High-Deductible Health Plans and the Challenges They Pose to Radiologists

Patients with high-deductible health plans will increasingly be motivated to contact their hospitals or various websites to try to obtain information about the costs of expensive services like advanced imaging. Unfortunately, they will not find price transparency but rather confusion and opaqueness. Hospital personnel and commercial websites often unwittingly provide erroneous pricing information. The reasons for this are explained. Detailed examples of the erroneous information are provided. State-mandated websites may be somewhat of an improvement, but their methodology seems to vary from state to state, and they too can be confusing. All this obviously creates problems for patients, who are left not knowing what their true costs will be. The situation also creates problems for radiologists and their hospitals. Because of misunderstandings that can occur during the information-gathering phase, the pricing information shown for many hospital facilities may be greatly inflated, placing them at a competitive disadvantage. Certain strategic solutions to the problems are available, and these are discussed.     

复杂性先天性心脏病影像学诊断的综合评估

目的:综合评估心脏超声(TTE)、MRI、电子束CT(EBT)和心血管数字血管造影(CVDI)在复杂性先天性心 脏病诊断中的作用。方法:搜集本院经外科手术治疗的复杂性先天性心脏病患者158例,其中行CVDI检查156例,EBT 检查14例,MRI检查3例。结果:158例患者中,TTE的诊断符合率为78.5%(124/158),CVDI的诊断符合率为94.9% (148/156),EBT的诊断符合率为85.7%(12/14);经χ2检验,P<0.01,提示3者在诊断复杂性先心病中的差异具有统计 学意义,CVDI的诊断符合率明显高于TTE和EBT。在合并总的畸形和心外畸形上CVDI和EBT的诊断符合率高于 TTE;在诊断心内畸形方面,TTE则优于CVDI。结论:4种影像技术在诊断复杂性先天性心脏病时各有优缺点,有选择性 地联合应用各种影像技术将有助于提高术前的影像诊断符合率。     

Assessment of the Radiology Support,Communication and Alignment Network to Reduce Medical Imaging Overutilization: A Multipractice Cohort Study

PurposeThe aim of this study was to determine whether participation in Radiology Support, Communication and Alignment Network (R-SCAN) results in a reduction of inappropriate imaging in a wide range of real-world clinical environments.MethodsThis quality improvement study used imaging data from 27 US academic and private practices that completed R-SCAN projects between January 25, 2015, and August 8, 2018. Each project consisted of baseline, educational (intervention), and posteducational phases. Baseline and posteducational imaging cases were rated as high, medium, or low value on the basis of validated ACR Appropriateness Criteria®. Four cohorts were generated: a comprehensive cohort that included all eligible practices and three topic-specific cohorts that included practices that completed projects of specific Choosing Wisely topics (pulmonary embolism, adnexal cyst, and low back pain). Changes in the proportion of high-value cases after R-SCAN intervention were assessed for each cohort using generalized estimating equation logistic regression, and changes in the number of low-value cases were analyzed using Poisson regression.ResultsUse of R-SCAN in the comprehensive cohort resulted in a greater proportion of high-value imaging cases (from 57% to 79%; odds ratio, 2.69; 95% confidence interval, 1.50-4.86; P = .001) and 345 fewer low-value cases after intervention (incidence rate ratio, 0.45; 95% confidence interval, 0.29-0.70; P < .001). Similar changes in proportion of high-value cases and number of low-value cases were found for the pulmonary embolism, adnexal cyst, and low back pain cohorts.ConclusionsR-SCAN participation was associated with a reduced likelihood of inappropriate imaging and is thus a promising tool to enhance the quality of patient care and promote wise use of health care resources.     

Perspectives on the Value of Advanced Medical Imaging: A National Survey of Primary Care Physicians

PurposeTo understand perceptions of primary care physicians (PCPs) about the value of advanced medical imaging.MethodsA national quantitative survey of 500 PCPs was conducted using an online self-administered questionnaire. Questions focused on advanced medical imaging (CT, MRI, and PET) and its perceived impact on the delivery of patient care. Responses were stratified by physician demographics.ResultsLarge majorities of the PCPs indicated that advanced imaging increases their diagnostic confidence (441; 88%); provides data not otherwise available (451; 90%); permits better clinical decision making (440; 88%); increases confidence in treatment choices (438; 88%), and shortens time to definitive diagnosis (430; 86%]). Most (424; 85%) believe that patient care would be negatively affected without access to advanced imaging. PCPs whose clinical careers predated the proliferation of advanced imaging modalities (>20 years of practice) assigned higher value to advanced imaging on several dimensions compared with younger physicians whose training overlapped widespread technology availability.ConclusionsBy a variety of metrics, large majorities of PCPs believe that advanced medical imaging provides considerable value to patient care. Those whose careers predated the widespread availability of advanced imaging tended to associate it with even higher value.     

Imaging of the temporomandibular joint: An update

Imaging of the temporomandibular joint (TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is commonly used for evaluation of the TMJ due to its superior contrast resolution and its ability to acquire dynamic imaging for demonstration of the functionality of the joint. Computed tomography and ultrasound imaging have specific indication in imaging of the TMJ. This article focuses on state of the art imaging of the temporomandibular joint. Relevant normal anatomy and biomechanics of movement of the TMJ are discussed for better understanding of many TMJ pathologies. Imaging of internal derangements is discussed in detail. Different arthropathies and common tumors are also discussed in this article.     

肾上腺肿瘤影像学检查的临床应用价值(附102例分析)

目的：评价各种影像学检查方法诊断肾上腺肿瘤的临床价值,为临床医师合理选择和设计检查程序提供参考。材料与方法：以手术病理为依据,用比较影像学的方法,对各种影像学检查方法的定位、定性诊断正确率对比分析。结果：102例肾上腺肿瘤中良性肿瘤84例（内含囊性占位10例）,恶性肿瘤18例。IVP、BUS、CT、CDFI、MRI的术前定位诊断正确率分别为46．3％、91．6％、96.9％、94．1％、92.9％,定性诊断正确率分别为13.4％、83.2％（鉴别囊、实性）、69.4％、64.7％、78.6％;综合影像组则高达100％及84．3％。结论：IVP定位、定性诊断正确率低;BUS对囊、实性的识别力高;IVP＋BUS可作为肾上腺肿瘤的筛选手段;CT、CDFI、MRI对肾上腺肿瘤的定位诊断正确率高,定性诊断正确率相近,对鉴别良恶性有一定价值。综合影像检查可发挥多种检查的互补作用,明显提高肾上腺肿瘤的诊断正确率。     

Unscheduled Radiologic Examination Orders in the Electronic Health Record: A Novel Resource for Targeting Ambulatory Diagnostic Errors in Radiology

PurposeThe aim of this study was to assess the prevalence of unscheduled radiologic examination orders in an electronic health record, and the proportion of unscheduled orders that are clinically necessary, by modality.MethodsThis retrospective study was conducted from January to October 2016 at an academic institution. All unscheduled radiologic examination orders were retrieved for seven modalities (CT, MR, ultrasound, obstetric ultrasound, bone densitometry, mammography, and fluoroscopy). After excluding duplicates, 100 randomly selected orders from each modality were assigned to two physician reviewers who classified their clinical necessity, with 10% overlap. Interannotator agreement was assessed using κ statistics, the percentage of clinically necessary unscheduled orders was compared, and χ² analysis was used to assess differences by modality.ResultsA total 494,503 radiologic examination orders were placed during the study period. After exclusions, 33,546 unscheduled orders were identified, 7% of all radiologic examination orders. Among 700 reviewed unscheduled orders, agreement was substantial (κ = 0.63). Eighty-seven percent of bone densitometric examinations and sixty-five percent of mammographic studies were considered clinically necessary, primarily for follow-up management. The majority of orders in each modality were clinically necessary, except for CT, obstetric ultrasound, and fluoroscopy (P < .0001).ConclusionsLarge numbers of radiologic examination orders remain unscheduled in the electronic health record. A substantial portion are clinically necessary, representing potential delays in executing documented provider care plans. Clinically unnecessary unscheduled orders may inadvertently be scheduled and performed. Identifying and performing clinically necessary unscheduled radiologic examination orders may help reduce diagnostic errors related to diagnosis and treatment delays and enhance patient safety, while eliminating clinically unnecessary unscheduled orders will help avoid unneeded testing.     

Optimizing the Imaging Protocol for Ex Vivo Coronary Artery Wall Using High-Resolution MRI: An Experimental Study on Porcine and Human

Objective

To optimize the MR imaging protocol for coronary arterial wall depiction in vitro and characterize the coronary atherosclerotic plaques.

Materials and Methods

MRI examination was prospectively performed in ten porcine hearts in order to optimize the MR imaging protocol. Various surface coils were used for coronary arterial wall imaging with the same parameters. Then, the image parameters were further optimized for high-resolution coronary wall imaging. The signal-noise ratio (SNR) and contrast-noise ratio (CNR) of images were measured. Finally, 8 human cadaver hearts with coronary atherosclerotic plaques were prospectively performed with MRI examination using optimized protocol in order to characterize the coronary atherosclerotic plaques.

Results

The SNR and CNR of MR image with temporomandibular coil were the highest of various surface coils. High-resolution and high SNR and CNR for ex vivo coronary artery wall depiction can be achieved using temporomandibular coil with 512 × 512 in matrix. Compared with histopathology, the sensitivity and specificity of MRI for identifying advanced plaques were: type IV-V (lipid, necrosis, fibrosis), 94% and 95%; type VI (hemorrhage), 100% and 98%; type VII (calcification), 91% and 100%; and type VIII (fibrosis without lipid core), 100% and 98%, respectively.

Conclusion

Temporomandibular coil appears to be dramatically superior to eight-channel head coil and knee coil for ex vivo coronary artery wall imaging, providing higher spatial resolution and improved the SNR. Ex vivo high-resolution MRI has capability to distinguish human coronary atherosclerotic plaque compositions and accurately classify advanced plaques.