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Scharitzer M, Schima W, Walshe M, Verin E, Doratiotto S, Ekberg O, Farneti D, Pokieser P, Quaia E, Woisard V, Xinou E, Speyer R. ESSD-ESGAR best practice position statements on the technical performance of videofluoroscopic swallowing studies in adult patients with swallowing disorders. Eur Radiol 2025; 35:3169-3180. [PMID: 39636423 PMCID: PMC12081525 DOI: 10.1007/s00330-024-11241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 10/12/2024] [Accepted: 11/08/2024] [Indexed: 12/07/2024]
Abstract
OBJECTIVES Videofluoroscopic swallowing studies (VFSS) remain the gold standard for the instrumental assessment of oropharyngeal swallowing disorders alongside flexible endoscopic evaluation of swallowing (FEES), requiring a high standard of quality and correct implementation. The current best practice position statements aim to guide the clinical practice of VFSS in individuals experiencing swallowing disorders. MATERIALS AND METHODS An international expert consensus panel with expertise in oropharyngeal dysphagia, comprised of radiologists, speech-language therapists, otolaryngologists, and other professionals in the field, convened by the European Society of Swallowing Disorders (ESSD) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), developed best practice position statements. They were established using an online Delphi methodology involving an online panel discussion and item preparation and three consecutive rounds. Consensus was reached when ≥ 80% of the participants agreed on a specific recommendation. RESULTS Eighteen best practice position statements were formulated, thereby establishing standard recommendations on the technical performance of VFSS. They cover VFSS planning, correct implementation, documentation, radiation protection, equipment and maintenance, and education and training. CONCLUSION These position statements summarise the panel's deliberations and recommendations in performing VFSS, representing the agreed consensus of experts from ESSD and ESGAR. They provide a structured framework for optimising and standardising the performance of VFSS in patients with swallowing disorders. KEY POINTS Question Significant regional and national differences in clinical practice when performing VFSS highlight the need for interdisciplinary recommendations to optimise patient care. Findings Eighteen statements were developed by representatives of the ESSD and the ESGAR. Clinical relevance These best practice position statements on the technical performance of VFSS may serve as a basis for standardising the procedure and ensuring high-quality service.
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Affiliation(s)
- Martina Scharitzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Barmherzige Schwestern Krankenhaus, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Sankt Josef Krankenhaus, Vienna, Austria
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Eric Verin
- Department of Pulmonary Rehabilitation, UNIROUEN, Normandie University, Rouen, France
| | - Stefano Doratiotto
- Department of Diagnostic and Interventional Radiology, Ca' Foncello Hospital, Treviso, Italy
| | - Olle Ekberg
- Division of Medical Radiology, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Daniele Farneti
- Audiologic Phoniatric Service, ENT Department AUSL Romagna, Infermi Hospital, Rimini, Italy
| | - Peter Pokieser
- Teaching Center, Medical University of Vienna, Vienna, Austria
| | - Emilio Quaia
- Radiology Department, Padova University Hospital, University of Padova, Padova, Italy
| | - Virginie Woisard
- Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, University Hospital of Toulouse, Toulouse, France
| | - Ekaterini Xinou
- Radiology Department, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Renée Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway
- MILO Foundation, Centre for Augmentative and Alternative Communication, Schijndel, The Netherlands
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Bahr-Hamm K, Gouveris H, Leggewie B, Becker S, Bärhold F, Ernst BP. Structured Reporting in Sleep Medicine. Diagnostics (Basel) 2025; 15:1117. [PMID: 40361934 PMCID: PMC12071453 DOI: 10.3390/diagnostics15091117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Revised: 04/11/2025] [Accepted: 04/25/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Somnological findings are often written as free texts, supported by questionnaires. The quality and structure of free-text reports (FTRs) vary between examiners and specialties, depending on the individual level of expertise and experience in sleep medicine. This study aimed to compare the quality of free-text reports (FTRs) and structured reports (SRs) from somnological consultations in otolaryngology for patients assessed for obstructive sleep apnea (OSA). Methods: This study compared free-text reports (FTRs) and structured reports (SRs) from 50 patients with suspected OSA, including medical history, clinical examination findings, and medical letters, all prepared by six examiners with similar experience levels. A web-based approach was used to develop a standardized template for structured somnological reporting. The completeness and time required for both FTRs and SRs were evaluated, and a questionnaire was administered to assess user satisfaction with each reporting method. Results: The completeness scores of SRs were significantly higher than those of FTRs (88% vs. 54.2%, p < 0.001). The mean time to complete an SR was significantly shorter than that for FTRs (10.2 vs. 16.8 min, p < 0.001). SRs had significantly higher user satisfaction compared to FTRs (VAS 8.3 vs. 2.2, p < 0.001). Conclusions: Compared to FTRs, SRs for OSA patients are more comprehensive and faster. The use of SR is more satisfactory for examiners and supports the learning effect.
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Affiliation(s)
- Katharina Bahr-Hamm
- Department of Otorhinolarynoglogy, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Haralampos Gouveris
- Department of Otorhinolarynoglogy, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Barbara Leggewie
- Department of Otorhinolaryngology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Sven Becker
- Department of Otolaryngology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.B.); (F.B.)
| | - Friederike Bärhold
- Department of Otolaryngology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.B.); (F.B.)
| | - Benjamin Philipp Ernst
- Department of Otorhinolaryngology, University Medical Center Frankfurt, 60596 Frankfurt am Main, Germany;
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Ebersole BM, Chapman J, Warneke CL, Buoy S, Tang X, McMillan H, Aldridge E, Barbon CEA, Hutcheson KA. Compensatory Swallowing Strategies Recommended in Oncology Practice: Practice Patterns and Relationship to Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Grades. Dysphagia 2025:10.1007/s00455-024-10799-8. [PMID: 39827333 DOI: 10.1007/s00455-024-10799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 12/30/2024] [Indexed: 01/22/2025]
Abstract
Compensatory swallow strategies are recommended to improve swallow safety and efficiency; however, there is limited evidence on use in specific populations or their relationship to swallow study results. We sought to describe/explore strategy recommendations in an oncology practice and their relationship to Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) grades as a marker of clinical utility of the tool. This is a sub-study of a STARI-guided retrospective implementation evaluation at a single comprehensive cancer center. Electronic health record databases were queried to sample all modified barium swallow studies (MBS) for all adult oncology patients from 2016 to 2021, excluding total laryngectomy, leak studies and those with missing DIGEST grades. For patients with multiple MBS studies across the study period, one MBS was randomly selected to be included in the analytic sample. DIGEST grade, diet recommendation, oncologic details, and swallow strategy details were chart abstracted. Strategies and oral intake recommendations were classified from least to most restrictive. This study included 4570 patients representing diverse oncology populations (46% head and neck). DIGEST grades indicating at least mild dysphagia (grades ≥ 1) were reported in 2486 of MBS (54%). Strategies were recommended in 2028 MBS (44%). As DIGEST grade increased so did strategy utilization and complexity (Spearman's r (rS) = 0.76, p < 0.0001). This pattern was consistent for Safety (rS = 0.68) and Efficiency (rS = 0.73) grades (both p < 0.0001). Swallow strategies are frequently recommended in oncology populations. This is the first study to show a systematic link between DIGEST grade and MBS compensatory strategy recommendations, supporting clinical effectiveness of DIGEST as an evidence-based practice tool.
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Affiliation(s)
- Barbara M Ebersole
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Julianna Chapman
- Department of Rehabilitation, Newberg Medical Center, Newberg, OR, USA
| | - Carla L Warneke
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sheila Buoy
- Department of Head and Neck Surgery-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Tang
- Department of Head and Neck Surgery-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Holly McMillan
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Ella Aldridge
- Department of Head and Neck Surgery-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carly E A Barbon
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Yang Q, Peng R, Ma L, Han Y, Yuan L, Yin D, Li A, Wang Y, Zheng M, Huang Y, Ren J. "3 + X D" structured report in radiology standardized resident training: Can it meet high-level teaching objectives? Eur J Radiol 2024; 181:111780. [PMID: 39423779 DOI: 10.1016/j.ejrad.2024.111780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/22/2024] [Accepted: 10/08/2024] [Indexed: 10/21/2024]
Abstract
PURPOSE To evaluate the impact of the innovative "3 + X D" structured report (SR) designed based on Bloom's taxonomy on the learning outcomes of radiology residents during standardized training. METHODS This is a prospective study that recruited 120 radiology residents from our hospital between 2020 and 2022. Randomly selected 60 residents from the 2020 grade to constituted the control group, and randomly selected 60 residents from the 2021 grade to formed the experimental group. The former group was trained utilizing the Free-text Reports (FTR) template, while the latter group received training with the "3 + X D" structured reports (SR) template. The learning outcomes of both groups was evaluated utilizing both objective and subjective measures. Objective assessments encompassed examinations of theoretical knowledge, diagnostic skills, and total scores, aligning with the cognitive domains of remembering, understanding, applying, and analyzing as outlined by Bloom's Taxonomy. Subjective assessments, on the other hand, comprised survey questionnaires administered to residents and feedback from clinical instructors, which correlated with the higher-order cognitive level of analyzing, evaluating, and creating within Bloom's Taxonomy. RESULTS On 60 residents (mean age, 24.15 years ± 2.11[SD]; 25 male) from control group, and 60 residents (mean age, 24.58 years ± 1.88 [SD]; 27 male) from experimental group. Following the training, significant improvements were observed in the theoretical knowledge, diagnostic skills, and total scores for both groups (p < 0.001). Furthermore, the experimental group demonstrated significantly higher diagnostic skills and total scores compared to the control group (p < 0.001). However, no significant difference was observed in the theoretical knowledge exam between the two groups (p = 0.236). The questionnaire used for subjective assessments had good reliability (Cronbach α was 0.826) and acceptable validity (The KMO was 0.692). Additionally, the survey questionnaires indicated that the experimental group rated higher than the control group in terms of cultivating imaging thinking ability, diagnostic confidence, diagnostic speed, and the convenience of the templates (p < 0.001). Clinicians' feedback scores for the experimental group markedly surpassed those for the control group (p < 0.05). CONCLUSIONS Utilizing the "3 + X D" SR template grounded in Bloom's taxonomy for training, the professional competency of radiology residents, particularly their diagnostic skills, saw a marked enhancement, successfully meeting the higher-level educational objectives. Consequently, the "3 + X D" SR template is highly recommended for the standardized training of radiology residents.
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Affiliation(s)
- Qingling Yang
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China; Department of Interventional Surgery Center, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Rui Peng
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Lina Ma
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Ye Han
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Lei Yuan
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Danqing Yin
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Aceng Li
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Yang Wang
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Yayu Huang
- Internal Medicine Teaching and Research Office, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China
| | - Jing Ren
- Department of Radiology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), 127 Chang Le West Road, Xi'an, Shaanxi Province, China.
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Dhar SI, Nativ-Zeltzer N, Starmer H, Morimoto LN, Evangelista L, O'Rourke A, Fritz M, Rameau A, Randall DR, Cates D, Allen J, Postma G, Kuhn M, Belafsky P. The American Broncho-Esophagological Association Position Statement on Swallowing Fluoroscopy. Laryngoscope 2023; 133:255-268. [PMID: 35543231 DOI: 10.1002/lary.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop an expert consensus statement on the clinical use of swallowing fluoroscopy in adults that reduces practice variation and identifies opportunities for quality improvement in the care of patients suffering from swallowing impairment. METHODOLOGY A search strategist reviewed data sources (PubMed, Embase, Cochrane, Web of Science, Scopus) to use as evidence for an expert development group to compose statements focusing on areas of controversy regarding swallowing fluoroscopy. Candidate statements underwent two iterations of a modified Delphi protocol to reach consensus. RESULTS A total of 2184 publications were identified for title and abstract review with 211 publications meeting the criteria for full text review. Of these, 148 articles were included for review. An additional 116 publications were also included after reviewing the references of the full text publications from the initial search. These 264 references guided the authors to develop 41 candidate statements in various categories. Forty statements encompassing patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study and esophagram techniques, and interpretation of swallowing fluoroscopy met criteria for consensus. One statement on esophagram technique reached near-consensus. CONCLUSIONS These 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults can guide the development of best practices, improve quality and safety of care, and influence policy in both the outpatient and inpatient settings. The lack of consensus on some aspects of esophagram technique likely reflects gaps in knowledge and clinical practice variation and should be a target for future research. Laryngoscope, 133:255-268, 2023.
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Affiliation(s)
- Shumon Ian Dhar
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | | | - Lisa Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Ashli O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Mark Fritz
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Anaïs Rameau
- The Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, U.S.A
| | - Derrick R Randall
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Jacqueline Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory Postma
- Department of Otolaryngology-Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Maggie Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Peter Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
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Seyedhasani SN, Dorri S, Pournik O, Alamdaran SA, Eslami S. Improving data adequacy of ultrasonography reports for non-alcoholic fatty liver disease (NAFLD) through a national structured template. Acta Radiol 2023; 64:473-478. [PMID: 35538852 DOI: 10.1177/02841851221093141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a prevalent disorder that increases due to lifestyle, the rising rate of obesity, and population ages worldwide. Diagnostic ways, including sonography, do not have an explicit reporting structure. PURPOSE To create a structure template for NAFLD reporting, investigate its completeness, and assess the specialist opinions of using it in clinical practice. MATERIAL AND METHODS A structured reporting template (SRT) was designed and implemented in four stages. At first, important features were extracted from a comprehensive literature review and were evaluated by 10 radiologists and gastroenterologists using the Likert scale. Finally, the usefulness of the SRT in comparison with the conventional reporting template (CRT) was judged by 10 gastroenterologists completing the questionnaire. RESULTS Demographic information and sonography of the liver, gallbladder, and spleen organs were the most critical features. The completeness scores of SRT reports were higher than CRT scores for almost all the factors studied. The difference in the scores was significant for most of the parameters. Moreover, the total completeness score increased from 42% in CRT to 92% in SRT. A comparison of the report adequacy of two reports was seen in all items. The SRT obtained more rates from specialists. CONCLUSION Introduction of the SRT for NAFLD significantly enhanced the completeness of reporting to reduce variability in the interpretation of the related reports by clinicians. Nevertheless, more studies are needed to generalize the results in real scales for patients with NAFLD.
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Affiliation(s)
- Seyedeh Nahid Seyedhasani
- Department of Health Information Technology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Health Sciences Research Center, 435810Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Sara Dorri
- Health Information Technology Research Center, 48455Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Pournik
- Department of Community Medicine, School of Medicine, 440827Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeid Eslami
- Department of Medical Informatics, School of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
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7
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Fei X, Chen P, Wei L, Huang Y, Xin Y, Li J. Quality Management of Pulmonary Nodule Radiology Reports Based on Natural Language Processing. Bioengineering (Basel) 2022; 9:244. [PMID: 35735487 PMCID: PMC9220149 DOI: 10.3390/bioengineering9060244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022] Open
Abstract
To investigate the feasibility of automated follow-up recommendations based on findings in radiology reports, this paper proposed a Natural Language Processing model specific for Pulmonary Nodule Radiology Reports. Unstructured findings used to describe pulmonary nodules in 48,091 radiology reports were processed in this study. We established an NLP model to extract information entities from findings of radiology reports, using deep learning and conditional random-field algorithms. Subsequently, we constructed a knowledge graph comprising 168 entities and four relationships, based on the export recommendations of the internationally renowned Fleischner Society for pulmonary nodules. These were employed in combination with rule templates to automatically generate follow-up recommendations. The automatically generated recommendations were then compared to the impression part of the reports to evaluate the matching rate of proper follow ups in the current situation. The NLP model identified eight types of entities with a recognition accuracy of up to 94.22%. A total of 43,898 out of 48,091 clinical reports were judged to contain appropriate follow-up recommendations, corresponding to the matching rate of 91.28%. The results show that NLP can be used on Chinese radiology reports to extract structured information at the content level, thereby realizing the prompt and intelligent follow-up suggestion generation or post-quality management of follow-up recommendations.
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Affiliation(s)
- Xiaolu Fei
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (X.F.); (P.C.); (L.W.); (Y.H.)
| | - Pengyu Chen
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (X.F.); (P.C.); (L.W.); (Y.H.)
| | - Lan Wei
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (X.F.); (P.C.); (L.W.); (Y.H.)
| | - Yue Huang
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (X.F.); (P.C.); (L.W.); (Y.H.)
| | - Yi Xin
- School of Life Science, Beijing Institute of Technology, Beijing 100081,China;
| | - Jia Li
- Information Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (X.F.); (P.C.); (L.W.); (Y.H.)
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8
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Nobel JM, van Geel K, Robben SGF. Structured reporting in radiology: a systematic review to explore its potential. Eur Radiol 2022; 32:2837-2854. [PMID: 34652520 PMCID: PMC8921035 DOI: 10.1007/s00330-021-08327-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/15/2021] [Accepted: 09/13/2021] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Structured reporting (SR) in radiology reporting is suggested to be a promising tool in clinical practice. In order to implement such an emerging innovation, it is necessary to verify that radiology reporting can benefit from SR. Therefore, the purpose of this systematic review is to explore the level of evidence of structured reporting in radiology. Additionally, this review provides an overview on the current status of SR in radiology. METHODS A narrative systematic review was conducted, searching PubMed, Embase, and the Cochrane Library using the syntax 'radiol*' AND 'structur*' AND 'report*'. Structured reporting was divided in SR level 1, structured layout (use of templates and checklists), and SR level 2, structured content (a drop-down menu, point-and-click or clickable decision trees). Two reviewers screened the search results and included all quantitative experimental studies that discussed SR in radiology. A thematic analysis was performed to appraise the evidence level. RESULTS The search resulted in 63 relevant full text articles out of a total of 8561 articles. Thematic analysis resulted in 44 SR level 1 and 19 level 2 reports. Only one paper was scored as highest level of evidence, which concerned a double cohort study with randomized trial design. CONCLUSION The level of evidence for implementing SR in radiology is still low and outcomes should be interpreted with caution. KEY POINTS • Structured reporting is increasingly being used in radiology, especially in abdominal and neuroradiological CT and MRI reports. • SR can be subdivided into structured layout (SR level 1) and structured content (SR level 2), in which the first is defined as being a template in which the reporter has to report; the latter is an IT-based manner in which the content of the radiology report can be inserted and displayed into the report. • Despite the extensive amount of research on the subject of structured reporting, the level of evidence is low.
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Affiliation(s)
- J Martijn Nobel
- Department of Radiology, Maastricht University Medical Center+, Postbox 5800, 6202 AZ, Maastricht, the Netherlands.
- Department of Educational Development and Research and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Koos van Geel
- Department of Educational Development and Research and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
- Department of Medical Imaging of Zuyderland Medical Center, Heerlen, the Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center+, Postbox 5800, 6202 AZ, Maastricht, the Netherlands
- Department of Educational Development and Research and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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9
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Effects of Transcranial Direct Durrent Stimulation on Post-stroke Dysphagia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2022; 103:1436-1447. [PMID: 35337844 DOI: 10.1016/j.apmr.2022.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This review aimed to systematically evaluate the effect of transcranial direct current stimulation (tDCS) on post-stroke dysphagia. DATA SOURCES PubMed, Cochrane Library (CENTRAL), Web of Science, VIP, CNKI, and Wanfang databases were systematically searched up to June 2021. STUDY SELECTION Randomized controlled trials (RCTs) on the effects of tDCS on post-stroke dysphagia DATA EXTRACTION: The extracted data included the author, country of publication, time of publication, key elements of bias risk assessment (such as randomized controlled trials and blind methods), sample size and basic information (age, course of disease, stroke location), intervention measures, treatment methods of tDCS (stimulation location, intensity, and duration), relevant outcome indicators, and relevant data (standard deviations).The Cochrane Risk of Bias Assessment Tool and PEDro Scale were used to assess the risk of bias. DATA SYNTHESIS Sixteen RCTs were included in this meta-analysis. Overall, the results revealed a large and statistically significant pooled effect size (0.80, CI 0.45-1.14; p<0.00001). The subgroup that explored the course of the disease yielded a large and significant effect size for the chronic phase group (0.80, CI 0.43-1.16; p<0.0001). For the stimulation intensity, 1 mA and 1.6 mA showed a moderate and significant effect sizes (0.47, CI 0.13-0.81; p=0.006 vs 1.39, CI 0.69-2.08; p<0.0001). In the subgroup analyses, the affected (0.87, CI 0.26-1.48; p=0.005) vs. unaffected (0.61, CI 0.23-0.99; p=0.002) hemisphere showed a significant result, and stimulation of the affected hemisphere had a more obvious effect. Subgroup analysis of stroke location showed that tDCS was effective for dysphagia after unilateral hemispheric stroke, bulbar paralysis, and brainstem stroke but not for dysphagia after ataxic and basal ganglia stroke. However, the subgroup analysis of stroke location revealed a significant result (0.81, CI 0.44-1.18; p<0.001). CONCLUSION This meta-analysis demonstrated the height and significant beneficial effect of tDCS on improving post-stroke dysphagia.
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Chan CH, Huang WC, Lu YC, Hsiao HF, Chan WP. BatchBMD as an Efficient and Accurate Dual-Energy X-ray Absorptiometry Report Generator. Diagnostics (Basel) 2021; 11:diagnostics11122403. [PMID: 34943639 PMCID: PMC8700356 DOI: 10.3390/diagnostics11122403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/04/2022] Open
Abstract
Dual-energy X-ray absorptiometry is the gold standard for evaluating Bone Mineral Density (BMD); however, a typical BMD report is generated in a time-inefficient manner and is prone to error. We developed a rule-based automated reporting system, BatchBMD, that accelerates DXA reporting while improving its accuracy over current systems. BatchBMD generates a structured report, customized to the specific clinical purpose. To compare BatchBMD to a Web-based Reporting (WBR) system for efficiency and accuracy, 500 examinations were randomly chosen from those performed at the Taipei Municipal Wanfang Hospital from January to March 2021. The final assessment included all 2326 examinations conducted from September 2020 to March 2021. The average reporting times were 6.7 and 10.8 min for BatchBMD and the WBR system, respectively, while accuracy was 99.4% and 98.2%, respectively. Most of the errors made by BatchBMD were digit errors in the appendicular skeletal muscle index. After correcting this, 100% accuracy across all 2326 examinations was validated. This automated and accurate BMD reporting system significantly reduces report production workload for radiologists and technicians while increasing productivity and quality. Additionally, the portable software, which employs a simple framework, can reduce deployment costs in clinical practice.
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Affiliation(s)
- Chun-Hsiang Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-H.C.); (Y.-C.L.); (H.-F.H.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Wen-Chi Huang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 106, Taiwan;
| | - Yi-Chien Lu
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-H.C.); (Y.-C.L.); (H.-F.H.)
| | - Hsing-Fen Hsiao
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-H.C.); (Y.-C.L.); (H.-F.H.)
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (C.-H.C.); (Y.-C.L.); (H.-F.H.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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11
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ENT Residents Benefit from a Structured Operation Planning Approach in the Training of Functional Endoscopic Sinus Surgery. MEDICINA-LITHUANIA 2021; 57:medicina57101062. [PMID: 34684099 PMCID: PMC8541081 DOI: 10.3390/medicina57101062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 01/11/2023]
Abstract
Background and Objectives: Preoperative planning utilizing computed tomographies (CT) is of utmost importance in functional endoscopic sinus surgery (FESS). Frequently, no uniform documentation and planning structures are available to residents in training. Consequently, overall completeness and quality of operation planning may vary greatly. The objective of the present study was to evaluate the impact of a structured operation planning (SOP) approach on the report quality and user convenience during a 4-day sinus surgery course. Materials and Methods: Fifteen participant were requested to plan a FESS procedure based on a CT scan of the paranasal sinuses that exhibited common pathological features, in a conventional manner, using a free text. Afterwards, the participants reevaluated the same scans by means of a specifically designed structured reporting template. Two experienced ENT surgeons assessed the collected conventional operation planning (COP) and SOP methods independently with regard to time requirements, overall quality, and legibility. User convenience data were collected by utilizing visual analogue scales. Results: A significantly greater time expenditure was associated with SOPs (183 s vs. 297 s, p = 0.0003). Yet, legibility (100% vs. 72%, p < 0.0001) and overall completeness (61.3% vs. 22.7%, p < 0.0001) of SOPs was significantly superior to COPs. Additionally, description of highly relevant variants in anatomy and pathologies were outlined in greater detail. User convenience data delineated a significant preference for SOPs (VAS 7.9 vs. 6.9, p = 0.0185). Conclusions: CT-based planning of FESS procedures by residents in training using a structured approach is more time-consuming while producing a superior report quality in terms of detailedness and readability. Consequently, SOP can be considered as a valuable tool in the process of preoperative evaluations, especially within residency.
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Standiford TC, Farlow JL, Brenner MJ, Conte ML, Terrell JE. Clinical Decision Support Systems in Otolaryngology-Head and Neck Surgery: A State of the Art Review. Otolaryngol Head Neck Surg 2021; 166:35-47. [PMID: 33874795 DOI: 10.1177/01945998211004529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To offer practical, evidence-informed knowledge on clinical decision support systems (CDSSs) and their utility in improving care and reducing costs in otolaryngology-head and neck surgery. This primer on CDSSs introduces clinicians to both the capabilities and the limitations of this technology, reviews the literature on current state, and seeks to spur further progress in this area. DATA SOURCES PubMed/MEDLINE, Embase, and Web of Science. REVIEW METHODS Scoping review of CDSS literature applicable to otolaryngology clinical practice. Investigators identified articles that incorporated knowledge-based computerized CDSSs to aid clinicians in decision making and workflow. Data extraction included level of evidence, Osheroff classification of CDSS intervention type, otolaryngology subspecialty or domain, and impact on provider performance or patient outcomes. CONCLUSIONS Of 3191 studies retrieved, 11 articles met formal inclusion criteria. CDSS interventions included guideline or protocols support (n = 8), forms and templates (n = 5), data presentation aids (n = 2), and reactive alerts, reference information, or order sets (all n = 1); 4 studies had multiple interventions. CDSS studies demonstrated effectiveness across diverse domains, including antibiotic stewardship, cancer survivorship, guideline adherence, data capture, cost reduction, and workflow. Implementing CDSSs often involved collaboration with health information technologists. IMPLICATIONS FOR PRACTICE While the published literature on CDSSs in otolaryngology is finite, CDSS interventions are proliferating in clinical practice, with roles in preventing medical errors, streamlining workflows, and improving adherence to best practices for head and neck disorders. Clinicians may collaborate with information technologists and health systems scientists to develop, implement, and investigate the impact of CDSSs in otolaryngology.
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Affiliation(s)
| | - Janice L Farlow
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Marisa L Conte
- Department of Research and Informatics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jeffrey E Terrell
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Geyer T, Rübenthaler J, Marschner C, von Hake M, Fabritius MP, Froelich MF, Huber T, Nörenberg D, Rückel J, Weniger M, Martens C, Sabel L, Clevert DA, Schwarze V. Structured Reporting Using CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma (HCC)-Impact and Advantages on Report Integrity, Quality and Interdisciplinary Communication. Cancers (Basel) 2021; 13:cancers13030534. [PMID: 33572502 PMCID: PMC7866827 DOI: 10.3390/cancers13030534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Contrast-enhanced ultrasound (CEUS) is an increasingly accepted imaging modality for visualizing hepatocellular carcinoma (HCC) and is recommended as a secondary imaging option by most leading hepatology societies. In recent years, the use of structured reporting (SR) has been recommended by several societies to standardize report content and improve report quality of various diagnostic modalities when compared to conventional free-text reports (FTR). Our single-center study aimed to evaluate the use of SR using a CEUS LI-RADS software template in CEUS examinations of 50 HCC patients. SR significantly increased report integrity, satisfaction of the referring physicians, linguistic quality and overall report quality compared to FTR. Therefore, the use of SR in CEUS examinations of HCC patients may represent a valuable tool to facilitate clinical decision-making and improve interdisciplinary communication in the future. Abstract Background: Our retrospective single-center study aims to evaluate the impact of structured reporting (SR) using a CEUS LI-RADS template on report quality compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC). Methods: We included 50 patients who underwent CEUS for HCC staging. FTR created after these examinations were compared to SR retrospectively generated by using template-based online software with clickable decision trees. The reports were evaluated regarding report completeness, information extraction, linguistic quality and overall report quality by two readers specialized in internal medicine and visceral surgery. Results: SR significantly increased report completeness with at least one key feature missing in 31% of FTR vs. 2% of SR (p < 0.001). Information extraction was considered easy in 98% of SR vs. 86% of FTR (p = 0.004). The trust of referring physicians in the report was significantly increased by SR with a mean of 5.68 for SR vs. 4.96 for FTR (p < 0.001). SR received significantly higher ratings regarding linguistic quality (5.79 for SR vs. 4.83 for FTR (p < 0.001)) and overall report quality (5.75 for SR vs. 5.01 for FTR (p < 0.001)). Conclusions: Using SR instead of conventional FTR increases the overall quality of reports in CEUS examinations of HCC patients and may represent a valuable tool to facilitate clinical decision-making and improve interdisciplinary communication in the future.
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Affiliation(s)
- Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
- Correspondence: ; Tel.: +49-894-4007-3620
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
| | - Constantin Marschner
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
| | - Malte von Hake
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
| | - Matthias P. Fabritius
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany; (M.F.F.); (T.H.); (D.N.)
| | - Thomas Huber
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany; (M.F.F.); (T.H.); (D.N.)
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany; (M.F.F.); (T.H.); (D.N.)
| | - Johannes Rückel
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
| | - Maximilian Weniger
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Corinna Martens
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Laura Sabel
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
| | - Dirk-André Clevert
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
| | - Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (C.M.); (M.v.H.); (M.P.F.); (J.R.); (L.S.); (D.-A.C.); (V.S.)
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Ernst BP, Reissig MR, Strieth S, Eckrich J, Hagemann JH, Döge J, Matthias C, Gouveris H, Rübenthaler J, Weiss R, Sommer WH, Nörenberg D, Huber T, Gonser P, Becker S, Froelich MF. The role of structured reporting and structured operation planning in functional endoscopic sinus surgery. PLoS One 2020; 15:e0242804. [PMID: 33253265 PMCID: PMC7703956 DOI: 10.1371/journal.pone.0242804] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
Computed tomography (CT) scans represent the gold standard in the planning of functional endoscopic sinus surgeries (FESS). Yet, radiologists and otolaryngologists have different perspectives on these scans. In general, residents often struggle with aspects involved in both reporting and operation planning. The aim of this study was to compare the completeness of structured reports (SR) of preoperative CT images and structured operation planning (SOP) to conventional reports (CR) and conventional operation planning (COP) to potentially improve future treatment decisions on an individual level. In total, 30 preoperative CT scans obtained for surgical planning of patients scheduled for FESS were evaluated using SR and CR by radiology residents. Subsequently, otolaryngology residents performed a COP using free texts and a SOP using a specific template. All radiology reports and operation plannings were evaluated by two experienced FESS surgeons regarding their completeness for surgical planning. User satisfaction of otolaryngology residents was assessed by using visual analogue scales. Overall radiology report completeness was significantly higher using SRs regarding surgically important structures compared to CRs (84.4 vs. 22.0%, p<0.001). SOPs produced significantly higher completeness ratings (97% vs. 39.4%, p<0.001) regarding pathologies and anatomical variances. Moreover, time efficiency was not significantly impaired by implementation of SR (148 s vs. 160 s, p = 0.61) and user satisfaction was significantly higher for SOP (VAS 8.1 vs. 4.1, p<0.001). Implementation of SR and SOP results in a significantly increased completeness of radiology reports and operation planning for FESS. Consequently, the combination of both facilitates surgical planning and may decrease potential risks during FESS.
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Affiliation(s)
- Benjamin Philipp Ernst
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
- * E-mail:
| | - Manuel René Reissig
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, University Hospital Bonn, Bonn, North Rhine-Westphalia, Germany
| | - Jonas Eckrich
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Jan H. Hagemann
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Julia Döge
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Haralampos Gouveris
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | | | - Roxanne Weiss
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Hessen, Germany
| | - Wieland H. Sommer
- Department of Radiology, LMU University Hospital, Munich, Bavaria, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Baden-Wuerttemberg, Germany
| | - Thomas Huber
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Baden-Wuerttemberg, Germany
| | - Phillipp Gonser
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Tübingen Medical Center, Tübingen, Baden-Wuerttemberg, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Tübingen Medical Center, Tübingen, Baden-Wuerttemberg, Germany
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Baden-Wuerttemberg, Germany
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15
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Hwang JE, Seoung BO, Lee SO, Shin SY. Implementing Structured Clinical Templates at a Single Tertiary Hospital: Survey Study. JMIR Med Inform 2020; 8:e13836. [PMID: 32352392 PMCID: PMC7226057 DOI: 10.2196/13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 11/26/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Electronic health record (EHR) systems have been widely adopted in hospitals. However, since current EHRs mainly focus on lowering the number of paper documents used, they have suffered from poor search function and reusability capabilities. To overcome these drawbacks, structured clinical templates have been proposed; however, they are not widely used owing to the inconvenience of data entry. Objective This study aims to verify the usability of structured templates by comparing data entry times. Methods A Korean tertiary hospital has implemented structured clinical templates with the modeling of clinical contents for the last 6 years. As a result, 1238 clinical content models (ie, body measurements, vital signs, and allergies) have been developed and 492 models for 13 clinical templates, including pathology reports, were applied to EHRs for clinical practice. Then, to verify the usability of the structured templates, data entry times from free-texts and four structured pathology report templates were compared using 4391 entries from structured data entry (SDE) log data and 4265 entries from free-text log data. In addition, a paper-based survey and a focus group interview were conducted with 23 participants from three different groups, including EHR developers, pathology transcriptionists, and clinical data extraction team members. Results Based on the analysis of time required for data entry, in most cases, beginner users of the structured clinical templates required at most 70.18% more time for data entry. However, as users became accustomed to the templates, they were able to enter data more quickly than via free-text entry: at least 1 minute and 23 seconds (16.8%) up to 5 minutes and 42 seconds (27.6%). Interestingly, well-designed thyroid cancer pathology reports required 14.54% less data entry time from the beginning of the SDE implementation. In the interviews and survey, we confirmed that most of the interviewees agreed on the need for structured templates. However, they were skeptical about structuring all the items included in the templates. Conclusions The increase in initial elapsed time led users to hold a negative opinion of SDE, despite its benefits. To overcome these obstacles, it is necessary to structure the clinical templates for optimum use. In addition, user experience in terms of ease of data entry must be considered as an essential aspect in the development of structured clinical templates.
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Affiliation(s)
- Ji Eun Hwang
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Byung Ook Seoung
- Office of Medical Information, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Office of Medical Information, Asan Medical Center, Seoul, Republic of Korea.,Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Yong Shin
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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16
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Kim SH, Sobez LM, Spiro JE, Curta A, Ceelen F, Kampmann E, Goepfert M, Bodensohn R, Meinel FG, Sommer WH, Sommer NN, Galiè F. Structured reporting has the potential to reduce reporting times of dual-energy x-ray absorptiometry exams. BMC Musculoskelet Disord 2020; 21:248. [PMID: 32299400 PMCID: PMC7164197 DOI: 10.1186/s12891-020-03200-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/10/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In recent years, structured reporting has been shown to be beneficial with regard to report completeness and clinical decision-making as compared to free-text reports (FTR). However, the impact of structured reporting on reporting efficiency has not been thoroughly evaluted yet. The aim of this study was to compare reporting times and report quality of structured reports (SR) to conventional free-text reports of dual-energy x-ray absorptiometry exams (DXA). METHODS FTRs and SRs of DXA were retrospectively generated by 2 radiology residents and 2 final-year medical students. Time was measured from the first view of the exam until the report was saved. A random sample of DXA reports was selected and sent to 2 referring physicians for further evaluation of report quality. RESULTS A total of 104 DXA reports (both FTRs and SRs) were generated and 48 randomly selected reports were evaluated by referring physicians. Reporting times were shorter for SRs in both radiology residents and medical students with median reporting times of 2.7 min (residents: 2.7, medical students: 2.7) for SRs and 6.1 min (residents: 5.0, medical students: 7.5) for FTRs. Information extraction was perceived to be significantly easier from SRs vs FTRs (P < 0.001). SRs were rated to answer the clinical question significantly better than FTRs (P < 0.007). Overall report quality was rated significantly higher for SRs compared to FTRs (P < 0.001) with 96% of SRs vs 79% of FTRs receiving high or very high-quality ratings. All readers except for one resident preferred structured reporting over free-text reporting and both referring clinicians preferred SRs over FTRs for DXA. CONCLUSIONS Template-based structured reporting of DXA might lead to shorter reporting times and increased report quality.
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Affiliation(s)
- Su Hwan Kim
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Lara M Sobez
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Judith E Spiro
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Adrian Curta
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Felix Ceelen
- Munich Transplant Center, University Hospital, LMU Munich, Munich, Germany
| | - Eric Kampmann
- Department of Internal Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Martin Goepfert
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Felix G Meinel
- Department of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Wieland H Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nora N Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Galiè
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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Evidence of the benefits, advantages and potentialities of the structured radiological report: An integrative review. Artif Intell Med 2019; 102:101770. [PMID: 31980107 DOI: 10.1016/j.artmed.2019.101770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 12/27/2022]
Abstract
The structured report is a new trend for the preparation and manipulation of radiological examination reports. The structuring of the radiological report data can bring many benefits and advantages over other existing methodologies. Research and studies about the structured radiological report are highly relevant in clinical and academic subjects, improving medical practice, reducing unobserved problems by radiologists, improving reporting practices and medical diagnoses. Exposing the benefits, advantages and potential of the structured radiological report is important in encouraging the acceptance and implementation of this method by radiology professionals who are still somewhat resistant. The present review highlights the factors that contribute to the consolidation of adopting the structured radiology report methodology, addressing a variety of studies focused on the structuring of the radiological report. This integrative review of the literature is proposed by searching publications and journals databases (CAPES - Coordination of Improvement of Higher-Level Personnel, SciELO - Scientific Electronic Library Online, and PubMed - Publisher Medline) to develop a complete and unified understanding of the subject, so that it becomes a major part of evidence-based initiatives.
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18
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The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency. Eur Arch Otorhinolaryngol 2019; 277:269-276. [PMID: 31612337 DOI: 10.1007/s00405-019-05679-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Free text reports (FTR) of head and neck ultrasound studies are currently deployed in most departments. Because of a lack of composition and language, these reports vary greatly in terms of quality and reliability. This may impair the learning process during residency. The purpose of the study was to analyze the longitudinal effects of using structured reports (SR) of head and neck ultrasound studies during residency. METHODS Attending residents (n = 24) of a tripartite course on head and neck ultrasound, accredited by the German Society for Ultrasound in Medicine (DEGUM), were randomly allocated to pictures of common diseases. Both SRs and FTRs were compiled. All reports were analyzed concerning completeness, acquired time and legibility. Overall user contentment was evaluated by a questionnaire. RESULTS SRs achieved significantly higher ratings regarding completeness (95.6% vs. 26.4%, p < 0.001), description of pathologies (72.2% vs. 58.9%, p < 0.001) and legibility (100% vs. 52.4%, p < 0.001) with a very high inter-rater reliability (Fleiss' kappa 0.9). Reports were finalized significantly faster (99.1 s vs. 115.0 s, p < 0.001) and user contentment was significantly better when using SRs (8.3 vs. 6.3, p < 0.001). In particular, only SRs showed a longitudinally increasing time efficiency (- 20.1 s, p = 0.036) while maintaining consistent completeness ratings. CONCLUSIONS The use of SRs of head and neck ultrasound studies results in an increased longitudinal time-efficiency while upholding the report quality at the same time. This may indicate an additive learning effect of structured reporting. Superior outcomes in terms of comprehensiveness, legibility and time-efficiency can be observed immediately after implementation.
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Creating high-quality radiology reports in foreign languages through multilingual structured reporting. Eur Radiol 2019; 29:6038-6048. [PMID: 31028444 DOI: 10.1007/s00330-019-06206-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/19/2019] [Accepted: 03/26/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Globalization and migration are increasing the demand for reports in different languages. We aimed to examine if structured reports created by non-German-speaking radiologists with multilingual templates show significant differences in quality to structured reports and free-text reports by German native speakers. METHODS We used structured templates that allow radiologists to report in their mother tongue and then switch the report language to German or English automatically using proprietary software. German- and English-speaking radiology residents created structured reports in both German and English with these templates. Reports for three different exam types were created (intensive care chest x-ray, shoulder x-ray specifically for degenerative processes, and CT pulmonary angiogram for pulmonary embolism). The report quality of automatically translated German structured reports by English-speaking radiologists and German structured reports by German radiologists was then evaluated by German clinicians with a standardized questionnaire. The questionnaire was designed to assess attributes including content, comprehensibility, clinical consequences, and overall quality. RESULTS Structured reports by English-speaking radiologists that were automatically translated into German and German structured reports by German radiologists both received very high or high overall quality ratings in the majority of cases, showing no significant differences in quality. Likewise, no significant differences were observed between the two report types regarding comprehensibility and clinical consequences. Structured reports by German radiologists received significantly better ratings for overall quality and comprehensibility compared to free-text reports by German radiologists. CONCLUSIONS Multilingual structured reporting templates may serve as a feasible tool for creating high-quality radiology reports in foreign languages. KEY POINTS • Multilingualism in structured reporting templates can be a useful tool for creating high-quality radiology reports in foreign languages. • German reports created with multilingual structured reporting templates by English-speaking radiologists and German structured reports by German radiologists exhibit no significant differences in overall report quality. • Multilingual structured reporting templates can help radiologists overcome communication barriers and facilitate teleradiology.
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Ernst BP, Katzer F, Künzel J, Hodeib M, Strieth S, Eckrich J, Tattermusch A, Froelich MF, Matthias C, Sommer WH, Becker S. Impact of structured reporting on developing head and neck ultrasound skills. BMC MEDICAL EDUCATION 2019; 19:102. [PMID: 30971248 PMCID: PMC6458758 DOI: 10.1186/s12909-019-1538-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/31/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Reports of head and neck ultrasound examinations are frequently written by hand as free texts. This is a serious obstacle to the learning process of the modality due to a missing report structure and terminology. Therefore, there is a great inter-observer variability in overall report quality. Aim of the present study was to evaluate the impact of structured reporting on the learning process as indicated by the overall report quality of head and neck ultrasound examinations within medical school education. METHODS Following an immersion course on head and neck ultrasound, previously documented images of three common pathologies were handed out to 58 medical students who asked to create both standard free text reports (FTR) and structured reports (SR). A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion and readability by two independent raters (Paired Wilcoxon test, 95% CI). Ratings were assessed for inter-rater reliability (Fleiss' kappa). Additionally, a questionnaire was utilized to evaluate user satisfaction. RESULTS SRs received significantly better ratings in terms of report completeness (97.7% vs. 53.5%, p < 0.001) regarding all items. In addition, pathologies were described in more detail using SRs (70% vs. 51.1%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 54.4%, p < 0.001). Mean time to complete was significantly lower (79.6 vs. 205.4 s, p < 0.001) and user satisfaction was significantly higher when using SRs (8.5 vs. 4.1, p < 0.001). Also, inter-rater reliability was very high (Fleiss' kappa 0.93). CONCLUSIONS SRs of head and neck ultrasound examinations provide more detailed information with a better readability in a time-saving manner within medical education. Also, medical students may benefit from SRs in their learning process due to the structured approach and standardized terminology.
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Affiliation(s)
- Benjamin P. Ernst
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Fabian Katzer
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Mohamed Hodeib
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Jonas Eckrich
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | | | - Matthias F. Froelich
- Institute of Clinical Radiology and Nuclear Medicine, Institute of Clinical Radiology and Nuclear Medicine, Faculty Mannheim-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Wieland H. Sommer
- Department of Radiology, LMU University Hospital, Marchioninistraße 15, 81377 Munich, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
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21
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Ernst BP, Hodeib M, Strieth S, Künzel J, Bischof F, Hackenberg B, Huppertz T, Weber V, Bahr K, Eckrich J, Hagemann J, Engelbarts M, Froelich MF, Solbach P, Linke R, Matthias C, Sommer WH, Becker S. Structured reporting of head and neck ultrasound examinations. BMC Med Imaging 2019; 19:25. [PMID: 30917796 PMCID: PMC6437950 DOI: 10.1186/s12880-019-0325-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/11/2019] [Indexed: 12/25/2022] Open
Abstract
Background Reports of head and neck ultrasound examinations are frequently written by hand as free texts. Naturally, quality and structure of free text reports is variable, depending on the examiner’s individual level of experience. Aim of the present study was to compare the quality of free text reports (FTR) and structured reports (SR) of head and neck ultrasound examinations. Methods Both standard FTRs and SRs of head and neck ultrasound examinations of 43 patients were acquired by nine independent examiners with comparable levels of experience. A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion, and readability by four independent raters with different specializations (Paired Wilcoxon test, 95% CI) and inter-rater reliability was assessed (Fleiss’ kappa). A questionnaire was used to compare FTRs vs. SRs with respect to user satisfaction (Mann-Whitney U test, 95% CI). Results By comparison, completeness scores of SRs were significantly higher than FTRs’ completeness scores (94.4% vs. 45.6%, p < 0.001), and pathologies were described in more detail (91.1% vs. 54.5%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 47.1%, p < 0.001). The mean time to complete a report, however, was significantly higher in SRs (176.5 vs. 107.3 s, p < 0.001). SRs achieved significantly higher user satisfaction ratings (VAS 8.87 vs. 1.41, p < 0.001) and a very high inter-rater reliability (Fleiss’ kappa 0.92). Conclusions As compared to FTRs, SRs of head and neck ultrasound examinations are more comprehensive and easier to understand. On the balance, the additional time needed for completing a SR is negligible. Also, SRs yield high inter-rater reliability and may be used for high-quality scientific data analyses.
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Affiliation(s)
- Benjamin P Ernst
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Mohamed Hodeib
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Fabian Bischof
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Berit Hackenberg
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Tilmann Huppertz
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Veronika Weber
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Bahr
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jonas Eckrich
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jan Hagemann
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Matthias Engelbarts
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Matthias F Froelich
- Department of Radiology, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany
| | - Philipp Solbach
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Richard Linke
- Department of General and Visceral Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Wieland H Sommer
- Department of Radiology, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Structured reporting in petrous bone MRI examinations: impact on report completeness and quality. Int J Comput Assist Radiol Surg 2018; 13:1971-1980. [DOI: 10.1007/s11548-018-1828-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022]
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Sposato LA, Stirling D, Saposnik G. Therapeutic Decisions in Atrial Fibrillation for Stroke Prevention: The Role of Aversion to Ambiguity and Physicians' Risk Preferences. J Stroke Cerebrovasc Dis 2018; 27:2088-2095. [PMID: 29650382 DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Knowledge-to-action gaps influence therapeutic decisions in atrial fibrillation (AF). Physician-related factors are common, but the least studied. We evaluated the prevalence and determinants of physician-related factors and knowledge-to-action gaps among physicians involved in the management of AF patients. DESIGN In this cross-sectional study, participants from 6 South American countries recruited during an educational program answered questions regarding 16 case scenarios of patients with AF and completed experiments assessing 3 outcome measures: therapeutic inertia, herding, and errors in risk stratification knowledge translated into action (ERSKTA) based on commonly used stratification tools (Congestive heart failure, Hypertension, Age ≥75 years (double), Diabetes mellitus, previous Stroke/transient ischemic attack/thromboembolism (double), Vascular disease, Age 65-74 years, and female gender (score of 0 for males and 1 for female) (CHA2DS2-VASc) and Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, and previous Stroke/transient ischemic attack (double) (CHADS2)). Logistic regression analysis was conducted to determine factors associated with the outcomes. RESULTS Overall, 149 physicians were invited to participate, of which 88 (59.1%) completed the online assessment tool. Cardiology was the most frequent specialty (69.3%). Therapeutic inertia was present in 53 participants (60.2%), herding in 66 (75.0%), and ERSKTA in 46 (52.3%). Therapeutic inertia was inversely associated with willingness to take financial risks (odds ratio [OR] .72, 95% confidence interval [CI] .59-.89 per point in the financial risk propensity score), herding was associated with aversion to ambiguity in the medical domain (OR 5.35, 95% CI 1.40-20.46), and ERSKTA was associated with the willingness to take risks (OR 1.70, 95% CI 1.15-2.50, per point in score). CONCLUSIONS Among physicians involved in stroke prevention in AF, individual risk preferences and aversion to ambiguity lead to therapeutic inertia, herding, and errors in risk stratification and subsequent use of oral anticoagulants. Educational interventions, including formal training in risk management and decision-making are needed.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Stroke Dementia and Heart Disease Laboratory, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Devin Stirling
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Stroke Outcome Research Center, Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.
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Sabel BO, Plum JL, Czihal M, Lottspeich C, Schönleben F, Gäbel G, Schinner R, Schoeppe F, Meinel FG. Structured Reporting of CT Angiography Runoff Examinations of the Lower Extremities. Eur J Vasc Endovasc Surg 2018; 55:679-687. [PMID: 29627139 DOI: 10.1016/j.ejvs.2018.01.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/27/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim was to evaluate the effect of structured reporting of computed tomography angiography (CTA) runoff studies on clarity, completeness, clinical relevance, usefulness of the radiology reports, further testing, and therapy in patients with known or suspected peripheral arterial disease. METHODS Conventional reports (CRs) and structured reports (SRs) were generated for 52 patients who had been examined with a CTA runoff examination of the lower extremities. The sample size was based on power calculations with a power of 95% and a significance level of .007 (adjusted for multiple testing). CRs were dictated in a free text form; SRs contained a consistent ordering of observations with standardised subheadings. CRs were compared with SRs. Two vascular medicine specialists and two vascular surgeons rated the reports regarding their satisfaction with clarity, completeness, clinical relevance, and usefulness as well as overall satisfaction. Additionally, they made hypothetical decisions on further testing and therapy. Median ratings were compared using the Wilcoxon signed rank test and generalised linear mixed effects models. RESULTS SRs received higher ratings for satisfaction with clarity (median rating 9.0 vs. 7.0, p < .0001) and completeness (median rating 9.0 vs. 7.5, p < .0001) and were judged to be of greater clinical relevance (median rating 9.0 vs. 8.0, p < .0001) and usefulness (median rating 9.0 vs. 8.0, p < .0001). Overall satisfaction was also higher for SRs (median rating 9.0 vs. 7.0, p < .0001) than CRs. There were no significant differences in further testing or therapy. CONCLUSION Referring clinicians perceive SRs of CTA runoff examinations of the lower extremities as offering superior clarity, completeness, clinical relevance, and usefulness than CRs. Structured reporting does not appear to alter further testing or therapy in patients with known or suspected peripheral arterial disease.
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Affiliation(s)
- Bastian O Sabel
- Department of Radiology, University Hospital, LMU Munich, Germany.
| | - Jessica L Plum
- Department of Radiology, University Hospital, LMU Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Christian Lottspeich
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Frank Schönleben
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Gabor Gäbel
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Germany
| | | | - Felix G Meinel
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, Rostock University Medical Centre, Rostock, Germany
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Schoeppe F, Sommer WH, Nörenberg D, Verbeek M, Bogner C, Westphalen CB, Dreyling M, Rummeny EJ, Fingerle AA. Structured reporting adds clinical value in primary CT staging of diffuse large B-cell lymphoma. Eur Radiol 2018; 28:3702-3709. [PMID: 29600475 DOI: 10.1007/s00330-018-5340-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate whether template-based structured reports (SRs) add clinical value to primary CT staging in patients with diffuse large B-cell lymphoma (DLBCL) compared to free-text reports (FTRs). METHODS In this two-centre study SRs and FTRs were acquired for 16 CT examinations. Thirty-two reports were independently scored by four haematologists using a questionnaire addressing completeness of information, structure, guidance for patient management and overall quality. The questionnaire included yes-no, 10-point Likert scale and 5-point scale questions. Altogether 128 completed questionnaires were evaluated. Non-parametric Wilcoxon signed-rank test and McNemar's test were used for statistical analysis. RESULTS SRs contained information on affected organs more often than FTRs (95 % vs. 66 %). More SRs commented on extranodal involvement (91 % vs. 62 %). Sufficient information for Ann-Arbor classification was included in more SRs (89 % vs. 64 %). Information extraction was quicker from SRs (median rating on 10-point Likert scale=9 vs. 6; 7-10 vs. 4-8 interquartile range). SRs had better comprehensibility (9 vs. 7; 8-10 vs. 5-8). Contribution of SRs to clinical decision-making was higher (9 vs. 6; 6-10 vs. 3-8). SRs were of higher quality (p < 0.001). All haematologists preferred SRs over FTRs. CONCLUSIONS Structured reporting of CT examinations for primary staging in patients with DLBCL adds clinical value compared to FTRs by increasing completeness of reports, facilitating information extraction and improving patient management. KEY POINTS • Structured reporting in CT helps clinicians to assess patients with lymphoma. • This two-centre study showed that structured reporting improves information content and extraction. • Patient management may be improved by structured reporting. • Clinicians preferred structured reports over free-text reports.
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Affiliation(s)
- Franziska Schoeppe
- Department of Radiology, University Hospital, LMU Munich, Marchionistr. 15, 81377, Munich, Germany.
| | - Wieland H Sommer
- Department of Radiology, University Hospital, LMU Munich, Marchionistr. 15, 81377, Munich, Germany
| | - Dominik Nörenberg
- Department of Radiology, University Hospital, LMU Munich, Marchionistr. 15, 81377, Munich, Germany
| | - Mareike Verbeek
- III. Department of Internal Medicine and Comprehensive Cancer Center, Technical University of Munich (TUM), Munich, Germany
| | - Christian Bogner
- III. Department of Internal Medicine and Comprehensive Cancer Center, Technical University of Munich (TUM), Munich, Germany
| | - C Benedikt Westphalen
- Department of Internal Medicine III and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Martin Dreyling
- Department of Internal Medicine III and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Ernst J Rummeny
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich (TUM), Munich, Germany
| | - Alexander A Fingerle
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich (TUM), Munich, Germany
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