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Chen MC, Ball RL, Yang L, Moradzadeh N, Chapman BE, Larson DB, Langlotz CP, Amrhein TJ, Lungren MP. Deep Learning to Classify Radiology Free-Text Reports. Radiology 2017; 286:845-852. [PMID: 29135365 DOI: 10.1148/radiol.2017171115] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate the performance of a deep learning convolutional neural network (CNN) model compared with a traditional natural language processing (NLP) model in extracting pulmonary embolism (PE) findings from thoracic computed tomography (CT) reports from two institutions. Materials and Methods Contrast material-enhanced CT examinations of the chest performed between January 1, 1998, and January 1, 2016, were selected. Annotations by two human radiologists were made for three categories: the presence, chronicity, and location of PE. Classification of performance of a CNN model with an unsupervised learning algorithm for obtaining vector representations of words was compared with the open-source application PeFinder. Sensitivity, specificity, accuracy, and F1 scores for both the CNN model and PeFinder in the internal and external validation sets were determined. Results The CNN model demonstrated an accuracy of 99% and an area under the curve value of 0.97. For internal validation report data, the CNN model had a statistically significant larger F1 score (0.938) than did PeFinder (0.867) when classifying findings as either PE positive or PE negative, but no significant difference in sensitivity, specificity, or accuracy was found. For external validation report data, no statistical difference between the performance of the CNN model and PeFinder was found. Conclusion A deep learning CNN model can classify radiology free-text reports with accuracy equivalent to or beyond that of an existing traditional NLP model. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Matthew C Chen
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - Robyn L Ball
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - Lingyao Yang
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - Nathaniel Moradzadeh
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - Brian E Chapman
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - David B Larson
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - Curtis P Langlotz
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - Timothy J Amrhein
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
| | - Matthew P Lungren
- From the Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 725 Welch Rd, Room 1675, Stanford, Calif 94305-5913 (M.C.C., N.M., D.B.L., C.P.L., M.P.L.); Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, Calif (R.L.B., L.Y.); Department of Bioinformatics, University of Utah Medical Center, Salt Lake City, Utah (B.E.C.); and Department of Radiology, Duke University Medical Center, Durham, NC (T.J.A.)
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Westermann RW, Schick C, Graves CM, Duchman KR, Weinstein SL. What Does a Shoulder MRI Cost the Consumer? Clin Orthop Relat Res 2017; 475:580-584. [PMID: 27896680 PMCID: PMC5289202 DOI: 10.1007/s11999-016-5181-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/16/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND More than 100 MRIs per 1000 inhabitants are performed in the United States annually, more than almost every other country. Little is known regarding the cost of obtaining an MRI and factors associated with differences in cost. QUESTIONS/PURPOSES By surveying all hospital-owned and independent imaging centers in Iowa, we wished to determine (1) the cost to the consumer of obtaining a noncontrast shoulder MRI, (2) the frequency and magnitude of discounts provided, and (3) factors associated with differences in cost including location (hospital-owned or independent) and Centers for Medicare & Medicaid Services designation (rural, urban, and critical access). METHODS There were 71 hospitals and 26 independent imaging centers that offered MRI services in Iowa. Each site was contacted via telephone and posed a scripted request for the cost of the technical component of a noncontrast shoulder MRI. Radiologists' reading fees were not considered. Statistical analysis was performed using standard methods and significance was defined as a probability less than 0.05. RESULTS The mean technical component cost to consumers for an MRI was USD 1874 ± USD 694 (range, USD 500-USD 4000). Discounts were offered by 49% of imaging centers, with a mean savings of 21%. Factors associated with increased cost include hospital-owned imaging centers (USD 2062 ± USD 664 versus USD 1400 ± USD 441 at independent imaging centers; p < 0.001; mean difference, USD 662; 95% CI, USD 351-USD 893) and rural imaging centers, unless designated as a critical access hospital (USD 2213 ± USD 668 versus USD 1794 ± USD 680; p = 0.0202; mean difference, USD 419; 95% CI, USD 66-USD 772). CONCLUSIONS In Iowa, the cost to the consumer of a shoulder MRI is significantly less at independent imaging centers compared with hospital-owned centers. Referring physicians and healthcare consumers should be aware that there may be substantial price discrepancies between centers that provide advanced imaging services. LEVEL OF EVIDENCE Level IV, Economic and decision analysis.
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Affiliation(s)
- Robert W. Westermann
- grid.214572.70000000419368294Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr., 01008 JPP, Iowa City, IA 52242 USA
| | - Cameron Schick
- grid.214572.70000000419368294Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr., 01008 JPP, Iowa City, IA 52242 USA
| | - Christopher M. Graves
- grid.214572.70000000419368294Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr., 01008 JPP, Iowa City, IA 52242 USA
| | - Kyle R. Duchman
- grid.214572.70000000419368294Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr., 01008 JPP, Iowa City, IA 52242 USA
| | - Stuart L. Weinstein
- grid.214572.70000000419368294Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr., 01008 JPP, Iowa City, IA 52242 USA
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Yi PH, Cross MB, Johnson SR, Rasinski KA, Nunley RM, Della Valle CJ. Patient Attitudes Toward Orthopedic Surgeon Ownership of Related Ancillary Businesses. J Arthroplasty 2016; 31:1635-1640.e4. [PMID: 26897493 DOI: 10.1016/j.arth.2016.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Physician ownership of businesses related to orthopedic surgery, such as surgery centers, has been criticized as potentially leading to misuse of health care resources. The purpose of this study was to determine patients' attitudes toward surgeon ownership of orthopedic-related businesses. METHODS We surveyed 280 consecutive patients at 2 centers regarding their attitudes toward surgeon ownership of orthopedic-related businesses using an anonymous questionnaire. Three surgeon ownership scenarios were presented: (1) owning a surgery center, (2) physical therapy (PT), and (3) imaging facilities (eg, Magnetic Resonance Imaging scanner). RESULTS Two hundred fourteen patients (76%) completed the questionnaire. The majority agreed that it is ethical for a surgeon to own a surgery center (73%), PT practice (77%), or imaging facility (77%). Most (>67%) indicated that their surgeon owning such a business would have no effect on the trust they have in their surgeon. Although >70% agreed that a surgeon in all 3 scenarios would make the same treatment decisions, many agreed that such surgeons might perform more surgery (47%), refer more patients to PT (61%), or order more imaging (58%). Patients favored surgeon autonomy, however, believing that surgeons should be allowed to own such businesses (78%). Eighty-five percent agreed that patients should be informed if their surgeon owns an orthopedic-related business. CONCLUSION Although patients express concern over and desire disclosure of surgeon ownership of orthopedic-related businesses, the majority believes that it is an ethical practice and feel comfortable receiving care at such a facility.
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Affiliation(s)
- Paul H Yi
- University of California, San Francisco, San Francisco, California
| | | | | | | | - Ryan M Nunley
- Washington University in St. Louis, St. Louis, Missouri
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Amrhein TJ, Paxton BE, Lungren MP, Befera NT, Collins HR, Yurko C, Eastwood JD, Kilani RK. Physician self-referral and imaging use appropriateness: negative cervical spine MRI frequency as an assessment metric. AJNR Am J Neuroradiol 2014; 35:2248-53. [PMID: 25104287 DOI: 10.3174/ajnr.a4076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging self-referral is increasingly cited as a contributor to diagnostic imaging overuse. The purpose of this study was to determine whether ownership of MR imaging equipment by ordering physicians influences the frequency of negative cervical spine MR imaging findings. MATERIALS AND METHODS A retrospective review was performed of 500 consecutive cervical spine MRIs ordered by 2 separate referring-physician groups serving the same geographic community. The first group owned the scanners used and received technical fees for their use, while the second group did not. Final reports were reviewed, and for each group, the percentage of negative study findings and the frequency of abnormalities were calculated. The number of concomitant shoulder MRIs was recorded. RESULTS Five hundred MRIs meeting inclusion criteria were reviewed (250 with financial interest, 250 with no financial interest). Three hundred fifty-two had negative findings (190 with financial interest, 162 with no financial interest); there were 17.3% more scans with negative findings in the financial interest group (P = .006). Among scans with positive findings, there was no significant difference in the mean number of lesions per scan, controlled for age (1.90 with financial interest, 2.19 with no financial interest; P = .23). Patients in the financial interest group were more likely to undergo concomitant shoulder MR imaging (24 with financial interest, 11 with no financial interest; P = .02). CONCLUSIONS Cervical spine MRIs referred by physicians with a financial interest in the imaging equipment used were significantly more likely to have negative findings. There was otherwise a highly similar distribution and severity of disease between the 2 patient samples. Patients in the financial interest group were more likely to undergo concomitant shoulder MR imaging.
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Affiliation(s)
- T J Amrhein
- From the Department of Radiology (T.J.A., B.E.P., N.T.B., C.Y., J.D.E., R.K.K.), Duke University Medical Center, Durham, North Carolina
| | - B E Paxton
- From the Department of Radiology (T.J.A., B.E.P., N.T.B., C.Y., J.D.E., R.K.K.), Duke University Medical Center, Durham, North Carolina
| | - M P Lungren
- Department of Radiology (M.P.L.), Stanford University School of Medicine, Stanford, California
| | - N T Befera
- From the Department of Radiology (T.J.A., B.E.P., N.T.B., C.Y., J.D.E., R.K.K.), Duke University Medical Center, Durham, North Carolina
| | - H R Collins
- Center for Biomedical Imaging (H.R.C.), Medical University of South Carolina, Charleston, South Carolina
| | - C Yurko
- From the Department of Radiology (T.J.A., B.E.P., N.T.B., C.Y., J.D.E., R.K.K.), Duke University Medical Center, Durham, North Carolina
| | - J D Eastwood
- From the Department of Radiology (T.J.A., B.E.P., N.T.B., C.Y., J.D.E., R.K.K.), Duke University Medical Center, Durham, North Carolina
| | - R K Kilani
- From the Department of Radiology (T.J.A., B.E.P., N.T.B., C.Y., J.D.E., R.K.K.), Duke University Medical Center, Durham, North Carolina
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