A report on the Academic Emergency Medicine 2015 consensus conference “Diagnostic imaging in the emergency department: a research agenda to optimize utilization”

In May 2015, the Academic Emergency Medicine consensus conference “Diagnostic imaging in the emergency department: a research agenda to optimize utilization” was held. The goal of the conference was to develop a high-priority research agenda regarding emergency diagnostic imaging on which to base future research. In addition to representatives from the Society of Academic Emergency Medicine, the multidisciplinary conference included members of several radiology organizations: American Society for Emergency Radiology, Radiological Society of North America, the American College of Radiology, and the American Association of Physicists in Medicine. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Through a multistep consensus process, participants developed targeted research questions for future research in six content areas within emergency diagnostic imaging: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use.     

Highlights from the scientific and educational abstracts presented at the ASER 2015 annual scientific meeting and postgraduate course

The American Society of Emergency Radiology (ASER) 2015 Annual Scientific Meeting and Postgraduate Course offered dedicated learning sessions, oral presentations, and digital exhibits on a broad spectrum of topics in emergency radiology, including traumatic and non-traumatic emergencies, quality, communication, education, technological innovations, and the evolving identity of the emergency radiology subspecialty. This article highlights the scientific and educational abstracts presented at the meeting.     

Highlights from the scientific and educational abstracts presented at the ASER 2011 Annual Scientific Meeting and Postgraduate Course

The American Society of Emergency Radiology (ASER) 2011 Annual Scientific Meeting and Post-Graduate Course encompassed a wide range of topics: traumatic and nontraumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, military radiology and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting (Emerg Radiol 18:453–481, 2011).     

Highlights from the scientific and educational abstracts presented at the ASER 2010 Annual Scientific Meeting and Postgraduate Course

The American Society of Emergency Radiology 2010 Annual Scientific Meeting and Postgraduate Course encompassed a wide range of topics: traumatic and non-traumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, military radiology, and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting (Emerg Radiol 17:517-551, 2010).     

Highlights from the scientific and educational abstracts presented at the ASER 2013 Annual Scientific Meeting and Postgraduate Course

The American Society of Emergency Radiology (ASER) 2013 Annual Scientific Meeting and Postgraduate Course offered dedicated learning sessions, oral presentations, and digital exhibits on a broad spectrum of topics in emergency radiology, including traumatic and nontraumatic emergencies, quality, communication, education, and technology. This article highlights the scientific and educational abstracts presented at the meeting (Emergc Radiol 20:345–378, 2013).     

Interobserver agreement between radiologists and radiology residents and emergency physicians in the detection of PE using CTPA

ObjectiveTo assess interobserver agreement between thoracic radiologists, radiology residents, and emergency physicians in diagnosing pulmonary embolism (PE).Materials and methodsEmergency physicians, radiology residents, and thoracic radiologists evaluated 123 computed tomography pulmonary angiography images. Interobserver agreement was analysed using kappa statistics.ResultsVery good agreements were observed between thoracic radiologists and radiology residents (0.81 and 0.82). Fair and moderate agreements (0.39 and 0.42) were demonstrated between emergency physicians and thoracic radiologists.ConclusionsImportant differences in interobserver agreement were found, with emergency physicians tending to overdiagnose PE.     

Soft copy interpretation of emergency department examinations

The ability of the radiology department to fully support 24-hour emergency services is becoming increasingly critical in the modern health care environment. Physical separation of departments and the unique requirements of the emergency department, however, can limit the quality of the resulting services provided by radiology with both unreported studies and an undesirable delay in interpretation. The introduction of a picture archiving and communication system (PACS) with diagnostic quality workstations has allowed the initiation of full-time soft copy image interpretation for services rendered to the emergency department. Soft copy interpretation with PACS archiving has reduced the number of unreported examinations, shortened the time to interpretation, and markedly improved the accountability for examinations performed for the emergency department.The opinions or assertions contained in this article are the private views of the authors and are not to be construed as official or as reflecting the views of the Army Medical Department, the Department of the Army, or the Department of Defense.Presented at the 6th Annual Meeting of the American Society of Emergency Radiology, Scottsdale, AZ, March 25–29, 1995.     

Do radiologists use the American College of Radiology Musculoskeletal Appropriateness Criteria?

OBJECTIVE: The objective of this study was to determine the proportion of radiologists in three different radiology organizations who report using the American College of Radiology (ACR) musculoskeletal appropriateness criteria. MATERIALS AND METHODS: Radiologists from the Society of Skeletal Radiology, Georgia Radiological Society, and Utah Radiological Society were surveyed regarding their use of the ACR musculoskeletal appropriateness criteria. The surveys were carried out during 1998 and data were collected using written survey forms, telephone, and fax. RESULTS: The overall survey response rate was 298 (64%) of 465. Overall, 30% of respondents reported using the musculoskeletal appropriateness criteria. The proportion of respondents who used the musculoskeletal criteria was not different across the three organizations or for private practice compared with academic radiologists. CONCLUSION: The proportion of radiologists who report using the ACR musculoskeletal radiology appropriateness criteria is low. This result is consistent with other reports in the literature that show little impact on the practice of physicians after the distribution of written practice guidelines.     

Highlights from the scientific and educational abstracts presented at the ASER 2009 Annual Scientific Meeting and Postgraduate Course

The American Society of Emergency Radiology 2009 Annual Scientific Meeting and Postgraduate Course encompassed a wide range of topics: traumatic and nontraumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, military radiology, and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting (Scientific and Educational Abstracts Presented at the ASER, Emerg Radiol 16:501–516, 2009).     

Interventional Radiology Workforce Shortages Affecting Small and Rural Practices: A Report of the SIR/ACR Joint Task Force on Recruitment and Retention of Interventional Radiologists to Small and Rural Practices

Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists. Lack of access to interventional radiologic services results in a failure to meet the needs of patients, hospitals, and other community stakeholders. Acknowledging this challenge, the ACR’s Commission on General, Small, Emergency and/or Rural Practice and Commission on Interventional and Cardiovascular Imaging and the Society of Interventional Radiology partnered to establish a joint task force to study this issue and identify strategies the ACR and the Society of Interventional Radiology should take to improve small and rural practice recruitment and retention of interventional radiologists. This report describes the deliberations and recommendations of the task force.     

Variability in the practice of emergency radiology: a survey of the members of the American Society of Emergency Radiology

Objective: To assess the variation in practice for selected clinical scenarios among members of the American Society of Emergency Radiology. Methods: A survey was distributed to assess the standard imaging approach to nine common emergency radiology clinical scenarios. Institutional demographics were also assessed. The respondent's institution was used as the primary unit of analysis. Results: A total of 140 institutions were included in the primary analysis. Major variation was identified in the imaging approach to all scenarios studied. Practice size and type did not explain the variation. However, significant differences (P < 0.006) were observed between practice in the United States and the remainder of the world. Conclusions: There is no consensus among the members of the American Society of Emergency Radiology as to the best imaging approach to nine common clinical problems. The identification of this variation may serve as the seed for future research and discussion.     

From shared data to sharing workflow: Merging PACS and teleradiology

Due to a host of technological, interface, operational and workflow limitations, teleradiology and PACS/RIS were historically developed as separate systems serving different purposes. PACS/RIS handled local radiology storage and workflow management while teleradiology addressed remote access to images. Today advanced PACS/RIS support complete site radiology workflow for attending physicians, whether on-site or remote. In parallel, teleradiology has emerged into a service of providing remote, off-hours, coverage for emergency radiology and to a lesser extent subspecialty reading to subscribing sites and radiology groups.When attending radiologists use teleradiology for remote access to a site, they may share all relevant patient data and participate in the site's workflow like their on-site peers. The operation gets cumbersome and time consuming when these radiologists serve multi-sites, each requiring a different remote access, or when the sites do not employ the same PACS/RIS/Reporting Systems and do not share the same ownership. The least efficient operation is of teleradiology companies engaged in reading for multiple facilities. As these services typically employ non-local radiologists, they are allowed to share some of the available patient data necessary to provide an emergency report but, by enlarge, they do not share the workflow of the sites they serve.Radiology stakeholders usually prefer to have their own radiologists perform all radiology tasks including interpretation of off-hour examinations. It is possible with current technology to create a system that combines the benefits of local radiology services to multiple sites with the advantages offered by adding subspecialty and off-hours emergency services through teleradiology. Such a system increases efficiency for the radiology groups by enabling all users, regardless of location, to work “local” and fully participate in the workflow of every site. We refer to such a system as SuperPACS.     

Transfer patient imaging: a survey of members of the American Society of Emergency Radiology

When trauma patients are transferred from outside hospitals, the receiving clinicians often consult their local radiologists for definitive interpretations of outside examinations (IOE). Such requests introduce a host of logistical, medicolegal, and financial concerns related to quality control and resource utilization. We surveyed 701 members of the American Society of Emergency Radiology to elucidate these concerns. We found that the majority of emergency departments still rely on compact disks for conveyance of outside images; hard film and network transfers were minor mechanisms for most respondents. Sixty-nine percent of the respondents indicated that radiologist reports accompany fewer than 25?% of all transferred imaging studies; of the reports that do arrive, most are unverified preliminary reads. There is considerable variability in billing practices and reimbursement patterns for radiologic second opinions; 68?% of the respondents do not know how often their IOEs are reimbursed. Suboptimal communication between community hospitals and referral centers may result in duplicated efforts and inconsistent quality of medical imaging studies. Further investigation into the role of radiology trainees in the handling of outside studies is also highly recommended.     

Radiology malpractice in the emergency room setting

Emergency patients present particular liability risks unique to the setting in which they are admitted for care. This article examines the areas of liability for radiologists working in emergency medicine. First, a background of medical malpractice law is set forth to assure an understanding of liability exposure for physicians generally. The article then discusses added risk factors that present in emergency medicine radiology. Court findings from actual legal cases involving emergency radiology are reviewed. Finally, some risk management recommendations are included to assist radiologists working in the area of emergency medicine better to manage the liability risks inherent in their practice.     

How Radiologists Can Benefit From Direct Communication With Patients

Effective communication is foundational to Radiology. Historically, radiologists have been considered “doctors’ doctors,” communicating primarily with referring physicians and other radiologists. Aside from interventional radiology and breast imaging, direct communication between radiologists and patients has typically been limited. In recent years, major radiology professional societies have launched initiatives aimed toward increasing direct radiologist and patient communication. These include the American College of Radiology's Imaging 3.0 and Radiological Society of North America's Radiology Cares initiatives. Prior work has highlighted potential patient benefits of increased communication by demonstrating patient preferences for speaking with imaging experts about the results of their imaging studies and introducing strategies to harness existing information technology resources to achieve this goal. In this review, we explore the unique benefits that radiologists can derive from communicating with patients in regular and meaningful ways.     

The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

Emergency Radiology - To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and...     

Looking back,moving forward: 1988–2013. The first 25 years of the American Society of Emergency Radiology

The American Society of Emergency Radiology (ASER) was founded in 1988 and is celebrating its 25th Anniversary. ASER is thriving and emergency radiology has never enjoyed greater popularity than at present. This history describes the genesis of the Society, its growth and current state of affairs. It is based on the recollections and personal files of the authors, one Founder and both former ASER Presidents and Gold Medalists, the ASER archives, and interviews and correspondence with many ASER members. It is hoped that this brief review will be interesting to the reader, provide some insight into ASER evolution over the years, and hold some lessons moving forward.     

Experience of Women in IR in the Arab World: Survey by the Pan Arab Interventional Radiology Society

We report our assessment of the experience of female interventional radiologists in different Arab countries based on an online questionnaire that was sent to 57 female interventional radiologists in 5 Arab countries. These interventional radiologists were identified from the Pan Arab Interventional Radiology Society database and through personal communications. The survey included items related to demographics, social status, and the professional challenges of interventional radiologists, with a response rate of 93%. Forty-five percent of respondents were between 31 and 45 years of age. Interventional radiology practice represented 25%–50% of work time for 51% of respondents, and the main challenges reported were related to radiation exposure, balancing family/work life, and the male-dominated interventional radiology community.     

The yield of CT pulmonary angiograms to exclude acute pulmonary embolism

There is accumulating evidence regarding the overuse of computed tomography pulmonary angiography (CTPA) to exclude pulmonary embolism (PE). We evaluated the yield of CTPA studies performed at our tertiary care hospital between April 2008 and March 2010 for emergency patients (ED), inpatients (INPT), and intensive care unit inpatients (ICU). For each patient group, we also compared CTPA positivity rates among the following: daytime and on-call studies, 1 year before and after institution of an Emergency Radiology division, interpreting thoracic and non-thoracic radiologists, and individual emergency physicians. Patients with a history of PE and indeterminate studies were excluded. The diagnosis of PE was based on the radiology report. D-dimer values obtained within 24 h prior to CTPA were recorded. A total of 3,571/4,757 CTPA studies satisfied the inclusion criteria. The fraction of positive studies was 252/1,677 (15.0 %) ED, 255/1,548 (16.5 %) INPT, and 62/346 (17.9 %) ICU. There was no difference in yield between patient groups, daytime vs. on-call studies, before vs. after instituting an emergency radiology division, and thoracic vs. non-thoracic radiologists (p?>?0.05). For individual emergency physicians, the mean CTPA positivity rate was 15.4 % but varied considerably (σ?=?8.5 %, range, 0–38.5 %). In comparison to other recent studies, our yield of ED CTPA is relatively high but varied widely among individual emergency physicians. While the reasons for such differences require further investigation, our results reinforce the importance of a strong clinical assessment in the work-up of suspected PE.     

The radiology assistant: a contrarian’s view

Recent and rapid increases in the utilization of diagnostic imaging have not been matched by concomitant additions to the supply of radiologists and radiology technologists. One proposal to alleviate an expected worsening of this emerging workforce crisis is to create a new job category, the radiology assistant (RA), encompassing a roster of enhanced capabilities that would allow the radiologists to divest themselves of some of their non-interpretative duties with respect to the performance of imaging tests. Through the collaborative efforts of the American College of Radiology and the American Society of Radiology Technologists a nationally recognized, baccalaureate-level curriculum has been designed for the training of RAs. A centerpiece of the curriculum is instruction in fluoroscopy. However, examinations of the GI tract by fluoroscopy are rapidly declining in frequency, raising doubt about the enhanced value an RA would bring to a radiology practice in the near future and worries about encroachment on the range of radiologists responsibilities over the long term.