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Mitsuyama Y, Tatekawa H, Takita H, Sasaki F, Tashiro A, Oue S, Walston SL, Nonomiya Y, Shintani A, Miki Y, Ueda D. Comparative analysis of GPT-4-based ChatGPT's diagnostic performance with radiologists using real-world radiology reports of brain tumors. Eur Radiol 2024:10.1007/s00330-024-11032-8. [PMID: 39198333 DOI: 10.1007/s00330-024-11032-8] [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: 12/15/2023] [Revised: 07/08/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVES Large language models like GPT-4 have demonstrated potential for diagnosis in radiology. Previous studies investigating this potential primarily utilized quizzes from academic journals. This study aimed to assess the diagnostic capabilities of GPT-4-based Chat Generative Pre-trained Transformer (ChatGPT) using actual clinical radiology reports of brain tumors and compare its performance with that of neuroradiologists and general radiologists. METHODS We collected brain MRI reports written in Japanese from preoperative brain tumor patients at two institutions from January 2017 to December 2021. The MRI reports were translated into English by radiologists. GPT-4 and five radiologists were presented with the same textual findings from the reports and asked to suggest differential and final diagnoses. The pathological diagnosis of the excised tumor served as the ground truth. McNemar's test and Fisher's exact test were used for statistical analysis. RESULTS In a study analyzing 150 radiological reports, GPT-4 achieved a final diagnostic accuracy of 73%, while radiologists' accuracy ranged from 65 to 79%. GPT-4's final diagnostic accuracy using reports from neuroradiologists was higher at 80%, compared to 60% using those from general radiologists. In the realm of differential diagnoses, GPT-4's accuracy was 94%, while radiologists' fell between 73 and 89%. Notably, for these differential diagnoses, GPT-4's accuracy remained consistent whether reports were from neuroradiologists or general radiologists. CONCLUSION GPT-4 exhibited good diagnostic capability, comparable to neuroradiologists in differentiating brain tumors from MRI reports. GPT-4 can be a second opinion for neuroradiologists on final diagnoses and a guidance tool for general radiologists and residents. CLINICAL RELEVANCE STATEMENT This study evaluated GPT-4-based ChatGPT's diagnostic capabilities using real-world clinical MRI reports from brain tumor cases, revealing that its accuracy in interpreting brain tumors from MRI findings is competitive with radiologists. KEY POINTS We investigated the diagnostic accuracy of GPT-4 using real-world clinical MRI reports of brain tumors. GPT-4 achieved final and differential diagnostic accuracy that is comparable with neuroradiologists. GPT-4 has the potential to improve the diagnostic process in clinical radiology.
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Affiliation(s)
- Yasuhito Mitsuyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroyuki Tatekawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hirotaka Takita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Fumi Sasaki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Akane Tashiro
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Satoshi Oue
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shannon L Walston
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yuta Nonomiya
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
- Center for Health Science Innovation, Osaka Metropolitan University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
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Fardanesh R, Beavers K, Jochelson MS, Ulaner GA. Value of subspecialist second opinion reads of 18 F-FDG PET-CT examinations for patients with breast cancer. Nucl Med Commun 2023; 44:825-829. [PMID: 37395540 DOI: 10.1097/mnm.0000000000001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Determine if subspecialist second opinion review alters reporting of malignancy on 18 F-FDG PET/CT for patients with breast cancer. METHODS This IRB-approved retrospective study compared 248 s opinion reads of 18 F-FDG PET/CT exams performed for patients with breast cancer against the original outside institution reports. Subspecialist reviews documented if malignant findings on the outside report were believed to be malignant and noted additional malignant findings not described on the outside report. Reference standard for malignancy or benignity was determined by pathology or follow-up imaging. RESULTS Of 248 cases, 27 (11%) had discrepancies in the presence or absence of extra-axillary nodal or distant metastases. Of these 27, 14 (52%) had biopsy or imaging follow-up as a reference standard for malignancy/benignity. In cases with reference standard proof, the subspecialist second opinion review was correct in 13/14 (93%) of cases. This included eleven cases that the original report called malignant, but the subspecialist review called benign and subsequently proven to be benign; as well as two metastases called on subspecialist review, but not on the original report, and subsequently biopsy proven to be metastases. In one case, the second opinion read called a suspicious lesion that was biopsy proven to be benign. CONCLUSION Subspecialist review improves the accuracy of diagnosis for the presence or absence of malignancy on FDG PET/CT examinations in patients with breast cancer. This demonstrates the value of performing second opinion reads of 18 F-FDG PET/CT studies in patients with breast cancer, particularly by subspecialist second opinion review reducing false positive reads.
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Affiliation(s)
- Reza Fardanesh
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiologic Sciences, University of California, Los Angeles, Los Angeles, California
| | - Kimberly Beavers
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology, AdventHealth Medical Group, Orlando, Florida
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gary A Ulaner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, Departments of
- Radiology
- Translational Genomics, University of Southern California, Los Angeles, California, USA
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Eccher A, Malvi D, Novelli L, Mescoli C, D'Errico A. Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In. Clin Pract 2023; 13:610-615. [PMID: 37218806 DOI: 10.3390/clinpract13030055] [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: 03/12/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Second opinion consultation is a well-established practice in different clinical settings of diagnostic medicine. However, little is known about second opinion consultation activity in transplantation, and even less is known about it concerning donor assessment. The consultations provided by the second opinion service led to the safer and homogeneous management of donors with a history of malignancy or ongoing neoplasm by transplant centers. Indeed, two of the most important aspects are the reduction of semantic differences in cancer reporting and the standardization of procedures, which are mainly due to the different settings and logistics of different pathology services. This article aims to discuss the role and the future of the second opinion in Italy during organ procurement, highlighting the critical issues and areas for improvement.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, 37136 Verona, Italy
- Second Opinion, National Transplant Center, 00161 Rome, Italy
| | - Deborah Malvi
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Novelli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, 50134 Florence, Italy
| | - Claudia Mescoli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, 35128 Padua, Italy
| | - Antonietta D'Errico
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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DiPiro PJ, Licaros A, Zhao AH, Glazer DI, Healey MJ, Curley PJ, Giess CS, Khorasani R. Frequency and Clinical Utility of Alerts for Intra-Institutional Radiologist Discrepant Opinions. J Am Coll Radiol 2023; 20:431-437. [PMID: 36841320 DOI: 10.1016/j.jacr.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Determine the rate of documented notification, via an alert, for intra-institutional discrepant radiologist opinions and addended reports and resulting clinical management changes. METHODS This institutional review board-exempt, retrospective study was performed at a large academic medical center. We defined an intra-institutional discrepant opinion as when a consultant radiologist provides a different interpretation from that formally rendered by a colleague at our institution. We implemented a discrepant opinion policy requiring closed-loop notification of the consulting radiologist's second opinion to the original radiologist, who must acknowledge this alert within 30 days. This study included all discrepant opinion alerts created December 1, 2019, to December 31, 2021, of which two radiologists and an internal medicine physician performed consensus review. Primary outcomes were degree of discrepancy and percent of discrepant opinions leading to change in clinical management. Secondary outcome was report addendum rate compared with an existing peer learning program using Fisher's exact test. RESULTS Of 114 discrepant opinion alerts among 1,888,147 reports generated during the study period (0.006%), 58 alerts were categorized as major (50.9%), 41 as moderate (36.0%), and 15 as minor discrepancies (13.1%). Clinical management change occurred in 64 of 114 cases (56.1%). Report addendum rate for discrepant opinion alerts was 4-fold higher than for peer learning alerts at our institution (66 of 315 = 21% versus 432 of 8,273 =5.2%; P < .0001). DISCUSSION Although discrepant intra-institutional radiologist second opinions were rare, they frequently led to changes in clinical management. Capturing these discrepancies by encouraging alert use may help optimize patient care and document what was communicated to the referring or consulting care team by consulting radiologists.
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Affiliation(s)
- Pamela J DiPiro
- Radiology Quality and Safety Officer, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Andro Licaros
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; and Oncologic Imaging Fellow, Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Anna H Zhao
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; and Radiology Resident, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel I Glazer
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Medical Director of CT and Director, Cross-Sectional Interventional Radiology (CSIR), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Michael J Healey
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; and Associate Chief Medical Officer, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patrick J Curley
- Executive Director, Quality, Safety, Equity & Experience, Enterprise Radiology, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine S Giess
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Deputy Chair, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Vice Chair, Radiology Quality and Safety, Mass General Brigham; Vice Chair, Department of Radiology; Distinguished Chair, Medical Informatics; Director, Center for Evidence Based Imaging; Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Neuroradiology diagnostic errors at a tertiary academic centre: effect of participation in tumour boards and physician experience. Clin Radiol 2022; 77:607-612. [PMID: 35589432 DOI: 10.1016/j.crad.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
Abstract
AIM To quantify and correlate the diagnostic error rates in radiological interpretation with the experience of the attending neuroradiologist at a tertiary academic medical centre. MATERIALS AND METHODS The institution's Neuroradiology Quality Assurance Database of diagnostic errors was searched for misses from 2014-2020. Attendance at Head and Neck (H&N), Brain, and Paediatric Neuroradiology (PN) tumour boards (TB) as the presenting radiologist was recorded. Number of post-fellowship years of clinical practice (CPY) and frequency of TB attendance were considered separate metrics of a radiologist's experience. Radiological errors were categorised as Total, H&N, Skull Base (SKB), Brain, or PN diagnostic errors. Diagnostic error rates per attending neuroradiologist within each category were correlated with the frequency of TB participation and CPY using Spearman's rank correlation coefficients. RESULTS A total 607 examinations contained a diagnostic error. Spearman's rank correlation coefficients between Total TB participation and Total, H&N, SKB, Brain error rates were: -0.89 (p=0.0002); -0.81 (p=0.002); -0.66 (p=0.03); -0.82 (p=0.002); respectively. Spearman's rank correlation coefficients between CPY and Total, H&N, SKB, Brain and PN error rates were: 0.05 (p=0.88); 0.08 (p=0.82); 0.28 (p=0.41); -0.10 (p=0.77); -0.16 (p=0.63), respectively. Spearman's rank correlation coefficients between H&N TB and H&N, SKB error rates; and between Brain TB attendance and Brain error rates were statistically significant (p<0.05). CONCLUSION The present study shows a strong correlation between high TB participation rates and low diagnostic error rates. The number of years in practice did not appear to influence error rate.
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Khatri GD, Flowers MG, Robinson JD. Transfer patient imaging: A novel peer feedback program beyond institutional boundaries. Curr Probl Diagn Radiol 2022; 51:722-727. [DOI: 10.1067/j.cpradiol.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
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Mahajan A, Shukla S, Mali R, Agarwal U, Sable N, Vaish R, Ankathi S, Patil V, Janu A, Prabhash K, Noronha V, Pai P, Laskar S, Patil A, Patil V, Menon N, Thiagarajan S, Chaturvedi P. Second opinion interpretations by specialty radiologists in head-and-neck oncology and their impact on clinical management: A retrospective observational study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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8
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Schwarz J, Bärkås A, Blease C, Collins L, Hägglund M, Markham S, Hochwarter S. Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review. JMIR Ment Health 2021; 8:e34170. [PMID: 34904956 PMCID: PMC8715358 DOI: 10.2196/34170] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)-often referred to as open notes-have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. OBJECTIVE This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders' perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. METHODS A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. RESULTS Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members' mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. CONCLUSIONS PAEHRs in MHC may strengthen user involvement, patients' autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Annika Bärkås
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Lorna Collins
- Social Science Research Unit, University College London, London, United Kingdom
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sarah Markham
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Stefan Hochwarter
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
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Interpretations of Examinations Outside of Radiologists' Fellowship Training: Assessment of Discrepancy Rates Among 5.9 Million Examinations From a National Teleradiology Databank. AJR Am J Roentgenol 2021; 218:738-745. [PMID: 34730371 DOI: 10.2214/ajr.21.26656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: In community settings, radiologists commonly function as multispecialty radiologists, interpreting examinations outside of their fellowship training. Objective: To compare discrepancy rates for preliminary interpretations of acute community-setting examinations concordant versus discordant with interpreting radiologists' fellowship training. Methods: This retrospective study used the databank of a U.S. teleradiology company that provides preliminary interpretations for client community hospitals. The analysis included 5,883,980 acute examinations performed from 2012 to 2016 that were preliminarily interpreted by 269 teleradiologists with a fellowship of neuroradiology, abdominal radiology, or musculoskeletal radiology. When providing final interpretations, client on-site radiologists voluntarily submitted quality assurance (QA) requests if preliminary and final interpretations were discrepant; the teleradiology company's QA committee categorized discrepancies as major (n=8,444) or minor (n=17,208). Associations among examination type (common vs advanced), relationship between examination subspecialty and the teleradiologist's fellowship (concordant vs discordant), and major and minor discrepancies were assessed using three-way conditional analyses with generalized estimating equations. Results: For examinations with concordant subspecialty, major discrepancy rate was lower for common than advanced examinations [0.13% vs 0.26%; relative risk (RR) 0.50, 95% CI: 0.42, 0.60; p < .001]. For examinations with discordant subspecialty, major discrepancy rate was lower for common than advanced examinations (0.14% vs 0.18%; RR 0.81, 95% CI: 0.72, 0.90; p < .001). For common examinations, major discrepancy rate was not different between examinations with concordant versus discordant subspecialty (0.13% vs 0.14%; RR 0.90, 95% CI: 0.81, 1.01; p = .07). For advanced examinations, major discrepancy rate was higher for examinations with concordant versus discordant subspecialty (0.26% vs 0.18%; RR 1.45, 95% CI: 1.18, 1.79; p < .001). Minor discrepancy rate was higher among advanced examinations for those with concordant versus discordant subspecialty (0.34% vs 0.29%; RR 1.17, 95% CI: 1.001, 1.36; p = .04), but not different for other comparisons (p > .05). Conclusion: Major and minor discrepancy rates were not higher for acute community-setting examinations outside of interpreting radiologists' fellowship training. Discrepancy rates increased for advanced examinations. Clinical Impact: The findings support multispecialty radiologist practice in acute community settings. Efforts to match examination and interpreting radiologist subspecialty may not reduce diagnostic discrepancies.
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Henkelmann J, Ehrengut C, Denecke T. Restructuring of a Hospital Radiology Department: Subspecialization Between Man, Machine, and Multidisciplinary Board. ROFO-FORTSCHR RONTG 2021; 194:152-159. [PMID: 34674217 DOI: 10.1055/a-1545-4713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Radiology, like almost no other discipline, is faced with a rapid increase in information and technology. This and the growing demands regarding referring medicine, quality requirements, and personnel efficiency increasingly require subspecialization in terms of content. There is already an established move towards radiological subspecialization in the Anglo-American region. In this review article, the content and possibilities of restructuring a hospital radiology department are presented in order to support acceptance in German-speaking countries. METHOD Based on the current literature, the aspects of subspecialized radiology as well as its necessity, advantages, and disadvantages are discussed and the challenges to hospital management with respect to strategic implementation in the individual phases are presented based on the example of a university radiology department. The viewpoints also take into account the education regulations and integrate a modern learning concept. RESULTS AND CONCLUSION Modern restructuring of hospital radiology departments is faced with increasing demands on a traditionally technically organized radiology department with regard to the complexity of referring medicine, subspecialization pressure (including in certified boards), and staff efficiency. The restructuring of a radiology department must be aligned with the clinical requirements and discussed in the overall concept of radiology including its environment. KEY POINTS · The tremendous expansion of knowledge requires a content-based subspecialization of modern radiology as a cross-sectional discipline.. · Proactive radiology meets the increasing demands of its clinical partners and offers great potential for improving quality and efficiency.. · The restructuring of a hospital radiology department requires well-planned strategic management taking into account all involved processes, resources, and personnel qualifications.. CITATION FORMAT · Henkelmann J, Ehrengut C, Denecke T. Restructuring of a Hospital Radiology Department: Subspecialization Between Man, Machine, and Multidisciplinary Board. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1545-4713.
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Affiliation(s)
- Jeanette Henkelmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Germany
| | - Constantin Ehrengut
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Germany
| | - Timm Denecke
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Germany
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Tee QX, Nambiar M, Stuckey S. Error and cognitive bias in diagnostic radiology. J Med Imaging Radiat Oncol 2021; 66:202-207. [PMID: 34467643 DOI: 10.1111/1754-9485.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
The above article was posted prematurely on 31 August 2021. The article will be made fully available at a later date.
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Affiliation(s)
- Qiao Xin Tee
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
| | - Mithun Nambiar
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
| | - Stephen Stuckey
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Heinz SA, Yakar D, Dierckx RAJO, Lamers MJ, Kwee TC. Recommendations in Second Opinion Reports of Neurologic Head and Neck Imaging: Frequency, Referring Clinicians' Compliance, and Diagnostic Yield. AJNR Am J Neuroradiol 2021; 42:1676-1682. [PMID: 34244129 DOI: 10.3174/ajnr.a7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/05/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Second opinion reports of neurologic head and neck imaging are requested with increased regularity, and they may contain a recommendation to the clinician. Our aim was to investigate the frequency and determinants of the presence of a recommendation and the adherence by the referring physician to the recommendation in a second opinion neurology head and neck imaging report and the diagnostic yield of these recommendations. MATERIALS AND METHODS This retrospective study included 994 consecutive second opinion reports of neurology head and neck imaging examinations performed at a tertiary care center. RESULTS Of the 994 second opinion reports, 12.2% (121/994) contained a recommendation. An oncologic imaging indication was significantly (P = .030) associated with a lower chance of a recommendation in the second opinion report (OR = .67; 95% CI, 0.46-0.96). Clinicians followed 65.7% (88/134) of the recommendations. None of the investigated variables (patient age, sex, hospitalization status, indication for the second opinion report, experience of the radiologist who signed the second opinion report, strength of the recommendation, and whether the recommendation was made due to apparent quality issues of the original examination) were significantly associated with the compliance of the referring physician to this recommendation. The 134 individual recommendations eventually led to the establishment of 52 (38.2%) benign diagnoses and 28 (20.6%) malignant diagnoses, while no definitive diagnosis could be established in 56 (41.2%) cases. CONCLUSIONS Recommendations are relatively common in second opinion reports of neurology head and neck imaging examinations, though less for oncologic indications. They are mostly followed by requesting physicians, thus affecting patient management. In most cases, they also lead to the establishment of a diagnosis, hence adding value to patient care.
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Affiliation(s)
- S A Heinz
- From the Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - D Yakar
- From the Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R A J O Dierckx
- From the Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M J Lamers
- From the Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - T C Kwee
- From the Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Halasy M, Shafrin J. When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits. Mayo Clin Proc Innov Qual Outcomes 2021; 5:502-510. [PMID: 33997646 PMCID: PMC8105538 DOI: 10.1016/j.mayocpiqo.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In order to produce a mathematical model for better understanding of the benefits and utilization of second opinions and to understand the contradiction between the value of second opinions and their perceived underuse, we developed an expected utility theory model to quantify their value. We use a case-based example to find types of biases that could affect second opinions. Although the baseline expected utility theory model presented assumes providers are rational, we relax this and discuss the implications for how these alternative specifications alter predicted use. We found that second opinions are valuable when diagnostic accuracy is variable across physicians or access to high-quality care is restricted. In a stylized simulation example in which about half (50.1%) of diagnoses were incorrect, receipt of 1 second opinion reduced the error rate to 25.8% and receipt of 2 second opinions reduced the error rate to 16.0%. After incorporating potential biases into the model, the value of second opinions increases only when aversion to changing the initial diagnosis is greater than aversion to correcting a mistake. Additionally, this model reveals that second opinions have value even when diagnostic accuracy is perfect. Further, when financial incentives differ from the incentives of the initial consult, a second opinion offers patients a reasonable bound of their treatment options. To conclude, we identify numerous reasons for underuse of second opinions. Specifically, value depends on the degree of diagnostic uncertainty, presence of behavioral biases, and variation in local compensation regimes. Despite their value, recent trends could actually decrease the value of second opinions.
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Affiliation(s)
- Michael Halasy
- College of Medicine, Spine Center, Mayo Clinic, Rochester, MN
| | - Jason Shafrin
- Center for Healthcare Economics and Policy, FTI Consulting, Los Angeles, CA
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Hacein-Bey L. SCIWORA no more? The case for targeted cervical spine MRI in blunt trauma. J Neuroradiol 2021; 48:139-140. [PMID: 33958135 DOI: 10.1016/j.neurad.2021.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Lotfi Hacein-Bey
- Neuroradiology, University of California Davis School of Medicine, Sacramento, CA 95815, United States.
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The Accuracy of On-Call CT Reporting in Teleradiology Networks in Comparison to In-House Reporting. Healthcare (Basel) 2021; 9:healthcare9040405. [PMID: 33916229 PMCID: PMC8065948 DOI: 10.3390/healthcare9040405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: We aimed to compare the accuracy of after-hours CT reports created in a traditional in-house setting versus a teleradiology setting by assessing the discrepancy rates between preliminary and final reports. (2) Methods: We conducted a prospective study to determine the number and severity of discrepancies between preliminary and final reports for 7761 consecutive after-hours CT scans collected over a 21-month period. CT exams were performed during on-call hours and were proofread by an attending the next day. Discrepancies between preliminary and gold-standard reports were evaluated by two senior attending radiologists, and differences in rates were assessed for statistical significance. (3) Results: A total of 7209 reports were included in the analysis. Discrepancies occurred in 1215/7209 cases (17%). Among these, 433/7209 reports (6%) showed clinically important differences between the preliminary and final reports. A total of 335/5509 of them were in-house reports (6.1%), and 98/1700 were teleradiology reports (5.8%). The relative frequencies of report changes were not significantly higher in teleradiology. (4) Conclusions: The accuracy of teleradiology reports was not inferior to that of in-house reports, with very similar clinically important differences rates found in both reporting situations.
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Musculoskeletal Outside Interpretation (MOI-RADS): an automated quality assurance tool to prospectively track discrepancies in second-opinion interpretations in musculoskeletal imaging. Skeletal Radiol 2021; 50:723-730. [PMID: 32968823 DOI: 10.1007/s00256-020-03601-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To implement an automated quality assurance tool to prospectively track discrepancies in musculoskeletal (MSK) exams submitted for second-opinion radiology interpretation at a tertiary center. METHODS From 2013 to 2020, a standardized template was included in re-interpretation MSK reports, and a concordance assessment compared with primary interpretation was assigned. Analysis of standardized template implementation and discordance rates was performed. Of the re-interpretations that demonstrated likely clinically relevant discordance, a sample was randomly selected and the EMR was reviewed to evaluate the impact on patient care and change in medical management. RESULTS A total of 1052 re-interpretations were identified using the standardized template. Services with higher requests for second-opinion interpretation were oncology (n = 351, 33%) and orthopedic surgery (n = 255, 24%). Overall utilization rate of the template was 65% with marked decreased during the last year (22% rate). In comparison to the primary report, there was a 30% discordance rate (n = 309) with 18% (n = 184) classified as likely clinically relevant. From the subset of discrepancies that could be clinically relevant, there was a change in management in 63% of the cases (19/30) with the re-interpretation ultimately proving correct in 80% of the cases (24/30). CONCLUSION Implementation of a quality assurance tool embedded in the radiology workflow of second-opinion interpretations can facilitate the analysis of patient care impact; however, stricter implementation is necessary. Oncologic studies were the most common indication for re-interpretations. Although the primary and second interpretations in the majority of cases were in agreement, subspecialty MSK radiology interpretation was shown to be more accurate than primary interpretations and impacted clinical management in cases of discrepancy.
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Providing second-opinion interpretations of pediatric imaging: embracing the call for value-added medicine. Pediatr Radiol 2021; 51:523-528. [PMID: 33743036 DOI: 10.1007/s00247-019-04596-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/07/2019] [Accepted: 11/28/2019] [Indexed: 10/21/2022]
Abstract
The value of obtaining second-opinion interpretations by specialty radiologists has been established. In pediatric radiology, this has primarily been explored in general terms, comparing tertiary pediatric radiologists' interpretations to referral reads. In adults, second reads by subspecialty radiologists have been shown to yield changes in patient management, including in neuroradiology, musculoskeletal radiology and oncological radiology. Here, we examine second-opinion reads by pediatric radiologists by reviewing the pediatric and adult subspecialty literature. We also present our experience in providing subspecialty outside reads, summarizing lessons learned in implementing a system for outside interpretations into a pediatric radiology practice.
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Danda D, Mezrich J. Second thoughts: Emergency clinicians see value in secondary interpretations. Clin Imaging 2020; 68:7-12. [PMID: 32554166 DOI: 10.1016/j.clinimag.2020.05.036] [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] [Received: 10/22/2019] [Revised: 05/13/2020] [Accepted: 05/29/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Secondary interpretations of imaging studies performed at another facility are increasingly common in radiology, particularly emergency radiology. While data suggests there are often discrepancies found between original and secondary reports, the benefit from the clinician perspective is unclear. METHODS AND MATERIALS An anonymous electronic survey on secondary interpretations was circulated to 58 attending adult emergency physicians and trauma surgeons at a Level I trauma center from March 2018 to April 2018. Chi-squared testing was used for statistical analysis. RESULTS 80.8% of respondents requested secondary interpretations either "always" or "most of the time." Over half of the respondents cited trust in the house radiologist interpretation as the primary reason for secondary interpretation requests. 92.3% and 84.6% of respondents felt that the ability to obtain second interpretations improves patient care and facilitates disposition, respectively. 88.5% of respondents reported reduced imaging utilization due to secondary reads. When presented with conflicting interpretations, all trauma surgeons would rely on the in-house interpretation, whereas 50% of the emergency physicians would pursue further imaging (p < 0.05). 96.2% of respondents were uncertain about insurance coverage of secondary interpretations, but 73.1% would continue to order them, regardless. CONCLUSION Secondary reads were heavily utilized, felt to influence patient care, reduced additional imaging and aided in disposition, suggesting clinical benefit. When presented with conflicting reports, trauma surgeons would rely on the in-house interpretation whereas emergency physicians more often opted to pursue additional imaging. Most respondents would still request secondary interpretations despite being unaware of insurance coverage for these interpretations.
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Affiliation(s)
- Dipan Danda
- Yale School of Medicine, Department of Radiology and Biomedical Imaging, United States of America
| | - Jonathan Mezrich
- Yale School of Medicine, Department of Radiology and Biomedical Imaging, 333 Cedar Street, TE-2, New Haven, CT 06520, United States of America.
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How Do American Radiology Institutions Deal With Second Opinion Consultations on Outside Studies? AJR Am J Roentgenol 2020; 214:144-148. [DOI: 10.2214/ajr.19.21805] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Siegel EL. Making AI Even Smarter Using Ensembles: A Challenge to Future Challenges and Implications for Clinical Care. Radiol Artif Intell 2019; 1:e190187. [PMID: 33937807 PMCID: PMC8017374 DOI: 10.1148/ryai.2019190187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 06/12/2023]
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Second-Opinion Consultations: Limitations and Perspectives From a Developing Country. AJR Am J Roentgenol 2019; 213:W97. [DOI: 10.2214/ajr.19.21366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shmueli L, Shmueli E, Pliskin JS, Balicer RD, Davidovitch N, Hekselman I, Greenfield G. Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study. BMJ Open 2019; 9:e025673. [PMID: 31352409 PMCID: PMC6661653 DOI: 10.1136/bmjopen-2018-025673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare. DESIGN An observational study. SETTING Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel. PARTICIPANTS The entire sample included 1 392 907 patients aged 21 years and above who visited at least one specialist over an 18 months period, either in the secondary care or privately via the supplementary insurance. OUTCOMES MEASURES An algorithm was developed to identify potential second-opinion instances in the dataset using visits and claims data. Multivariate logistic regression was used to identify characteristics of second-opinion seekers by the type of insurance they used. RESULTS 143 371 (13%) out of 1 080 892 patients who had supplementary insurance sought a single second opinion, mostly from orthopaedic surgeons. Relatively to patients who sought second opinion via the supplementary insurance, second-opinion seekers via the health fund tended to be females (OR=1.2, 95% CI 1.17 to 1.23), of age 40-59 years (OR=1.36, 95% CI 1.31 to 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08 to 1.18). In contrast, second-opinion seekers via the supplementary insurance tended to be native-born and established immigrants (OR=0.79, 95% CI 0.76 to 0.84), in a high socioeconomic level (OR=0.39, 95% CI 0.37 to 0. 4) and living in central areas (OR=0.88, 95% CI 0.85 to 0.9). CONCLUSIONS Certain patient profiles tended to seek second opinions via the supplementary insurance more than others. People from the centre of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas. Further research is recommended to examine the availability of medical specialists by specialty and residence.
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Affiliation(s)
- Liora Shmueli
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| | - Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Joseph S Pliskin
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ran D Balicer
- Epidemiology, Ben-Gurion University, Tel Aviv, Israel
- Clalit Research Institute, Tel Aviv, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance, Bnei Brak, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geva Greenfield
- Department of Primary Care & Public Health, Imperial College London, London, UK
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Patel SH, Stanton CL, Miller SG, Patrie JT, Itri JN, Shepherd TM. Risk Factors for Perceptual-versus-Interpretative Errors in Diagnostic Neuroradiology. AJNR Am J Neuroradiol 2019; 40:1252-1256. [PMID: 31296527 DOI: 10.3174/ajnr.a6125] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/09/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diagnostic errors in radiology are classified as perception or interpretation errors. This study determined whether specific conditions differed when perception or interpretation errors occurred during neuroradiology image interpretation. MATERIALS AND METHODS In a sample of 254 clinical error cases in diagnostic neuroradiology, we classified errors as perception or interpretation errors, then characterized imaging technique, interpreting radiologist's experience, anatomic location of the abnormality, disease etiology, time of day, and day of the week. Interpretation and perception errors were compared with hours worked per shift, cases read per shift, average cases read per shift hour, and the order of case during the shift when the error occurred. RESULTS Perception and interpretation errors were 74.8% (n = 190) and 25.2% (n = 64) of errors, respectively. Logistic regression analyses showed that the odds of an interpretation error were 2 times greater (OR, 2.09; 95% CI, 1.05-4.15; P = .04) for neuroradiology attending physicians with ≤5 years of experience. Interpretation errors were more likely with MR imaging compared with CT (OR, 2.10; 95% CI, 1.09-4.01; P = .03). Infectious/inflammatory/autoimmune diseases were more frequently associated with interpretation errors (P = .04). Perception errors were associated with faster reading rates (6.01 versus 5.03 cases read per hour; P = .004) and occurred later during the shift (24th-versus-18th case; P = .04). CONCLUSIONS Among diagnostic neuroradiology error cases, interpretation-versus-perception errors are affected by the neuroradiologist's experience, technique, and the volume and rate of cases read. Recognition of these risk factors may help guide programs for error reduction in clinical neuroradiology services.
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Affiliation(s)
- S H Patel
- From the Departments of Radiology and Medical Imaging (S.H.P.)
| | - C L Stanton
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York
| | - S G Miller
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York
| | - J T Patrie
- Public Health Sciences (J.T.P.), University of Virginia Health System, Charlottesville, Virginia
| | - J N Itri
- Department of Radiology (J.N.I.), Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - T M Shepherd
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York.,Center for Advanced Imaging Innovation and Research (T.M.S.), New York, New York
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Second opinions in orthopedic oncology imaging: can fellowship training reduce clinically significant discrepancies? Skeletal Radiol 2019; 48:143-147. [PMID: 30003278 DOI: 10.1007/s00256-018-3024-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/12/2018] [Accepted: 06/28/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine factors that lead to significant discrepancies in second-opinion consultation of orthopedic oncology patients, and particularly if musculoskeletal fellowship training can decrease clinically significant discrepancies. METHODS A PACS database was queried for secondary reads on outside cross-sectional imaging studies, as requested by orthopedic oncology from 2014 to 2017. Comparison of original and secondary reports was performed using a published seven-point scale that defines clinically significant discrepancies. An online search was performed for each original radiologist to record if a fellowship in musculoskeletal imaging was completed. Additionally, years of post-residency experience, number of Medicare part B patients billed per year (marker of practice volume), and average hierarchical condition category for each radiologist (marker of practice complexity) was recorded. RESULTS A total of 571 patients met the inclusion criteria, with 184 cases initially interpreted by an outside fellowship trained musculoskeletal (MSK) radiologist and 387 cases initially interpreted by a non-MSK trained radiologist. The rate of clinically significant discrepancy was 9.2% when initially interpreted by MSK radiologists compared with 27.9% when initially performed by non-MSK radiologists (p < 0.05). After adjustment by both patient characteristics and radiologist characteristics, the likelihood of clinically significant discrepancies was greater for initial interpretations by non-MSK radiologists compared with MSK radiologists (OR = 1.36; 95% CI = 1.23-2.49). CONCLUSION In orthopedic oncology patients, the rate of clinically significant discrepancies was significantly higher when initially interpreted by non-MSK radiologists compared with MSK radiologists. The lower rate of clinically significant discrepancies demonstrates that subspecialty training may direct more appropriate diagnosis and treatment.
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Whorms DS, Giess CS, Golshan M, Freedman RA, Bunnell CA, Alper EC, Losk K, Khorasani R. Clinical Impact of Second Opinion Radiology Consultation for Patients With Breast Cancer. J Am Coll Radiol 2018; 16:814-823. [PMID: 30579707 DOI: 10.1016/j.jacr.2018.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/06/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the incidence and clinical significance of discrepancy in subspecialty interpretation of outside breast imaging examinations for newly diagnosed breast cancer patients presenting to a tertiary cancer center. MATERIALS AND METHODS This Institutional Review Board-approved retrospective study included patients presenting from July 2016 to March 2017 to a National Cancer Institute-designated comprehensive cancer center for second opinion after breast cancer diagnosis. Outside and second opinion radiology reports of 252 randomly selected patients were compared by two subspecialty breast radiologists to consensus. A peer review score was assigned, modeled after ACR's RADPEERTM peer review metric: 1-agree; 2-minor discrepancy (unlikely clinically significant); 3-moderate discrepancy (may be clinically significant); 4-major discrepancy (likely clinically significant). Among cases with clinically significant discrepancies, rates of clinical management change (management alterations including change in follow-up, neoadjuvant therapy use, and surgical management as a direct result of image review), and detection of additional malignancy were assessed through electronic medical record review. RESULTS A significant difference in interpretation (scores = 3 or 4) was seen in 41 of 252 cases (16%, 95% confidence interval [CI], 11.7%-20.8%). The difference led to additional workup in 38 of 252 cases (15%, 95% CI 10.6%-19.5%) and change in clinical management in 18 of 252 cases (7.1%, 95% CI 4.0%-10.2%), including 15 of 252 with change in surgical management (6.0%, 95% CI, 3.0%-8.9%). An additional malignancy or larger area of disease was identified in 11 of 252 cases (4.4%, 95% CI, 1.8%-6.9%). CONCLUSION Discrepancy between outside and second-opinion breast imaging subspecialists frequently results in additional workup for breast cancer patients, changes in treatment plan, and identification of new malignancies.
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Affiliation(s)
- Debra S Whorms
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Catherine S Giess
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mehra Golshan
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Rachel A Freedman
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Craig A Bunnell
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Emily C Alper
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katya Losk
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ramin Khorasani
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Gambino O, Rundo L, Cannella V, Vitabile S, Pirrone R. A framework for data-driven adaptive GUI generation based on DICOM. J Biomed Inform 2018; 88:37-52. [DOI: 10.1016/j.jbi.2018.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022]
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JOURNAL CLUB: Hepatopancreaticobiliary Imaging Second-Opinion Consultations: Is There Value in the Second Reading? AJR Am J Roentgenol 2018; 211:1264-1272. [DOI: 10.2214/ajr.17.19452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Importance of the physical exam: double-blind randomized controlled trial of radiologic interpretation of ventral hernias after selective clinical information. Hernia 2018; 23:987-994. [DOI: 10.1007/s10029-018-1856-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry. This article highlights the special situation of second opinions in psychiatry, discusses possible barriers to the adoption of second opinions in psychiatry, and the potential for greater use of second opinions in this field. OBJECTIVE In psychiatry, second opinions have been neglected by the typical drivers of innovations in health care, including insurers and other commercial drivers as well as psychiatrists and patients themselves. This review identifies current barriers to widespread adoption of second opinions in psychiatric practice, discusses the benefits of second opinions that have been demonstrated in other disciplines, and outlines the potential gains to be realized through use of second opinions in psychiatry. METHODS Literature in the area was reviewed through a search of the main medical databases. This literature review was supported by in-depth interviews with health care personnel and insurers. CONCLUSIONS Second opinions are rarely obtained in psychiatry and there is little literature on this subject. The stigmatization of psychiatric disorders and patients and the uniqueness of the patient-doctor relationship in psychiatry, especially in psychotherapeutic care, may pose considerable obstacles to the use of second opinions in this field. In addition, more stakeholders, such as social workers, government agencies and regulators, health care and disability insurers, and social security agencies, are involved in the mental health compared with the somatic health sector, which may make it more difficult to achieve a coordinated approach in psychiatric care. However, we have found no convincingly good reason why second opinions have not been at least discussed in psychiatry. Psychiatry could benefit from ongoing discussions concerning the outcomes of second opinions in other medical disciplines.
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Itri JN, Tappouni RR, McEachern RO, Pesch AJ, Patel SH. Fundamentals of Diagnostic Error in Imaging. Radiographics 2018; 38:1845-1865. [DOI: 10.1148/rg.2018180021] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jason N. Itri
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Rafel R. Tappouni
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Rachel O. McEachern
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Arthur J. Pesch
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Sohil H. Patel
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
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Volume and Coverage of Secondary Imaging Interpretation Under Medicare, 2003 to 2016. J Am Coll Radiol 2018; 15:1394-1400. [DOI: 10.1016/j.jacr.2018.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/13/2018] [Indexed: 11/22/2022]
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Rosenkrantz AB, Duszak R, Babb JS, Glover M, Kang SK. Discrepancy Rates and Clinical Impact of Imaging Secondary Interpretations: A Systematic Review and Meta-Analysis. J Am Coll Radiol 2018; 15:1222-1231. [DOI: 10.1016/j.jacr.2018.05.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 12/27/2022]
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Does Second Reader Opinion Affect Patient Management in Pancreatic Ductal Adenocarcinoma? Acad Radiol 2018; 25:825-832. [PMID: 29373213 DOI: 10.1016/j.acra.2017.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the impact of second-opinion assessment on cancer staging and patient management in patients with pancreatic ductal adenocarcinoma. METHODS AND MATERIALS This retrospective study was approved by our institutional review board with a waiver of informed consent. Second-opinion reports between January 1, 2009 and December 31, 2013, alongside outside reports for 65 consecutive cases of biopsy-proven pancreatic adenocarcinomas, were presented in random order to two experienced abdominal surgeons who independently reviewed them blinded to the origin of the report, images of the examinations, and patient identifier. Each surgeon filled in a questionnaire for each report recommending cancer staging and patient management. Recommended patient management and staging were evaluated against reference standards (actual patient management at 6 months following second-opinion assessment, and pathology or other clinical and imaging reference standards at 6 months or longer, respectively) using Cohen kappa. RESULTS Cancer staging differed in 13% (9 of 65) of cases for surgeon 1 and in 18.4% (12 of 65) for surgeon 2. Patient management changed in 38.4% (25 of 65) of cases for surgeon 1 and in 20% (13 of 65) for surgeon 2. When compared to the pathologic staging gold standard, second opinion was correct in 85.7% (six of seven) of the time for both surgeons. Recommended patient management from second-opinion reports showed good agreement with the reference standard (weighted k = 0.6467 [0.4014-0.892] and weighted k = 0.6262 [0.3954-0.857] for surgeon 2). CONCLUSION Second-opinion review by subspecialized oncologic radiologists can impact patient care, specifically in terms of management decision.
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McCarron M, Wade C, Flynn P, McVerry F. The value of neuroimaging team meetings for patients in a district general hospital. Clin Med (Lond) 2018; 18:206-211. [PMID: 29858429 PMCID: PMC6334082 DOI: 10.7861/clinmedicine.18-3-206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neuroradiologists provide quality-assured neuroimaging -reports. We developed the use of a neuroimaging team meeting to provide second-opinion reporting by neuroradiologists on neuroimaging that had previously been reported by general -radiologists. Neuroimaging from selected patients was reviewed at the meeting. Where there were discrepancies between an original report from a general radiologist and the report obtained from the meeting involving a neuroradiologist, we classified the discrepancies, recorded the scan modality -involved and used the data to assess temporal trends in discrepancy rates. Over 4 years, 562 patients (312 women, 250 men, mean age 50.6 [SD 17.3] years) were studied. Agreement occurred for 396 (70.5%) patients. Discrepancies that were not clinically important occurred for 60 (10.7%) patients. Clinically important discrepancies were found for 106 (18.9%) patients: missed lesions for 47 (8.3%) patients and misinterpretations for 59 (10.5%) patients. Cerebrovascular disease was the most common reason for a recommendation of neuroimaging review at a meeting. Scan modality did not influence the frequency of discrepancies. Discrepancy rates decreased with time (chi-squared test for linear trend p=0.015), while the frequency of neuroradiologists' recommendations for new investigations was stable at one in seven patients. Neuroimaging team meetings can facilitate improvements in neurology diagnoses.
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The Clinical Impact of Resident-attending Discrepancies in On-call Radiology Reporting: A Retrospective Assessment. Acad Radiol 2018; 25:727-732. [PMID: 29337090 DOI: 10.1016/j.acra.2017.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to quantify the clinical impact of resident-attending discrepancies at a tertiary referral academic radiology residency program by assessing rates of intervention, discrepancy confirmation, recall rate, and management change rate; furthermore, a discrepancy categorization system will be assessed. MATERIALS AND METHODS Retrospective review of the records was performed for n = 1482 discrepancies that occurred in the 17-month study period to assess the clinical impact of discrepancies. Discrepancies were grouped according to a previously published classification system. Management changes were recorded and grouped by severity. The recall rate was estimated for discharged patients. Any confirmatory testing was reviewed to evaluate the accuracy of the discrepant report. Categorical variables were compared to the chi-square test. RESULTS The 1482 discrepancies led to management change in 661 cases (44.6%). The most common management change was follow-up imaging. Procedural interventions including surgery occurred in 50 cases (3.3%). The recall rate was 2.6%. Management changes were more severe with computed tomography examinations, inpatients, and when the discrepancy was in the chest and abdomen subspecialty. Also, management changes correlated with the discrepancy category assigned by the attending at the time of review. CONCLUSIONS Resident-attending discrepancies do cause management changes in 44.6% of discrepancies (0.62% overall); the most frequent change is follow-up imaging. The discrepancy categorization assigned by the attending correlated with the severity of management change.
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Added value of double reading in diagnostic radiology,a systematic review. Insights Imaging 2018; 9:287-301. [PMID: 29594850 PMCID: PMC5990995 DOI: 10.1007/s13244-018-0599-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 01/10/2023] Open
Abstract
Objectives Double reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading. Methods A systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers. Results The literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports. Conclusions The systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects. Key Points • In double reading, two or more radiologists read the same images. • A systematic literature review was performed. • The discrepancy rates varied from 0.4 to 22% in various studies. • Double reading by sub-specialists found high discrepancy rates. Electronic supplementary material The online version of this article (10.1007/s13244-018-0599-0) contains supplementary material, which is available to authorised users.
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Vetter SY, Schüler S, Hackbusch M, Müller M, Swartman B, Schnetzke M, Grützner PA, Franke J. Tablets for Image Review and Communication in Daily Routine of Orthopedic Surgeons-An Evaluation Study. J Digit Imaging 2018; 31:74-83. [PMID: 28799133 PMCID: PMC5788817 DOI: 10.1007/s10278-017-0011-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Medical images are essential in modern traumatology and orthopedic surgery. Access to images is often cumbersome due to a limited number of workstations. Moreover, due to the tremendous increase of data, the time to review or to communicate images has also become limited. One approach to overcome these problems is to make use of modern mobile devices, like tablet computers, to facilitate image access and associated workflows. Ten orthopedic surgeons were equipped with an Apple iPad mini 2 and specialized viewing software for medical images. The surgeons were able to send images from a workstation onto the tablets or to search for patient images directly. The software enabled the physicians to share images, annotated key slices, and messages instantly with their colleagues. The surgeons carried the tablets within or in the periphery of the hospital. The participants evaluated the software by means of daily questionnaires. Data was collected for a period of 9 months. Nearly 25 images were viewed in total by the surgeons per day. The tablet viewer was used for accessing approximately 30% of these images. On average, the surgeons were asked 1.7 times per day by a colleague for a second opinion. They used the tablets in approximately 29% of these cases. Furthermore, the mean time for accessing images was significantly lower using mobile software compared to conventional methods. Tablet computers can play a vital role for image access and communication in the daily routine of an orthopedic surgeon. Mobile image access is an important aspect for surgeons, especially in larger facilities, to facilitate and accelerate the clinical workflows.
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Affiliation(s)
- Sven Y Vetter
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Svenja Schüler
- Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Matthes Hackbusch
- Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michael Müller
- Department Computer Assisted Medical Interventions, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany
- mbits imaging GmbH, Bergheimer Str. 147, D-69115, Heidelberg, Germany
| | - Benedict Swartman
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Alves I, Cunha TM. Clinical importance of second-opinion interpretations by radiologists specializing in gynecologic oncology at a tertiary cancer center: magnetic resonance imaging for endometrial cancer staging. Radiol Bras 2018; 51:26-31. [PMID: 29559763 PMCID: PMC5846322 DOI: 10.1590/0100-3984.2016.0171] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether there are substantive differences between the initial interpretations of magnetic resonance imaging (MRI) scans acquired at outside facilities and the second-opinion interpretations of radiologists specializing in gynecologic oncology at a tertiary cancer center, among patients referred for endometrial cancer staging. Materials and Methods This was a retrospective, comparative analysis of 153 initial and second-opinion MRI reports for endometrial cancer staging officially submitted for review by radiologists specializing in gynecologic oncology. For each case, the relationship between the initial and second-opinion reports, regarding the suggested diagnosis and the clinically relevant MRI findings reported, was categorized as "agreement" or "disagreement". Histopathology was used in order to establish the definitive diagnosis. Results Disagreement was found in 58 (37.9%) of the 153 cases. Second-opinion interpretations reported findings that affected the preoperative cancer staging and could have led to a change in treatment in 38 cases (24.8%); that did not affect the preoperative staging but provided information that was more accurate in 8 (5.2%); and that suggested a new cancer diagnosis in 12 (7.8%). In 37 cases (24.2%), there was a potential for changes in patient care. Among the 58 cases of disagreement, a definitive (histopathological) diagnosis was made in 41 (70.7%). In 31 (75.6%) of those 41 cases, the second-opinion report was more accurate than was the initial report. Conclusion Discordant interpretations of MRI examinations, which can have a substantial effect on the clinical management of patients, appear to be common.
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Affiliation(s)
- Inês Alves
- MD, Department of Radiology, Hospital Central do Funchal, Funchal, Portugal
| | - Teresa Margarida Cunha
- MD, Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Shmueli L, Davidovitch N, Pliskin JS, Balicer RD, Hekselman I, Greenfield G. Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel. Isr J Health Policy Res 2017; 6:67. [PMID: 29221461 PMCID: PMC5721599 DOI: 10.1186/s13584-017-0191-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. Methods A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one. Results Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%). Conclusions Clinical uncertainty or dissatisfaction with patient-physician communication were the main reasons for seeking a SO. Policy makers should be aware that many patients choose a physician for a SO based on recommendations made outside the medical system. We recommend creating mechanisms that help patients in the complicated process of seeking a SO, suggest specialists who are suitable for the specific medical problem of the patient, and provide tools to reconcile discrepant opinions. Electronic supplementary material The online version of this article (10.1186/s13584-017-0191-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liora Shmueli
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.,Department of Industrial Engineering and Management Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, 101 Arlozorov, 62098, Tel-Aviv, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance Systems, Clalit Health Services, 1 Ben Gurion, 5120149, Bnei Brak, Israel
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St. Dunstan's Road, London, W6 8RP, UK
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Sawan P, Rebeiz K, Schoder H, Batlevi C, Moskowitz A, Ulaner GA, Dunphy M, Mannelli L. Specialized second-opinion radiology review of PET/CT examinations for patients with diffuse large B-cell lymphoma impacts patient care and management. Medicine (Baltimore) 2017; 96:e9411. [PMID: 29390562 PMCID: PMC5758264 DOI: 10.1097/md.0000000000009411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To identify discrepancies in fludeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) reports generated by general radiologists and subspecialized oncological radiologists for patients with diffuse large B-cell lymphoma (DLBCL), and to assess if such discrepancies impact patient management.Two radiologists retrospectively reviewed 72 PET/CT scans of patients with DLBCL referred to our institutions between 2009 and 2011, and recorded the discrepancies between the outside and second-opinion reports regarding multiple preset criteria using kappa statistic (Κ), including the disease stage. A multidisciplinary staging that considered all patient clinical data, pathology, and follow up radiological scans, was considered as standard of reference. A hemato-oncologist, blinded to the reports' origin, subjectively graded the quality and structure of these reports for each patient to determine if clinical stage and disease activity could be derived accurately from these reports.Agreement was not, or slightly, achieved between the reports regarding the binary and multilevel criteria (Κ < 0-0.2 and weighted Κ = 0.082, respectively). Second-opinion reviews of PET/CT scans were concordant with the multidisciplinary staging in 78% of cases with an almost perfect agreement (Κ = 0.860). A change in staging was demonstrated in 36% of cases. In addition, 68% of second-opinion reports were assigned the highest grades on quality (grades 4 and 5) by the hemato-oncologist, compared with 15% of outside reports, with no noted agreement (weighted Κ = -0.007).Second-opinion review of PET/CT scans by sub-specialized oncological radiologists increases accuracy of initial staging, posttreatment evaluation and also the clinical relevance of the radiology reports.
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Affiliation(s)
- Peter Sawan
- Department of Radiology
- Department of Molecular Imaging and Therapy
| | | | | | - Connie Batlevi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, York Avenue, New York, NY
| | - Alison Moskowitz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, York Avenue, New York, NY
| | | | | | - Lorenzo Mannelli
- Department of Radiology
- Department of Molecular Imaging and Therapy
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Abstract
The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines "value" as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists' diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities. Main Messages • Value-based healthcare defines value as patient's outcome over costs. • The VBH framework disregards the diagnosis as an outcome. • VBH considers diagnosis only if wrong or a cause of complications. • A correct diagnosis is the first outcome that matters to patients. • Metrics to measure radiologists' impacts on patient outcomes are key. • The value provided by radiology is multifaceted, going beyond exam volumes.
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Rozenberg A, Kenneally BE, Abraham JA, Strogus K, Roedl JB, Morrison WB, Zoga AC. Clinical Impact of Second-Opinion Musculoskeletal Subspecialty Interpretations During a Multidisciplinary Orthopedic Oncology Conference. J Am Coll Radiol 2017; 14:931-936. [DOI: 10.1016/j.jacr.2017.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
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Wang W, van Heerden J, Tacey MA, Gaillard F. Neuroradiologists Compared with Non-Neuroradiologists in the Detection of New Multiple Sclerosis Plaques. AJNR Am J Neuroradiol 2017; 38:1323-1327. [PMID: 28473341 DOI: 10.3174/ajnr.a5185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis monitoring is based on the detection of new lesions on brain MR imaging. Outside of study populations, MS imaging studies are reported by radiologists with varying expertise. The aim of this study was to investigate the accuracy of MS reporting performed by neuroradiologists (someone who had spent at least 1 year in neuroradiology subspecialty training) versus non-neuroradiologists. MATERIALS AND METHODS Patients with ≥2 MS studies with 3T MR imaging that included a volumetric T2 FLAIR sequence performed between 2009 and 2011 inclusive were recruited into this study. The reports for these studies were analyzed for lesions detected, which were categorized as either progressed or stable. The results from a previous study using a semiautomated assistive software for lesion detection were used as the reference standard. RESULTS There were 5 neuroradiologists and 5 non-neuroradiologists who reported all studies. In total, 159 comparison pairs (ie, 318 studies) met the selection criteria. Of these, 96 (60.4%) were reported by a neuroradiologist. Neuroradiologists had higher sensitivity (82% versus 42%), higher negative predictive value (89% versus 64%), and lower false-negative rate (18% versus 58%) compared with non-neuroradiologists. Both groups had a 100% positive predictive value. CONCLUSIONS Neuroradiologists detect more new lesions than non-neuroradiologists in reading MR imaging for follow-up of MS. Assistive software that aids in the identification of new lesions has a beneficial effect for both neuroradiologists and non-neuroradiologists, though the effect is more profound in the non-neuroradiologist group.
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Affiliation(s)
- W Wang
- From the Department of Radiology (W.W., F.G.)
| | - J van Heerden
- Perth Radiological Clinic (J.v.H.), Subiaco, Western Australia, Australia
| | - M A Tacey
- Melbourne Epicentre (M.A.T.), the Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - F Gaillard
- From the Department of Radiology (W.W., F.G.)
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Second Medical Opinion: Utilization Rates and Characteristics of Seekers in a General Population. Med Care 2017; 54:921-8. [PMID: 27213545 DOI: 10.1097/mlr.0000000000000567] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Second opinion (SO) is common in medical practice and can reduce unnecessary risks and costs. To date, there is no population-based estimation of how many people seek SOs and what the characteristics of second-opinion seekers are. OBJECTIVES To estimate how many people seek SOs, and what the characteristics of second-opinion seekers are. METHODS We conducted both a medical records analysis (n=1,392,907) and a cross-sectional national telephone survey with a representative sample of the general Israeli population (n=848, response rate=62%). In the medical records analysis, we linked consultations with specialists at community secondary care and private consultations using claims data. We developed a time-sensitive algorithm that identified potential SO instances. In both methods, we predicted the characteristics of second-opinion seekers using multivariate logistic regressions. RESULTS The medical records analysis and the survey findings were highly consistent, and showed that about sixth (14.9% in the medical records vs. 17.2% in the survey) of a general population sought a SO, mostly from orthopedic surgeons. Women, native-born, and established immigrants, people living in central urban areas or close to central urban areas, people with chronic conditions, and those who perceived their health status as not very good, were more likely to seek SOs than others. CONCLUSIONS A considerable amount of people sought a SO. Certain patient profiles tended to seek SOs more than others. Such utilization patterns are important to devise policy regarding SOs, due to their implications on expenditure, policy, clinical outcomes, and patient satisfaction.
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SanthoshKumar GV, Mahajan A, Desai S, Thakur M. Second Opinion by In-House Radiologists: Present Picture and Emphasis on Standardizing Imaging Protocol in Oncology. Curr Probl Diagn Radiol 2017; 46:356-359. [PMID: 28552548 DOI: 10.1067/j.cpradiol.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/19/2017] [Accepted: 04/06/2017] [Indexed: 02/05/2023]
Abstract
Standardization of imaging acquisition protocol, modification in protocols for specific tumor and standardization in providing image data sets for outside referral, will help not only patients but also oncologists (who requests the second read) and the radiologists (who provides the second read on outside imaging). The practical benefits to patients include, cost savings (limiting the repeat radiological examination), timely initiation of treatment; the unrealized benefits include prevention of unnecessary anxiety and discomfort. In such second opinions, the radiologists should answer key clinical issues about resectability and other relevant findings in provisionally diagnosed cancers. In this article we will discuss the present scenario regarding second opinion of outside diagnostic imaging, the current approach, challenges and its optimization.
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Affiliation(s)
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
| | - Subhash Desai
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Meenakshi Thakur
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
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Abstract
OBJECTIVE This study aimed to determine whether second-opinion reviews of PET/CT examinations by subspecialists alter reporting of malignant findings. MATERIALS AND METHODS This IRB-approved study compared 240 fluorine-18 fluorodeoxyglucose PET/CT consecutively dictated reports by two nuclear medicine subspecialists against the original outside institution reports. Subspecialist reviews documented whether malignant findings on the outside report were malignant and noted additional malignant findings not described on the outside report. The final diagnosis of malignancy or benignity was determined by pathology when available, otherwise by imaging follow-up. RESULTS A total of 22 findings (in 20 reports) called suspicious/malignant on the outside reports were deemed benign by subspecialist review. A final diagnosis was available for 20 of 22 findings by pathology (n=3) or follow-up imaging (n=17). The subspecialist review was accurate in 20 (100%) of 20 cases where a final diagnosis was available. The subspecialist review called 11 findings (in 11 reports) suspicious/malignant that were not described or deemed benign on the outside reports. Definitive diagnosis was available for 10 of 11 findings by pathology (n=7) or follow-up imaging (n=3). The second-opinion report was accurate in seven (70%) of 10 cases where a final diagnosis was available. CONCLUSION In 31 (13%) of 240 fluorine-18 fluorodeoxyglucose PET/CT examinations performed at an outside institution, subspecialist review resulted in at least one discordant opinion of malignancy. For 28 discrepant cases where a final diagnosis was available, the subspecialist review defined malignancy or benignity correctly in 25 (89%) of 28 cases. This provides evidence for the cost and effort invested in performing second-opinion reviews of PET/CT studies.
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Khalilzadeh O, Rahimian M, Batchu V, Vadvala HV, Novelline RA, Choy G. Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital. Diagn Interv Radiol 2016. [PMID: 26200483 DOI: 10.5152/dir.2015.15003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE A second opinion is a valuable resource in confirming proper medical diagnosis and treatment. This study evaluates the effectiveness of second-opinion radiology consultations to reassess the cervical spine computed tomography (CT) scans of the trauma patients referred to our hospital. METHODS Cervical spine CT scans of 301 consecutive adult trauma patients, who were referred to our hospital from outside institutions, were analyzed. The emergency radiologists at our institution completed the over-read reports on the CT images obtained at the outside facilities. A single radiologist compared the outside- and over-read reports and determined the discrepancy of the radiologic reports. RESULTS Based on the outside reports, 31% of the CT scans had cervical traumatic injury. In 92% of patients, the first-read and the over-read reports had consistent radiologic findings. About 90% of the positive, and 93% of the negative radiologic findings, were reported consistently in the over-read reports. Our analysis showed that the over-read reporting resulted in reassurance of negative findings in 63%; confirmation of positive findings in 29%; clearing a false diagnosis in 3%; and detection of a missed diagnosis in 5%. A rescan was done in 80% of patients with inconsistent and 20% of patients with consistent findings (P < 0.05). The most common missed radiologic findings in the first-reports were transverse and spinous process fractures and the most common misdiagnoses were dens fractures. CONCLUSION For a service offering second-opinion consultations on cervical spine trauma, review of outside CT studies improves diagnosis and benefits patient care.
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Affiliation(s)
- Omid Khalilzadeh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Vreeland A, Persons KR, Primo HR, Bishop M, Garriott KM, Doyle MK, Silver E, Brown DM, Bashall C. Considerations for Exchanging and Sharing Medical Images for Improved Collaboration and Patient Care: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2016; 29:547-58. [PMID: 27351992 PMCID: PMC5023527 DOI: 10.1007/s10278-016-9885-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The need for providers and patients to exchange and share imaging has never been more apparent, yet many organizations are only now, as a part of a larger enterprise imaging initiative, taking steps to streamline an important process that has historically been facilitated with the use of CDs or insecure methods of communication. This paper will provide an introduction to concepts and common-use cases for image exchange, outline challenges that have hindered adoption to date, and describe standards for image exchange that show increasing promise of being adopted by vendors and providers.
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Affiliation(s)
- Amy Vreeland
- Imaging Strategies, 30 Locke Road, Waban, MA, 02468, USA.
| | | | - Henri Rik Primo
- Siemens Medical Solutions USA, Inc., Digital Health Services, 60 Valley Stream Parkway, Malvern, PA, 19355, USA
| | - Matthew Bishop
- UnityPoint Health IT, 4500 Utica Ridge Road, Bettendorf, IA, 52722, USA
| | - Kimberley M Garriott
- Logicalis, Inc, Healthcare Strategies Division, 9225 Priority Way, Suite 115, Indianapolis, IN, 46240, USA
| | | | - Elliott Silver
- McKesson Imaging and Workflow Solutions Division, 475 Allendale Road, King of Prussia, PA, 19406, USA
| | - Danielle M Brown
- Aspirus IT, 2800 Westhill Drive, Suite 102, Wausau, WI, 54401, USA
| | - Chris Bashall
- Sir Charles Gairdner Hospital Radiology Dept, 1 Hospital Avenue, Nedlands, 6009, WA, Australia
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