The Impact of the Patient Protection and Affordable Care Act on Radiology: Beyond Reimbursement

The 2014 ACR Forum focused on the noneconomic implications of the Affordable Care Act on the field of radiology, with specific attention to the importance of the patient experience, the role of radiology in public and population health, and radiology’s role in the effort to lower overall health care costs. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to best prepare the radiology community for the rapidly evolving health care landscape.     

Radiology Support,Communication, and Alignment Network and Its Role to Promote Health Equity in the Delivery of Radiology Care

Racial, ethnic, and socioeconomic disparities in radiological care have been well documented in both the emergency and outpatient setting. Health IT has the potential to facilitate equitable care across diverse populations. Ordering the appropriate study is the first step in the greater mission of improving access and equity for everyone. Radiology Support, Communication, and Alignment Network (R-SCAN) is an informatics-based solution using clinical decision support (CDS) to promote health equity through optimization in appropriate imaging utilization. R-SCAN and CDS may help combat the potential implicit bias of clinicians by providing evidence-based imaging guidelines at the point of care and ensure that patients will receive equitable and appropriate imaging regardless of ethnic and socioeconomic background. By fostering multidisciplinary collaboration between radiologists and referring clinicians, R-SCAN initiatives across the nation have demonstrated successful reductions in inappropriate imaging utilization, particularly in regions with vulnerable populations.     

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

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

Point-of-Care Virtual Radiology Consultations in Primary Care: A Feasibility Study of a New Model for Patient-Centered Care in Radiology

BackgroundThe goal of this study is to assess the value of point-of-care virtual consultations in radiology.MethodsWe conducted an institutional review board–approved feasibility study of video-based radiology consultations in an internal medicine primary care clinic at a quaternary academic medical center. The study included 3 primary care providers (PCPs) and enrolled 43 patients. Inclusion criteria consisted of the following: age > 18 years, English speaking, recent radiology examination at our institution, and patient consenting to participate. Patients completed a pre- and postvisit survey. PCPs completed a postvisit survey. Primary study end points included the effect on patient and provider satisfaction, effect on patient experience and understanding of medical condition, and impact on PCP’s management decisions. Statistical significance was assessed using Fisher’s exact test.ResultsOf the enrolled patients, 93% (n = 40 of 43) indicated that they were satisfied with the virtual consultation visit. The PCPs were satisfied with the virtual consultation in 97% of consultations (n = 42 of 43). In addition, 88% (n = 38 of 43) of patients indicated improved understanding of their medical condition as a result of the virtual consultation, and 91% of patients (n = 39 of 43) were interested in similar consultations in the future. The participating PCPs indicated that the consultation was helpful in their management decisions in 83% of visits. Patient’s interest in receiving their imaging results from radiologist increased from 56% to 88% when comparing pre– and post–virtual consultation survey results (P = .03).ConclusionInitial experience with virtual radiology consultations show high rates of patient and provider satisfaction. Virtual radiology consultations have the potential to advance radiology’s value in care delivery.     

System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings

The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings. Our institution aimed to improve communication and follow-up of incidental radiology findings in ED patients through the collaborative development and implementation of system-level process changes including a standardized loop-closure method. We assembled a multidisciplinary team to address the nature of these incidental findings and designed new workflows and operational pathways for both radiology and ED staff to properly communicate incidental findings. Our results are based on all incidental findings received and acknowledged between November 1, 2016, and May 30, 2017. The total number of incidental findings discovered was 1,409. Our systematic compliance fluctuated between 45% and 95% initially after implementation. However, after overcoming various challenges through optimization, our system reached a compliance rate of 93% to 95%. Through the implementation of our new, standardized communication system, a high degree of compliance with loop closure for ED incidental radiology findings was achieved at our institution.     

Comprehensive Health Care Economics Curriculum and Training in Radiology Residency

PurposeTo investigate the ability to successfully develop and institute a comprehensive health care economics skills curriculum in radiology residency training utilizing didactic lectures, case scenario exercises, and residency miniretreats.MethodsA comprehensive health care economics skills curriculum was developed to significantly expand upon the basic ACGME radiology residency milestone System-Based Practice, SBP2: Health Care Economics requirements and include additional education in business and contract negotiation, radiology sales and marketing, and governmental and private payers’ influence in the practice of radiology.ResultsA health care economics curriculum for radiology residents incorporating three phases of education was developed and implemented. Phase 1 of the curriculum constituted basic education through didactic lectures covering System-Based Practice, SBP2: Health Care Economics requirements. Phase 2 constituted further, more advanced didactic lectures on radiology sales and marketing techniques as well as government and private insurers’ role in the business of radiology. Phase 3 applied knowledge attained from the initial two phases to real-life case scenario exercises and radiology department business miniretreats with the remainder of the radiology department.ConclusionA health care economics skills curriculum in radiology residency is attainable and essential in the education of future radiology residents in the ever-changing climate of health care economics. Institution of more comprehensive programs will likely maximize the long-term success of radiology as a specialty by identifying and educating future leaders in the field of radiology.     

双定位像结合Care Dose 4D和Care kV技术在降低肺部CT辐射剂量的临床应用价值

目的 探讨双定位像结合Care Dose 4D和Care kV技术在肺部CT检查中的可行性及其临床应用价值。方法 连续纳入临床确诊为肺部肿瘤行肺部CT扫描的患者60例,按随机数表法分为对照组和试验组,每组各30例,对照组行单定位像（AP）结合Care Dose 4D和Care kV技术扫描,试验组行双定位像（AP和lat）结合Care Dose 4D和Care kV技术扫描。由2位高年资医师采用双盲法对两组图像和病变组织的信噪比（SNR）、对比噪声比（CNR）,及整体图像质量进行综合分析和评价,同时计算有效辐射剂量。结果 60例患者均成功完成肺部CT检查,试验组整体图像质量评分为4.57±0.45,与对照组的4.73±0.45相比差异无统计学意义（P>0.05）。对照组图像SNR、CNR、病变组织SNR、CNR与试验组相比差异均无统计学意义（P>0.05）。试验组和对照组的容积CT剂量指数CTDI_vol、剂量长度乘积（DLP）、有效剂量（E）,差异有统计学意义（t=8.514、8.464、8.464,P<0.001）。与对照组相比,试验组有效剂量降低了33.3%。结论 较单定位像（AP）肺部CT检查,双定位像（AP和lat）结合Care Dose 4D和Care kV技术肺部CT检查可获得满足诊断及临床需求图像,同时明显降低辐射剂量,可成为肺部CT常规检查方式。