Diagnostic accuracy with US: remote radiologists' versus on-site radiologists' interpretations

PURPOSE: To compare the diagnostic accuracy of radiologists interpreting static ultrasonographic (US) images electronically transmitted to an academic medical center (remote radiologists) with that of radiologists performing "hands-on" US at a community-based outpatient site (on-site radiologists). MATERIALS AND METHODS: During 8 months, 80 patients underwent pelvic US at a community-based outpatient site. Images were electronically transmitted to a remote medical center as they were acquired at the community site and were printed on a laser printer identical to the one used at the outpatient site. The reference standard for correct diagnosis was based on histopathologic findings (n = 13), additional imaging results (n = 34), or review by a second independent observer (n = 33). Both an on-site and a remote radiologist interpreted the images, and their interpretations were rated as agree, both correct; agree, both incorrect; or disagree. Cases of disagreement were rated as major or minor. RESULTS: On-site and remote radiologists agreed in 69 of 80 patients (86%), and both radiologists were correct in all of these cases. There were 10 minor discrepancies and one major discrepancy. The diagnostic accuracies of the one-site and remote radiologists were 92% and 94%, respectively. CONCLUSION: High levels of diagnostic accuracy can be achieved by radiologists interpreting static US images. Strict protocols and excellent communication between the radiologist and sonographer are necessary to avoid diagnostic errors.     

Influences affecting radiologists' choices of academic or private practice careers

The authors surveyed 5,000 practicing radiologists and 3,000 individuals currently in radiology training to determine the aspects of their backgrounds, education, training, and attitudes that most affected their career decisions. The choice of academic radiology was associated with receiving medical school education or radiology training at an institution ranking among the 20 with the most federal grant funding, publishing research articles, and participating in a variety of interpersonal research experiences during radiology training. Academic radiologists were more likely to choose their careers because of their interests, aptitudes, and greater concern for the value of doing research. Private practitioners rated family obligations, leisure time, and level of personal income as more significant influences on their career choices. Programs interested in training more academic radiologists should reconsider how they select trainees and provide an appropriate research environment during training.     

Morality, ethics, and radiologists' responsibilities.

The goal of this discussion was to address the matter and methodology of ethics and critical thinking and to ask several questions about the relationship between ethics and radiology. Questions about the nature of the moral and how ethics inform decision making raise our awareness and may provide new understanding about moral thinking. Why is medicine a moral endeavor? Overridingness, universalizability, and other-regarding virtues were discussed. How do ethics inform medical decision making? Ethical theories, including parentalism, autonomy, and the engagement model, were discussed. What are radiologists' ethical responsibilities? Our ethical responsibilities as radiologists entail seven briefly described elements: assessing the appropriateness of the imaging examination, participating in the informed consent process, protecting patient interests, providing excellent image interpretation, communicating effectively with physicians and patients, seeking continued learning, and continuously improving quality. Of these responsibilities, competence, loyal concern for the patient's well-being, and respect for his or her person provide the basis for trust in the patient-physician relationship. If the central paradox in medicine is the tension between self-interest and altruism, then responsibility to the patient in this trust has the greatest force and overrides other obligations. Finally, our challenge is to critically examine our and each other's professional role and the extent to which we achieve excellence in our contribution to patient care; to break out of comfortable habits and reflect on new, alternative ways of knowing as caregivers; to think about what we are doing in medicine and the consequences for the human mind and spirit of our patients, our colleagues, and ourselves; and to provide a forum for this important dialogue in our practices, residency programs, and continuing education curricula.     

Management of patients taking antiplatelet or anticoagulant medication requiring invasive breast procedures: United Kingdom survey of radiologists' and surgeons' current practice

AIM: To determine the current practice in the UK National Health Service Breast Screening Programme for invasive diagnostic procedures and surgery in patients taking anticoagulant and antiplatelet medication. MATERIALS AND METHODS: Lead radiologists and surgeons at each breast screening service were surveyed to determine current practice. One hundred and five respondents provided information regarding their services, protocols, and willingness to proceed with combinations of procedures and anti-haemostatic medications. RESULTS: Between units there was wide variation in practice. Within 21 services providing more than one response, 10 (48%) disagreed on whether protocols existed. Decisions to perform biopsies were unrelated to professional group. The taking of a drug history was variable. Surgeons reported more adverse effects than radiologists [21 (48%) versus 12 (26%)], but no difference in self-assessment of knowledge. CONCLUSION: Both radiologists and surgeons have expressed uncertainty about their understanding of anticoagulant and antiplatelet treatment. This is reflected in a wide range of practice. Guidance regarding the management of these patients is suggested.     

Optimization of region of interest luminances may enhance radiologists' light adaptation

RATIONALE AND OBJECTIVES: Radiologic image details are best discriminated at luminance levels to which the eye is adapted. Recommendations that ambient light conditions are matched to overall monitor luminance to encourage appropriate adaptation are based on an assumption that clinically significant regions within the image match average monitor luminance. The current work examines this assumption. MATERIALS AND METHODS: Three image types were considered: posteroanterior (PA) chest; PA wrist; and computed tomography (CT) head. Luminance at clinically significant regions was measured at hilar region and peripheral lung (chest), distal radius (wrist), and supraventricular white matter (head). Average monitor luminances were calculated from measurements at 16 regions of the display face plate. Three ambient light levels-30, 100 and 400 lux-were employed. Thirty samples of each image type were used. RESULTS: Statistically significant differences were noted between average monitor luminances and clinically important regions of interest of up to a factor of 3.8, 2, and 6.3 for chest, wrist, and CT head images respectively (P < .0001). Values for the hilum of the chest and distal radius were higher than average monitor levels, whereas the reverse was observed for the peripheral lung and CT brain. Increasing ambient light had no impact on results. CONCLUSIONS: Clinically important radiologic information for common radiologic examinations is not being presented to observers in a way that facilitates optimized adaptation. This may have a significant impact on the ability of the observer to identify details with low contrast discriminability. The importance of image-processing algorithms focussing on clinically significant abnormalities rather than anatomic regions is highlighted.     

The reliability of radiologists' quality assessment of MR pelvic scans.

The purpose of this study was to test the reliability of radiologists' subjective assessment of the quality of MR scans of the pelvis. A four-grade ordinal subjective scale, based on the degree of artifact and contrast between pelvic organs, was developed in a pilot study by two MR radiologists. Forty pelvic scans were graded "blindly" in random order by the same two "practiced" MR radiologists, and an objective measurement of scan artifact was obtained for each scan. Twenty-eight pelvic scans were also graded by two "unpracticed" radiologists not involved in the development of the scale. For the practiced radiologists, the interobserver percentage agreement was 80% (weighted kappa of 0.78) and the intraobserver percentage agreement was 75% (weighted kappa of 0.73). For the unpracticed radiologists the percentage agreement was 61% and the weighted kappa was 0.55. The correlation between the subjective and objective measurement was only 0.27. In conclusion, the objective measurement of scan artifact showed poor correlation with the radiologists' subjective assessment of scan quality. The subjective assessment demonstrated satisfactory reliability and, therefore, could be considered as an additional outcome measurement for scan quality in clinical trials or as a relevant measure of quality assurance.     

Survey of gynecologists' and interventional radiologists' opinions of uterine fibroid embolization.

PURPOSE: To evaluate the opinions of gynecologists and interventional radiologists regarding uterine fibroid embolization (UFE). METHODS: We mailed surveys to all gynecologists and interventional radiologists practising in Toronto, Ontario. Study criteria excluded those physicians who did not assess or treat patients with uterine fibroids. We evaluated whether they educated patients regarding UFE, together with their opinion of current and future effectiveness of UFE, self-rated knowledge of fibroid treatment options, and recommendations for treatment in several clinical scenarios. RESULTS: A total of 102 gynecologists (46.4% response rate) and 28 interventional radiologists (51.9% response rate) completed the survey. After applying the exclusion criteria, the final study population was 82 gynecologists and 17 interventional radiologists. Both groups reported high rates of patient education regarding UFE (gynecologists 100% and interventional radiologist 88.2%, P > 0.05). Interventional radiologists had higher self-rated knowledge of UFE (P = 0.05), and gynecologists had higher self-rated knowledge of all other treatment options (P = 0.00). Interventional radiologists had a more favourable opinion of the current effectiveness (P < 0.05) and future use (P > 0.05) of UFE. In 5 of the 7 clinical scenarios, interventional radiologists chose UFE, whereas gynecologists chose other treatment options (P < 0.05). CONCLUSIONS: Although most gynecologists and intterventional radiologists educate their patients regarding UFE as a treatment option for uterine fibroids, interventional radiologists have greater self-rated knowledge and a higher opinion of current effectiveness and future use and recommend UFE more often for uterine fibroid scenarios.     

Influence of radiologists' sex and training on fluoroscopy doses during barium enema

Variables influencing radiation exposure were studied using analysis of covariance in 523 double contrast barium enemas performed by 21 radiology residents (12 female, 9 male). Dose-area products (DAPs) (ns), number of exposures per patient (p < 0.05) and screening times (p < 0.05) were higher for female residents (mean 52.0 Gy cm2, 9.55 exposures and 4.02 min, respectively) than for male residents (mean 41.7 Gy cm2, 8.26 exposures and 3.20 min, respectively). The number of lectures on radiation protection attended by the resident (range 0-20) had no significant effect on these radiation-related variables. Other factors explaining these variables were patient age, diagnosis and anteroposterior thickness. Radiologists' use of ionizing radiation during fluoroscopy may be sex-related. Traditional lecture-based education on radiation protection was not effective with this group; thus, improved methods should be developed to control doses.     

Diagnostic accuracy of sequential angio-urography with the spot-camera in clinical practice

In this perspective study the authors examined 57 patients to evaluate diagnostic accuracy of sequential angiourography (AUS) using spot-camera and image subtraction for the visualization of the vascular phase of the renal arteries. All the subjects underwent surgery or follow-up with other clinical and radiological methods. The results obtained with this technique, of low cost and simple execution, were satisfactory: accuracy 98%, sensitivity 100%, specificity 98%.     

The changing concept of radiographer's role in UAE: An analysis of radiologists' opinions and acceptance

IntroductionThe role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE.AimThis study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles.MethodsData was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol.ResultsA total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development.ConclusionRadiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training.Implications for practiceGuidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions.