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Costa DN, Nguyen N, Garant A, Meng X, Courtney KD, Shah RB, Pedrosa I. The role of the radiologist in the prostate cancer multidisciplinary conference. Abdom Radiol (NY) 2024:10.1007/s00261-024-04433-2. [PMID: 38951230 DOI: 10.1007/s00261-024-04433-2] [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: 03/01/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
The broad range of disease aggressiveness together with imperfect screening, diagnostic, and treatment options in prostate cancer (PCa) makes medical decision-making complex. The primary goal of a multidisciplinary conference is to improve patient outcomes by combining evidence-based data and expert opinion to discuss optimal management, including for those patients with challenging presentations. The primary purpose of the genitourinary imaging specialist in the prostate cancer multidisciplinary conference is to use imaging findings to reduce uncertainty by answering clinical questions. In this review, we discuss the role and the opportunities for an imaging specialist to add value in the care of men with prostate cancer discussed at multidisciplinary conferences.
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Affiliation(s)
- Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Nghi Nguyen
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aurelie Garant
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kevin D Courtney
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rajal B Shah
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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2
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Dijk SW, Kroencke T, Wollny C, Barkhausen J, Jansen O, Halfmann MC, Rizopoulos D, Hunink MGM. Medical Imaging Decision And Support (MIDAS): Study protocol for a multi-centre cluster randomized trial evaluating the ESR iGuide. Contemp Clin Trials 2023; 135:107384. [PMID: 37949165 DOI: 10.1016/j.cct.2023.107384] [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: 07/03/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Medical imaging plays an essential role in healthcare. As a diagnostic test, imaging is prone to substantial overuse and potential overdiagnosis, with dire consequences to patient outcomes and health care costs. Clinical decision support systems (CDSSs) were developed to guide referring physicians in making appropriate imaging decisions. This study will evaluate the effect of implementing a CDSS (ESR iGuide) with versus without active decision support in a physician order entry on the appropriate use of imaging tests and ordering behaviour. METHODS A protocol for a multi-center cluster-randomized trial with departments acting as clusters, combined with a before-after-revert design. Four university hospitals with eight participating departments each for a total of thirty-two clusters will be included in the study. All departments start in control condition with structured data entry of the clinical indication and tracking of the imaging exams requested. Initially, the CDSS is implemented and all physicians remain blinded to appropriateness scores based on the ESR imaging referral guidelines. After randomization, half of the clusters switch to the active intervention of decision support. Physicians in the active condition are made aware of the categorization of their requests as appropriate, under certain conditions appropriate, or inappropriate, and appropriate exams are suggested. Physicians may change their requests in response to feedback. In the revert condition, active decision support is removed to study the educational effect. RESULTS/CONCLUSIONS The main outcome is the proportion of inappropriate diagnostic imaging exams requested per cluster. Secondary outcomes are the absolute number of imaging exams, radiation from diagnostic imaging, and medical costs. TRIAL REGISTRATION NUMBER Approval from the Medical Ethics Review Committee was obtained under protocol numbers 20-069 (Augsburg), B 238/21 (Kiel), 20-318 (Lübeck) and 2020-15,125 (Mainz). The trial is registered in the ClinicalTrials.gov register under registration number NCT05490290.
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Affiliation(s)
- Stijntje W Dijk
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Thomas Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Claudia Wollny
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Joerg Barkhausen
- Department of Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M G Myriam Hunink
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States of America.
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3
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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [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: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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Hegde S, Larsen E, Torbett O, Ponnala S, Pohl E, Sze R, Schaeubinger MM. A proactive learning approach toward building adaptive capacity during COVID-19: A radiology case study. APPLIED ERGONOMICS 2023; 110:104009. [PMID: 36905728 PMCID: PMC9986132 DOI: 10.1016/j.apergo.2023.104009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has challenged organizations to adapt under uncertainty and time pressure, with no pre-existing protocols or guidelines available. For organizations to learn to adapt effectively, there is a need to understand the perspectives of the frontline workforce involved in everyday operations. This study implemented a survey-tool to elicit narratives of successful adaptation based on the lived experiences frontline radiology staff at a large multispecialty pediatric hospital. Fifty-eight members of the radiology frontline staff responded to the tool between July and October of 2020. Qualitative analysis of the free-text data revealed five categories of themes that underpinned adaptive capacity of the radiology department during the pandemic: information flow, attitudes and initiative, new and adjusted workflows, availability and utilization of resources, and collaboration and teamwork. Enablers of adaptive capacity included timely and clear communication about procedures and policies from the leadership to frontline staff, and revised workflows with flexible work arrangements, such as remote patient screening. Responses to multiple choice questions in the tool helped identify the main categories of challenges faced by staff, factors that enabled successful adaptation, and resources used. The study demonstrates the use of a survey-tool to proactively identify frontline adaptations. The paper also reports a system-wide intervention resulting directly from a discovery enabled by the findings based on the use of RETIPS in the radiology department. In general, the tool could be used in concert with existing learning mechanisms, such as safety event reporting systems, to inform leadership-level decisions to support adaptive capacity.
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Affiliation(s)
| | | | | | | | - Erin Pohl
- Children's Hospital of Philadelphia, USA
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5
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Aipanda CN, Karera A, Kalondo L, Amkongo M. Radiation risk-benefit communication during paediatric CT imaging: Experiences of radiographers at two public hospitals. Radiography (Lond) 2023; 29:301-306. [PMID: 36680869 DOI: 10.1016/j.radi.2023.01.006] [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: 12/03/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Radiation dose knowledge and effective communication skills are essential for both radiographers and radiologists to be able to appropriately fulfil their legal responsibilities to justify each medical exposure. Furthermore, they enable the optimisation of imaging protocols and techniques according to the child's characteristics and underlying clinical conditions. Previous studies have shown that radiographers do not provide paediatric patients and their parents/guardians with adequate information about doses and risks before a procedure. However, they have a legal responsibility to explain the radiation risk associated with performing the procedure as well as the associated risk of not performing the same procedure. There are several obstacles to describing ionizing radiation risk, including the ionizing radiation language that is not readily understood by non-imaging personnel. This study aimed to explore and describe the radiographers' experiences of radiation risk-benefit communication during paediatric CT imaging at two public hospitals. This is important to understand the effectiveness of the communication process and institute corrective action where shortcomings are evident. METHODS A qualitative, exploratory, descriptive research design was applied. The sample consisted of 12 purposively selected radiographers who were trained and working in the CT imaging department. Data were collected using face-to-face individual interviews. Tesch's 8 steps were used to analyse the data collected and generate themes and subthemes. RESULTS Two themes emerged from the data collected: (1)Positive experiences with two sub-themes (job satisfaction and mutual benefit) and (2) negative experiences with three sub-themes (.professional deprecation, ineffectual outcomes and communication impediments). CONCLUSION Positive experiences boosted radiographers' confidence and enhanced their participation in radiation risk-benefit communication with paediatric patients' parents and guardians while negative experiences hindered patient-centred care in the process of risk-benefit communication. IMPLICATIONS FOR PRACTICE Continuous education of radiographers and doctors on radiation risk-benefit communication before paediatric CT procedures is recommended, in line with their scope of practice, to improve patient-centred care.
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Affiliation(s)
- C N Aipanda
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, P.O Box 13301, Windhoek, Namibia.
| | - A Karera
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, P.O Box 13301, Windhoek, Namibia.
| | - L Kalondo
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, P.O Box 13301, Windhoek, Namibia.
| | - M Amkongo
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, P.O Box 13301, Windhoek, Namibia.
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Brady AP, Uberoi R, Lee MJ, Müller-Hülsbeck S, Adam A. Leadership in Interventional Radiology - Fostering a Culture of Excellence. Can Assoc Radiol J 2023; 74:185-191. [PMID: 35471189 DOI: 10.1177/08465371221089249] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This invited article reviews the current status of Interventional Radiology (IR), in terms of its status as a speciality, and outlines the conditions needed for IR to function optimally within healthcare settings. Guidance is offered in terms of developing an IR department, ensuring high-quality practice, dealing with administrative and political challenges, dealing with industry and creating a legacy.
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Affiliation(s)
- Adrian P Brady
- 36860Mercy University Hospital and University College Cork, Cork, Ireland
| | - Raman Uberoi
- 6397Oxford University Hospitals Trust, Oxford, UK
| | - Michael J Lee
- 57978Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Andreas Adam
- Professor Emeritus of Interventional Radiology, 405987King's College London, London, UK
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Phelan A, Broughan J, McCombe G, Collins C, Fawsitt R, O’Callaghan M, Quinlan D, Stanley F, Cullen W. Impact of enhancing GP access to diagnostic imaging: A scoping review. PLoS One 2023; 18:e0281461. [PMID: 36897853 PMCID: PMC10004541 DOI: 10.1371/journal.pone.0281461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care. METHODS A search was conducted of 'PubMed', 'Cochrane Library', 'Embase' and 'Google Scholar' for papers published between 2012-2022 using Arksey and O'Malley's scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR). RESULTS Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process. CONCLUSION Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.
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Affiliation(s)
- Amy Phelan
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John Broughan
- Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Claire Collins
- Research, Policy and Information, Irish College of General Practitioners, Dublin, Ireland
| | - Ronan Fawsitt
- General Practice, Castle Gardens Medical Centre, Kilkenny, Ireland
- Primary Care Advisor, Ireland East Hospital Group, Dublin, Ireland
| | - Mike O’Callaghan
- Irish College of General Practitioners, ICGP, Dublin, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Fintan Stanley
- Irish College of General Practitioners, ICGP, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
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Omofoye TS. Radiology Education as a Global Health Service Vehicle. Radiol Imaging Cancer 2022; 4:e220156. [PMID: 36399040 PMCID: PMC9713591 DOI: 10.1148/rycan.220156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Akkihal K, Adams EC, Khan S, Jafri F, Taboada J, Varkey T. Evidence-based imaging for the management of lower back pain in the emergency department: A narrative review. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients often present to the emergency department with nonspecific complaints of lumbar back pain. Because of the nature of the emergency department, the lack of knowledge or time on the part of providers, and the high levels of quick decision making, unnecessary imaging studies are often ordered to provide care for the patient’s emotional and perceived physical needs. This narrative review will present a hypothetical typical standardized case of a patient presenting with lower back pain, examine the current evidence and recommendations from the major ruling bodies in internal medicine, neurology, neurosurgery, and radiology, evaluate the major statements released by the Choosing Wisely campaign, and finally, present a new diagnostic decision tree for the management of lumbar back pain.
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Brady AP. Radiology's Contribution to Individual Healthcare and to Society - a Shift from Volume to Value. Can Assoc Radiol J 2022; 73:616-617. [PMID: 35442109 DOI: 10.1177/08465371221093276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Siu VJ, Varkey T, Khan UN, Ding JB, Gandhi S. Lend Me a Hand: A Value-Based Care Case Study on Pan Plexopathy of Unknown Origin. Cureus 2021; 13:e20354. [PMID: 35036194 PMCID: PMC8752405 DOI: 10.7759/cureus.20354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/26/2022] Open
Abstract
This paper discusses an interesting case of pan plexopathy and the difficulties associated with the diagnostic processes based on patient-specific circumstances. It walks through the major differential of the etiology of the patient’s particular presenting symptoms and the associated diagnostic and therapeutic process by which this particular patient was treated. In the discussion, the relevant anatomy of the brachial plexus and the surrounding structures in both the cervical and the axillary regions is discussed and key clinical pearls that became apparent throughout the diagnostic workup that was significant for a hematoma and therapeutic process aimed at providing symptomatic relief until recovery to baseline. This case study discusses the benefits, drawbacks, and financial costs of utilizing the major different imaging modalities such as CT, MRI, or Point of Care Ultrasound (POCUS). Finally, this study provides a new diagnostic algorithm for the selection of the imaging modality based on the major principles of value-based care as detailed by both the Radiological Society of North America and the European Society of Radiology.
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