Daytime, evening, and overnight: the 24-h radiology cycle and impact on interpretative accuracy

PURPOSE

To assess the influence of time of day when a study is interpreted on discrepancy rates for common and advanced studies performed in the acute community setting.

METHODS

This retrospective study used the databank of a U.S. teleradiology company to retrieve studies between 2012 and 2016 with a preliminary report followed by a final report by the on-site client hospital. Neuroradiology, abdominal radiology, and musculoskeletal radiology studies were included. Teleradiologists were fellowship trained in one of these subspecialty areas. Daytime, evening, and overnight times were defined. Associations between major and minor discrepancies, time of day, and whether the study was common or advanced were tested with significance set at p = .05.

RESULTS

A total of 5,883,980 studies were analyzed. There were 8444 major discrepancies (0.14%) and 17,208 minor discrepancies (0.29%). For common studies, daytime (0.13%) and evening (0.13%) had lower major discrepancy rates compared to overnight (0.14%) (daytime to overnight, RR = 0.57, 95%CI: 0.45, 0.72, p < 0.01 and evening to overnight, RR = 0.57, 95%CI: 0.49,0.67, p < 0.01). Minor discrepancy rates for common studies were decreased for evening (0.29%) compared to overnight (0.30%) (RR = 0.89, 95%CI: 0.80,0.99, p = 0.029). For advanced studies, daytime (.15%) had lower major discrepancy rates compared to evening (0.20%) and overnight (.23%) (daytime to evening, RR = 0.77, 95%CI: 0.61, 0.97, p = 0.028 and daytime to overnight, RR = 0.66, 95%CI: 0.50, 0.87, p ≤ 0.01).

CONCLUSION

Significantly higher major discrepancy rates for studies interpreted overnight suggest the need for radiologists to exercise greater caution when interpreting studies overnight and may require practice management strategies to help optimize overnight work conditions. The lower major discrepancy rates on advanced studies interpreted during the daytime suggest the need for reserving advanced studies for interpretation during the day when possible.

ACR Appropriateness Criteria® Headache: 2022 Update

Headache is an ancient problem plaguing a large proportion of the population. At present, headache disorders rank third among the global causes of disability, accounting for over $78 billion per year in direct and indirect costs in the United States. Given the prevalence of headache and the wide range of possible etiologies, the goal of this document is to help clarify the most appropriate initial imaging guidelines for headache for eight clinical scenarios/variants, which range from acute onset, life-threatening etiologies to chronic benign scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Starting an Emergency Radiology Division: Scheduling and Staffing, Compensation, and Equity and Parity

Establishing an emergency radiology division in a practice that has long-standing patterns of operational routines comes with both challenges and opportunities. In this article, considerations around scheduling and staffing, compensation, and equity and parity are provided with supporting literature references. Furthermore, a panel of experts having established, grown and managed emergency radiology divisions in North America and Europe share their experiences through a question and answer format.

Multireader evaluation of radiologist performance for COVID-19 detection on emergency department chest radiographs

BACKGROUND

Chest radiographs (CXR) are frequently used as a screening tool for patients with suspected COVID-19 infection pending reverse transcriptase polymerase chain reaction (RT-PCR) results, despite recommendations against this. We evaluated radiologist performance for COVID-19 diagnosis on CXR at the time of patient presentation in the Emergency Department (ED).

MATERIALS AND METHODS

We extracted RT-PCR results, clinical history, and CXRs of all patients from a single institution between March and June 2020. 984 RT-PCR positive and 1043 RT-PCR negative radiographs were reviewed by 10 emergency radiologists from 4 academic centers. 100 cases were read by all radiologists and 1927 cases by 2 radiologists. Each radiologist chose the single best label per case: Normal, COVID-19, Other - Infectious, Other - Noninfectious, Non-diagnostic, and Endotracheal Tube. Cases labeled with endotracheal tube (246) or non-diagnostic (54) were excluded. Remaining cases were analyzed for label distribution, clinical history, and inter-reader agreement.

RESULTS

1727 radiographs (732 RT-PCR positive, 995 RT-PCR negative) were included from 1594 patients (51.2% male, 48.8% female, age 59 ± 19 years). For 89 cases read by all readers, there was poor agreement for RT-PCR positive (Fleiss Score 0.36) and negative (Fleiss Score 0.46) exams. Agreement between two readers on 1638 cases was 54.2% (373/688) for RT-PCR positive cases and 71.4% (679/950) for negative cases. Agreement was highest for RT-PCR negative cases labeled as Normal (50.4%, n = 479). Reader performance did not improve with clinical history or time between CXR and RT-PCR result.

CONCLUSION

At the time of presentation to the emergency department, emergency radiologist performance is non-specific for diagnosing COVID-19.

Isotropic CT examination of abdomen and pelvis diagnostic quality of reformat

RATIONALE AND OBJECTIVES

To evaluate the image quality of axial and coronal reformats obtained from isotropic resolution abdomino-pelvic computed tomography (CT) examinations.

MATERIALS AND METHODS

Thirty consecutive patients with intravenous contrast-enhanced abdomino-pelvic CT examinations (Brilliance 40, Philips Medical Systems, Cleveland, OH) were enrolled for the study. The raw data were reconstructed into two sets of source axial images: 0.9-mm slice widths with 0.45-mm reconstruction interval (isotropic resolution) and 4-mm slice widths with 3-mm reconstruction interval (anisotropic resolution: group A). Isotropic data set was reformatted into axial and coronal stacks (groups B and C, respectively) with 4-mm slice width and 3-mm interval. Three independent readers evaluated stacks A to C using a 3-point scale for resolution of hepatic vessels, edge sharpness of kidneys, respiratory motion artifact, reconstruction artifact, noise, and overall image quality.

RESULTS

There was no statistical difference among the groups A to C for vessel resolution, motion artifact, noise, and overall quality. The scores given to group C were significantly lower than those to groups A and B for reconstruction artifacts. There was no difference among groups A to C for overall impression of image quality. The interreader agreements were excellent for axial images (groups A and B) and moderate for coronal reformats.

CONCLUSION

Isotropic scanning of the abdomen and pelvis allows creation of reformats with similar image quality as similar thickness axial source images. These reformats are of sufficient quality to form the basis of clinical interpretation.