An Electronic Health Record Order Entry-Enabled Educational Intervention Is Not Effective in Reducing STAT Inpatient Radiology Orders

ObjectiveAssess whether introducing order priorities with defined performance expectations in the electronic health record (EHR) reduces immediate inpatient radiology orders.Materials and MethodsThis Institutional Review Board–approved, retrospective study was performed at a 776-bed academic hospital conducting 164,000+ inpatient radiology examinations annually. Study period was January 2, 2017, to July 23, 2017; 14 weeks pre- and postimplementation of an education-only intervention including replacing urgent and as soon as possible priorities with imaging within next 6, 12, or 24 hours; imaging in the morning; and required for discharge priorities. STAT routine, timed, today order priorities remained unchanged. Institution-wide training immediately pre- and postimplementation was provided through two waves of e-mail and electronic tip sheets. Primary outcome measure was total STAT studies ordered of total radiology studies ordered per week (STAT rate). Secondary outcomes were non-STAT, non-routine (non-SR) order rate, and routine order rate. Paired t test and statistical process control (SPC) analysis were performed.ResultsSTAT rate pre- (22.5%, 7,150 STAT of 31,765 total; weeks 1-14) and postintervention (23.4%, 7,481 STAT of 32,034 total; weeks 16-29) remained unchanged (P = .37). SPC demonstrated no special cause variation. Postintervention non-SR rate increased 3-fold (2.7%, 859 non-SR of 31,765 total pre-intervention versus 8.2%, 2,615 non-SR of 32,034 total postintervention; 8.2%/2.7% = 3.0; P < .0001). There was an 8.8% relative reduction in routine rate postintervention (73.9%, 23,471 routine of 31,765 total pre-intervention; 67.4%, 21,579 routine of 32,034 total postintervention; (73.9% ? 67.4%)/73.9% × 100 = 8.8%; P < .0001).ConclusionImplementing ordering priorities with defined performance expectations in the EHR reduced routine but did not reduce STAT inpatient radiology orders. More stringent interventions may be needed to reduce unnecessary STAT inpatient radiology ordering to improve use of limited imaging resources.     

Radiology Practices Employing Nurse Practitioners and Physician Assistants: Characteristics and Trends From 2017 Through 2019

PurposeThe number and roles of US nonphysician practitioners (NPPs) have expanded considerably, but little is known about their use by radiology practices. The authors assessed characteristics and trends of radiology practices employing Medicare-recognized NPPs.MethodsUsing Medicare databases from 2017 through 2019, the authors mapped all nurse practitioners and physician assistants (together “NPPs”) to employer groups for which all physicians were radiologists (“radiology practices”). Practices were characterized by size, geography, and radiologist characteristics. Temporal changes were assessed, and NPP employment likelihood was estimated using multivariate logistic regression modeling.ResultsAs the number of US radiology practices declined by 36.5% (from 2,643 to 1,679) between 2017 and 2019, the number employing NPPs increased by 10.5% (from 228 [8.6%] to 252 [15.0%]). The number of radiologists in NPP-employing practices increased by 10.4% (from 6,596 [35.1%] to 7,282 [40.0%]) as the number of radiology-employed NPPs increased by 17.5% (from 588 to 691). Practices were more likely to employ NPPs when medium (odds ratio [OR], 1.31) or large (OR, 1.25) in size, when urban located (OR, 1.35), and as their percentages of interventional radiologists increased (OR, 5.53 per percentage point) (P < .01 for all). Practices were less likely to employ NPPs as mean radiologist years since completing training increased (OR, 0.99 per year; P < .01).ConclusionsEmployment of NPPs by radiology practices has grown considerably in recent years, particularly in larger and urban practices and in those that employ more interventional and early-career radiologists. More work is necessary to better understand how this expanding use of NPPs affects the specialty.     

Influences of Radiology Trainees on Screening Mammography Interpretation

PurposeParticipation of radiology trainees in screening mammographic interpretation is a critical component of radiology residency and fellowship training. The aim of this study was to investigate and quantify the effects of trainee involvement on screening mammographic interpretation and diagnostic outcomes.MethodsScreening mammograms interpreted at an academic medical center by six dedicated breast imagers over a three-year period were identified, with cases interpreted by an attending radiologist alone or in conjunction with a trainee. Trainees included radiology residents, breast imaging fellows, and fellows from other radiology subspecialties during breast imaging rotations. Trainee participation, patient variables, results of diagnostic evaluations, and pathology were recorded.ResultsA total of 47,914 mammograms from 34,867 patients were included, with an overall recall rate for attending radiologists reading alone of 14.7% compared with 18.0% when involving a trainee (P < .0001). Overall cancer detection rate for attending radiologists reading alone was 5.7 per 1,000 compared with 5.2 per 1,000 when reading with a trainee (P = .517). When reading with a trainee, dense breasts represented a greater portion of recalls (P = .0001), and more frequently, greater than one abnormality was described in the breast (P = .013). Detection of ductal carcinoma in situ versus invasive carcinoma or invasive cancer type was not significantly different. The mean size of cancers in patients recalled by attending radiologists alone was smaller, and nodal involvement was less frequent, though not statistically significantly.ConclusionsThese results demonstrate a significant overall increase in recall rate when interpreting screening mammograms with radiology trainees, with no change in cancer detection rate. Radiology faculty members should be aware of this potentiality and mitigate tendencies toward greater false positives.     

The Adoption and Impact on Performance of an Automated Outcomes Feedback Application for Tomosynthesis Screening Mammography

ObjectiveTo evaluate a tomosynthesis screening mammography automated outcomes feedback application’s adoption and impact on performance.MethodsThis prospective intervention study evaluated a feedback application that provided mammographers subsequent imaging and pathology results for patients that radiologists had personally recalled from screening. Deployed to 13 academic and 5 private practice attending radiologists, adoption was studied from March 29, 2018, to March 20, 2019. Radiologists indicated if reviewed feedback would influence future clinical decisions. For a subset of eight academic radiologists consistently interpreting screening mammograms during the study, performance metrics were compared pre-intervention (January 1, 2016, to September 30, 2017) and post-intervention (October 1, 2017 to June 30, 2018). Abnormal interpretation rate, positive predictive value of biopsies performed, sensitivity, specificity, and cancer detection rate were compared using Pearson’s χ² test. Logistic regression models were fit, adjusting for age, race, breast density, prior comparison, breast cancer history, and radiologist.ResultsThe 18 radiologists reviewed 68.5% (1,398 of 2,042) of available feedback cases and indicated that 17.4% of cases (243 of 1,398) could influence future decisions. For the eight academic radiologist subset, after multivariable adjustment with comparison to pre-intervention, average abnormal interpretation rate decreased (from 7.5% to 6.7%, adjusted odds ratio [aOR] 0.86, P < .01), positive predictive value of biopsies performed increased (from 40.6% to 51.3%, aOR 1.48, P = .011), and specificity increased (from 93.0% to 93.9%, aOR 1.17, P < .01) post-intervention. There was no difference in cancer detection rate per 1,000 examinations (from 5.8 to 6.1, aOR 1.01, P = .91) or sensitivity (from 81.2% to 78.7%, aOR 0.84, P = .47).ConclusionsRadiologists used a screening mammography automated outcomes feedback application. Its use decreased false-positive examinations, without evidence of reduced cancer detection.     

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.     

Dedicated Diagnostic Radiology/Radiation Oncology Rounds: Added Value Beyond Traditional Tumor Boards

ObjectivesWe aimed to evaluate the impact of collaborative discussion between diagnostic radiologists and radiation oncologists on radiation oncology management for thoracic oncology patients.MethodsWe reviewed cases presented at multidisciplinary thoracic tumor boards (TTB) (n = 122) and diagnostic radiology/radiation oncology rounds (DR/ROR) (n = 45). Changes in planned radiation management following imaging discussion were categorized—no change, timing change, and treatment volume change. Phase of care was also classified. In DR/ROR, radiation oncologists were surveyed regarding (1) change in radiation oncology management and (2) change in confidence (both 5-point Likert scales).ResultsDiscussion of imaging with a radiologist changed radiation oncology management in 31.1% of TTB cases and 68.9% of DR/ROR cases (P < 0.001). Changes to the timing of initiating radiation therapy occurred with similar frequency in the 2 settings (31.1% vs 46.7%, P = 0.063). Changes to target volume occurred more frequently in DR/ROR (35.6% vs <1%), P < 0.001. Over half of imaging discussions in DR/ROR resulted in at least “moderate” change in radiation oncology management, and the level of confidence held by the radiation oncologists increased following discussion with radiologists in 95.6% of cases.ConclusionCollaborative discussions between radiation oncologists and diagnostic radiologists in a multispecialty tumor board and in targeted 2-specialty rounds are not redundant, but result in different management changes and at different phases of care. Our study emphasizes the importance of consultation with physicians as an area where radiologists can add value, specifically the added benefit of smaller collaborative discussions.     

Clinical Access and Utilization of Reports and Images in Neuroradiology

BackgroundThe radiology report serves as the primary means of communication between radiologist and clinician. However, the value clinicians place on imaging and reports is variable, with many images of studies or their reports never being viewed. This has implications on the perceived value of the radiologist in the imaging chain. We hypothesized that neurologists, neurosurgeons, and otolaryngologists would view neuroradiology images most frequently and neuroradiology reports least frequently of all medical specialties.Materials and MethodsOrdering data were collected on all neuroradiology studies over a 1-month period. Imaging study date and time stamps were obtained for (1) when imaging study orders were placed, (2) when the patient underwent the imaging study, (3) when the imaging studies were viewed, and (4) when the radiology reports were accessed and by whom. Each data point included provider names, locations, departments, and level of training.ResultsThere were 7,438 imaging neuroradiology studies ordered. Overall, 85.7% (6,372) of reports and 53.2% (3,956) of imaging studies were viewed and 13.1% (977) of studies had neither images nor reports viewed. Inpatient neurosurgeons and neurologists viewed both imaging and reports significantly more than primary care specialties (P < .001). In the outpatient setting, this trend stayed true for neurosurgeons though was not true for neurologists (P < .001). Outpatient study imaging and reports were both viewed the least (48.6%), and inpatient study reports were viewed the most (95.2%; P < .001).ConclusionViewing of imaging and reports varies with neurosurgeons viewing neuroradiology studies more than all other medical specialties. Overall, the reports were viewed significantly more than the images, suggesting that the radiologist and his or her interpretation are more valuable than the study’s images. The radiologists’ value, as measured by reports viewed, was maximal with obstetricians and gynecologists and psychiatry clinicians.     

Pediatric Emergency Imaging Studies in Academic Radiology Departments: A Nationwide Survey of Staffing Practices

ObjectiveParticularly for pediatric patients presenting with acute conditions or challenging diagnoses, identifying variation in emergency radiology staffing models is essential in establishing a standard of care. We conducted a cross-sectional survey among radiology departments at academic pediatric hospitals to evaluate staffing models for providing imaging interpretation for emergency department imaging requests.MethodsWe conducted an anonymous telephone survey of academic pediatric hospitals affiliated with an accredited radiology residency program across the United States. We queried the timing, location, and experience of reporting radiologists for initial and final interpretations of emergency department imaging studies, during weekday, overnight, and weekend hours. We compared weekday with overnight, and weekday with weekend, using Fisher’s exact test and an α of 0.05.ResultsSurveying 42 of 47 freestanding academic pediatric hospitals (89%), we found statistically significant differences for initial reporting radiologist, final reporting radiologist, and final report timing between weekday and overnight. We found statistically significant differences for initial reporting radiologist and final report timing between weekday and weekend. Attending radiologist involvement in initial reports was 100% during daytime, but only 33.3% and 69.0% during overnight and weekends. For initial interpretation during overnight and weekend, 38.1% and 28.6% use resident radiologists without attending radiologists, and 28.6% and 2.4% use teleradiology. All finalized reports as soon as possible during weekdays, but only 52.4% and 78.6% during overnight and weekend.DiscussionA minority of hospitals use 24-hour in-house radiology attending radiologist coverage. During overnight periods, the majority of academic pediatric emergency departments rely on resident radiologists without attending radiologist supervision or outside teleradiology services to provide initial reports. During weekend periods, over a quarter rely on resident radiologists without attending radiologist supervision for initial reporting. This demonstrates significant variation in staffing practices at academic pediatric hospitals. Future studies should look to determine whether this variation has any impact on standard of care.     

Diagnostic Performance of a New Convolutional Neural Network Algorithm for Detecting Developmental Dysplasia of the Hip on Anteroposterior Radiographs

ObjectiveTo evaluate the diagnostic performance of a deep learning algorithm for the automated detection of developmental dysplasia of the hip (DDH) on anteroposterior (AP) radiographs.Materials and MethodsOf 2601 hip AP radiographs, 5076 cropped unilateral hip joint images were used to construct a dataset that was further divided into training (80%), validation (10%), or test sets (10%). Three radiologists were asked to label the hip images as normal or DDH. To investigate the diagnostic performance of the deep learning algorithm, we calculated the receiver operating characteristics (ROC), precision-recall curve (PRC) plots, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared them with the performance of radiologists with different levels of experience.ResultsThe area under the ROC plot generated by the deep learning algorithm and radiologists was 0.988 and 0.988–0.919, respectively. The area under the PRC plot generated by the deep learning algorithm and radiologists was 0.973 and 0.618–0.958, respectively. The sensitivity, specificity, PPV, and NPV of the proposed deep learning algorithm were 98.0, 98.1, 84.5, and 99.8%, respectively. There was no significant difference in the diagnosis of DDH by the algorithm and the radiologist with experience in pediatric radiology (p = 0.180). However, the proposed model showed higher sensitivity, specificity, and PPV, compared to the radiologist without experience in pediatric radiology (p < 0.001).ConclusionThe proposed deep learning algorithm provided an accurate diagnosis of DDH on hip radiographs, which was comparable to the diagnosis by an experienced radiologist.     

Gender Disparity in Chest Radiology in North America

PurposeIn the current cultural climate, gender disparity is a topical and contentious issue. In academic medicine, there is an underrepresentation of female faculty in leadership positions with lower research output and fewer grant awards. We study the gender differences in faculty rank, leadership positions, and research output among chest radiologists in North America.Materials and MethodsA list of clinical faculty at radiology programs in North America was obtained using the FREIDA database and program websites. Demographic information and data pertaining to academic rank, peer-reviewed publications, and research productivity of each chest radiologist was obtained from Doximity and SCOPUS databases.ResultsFour hundred ten (281 male:129 female) academic chest radiologists were included. Females were underrepresented at senior faculty level accounting for 18.8% (n = 21) of full, 29.2% (n = 21) of associate and 40.7% (n = 61) of assistant professors. 23.1% (n = 14) of department chiefs were women. Women were more likely to occupy a faculty position in chest radiology in Canada than in US (P < 0.05). The median H-index, and numbers of publications and citations were lower for females than male faculty (P < 0.05). Male faculty had more years of experience – median of 19 years, 16.5 years for females (P < 0.05).ConclusionsGender disparity exists in chest radiology with similar male predominance in terms of senior faculty rank, leadership roles, and research productivity to other medical specialties. The observed deficiency of research and scholarly output among female chest radiologists and the paucity of aspirational female radiologists in senior academic/leadership positions are factors which perpetuate this gender disparity and contribute to persistence of the gender pay gap.     

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.     

A Multidisciplinary Approach to Improving Appropriate Follow-Up Imaging of Ovarian Cysts: A Quality Improvement Initiative

PurposeIncidental ovarian cysts are frequently detected on imaging. Despite published follow-up consensus statements, there remains variability in radiologist follow-up recommendations and clinician practice patterns. The aim of this study was to evaluate if collaborative ovarian cyst management recommendations and a radiologist decision support tool can improve adherence to follow-up recommendations.MethodsGynecologic oncologists and abdominal radiologists convened to develop collaborative institutional recommendations for the management of incidental, asymptomatic simple ovarian cysts detected on ultrasound, CT, and MRI. The recommendations were developed by modifying the published consensus recommendations developed by the Society of Radiologists in Ultrasound on the basis of local practice patterns and the experience of the group members. A less formal process involved the circulation of the published consensus recommendations, followed by suggestions for revisions and subsequent consensus, in similar fashion to the ACR Incidental Findings Committee II. The recommendations were developed by building on the published work of experienced groups to provide the authors’ medical community with a set of recommendations that could be endorsed by both the Department of Gynecology and the Department of Radiology to provide supportive guidance to the clinicians who manage incidental ovarian cysts. The recommendations were integrated into a radiologist decision support tool accessible from the dictation software. Nine months after tool launch, institutional review board approval was obtained, and radiology reports mentioning ovarian cysts in the prior 34 months were retrospectively reviewed. For cysts detected on ultrasound, adherence rates to Society of Radiologists in Ultrasound recommendations were calculated for examinations before tool launch and compared with adherence rates to the collaborative institutional recommendations after tool launch. Additionally, electronic medical records were reviewed to determine the follow-up chosen by the clinician.ResultsFor cysts detected on ultrasound, radiologist adherence to recommendations improved from 50% (98 of 197) to 80% (111 of 139) (P < .05). Overmanagement decreased from 34% (67 of 197) to 10% (14 of 139) (P < .05). A recommendation was considered “overmanaged” if the radiologist recommended follow-up when it was not indicated or if the recommended follow-up time was at a shorter interval than indicated. Clinician adherence to radiologist recommendations showed statistically nonsignificant improvement from 49% (36 of 73) to 57% (27 of 47) (P = .5034).ConclusionsManagement recommendations developed through collaboration with clinicians may help standardize follow-up of ovarian cysts and reduce overutilization.     

Physician Rating Websites: Do Radiologists Have an Online Presence?

PurposeGiven that patient satisfaction and provider transparency intersect on online physician-rating websites, we aimed to assess radiologist representation on these increasingly popular sites.MethodsFrom a directory of all Medicare participating physicians, we randomly selected 1,000 self-designated diagnostic radiologists and manually extracted their rating information from five popular online physician-review websites (HealthGrades, Healthcare Reviews, RateMDs, Kudzu, and Yelp). Using automated web “data-scraping” techniques, we separately extracted all radiologist and nonradiologist rating information from a single amenable site (Healthcare Reviews). Rating characteristics were analyzed.ResultsOf 1,000 sampled self-designated diagnostic radiologists representing all 50 states, only 197 (19.7%) were profiled on any of the five online physician-review websites. Only 24 (2.4%) were rated on two of the sites, and none was profiled on ≥3 sites. Of all 6,775 physicians listed on a single electronically interrogated site, only 30 (0.4%) were radiologists. With 28,555 (5.2%) of all 547,849 Medicare-participating physicians identified as diagnostic radiologists, radiologists were thus significantly underrepresented online (P < .0001). Although reviewed radiologists and nonradiologists were rated online by similar numbers of patients (1.13 ± 0.43 versus 1.03 ± 0.22, P = .22), radiologists were rated (on a low to high score of 1 to 10) significantly higher than nonradiologists (median 8.5 versus 5, P = .04).ConclusionsMost diagnostic radiologists are not profiled on common online physician-rating websites, and they are significantly underrepresented compared with nonradiologists. Reviewed radiologists, however, scored favorably. Given the potential for patient satisfaction scores and public domain information to affect referrals and future value-based payments, initiatives to enhance radiologists’ online presence are advised.     

Thyroid Nodules Detected on CT: A Retrospective Audit Study and Analysis of Differences in Reporting Practices Across Radiology Subspecialties

Thyroid nodules (TNs) are common incidental findings  on imaging and TN reporting practices are variable among radiologists, leading to unnecessary or inadequate investigations. We aimed to document current literature adherence for TN reporting practices on thoracic CTs and assess the variability in TN reporting across radiology subspecialties. This is a 2-parts retrospective study. First part was an audit study including all adult patients with thoracic CTs in January 2020. Patients with prior thyroidectomy and/or lack of TN were excluded. A local committee was created for literature review and elaboration of a local TN management algorithm. The algorithm was shared with the thoracic radiology team. Imaging and medical records were reviewed and adequate adherence was assessed in the pre- and post-intervention cohorts. Second part included all adult patients who underwent neck or cervical spine CT imaging in the same timeframe and with same inclusion/exclusion criteria as the pre-intervention thoracic cohort. In the pre-intervention cohort 802 participants were screened and 137 patients included. TNs were reported in “body” and “conclusion” of the report in 51% and 7% of the time respectively. Thyroid US was recommended in 10% of the patients and inadequately recommended 3% of the time. Overall adequate adherence was 86%. In the post-intervention cohort 962 participants were screened and 167 patients included. Thyroid US was recommended in 7% of the patients and no inadequate US recommendation was made. Overall adequate adherence in the post-intervention cohort was 93%, increased by 7% (P= 0.039). The musculoskeletal and neuroradiology cohorts reported more TNs in “conclusion” (P= 0.013 and P< 0.0001) and recommended more thyroid US (P = 0.033 and P= 0.0018) compared to the preintervention thoracic cohort. No significant difference in overall adequate adherence between subspecialties (P= 0.48 and P= 0.51). Improvement in adequate TN reporting on thoracic CT by 7% while reducing inadequate thyroid US recommendations from 3% to none. Significant reporting trends were also noted across radiology subspecialties.     

The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance

PurposeThe aim of this study was to assess the effect of overnight shifts (ONS) on radiologist fatigue, visual search pattern, and diagnostic performance.MethodsThis experimental study was approved by the institutional review board. Twelve radiologists (five faculty members and seven residents) each completed two sessions: one during a normal workday (“not fatigued”) and another in the morning after an ONS (“fatigued”). Each radiologist completed the Swedish Occupational Fatigue Inventory. During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. Viewing time, diagnostic confidence, and eye-tracking data were recorded.ResultsSwedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after ONS (P < .01). Overall, participants demonstrated worse diagnostic performance in the fatigued versus not fatigued state (P < .05). Total viewing time per case was longer when fatigued (35.9 ± 25.8 seconds) than not fatigued (24.8 ± 16.3 seconds) (P < .0001). Total viewing time per case was longer for residents (P < .05). Mean total fixations generated during the search increased by 60% during fatigued sessions (P < .0001). Mean time to first fixate on the fracture increased by 34% during fatigued sessions (P < .0001) and was longer for residents (P < .01). Dwell times associated with true- and false-positive decisions increased, whereas those with false negatives decreased.ConclusionsAfter ONS, radiologists were more fatigued with worse diagnostic performance, a 45% increase in view time per case, a 60% increase in total gaze fixations, and a 34% increase in time to fixate on the fracture. The effects of fatigue were more pronounced in residents.     

Comparison of Chest Radiograph Impressions for Diagnosing Pneumonia: Accounting for Categories of Language Certainty

ObjectivesUncertain language in chest radiograph (CXR) reports for the diagnosis of pneumonia is prevalent. The purpose of this study is to validate an a priori stratification of CXR results for diagnosing pneumonia based on language of certainty.DesignRetrospective chart review.Setting and participantsCXR reports of 2,411 patient visits ≥ 18 years, admitted to medicine, who received a CXR and noncontrast chest CT within 48 hours of emergency department registration at two large academic hospitals (tertiary and quaternary care) were reviewed.MethodsThe CXR and CT report impressions were categorized as negative, uncertain, or positive. Uncertain CXRs were further stratified into four categories based on language modifiers for the degree of pneumonia certainty. Comparison of CXR and CT results were determined using χ² test; a P value of less than .0033 was considered significant to account for multiple comparisons.ResultsCXR reports for the diagnosis of pneumonia revealed the following distribution: 61% negative, 32% uncertain, and 7% positive; CT reports were 55% negative, 22% uncertain, and 23% positive for the diagnosis of pneumonia. There were significant differences between CXR categories compared with CT categories for diagnosis of pneumonia (P < .001). Negative CXR results were not significantly different than the uncertain category with the most uncertain language (P = .030) but were significantly different from all other uncertain categories and positive CXR results (each P < .001). Positive CXR results were not significantly different than the least uncertain category (most certain language) (P = .130) but were significantly different from all other categories (each P < .001).Conclusions and implicationsLanguage used in CXR reports to diagnose pneumonia exists in categories of varying certainty and should be considered when evaluating patients for pneumonia.     

Factors Influencing Patients’ Perspectives of Radiology Imaging Centers: Evaluation Using an Online Social Media Ratings Website

PurposeThe goal of this study was to use patient reviews posted on Yelp.com, an online ratings website, to identify factors most commonly associated with positive versus negative patient perceptions of radiology imaging centers across the United States.MethodsA total of 126 outpatient radiology centers from the 46 largest US cities were identified using Yelp.com; 1,009 patient reviews comprising 2,582 individual comments were evaluated. Comments were coded as pertaining to either the radiologist or other service items, and as expressing either a positive or negative opinion. Distribution of comments was compared with center ratings using Fisher’s exact test.ResultsOverall, 14% of comments were radiologist related; 86% pertained to other aspects of service quality. Radiologist-related negative comments more frequent in low-performing centers (mean rating ≤2 on 1-5 scale) than high-performing centers (rating ≥4) pertained to imaging equipment (25% versus 7%), report content (25% versus 2%), and radiologist professionalism (25% versus 2%) (P < .010). Other service-related negative comments more frequent in low-performing centers pertained to receptionist professionalism (70% versus 21%), billing (65% versus 10%), wait times (60% versus 26%), technologist professionalism (55% versus 12%), scheduling (50% versus 17%), and physical office conditions (50% versus 5%) (P < .020). Positive comments more frequent in high-performing centers included technologist professionalism (98% versus 55%), receptionist professionalism (79% versus 50%), wait times (72% versus 40%), and physical office conditions (64% versus 25%) (P < .020).ConclusionsPatients’ perception of radiology imaging centers is largely shaped by aspects of service quality. Schedulers, receptionists, technologists, and billers heavily influence patient satisfaction in radiology. Thus, radiologists must promote a service-oriented culture throughout their practice.     

Agreement in the reporting of General Practitioner requested musculoskeletal radiographs: Reporting radiographers and consultant radiologists compared with an index radiologist

IntroductionThis study assessed the inter-observer agreement of reporting radiographers and consultant radiologists compared with an index radiologist when reporting General Practitioner (GP) requested musculoskeletal radiographs. The potential effect of discordant reports on patient management and outcome was also examined.MethodsThree reporting radiographers, three consultant radiologists and an index radiologist reported on a retrospective randomised sample of 219 GP requested musculoskeletal radiographs, in conditions simulating clinical practice. A speciality doctor in radiology compared the observers’ reports with the index radiologist report for agreement and assessed whether any discordance between reports was clinically important.ResultsOverall agreement with the index radiologist was 47.0% (95% CI, 40.5–53.6) and 51.6% (95% CI, 45.0–58.1) for the consultant radiologists and reporting radiographers, respectively. The results for the appendicular and axial skeleton were 48.6% (95% CI, 41.3–55.9) and 40.9% (95% CI, 27.7–55.6) for the radiologists, and 52.6% (95% CI, 45.2–59.8) and 47.7% (95% CI, 33.8–62.1) for the radiographers, respectively. The difference in overall observer agreement between the two professional groups with the index radiologist was not statistically significant (p = 0.34). Discordance with the index radiologist's reports was judged to be clinically important in less than 10% of the observer's reports.ConclusionReporting radiographers and consultant radiologists demonstrate similar levels of concordance with an index radiologist when reporting GP requested musculoskeletal radiographs.Implications for practiceThese findings contribute to the wider evidence base that selected radiographers with appropriate postgraduate education and training are proficient to report on musculoskeletal radiographs, irrespective of referral source.     

Comparing Artificial Intelligence Approaches to Retrieve Clinical Reports Documenting Implantable Devices Posing MRI Safety Risks

ObjectiveAssess sensitivity, specificity, and accuracy of two approaches to identify patients with implantable devices that pose safety risks for MRI—an expert-derived approach and an ontology-derived natural language processing (NLP). Determine the proportion of clinical data that identify these implantable devices.MethodsThis Institutional Review Board–approved retrospective study was performed at a 793-bed academic hospital. The expert-derived approach used an open-source software with a list of curated terms to query for implantable devices posing high safety risk (“MRI-Red”) in patients undergoing MRI. The ontology-derived approach used an NLP system with terms mapped to Systematized Nomenclature of Medicine—Clinical Terms. Queries were performed in three clinical data types—25,000 radiology reports, 174,769 emergency department (ED) notes, and 41,085 other clinical reports (eg, cardiology, operating room, physician notes, radiology reports, pathology reports, patient letters). Sensitivity, specificity, and accuracy of both methods against manual review of a randomly sampled 465 reports were assessed and tested for significant differences between expert-derived and ontology-derived approaches using t test.ResultsAccuracy, sensitivity, and specificity of expert-versus ontology-derived approaches were similar (0.83 versus 0.91, P = .080; 0.88 versus 0.96, P = .178; 0.82 versus 0.92, P = .110). The proportion of radiology reports, ED notes, and other clinical reports retrieved containing implantable devices with high safety risks for MRI ranged from 1.47% to 1.88%.DiscussionArtificial intelligence approaches such as expert-driven NLP and ontology-driven NLP have similar accuracy in identifying patients with implantable devices that pose high safety risks for MRI.