-a survey. Scand J Prim Health Care 2024:1-8. [PMID: 38916978 DOI: 10.1080/02813432.2024.2366247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
AIM This study aimed to survey general practitioners' (GPs) and radiologists' perspectives on referrals, imaging justification, and unnecessary imaging in Norway. MATERIALS AND METHODS The survey covered access to imaging, responsibilities, attitudes toward justification assessment, referral process, and demographics using multiple choice questions, statements to report agreement with using the Likert scale and one open question. RESULTS Forty radiologists and 58 GPs attending national conferences completed a web-based survey, with a 20/15% response rate, respectively. Both radiologists (97%) and GPs (100%) considered avoiding unnecessary examinations essential to their role in the healthcare service. Still, 91% of GPs admitted that they referred to imaging they thought was not helpful, while about 60% of the radiologists agreed that unnecessary imaging was conducted in their workplace. GPs reported pressure from patients and patients having private insurance as the most common reasons for doing unnecessary examinations. In contrast, radiologists reported a lack of clinical information and the inability to discuss patient cases with the GPs as the most common reasons. CONCLUSION This study adds to our understanding of radiologists' and GPs' perspectives on unnecessary imaging and referrals. Better guidelines and, even more importantly, better communication between the referrer and the radiologist are needed. Addressing these issues can reduce unnecessary imaging and improve the quality and safety of care.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
| | - Ingrid Øfsti Brandsæter
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
- Centre of Medical Ethics, Centre of Medical Ethics at the University of Oslo, Blindern, Norway
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Musa A, Awan OA. A Novel Suggestion to Augment Medical Student Education in Neuroradiology Clerkships. Acad Radiol 2024; 31:2636-2638. [PMID: 37147160 DOI: 10.1016/j.acra.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Arif Musa
- ProMedica Monroe Regional Hospital, Monroe, Michigan
| | - Omer A Awan
- University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201.
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Espinosa O, Puentes G, Bejarano V, Hedgire S, Daye D, Arias ML, Duszak R. Which health conditions report the most spending on medical imaging? Evidence for Colombia. Curr Probl Diagn Radiol 2024:S0363-0188(24)00079-3. [PMID: 38714393 DOI: 10.1067/j.cpradiol.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/01/2024] [Indexed: 05/09/2024]
Abstract
Medical imaging is essential for the proper diagnosis and treatment of many diseases. The literature has found that medical imaging generally accounts for a significant percentage of total healthcare spending. We analyzed a national database between 2013 and 2021, with more than 19 million patients on average, to review which health conditions account for the highest spending on medical imaging in the Colombian health system. We segmented the analysis by type of medical imaging, life cycles, health condition and sex. Our findings indicate that cardiac and mental illnesses account for the highest per capita spending on medical imaging, especially for the elderly. As a proportion of total expenditure, hypertension and tuberculosis are added, with special emphasis on the infancy-childhood life cycle.
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Affiliation(s)
- Oscar Espinosa
- Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Gabriela Puentes
- Departament of Radiology, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
| | - Valeria Bejarano
- Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Sandeep Hedgire
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, United States.
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, United States.
| | - Martha-Liliana Arias
- Department of Accounting Sciences, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia.
| | - Richard Duszak
- Department of Radiology, University of Mississippi Medical Center, Mississippi, United States.
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Lee A, Schoen J, Scheel JR, Frederick-Dyer K. A CT Scan of Our Earth: The Radiology Department's How-To Guide for Addressing Planetary Health. J Am Coll Radiol 2024; 21:280-284. [PMID: 38042232 DOI: 10.1016/j.jacr.2023.11.020] [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: 08/05/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023]
Abstract
The planet has a fever, and it is getting worse. Climate change manifests through mechanisms such as extreme weather, shifting disease burden, wildfires, and drought, which all have negative implications on human health. Simultaneously, the health care sector is responsible for 4.6% of global greenhouse gas emissions. As users of some of the hospital's most energy-intensive equipment, radiology departments are key stakeholders in the transition to clean energy. The authors propose a framework to guide radiology departments to advance health care sustainability. The approach outlines how a radiology department can reduce its environmental footprint through appointing a sustainability officer, forming a dedicated green team, incorporating sustainability into the departmental strategic plan, quantifying total greenhouse gas emissions, committing to education, and advocating for systemic change. By delineating a structured path, the authors hope to encourage the transition toward environmentally friendly practices in all radiology practice settings.
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Affiliation(s)
- Amanda Lee
- Duke University Medical Center, Durham, North Carolina. https://twitter.com/AmandaLeeMD
| | - Julia Schoen
- Wake Forest University, Winston-Salem, North Carolina; and Co-Chair, ACR Sustainability Task Force. https://twitter.com/juliaschoenMD
| | - John R Scheel
- Vice Chair of Global and Planetary Health, Vanderbilt University Medical Center, Nashville, Tennessee. https://twitter.com/JohnRScheel
| | - Katherine Frederick-Dyer
- Radiology Medical Director of CT and the Vanderbilt Ingram Cancer Center and Director of Body MRI, Vanderbilt University Medical Center, Nashville, Tennessee.
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8
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Takahashi S. Editorial for "Association of Pathological Features and Multiparametric MRI-Based Radiomics with TP53-Mutated Prostate Cancer". J Magn Reson Imaging 2024. [PMID: 38190345 DOI: 10.1002/jmri.29224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Satoru Takahashi
- Imaging Research Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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9
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Christensen EW, Pelzl CE, Rula EY, Nicola LP, Nicola GN. Prevalence of "One-Off Events" in Radiology: Implications for Radiology in Episode-Based Alternative Payment Models. Curr Probl Diagn Radiol 2024; 53:48-53. [PMID: 37704487 DOI: 10.1067/j.cpradiol.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE As reimbursement mechanisms become more value-based, there are questions about the applicability of these mechanisms for nonepisodic care, particularly care provided by nonpatient-facing specialists, for example, radiologists. Accordingly, this study examined the prevalence of nonepisodic care-one-off events-in diagnostic radiology. METHODS We conducted a multiyear (2015-2019) retrospective study of diagnostic imaging using a large commercial payer database including commercial insurance and Medicare Advantage. Using a 12-month evaluation period starting with the day of the initial imaging study/studies, we categorized imaging studies as one-off events if there were no additional studies (beyond the first day of the evaluation period) for the next 12 months in the same body region. We also evaluated an alternative, more stringent definition of a one-off event: the only imaging study during the 12-month evaluation period. We computed the percentage of one-off events overall and by body region. RESULTS We found that one-off events comprised 33.2%-45.8% of imaging studies depending on whether one-off events are defined as the only study in the evaluation period or imaging only on the first day of the evaluation period, respectively. This share varied widely by body region: highest for cardiac (80.9%-87.7%) and lower for chest (26.8%-35.2%). By place-of-service, the proportion was lowest for the inpatient (12.9%-29.1%) and long-term care settings (18.6%-30%). DISCUSSION Given the sizeable share of imaging studies categorized as one-off events, much of radiologists' workload falls outside of the framework of episodic measurement tools and value-based payment models.
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Affiliation(s)
- Eric W Christensen
- Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, Reston, VA; Health Services Management, University of Minnesota, St. Paul, MN
| | - Casey E Pelzl
- Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, Reston, VA.
| | | | - Lauren P Nicola
- Triad Radiology Associates, Winston-Salem, NC; American College of Radiology Board of Chancellors, Reston, VA
| | - Gregory N Nicola
- American College of Radiology Board of Chancellors, Reston, VA; Hackensack Radiology Group, PA, River Edge, NJ; American College of Radiology Commission on Economics, Reston, VA
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Sim JZT, Bhanu Prakash KN, Huang WM, Tan CH. Harnessing artificial intelligence in radiology to augment population health. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1281500. [PMID: 38021439 PMCID: PMC10663302 DOI: 10.3389/fmedt.2023.1281500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
This review article serves to highlight radiological services as a major cost driver for the healthcare sector, and the potential improvements in productivity and cost savings that can be generated by incorporating artificial intelligence (AI) into the radiology workflow, referencing Singapore healthcare as an example. More specifically, we will discuss the opportunities for AI in lowering healthcare costs and supporting transformational shifts in our care model in the following domains: predictive analytics for optimising throughput and appropriate referrals, computer vision for image enhancement (to increase scanner efficiency and decrease radiation exposure) and pattern recognition (to aid human interpretation and worklist prioritisation), natural language processing and large language models for optimising reports and text data-mining. In the context of preventive health, we will discuss how AI can support population level screening for major disease burdens through opportunistic screening and democratise expertise to increase access to radiological services in primary and community care.
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Affiliation(s)
- Jordan Z. T. Sim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - K. N. Bhanu Prakash
- Clinical Data Analytics & Radiomics, Cellular Image Informatics, Bioinformatics Institute, Singapore, Singapore
| | - Wei Min Huang
- Healthcare-MedTech Division & Visual Intelligence Department, Institute for Infocomm Research, Singapore, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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11
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Komarraju A, Van Rilland EZ, Gebhardt MC, Anderson ME, Heincelman C, Wu JS. What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference? Clin Orthop Relat Res 2023; 481:2005-2013. [PMID: 36929904 PMCID: PMC10499106 DOI: 10.1097/corr.0000000000002626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/12/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Multidisciplinary orthopaedic oncology conferences are important in developing the treatment plan for patients with suspected orthopaedic bone and soft tissue tumors, involving physicians from several services. Past studies have shown the clinical value of these conferences; however, the impact of radiology input on the management plan and time cost for radiology to staff these conferences has not been fully studied. QUESTIONS/PURPOSES (1) Does radiology input at multidisciplinary conference help guide clinical management and improve clinician confidence? (2) What is the time cost of radiology input for a multidisciplinary conference? METHODS This prospective study was conducted from October 2020 to March 2022 at a tertiary academic center with a sarcoma center. A single data questionnaire for each patient was sent to one of three treating orthopaedic oncologists with 41, 19, and 5 years of experience after radiology discussion at a weekly multidisciplinary conference. A data questionnaire was completed by the treating orthopaedic oncologist for 48% (322 of 672) of patients, which refers to the proportion of those three oncologists' patients for which survey data were captured. A musculoskeletal radiology fellow and musculoskeletal fellowship-trained radiology attending physician provided radiology input at each multidisciplinary conference. The clinical plan (leave alone, follow-up imaging, follow-up clinically, recommend different imaging test, core needle biopsy, surgical excision or biopsy or fixation, or other) and change in clinical confidence before and after radiology input were documented. A second weekly data questionnaire was sent to the radiology fellow to estimate the time cost of radiology input for the multidisciplinary conference. RESULTS In 29% (93 of 322) of patients, there was a change in the clinical plan after radiology input. Biopsy was canceled in 30% (24 of 80) of patients for whom biopsy was initially planned, and surgical excision was canceled in 24% (17 of 72) of patients in whom surgical excision was initially planned. In 21% (68 of 322) of patients, there were unreported imaging findings that affected clinical management; 13% (43 of 322) of patients had a missed finding, and 8% (25 of 322) of patients had imaging findings that were interpreted incorrectly. For confidence in the final treatment plan, 78% (251 of 322) of patients had an increase in clinical confidence by their treating orthopaedic oncologist after the multidisciplinary conference. Radiology fellows and attendings spent a mean of 4.2 and 1.5 hours, respectively, reviewing and presenting at a multidisciplinary conference each week. The annual combined prorated time cost for the radiology attending and fellow was estimated at USD 24,310 based on national median salary data for attendings and internal salary data for fellows. CONCLUSION In a study taken at one tertiary-care oncology program, input from radiology attendings and fellows in the setting of a multidisciplinary conference helped to guide the final treatment plan, reduce procedures, and improve clinician confidence in the final treatment plan, at an annual time cost of USD 24,310. CLINICAL RELEVANCE Multidisciplinary orthopaedic oncology conferences can lead to changes in management plans, and the time cost to the radiologists should be budgeted for by the radiology department or parent institution.
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Affiliation(s)
- Aparna Komarraju
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Mark C. Gebhardt
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Megan E. Anderson
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carrie Heincelman
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jim S. Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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12
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Teuteberg N, Barnard MM, Fernandez A, Cloete K, Mukosi M, Pitcher R. The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa. Cureus 2023; 15:e47616. [PMID: 38021905 PMCID: PMC10667617 DOI: 10.7759/cureus.47616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.
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Affiliation(s)
- Nolene Teuteberg
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
| | - Michelle M Barnard
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Amanda Fernandez
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Keith Cloete
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Matodzi Mukosi
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
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13
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Practical Approaches to Advancing Health Equity in Radiology, From the AJR Special Series on DEI. AJR Am J Roentgenol 2023:1-10. [PMID: 36629307 DOI: 10.2214/ajr.22.28783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite significant advances in healthcare, many patients from medically underserved populations are impacted by existing healthcare disparities. Radiologists are uniquely positioned to decrease health disparities and advance health equity efforts in their practices. However, literature on practical tools for advancing radiology health equity efforts applicable to a wide variety of patient populations and care settings is lacking. Therefore, this article seeks to equip radiologists with an evidence-based and practical knowledge toolkit of health equity strategies, presented in terms of four pillars of research, clinical care, education, and innovation. For each pillar, equity efforts across diverse patient populations and radiology practice settings are examined through the lens of existing barriers, current best practices, and future directions, incorporating practical examples relevant to a spectrum of patient populations. Health equity efforts provide an opportune window to transform radiology through personalized care delivery that is responsive to diverse patient needs. Guided by compassion and empathy as core principles of health equity, leveraging the four pillars provides a helpful framework to advance health equity efforts as a step towards social justice in health.
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Inaugural Pan-Canadian RADGames: Results From a Successful Approach to Radiology Education for Medical Students. Acad Radiol 2023; 30:113-121. [PMID: 35995693 DOI: 10.1016/j.acra.2022.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 01/13/2023]
Abstract
RATIONALE AND OBJECTIVES A goal in radiology undergraduate medical education is to improve exposure to the field. In 2022, the Canadian Association of Radiologists' Medical Student Network hosted for the first time "RADGames," an interactive image interpretation contest for medical students across Canada. This program was aimed to spark interest in radiology and improve students' image interpretation skills through gamification with expert guidance. MATERIALS AND METHODS Volunteers from Radiology Interest Groups in Canadian medical schools set up a virtual event for the competition using breakout rooms and a quiz platform. Participant recruitment was through social media and advertisement by medical student associations. Participants were surveyed anonymously for feedback following the event. Data about previous exposure to and knowledge of radiology, and an evaluation of the event including self-perceived impact on participants' understanding of the field were collected. RESULTS Eighty seven medical students from 15 of Canada's 17 medical schools competed against one another virtually. Forty seven (54%) responded to the post-event evaluation survey. All responses about the event itself were favourable. Respondents overwhelmingly indicated that RADGames increased their interest in radiology (38, 81%), their understanding of the work of a radiologist (31, 66%) and their knowledge about medical imaging (46, 98%), and improved their confidence in basic imaging interpretation (36, 77%). CONCLUSION The Canadian Association of Radiologists' Medical Student Network hosted Canada's first national image interpretation competition for medical students, RADGames. Feedback was overwhelmingly positive, with perceived benefits to participants on their understanding of and interest in radiology.
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Rockall AG, Justich C, Helbich T, Vilgrain V. Patient communication in radiology: Moving up the agenda. Eur J Radiol 2022; 155:110464. [PMID: 36038410 DOI: 10.1016/j.ejrad.2022.110464] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
Optimised communication between patients and the imaging team is an essential component of providing patient-centred and value-based care. Communication with patients can be challenging in the setting of busy radiology departments where there is a focus on efficient and accurate diagnosis. Traditionally, most results are provided directly to the referring clinician. However, the importance of direct communication between the radiologist and patient is increasingly relevant, particularly in the context of face-to-face settings such as rapid assessment and ultrasound clinics, and interventional radiology, as well as in written form through electronic patient portals. Artificial intelligence tools may improve efficiency, allowing more time for radiologists to communicate directly with patients. There is a need for dedicated training in communication skills for imaging professionals. This review considers the topic of patient communication in the setting of imaging departments and discusses the ways that communication skills may be improved through training and through harnessing emerging digital technologies that may enhance the quality of communication.
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Affiliation(s)
- Andrea G Rockall
- Department of Cancer and Surgery, Faculty of Medicine, Imperial College London, UK; Department of Radiology, Imperial Healthcare NHS Trust, London, UK.
| | | | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna & General Hospital, Division of Molecular and Structural Preclinical Imaging, Waehringer Guertel 18-20, Floor 7F, 1090 Vienna, Austria
| | - Valerie Vilgrain
- Université Paris Cité and Department of Radiology, Hôpital Beaujon, APHP.Nord, Paris, France
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Validation of a deep learning, value-based care model to predict mortality and comorbidities from chest radiographs in COVID-19. PLOS DIGITAL HEALTH 2022; 1:e0000057. [PMID: 36812559 PMCID: PMC9931278 DOI: 10.1371/journal.pdig.0000057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022]
Abstract
We validate a deep learning model predicting comorbidities from frontal chest radiographs (CXRs) in patients with coronavirus disease 2019 (COVID-19) and compare the model's performance with hierarchical condition category (HCC) and mortality outcomes in COVID-19. The model was trained and tested on 14,121 ambulatory frontal CXRs from 2010 to 2019 at a single institution, modeling select comorbidities using the value-based Medicare Advantage HCC Risk Adjustment Model. Sex, age, HCC codes, and risk adjustment factor (RAF) score were used. The model was validated on frontal CXRs from 413 ambulatory patients with COVID-19 (internal cohort) and on initial frontal CXRs from 487 COVID-19 hospitalized patients (external cohort). The discriminatory ability of the model was assessed using receiver operating characteristic (ROC) curves compared to the HCC data from electronic health records, and predicted age and RAF score were compared using correlation coefficient and absolute mean error. The model predictions were used as covariables in logistic regression models to evaluate the prediction of mortality in the external cohort. Predicted comorbidities from frontal CXRs, including diabetes with chronic complications, obesity, congestive heart failure, arrhythmias, vascular disease, and chronic obstructive pulmonary disease, had a total area under ROC curve (AUC) of 0.85 (95% CI: 0.85-0.86). The ROC AUC of predicted mortality for the model was 0.84 (95% CI,0.79-0.88) for the combined cohorts. This model using only frontal CXRs predicted select comorbidities and RAF score in both internal ambulatory and external hospitalized COVID-19 cohorts and was discriminatory of mortality, supporting its potential use in clinical decision making.
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Munir A, Awan OA. The Business of Medicine: Tips for Radiology Trainees. Acad Radiol 2022; 29:945-947. [PMID: 35512946 DOI: 10.1016/j.acra.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/01/2022]
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Youens D, Doust J, Ha TN, O'Leary P, Slavotinek J, Wright C, Moorin R. Association of regulatory body actions and subsequent media coverage with use of services in a fee-for-service system: a longitudinal cohort study of CT scanning in Australia. BMJ Open 2022; 12:e057424. [PMID: 35450909 PMCID: PMC9024258 DOI: 10.1136/bmjopen-2021-057424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The professional service review (PSR) is an Australian Government agency aiming to reduce inappropriate practices funded via Medicare, Australia's public insurer. Our objective was to examine changes in CT following the 2008-2009 PSR annual report, which noted excessive CT use. DESIGN Interrupted time series analysis examined trends in CT use following the 2008-2009 PSR report, estimating both change in the immediate rate of CT and the slope of the trend in usage postintervention. SETTING Medicare-funded imaging (most out-of-hospital imaging) in Australia. PARTICIPANTS Patients receiving Medicare-funded CT and other imaging. INTERVENTION The 2008-2009 PSR report highlighted concerns regarding excessive CT use. Two providers were financially penalised for CT overuse with these cases detailed in the PSR report and highlighted in an associated Report to the Professions, distributed to 50 000 providers. Media articles on radiation risks followed. OUTCOMES Quarterly rates of out-of-hospital CT, MRI (as a comparator), and all other Medicare-funded diagnostic imaging examinations 2001-2019. RESULTS CT scanning increased from 4663.5 per 100 000 person-years in 2001 to 14 506 in 2019 (211% increase), with substantial variation by type and anatomical region. The 2008-2009 PSR report was followed by an immediate reduction in CT scanning of 237.7 CTs per 100 000 people per quarter (95% CI -333.4 to -141.9) though growth in use soon continued at the preintervention rate. The degree of change in utilisation following the report differed between states/territories and by scan type, both in terms of the immediate change and the slope. For other diagnostic imaging modalities, there was an increase in the slope, while for MRI there was no change in either parameter. CONCLUSION Actions consisting of financial disincentives for service overtesting and provider/public education components may limit excessive use of diagnostic imaging in fee-for-service systems, however, effects observed here were only short lived.
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Affiliation(s)
- David Youens
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Jenny Doust
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Thi Ninh Ha
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Peter O'Leary
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cameron Wright
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Population Health, Curtin University, Crawley, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rachael Moorin
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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3D printing units should be centrally managed in the radiology department. Eur J Radiol 2022; 148:110161. [DOI: 10.1016/j.ejrad.2022.110161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
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Pyrros A, Rodríguez-Fernández JM, Borstelmann SM, Gichoya JW, Horowitz JM, Fornelli B, Siddiqui N, Velichko Y, Koyejo S, Galanter W. Detecting Racial/Ethnic Health Disparities Using Deep Learning From Frontal Chest Radiography. J Am Coll Radiol 2022; 19:184-191. [PMID: 35033309 PMCID: PMC8820271 DOI: 10.1016/j.jacr.2021.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of this study was to assess racial/ethnic and socioeconomic disparities in the difference between atherosclerotic vascular disease prevalence measured by a multitask convolutional neural network (CNN) deep learning model using frontal chest radiographs (CXRs) and the prevalence reflected by administrative hierarchical condition category codes in two cohorts of patients with coronavirus disease 2019 (COVID-19). METHODS A CNN model, previously published, was trained to predict atherosclerotic disease from ambulatory frontal CXRs. The model was then validated on two cohorts of patients with COVID-19: 814 ambulatory patients from a suburban location (presenting from March 14, 2020, to October 24, 2020, the internal ambulatory cohort) and 485 hospitalized patients from an inner-city location (hospitalized from March 14, 2020, to August 12, 2020, the external hospitalized cohort). The CNN model predictions were validated against electronic health record administrative codes in both cohorts and assessed using the area under the receiver operating characteristic curve (AUC). The CXRs from the ambulatory cohort were also reviewed by two board-certified radiologists and compared with the CNN-predicted values for the same cohort to produce a receiver operating characteristic curve and the AUC. The atherosclerosis diagnosis discrepancy, Δvasc, referring to the difference between the predicted value and presence or absence of the vascular disease HCC categorical code, was calculated. Linear regression was performed to determine the association of Δvasc with the covariates of age, sex, race/ethnicity, language preference, and social deprivation index. Logistic regression was used to look for an association between the presence of any hierarchical condition category codes with Δvasc and other covariates. RESULTS The CNN prediction for vascular disease from frontal CXRs in the ambulatory cohort had an AUC of 0.85 (95% confidence interval, 0.82-0.89) and in the hospitalized cohort had an AUC of 0.69 (95% confidence interval, 0.64-0.75) against the electronic health record data. In the ambulatory cohort, the consensus radiologists' reading had an AUC of 0.89 (95% confidence interval, 0.86-0.92) relative to the CNN. Multivariate linear regression of Δvasc in the ambulatory cohort demonstrated significant negative associations with non-English-language preference (β = -0.083, P < .05) and Black or Hispanic race/ethnicity (β = -0.048, P < .05) and positive associations with age (β = 0.005, P < .001) and sex (β = 0.044, P < .05). For the hospitalized cohort, age was also significant (β = 0.003, P < .01), as was social deprivation index (β = 0.002, P < .05). The Δvasc variable (odds ratio [OR], 0.34), Black or Hispanic race/ethnicity (OR, 1.58), non-English-language preference (OR, 1.74), and site (OR, 0.22) were independent predictors of having one or more hierarchical condition category codes (P < .01 for all) in the combined patient cohort. CONCLUSIONS A CNN model was predictive of aortic atherosclerosis in two cohorts (one ambulatory and one hospitalized) with COVID-19. The discrepancy between the CNN model and the administrative code, Δvasc, was associated with language preference in the ambulatory cohort; in the hospitalized cohort, this discrepancy was associated with social deprivation index. The absence of administrative code(s) was associated with Δvasc in the combined cohorts, suggesting that Δvasc is an independent predictor of health disparities. This may suggest that biomarkers extracted from routine imaging studies and compared with electronic health record data could play a role in enhancing value-based health care for traditionally underserved or disadvantaged patients for whom barriers to care exist.
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Affiliation(s)
- Ayis Pyrros
- DuPage Medical Group, Department of Radiology,Corresponding author: Ayis Pyrros, MD, 40 S Clay Street, Hinsdale, IL 60521, 267-254-3556,
| | | | | | | | | | | | | | - Yury Velichko
- Northwestern Memorial Hospital, Northwestern University, Radiology
| | - Sanmi Koyejo
- University of Illinois at Urbana-Champaign, Department of Computer Science
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22
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García-Figueiras R, Baleato-González S. ¿Tiene futuro la ecografía en la radiología? RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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García-Figueiras R, Baleato-González S. Is there a future for ultrasound in radiology? RADIOLOGIA 2022; 64:74-75. [DOI: 10.1016/j.rxeng.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022]
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Kuhrij L, Marang-van de Mheen PJ. Adding value to the diagnostic process. BMJ Qual Saf 2021; 31:489-492. [PMID: 34862315 DOI: 10.1136/bmjqs-2021-014092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Laurien Kuhrij
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
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Emergency radiology training in Germany: current status and future directions. Radiologe 2021; 61:29-38. [PMID: 34850245 DOI: 10.1007/s00117-021-00939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Emergency radiology (ER) is an important part of radiology. But what exactly is ER? How can the required competencies be acquired in a good and feasible way? Who should be in charge of this? OBJECTIVES Discussion of ER contents and suggestions for the improvement of the acquisition of respective competencies during radiology training. MATERIALS AND METHODS General literature review, in particular the current German blueprint for medical specialist training regulations (Weiterbildungsordnung, WBO 2020), publications by the German Radiological Society (DRG), the European Society of Radiology (ESR), the European Society of Emergency Radiology (ESER) and the American Society of Emergency Radiology (ASER). RESULTS AND CONCLUSIONS As proof of competence in ER in Germany, confirmation from the authorised residency training supervisor as to whether there is 'competence to act' either 'independently' or 'under supervision' in the case of 'radiology in an emergency situation …, e.g. in the case of polytrauma, stroke, intensive care patients' is sufficient. The ESER refers to all acute emergencies with clinical constellations requiring an immediate diagnosis 24/7 and, if necessary, acute therapy. The ESER and ASER offer, among other things, practical fellowships in specialised institutions, while the ESER complements this with a European Diploma in Emergency Radiology (EDER). On a national level, it would be advisable to use existing definitions, offers and concepts, from the ESR, ESER and ASER. Specialised institutions could support the acquisition of ER competencies with fellowships. For Germany, it seems sensible to set up a separate working group (Arbeitsgemeinschaft, AG) on ER within the DRG in order to drive the corresponding further ER development.
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Sotomayor CG, Mendoza M, Castañeda V, Farías H, Molina G, Pereira G, Härtel S, Solar M, Araya M. Content-Based Medical Image Retrieval and Intelligent Interactive Visual Browser for Medical Education, Research and Care. Diagnostics (Basel) 2021; 11:diagnostics11081470. [PMID: 34441404 PMCID: PMC8392084 DOI: 10.3390/diagnostics11081470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 01/17/2023] Open
Abstract
Medical imaging is essential nowadays throughout medical education, research, and care. Accordingly, international efforts have been made to set large-scale image repositories for these purposes. Yet, to date, browsing of large-scale medical image repositories has been troublesome, time-consuming, and generally limited by text search engines. A paradigm shift, by means of a query-by-example search engine, would alleviate these constraints and beneficially impact several practical demands throughout the medical field. The current project aims to address this gap in medical imaging consumption by developing a content-based image retrieval (CBIR) system, which combines two image processing architectures based on deep learning. Furthermore, a first-of-its-kind intelligent visual browser was designed that interactively displays a set of imaging examinations with similar visual content on a similarity map, making it possible to search for and efficiently navigate through a large-scale medical imaging repository, even if it has been set with incomplete and curated metadata. Users may, likewise, provide text keywords, in which case the system performs a content- and metadata-based search. The system was fashioned with an anonymizer service and designed to be fully interoperable according to international standards, to stimulate its integration within electronic healthcare systems and its adoption for medical education, research and care. Professionals of the healthcare sector, by means of a self-administered questionnaire, underscored that this CBIR system and intelligent interactive visual browser would be highly useful for these purposes. Further studies are warranted to complete a comprehensive assessment of the performance of the system through case description and protocolized evaluations by medical imaging specialists.
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Affiliation(s)
- Camilo G. Sotomayor
- Radiology Department, Clinical Hospital University of Chile, University of Chile, Santiago 8380453, Chile; (C.G.S.); (G.P.)
- Center for Medical Informatics and Telemedicine, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (V.C.); (S.H.)
- Department of Electronic Engineering, Federico Santa Maria Technical University, Valparaíso 2340000, Chile
| | - Marcelo Mendoza
- Department of Informatics, Federico Santa Maria Technical University, Santiago 8380453, Chile; (M.M.); (H.F.); (G.M.); (M.S.)
| | - Víctor Castañeda
- Center for Medical Informatics and Telemedicine, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (V.C.); (S.H.)
- Department of Medical Technology, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Humberto Farías
- Department of Informatics, Federico Santa Maria Technical University, Santiago 8380453, Chile; (M.M.); (H.F.); (G.M.); (M.S.)
| | - Gabriel Molina
- Department of Informatics, Federico Santa Maria Technical University, Santiago 8380453, Chile; (M.M.); (H.F.); (G.M.); (M.S.)
| | - Gonzalo Pereira
- Radiology Department, Clinical Hospital University of Chile, University of Chile, Santiago 8380453, Chile; (C.G.S.); (G.P.)
| | - Steffen Härtel
- Center for Medical Informatics and Telemedicine, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (V.C.); (S.H.)
| | - Mauricio Solar
- Department of Informatics, Federico Santa Maria Technical University, Santiago 8380453, Chile; (M.M.); (H.F.); (G.M.); (M.S.)
| | - Mauricio Araya
- Department of Electronic Engineering, Federico Santa Maria Technical University, Valparaíso 2340000, Chile
- Correspondence:
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