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Kwak DH, Yang L, Hu-Wang E, Seetharam S, Nijhawan K, Chung JH, Patel P. Peer learning is both preferable and less expensive than score-based peer review: Initial experience at a tertiary academic center. Clin Imaging 2024; 106:110065. [PMID: 38113549 DOI: 10.1016/j.clinimag.2023.110065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To examine radiologist experiences and perceptions during a transition from score-based peer review to a peer learning program, and to assess differences in time-cost efficiency between the two models of quality improvement. METHODS Differences in Likert scale survey responses from radiologists (N = 27) in a multispecialty group at a single tertiary academic center before and following intervention were evaluated by Mann-Whitney U test. Multiple variable linear regression analysis assessed independent variables and program preference. RESULTS All positive impacts rated significantly higher for the peer learning program. Workflow disruption for the peer learning program rated significantly lower. 70.4 % (19 of 27) preferred the new program, and 25.9 % (7 of 27) preferred the old program. Only the "worth investment" questionnaire score demonstrated a significant correlation to program preference and with an effect that was greatest among all variables (Beta = 1.11, p = 0.02). There was a significantly decreased amount of time per month used to complete peer learning exercises (0.76 ± 0.45 h, N = 27) versus peer review exercises (1.71 ± 1.84 h, N = 34, p = 0.011). The result was a difference of 0.95 ± 1.89 h/month (11.4 ± 22.7 h/year), translating to an estimated direct salary time-cost saving of $1653.68/year/radiologists and a direct productivity time-cost saving of $3469.39/year/radiologist when utilizing the peer learning program. CONCLUSIONS There was a strongly positive perception of the new peer learning program. There was a substantial implied direct time-cost saving from the transition to the peer learning program. PRECIS The peer learning model emphasizes learning from errors via feedback in a non-punitive environment. This model was positively perceived and demonstrated substantial implied direct time-cost saving.
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Affiliation(s)
- Daniel H Kwak
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, United States of America.
| | - Lindsay Yang
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, United States of America
| | - Eileen Hu-Wang
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, United States of America
| | - Sachin Seetharam
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, United States of America
| | - Karan Nijhawan
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, United States of America
| | - Jonathan H Chung
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, United States of America
| | - Pritesh Patel
- Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, United States of America
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Altuğ E, Şener K, Çakir A, Erdem ZB, Eyüpoğlu G, Güven R. Accuracy of emergency physician bedside ultrasonography compared with private teleradiologist for acute appendicitis diagnosis. Ir J Med Sci 2023; 192:1473-1479. [PMID: 36076151 DOI: 10.1007/s11845-022-03149-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Acute appendicitis (AA) is a common cause of abdominal pain resulting in admission to the emergency room. Imaging methods such as ultrasonography and CT are usually used for diagnosing acute appendicitis. Reports regarding CT scans conducted during night shifts are prepared by private teleradiologists. AIMS The aim of this study was to compare the accuracy of point-of-care ultrasound performed by an emergency medicine specialist and private teleradiologists in the diagnosis of AA. METHODS This study was conducted prospectively and in a single center in the emergency department of a tertiary hospital. Patients who were admitted to the study between 15.09.2020 and 15.09.2021 and were diagnosed with AA who met the study criteria were included. A total of 134 patients diagnosed with AA, who met the inclusion criteria, out of 158 operated patients were included in the study. RESULTS In the study, 77 were male and 57 were female. The mean age of patients with histopathologically positive AA was 31 and 31.5 in negative patients. The sensitivity and specificity of POCUS performed by the emergency physician and private teleradiology for the diagnosis of AA were 78.4% and 59.3% and 58.8% and 53.1%, respectively. CONCLUSIONS POCUS performed by an emergency medicine specialist showed a higher sensitivity for the diagnosis of AA compared with private teleradiology. Hence, POCUS is more successful in diagnosing AA than private teleradiology. In conclusion, we recommend the concurrent use of AS and POCUS in emergency departments rather than private teleradiology for the diagnosis of AA.
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Affiliation(s)
- Ertuğrul Altuğ
- Department of Emergency Medicine, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Kemal Şener
- Department of Emergency Medicine, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Adem Çakir
- Department of Emergency Medicine, Ministry of Health of Turkey Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Zeynep Betül Erdem
- Department of Medical Pathology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Gökhan Eyüpoğlu
- Department of Emergency Medicine, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Ramazan Güven
- Department of Emergency Medicine, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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3
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Yeates EO, Grigorian A, Chinn J, Young H, Colin Escobar J, Glavis-Bloom J, Anavim A, Yaghmai V, Nguyen NT, Nahmias J. Night Radiology Coverage for Trauma: Residents, Teleradiology, or Both? J Am Coll Surg 2022; 235:500-509. [PMID: 35972171 DOI: 10.1097/xcs.0000000000000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients. STUDY DESIGN A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10 pm to 8 am were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist's interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared. RESULTS A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001). CONCLUSIONS This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.
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Affiliation(s)
- Eric O Yeates
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Areg Grigorian
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
- Department of Surgery, University of Southern California (USC), Los Angeles, CA (Grigorian)
| | - Justine Chinn
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Hayley Young
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Jessica Colin Escobar
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Justin Glavis-Bloom
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Arash Anavim
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Vahid Yaghmai
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Ninh T Nguyen
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Jeffry Nahmias
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
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Vendrell JF, Frandon J, Boussat B, Cotton F, Ferretti G, Sans N, Tasu JP, Beregi JP, Larbi A. Double Reading of Outsourced CT/MR Radiology Reports: Retrospective Analysis. J Patient Saf 2021; 17:e1267-e1271. [PMID: 30531236 DOI: 10.1097/pts.0000000000000525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Our objective was to determine disagreement rates in radiological reports provided by using a double-reading protocol in a national teleradiology company. METHODS From January 2015 to July 2016, 134169 radiological exams from 36 French centers, benefited outsourced interpretations by certified radiologists, in both regular and after-hours activities. Of these, 2040 CT and MR-scans (1.5%) were subjected to a second opinion by other radiologists in the field of their anatomical specialty (cerebral, thoracic, abdominal-pelvic, and osteoarticular). A five-point agreement scale graded from 0 to 4 was assigned for each exam. Disagreements were considered as minor if no clinical consequence for patient (scores 1 and 2) and major if potential clinical consequence (score 3 and 4). Independent radiologists performed a retrospective analysis and a stratified statistical analysis. RESULTS Double reading was performed on CT-scans (n = 934/2040, 45.8%) and MR-scans (n = 1106/2040, 54.2%) performed in regular (80.1%) and after-hours activities (19.9%). Disagreement scores occurred in 437 exams (21.4%), including major disagreements in 59 (2.9%). Among these, 48/754 were assigned by the thoracic second reader (6.4%), 6/70 by the abdominal-pelvic second reader (8.6%), 3/901 by the osteoarticular second reader (0.3%), and 2/315 by the cerebral second reader (0.6%), with statistical significant difference. No additional disagreement rate was observed in regular and after-hours activities (P = 0.63). CONCLUSIONS Double-reading of outsourced CT and MRI interpretations yielded 21.4% disagreement rate, with potential clinical consequence for patient in 2,9% of the cases. These results are in accordance with those previously reported and suggests that quality assurance of outsourced interpretations is needed.
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Affiliation(s)
| | - Julien Frandon
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
| | - Bastien Boussat
- Quality of care unit, Grenoble Alpes University Hospital, TIMC UMR 5525 CNRS, Grenoble Alpes University, France
| | - François Cotton
- Department of Radiology, Université de Lyon 1, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite Cedex, CREATIS INSA - 502, 69621 Villeurbanne Cedex, France
| | - Gilbert Ferretti
- Department of Medical Informatics, Centre Hospitalier et Universitaire de Grenoble, Hôpital Nord, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Nicolas Sans
- Department of Radiology, Centre Hospitalier et Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Jean-Pierre Tasu
- Department of radiology, Centre Hospitalier et Universitaire de Poitiers, Hôpital de la Milétrie, 2 Rue de la Milétrie, 86021 Poitiers cedex, France
| | - Jean-Paul Beregi
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
| | - Ahmed Larbi
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
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Pfeifer CM, Dinh ML. Discrepancy rates of preliminary and final reports for after-hours pediatric teleradiology interpretations. Acta Radiol Open 2021; 10:2058460121989319. [PMID: 33628460 PMCID: PMC7883166 DOI: 10.1177/2058460121989319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Children’s hospitals often do not have a high enough volume to justify providing radiologist staffing overnight, leading to hospitals employing teleradiology services to offer preliminary reports. There is limited literature related to discrepancies between preliminary teleradiology pediatric radiologists and final interpretations. Purpose The purpose of this study is to examine discrepancy rates for teleradiologists preliminarily interpreting pediatric exams at a children’s hospital. Material and Methods Eight thousand seven hundred seventy-eight consecutive preliminary reports issued by pediatric teleradiologists were reviewed. The hospital utilized a system in which local onsite radiologists rated the preliminary reports of teleradiologists following the interpretations as part of standard operating procedure. Discrepancies were also rated according to whether the discrepancy was actionable (judged to alter patient management by the final rater) or not. Rates were stratified by modality, preliminary teleradiologist reader, and final rater and compared to each using a normal approximation. The mean discrepancy rates were compared using a z test for proportions. Linear regression was applied to the effect of years of radiologist experience on the total and actionable discrepancy rates. Results The overall actionable discrepancy rate was 1.6%, similar to inter-observer discrepancy rates reported in other studies. There were no significant differences in the actionable discrepancy rates among teleradiologists. There was no correlation between years of experience and discrepancy rate for either the teleradiologists or the final raters. Conclusion Pediatric subspecialty teleradiologists issue reports that mirror discrepancy rates typical of radiologists who issue reports for emergent adult studies. Years of radiologist experience is not a predictor of discrepancy rate.
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Affiliation(s)
- Cory M Pfeifer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary L Dinh
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Jo SY, Scanlon M, Cook T. Preliminary Radiology Report Discordances and Patient Outcomes. J Am Coll Radiol 2020; 17:1621-1625. [PMID: 32768423 DOI: 10.1016/j.jacr.2019.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES At our institution, resident and fellow radiologists issue preliminary reports for off-hours imaging studies, which are overread by attending radiologists the next day using structured discrepancy templates. In this study, we examined the impact on patient management and outcome of studies with major discordance. MATERIALS AND METHODS For our retrospective observational study, preliminary reports between March and June 2017 that received major discordance were identified through report text search. Electronic medical records were reviewed for patient management change and patient outcome. RESULTS Of the 199 cases, 52 cases (26%) had management change and 119 cases (60%) did not have management change. In 25 cases (13%), the preliminary report was proven correct on subsequent management. Three cases (2%) were lost to follow-up. In only one case was adverse outcome directly related to the discordant finding. In cases with patient management change, there was higher proportion of perceptual error compared with those without management change (73% versus 59%). In 47 cases (24%), the discordant finding or diagnosis was known to the clinical team, and better history could have avoided the major change. CONCLUSION Adverse outcome from the discordant imaging finding was low (0.5%). Major change in preliminary report could be reduced with better clinical history. Patient management change was more frequently seen with perceptual errors, placing greater emphasis on strategies to reduce them.
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Affiliation(s)
| | - Mary Scanlon
- Vice Chair of Education, Chairperson, Radiation Safety Committee, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tessa Cook
- Assistant Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Co-Director, Center for Practice Transformation; Fellowship Director, Imaging Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Abstract
This article addresses duty of candour in relation to radiologists. The legislation underpinning duty of candour, definition of terms and the requirements for its application are explained. Consideration is given as to the differences between duty of candour and openness of discussion. The issue of how duty of candour should apply to radiologists (both diagnostic and interventional) is then addressed.
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8
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Friedberg E, Chong ST, Pyatt RS, Ferrara S, Strong BW, Nicola GN, Bozman R, Duszak R. Unifying the Silos of Subspecialized Radiology: The Essential Role of the General Radiologist. J Am Coll Radiol 2018; 15:1158-1163. [DOI: 10.1016/j.jacr.2018.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
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9
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Kelleher MS, Forman HP, Goodman TR, Pahade JK. Proctoring of New Emergency Radiologists to Promote Clinical Excellence and Ensure Quality of Care. J Am Coll Radiol 2016; 13:967-72. [DOI: 10.1016/j.jacr.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/28/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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10
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Abstract
Peer review in radiology means an assessment of the accuracy of a report issued by another radiologist. Inevitably, this involves a judgement opinion from the reviewing radiologist. Peer feedback is the means by which any form of peer review is communicated back to the original author of the report. This article defines terms, discusses the current status, identifies problems, and provides some recommendations as to the way forward, concentrating upon the software requirements for efficient peer review and peer feedback of reported imaging studies. Radiologists undertake routine peer review in their everyday clinical practice, particularly when reporting and preparing for multidisciplinary team meetings. More formal peer review of reported imaging studies has been advocated as a quality assurance measure to promote good clinical practice. It is also a way of assessing the competency of reporting radiologists referred for investigation to bodies such as the General Medical Council (GMC). The literature shows, firstly, that there is a very wide reported range of discrepancy rates in many studies, which have used a variety of non-comparable methodologies; and secondly, that applying scoring systems in formal peer review is often meaningless, unhelpful, and can even be detrimental. There is currently a lack of electronic peer feedback system software on the market to inform radiologists of any review of their work that has occurred or to provide them with clinical outcome information on cases they have previously reported. Learning opportunities are therefore missed. Radiologists should actively engage with the medical informatics industry to design optimal peer review and feedback software with features to meet their needs. Such a system should be easy to use, be fully integrated with the radiological information and picture archiving systems used clinically, and contain a free-text comment box, without a numerical scoring system. It should form a temporary record that cannot be permanently archived. It must provide automated feedback to the original author. Peer feedback, as part of everyday reporting, should enhance daily learning for radiologists. Software requirements for everyday peer feedback differ from those needed for a formal peer review process, which might only be necessary in the setting of a formal GMC enquiry into a particular radiologist's reporting competence, for example.
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Affiliation(s)
- N H Strickland
- Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
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11
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Sun YV. The Influences of Genetic and Environmental Factors on Methylome-wide Association Studies for Human Diseases. CURRENT GENETIC MEDICINE REPORTS 2014; 2:261-270. [PMID: 25422794 DOI: 10.1007/s40142-014-0058-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
DNA methylation (DNAm) is an essential epigenetic mechanism for normal development, and its variation may be associated with diseases. High-throughput technology allows robust measurement of DNA methylome in population studies. Methylome-wide association studies (MWAS) scan DNA methylome to detect new epigenetic loci affecting disease susceptibility. MWAS is an emerging approach to unraveling the mechanism linking genetics, environment, and human diseases. Here I review the recent studies of genetic determinants and environmental modifiers of DNAm, and the concept for partitioning genetic and environmental contribution to DNAm. These studies establish the correlation maps between genome and methylome, and enable the interpretation of epigenetic association with disease traits. Recent findings suggested that MWAS was a promising genomic method to identify epigenetic predictors accounting for unexplained disease risk. However, new study designs, analytical methods and shared resources need to be implemented to address the limitations and challenges in future epigenomic epidemiologic studies.
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Affiliation(s)
- Yan V Sun
- Department of Epidemiology, Rollins School of Public Health; Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
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12
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Wu MZ, McInnes MDF, Macdonald DB, Kielar AZ, Duigenan S. CT in adults: systematic review and meta-analysis of interpretation discrepancy rates. Radiology 2013; 270:717-35. [PMID: 24475832 DOI: 10.1148/radiol.13131114] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To use meta-analysis to determine the discrepancy rate when interpreting computed tomography (CT) studies performed in adult patients and to determine whether discrepancy rate differs on the basis of body region or level of radiologist training. MATERIALS AND METHODS MEDLINE and EMBASE were searched from 1946 to June 2012 by using the combination "radiology AND (error OR peer review)." Two reviewers independently selected studies that met the inclusion criteria and extracted study data. Total and major discrepancy rates were investigated with a random-effects meta-analysis, and subgroups were compared by using the χ(2) Q statistic. Subgroup analyses were performed on the basis of the level of training of the initial radiologist and the body system scanned. RESULTS Fifty-eight studies met the inclusion criteria (388 123 CT examinations). The pooled total discrepancy rate was 7.7% (95% confidence interval [CI]: 5.6%, 10.3%), and the major discrepancy rate was 2.4% (95% CI: 1.7%, 3.2%). The pooled major discrepancy rate was comparable for staff (2.9%; 95% CI: 1.2%, 6.7%) and residents (2.2%; 95% CI: 1.7%, 2.9%) (Q = 0.92, P = .633). The pooled major discrepancy rates for head CT (0.8%; 95% CI: 0.4%, 1.6%) and spine CT (0.7%; 95% CI: 0.2%, 2.7%) were lower than those for chest CT (2.8%; 95% CI: 1.5%, 5.4%) and abdominal CT (2.6%; 95% CI: 1.0%, 6.7%) (Q = 8.28, P = .041). Lack of blinding of the reference radiologist to the initial report was associated with a lower major discrepancy rate (2.0%; 95% CI: 1.4%, 2.7%; 43 studies) than when blinding was present (12.1%; 95% CI: 4.4%, 29.4%; five studies) (Q = 10.65, P = .001). CONCLUSION Potentially useful reference ranges were identified in the subgroup analyses on the basis of body region scanned at adult CT. However, considerable heterogeneity that is only partially explained by subgroup analysis signifies that further research is necessary--particularly regarding the question of blinding of the reference radiologist.
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Affiliation(s)
- Mark Z Wu
- From the Department of Medical Imaging, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (M.Z.W., M.D.F.M.); and Department of Medical Imaging, the Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (D.B.M., A.Z.K., S.D.)
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13
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Hohmann J, de Villiers P, Urigo C, Sarpi D, Newerla C, Brookes J. Quality assessment of out sourced after-hours computed tomography teleradiology reports in a Central London University Hospital. Eur J Radiol 2012; 81:e875-9. [PMID: 22608063 DOI: 10.1016/j.ejrad.2012.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/15/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
The study was designed to assess the quality of out sourced after-hours computed tomography teleradiology service reports. We evaluated 1028 patients over a time period of five month in 2009/2010 (437 female, 591 male, mean age: 51 years, range: 0-97 years) who were referred either by the A&E or other in house departments from 7 pm to 8 am for different reasons. Reporting was done by a teleradiology service provider located in the UK and Australia. Reports were assessed during the routinely performed morning meeting by a panel of in house radiologists. Assessment was done by a five point agreement scale (5="No disagreement", 1="…unequivocal potential for serious morbidity or threat to life"). In 811 (79%) patients no disagreement was found, 164 (16%) were rated as category 4, 40 (4%) as category 3 ("…likelihood of harm is low"). In 13 (1.3%) patients a decision of category 2 was made ("…strong likelihood of moderate morbidity but not threat to life"). No category 1 decision was made. As this was just a discrepancy decision, a follow up of the category 2 patients was done over a period of a maximum of 6 months. In 8 (0.8%) patients the in house reports were correct, in 2 (0.2%) patients the teleradiology service provider was right and in 3 (0.3%) patients the final diagnoses remained unclear. In conclusion there was a small rate (0.8%) of proven serious misinterpretations by the teleradiology service provider, but these were less than in comparable studies with preliminary in house staff reports (1.6-24.6%).
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Affiliation(s)
- Joachim Hohmann
- Imaging Department, University College Hospital, University College London Hospitals, University College London, 235 Euston Road, London NW1 2BU, UK.
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14
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Cao MD, Minh CD, Shimizu S, Antoku Y, Torata N, Kudo K, Okamura K, Nakashima N, Tanaka M. Emerging technologies for telemedicine. Korean J Radiol 2012; 13 Suppl 1:S21-30. [PMID: 22563284 PMCID: PMC3341457 DOI: 10.3348/kjr.2012.13.s1.s21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 12/02/2011] [Indexed: 11/15/2022] Open
Abstract
This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.
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Affiliation(s)
- Minh Duc Cao
- Vietnam Research and Education Network, National Agency for Science and Technology Information, Hanoi 10000, Vietnam
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15
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Rubin DL. Informatics in radiology: Measuring and improving quality in radiology: meeting the challenge with informatics. Radiographics 2012; 31:1511-27. [PMID: 21997979 DOI: 10.1148/rg.316105207] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Quality is becoming a critical issue for radiology. Measuring and improving quality is essential not only to ensure optimum effectiveness of care and comply with increasing regulatory requirements, but also to combat current trends leading to commoditization of radiology services. A key challenge to implementing quality improvement programs is to develop methods to collect knowledge related to quality care and to deliver that knowledge to practitioners at the point of care. There are many dimensions to quality in radiology that need to be measured, monitored, and improved, including examination appropriateness, procedure protocol, accuracy of interpretation, communication of imaging results, and measuring and monitoring performance improvement in quality, safety, and efficiency. Informatics provides the key technologies that can enable radiologists to measure and improve quality. However, few institutions recognize the opportunities that informatics methods provide to improve safety and quality. The information technology infrastructure in most hospitals is limited, and they have suboptimal adoption of informatics techniques. Institutions can tackle the challenges of assessing and improving quality in radiology by means of informatics.
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Affiliation(s)
- Daniel L Rubin
- Department of Radiology, Stanford University, Richard M. Lucas Center, 1201 Welch Rd, Office P285, Stanford, CA 94305-5488, USA. dlrubin@ stanford.edu
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Shimizu S, Itaba S, Yada S, Takahata S, Nakashima N, Okamura K, Rerknimitr R, Akaraviputh T, Lu X, Tanaka M. Significance of telemedicine for video image transmission of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography procedures. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:366-74. [PMID: 21127912 DOI: 10.1007/s00534-010-0351-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND With the rapid and marked progress in gastrointestinal endoscopy, the education of doctors in many new diagnostic and therapeutic procedures is of increasing importance. Telecommunications (telemedicine) is very useful and cost-effective for doctors' continuing exposure to advanced skills, including those needed for hepato-pancreato-biliary diseases. Nevertheless, telemedicine in endoscopy has not yet gained much popularity. We have successfully established a new system which solves the problems of conventional ones, namely poor streaming images and the need for special expensive teleconferencing equipment. METHODS The digital video transport system, free software that transforms digital video signals directly into Internet Protocol without any analog conversion, was installed on a personal computer using a network with as much as 30 Mbps per channel, thereby providing more than 200 times greater information volume than the conventional system. Kyushu University Hospital in Japan was linked internationally to worldwide academic networks, using security software to protect patients' privacy. RESULTS Of the 188 telecommunications link-ups involving 108 institutions in 23 countries performed between February 2003 and August 2009, 55 events were endoscopy-related, 19 were live demonstrations, and 36 were gastrointestinal teleconferences with interactive discussions. The frame rate of the transmitted pictures was 30/s, thus preserving smooth high-quality streaming. CONCLUSIONS This paper documents the first time that an advanced tele-endoscopy system has been established over such a wide area using academic high-volume networks, funded by the various governments, and which is now available all over the world. The benefits of a network dedicated to research and education have barely been recognized in the medical community. We believe our cutting-edge system will be a milestone in endoscopy and will improve the quality of gastrointestinal education, especially with respect to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures.
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Affiliation(s)
- Shuji Shimizu
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Babiarz LS, Yousem DM. Quality control in neuroradiology: discrepancies in image interpretation among academic neuroradiologists. AJNR Am J Neuroradiol 2011; 33:37-42. [PMID: 22033725 DOI: 10.3174/ajnr.a2704] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prior studies have found a 3%-6% clinically significant error rate in radiology practice. We set out to assess discrepancy rates between subspecialty-trained university-based neuroradiologists. Over 17 months, university neuroradiologists randomly reviewed 1000 studies and reports of previously read examinations of patients in whom follow-up studies were read. The discrepancies between the original and "second opinion" reports were scored according to a 5-point scale: 1, no change; 2, clinically insignificant detection discrepancy; 3, clinically insignificant interpretation discrepancy; 4, clinically significant detection discrepancy; and 5, clinically significant interpretation discrepancy. Of the 1000 studies, 876 (87.6%) showed agreements with the original report. The neuroradiology division had a 2.0% (20/1000; 95% CI, 1.1%-2.9%) rate of clinically significant discrepancies involving 8 CTs and 12 MR images. Discrepancies were classified as vascular (n = 7), neoplastic (n = 9), congenital (n = 2), and artifacts (n = 2). Individual neuroradiologist's scores ranged from 0% to 7.7% ± 2.3% (n = 18). Both CT and MR imaging studies had a discrepancy rate of 2.0%. Our quality assessment study could serve as initial data before intervention as part of a PQI project.
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Affiliation(s)
- L S Babiarz
- Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Larson PA, Pyatt RS, Grimes CK, Abudujeh HH, Chin KW, Roth CJ. Getting the Most Out of RADPEER™. J Am Coll Radiol 2011; 8:543-8. [DOI: 10.1016/j.jacr.2010.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 12/20/2010] [Indexed: 10/17/2022]
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Ruma J, Klein KA, Chong S, Wesolowski J, Kazerooni EA, Ellis JH, Myles JD. Cross-Sectional Examination Interpretation Discrepancies Between On-Call Diagnostic Radiology Residents and Subspecialty Faculty Radiologists: Analysis by Imaging Modality and Subspecialty. J Am Coll Radiol 2011; 8:409-14. [DOI: 10.1016/j.jacr.2011.01.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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Breil B, Fritz F, Thiemann V, Dugas M. Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains. BMC Med Inform Decis Mak 2011; 11:34. [PMID: 21609424 PMCID: PMC3125312 DOI: 10.1186/1472-6947-11-34] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format. METHODS Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions. RESULTS More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed. CONCLUSION Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.
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Affiliation(s)
- Bernhard Breil
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany.
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Harolds JA, Duszak R, Strax R, Short B, Kaye AD. Preventing Another Group From Displacing Your Practice: Perspectives From the 2010 AMCLC. J Am Coll Radiol 2011; 8:99-103. [DOI: 10.1016/j.jacr.2010.06.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 06/30/2010] [Indexed: 11/15/2022]
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A twin approach to unraveling epigenetics. Trends Genet 2011; 27:116-25. [PMID: 21257220 PMCID: PMC3063335 DOI: 10.1016/j.tig.2010.12.005] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/09/2010] [Accepted: 12/13/2010] [Indexed: 01/07/2023]
Abstract
The regulation of gene expression plays a pivotal role in complex phenotypes, and epigenetic mechanisms such as DNA methylation are essential to this process. The availability of next-generation sequencing technologies allows us to study epigenetic variation at an unprecedented level of resolution. Even so, our understanding of the underlying sources of epigenetic variability remains limited. Twin studies have played an essential role in estimating phenotypic heritability, and these now offer an opportunity to study epigenetic variation as a dynamic quantitative trait. High monozygotic twin discordance rates for common diseases suggest that unexplained environmental or epigenetic factors could be involved. Recent genome-wide epigenetic studies in disease-discordant monozygotic twins emphasize the power of this design to successfully identify epigenetic changes associated with complex traits. We describe how large-scale epigenetic studies of twins can improve our understanding of how genetic, environmental and stochastic factors impact upon epigenetics, and how such studies can provide a comprehensive understanding of how epigenetic variation affects complex traits.
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Agrawal A, Agrawal A, Pandit M, Kalyanpur A. Systematic survey of discrepancy rates in an international teleradiology service. Emerg Radiol 2010; 18:23-9. [PMID: 20737281 DOI: 10.1007/s10140-010-0899-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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Shiels WE. Pediatric teleradiology outsourcing: downside considerations. Pediatr Radiol 2010; 40:1349-52. [PMID: 20523984 DOI: 10.1007/s00247-010-1666-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 03/23/2010] [Indexed: 11/28/2022]
Affiliation(s)
- William E Shiels
- Department of Radiology and The Children's Radiological Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Abujudeh HH, Boland GW, Kaewlai R, Rabiner P, Halpern EF, Gazelle GS, Thrall JH. Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists. Eur Radiol 2010; 20:1952-7. [PMID: 20336300 DOI: 10.1007/s00330-010-1763-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 12/07/2009] [Accepted: 01/14/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the discrepancy rate for the interpretation of abdominal and pelvic computed tomography (CT) examinations among experienced radiologists. METHODS Ninety abdominal and pelvic CT examinations reported by three experienced radiologists who specialize in abdominal imaging were randomly selected from the radiological database. The same radiologists, blinded to previous interpretation, were asked to re-interpret 60 examinations: 30 of their previous interpretations and 30 interpreted by others. All reports were assessed for the degree of discrepancy between initial and repeat interpretations according to a three-level scoring system: no discrepancy, minor, or major discrepancy. Inter- and intrareader discrepancy rates and causes were evaluated. RESULTS CT examinations included in the investigation were performed on 90 patients (43 men, mean age 59 years, SD 14, range 19-88) for the following indications: follow-up/evaluation of malignancy (69/90, 77%), pancreatitis (5/90, 6%), urinary tract stone (4/90, 4%) or other (12/90, 13%). Interobserver and intraobserver major discrepancy rates were 26 and 32%, respectively. Major discrepancies were due to missed findings, different opinions regarding interval change of clinically significant findings, and the presence of recommendation. CONCLUSIONS Major discrepancy of between 26 and 32% was observed in the interpretation of abdominal and pelvic CT examinations.
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Affiliation(s)
- Hani H Abujudeh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Bad Money Drives Out Good: Forebodings of a Corporatized American Radiology—The 2009 Eugene Caldwell Lecture. AJR Am J Roentgenol 2009; 193:1481-5. [DOI: 10.2214/ajr.09.3144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Benjamin M, Aradi Y, Shreiber R. From shared data to sharing workflow: merging PACS and teleradiology. Eur J Radiol 2009; 73:3-9. [PMID: 19914789 DOI: 10.1016/j.ejrad.2009.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/07/2009] [Indexed: 11/16/2022]
Abstract
Due to a host of technological, interface, operational and workflow limitations, teleradiology and PACS/RIS were historically developed as separate systems serving different purposes. PACS/RIS handled local radiology storage and workflow management while teleradiology addressed remote access to images. Today advanced PACS/RIS support complete site radiology workflow for attending physicians, whether on-site or remote. In parallel, teleradiology has emerged into a service of providing remote, off-hours, coverage for emergency radiology and to a lesser extent subspecialty reading to subscribing sites and radiology groups. When attending radiologists use teleradiology for remote access to a site, they may share all relevant patient data and participate in the site's workflow like their on-site peers. The operation gets cumbersome and time consuming when these radiologists serve multi-sites, each requiring a different remote access, or when the sites do not employ the same PACS/RIS/Reporting Systems and do not share the same ownership. The least efficient operation is of teleradiology companies engaged in reading for multiple facilities. As these services typically employ non-local radiologists, they are allowed to share some of the available patient data necessary to provide an emergency report but, by enlarge, they do not share the workflow of the sites they serve. Radiology stakeholders usually prefer to have their own radiologists perform all radiology tasks including interpretation of off-hour examinations. It is possible with current technology to create a system that combines the benefits of local radiology services to multiple sites with the advantages offered by adding subspecialty and off-hours emergency services through teleradiology. Such a system increases efficiency for the radiology groups by enabling all users, regardless of location, to work "local" and fully participate in the workflow of every site. We refer to such a system as SuperPACS.
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Kennedy S, Forman HP, Kaye AH, Bhargavan M, Sunshine JH. The reasons that many radiology practices don't use off-hours services. J Am Coll Radiol 2008; 5:887-92. [PMID: 18657784 DOI: 10.1016/j.jacr.2008.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare radiology practices that use external, internal, and no off-hours services. METHODS From August 2005 to June 2006, 300 nonspecialty hospitals randomly selected from the AHA Guide 2005 Edition were contacted by telephone, e-mail, and mail, with attempts made to speak to the chiefs of radiology. A total of 115 responses were obtained (a 38.3% response rate), with 64 from radiology practices that used external off-hours services, 13 from practices with internal services, and 38 from practices with no services. The demographics of the practices in the 3 categories were compared, and answers to category-specific survey questions were tabulated. Responses were analyzed using descriptive statistics. RESULTS Radiology practices using internal off-hours services were significantly larger (mean size, 19.9 full-time radiologists) than those using external off-hours services (mean size, 8.2 full-time radiologists) and those not using any off-hours service (mean size, 10.7 full-time radiologists). A sufficient number of radiologists or residents covering nights had the highest reported importance in the decision not to adopt an external service. Cost and quality concerns were also cited. The consistency of interpreting radiologists known to a practice had the highest importance in the decision to use an internal rather than an external off-hours service. Frequent reasons cited for radiologists to take regular internal off-hours employment were financial incentives provided and a preference for off-hours shifts. CONCLUSIONS As long as there are sufficient numbers of radiologists and residents to handle the volume of interpretations, many practices will not use external off-hours services. Such services could help increase their adoption by offering lower cost and proven quality.
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Affiliation(s)
- Scott Kennedy
- Yale University School of Medicine, New Haven, CT 06510, USA.
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Kaye AH, Forman HP, Kapoor R, Sunshine JH. A survey of radiology practices' use of after-hours radiology services. J Am Coll Radiol 2008; 5:748-58. [PMID: 18514955 DOI: 10.1016/j.jacr.2008.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE The study's purpose was to identify the characteristics of and the motives behind radiologists' use of after-hours services. METHODS From August of 2005 to June of 2006, 300 nonspecialty hospitals randomly selected from the 2005 American Hospital Association Directory of Hospitals were contacted by phone, e-mail, and mail, with an attempt made to speak to the chiefs of radiology. We obtained 115 responses, a 38.3% response rate, including 64 from practices that used an external after-hours service. These 64 are the subject of this study. Responses were analyzed using descriptive statistical analyses. RESULTS Practices gave convenience as the most important reason they use after-hours services, with value for recruiting ranked second and shortage of radiologists for off-hours coverage ranked third. Three-fourths of practices said they receive 5% or less of their reads from these services. Two-thirds of practices paid the service approximately as much as they collected or more. Approximately 40% of respondents used an after-hours service located internationally. Of these, 56% said that the radiologists reading internationally were either all Americans or mostly Americans and 40% did not know the proportion of foreigners. Regardless, in-state licensure of all interpreting teleradiologists is essentially universal. CONCLUSION Most radiology groups using after-hours services do so for convenience rather than shortage of staff to provide coverage. Most practices send a small percentage of their studies to the services. Although overseas-located services are commonly used, there is little evidence of other than American radiologists or American-trained radiologists at these services.
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Affiliation(s)
- Adam H Kaye
- Yale University School of Medicine, New Haven, Connecticut 06511, USA.
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Dixon AK, FitzGerald R. Outsourcing and teleradiology: potential benefits, risks and solutions from a UK/European perspective. J Am Coll Radiol 2008; 5:12-8. [PMID: 18180002 DOI: 10.1016/j.jacr.2007.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Indexed: 11/27/2022]
Affiliation(s)
- Adrian K Dixon
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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The Radiology World Is Flat: Problems or Solutions for Radiologists? J Am Coll Radiol 2007; 4:754-7. [DOI: 10.1016/j.jacr.2007.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Indexed: 11/18/2022]
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Krestin GP, Miller JC, Golding SJ, Frija GG, Glazer GM, Ringertz HG, Thrall JH. Reinventing radiology in a digital and molecular age: summary of proceedings of the Sixth Biannual Symposium of the International Society for Strategic Studies in Radiology (IS3R), August 25 27, 2005. Radiology 2007; 244:633-8. [PMID: 17690325 DOI: 10.1148/radiol.2443070165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Saket DD. The provision of emergency radiology services and potential radiologist workforce crisis: is there a role for the emergency-dedicated radiologist? Semin Ultrasound CT MR 2007; 28:81-4. [PMID: 17432761 DOI: 10.1053/j.sult.2007.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One of the greatest challenges facing the specialty of radiology over the next several years will involve the provision of emergency radiology services. The demand for medical imaging--especially computed tomography and magnetic resonance imaging--continues to explode in the emergency setting and threatens to overwhelm the resources of many radiology practices. How our specialty decides ultimately to respond is critical, as it will have far-reaching implications, which will define the role and perceived value of the radiologist in all settings for years to come.
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Affiliation(s)
- Daniel D Saket
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Joffe SA, Burak JS, Rackson M, Klein DA, Joffe MM. The Effect of International Teleradiology Attending Radiologist Coverage on Radiology Residents’ Perceptions of Night Call. J Am Coll Radiol 2006; 3:872-8. [PMID: 17412187 DOI: 10.1016/j.jacr.2006.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine the effects of international teleradiology attending radiologist coverage (ITARC) of emergency examinations on radiology residents' perceptions of night call. METHODS A survey was administered at 2 different radiology residency programs that have attending radiologists who cover the night shift via teleradiology from Israel 5 nights per week. The survey consisted of 12 questions concerning residents' education and anxiety during on-call shifts and the effects of ITARC on these aspects of residency training. The questions were answered on a scale ranging from 1 to 5, with 3 being neutral. RESULTS The radiology residents felt that ITARC improved the on-call learning experience (score = 3.7; 1 = much worse, 5 = much improved). The residents felt neutral about the statements "Review of cases with the attending radiologist over the telephone is comparable educationally to having the attending radiologist in person at the workstation" (score = 3.0) and "Having an attending radiologist easily available diminishes the need for me to commit to a diagnosis on my own and is therefore detrimental to my education" (score = 2.9; 1 = strongly disagree, 5 = strongly agree). The residents' stress levels on call were high without ITARC (score = 1.8; 1 = very high, 5 = very low) and moderate with ITARC (score = 2.7). The residents' anxiety levels before a night on call were moderate without ITARC (score = 2.9; 1 = very high, 5 = very low) and low with ITARC (score = 3.7). CONCLUSIONS Radiology residents felt that ITARC improved their educational experience. International teleradiology attending radiologist coverage also decreased radiology residents' stress and anxiety related to on-call shifts.
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Affiliation(s)
- Sandor A Joffe
- Department of Radiology, Beth Israel Medical Center, New York, NY 10003, USA.
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Cheng LTE, Ng SES. Teleradiology in Singapore – Taking Stock and Looking Ahead. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n8p552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Teleradiology will have a significant impact on the delivery of healthcare and the practice of medicine. In order to ensure a positive outcome, the expected benefits, limitations and potential pitfalls of teleradiology must be carefully considered. For Singapore, teleradiology can be used to facilitate a quantum leap in the standards of radiological services. This can be achieved through the development of an integrated, nationwide, high-speed radiology network which will allow patients to have access to high-quality and responsive subspecialty radiology expertise located throughout the country. If judiciously implemented, teleradiology has the potential to propel Singapore radiology to an unprecedented level of professional quality and service delivery, and will provide the framework for sustainable radiological insourcing from other countries.
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Authors’ Reply. J Am Coll Radiol 2006. [DOI: 10.1016/j.jacr.2006.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Boland GWL. Stakeholder Expectations for Radiologists: Obstacles or Opportunities? J Am Coll Radiol 2006; 3:156-63. [PMID: 17412031 DOI: 10.1016/j.jacr.2005.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Indexed: 11/29/2022]
Affiliation(s)
- Giles W L Boland
- Massachusetts General Hospital, Department of Radiology, Boston, MA 02114, USA.
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FitzGerald R. Re: “Outsourced Teleradiology Imaging Services: An Analysis of Discordant Interpretation in 124,870 Cases”. J Am Coll Radiol 2005; 2:804; author reply 804. [PMID: 17411934 DOI: 10.1016/j.jacr.2005.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Indexed: 11/23/2022]
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