Patients Want to Meet With Imaging Experts

PurposeThe evolving health care landscape demands a multidisciplinary approach to care and increased emphasis on patient engagement. Radiologists may play an important role in this respect, by improving patient agency and understanding through direct patient interaction. The purpose of this study is to assess patient preferences and perceptions regarding direct communication with radiologists, focusing on a medically underserved demographic.MethodsOur institutional review board approved this HIPAA-compliant study. English- and/or Spanish-speaking adults undergoing imaging studies across two tertiary-care hospitals and a busy outpatient center were surveyed over a consecutive two-month period, to assess knowledge of the role of a radiologist, interest in, and perceived benefits of reviewing examination results with imaging experts.ResultsA total of 628 surveys were completed: 20% of total respondents accurately identified the role of radiologists; 28% identified radiologists as doctors. A total of 68% of respondents expressed an interest in receiving imaging results immediately, or whenever results became available, regardless of when referring physicians received results. An interest in reviewing imaging results with an expert was indicated by 81% of respondents; 88% anticipated that reviewing imaging results with an expert would be beneficial. Although 58% of respondents indicated that they might be willing to pay out of pocket for such a service, 50% selected $0 when asked to indicate an amount.ConclusionsAlthough most patients do not know the role of radiologists, they want immediate results, and perceive value in consulting directly with imaging experts.     

Has NICE guidance changed the management of the suspected scaphoid fracture: A survey of UK practice

IntroductionDespite scaphoid fractures being relatively uncommon pro-active treatment of suspected fractures has been seen as a risk management strategy. The poor positive predictive value of X-rays has led to published guidelines advocating MRI as a first-line or early imaging tool. It is unclear whether UK hospitals have been able to introduce early scanning and this national survey sought to establish the current management strategies for patients with a suspected scaphoid fracture.MethodAn electronic survey of UK emergency departments (ED) was conducted to establish the initial and follow up strategies for patients with negative imaging. Comparison of first and second-line imaging modalities was undertaken together with review of the clinical speciality responsible for ongoing management.Results166 UK NHS Trusts were identified with emergency department facilities of which 66 (39.8%) responded. All sites perform an X-ray as the initial examination. For those with a negative examination ED follow up was the most common approach (54.6%), although many sites refer patients to other specialities including orthopaedics (39.4%) for follow up. The data demonstrated inconsistencies in the number of follow-up episodes and the different imaging investigations utilised. Frustration with the challenges presented by this patient cohort was evident.ConclusionThe suspected scaphoid fracture represents an ongoing challenge to the NHS with many resource intensive pathways reliant on access to complex imaging investigations.Implications for practiceOur study identified that UK Emergency Departments have limited early access to complex imaging for scanning of the scaphoid. A range of strategies are used for follow up of suspected scaphoid fractures and these are resource intensive. Overtreatment of patients with suspected scaphoid fracture is used as a risk management approach.     

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.     

Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports

PurposeImaging results are generally communicated to patients by referring providers. Directly communicating results has been suggested as a way for radiologists to add value, though few studies have investigated patients’ preferences in this regard. The aim of this study was to determine patients’ preferences for receiving their imaging results.MethodsIn this institutional review board-approved study, adult outpatients undergoing CT or MRI at an academic medical center and an affiliated county hospital over a 4-week period (n = 2,483) were surveyed. The survey assessed patients’ preferred delivery method for radiology results and their understanding of radiologists’ education and role.ResultsA total of 617 surveys (25% response rate) were completed, 475 (77%) and 142 (23%) by academic medical center and county hospital patients, respectively. Among all respondents, the majority of patients (387 of 617 [63%]) preferred models of results delivery centered on the referring physician as opposed to the radiologist. Regardless of who verbally relayed the results, 64% of all respondents (398 of 617) wanted the option to receive a copy of the report, and 522 of 614 (85%) wanted to see their images. Among patients wanting copies of their reports, academic medical center patients expressed equal interest in mail, e-mail, and online portal options (33%, 31%, and 36%, respectively), and county hospital patients preferred mail (55%, 28%, and 17%, respectively) (P < .001).ConclusionsPatients prefer receiving their imaging results through their referring providers. Many patients would also like to view their images and receive copies of their reports, potential avenues through which radiologists could add value.     

3种图像模式在影像引导放射治疗中的差异性研究

目的 检测并分析电子射野影像系统( EPID)、kV级平面摄像(kV planar)、kV级锥形束CT( CBCT)3种图像模式在影像引导放疗(IGRT)中摆位误差的精度.方法 通过在计划系统的模体CT图像上模拟25组摆位偏差,生成25组DRR参考图像和25组三维CT参考图像,分别与模体在原点位置获取的EPID,kV planar和CBCT 3种图像模式进行图像配准和摆位误差的测量,检测并比较3种图像模式在摆位误差测量中的精度.结果 共读取675组残留误差,3种图像及其相应的配准方法均具有较高的精确度,残留误差的平均值在x、y、z方向上均＜1 mm,CBCT的灰度值配准精度＜0.1 mm,kV planar图像在手动配准时其测量摆位误差的精度好于EPID(＜0.65 mm),在自动配准方法时与EPID具有同等的精度.结论 医院IGRT系统的3种图像模式及其相应的配准方法均可以满足临床应用,CBCT为首选,结合图像质量、成像剂量和配准精度等因素,kV planar优于EPID.     

The impact of teaching experimental research on-line: Research-informed teaching and COVID-19

IntroductionAs part of the BSc (Hons) Diagnostic Radiography programme students learn and undertake research relevant to their development as first post radiographers (dose optimisation and image quality) within the Research-Informed Teaching experience (RiTe). Due to the COVID-19 pandemic, the delivery of RiTe to our year 2 students was moved to an online format using Microsoft Teams and Blackboard Collaborate and focused on a key area of current practice - COVID-19 and chest X-ray imaging. Within RiTe students are placed into collaborative enquiry-based learning (CEBL) groups to share tasks, but to also support and learn from one another.MethodsAn online survey was used to explore the year 2 student cohort task value and self-efficacy of this online version of RiTe.ResultsA 73% (32/44) response rate was achieved. Students found the online version of RiTe to be a positive learning and development experience. There was strong agreement that they not only found it relevant to their area of practice (task-value), but also strongly agreed that they understood and could master the skills taught (self-efficacy).ConclusionThis online version of RiTe was effectively structured to help scaffold student learning and development of research data analysis skills despite the lack of face-to-face teaching. The students also valued the topic area (COVID-19 and chest X-ray imaging). A blended learning approach with RiTe will be used next year with a combination of collaborative online teaching and physical data collection and analysis in the university-based X-ray imaging laboratory. Further evaluation and data collection will also be undertaken.Implications for practiceUniversity-based empirical work in groups to learn about research can be replaced by an online mechanism whilst still maintaining task-value and acceptable self-efficacy.     

The Current State of Teleradiology Across the United States: A National Survey of Radiologists’ Habits,Attitudes, and Perceptions on Teleradiology Practice

PurposeTo explore the current state of teleradiology practice, defined as the interpretation of imaging examinations at a different facility from where the examination was performed.MethodsA national survey addressing radiologists’ habits, attitudes, and perceptions regarding teleradiology was distributed by e-mail to a random sample of ACR members in early 2019.ResultsAmong 731 of 936 respondents who indicated a non-teleradiologist primary work setting, 85.6% reported performing teleradiology within the past 10 years and 25.4% reported that teleradiology represents a majority of their annual imaging volumes; 84.4% performed teleradiology for internal examinations and 45.7% for external examinations; 46.2% performed teleradiology for rural areas and 37.2% for critical access hospitals; 91.3% performed teleradiology during weekday normal business hours and 44.5% to 79.6% over evening, overnight, and weekend hours. In all, 76.9% to 86.2% perceived value from teleradiology for geographic, after-hours, and multispecialty coverage, as well as reduced interpretation turnaround times. The most common challenges for teleradiology were electronic health record access (62.8%), quality assurance (53.8%), and technologist proximity (48.4%). The strategy most commonly considered useful for improving teleradiology was technical interpretation standards (33.3%). Radiologists in smaller practices were less likely to perform teleradiology or performed teleradiology for lower fractions of work, were less likely to experience coverage advantages of teleradiology, and reported larger implementation challenges, particularly relating to electronic health records and prior examination access.ConclusionDespite historic concerns, teleradiology is widespread throughout modern radiology practice, helping practices achieve geographic, after-hours, and multispecialty coverage; reducing turnaround times; and expanding underserved access. Nonetheless, quality assurance of offsite examinations remains necessary. IT integration solutions could help smaller practices achieve teleradiology’s benefits.     

Medical student education in the time of COVID-19: A virtual solution to the introductory radiology elective

Rationale and objectivesDuring the COVID-19 pandemic, medical educators and students are facing unprecedented challenges while navigating the new virtual landscape that social-distancing policies mandate. In response to these challenges, a new virtual introduction to radiology elective was established with unique online resources and curriculum.Materials and methodsA previously in-person 2-week introductory radiology elective was converted into a completely virtual experience using an internally developed, open-source, peer-reviewed, web-based teaching modules combined with virtual lectures, interdisciplinary conferences, and readout sessions of de-identified cases loaded to a DICOM viewer. Students from the first four months of course enrollment completed a multiple choice pre- and post-course knowledge assessments and a 5-point Likert Scale survey as part of their educational experience.ResultsIn total, 26 4th-year medical students participated over 4 separate 2-week sessions from July to October of 2020. This included 12 students from the home intuition and 14 visiting students. On average, students scored 62.2% on the 55-question pre-test and 89.0% on the same test upon completion of the course, a statistically significant increase (p < 0.001). All 26 students felt engaged throughout the course. All 26 agreed (23 “strongly agreed”) that they were more comfortable looking at imaging studies following the course. All 26 also agreed (21 “strongly agreed”) that the course helped them prepare for their future clinical rotations and careers.ConclusionInitial pilot program using unique web-based resources and student encounters during a two-week virtual introductory radiology elective proved to be a positive educational experience for the first 26 students enrolled.     

Natural Language Processing of Radiology Reports in Patients With Hepatocellular Carcinoma to Predict Radiology Resource Utilization

ObjectiveRadiology is a finite health care resource in high demand at most health centers. However, anticipating fluctuations in demand is a challenge because of the inherent uncertainty in disease prognosis. The aim of this study was to explore the potential of natural language processing (NLP) to predict downstream radiology resource utilization in patients undergoing surveillance for hepatocellular carcinoma (HCC).Materials and MethodsAll HCC surveillance CT examinations performed at our institution from January 1, 2010, to October 31, 2017 were selected from our departmental radiology information system. We used open source NLP and machine learning software to parse radiology report text into bag-of-words and term frequency–inverse document frequency (TF-IDF) representations. Three machine learning models—logistic regression, support vector machine (SVM), and random forest—were used to predict future utilization of radiology department resources. A test data set was used to calculate accuracy, sensitivity, and specificity in addition to the area under the curve (AUC).ResultsAs a group, the bag-of-word models were slightly inferior to the TF-IDF feature extraction approach. The TF-IDF + SVM model outperformed all other models with an accuracy of 92%, a sensitivity of 83%, and a specificity of 96%, with an AUC of 0.971.ConclusionsNLP-based models can accurately predict downstream radiology resource utilization from narrative HCC surveillance reports and has potential for translation to health care management where it may improve decision making, reduce costs, and broaden access to care.     

Patient Awareness of Breast Density and Interest in Supplemental Screening Tests: Comparison of an Academic Facility and a County Hospital

PurposeThe aim of this study was to measure women’s knowledge of breast density and their attitudes toward supplemental screening tests in the setting of the California Breast Density Notification Law at an academic facility and a county hospital, serving women with higher and lower socioeconomic status, respectively.MethodsInstitutional review board exemptions were obtained. A survey was administered during screening mammography at two facilities, assessing women’s awareness of and interest in knowing their breast density and interest in and willingness to pay for supplemental whole breast ultrasound and contrast-enhanced spectral mammography (CEMG). The results were compared by using Fisher exact tests between groups.ResultsA total of 105 of 130 and 132 of 153 women responded to the survey at the academic and county facilities, respectively. Among respondents at the academic and county facilities, 23% and 5% were aware of their breast density, and 94% and 79% wanted to know their density. A majority were interested in supplemental ultrasonography and CEMG at both sites; however, fewer women had a willingness to pay for the supplemental tests at the county hospital compared with those at the academic facility (22% and 70%, respectively, for ultrasound, P < .0001; 20% and 65%, respectively, for CEMG, P < .0001).ConclusionsBoth groups of women were interested in knowing their breast density and in supplemental screening tests. However, women at the county hospital were less willing to incur out-of-pocket expenses, suggesting a potential for a disparity in health care access for women of lower socioeconomic status after the enactment of breast density notification legislation.     

A Novel Timesaving Method for Hepatobiliary Imaging for Suspected Acute Cholecystitis

Objective

To optimize resource utilization of cholescintigraphy for suspected acute cholecystitis with a time-saving method without a loss in diagnostic accuracy.

Fast spin-echo imaging of the temporomandibular joint

The applicability of a fast spin-echo (PSE) technique for magnetic resonance imaging of the tem-poromandibular joint (TMJ) was studied, and the technique compared with a conventional spin-echo (CSE) technique. Sagittal Tl-weighted CSE and dual-echo FSE images of 50 TMJs in 25 patients with symptoms of internal TMJ derangement were compared. CSE and FSE images were diagnostically comparable in 22 TMJs (44%). The FSE technique was rated better than CSE imaging for delineation of the disk in 26 joints (52%), whereas the CSE technique was rated better in only two joints (4%). The FSE technique was preferred overall in 54% of the joints. Mild to moderate joint effusion was detected in 17 joints because additional T2-weighted data were provided with the dual-echo FSE technique. The study showed that FSE imaging is an effective technique for evaluation of the TMJ. It is faster and diagnostically comparable to or better than CSE imaging, with the added advantage of providing T2-weighted data.     

Scanning Systems and Protocols Used During Imaging for Acute Pulmonary Embolism: How Much Do Our Clinical Colleagues Know?

RATIONALE AND OBJECTIVES: The imaging systems and protocols used during ventilation-perfusion lung (V-P) scintigraphy and computed tomographic (CT) pulmonary angiography (CTPA) can affect diagnostic performance. We investigated the level of awareness of these factors among US clinicians who refer patients for imaging for suspected acute pulmonary embolism. MATERIALS AND METHODS: Between September 2004 and February 2005, we conducted a mail survey of 855 physicians selected at random from three professional organizations. We asked participants how important the availability of state-of-the-art equipment was in their imaging decisions, whether V-P scintigraphy was performed with planar or single-photon emission CT (SPECT) equipment in their communities, to identify the most advanced type of CT scanner used for CTPA, and whether CT venography (CTV) was performed routinely after CTPA. RESULTS: We received completed surveys from 240 (29.8%) physicians practicing in 44 states. One hundred sixty-six respondents (70.9%) indicated that state-of-the-art equipment was an extremely or very important factor when they made imaging decisions. However, 191 clinicians (80.3%) did not know whether SPECT equipment was used for V-P scintigraphy, and 119 (50.6%) did not know the type of CT scanner used for CTPA in their communities. Of respondents, 39.2% reported access to multidetector row CT technology for CTPA, whereas 10.2% referred patients to facilities using single-detector CT. Only 9.3% of respondents indicated that CTV was performed routinely after CTPA. CONCLUSION: Although state-of-the-art equipment is important to them, clinicians practicing in the United States have limited knowledge of the equipment being used during CTPA and V-P scintigraphy scanning in their communities. Radiologists should intensify efforts to familiarize their clinical colleagues with the equipment they use.     

Implementation of an Intimate Partner Violence Screening Assessment and Referral System in an Academic Women’s Imaging Department

PurposeOne in five US women report that they have been victims of intimate partner violence (IPV) during their lifetime. With millions of women presenting for mammography every year, breast imaging centers may represent ideal venues to identify women at risk for IPV and refer them to appropriate support services. Our purpose was to evaluate implementation of a novel IPV screening and referral system for women presenting for mammography.MethodsA question was added to intake questionnaire (“Do you feel safe in your home?”) for adult women presenting for screening or diagnostic mammography from 2016 to 2017 at our hospital outpatient breast imaging sites. The proportion of women presenting for screening or diagnostic mammogram who felt unsafe was calculated. Bivariate logistic regression analyses were performed to compare baseline characteristics of women who stated that they felt unsafe at home versus women who did not state that they felt unsafe at home.ResultsIn all, 99,029 examinations were performed (68,158 unique patients). Of these patients, 71 stated that they felt unsafe at home (71 of 68,158, 0.1%). Women presenting for their first mammogram were more likely to report feeling unsafe at home (odds ratio 3.03, 95% confidence interval 1.31-7.06, P = .01). No differences were found in age (P = .148), ethnicity (P = .271), gravida (P = .676), parity (P = .752), age at menarche (P = .775), and history of breast cancer (P = .726).ConclusionsOur results demonstrate the feasibility of a screening and referral system for IPV in radiology departments.     

Adding value to imaging services: a survey of patient and referring physician preferences for direct radiologic reporting of results

PurposeTo identify preferences of patients and referring physicians for direct patient communication and notification of radiologic study results.MethodsAn anonymous survey was conducted of patients undergoing outpatient radiologic imaging studies and their referring physicians. The voluntary surveys elicited responses regarding preferences on a 5-point Likert scale (Strongly disagree, disagree, neutral, agree and strongly agree), as well as indicated by responding yes or no to specific questions.Results368 patients completed the survey. 81.5% of patient responders preferred all results communicated from the radiologist within the same day. 65.9% of patients preferred same day results if normal vs 65.8% if abnormal. 34.5% preferred to wait and review normal results with the referring physician. 41.5% preferred to wait and review abnormal results with the referring physician. It was found that patients were more likely to strongly agree with waiting to review results with the referring physician if the results were abnormal, as opposed to normal (18.5% vs 11.9%, respectively; P < 0.014). 64% of physicians did not want results reviewed with their patients; 87.6% did not want a report sent to the patient by the radiologist, even after report was sent to their office. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety.Conclusions58–82% of patients preferred same day radiologist communication of their results while 55–87.6% of physicians did not prefer same day radiologist communication of results directly with their patients. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety.     

Traditional Text-Only Versus Multimedia-Enhanced Radiology Reporting: Referring Physicians’ Perceptions of Value

PurposeThe aim of this study was to evaluate referring physicians’ perceptions of multimedia-enhanced radiology reporting (MERR) as an alternative to traditional text-only radiology reporting. MERR supplements text-only reports by embedding user-friendly interactive hyperlinks to key images and graphically plotting target lesion size longitudinally over time.MethodsOf 402 physicians responding to a web-based survey, 200 (50 each medical oncologists, radiation oncologists, neurosurgeons, and pulmonologists) practicing in the United States fulfilled criteria to complete an online survey with questions focusing on satisfaction with current text-only reports and the perceived value of image- and data-enriched reporting.ResultsThe mean respondent age was 46 years, with a mean of 15 years in posttraining clinical practice (85% men; 47% from academic medical centers). Although 80% were satisfied with the format of their current text-only radiology reports, 80% believed that MERR would represent an improvement. The most commonly reported advantages of MERR were “improved understanding of radiology findings by correlating images to text reports” (86%) and “easier access to images while monitoring progression of a disease/condition” (79%). Of the 28% of physicians with concerns about MERR implementation, the most common were that it was “too time intensive” (53%) and “the clinic workflow does not allow itself to view reports in such a fashion” (42%). Physicians indicated a strong increased likelihood of preferentially referring patients to (80%) and recommending peers to (79%) facilities that offer MERR.ConclusionMost specialist referring physicians believe that interactive image- and data-embedded MERR represents an improvement over current text-only radiology reporting. Compared with current report formatting, most would preferentially refer patients and peers to facilities offering more meaningful image- and graphically enriched reporting platforms.     

The Association of Program Directors in Radiology Well-Being 2019 Survey: Identifying Residency Gaps and Offering Solutions

PurposeThe Well-Being subcommittee of the Association of Program Directors in Radiology (APDR) Common Program Requirements (CPR) Ad Hoc Committee and the APDR Academic Output Task Force jointly conducted a study of APDR members’ current level of understanding and implementation of the 2017 ACGME CPR regarding well-being.MethodsA survey instrument consisting of 10 multiple-choice and open-ended questions was distributed to the 322 active members of the APDR. The survey focused on three main content areas: APDR member knowledge of the 2017 CPR, composition of department well-being curricula, and residency well-being innovations.ResultsIn all, 121 members (37.6%) responded to the survey. Of those, 67% rated their knowledge of requirements as incomplete. Responses also indicated that 74% of departments have not implemented a comprehensive well-being curriculum; 53% of programs do not offer the mandated self-screening tool; 15% of respondents do not offer residents protected time for medical, mental health, and dental appointments; and 42% do not offer their trainees access to an institutional mental health clinic. Survey comments offer numerous individual well-being initiatives from across the membership.ConclusionsThe results of the APDR Well-Being Survey indicate that many programs have substantial work remaining to achieve ACGME compliance. Well-being innovations were included in an effort to share best practices.     

Understanding the underutilization of cervical brachytherapy for locally advanced cervical cancer

PurposeTo understand the reasons behind current low utilization of brachytherapy for locally advanced cervical cancer in the United States.Methods and MaterialsA 17-item survey was e-mailed to the American Brachytherapy Society (ABS) listserv of active members in 2018. Responses of attending physicians in the United States were included in the analysis.ResultsAmong a total of 135 respondents, 81 completed the survey. Eighty-four percent agree/strongly agree that cervical brachytherapy is underutilized, and 46.9% disagree/strongly disagree that residents are receiving adequate training for brachytherapy; 75.3% agree/strongly agree that inadequate maintenance of brachytherapy skills is a major obstacle to brachytherapy use; and 71.6% agree/strongly agree that increased time requirement constitutes a major obstacle. Over 97% will recommend brachytherapy for most patients with cervical cancer if given access/time; 72.8% always perform their own brachytherapy, whereas 29.6% reported some type of barrier exists in performing brachytherapy themselves, with time required to perform brachytherapy (9.9%) being a leading factor. A quarter (24.7%) routinely refer to other radiation oncologists for brachytherapy. Even among ABS members, 37.0% reported that they would perform an intensity-modulated radiation therapy or stereotactic body radiation therapy boost in specific scenarios in potentially curable patients. The most common scenario is inability to place a uterine tandem (56.7%).ConclusionsThe underutilization of brachytherapy in cervical cancer is widely recognized by ABS members with inadequate training during residency and inadequate maintenance of skills being possible major contributing factors. Even among ABS members, there are identifiable barriers. Continued advocacy and future initiatives in enhancing access to brachytherapy training and efficiency are needed.