1
|
Gouel P, Callonnec F, Levêque É, Valet C, Blôt A, Cuvelier C, Saï S, Saunier L, Pepin LF, Hapdey S, Libraire J, Vera P, Viard B. Evaluation of the capability and reproducibility of RECIST 1.1. measurements by technologists in breast cancer follow-up: a pilot study. Sci Rep 2023; 13:9148. [PMID: 37277412 DOI: 10.1038/s41598-023-36315-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
The evaluation of tumor follow-up according to RECIST 1.1 has become essential in clinical practice given its role in therapeutic decision making. At the same time, radiologists are facing an increase in activity while facing a shortage. Radiographic technologists could contribute to the follow-up of these measures, but no studies have evaluated their ability to perform them. Ninety breast cancer patients were performed three CT follow-ups between September 2017 and August 2021. 270 follow-up treatment CT scans were analyzed including 445 target lesions. The rate of agreement of classifications RECIST 1.1 between five technologists and radiologists yielded moderate (k value between 0.47 and 0.52) and substantial (k value = 0.62 and k = 0.67) agreement values. 112 CT were classified as progressive disease (PD) by the radiologists, and 414 new lesions were identified. The analysis showed a percentage of strict agreement of progressive disease classification between reader-technologists and radiologists ranging from substantial to almost perfect agreement (range 73-97%). Analysis of intra-observer agreement was strong at almost perfect (k > 0.78) for 3 technologists. These results are encouraging regarding the ability of selected technologists to perform measurements according to RECIST 1.1 criteria by CT scan with good identification of disease progression.
Collapse
Affiliation(s)
- Pierrick Gouel
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France.
- QuantIF-LITIS EA4108, University of Rouen, Rouen, Normandy, France.
| | - Françoise Callonnec
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Émilie Levêque
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Céline Valet
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Axelle Blôt
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Clémence Cuvelier
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Sonia Saï
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Lucie Saunier
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Louis-Ferdinand Pepin
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Sébastien Hapdey
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, Normandy, France
| | - Julie Libraire
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Pierre Vera
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, Normandy, France
| | - Benjamin Viard
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| |
Collapse
|
2
|
Hetenyi S, Goelz L, Boehmcker A, Schorlemmer C. Quality Assurance of a Cross-Border and Sub-Specialized Teleradiology Service. Healthcare (Basel) 2022; 10:healthcare10061001. [PMID: 35742052 PMCID: PMC9223114 DOI: 10.3390/healthcare10061001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 02/06/2023] Open
Abstract
Background: The current literature discusses aspects of quality assurance (QA) and sub-specialization. However, the challenges of these topics in a teleradiology network have been less explored. In a project report, we aimed to review the development and enforcement of sub-specialized radiology at Telemedicine Clinic (TMC), one of the largest teleradiology providers in Europe, and to describe each step of its QA. Evaluation: The company-specific background was provided by the co-authors—current and former staff members of TMC. Detailed descriptions of the structures of sub-specialization and QA at TMC are provided. Exemplary quantitative evaluation of caseloads and disagreement rates of secondary reviews are illustrated. Description of Sub-specialization and Quality Assurance at TMC: Sub-specialization at TMC is divided into musculoskeletal radiology, neuroradiology, head and neck, a body, and an emergency section operating at local daytime in Europe and Australia. Quality assurance is based on a strict selection process of radiologists, specific reporting guidelines, feedback through the secondary reading of 100% of all radiology reports for new starters, and a minimum of 5% of radiology reports on a continuous basis for all other radiologists, knowledge sharing activities and ongoing training. The level of sub-specialization of each radiologist is monitored continuously on an individual basis in detail. After prospective secondary readings, the mean disagreement rate at TMC indicating at least possibly clinically relevant findings was 4% in 2021. Conclusion: With continuing and current developments in radiology in mind, the essential features of sub-specialization and innovative QA are relevant for further expansion of teleradiology services and for most radiology departments worldwide to respond to the increasing demand for value-based radiology.
Collapse
Affiliation(s)
- Szabolcs Hetenyi
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
| | - Leonie Goelz
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-30-56813829
| | - Alexander Boehmcker
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
- AIDOC Medical, Aminadav St. 3, Tel Aviv-Yafo 6706703, Israel
| | - Carlos Schorlemmer
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
| |
Collapse
|
3
|
Levy F, Rosen MP. How Radiologists Are Paid: An Economic History, Part III: The Bubble Years. J Am Coll Radiol 2020; 17:984-989. [DOI: 10.1016/j.jacr.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
|
4
|
Herr KD, Hanna TN, Restauri N. Cultivating Physician Character in Diagnostic Radiology Through Virtuous Caring and Collaborative Professionalism. Acad Radiol 2018; 25:1497-1502. [PMID: 29805063 DOI: 10.1016/j.acra.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 10/16/2022]
Abstract
In the contemporary environment of patient- and value-centered care, it is no longer sufficient to limit the definition of an "excellent radiologist" to someone who is skilled at image interpretation. Since diagnostic radiologists are physicians, they are held to a certain character standard expected of a physician, whose primary objective is to serve the best interest of patients. An "excellent radiologist," then, is better defined as one who is both skilled at interpreting medical imaging and embodies the attributes of physician character. The concept of physician character can be understood as the interplay between the practice of the care-related virtues, such as empathy, compassion, and kindness, and cooperative efforts with nonradiologist health care team members, termed collaborative professionalism. The very nature of the work of diagnostic radiology, aided by advances in technology, increasingly isolates the radiologist from both patients and other care providers, making it difficult to find opportunities for virtuous care and collaborative professionalism. Using the moral intuitionist model of character development as a conceptual framework, we first delineate the challenges that diagnostic radiologists face in demonstrating virtuous caring and collaborative professionalism. Then, we explore strategies that diagnostic radiologists can employ to overcome these barriers, thereby cultivating their own physician character and setting an example for other radiologists, medical students, and trainees. Finally, we will examine some of the limitations of applying this theoretical model to the real world.
Collapse
|
5
|
Moriarity AK, Brown ML, Schultz LR. Work and retirement preferences of practicing radiologists as a predictor of workforce needs. Acad Radiol 2014; 21:1067-71. [PMID: 25018078 DOI: 10.1016/j.acra.2014.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES The radiology job market has been described as highly variable, and recent practice hiring surveys predict that the number of available jobs will remain flat. Radiologists may be working more hours and retiring later than desired, activities that influence overall job availability. A national survey was performed to determine the desired work rate and retirement preferences of practicing radiologists, and the responses are used to estimate current and potential future work output and future workforce needs. MATERIALS AND METHODS Practicing radiologists were surveyed regarding current and preferred work level and desired and expected retirement age. A model incorporating these preferences and stratified by age was developed using survey responses and American Medical Association full-time equivalent (FTE) estimates. Available FTE radiologists are estimated under four scenarios from 2016 to 2031 in 5-year intervals. RESULTS The model predicts a total of 26,362 FTE radiologists available in 2011, which corresponds to previous estimates. Participants reported working more hours and expecting to retire later than desired, with younger radiologists and women reporting the greatest desired decrease in FTE hours worked. Under each scenario, there is an initial FTE availability in 2016 ranging from 21,156 to 24,537, which increases to between 27,753 and 31,435 FTE by 2031 depending on work rate and retirement patterns. CONCLUSIONS Practicing radiologists report that they currently work more hours than desired and expect to retire later than they would prefer. If radiologists changed current personal work rate and expected retirement age to meet these preferences, there would be an immediate shortage of FTE radiologists continuing until at least 2020 assuming no other workforce needs changes.
Collapse
Affiliation(s)
- Andrew K Moriarity
- Department of Diagnostic Radiology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202.
| | - Manuel L Brown
- Department of Diagnostic Radiology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202
| | - Lonni R Schultz
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI
| |
Collapse
|
6
|
Buddeberg-Fischer B, Hoffmann A, Christen S, Weishaupt D, Kubik-Huch R. Specialising in radiology in Switzerland: Still attractive for medical school graduates? Eur J Radiol 2012; 81:1644-51. [DOI: 10.1016/j.ejrad.2011.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/02/2011] [Indexed: 11/25/2022]
|
7
|
Benjamin M, Aradi Y, Shreiber R. From shared data to sharing workflow: merging PACS and teleradiology. Eur J Radiol 2009; 73:3-9. [PMID: 19914789 DOI: 10.1016/j.ejrad.2009.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/07/2009] [Indexed: 11/16/2022]
Abstract
Due to a host of technological, interface, operational and workflow limitations, teleradiology and PACS/RIS were historically developed as separate systems serving different purposes. PACS/RIS handled local radiology storage and workflow management while teleradiology addressed remote access to images. Today advanced PACS/RIS support complete site radiology workflow for attending physicians, whether on-site or remote. In parallel, teleradiology has emerged into a service of providing remote, off-hours, coverage for emergency radiology and to a lesser extent subspecialty reading to subscribing sites and radiology groups. When attending radiologists use teleradiology for remote access to a site, they may share all relevant patient data and participate in the site's workflow like their on-site peers. The operation gets cumbersome and time consuming when these radiologists serve multi-sites, each requiring a different remote access, or when the sites do not employ the same PACS/RIS/Reporting Systems and do not share the same ownership. The least efficient operation is of teleradiology companies engaged in reading for multiple facilities. As these services typically employ non-local radiologists, they are allowed to share some of the available patient data necessary to provide an emergency report but, by enlarge, they do not share the workflow of the sites they serve. Radiology stakeholders usually prefer to have their own radiologists perform all radiology tasks including interpretation of off-hour examinations. It is possible with current technology to create a system that combines the benefits of local radiology services to multiple sites with the advantages offered by adding subspecialty and off-hours emergency services through teleradiology. Such a system increases efficiency for the radiology groups by enabling all users, regardless of location, to work "local" and fully participate in the workflow of every site. We refer to such a system as SuperPACS.
Collapse
|
8
|
Bhargavan M, Kaye AH, Forman HP, Sunshine JH. Workload of Radiologists in United States in 2006–2007 and Trends Since 1991–1992. Radiology 2009; 252:458-67. [PMID: 19508987 DOI: 10.1148/radiol.2522081895] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mythreyi Bhargavan
- Research Department, American College of Radiology, 1891 Preston White Dr, Reston, VA 20191, USA.
| | | | | | | |
Collapse
|
9
|
Vannier MW. Medical imaging workstations: what is missing and what is coming? Arch Pathol Lab Med 2009; 133:542-6. [PMID: 19391647 DOI: 10.5858/133.4.542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2008] [Indexed: 11/06/2022]
Affiliation(s)
- Michael W Vannier
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
| |
Collapse
|
10
|
Weiss DL, Langlotz CP. Structured Reporting: Patient Care Enhancement or Productivity Nightmare? Radiology 2008; 249:739-47. [DOI: 10.1148/radiol.2493080988] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Kennedy S, Forman HP, Kaye AH, Bhargavan M, Sunshine JH. The reasons that many radiology practices don't use off-hours services. J Am Coll Radiol 2008; 5:887-92. [PMID: 18657784 DOI: 10.1016/j.jacr.2008.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare radiology practices that use external, internal, and no off-hours services. METHODS From August 2005 to June 2006, 300 nonspecialty hospitals randomly selected from the AHA Guide 2005 Edition were contacted by telephone, e-mail, and mail, with attempts made to speak to the chiefs of radiology. A total of 115 responses were obtained (a 38.3% response rate), with 64 from radiology practices that used external off-hours services, 13 from practices with internal services, and 38 from practices with no services. The demographics of the practices in the 3 categories were compared, and answers to category-specific survey questions were tabulated. Responses were analyzed using descriptive statistics. RESULTS Radiology practices using internal off-hours services were significantly larger (mean size, 19.9 full-time radiologists) than those using external off-hours services (mean size, 8.2 full-time radiologists) and those not using any off-hours service (mean size, 10.7 full-time radiologists). A sufficient number of radiologists or residents covering nights had the highest reported importance in the decision not to adopt an external service. Cost and quality concerns were also cited. The consistency of interpreting radiologists known to a practice had the highest importance in the decision to use an internal rather than an external off-hours service. Frequent reasons cited for radiologists to take regular internal off-hours employment were financial incentives provided and a preference for off-hours shifts. CONCLUSIONS As long as there are sufficient numbers of radiologists and residents to handle the volume of interpretations, many practices will not use external off-hours services. Such services could help increase their adoption by offering lower cost and proven quality.
Collapse
Affiliation(s)
- Scott Kennedy
- Yale University School of Medicine, New Haven, CT 06510, USA.
| | | | | | | | | |
Collapse
|
12
|
Rumack CM. How Can Academic Radiology Departments Manage the Risks to Education When Outsourcing Radiology? An Educator's Opinion. J Am Coll Radiol 2008; 5:786-90. [DOI: 10.1016/j.jacr.2008.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Indexed: 11/28/2022]
|
13
|
Is There Sufficient MDCT Capacity to Provide Colorectal Cancer Screening with CT Colonography for the U.S. Population? AJR Am J Roentgenol 2008; 190:1044-9. [DOI: 10.2214/ajr.07.3103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
14
|
Taylor GA. Quo vadis? Trends in demographics and pediatric care and their impact on the specialty of pediatric radiology. Pediatr Radiol 2007; 37:870-5. [PMID: 17602217 DOI: 10.1007/s00247-007-0534-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 05/02/2007] [Accepted: 05/15/2007] [Indexed: 11/27/2022]
Affiliation(s)
- George A Taylor
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA.
| |
Collapse
|
15
|
|
16
|
Levin DC, Rao VM. Turf Wars in Radiology: Challenges Leveled at Our Specialty and How to Respond to Them. J Am Coll Radiol 2007; 4:492-3. [PMID: 17601592 DOI: 10.1016/j.jacr.2007.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Indexed: 10/23/2022]
Abstract
When turf wars related to the practice of imaging erupt, they often take the form of debates between radiologists at a given hospital and others in their medical community. During these debates, others will often level challenges or accusations at radiologists. In this article, the authors present some of the more commonly heard challenges and their views on how to respond to these challenges.
Collapse
Affiliation(s)
- David C Levin
- Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Penn 19107, USA.
| | | |
Collapse
|
17
|
|
18
|
Forman HP. The Radiology Job Market: Help Wanted. AJR Am J Roentgenol 2006; 187:1147-8. [PMID: 17056896 DOI: 10.2214/ajr.06.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Howard P Forman
- Diagnostic Radiology, Yale University, 333 Cedar St., New Haven, CT 06510-3206, USA.
| |
Collapse
|