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Al Yassin A, Salehi Sadaghiani M, Mohan S, Bryan RN, Nasrallah I. It is About "Time": Academic Neuroradiologist Time Distribution for Interpreting Brain MRIs. Acad Radiol 2018; 25:1521-1525. [PMID: 29929936 DOI: 10.1016/j.acra.2018.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES Efficiency is central to current radiology practice. Knowledge of report generation timing is essential for workload optimization and departmental staffing decisions. Yet little research evaluates the distribution of activities performed by neuroradiologists in daily work. MATERIALS AND METHODS This observational study tracked radiologists interpreting 358 brain magnetic resonance imaging (MRI) in an academic practice over 9 months. We measured the total duration from study opening to report signing and times for five activities performed during this period: image viewing, report transcription, obtaining clinical data, education, and other. Attendings, fellows, and residents reading studies independently and attendings over-reading trainee-previewed studies were observed. RESULTS Ten attendings, 12 fellows, and 13 residents spent a mean of 11, 18, and 16 minutes reading brain MRIs independently. Mean duration was significantly different comparing attendings in all assignments to fellows (18.36 ± 1.05 minutes, p = 0.0001) or residents (16.31 ± 1.11 minutes, p = 0.001) but not between fellows/residents. Mean duration among attendings reading independently versus over-reading trainees was not statistically different. Attendings spent the same time on image viewing (4.07-5.33 minutes) with or without trainees. Attending transcription time was shortest when over-reading trainees (2.24 minutes) and longest when reading independently (4.20 minutes), demonstrating benefit of the draft report. Fellows and Residents spent longer on image viewing (7.14 minutes and 8.06 minutes, respectively) and transcription (7.02 minutes and 5.40 minutes, respectively) than attendings reading independently. CONCLUSION Neuroradiologist time/activity distributions for reading brain MRI studies were measured, setting the stage to establish a benchmark for future reference and suggesting opportunities for greater efficiency. Furthermore, report production time can be decreased when a draft report is available.
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Affiliation(s)
| | | | - Suyash Mohan
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ilya Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Institutional Pressure to Reduce Report Turnaround Time Is Damaging the Educational Mission. J Am Coll Radiol 2017; 14:537-540. [DOI: 10.1016/j.jacr.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 11/22/2022]
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England E, Collins J, White RD, Seagull FJ, Deledda J. Radiology report turnaround time: effect on resident education. Acad Radiol 2015; 22:662-7. [PMID: 25863792 DOI: 10.1016/j.acra.2014.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To compare resident workload from Emergency Department (ED) studies before and after the implementation of a required 1-hour report turnaround time (TAT) and to assess resident and faculty perception of TAT on resident education. MATERIALS AND METHODS Resident study volume will be compared for 3 years before and 1 year after the implementation of a required 1-hour TAT. Changes to resident workload will be compared among the different radiology divisions (body, muscuolskeletal (MSK), chest, and neuro), as well as during different shifts (daytime and overnight). Residents and faculty at two Midwest institutions, both of which have a required report TAT, will be invited to participate in an online survey to query the perceived effect on resident education by implementation of this requirement. A P < .05 was considered statistically significant. RESULTS A significant decrease in resident involvement in ED studies was noted in the MSK, chest, and neuro sections with average involvement of the 3 years before the 1-hour TAT of 89%, 88%, and 82%, respectively, which decreased to 66%, 68%, and 51% after the 1-hour TAT requirement (P < .05). The resident involvement in ED studies only mildly decreased in the body section from an average before the 1-hour TAT of 87% to 80% after the 1-hour TAT requirement (P < .1). There was an overall significant decrease in resident ED study involvement during the daytime (P = .01) but not after hours during resident call (P = .1). Seventy percent of residents (43 of 61) and 55% of faculty (63 of 114) responded to our surveys. Overall, residents felt their education from ED studies during the daytime and overnight were good. However, residents who were present both before and after the implementation of a required TAT felt their education had been significantly negatively affected. Faculty surveyed thought that the required TAT negatively affected their ability to teach and decreased the quality of resident education. CONCLUSIONS Residents are exposed to fewer ED studies after the implementation of a required 1-hour TAT. Overall, the current residents do not feel this decreased exposure to Emergency room studies affects their education. However, residents in training before and after this requirement feel their education has been significantly affected. Faculty perceives that the required TAT negatively affects their ability to teach, as well as the quality of resident education.
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Olisemeke B, Chen YF, Hemming K, Girling A. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review. J Digit Imaging 2014; 27:751-78. [PMID: 24888629 PMCID: PMC4391068 DOI: 10.1007/s10278-014-9706-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.
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Affiliation(s)
- B Olisemeke
- Radiology Department, Heart of England NHS Foundation Trust, Birmingham, UK,
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Lepanto L, Sicotte C, Lehoux P. Assessing task-technology fit in a PACS upgrade: do users' and developers' appraisals converge? J Digit Imaging 2012; 24:951-8. [PMID: 21465295 DOI: 10.1007/s10278-011-9378-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study was to measure users' perceived benefits of a picture archiving and communication system (PACS) upgrade, and compare their responses to those predicted by developers. The Task-Technology Fit (TTF) model served as the theoretical framework to study the relation between TTF, utilization, and perceived benefits. A self-administered survey was distributed to radiologists working in a university hospital undergoing a PACS upgrade. Four variables were measured: impact, utilization, TTF, and perceived net benefits. The radiologists were divided into subgroups according to their utilization profiles. Analysis of variance was performed and the hypotheses were tested with regression analysis. Interviews were conducted with developers involved in the PACS upgrade who were asked to predict impact and TTF. Users identified only a moderate fit between the PACS enhancements and their tasks, while developers predicted a high level of TTF. The combination of a moderate fit and an underestimation of the potential impact of changes in the PACS led to a low score for perceived net benefits. Results varied significantly among user subgroups. Globally, the data support the hypotheses that TTF predicts utilization and perceived net benefits, but not that utilization predicts perceived net benefits. TTF is a valid tool to assess perceived benefits, but it is important to take into account the characteristics of users. In the context of a technology that is rapidly evolving, there needs to be an alignment of what users perceive as a good fit and the functionality developers incorporate into their products.
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Affiliation(s)
- Luigi Lepanto
- Direction de l'évaluation des technologies et modes d'intervention en santé, Centre Hospitalier de l'Université de Montréal, 1058, St-Denis Street, Montreal, Quebec, Canada, H2X 3J4.
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Kumar PGA, Kirmani SJ, Humberg H, Kavarthapu V, Li P. Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. Orthopedics 2009; 32:815. [PMID: 19902895 DOI: 10.3928/01477447-20090922-08] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The reproducibility and accuracy of a digital software templating program on digital images was examined for primary uncemented total hip arthroplasty (THA). Forty-five patients waiting for an uncemented THA had templating performed of their digital picture archiving and communication systems (PACS) pelvic images with the TraumaCad software program (Orthocrat Ltd, Petach-Tikva, Israel). Acetabular cup size, femoral stem size, and femoral offset were noted by 2 observers, and again by 1 of the observers a week later. Through correlation coefficients and significance testing, the degree of intraobserver and interobserver variability was evaluated, as well as the level of accuracy for digital templating. Excellent correlation was found for all data sets, with no significant difference between them in intraobserver reproducibility. Also in terms of interobserver reproducibility, we found good levels of correlation, with no significant difference between the data sets. In terms of accuracy, the correlation was at least acceptable with no significant difference between any of the data sets. The use of the TraumaCad digital software program provides a reliable method of templating digital images for uncemented THAs. There is little intraobserver and interobserver variability, and the method produces an acceptable level of accuracy.
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King RJ, Craig PRS, Boreham BG, Majeed MA, Moran CG. The magnification of digital radiographs in the trauma patient: implications for templating. Injury 2009; 40:173-6. [PMID: 19095234 DOI: 10.1016/j.injury.2008.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 06/10/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Digital radiographs are increasingly used for planning orthopaedic surgical procedures, despite the fact that they are frequently not calibrated to correct for magnification. The typical magnification of digital radiographs in the trauma patient has not yet been reported. The aims of this study were to assess the magnification of such radiographs, and to discuss if and when accurate calibration is required for trauma templating. MATERIALS AND METHODS The operative notes and postoperative radiographs of 227 trauma patients were obtained. Each patient had undergone one of the following procedures: hip hemiarthroplasty, femoral nailing, tibial nailing, ankle plating, humeral nailing, humeral plating, or forearm plating. The dimensions of the implants used were measured on the uncalibrated postoperative radiographs using the hospital's Picture Archiving and Communication System software. The actual dimensions of the orthopaedic implants were obtained from the operation notes, and these were compared with the radiographic measurements. The intraobserver and interobserver variability of the radiographic measurements was also assessed. RESULTS The radiographic magnification was greatest for the femoral head, and most variable for the femoral shaft. The magnification was least for the forearm. In general the magnitude and variability of magnification was least at the peripheries. There was good correlation between the measured and actual dimensions of the implants. The intraobserver and interobserver variability between the radiographic measurements was extremely small. CONCLUSION Despite the ease and convenience of performing measurements on digital radiographs, these measurements are unreliable if the radiograph has not been calibrated. We believe that careful calibration of digital radiographs is essential for accurate templating in the trauma patient, although is less critical when templating the humeral canal, the tibial canal, the ankle and the forearm.
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Affiliation(s)
- R J King
- Trauma and Orthopaedic Surgery, Queen's Medical Centre, Nottingham, United Kingdom.
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Hurlen P, Østbye T, Borthne A, Gulbrandsen P. Introducing PACS to the late majority. A longitudinal study. J Digit Imaging 2008; 23:87-94. [PMID: 18979133 DOI: 10.1007/s10278-008-9160-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 08/21/2008] [Accepted: 09/28/2008] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to study whether the benefits from introducing a picture archiving and communication systems (PACS) reported by innovators and early adopters also can be achieved by a hospital belonging to the "late majority" and to see whether such benefits are sustained, using report turnaround time (RTAT) as an indicator. Activity-related data was retrieved from the radiology information system (RIS) over a 2-year period. The median RTAT for preliminary reports was initially reduced from 12 to 2 h then increased to 3 h. For final reports, the median RTAT was initially reduced from 23 to 13 h then gradually reverted back to 22 h. Innovators and early adopters demonstrate not only that positive results can be achieved but also the importance of involving key personnel. We believe that such involvement and the focus on wider organizational concerns are important when introducing PACS to the late majority, both for achieving and sustaining positive results.
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Affiliation(s)
- Petter Hurlen
- Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Mail Drawer 95, NO-1478, Lørenskog, Norway.
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Mackinnon AD, Billington RA, Adam EJ, Dundas DD, Patel U. Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit. Clin Radiol 2008; 63:796-804. [PMID: 18555038 DOI: 10.1016/j.crad.2007.12.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Revised: 12/21/2007] [Accepted: 12/24/2007] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the impact of picture archiving and communications systems (PACS) on reporting times and productivity in a large teaching hospital. MATERIALS AND METHODS Reporting time, defined as the time taken from patient registration to report availability, and productivity, defined as the number of reports issued per whole time equivalent (WTE) radiologist per month, were studied for 2 years pre- and 3 years post-PACS installation. Mean reporting time was calculated for plain radiographs and specialist radiology techniques [computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine]. Productivity, total department workload, and unreported film rates were also assessed. Pre- and post-PACS findings were compared. RESULTS Between 2002-2006 the number of radiological patient episodes increased by 30% from 11,531/month to 15,057/month. This was accompanied by a smaller increase in WTE reporting radiologists, from 32 to 37 (15%). Mean reporting times have improved substantially post-PACS, plain radiograph reporting time decreased by 26% (from 6.8 to 5 days; p=0.002) and specialty modalities by 24% (4.1 to 3.1 days; p<0.001). Radiologist productivity has increased by 18% (337 films to 407 films/WTE radiologist/month). Unreported films have decreased from 5 to 4% for plain radiographs and are steady for specialty modalities (< 1%). In most areas improvements have been sustained over a 3-year period. CONCLUSION Since the introduction of PACS, reporting times have decreased by 25% and the productivity improved by 18%. Sustained improvements are felt to reflect the efficiencies and cultural change that accompanied the introduction of PACS and digital dictation.
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Affiliation(s)
- A D Mackinnon
- Department of Radiology, St Georges Hospital NHS Trust, London, UK
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Buccoliero L, Calciolari S, Marsilio M, Mattavelli E. Picture, archiving and communication system in the Italian NHS: a primer on diffusion and evaluation analysis. J Digit Imaging 2008; 22:34-47. [PMID: 18293039 DOI: 10.1007/s10278-007-9101-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 11/18/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022] Open
Abstract
This contribution focuses on picture archiving and communication systems (PACS) in the Italian National Healthcare System (NHS). It finally aims to test the Chiefs Radiology Department's perceptions about PACS along the main evaluation dimensions emerging from the literature. First, a brief review of the main literature concerning PACS evaluation leads the authors to classify the different approaches undertaken and highlight the main variables of investigation. Second, the evidence emerging from a survey is presented and discussed in the light of the literature review. The survey aims to: (a) map out the degree of PACSs diffusion and their main features in the Italian NHS; (b) verify whether and how PACS impact the dimensions analyzed in many evaluation studies carried out to date; (c) test the relationship between some measured impacts and specific PACS features.
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Affiliation(s)
- Luca Buccoliero
- Centre for Research in Health and Social Care Management, CERGAS-Bocconi University and Public Management and Policy Department, SDA Bocconi School of Management, Via Bocconi 8, 20136 Milano, Italy.
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Abstract
Over the past decade, there have been many developments that have changed the practice of radiology and the education of radiology residents. These include workforce issues, the institution of the Accreditation Council for Graduate Medical Education duty-hours restrictions, the increased use of night float systems, and the implementation of picture archiving and communication systems as well as voice recognition. This article reviews the impact on resident education, summarizes potential problems introduced by these changes, and examines proposed solutions.
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Affiliation(s)
- Lori Deitte
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, FL 32209, USA.
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Nitrosi A, Borasi G, Nicoli F, Modigliani G, Botti A, Bertolini M, Notari P. A filmless radiology department in a full digital regional hospital: quantitative evaluation of the increased quality and efficiency. J Digit Imaging 2007; 20:140-8. [PMID: 17318704 PMCID: PMC1896266 DOI: 10.1007/s10278-007-9006-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 01/15/2007] [Accepted: 01/15/2007] [Indexed: 12/03/2022] Open
Abstract
Reggio Emilia hospital installed Picture Archiving and Communications Systems (PACS) as the final step towards a completely digital clinical environment completing the HIS/EMR and 1,400 web/terminals for patient information access. Financial benefits throughout the hospital were assessed upfront and measured periodically. Key indicators (radiology exam turnaround time, number of radiology procedures performed, inpatients length of stay before and after the PACS implementation, etc.) were analyzed and values were statistically tested to assess workflow and productivity improvements. The hospital went “filmless” in 28 weeks. Between the half of 2004 and the respective period in 2003, overall Radiology Department productivity increased by 12%, TAT improved by more than 60%. Timelier patient care resulted in decreased lengths of stay. Neurology alone experienced a 12% improvement in average patient stay. To quantify the impact of PACS on the average hospital stays and the expected productivity benefits to inpatient productivity were used a “high level” and a “detailed” business model. Annual financial upsides have exceeded $1.9 millions/year. A well-planned PACS deployment simplifies imaging workflow and improves patient care throughout the hospital while delivering substantial financial benefits. Staff buy-in was the key in this process and on-going training and process monitoring are a must.
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Affiliation(s)
- Andrea Nitrosi
- Servizio di Fisica Sanitaria, Arcispedale Santa Maria Nuova, V.le Risorgimento 80, 42100, Reggio Emilia, Italy.
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Davila JA, Kransdorf MJ, Duffy GP. Surgical planning of total hip arthroplasty: accuracy of computer-assisted EndoMap software in predicting component size. Skeletal Radiol 2006; 35:390-3. [PMID: 16572344 DOI: 10.1007/s00256-006-0106-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 12/06/2005] [Accepted: 12/12/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to assess the accuracy of a computer-assisted templating in the surgical planning of patients undergoing total hip arthroplasty utilizing EndoMap software (Siemans AG, Medical Solutions, Erlangen, Germany). Endomap Software is an electronic program that uses DICOM images to analyze standard anteroposterior radiographs for determination of optimal prosthesis component size. METHODS We retrospectively reviewed the preoperative radiographs of 36 patients undergoing uncomplicated primary total hip arthroplasty, utilizing EndoMap software, Version VA20. DICOM anteroposterior radiographs were analyzed using standard manufacturer supplied electronic templates to determine acetabular and femoral component sizes. No additional clinical information was reviewed. Acetabular and femoral component sizes were assessed by an orthopedic surgeon and two radiologists. Mean and estimated component size was compared with component size as documented in operative reports. RESULTS The mean estimated acetabular component size was 53 mm (range 48-60 mm), 1 mm larger than the mean implanted size of 52 mm (range 48-62 mm). Thirty-one of 36 acetabular component sizes (86%) were accurate within one size. The mean calculated femoral component size was 4 (range 2-7), 1 size smaller than the actual mean component size of 5 (range 2-9). Twenty-six of 36 femoral component sizes (72%) were accurate within one size, and accurate within two sizes in all but four cases (94%). CONCLUSION EndoMap Software predicted femoral component size well, with 72% within one component size of that used, and 94% within two sizes. Acetabular component size was predicted slightly better with 86% within one component size and 94% within two component sizes.
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Affiliation(s)
- Jesse A Davila
- Department of Radiology, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA
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Fleishon HB, Bhargavan M, Meghea C. Radiologists' reading times using PACS and using films: one practice's experience. Acad Radiol 2006; 13:453-60. [PMID: 16554225 DOI: 10.1016/j.acra.2005.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 12/16/2005] [Accepted: 12/19/2005] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES To measure the change in radiologists' productivity in terms of interpretation time per examination when using picture archiving and communication system (PACS) workstations in a particular private practice, Valley Radiologists, Ltd, as part of a feasibility study and subsequent business plan to implement a digital enterprise. MATERIALS AND METHODS Time to process a series of exams was measured for 18 radiologists during an uninterrupted period of a working day. Radiologists in the practice served in multiple locations. The data were analyzed in aggregate and by modality (plain film, ultrasound, computed tomography, and magnetic resonance imaging). Average time per exam, with and without PACS, was measured for each modality. Regression analysis was used to determine the independent effect of PACS on radiologist productivity. RESULTS The mean time to process an exam was 1.4 minutes (SE = 0.04) for plain film, 1.96 minutes (SE = 0.14) for ultrasound, 5.08 minutes (SE = 0.44) for computed tomography, and 6.83 minutes (SE = 0.31) for magnetic resonance imaging. Regression results indicate that PACS had no effect on the time taken to read a series of exams. CONCLUSIONS When considering a PACS purchase or implementation, decrease in radiologists' time to process an examination may not be realized. In this specific practice setting, we did not find evidence that PACS workstations alone, without any other changes in workflow design, improved radiologists' interpretation time.
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Affiliation(s)
- Howard B Fleishon
- Valley Radiologists Ltd., 5322 W. Northern Avenue, Glendale, AZ 85301, USA
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Abstract
Once the decision has been made to adopt PACS instead of a film-based radiology practice, there are a number of hurdles to jump. Users need to be aware of the impact the change will make on end users and be prepared to address issues that arise before they become problems. Someone who understands the technology of PACS must be identified to help make an informed decision about vendor selection, network architecture, workstation functionality, and archives. A PACS administrator should have the tools available to avoid problems with the system after implementation and should be able to repair the inevitable mistakes that will happen. Hopefully, this article can serve as a starting point for a potential new PACS adoption.
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Affiliation(s)
- Janice Honeyman-Buck
- Department of Radiology, 1600 SW Archer Road, PO Box 100374, University of Florida, Gainesville, FL 32610, USA
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Abstract
The purpose of this study was to measure the impact of electronic signature on report turnaround time. The Radiology Information System (RIS) database was interrogated to obtain a file containing all examinations recorded within a one-month period. Two sectors were specifically studied: abdominal ultrasound and chest radiography. Each of these sectors had one reader per day. The periods studied were October 2001 (before implementation of electronic signature) and February 2002 (3 months after electronic signature implementation). For the abdominal ultrasound examinations, the median time from transcription to final signature decreased from 11 days to 3 days with the introduction of electronic signature ( P < 0.001). For the chest radiographs, the median time from transcription to final signature decreased from 10 days to 5 days with the introduction of electronic signature ( P < 0.001). Electronic signature significantly shortens the time interval between transcription and finalization of radiology reports.
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Affiliation(s)
- Luigi Lepanto
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal-Hôpital Saint-Luc, 2nd floor, 1058 rue Saint-Denis, Montréal, Québec H2X 3J4, Canada.
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Oguz KK, Yousem DM, Deluca T, Herskovits EH, Beauchamp NJ. Impact of pager notification on report verification times. Acad Radiol 2002; 9:954-9. [PMID: 12186445 DOI: 10.1016/s1076-6332(03)80466-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to assess the impact on times of verification (TOVs) by a pager notification system (PNS) that informs physicians when reports are available for signature. MATERIALS AND METHODS An automated PNS was implemented in the authors' department in November 2000. Monthly report verification times of each physician were collected for 3 months in the years before and after initiation of the PNS. Radiologists enrolled in the PNS and those who were not were assigned into two groups for analysis. Mean TOVs for the two sets of 3 months and for the two groups were calculated and differences recorded. Two-tailed t tests were used to assess for statistical differences between the groups. RESULTS Twenty-nine of 37 radiologists voluntarily enrolled in the PNS (group 1). Mean TOV was 26.75 hours (standard deviation [SD] = 17.76) for these physicians before and 14.48 hours (SD = 11.86) after the PNS was employed (P < .01). For those physicians who did not enroll in the PNS, mean TOV was 11.53 hours (SD = 5.55) before and 9.77 hours (SD = 9.86) after the PNS was employed (P = .33). Both the absolute and percentage reductions in TOVs were significantly greater for those physicians enrolled in the PNS than for those who were not (P = .035). Twenty-three of 29 (79%) physicians who used the PNS showed a reduction in their report turnaround times. CONCLUSION Linking the PNS with the radiology information system to notify physicians of unsigned reports was effective in reducing report verification times.
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Affiliation(s)
- Kader Karli Oguz
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Twair AA, Torreggiani WC, Mahmud SM, Ramesh N, Hogan B. Significant savings in radiologic report turnaround time after implementation of a complete picture archiving and communication system (PACS). J Digit Imaging 2000; 13:175-7. [PMID: 11110256 PMCID: PMC3453071 DOI: 10.1007/bf03168392] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
One of the important advantages of the picture archiving and communication system (PACS) is the time saved in comparison with the conventional system. A group of 100 radiologic studies done in a conventional radiology department is compared with another group of the same number done in a completely filmless PACS department to assess the difference in the radiologist report turnaround time. There was a statistically significant (P < .00001) decrease in the median imaging-to-dictation time (IDT) of the PACS group (3 hours and 40 minutes) in comparison with the pre-PACS group (25 hours and 19 minutes). This can be attributed to the fact that PACS eliminates all the workload associated with hard copy films, thus, improving the department's efficiency and decreasing the number of lost films.
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Affiliation(s)
- A A Twair
- Department of Radiology, the Adelaide & Meath Hospital, Tallaght, Dublin, Ireland
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Abstract
It is commonly accepted that digital radiography (DR) improves workflow and patient throughput compared with traditional film radiography or computed radiography (CR). DR eliminates the film development step and the time to acquire the image from a CR reader. In addition, the wide dynamic range of DR is such that the technologist can perform the quality-control (QC) step directly at the modality in a few seconds, rather than having to transport the newly acquired image to a centralized QC station for review. Furthermore, additional workflow efficiencies can be achieved with DR by employing tight radiology information system (RIS) integration. In the DR imaging environment, this provides for patient demographic information to be automatically downloaded from the RIS to populate the DR Digital Imaging and Communications in Medicine (DICOM) image header. To learn more about this workflow efficiency improvement, we performed a comparative study of workflow steps under three different conditions: traditional film/screen x-ray, DR without RIS integration (ie, manual entry of patient demographics), and DR with RIS integration. This study was performed at the Cleveland Clinic Foundation (Cleveland, OH) using a newly acquired amorphous silicon flat-panel DR system from Canon Medical Systems (Irvine, CA). Our data show that DR without RIS results in substantial workflow savings over traditional film/screen practice. There is an additional 30% reduction in total examination time using DR with RIS integration.
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Affiliation(s)
- G A May
- Canon Research Center America, Palo Alto, CA 94304, USA.
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Mattern CW, Erickson BJ, King BF, Okryznski TW. Impact of electronic imaging on clinician behavior in the urgent care setting. J Digit Imaging 1999; 12:148-51. [PMID: 10342196 PMCID: PMC3452884 DOI: 10.1007/bf03168785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Although it is intuitively valuable that more expedient delivery of radiographic images and reports to clinicians would improve patient care, it is important to document these outcomes to validate further advances in these areas. We evaluated the care of 215 patients seen at a walk-in clinic to determine what benefit digital imaging is to the patient. Cohorts consisted of all patients for whom specified radiology examinations were ordered during a 7-day period. The first cohort was recruited when analog films were used. The second cohort received examinations performed with computed radiography (CR) acquisition and computer display, which had been in use for 2 years. Patients were categorized as to the type of study they received, as well as whether a staff radiologist was immediately available to read the study. Clinical behavior was characterized by outcome measures of time to final diagnosis, time to final treatment, and need for follow-up. Our analysis demonstrated a reduction in time to final diagnosis that was better appreciated during the times when a staff radiologist was not immediately available. It also suggested that greater time reductions were seen for patients who received extremity examinations than those who received chest, sinus, or rib films. These data suggest that digital imaging is a useful tool to improve clinical outcome of patients seen in the acute care setting.
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Affiliation(s)
- C W Mattern
- Mayo Medical Center, Rochester, MN 55905, USA
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