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Goumballa N, de-Oliveira F, Frandon J, Coisy F, Goupil J, Longueville F, Daladouire C, Grandpierre RG, Beregi JP. Trends in radiology requests and emergency admissions: a 10-year retrospective study in a university hospital. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2025; 73:203108. [PMID: 40383060 DOI: 10.1016/j.jeph.2025.203108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 03/20/2025] [Accepted: 04/08/2025] [Indexed: 05/20/2025]
Affiliation(s)
- Ndiaw Goumballa
- Department of Medical Imaging, Nîmes University Hospital, Nîmes, France
| | - Fabien de-Oliveira
- Department of Medical Imaging, Nîmes University Hospital, Nîmes, France; IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, Nîmes, France
| | - Julien Frandon
- Department of Medical Imaging, Nîmes University Hospital, Nîmes, France; IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, Nîmes, France
| | - Fabien Coisy
- Department of emergency, Nîmes University Hospital, Nîmes, France
| | - Jean Goupil
- Department of Medical Imaging, Nîmes University Hospital, Nîmes, France
| | | | | | | | - Jean Paul Beregi
- Department of Medical Imaging, Nîmes University Hospital, Nîmes, France; IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, Nîmes, France.
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Ghoshal S, King AH, Pang M, Hood CM, Sodickson AD, Gee MS, Lev MH, Harris MB, Succi MD. Trends in computed tomography utilization among emergency department patients with foot and ankle trauma. J Foot Ankle Surg 2025:S1067-2516(25)00117-6. [PMID: 40246140 DOI: 10.1053/j.jfas.2025.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 02/01/2025] [Accepted: 04/12/2025] [Indexed: 04/19/2025]
Abstract
The aim of this study was to assess the number of foot/ankle computed tomography (CT) exams ordered per encounter for patients presenting to the emergency department (ED) with foot and ankle trauma over a 5-year period. Secondary aims included evaluating the positivity rate of foot/ankle CT exams and identifying factors associated with receiving a CT foot/ankle. This retrospective study analyzed data from a large urban Level-1 trauma center between 2016 and 2021. Patients were identified by charted chief complaints related to foot and ankle trauma. The primary outcome was the number of CT foot/ankle exams ordered per patient in a given period. A univariate chi-square analysis was conducted to evaluate differences in patient presentations and imaging rates across the study period. Over the 5-year span, there were 9,845 patient encounters, with a significant increase in CT foot/ankle orders from 2.4 % to 6.6 % (p < 0.001). The CT positivity rate, defined as CTs with positive findings, declined from 95.2 % in 2016 to 84.1 % in 2021 (p < 0.001). Black patients had lower odds of receiving CT scans compared to White patients, as did Medicare recipients compared to Medicaid recipients (p < 0.001). Factors such as age (OR: 1.02 per year), year of visit (OR: 2.66 for 2021), time of day (OR: 1.62 for evening arrivals), and arrival by EMS (OR: 5.60) were significantly associated with higher CT order rates. This study highlights a marked increase in CT utilization for foot and ankle trauma with a corresponding decline in the rate of positive findings. Further research is necessary to explore the reasons behind this trend and to identify potential workflow or protocol adjustments to improve imaging efficacy.
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Affiliation(s)
- Soham Ghoshal
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Alexander H King
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Michael Pang
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - C Michael Hood
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Aaron D Sodickson
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael S Gee
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Michael H Lev
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Mitchel B Harris
- Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Marc D Succi
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA.
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Kim M, Park T, Kang J, Kim MJ, Kwon MJ, Oh BY, Kim JW, Ha S, Yang WS, Cho BJ, Son I. Development and validation of automated three-dimensional convolutional neural network model for acute appendicitis diagnosis. Sci Rep 2025; 15:7711. [PMID: 40044743 PMCID: PMC11882796 DOI: 10.1038/s41598-024-84348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 12/23/2024] [Indexed: 03/09/2025] Open
Abstract
Rapid, accurate preoperative imaging diagnostics of appendicitis are critical in surgical decisions of emergency care. This study developed a fully automated diagnostic framework using a 3D convolutional neural network (CNN) to identify appendicitis and clinical information from patients with abdominal pain, including contrast-enhanced abdominopelvic computed tomography images. A deep learning model-Information of Appendix (IA)-was developed, and the volume of interest (VOI) region corresponding to the anatomical location of the appendix was automatically extracted. It was analysed using a two-stage binary algorithm with transfer learning. The algorithm predicted three categories: non-, simple, and complicated appendicitis. The 3D-CNN architecture incorporated ResNet, DenseNet, and EfficientNet. The IA model utilising DenseNet169 demonstrated 79.5% accuracy (76.4-82.6%), 70.1% sensitivity (64.7-75.0%), 87.6% specificity (83.7-90.7%), and an area under the curve (AUC) of 0.865 (0.862-0.867), with a negative appendectomy rate of 12.4% in stage 1 classification identifying non-appendicitis versus. appendicitis. In stage 2, the IA model exhibited 76.1% accuracy (70.3-81.9%), 82.6% sensitivity (62.9-90.9%), 74.2% specificity (67.0-80.3%), and an AUC of 0.827 (0.820-0.833), differentiating simple and complicated appendicitis. This IA model can provide physicians with reliable diagnostic information on appendicitis with generality and reproducibility within the VOI.
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Affiliation(s)
- Minsung Kim
- Department of Surgery, Hallym University Medical Center, Hallym Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil, Pyeongan-dong, Dongan-gu, Anyang, Gyeonggi-do, Republic of Korea
| | - Taeyong Park
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang, Republic of Korea
| | - Jaewoong Kang
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang, Republic of Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Bo Young Oh
- Department of Surgery, Hallym University Medical Center, Hallym Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil, Pyeongan-dong, Dongan-gu, Anyang, Gyeonggi-do, Republic of Korea
| | - Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Sangook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Won Seok Yang
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Bum-Joo Cho
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang, Republic of Korea.
| | - Iltae Son
- Department of Surgery, Hallym University Medical Center, Hallym Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil, Pyeongan-dong, Dongan-gu, Anyang, Gyeonggi-do, Republic of Korea.
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Kinnersly J, Ahmed F, Selman C, Bourke EM. Skeletal radiograph interpretation discrepancies in the emergency department setting: A retrospective chart review. Emerg Med Australas 2025; 37:e14539. [PMID: 39604307 DOI: 10.1111/1742-6723.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/03/2024] [Accepted: 11/09/2024] [Indexed: 11/29/2024]
Abstract
OBJECTIVES To determine the frequency and clinical consequences of discrepancies in skeletal radiograph interpretation between emergency and radiology doctors in an Australian ED. METHODS We reviewed the records of adult and paediatric patients assessed with skeletal radiography in an ED in Victoria, Australia over 3 months (January to March 2022). Epidemiological data, the interpretation of the radiograph by ED and radiology doctors, and clinical management of the patient were recorded to determine interpretation discrepancies and the consequences of these. RESULTS There were 2359 unique skeletal radiographs in 1576 patient presentations during the study period. Of these, 140 (6%) had a discrepancy. Where a discrepancy existed, 47% of the ED interpretation reported a fracture and/or dislocation which was not present in the radiology interpretation (false positive), whereas the remaining (53%) were attributed to a missed fracture and/or dislocation (false negative). Thirty-five discrepancies (2%) required a change in patient management and were therefore clinically significant. The most commonly affected body region was the elbow, where 15% of radiographs were discrepant. Pathology was more often missed when multiple abnormalities were present on the same radiograph (odds ratio = 4.2, 95% confidence interval = 2.5-6.8). CONCLUSION The rate of clinically significant discrepancies in the interpretation of skeletal radiographs by emergency medicine doctors is low. This data support using the ED interpretation of radiographs to guide initial management as safe practice.
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Affiliation(s)
- Jack Kinnersly
- Emergency Department, Grampians Health, Ballarat, Victoria, Australia
| | - Furqan Ahmed
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris Selman
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Elyssia M Bourke
- Emergency Department, Grampians Health, Ballarat, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Variability in Resource Utilization in the Evaluation and Management of Simple Febrile Seizures Inpatients in US Children's Hospitals. J Neurosurg Anesthesiol 2023; 35:153-159. [PMID: 36745181 DOI: 10.1097/ana.0000000000000887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To characterize resource utilization in the evaluation and treatment of hospitalized simple febrile seizure (SFS) patients in US tertiary pediatric hospitals. METHODS This is a retrospective cohort study using the Pediatric Health Information System from 2010 to 2015. Children 6 months to 5 years of age who were inpatients with a diagnosis of SFS. Children who had brain magnetic resonance imaging (MRI), electroencephalography (EEG), or received anticonvulsants were compared with those who did not have testing or anticonvulsant treatment. Hospital-level variation in the utilization rates of MRI, EEG, or treatment with anticonvulsants was also evaluated. RESULTS In Pediatric Health Information System-participating institutions, 8.4% (n=3640) of children presenting to the emergency department with SFS were hospitalized. Among these SFS inpatients, 57.8% (n= 2104) did not receive further evaluation with MRI/EEG or treatment with anticonvulsants. There was evidence of wide inter-hospital variation in resource utilization rates. The median (interquartile range) utilization rate was 6.2% (3.0 to 11.0%) for MRI, 28.5% (16.0 to 46.3%) for EEG and 17.1% (10.9 to 22.3%) for treatment with anticonvulsants. CONCLUSION No specific hospital-level factors were identified that contributed to the variation in resource utilization in the evaluation and management of hospitalized SFS patients.
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Berlyand Y, Fraga JA, Succi MD, Yun BJ, Lee AHY, Baugh JJ, Whitehead D, Raja AS, Prabhakar AM. Impact of iodinated contrast allergies on emergency department operations. Am J Emerg Med 2022; 61:127-130. [PMID: 36096014 DOI: 10.1016/j.ajem.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Adverse reactions to intravenous (IV) iodinated contrast media are classified by the American College of Radiology (ACR) Manual on Contrast Media as either allergic-like (ALR) or physiologic (PR). Premedication may be beneficial for patients who have prior documented mild or moderate ALR. We sought to perform a retrospective analysis of patients who received computed tomography (CT) imaging in our emergency department (ED) to establish whether listing of an iodinated contrast media allergy results in a delay in care, increases the use of non-contrast studies, and to quantify the incidence of listing iodinated contrast allergies which do not necessitate premedication. METHODS We performed a retrospective analysis of CT scans performed in our academic medical center ED during a 6-month period. There were 12,737 unique patients of whom 454 patients had a listed iodinated contrast allergy. Of these, 106 received IV contrast and were categorized as to whether premedication was necessary. Descriptive statistics were used to evaluate patient demographics, clinical characteristics, and operational outcomes. A multivariate linear regression model was used to predict time from order to start (OTS time) of CT imaging while controlling for co-variates. RESULTS Non-allergic patients underwent contrast-enhanced CT imaging at a significantly higher rate than allergic patients (45.9% vs. 23.3%, p < 0.01). The OTS time for allergic patients who underwent contrast-enhanced CT imaging was 360 min and significantly longer than the OTS time for non-allergic patients who underwent contrast-enhanced CT imaging (118 min, p < 0.001). Of the 106 allergic patients who underwent contrast-enhanced CT imaging, 27 (25.5%) did not meet ACR criteria for necessitating premedication. The average OTS time for these 27 patients was 296 min, significantly longer than the OTS for non-allergic patients (118 min, p < 0.01) and did not differ from the OTS time for the 79 patients who did meet premedication criteria (382 min, p = 0.23). A multivariate linear regression showed that OTS time was significantly longer if a contrast allergy was present (p < 0.001). CONCLUSION A chart-documented iodinated contrast allergy resulted in a significant increase in time to obtain a contrast-enhanced CT study. This delay persisted among patients who did not meet ACR criteria for premedication. Appropriately deferring premedication could potentially reduce the ED length-of-stay by over 4 h for these patients.
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Affiliation(s)
- Yosef Berlyand
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - John Anthony Fraga
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Marc D Succi
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Brian J Yun
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Emergency Medicine, Boston Medical Center, 725 Albany Street, Boston, MA, USA
| | - Andy Hung-Yi Lee
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Joshua J Baugh
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - David Whitehead
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Anand M Prabhakar
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA.
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Carpenter CR, Griffey RT, Mills A, Doering M, Oliveira J. e Silva L, Bellolio F, Upadhye S, Broder JS. Repeat computed tomography in recurrent abdominal pain: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med 2022; 29:630-648. [PMID: 34897917 DOI: 10.1111/acem.14427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Computed tomography (CT) imaging is frequently obtained for recurrent abdominal pain after a prior emergency department (ED) evaluation. We evaluate the utility of repeat CT imaging following an indeterminate index CT in low-risk abdominal pain adult ED patients. METHODS An electronic search was designed for the patient-intervention-control-outcome-timing (PICOT) question: (P) adult patients with low-risk, recurrent, and previously undifferentiated atraumatic abdominal pain presenting to the ED after an index-negative CT within 12 months; (I) repeat CT versus (C) no repeat CT; for (O) abdominal surgery or other invasive procedure, mortality, identification of potentially life-threatening diagnosis, and hospital and intensive care unit admission rates; and return ED visit (T), all within 30 days. Four reviewers independently selected evidence for inclusion and then synthesized the results around the most prevalent themes of repeat CT timing, diagnostic yield, ionizing radiation exposure, and predictors of repetitive imaging. RESULTS Although 637 articles and abstracts were identified, no direct evidence was found. Thirteen documents were synthesized as indirect evidence. None of the indirect evidence defined a low-risk subset of abdominal pain nor did investigators describe whether reimaging occurred for complaints similar to the initial ED evaluation. Included studies did not describe the index CT findings and some reported explanatory findings noted on the original CT for which repeat CTs might have been indicated. The time frame for a repeat CT ranged from hours to 1 year. The frequency of repeat CTs (2%-47%) varied across studies as did the yield of imaging to alter downstream clinical decision making (range = 5%-67%). CONCLUSION Due to the absence of direct evidence our scoping review is unable to provide high-quality evidence-based recommendations upon which to confidently base an imaging practice guideline. There is no evidence to support or refute performing a CT for low-risk recurrent abdominal pain.
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Affiliation(s)
- Christopher R. Carpenter
- Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis Missouri USA
| | - Richard T. Griffey
- Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis Missouri USA
| | - Angela Mills
- Department of Emergency Medicine Columbia University College of Physicians and Surgeons New York New York USA
| | - Michelle Doering
- Becker Medical Library Washington University in St. Louis School of Medicine St. Louis Missouri USA
| | | | - Fernanda Bellolio
- Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA
| | - Suneel Upadhye
- Emergency Medicine/Health Research Methods Evidence & Impact McMaster University Hamilton Ontario Canada
| | - Joshua S. Broder
- Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
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Feng S, Liu Q, Patel A, Bazai SU, Jin C, Kim JS, Sarrafzadeh M, Azzollini D, Yeoh J, Kim E, Gordon S, Jang‐Jaccard J, Urschler M, Barnard S, Fong A, Simmers C, Tarr GP, Wilson B. Automated pneumothorax triaging in chest X‐rays in the New Zealand population using deep‐learning algorithms. J Med Imaging Radiat Oncol 2022; 66:1035-1043. [DOI: 10.1111/1754-9485.13393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sijing Feng
- Department of Radiology Dunedin Hospital Dunedin New Zealand
| | - Qixiu Liu
- Counties Manukau Health Auckland New Zealand
| | - Aakash Patel
- Dunedin School of Medicine Dunedin Hospital Dunedin New Zealand
| | - Sibghat Ullah Bazai
- School of Natural and Computational Sciences Massey University Palmerston North New Zealand
| | | | - Ji Soo Kim
- Auckland District Health Board Auckland New Zealand
| | | | | | - Jason Yeoh
- Auckland District Health Board Auckland New Zealand
| | - Eve Kim
- Auckland District Health Board Auckland New Zealand
| | - Simon Gordon
- Waikato District Health Board Hamilton New Zealand
| | - Julian Jang‐Jaccard
- School of Natural and Computational Sciences Massey University Palmerston North New Zealand
| | - Martin Urschler
- School of Computer Science University of Auckland Auckland New Zealand
| | | | - Amy Fong
- Department of Radiology Dunedin Hospital Dunedin New Zealand
| | - Cameron Simmers
- Department of Radiology Dunedin Hospital Dunedin New Zealand
| | | | - Ben Wilson
- Department of Radiology Dunedin Hospital Dunedin New Zealand
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Trend in radiologist workload compared to number of admissions in the emergency department. Eur J Radiol 2022; 149:110195. [DOI: 10.1016/j.ejrad.2022.110195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
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DeBenedectis CM, Spalluto LB, Americo L, Bishop C, Mian A, Sarkany D, Kagetsu NJ, Slanetz PJ. Health Care Disparities in Radiology-A Review of the Current Literature. J Am Coll Radiol 2022; 19:101-111. [PMID: 35033297 DOI: 10.1016/j.jacr.2021.08.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology. METHODS We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis. DISCUSSION We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.
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Affiliation(s)
- Carolynn M DeBenedectis
- Vice-Chair, Education; Director, Radiology Residency Program; Department of Radiology, President-elect, New England Roentgen Ray Society; and Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Lucy B Spalluto
- Vice-Chair, Health Equity; Director, Women in Radiology; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research; and Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Lisa Americo
- Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Casey Bishop
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Asim Mian
- Director, Radiology Residency Program; Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - David Sarkany
- Director, Radiology Residency Program; Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Nolan J Kagetsu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Priscilla J Slanetz
- Vice-Chair, Academic Affairs; Associate Program Director, Radiology Residency Program, Boston Medical Center; President-elect Massachusetts Radiologic Society; Secretary, Association of University Radiologists; Chair, Breast Imaging Panel 2, ACR Appropriateness Guidelines Committee; and Department of Radiology, Boston Medical Center, Boston, Massachusetts
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Clifford B, Conklin J, Huang SY, Feiweier T, Hosseini Z, Goncalves Filho ALM, Tabari A, Demir S, Lo WC, Longo MGF, Lev M, Schaefer P, Rapalino O, Setsompop K, Bilgic B, Cauley S. An artificial intelligence-accelerated 2-minute multi-shot echo planar imaging protocol for comprehensive high-quality clinical brain imaging. Magn Reson Med 2021; 87:2453-2463. [PMID: 34971463 DOI: 10.1002/mrm.29117] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE We introduce and validate an artificial intelligence (AI)-accelerated multi-shot echo-planar imaging (msEPI)-based method that provides T1w, T2w, T 2 ∗ , T2-FLAIR, and DWI images with high SNR, high tissue contrast, low specific absorption rates (SAR), and minimal distortion in 2 minutes. METHODS The rapid imaging technique combines a novel machine learning (ML) scheme to limit g-factor noise amplification and improve SNR, a magnetization transfer preparation module to provide clinically desirable contrast, and high per-shot EPI undersampling factors to reduce distortion. The ML training and image reconstruction incorporates a tunable parameter for controlling the level of denoising/smoothness. The performance of the reconstruction method is evaluated across various acceleration factors, contrasts, and SNR conditions. The 2-minute protocol is directly compared to a 10-minute clinical reference protocol through deployment in a clinical setting, where five representative cases with pathology are examined. RESULTS Optimization of custom msEPI sequences and protocols was performed to balance acquisition efficiency and image quality compared to the five-fold longer clinical reference. Training data from 16 healthy subjects across multiple contrasts and orientations were used to produce ML networks at various acceleration levels. The flexibility of the ML reconstruction was demonstrated across SNR levels, and an optimized regularization was determined through radiological review. Network generalization toward novel pathology, unobserved during training, was illustrated in five clinical case studies with clinical reference images provided for comparison. CONCLUSION The rapid 2-minute msEPI-based protocol with tunable ML reconstruction allows for advantageous trade-offs between acquisition speed, SNR, and tissue contrast when compared to the five-fold slower standard clinical reference exam.
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Affiliation(s)
- Bryan Clifford
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Serdest Demir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wei-Ching Lo
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | | | - Michael Lev
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pam Schaefer
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology and Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Berkin Bilgic
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Cauley
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Tu LH, Venkatesh AK, Malhotra A, Taylor RA, Sheth KN, Forman HP, Yaesoubi R. Scenarios to improve CT head utilization in the emergency department delineated by critical results reporting. Emerg Radiol 2021; 29:81-88. [PMID: 34617133 DOI: 10.1007/s10140-021-01947-w] [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: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Increasing use of advanced imaging in the emergency department (ED) has resulted in higher cost without better outcomes. Our goal was to evaluate the yield of CT head exams by scenario to guide efforts at improving patient selection. METHODS We performed a retrospective study at an academic medical center over 4 years (1/1/2014-12/31/2017). The chief complaint, imaging order, and exam result text were obtained for all adult ED encounters. For the 50 most common chief complaints leading to CT head exams, the ratio of exams to total encounters and ratio of critical results to imaging studies were calculated. Significant difference in "yield" was assessed via binomial test. RESULTS Over 708,145 adult ED encounters, 58,783 CT head exams were ordered, with an overall critical result yield of 8.0%. The three most common chief complaints had higher yield (p < 0.05): altered mental status (9.8%), fall (9.7%), and new headache (10.1%). Lower yield (p < 0.05) was found for 19 chief complaints: dizziness (6.2%), falls in patients > 65 years old (7.1%), syncope (5.3%), seizure with known epilepsy (4.8%), chest pain (3.7%), head injury (4.9%), headache re-evaluation (7.0%), alcohol intoxication (2.5%), fatigue (6.5%), headache-recurrent or in the setting of known migraines (5.2%), hypertension (4.4%), lethargy (5.8%), loss of consciousness (5.3%), migraine (3.2%), psychiatric evaluation (2.9%), near syncope (4.6%), drug problem (3.1%), symptomatically decreased blood sugar (3.2%), and suicidal (1.7%). CONCLUSION Our study provides a priority list of low yield scenarios of CT head use for improvement of patient selection.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Richard A Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Reza Yaesoubi
- Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Brower C, Rehani MM. Radiation risk issues in recurrent imaging. Br J Radiol 2021; 94:20210389. [PMID: 34161140 PMCID: PMC9328055 DOI: 10.1259/bjr.20210389] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
Millions of patients benefit from medical imaging every single day. However, we have entered an unprecedented era in imaging practices wherein 1 out of 125 patients can be exposed to effective dose >50 mSv from a single CT exam and 3 out of 10,000 patients undergoing CT exams could potentially receive cumulative effective doses > 100 mSv in a single day. Recurrent imaging with CT, fluoroscopically guided interventions, and hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) is more prevalent today than ever before. Presently, we do not know the cumulative doses that patients may be receiving across all imaging modalities combined. Furthermore, patients with diseases with longer life expectancies are being exposed to high doses of radiation enabling radiation effects to manifest over a longer time period. The emphasis in the past on improving justification of imaging and optimization of technique and practice has proved useful. While that must continue, the current situation requires imaging device manufacturers to urgently develop imaging technologies that are safer for patients as high doses have been observed in patients where imaging has been justified through clinical decision-support and optimized by keeping doses below the national benchmark doses. There is a need to have a critical look at the fundamental principles of radiation protection as cumulative doses are likely to increase in the coming years.
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14
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Kwok K, Hasan N, Duloy A, Murad F, Nieto J, Day LW. American Society for Gastrointestinal Endoscopy radiation and fluoroscopy safety in GI endoscopy. Gastrointest Endosc 2021; 94:685-697.e4. [PMID: 34399965 DOI: 10.1016/j.gie.2021.05.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Karl Kwok
- Department of Medicine, Division of Gastroenterology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Nazia Hasan
- Department of Medicine, Division of Gastroenterology, NorthBay Healthcare, Fairfield, California, USA
| | - Anna Duloy
- Department of Medicine, Division of Gastroenterology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Faris Murad
- Department of Gastroenterology, FHN Memorial Hospital, Freeport, Illinois, USA
| | - Jose Nieto
- Department of Gastroenterology, Borland Groover Clinic, Jacksonville, Florida, USA
| | - Lukejohn W Day
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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15
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Head and Neck CTA Utilization: Analysis of Ordering Frequency and Nonroutine Results Communication, With Focus on the Fifty Most Common Emergency Department Clinical Presentations. AJR Am J Roentgenol 2021; 218:544-551. [PMID: 34585611 DOI: 10.2214/ajr.21.26543] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Utilization of head and neck CTA in the emergency department (ED) has grown disproportionately to other neuroimaging examinations. Objective: To characterize utilization of head and neck CTA in the ED, comparing utilization and frequency of nonroutine results communication among patients' chief concerns. Methods: All adult ED visits for a single healthcare system from January 2014 to December 2017 were retrospectively reviewed. Variables recorded included chief concerns, whether head and neck CTA was performed, and, if so, whether the report documented nonroutine results communication. The fifty chief concerns resulting in the highest number of head and neck CTA examinations were identified. Frequencies of head and neck CTA ordering and of nonroutine results communication were calculated. A subset of reports documenting nonroutine communication were manually reviewed. Results: Head and neck CTA was ordered in 2.5% (17,903) of 708,145 ED visits in 236,476 patients (mean age 48.9±20.5 years; 110,952 male, 125,521 female, 3 unknown sex). Head and neck CTA was ordered for 833 distinct chief concerns. Nonroutine results communication was documented for 17.6% (31,55/17,903) of examinations. Among the fifty chief concerns associated with the highest number of examinations, frequency of ordering head and neck CTA ranged from <0.5% (five concerns) to 55.2% (stroke code), and frequency of nonroutine communication ranged from 5.6% (transient ischemic attack) to 67.5% (unresponsive). Chief concerns not among the fifty most common accounted for 50.0% (8956/17903) of examinations; these exhibited a collective frequency of nonroutine communication of 4.8% (429/8956). Manual review of 11.1% (350/3155) of reports with a nonroutine communication indicated an acute finding related to the indication in 51.1%, non-emergent but potentially explanatory finding in 28.0%, incidental finding in 28.0%, and communication of negative results in 6.9%. Conclusion: Head and neck CTA is ordered in 2.5% of ED visits for a wide range of chief concerns. Frequencies of ordering and of nonroutine results communication are highly variable among chief concerns. Acute indication-related findings account for half of nonroutine radiologist communications. Clinical Impact: Insight into patterns regarding head and neck CTA ordering and nonroutine results may help optimize patient selection and radiologist communications in the ED setting.
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Increasing Utilization of Emergency Department Neuroimaging from 2007 to 2017. AJR Am J Roentgenol 2021; 218:165-173. [PMID: 34346786 DOI: 10.2214/ajr.21.25864] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: The volume of emergency department (ED) visits and neuroimaging have grown since the start of the century. Little is known about this growth in the commercially insured and Medicare Advantage populations. Objective: To evaluate changing emergency department utilization of neuroimaging from 2007 to 2017 in both commercially insured and Medicare Advantage enrollees. Methods: Using patient-level claims from Optum's De-identified Clinformatics Data Mart database, which annually includes approximately 12 to 14 million commercial and Medicare Advantage health plan enrollees, annual ED utilization of head computed tomography (CT), head magnetic resonance (MR), head CT angiography (CTA), neck CTA, head MR angiography (MRA), neck MRA, and carotid duplex ultrasound (CDUS) were assessed from 2007 through 2017. To account for an aging sample population, utilization rates were adjusted using annual relative proportions of age groups and stratified by patient demographics, payer type, and provider state. Results: Between 2007 and 2017, age-adjusted ED neuroimaging utilization rates per 1000 ED visits increased 72% overall (compound annual growth rate [CAGR] 5%). This overall increase corresponded to an increase of 69% for head CT (CAGR 5%); 67% for head MRI (CAGR 5%); 1100% for head CTA (CAGR 25%); 1300% for neck CTA (CAGR 27%); 36% for head MRA (CAGR 3%); 52% for neck MRA (CAGR 4%); and a decrease of 8% for CDUS (CAGR -1%). The utilization of head CT and CTA of the head and neck per 1000 ED visits continuously increased in those 65 or older by 48% (CAGR 4%) and 1011% (CAGR 24%). Conclusion: Neuroimaging utilization in the ED grew considerably between 2007 and 2017, with growth of head and neck CTA far outpacing other modalities. Unenhanced head CT remains by far the dominant ED neuroimaging examination. Clinical Impact: The rapid growth of head and neck CTA observed in the fee-for-service Medicare population is also observed in the commercially insured and Medicare Advantage populations. The appropriateness of this growth should be monitored as the indications for CTA expand.
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Gardner WT, Rehman H, Frost A. Spinal epidural abscesses - The role for non-operative management: A systematic review. Surgeon 2021; 19:226-237. [PMID: 32684428 DOI: 10.1016/j.surge.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal Epidural Abscesses (SEAs) are traditionally seen as a surgical emergency. However, SEAs can be discovered in entirely asymptomatic patients. This presents a dilemma for the attending clinician as to whether to subject these patients to significant surgery. This systematic review updates the evidence surrounding the efficacy of non-operative SEA management by means of intravenous antibiotics ± radiologically-guided aspiration. AIMS 1. To assess failure rates of medical therapy for SEA. The absolute definition of 'failure' used by the study was recorded, and comparisons made. 2. To review of risk factors for success/failure of medical treatment for SEA. METHODS A database search with the MESH term 'epidural abscess' and keywords ['treatment' OR 'management'] were used. RESULTS 14 studies were included. The number of SEA patients managed non-operatively ranged from 19 to 142. There was significant heterogeneity across the studies. Pooled Failure of Medical Therapy (FMT) (defined as any poor outcome) was 29.40%. When FMT = mortality the pooled rate was 11.49%. Commonly cited risk factors for FMT included acute neurological compromise, diabetes mellitus, increasing age and Staphylococcus aureus. CONCLUSION SEA will always be a condition mostly managed surgically. Despite this, there is growing evidence that non-operative management can be possible in the correct patients. The key is in patient selection - patients with any of the above-mentioned risk factors have the potential to deteriorate further on medical treatment and have a worse outcome than if they had undergone emergency surgery straight away. Ongoing research will hopefully further investigate this crucial step.
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Affiliation(s)
- W T Gardner
- Department of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
| | - H Rehman
- Department of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - A Frost
- Department of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
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Mensah YB, Mensah K, Gbadamosi H, Mensah NA. Magnetic resonance imaging (MRI) utilization in a Ghanaian teaching hospital: trend and policy implications. Ghana Med J 2021; 54:3-9. [PMID: 32863407 PMCID: PMC7445703 DOI: 10.4314/gmj.v54i1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The use of Magnetic Resonance Imaging (MRI) is new in Ghana compared with some Western countries. A number of studies have observed increased MRI utilization due to increased sensitivity to diagnosis, and the paradigm shift to modalities that do not use radiation. Challenges with MRI use include high cost of the examination and inappropriate requests by referring clinicians. Objective To determine the MRI utilisation trend in Korle Bu Teaching Hospital (KBTH), Ghana and its policy implications. Materials and Methods A retrospective study undertaken in the Radiology Department, KBTH, from February to March, 2017. Eight hundred and forty request forms for MRI studies between January, 2013 and December 2016 were reviewed. Information on patient's age and sex, number of MRI studies done, body parts and clinical conditions evaluated, appropriateness of clinical requests and existing policies on MRI in Ghana was gathered. Measures of central tendency and spread were obtained. Chi square, Pearson's correlation and linear regression analysis were also used in the analysis. Results The top three body parts requested were Spine (55 %), Brain (19%) and Joints (6 %); degenerative disease was the most common clinical condition evaluated. Significant association and correlation were obtained between of the number of body parts evaluated and examination year as well as the variety of clinical conditions requested and examination year. Conclusion A progressive increase was noted in MRI utilisation both in number and diversity but no policy guiding MRI use in Ghana exists. Funding None declared
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Affiliation(s)
- Yaw B Mensah
- Department of Radiology, Korle Bu Teaching Hospital, Korle Bu Accra
| | | | | | - Naa A Mensah
- University of Ghana, Regional Institute of Population Studies, Legon, Accra
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Scheinfeld MH, Dym RJ. Update on establishing and managing an overnight emergency radiology division. Emerg Radiol 2021; 28:993-1001. [PMID: 33881670 PMCID: PMC8059109 DOI: 10.1007/s10140-021-01935-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Abstract
Emergency department (ED) radiology divisions that serve to provide overnight attending coverage have become an increasingly common feature of radiology departments. The purpose of this article is to review the common ED radiology coverage models, describe desirable traits of emergency radiologists, and discuss workflow in the ED radiology setting. ED radiologists may be trained as ED radiologists or may develop the necessary skills and adopt the subspecialty. Choosing radiologists with the correct traits such as being a “night owl” and remaining calm under pressure and implementing an acceptable work schedule such as shift length of 9–10 h and a “one week on, two weeks off” schedule contribute to sustainability of the position. Strategies to address the unique stressors and workflow challenges of overnight emergency radiology coverage are also presented. Workflow facilitators including trainees, PAs, radiology assistants, and clerks all have roles to play in managing high case volumes and in making sure that the service is well staffed. Usage of artificial intelligence software is the latest technique to streamline workflow by identifying cases which should be prioritized on a busy worklist. Implementing such strategies will maintain quality of care for patients regardless of time of day as well as sustainability and quality of life for overnight emergency radiologists.
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Affiliation(s)
- Meir H. Scheinfeld
- Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY 10467 USA
| | - R. Joshua Dym
- Department of Radiology, Division of Emergency Radiology, University Hospital, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB F508B, Newark, NJ 07103 USA
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20
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The Effect of Different Monitor Use on Radiography Interpretation in Emergency Medicine. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.801664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Patient Race/Ethnicity and Diagnostic Imaging Utilization in the Emergency Department: A Systematic Review. J Am Coll Radiol 2020; 18:795-808. [PMID: 33385337 DOI: 10.1016/j.jacr.2020.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE Diagnostic imaging often is a critical contributor to clinical decision making in the emergency department (ED). Racial and ethnic disparities are widely reported in many aspects of health care, and several recent studies have reported a link between patient race/ethnicity and receipt of imaging in the ED. METHODS The authors conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching three databases (PubMed, Embase, and the Cochrane Library) through July 2020 using keywords related to diagnostic imaging, race/ethnicity, and the ED setting, including both adult and pediatric populations and excluding studies that did not control for the important confounders of disease severity and insurance status. RESULTS The search strategy identified 7,313 articles, of which 5,668 underwent title and abstract screening and 238 full-text review, leaving 42 articles meeting the inclusion criteria. Studies were predominately conducted in the United States (41), split between adult (13) and pediatric (17) populations or both (12), and spread across a variety of topics, mostly focusing on specific anatomic regions or disease processes. Most studies (30 of 42 [71.4%]) reported an association between Black, African American, Hispanic, or nonwhite race/ethnicity and decreased receipt of imaging. CONCLUSIONS Despite heterogeneity among studies, patient race/ethnicity is linked with receipt of diagnostic imaging in the ED. The strength and directionality of this association may differ by specific subpopulation and disease process, and more efforts to understand potential underlying factors are needed.
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Nesselroth D, Klang E, Soffer S, Druskin E, Barash Y, Hoffmann C, Konen E, Zimlichman E. Yield of head CT for acute findings in patients presenting to the emergency department. Clin Imaging 2020; 73:1-5. [PMID: 33246274 DOI: 10.1016/j.clinimag.2020.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The aim of our study was to evaluate the yield of head CT in the ED in different age groups and different referral indications. PATIENTS AND METHODS Records of one large academic tertiary care ED were retrospectively reviewed for consecutive adult patients who underwent a head CT between January 1st 2017 and February 10th 2017. CT referral forms and interpretations were obtained and evaluated for demographics, referral indications, and findings. Scans were divided into three groups: acute findings, chronic findings, and normal. The cohort was divided into three age groups. Associations between referral indications and acute findings were calculated. RESULTS Overall, 1536 of adult patients with ED head CT were included. Acute findings were found in 239/1536 (15.5%) of the CTs. The frequency of acute findings increased with age (p = 0.027). The most common acute findings were brain hemorrhage (32.6%), infarct (27.6%), and mass (23%). The top three referral indications were focal neurologic deficit (28%), trauma (24.7%), and headache (17.5%). The rates of positive acute findings for different referral indications were seizure 27%, confusion 20%, syncope 19%, focal neurologic deficit 16%, head injury 15%, headache 12%, and dizziness 8%. CONCLUSION This study shows the yield of ED head CT for acute findings for different age groups and for different referral indications. The frequency of acute findings increased with age. Suspected seizure had the highest association with an acute finding, whereas dizziness had the lowest association.
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Affiliation(s)
- Dafna Nesselroth
- Sackler School of Medicine, Tel Aviv University, Einstein St 68, Tel Aviv, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel Aviv University, Einstein St 68, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel; DeepVision Lab, The Chaim Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel
| | - Shelly Soffer
- Sackler School of Medicine, Tel Aviv University, Einstein St 68, Tel Aviv, Israel; DeepVision Lab, The Chaim Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel.
| | - Evgeni Druskin
- Department of Diagnostic Imaging, Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel
| | - Yiftah Barash
- Sackler School of Medicine, Tel Aviv University, Einstein St 68, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel; DeepVision Lab, The Chaim Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel
| | - Chen Hoffmann
- Sackler School of Medicine, Tel Aviv University, Einstein St 68, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel
| | - Eli Konen
- Sackler School of Medicine, Tel Aviv University, Einstein St 68, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel Aviv University, Einstein St 68, Tel Aviv, Israel; The Chaim Sheba Medical Center, Tel Hashomer, Hospital Management, Ramat Gan, Israel
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Voutsinas N, Sun J, Chung M, Jacobi A, Genes N, Nassisi D, Halton K, Delman B. Improving Communication Between the Emergency Department and Radiology Department With a Novel Web-Based Tool in an Urban Academic Center. Curr Probl Diagn Radiol 2020; 50:293-296. [PMID: 33082082 DOI: 10.1067/j.cpradiol.2020.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/26/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
DESCRIPTION OF PROBLEM Streamlining communication between radiology and referring services is vital to ensure appropriate care with minimal delays. Increased subspecialization has led to compartmentalization of the radiology department with many physicians working in disparate areas. At our hospital, we anecdotally noted that a significant portion of incoming phone calls were misdirected to the wrong workstations. This resulted in wasted time, unnecessary interruptions, and delays in care because the referring clinicians could not efficiently navigate the radiology department staffing structure. Our quality improvement project involved developing a web-based tool allowing the emergency department (ED) to more efficiently contact the appropriate radiology desk and reduce misdirected phone calls. INSTITUTIONAL APPROACH EMPLOYED TO ADDRESS THE PROBLEM Surveys were sent to radiology residents and ED providers (attendings, residents, physician assistants) to assess how often phone calls were misdirected to the wrong radiology station. Radiology residents were asked which stations received the most misdirected phone calls, and what station the caller was often looking for. ED providers were asked which stations they intended when they were told they called the wrong station, and a series of questions in the survey assessed their knowledge of commonly called radiology station (Plain Film, CT Body, Ultrasound, Neuoradiology, Pediatrics, and Overnight Desk). ED and radiology physicians worked together to design a simple, easily accessed web-based tool that allowed the ED clinicians to determine which station should be called during for each hour of the day, which integrated differences in staffing by radiology throughout the day. After the tool had been implemented for 8 months, surveys were again sent to radiology residents and ED clinicians asking the same questions as before to assess for any significant change in response. Additional questions were added to the ED survey to assess awareness of the new tool. DESCRIPTION OF OUTCOMES IN CHANGE OF PRACTICE An interactive, easily updated schedule with optimal contact numbers was made available through the ED intranet. The design allowed for easy modification of contact numbers over time to accommodate changes in coverage location or staffing models. Prior to implementation contact information was presented on a static screen, which was unable to be changed and included multiple incorrect and defunct numbers. Additionally, contact defaulted to a general radiology pager, which was carried by a resident only responsible for plain films for most of the day. Numbers included in the new intranet tool were all pertinent reading room stations, all scheduling desks, and all technologist workspaces. Different schedules were provided for weekdays and weekends. Initial survey results showed that prior to the intervention, 74% of radiology residents said they received misdirected phone calls at least twice a day, and 57.9% of ED respondents reached the wrong recipient at least once per day. Frequencies of misdirected calls dropped to 58.4% of radiology residents (P = 0.37) and 17.9% of ED respondents (P < 0.01) on follow-up surveys 8 months after the tool was established. After establishing the new tool, 82.1% of ED respondents were aware of the new intranet contact tool and were using it to contact radiology. On the series of questions assessing ED respondents' knowledge of radiology numbers, over 50% of respondents knew the correct answer or answered using the call sheet after implementation; this resulted in statistically significant increases in accuracy for Body, Neuroradiology, and Pediatric radiology stations. Furthermore, with the exception of ED plain films, there was a statistically significant reduction in number of responses who said the general radiology pager should be called for reads. Fifty percent of radiology residents believed there was a reduction in the number of misdirected phone calls from the ED with this tool. CONCLUSION, LIMITATIONS, AND DESCRIPTIONS OF FUTURE DIRECTIONS Our tool was successful in accomplishing multiple goals. First, over 80% of ED respondents adopted the new tool. Second, the number of misdirected phone calls based on the subjective perception of ED respondents and radiology residents was reduced. Third, we objectively improved the ED respondents' behavior pattern in contacting the radiology department by either calling the correct number using the call tool, and by reducing the number of respondents who use the pager. Going forward, we hope to be able to expand use of this tool throughout the hospital in order to provide more timely and efficient care with other services by streamlining access between referring services and the appropriate radiology recipients.
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Affiliation(s)
- Nicholas Voutsinas
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
| | - Jean Sun
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Michael Chung
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Adam Jacobi
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Nicholas Genes
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Denise Nassisi
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Kathleen Halton
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Bradley Delman
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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Yoo K, Choi RY, Sun J, Veselis C, Kamat B, Kumaran M, Agosto O, Maresky HS. Incidental COVID-19 in the radiology department: Radiographic findings of COVID-19 in asymptomatic patient undergoing CT staging for breast cancer. Radiol Case Rep 2020; 15:1614-1617. [PMID: 32685081 PMCID: PMC7287467 DOI: 10.1016/j.radcr.2020.05.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 01/18/2023] Open
Abstract
A 59-year-old incarcerated woman who was diagnosed with invasive ductal carcinoma in 2016 was brought in for evaluation of the breast cancer. Upon evaluation of the computed tomography chest for breast cancer restaging, diffuse bilateral ground glass opacities and a reverse halo sign in the right lower lobe concerning for atypical viral pneumonia were discovered. The patient was afebrile, had an oxygen saturation of 100%, and denied chest pain as well as shortness of breath. On physical exam, she exhibited decreased breath sounds bilaterally and expiratory wheezing. She later received a COVID-19 test, which came back positive. Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also known as COVID-19) may remain asymptomatic in the initial phase, leading to under-recognition and incidental detection on procedures for standard clinical indications. Hospitals, in particular diagnostic imaging services, should prepare accordingly in regard to health precautions while keeping in mind the potential discrepancies between clinical presentation and resultant radiologic patterns. This awareness should be heightened in patients at higher risk (ie, prisoners). Furthermore, by acting upon the incidental detection of this virus during its early stages, subsequent steps could help prevent the spread of the virus.
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Affiliation(s)
- Kevin Yoo
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Robert Y Choi
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Justin Sun
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Clinton Veselis
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Bhishak Kamat
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Maruti Kumaran
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Omar Agosto
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Hillel S Maresky
- Department of Radiology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
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Deaner JD, Meeker AR, Ozzello DJ, Swaminathan V, Amarasekera DC, Zhang Q, Hamershock RA, Sergott RC. The Diagnostic Yield and Cost of Radiologic Imaging for Urgent and Emergent Ocular Conditions in an Eye Emergency Room. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2020. [DOI: 10.1055/s-0040-1715570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objective The aim of this study is to assess the diagnostic yield and economic cost of radiologic imaging for urgent and emergent ophthalmic conditions in an emergency room (ER) setting
Design Retrospective, consecutive case series.
Methods Charts of all patients who underwent radiologic imaging in a dedicated eye ER over a single year were reviewed. Data collected included age, patient reported chief complaint, visual acuity, principal examination finding, indication for imaging, imaging modalities performed, and the current procedural terminology (CPT) codes billed for the imaging performed. Imaging results were classified into three groups with binary outcomes: normal or abnormal; significant if it led to a change in patient management, and relevant if the imaging findings were related to the chief complaint or principal examination finding. Imaging costs were calculated using the billed CPT codes.
Results A total of 14,961 patients were evaluated during the 1-year study and 1,371 (9.2%) patients underwent imaging. Of these, 521 patients (38.0%) had significant findings. A majority of this group had significant and relevant findings (469, 34.2% of total). Subgroup analysis was performed based upon patient chief complaint, principal examination finding, and indication for imaging. Overall, the total cost of imaging was $656,078.34 with an average cost of $478.54 per patient.
Conclusion Imaging for urgent and emergent ophthalmic conditions in an eye ER resulted in significant management changes in 38.0% of patients. Radiographic imaging contributes to healthcare expenditures; however, these costs must be weighed against the substantial costs of delayed and misdiagnoses, especially when patients present with acute ophthalmological symptoms.
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Affiliation(s)
- Jordan D. Deaner
- Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Austin R. Meeker
- Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Daniel J. Ozzello
- Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Vishal Swaminathan
- Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | - Qiang Zhang
- Biostatistics Consulting Core, Vicky and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Philadelphia
| | - Rose A. Hamershock
- Biostatistics Consulting Core, Vicky and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Philadelphia
| | - Robert C. Sergott
- Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
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Trends in Publicly Reported Quality Measures of Hospital Imaging Efficiency, 2011-2018. AJR Am J Roentgenol 2020; 215:153-158. [PMID: 32432908 DOI: 10.2214/ajr.19.21993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. In 2011, the Centers for Medicare & Medicaid Services (CMS) initiated public reporting of outpatient imaging efficiency measures to reduce potentially inappropriate imaging and unnecessary exposure to ionizing radiation performed in hospital outpatient departments. Three CMS quality measures were designed to reduce duplicative CT in the Medicare population: OP-10, which CMS lists as "Abdomen Computed Tomography-Use of Contrast Material"; OP-11, which CMS lists as "Thorax CT-Use of Contrast Material"; and OP-14, which CMS lists as "Simultaneous Use of Brain CT and Sinus CT." We describe trends in hospital performance on these national hospital outpatient imaging efficiency measures since the inception of their public reporting. MATERIALS AND METHODS. This observational analysis used standard Medicare fee-for-service administrative claims to calculate hospital-specific scores for OP-10, OP-11, and OP-14. Consistent with CMS specifications, each measure was calculated as a percentage with appropriate exclusions and minimum case count requirements to ensure measure score validity and reliability. We report national performance as well as distributions of hospital performance scores for each annual public reporting period. Trend analyses were performed to examine changes in annual mean performance over time. Secondary analyses assessed trends and hospital performance by location (rural vs urban) and hospital characteristics. RESULTS. Between 2011 and 2018, the national mean rate of duplicate imaging declined for all three measures (OP-10, 18.9% vs 7.7%; OP-11, 5.6% vs 2.0%; OP-14, 2.5% vs 1.0%). For OP-10 and OP-11, most outlier hospitals were rural, small, and government-owned. For OP-10, rural facilities accounted for 32.2% of all facilities but 46.0% of outliers by the end of the study period. Similarly, for OP-11, rural facilities accounted for 30.1% of all facilities but 47.0% of outliers by the end of the study period. In general, the proportion of outliers located in rural areas decreased over time. CONCLUSION. National performance on CMS quality measures of duplicative CT has improved over time, with reduced variation observed between hospitals since the inception of public reporting. These successes support recent CMS policy initiatives to retire duplicative imaging measures from public reporting. Future work should seek to identify opportunities to use national public reporting initiatives to yield similar improvements across broader indications and settings.
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Rajpurkar P, Park A, Irvin J, Chute C, Bereket M, Mastrodicasa D, Langlotz CP, Lungren MP, Ng AY, Patel BN. AppendiXNet: Deep Learning for Diagnosis of Appendicitis from A Small Dataset of CT Exams Using Video Pretraining. Sci Rep 2020; 10:3958. [PMID: 32127625 PMCID: PMC7054445 DOI: 10.1038/s41598-020-61055-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
The development of deep learning algorithms for complex tasks in digital medicine has relied on the availability of large labeled training datasets, usually containing hundreds of thousands of examples. The purpose of this study was to develop a 3D deep learning model, AppendiXNet, to detect appendicitis, one of the most common life-threatening abdominal emergencies, using a small training dataset of less than 500 training CT exams. We explored whether pretraining the model on a large collection of natural videos would improve the performance of the model over training the model from scratch. AppendiXNet was pretrained on a large collection of YouTube videos called Kinetics, consisting of approximately 500,000 video clips and annotated for one of 600 human action classes, and then fine-tuned on a small dataset of 438 CT scans annotated for appendicitis. We found that pretraining the 3D model on natural videos significantly improved the performance of the model from an AUC of 0.724 (95% CI 0.625, 0.823) to 0.810 (95% CI 0.725, 0.895). The application of deep learning to detect abnormalities on CT examinations using video pretraining could generalize effectively to other challenging cross-sectional medical imaging tasks when training data is limited.
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Affiliation(s)
- Pranav Rajpurkar
- Stanford University Department of Computer Science, Stanford, USA
| | - Allison Park
- Stanford University Department of Computer Science, Stanford, USA
| | - Jeremy Irvin
- Stanford University Department of Computer Science, Stanford, USA
| | - Chris Chute
- Stanford University Department of Computer Science, Stanford, USA
| | - Michael Bereket
- Stanford University Department of Computer Science, Stanford, USA
| | | | | | | | - Andrew Y Ng
- Stanford University Department of Computer Science, Stanford, USA
| | - Bhavik N Patel
- Stanford University Department of Radiology, Stanford, USA.
- Stanford University AIMI Center, Stanford, USA.
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Parlangeli O, Liston PM, Marchigiani E, Bracci M, Giani A. Perceptions and Use of Computed Tomography in a Hospital Emergency Department: Technicians' Perspectives. HUMAN FACTORS 2020; 62:5-19. [PMID: 31017818 DOI: 10.1177/0018720819841758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study traces the evolution of perceptions and use of computed tomography (CT) by radiology technicians in the emergency department (ED) of a hospital in Italy across a 7-year period. BACKGROUND The sociotechnical context of the CT room of an ED has been neglected by scientific research-potentially impacting safety. METHOD Two studies were performed, one in 2011 and one in 2018. Six CT technicians were involved in each. Structured interviews were performed to gather information on perceptions related to the evolution of the use of CT according to nine different factors-e.g. the level of complexity, and mental workload. Observations were performed on duration of exams, the flow of people, conversations, and any critical issues. RESULTS The CT technology is appreciated, used effectively and with confidence by CT technicians. From 2011-2018, the execution times of the exams have decreased but not the proportion of time dedicated to the patient. Expectations for future improvements are limited by issues concerning the design of both the user interface and the social context of the ED workplace. CONCLUSIONS The safety and efficiency of the system as a whole are greatly dependent on the competence of the CT technicians. CT manufacturers rely on this competence to help compensate for the deficiencies created by suboptimal user interfaces and the lack of fit of the technology with the social context of the workplace. APPLICATION Training programs aimed at improving the management of relationships and communications between staff could improve performance and efficiency. CT manufacturers should try to better understand the cognitive and operational context of the workplaces where CT technicians work-and to design better diagnostic technology which accounts for these operational realities.
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Promoting head CT exams in the emergency department triage using a machine learning model. Neuroradiology 2019; 62:153-160. [DOI: 10.1007/s00234-019-02293-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
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Smith-Bindman R, Kwan ML, Marlow EC, Theis MK, Bolch W, Cheng SY, Bowles EJA, Duncan JR, Greenlee RT, Kushi LH, Pole JD, Rahm AK, Stout NK, Weinmann S, Miglioretti DL. Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016. JAMA 2019; 322:843-856. [PMID: 31479136 PMCID: PMC6724186 DOI: 10.1001/jama.2019.11456] [Citation(s) in RCA: 429] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
Abstract
Importance Medical imaging increased rapidly from 2000 to 2006, but trends in recent years have not been analyzed. Objective To evaluate recent trends in medical imaging. Design, Setting, and Participants Retrospective cohort study of patterns of medical imaging between 2000 and 2016 among 16 million to 21 million patients enrolled annually in 7 US integrated and mixed-model insurance health care systems and for individuals receiving care in Ontario, Canada. Exposures Calendar year and country (United States vs Canada). Main Outcomes and Measures Use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine imaging. Annual and relative imaging rates by imaging modality, country, and age (children [<18 years], adults [18-64 years], and older adults [≥65 years]). Results Overall, 135 774 532 imaging examinations were included; 5 439 874 (4%) in children, 89 635 312 (66%) in adults, and 40 699 346 (30%) in older adults. Among adults and older adults, imaging rates were significantly higher in 2016 vs 2000 for all imaging modalities other than nuclear medicine. For example, among older adults, CT imaging rates were 428 per 1000 person-years in 2016 vs 204 per 1000 in 2000 in US health care systems and 409 per 1000 vs 161 per 1000 in Ontario; for MRI, 139 per 1000 vs 62 per 1000 in the United States and 89 per 1000 vs 13 per 1000 in Ontario; and for ultrasound, 495 per 1000 vs 324 per 1000 in the United States and 580 per 1000 vs 332 per 1000 in Ontario. Annual growth in imaging rates among US adults and older adults slowed over time for CT (from an 11.6% annual percentage increase among adults and 9.5% among older adults in 2000-2006 to 3.7% among adults in 2013-2016 and 5.2% among older adults in 2014-2016) and for MRI (from 11.4% in 2000-2004 in adults and 11.3% in 2000-2005 in older adults to 1.3% in 2007-2016 in adults and 2.2% in 2005-2016 in older adults). Patterns in Ontario were similar. Among children, annual growth for CT stabilized or declined (United States: from 10.1% in 2000-2005 to 0.8% in 2013-2016; Ontario: from 3.3% in 2000-2006 to -5.3% in 2006-2016), but patterns for MRI were similar to adults. Changes in annual growth in ultrasound were smaller among adults and children in the United States and Ontario compared with CT and MRI. Nuclear medicine imaging declined in adults and children after 2006. Conclusions and Relevance From 2000 to 2016 in 7 US integrated and mixed-model health care systems and in Ontario, rates of CT and MRI use continued to increase among adults, but at a slower pace in more recent years. In children, imaging rates continued to increase except for CT, which stabilized or declined in more recent periods. Whether the observed imaging utilization was appropriate or was associated with improved patient outcomes is unknown.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, Epidemiology and Biostatistics, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Marilyn L. Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Emily C. Marlow
- Department of Public Health Sciences, University of California, Davis
- Graduate Group in Epidemiology, University of California, Davis
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Wesley Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville
| | | | | | - James R. Duncan
- Interventional Radiology Section, Washington University in St Louis, St Louis, Missouri
| | | | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jason D. Pole
- ICES, Toronto, Ontario, Canada
- Pediatric Oncology Group of Ontario and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alanna K. Rahm
- Center for Health Research, Genomic Medical Institute, Geisinger, Danville, Pennsylvania
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Diana L. Miglioretti
- Department of Public Health Sciences, University of California, Davis
- Kaiser Permanente Washington Health Research Institute, Seattle
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Use of Imaging in the Emergency Department: Do Individual Physicians Contribute to Variation? AJR Am J Roentgenol 2019; 213:637-643. [DOI: 10.2214/ajr.18.21065] [Citation(s) in RCA: 14] [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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An Important and Often Ignored Turnaround Time in Radiology - Clinician Turnaround Time: Implications for Musculoskeletal Radiology. J Belg Soc Radiol 2019; 103:49. [PMID: 31523748 PMCID: PMC6696790 DOI: 10.5334/jbsr.1834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There has been an increase in routine musculoskeletal (MSK) MRI studies performed on weekends. Study Aims: First, to assess whether radiologist interpretation of routine MSK MRI studies on weekends decreases the time to when the clinician reads the radiologist’s report compared to studies performed on the weekend but interpreted the following Monday. Second, to evaluate whether reports are more likely to be read by clinicians if the MRIs are interpreted by radiologists on weekends compared to the following Monday. Methods: A random sample of 1765 patients who underwent routine MSK MRIs from January 1, 2015 to December 31, 2016 was evaluated. The radiologist turnaround times (rTATs), clinician turnaround times (cTATs) and the provider turnaround time (pTAT) were calculated. The pTAT was the sum of the rTAT and the cTAT. Fisher’s exact tests were used to compare proportions. Wilcoxon Rank Sum tests were used to compare turnaround time metrics. Results: There was no difference in the pTAT for studies performed and interpreted on the weekends compared to those performed on the weekend but interpreted the following Monday (P = 0.750). However, clinicians were significantly less likely to read the reports interpreted on the weekend compared to studies interpreted on weekdays (P = 0.001). Conclusion: Routine MSK MRI studies performed on weekends can be interpreted by radiologists on the following weekday (Monday) without affecting the time at which the clinician reads the reports and these reports are more likely to be read by clinicians if the radiologist interprets the study on a weekday.
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Faggioni L, Gabelloni M, Neri E, Caramella D. Evidence-based Clinical Decision Support Systems for Suspected Pulmonary Embolism: Are We Ready to Go? Acad Radiol 2019; 26:1084-1086. [PMID: 31126810 DOI: 10.1016/j.acra.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 02/04/2023]
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Schrager JD, Patzer RE, Kim JJ, Pitts SR, Chokshi FH, Phillips JS, Zhang X. Racial and Ethnic Differences in Diagnostic Imaging Utilization During Adult Emergency Department Visits in the United States, 2005 to 2014. J Am Coll Radiol 2019; 16:1036-1045. [DOI: 10.1016/j.jacr.2019.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/20/2019] [Accepted: 03/10/2019] [Indexed: 12/22/2022]
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Juliusson G, Thorvaldsdottir B, Kristjansson JM, Hannesson P. Diagnostic imaging trends in the emergency department: an extensive single-center experience. Acta Radiol Open 2019; 8:2058460119860404. [PMID: 31392034 PMCID: PMC6669846 DOI: 10.1177/2058460119860404] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022] Open
Abstract
Background Emergency Department imaging volume has increased significantly in North America and Asia. Purpose To assess Emergency Department imaging trends in a European center. Material and Methods The institutional radiological information system was queried for all computed tomography (CT), ultrasound (US), and magnetic resonance (MR) studies performed for the Emergency Department during 2002–2017. Descriptive statistics and linear regression analyses were used to assess overall study rates and temporal trends in overall and after-hours imaging after adjusting for patient visitations. Results CT use increased significantly from 38/1000 visits to 108/1000 at the end of the observation by 5.5 new exams per 1000 visits/year (P < 0.0001). US use increased gradually at a rate of 1.2/1000 per year during 2002–2008 with an accelerated annual increase of 6.4/1000 in 2009–2011 (P < 0.0001) raising US rates from 7/1000 to 28/1000 visits per year with stable rates from 2012 onwards. After on-site MR became available in 2004, its use increased from 0.3/1000 to 7/1000 at a rate of 1.9/1000 visits per year in 2005–2009 (P < 0.0001) and remained stable from 2010. While there was a significant increase in after-hours imaging, growth remained proportional to the overall trend in the use of CT, MR, and night-time CT with the exception of a slight decrease in after-hour US in favor of standard working hours (P < 0.0001). Conclusion All modalities increased significantly in volume adjusted usage. US and MR rates have been stable since 2012 and 2010, respectively, after periods of increase while CT use continues to increase. Demand for after-hours imaging was mostly proportional to the overall trend.
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Affiliation(s)
- Gunnar Juliusson
- Department of Radiology, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Petur Hannesson
- Department of Radiology, Landspitali University Hospital, Reykjavik, Iceland
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Azman RR, Shah MNM, Ng KH. Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks. Korean J Radiol 2019; 20:399-404. [PMID: 30799570 PMCID: PMC6389812 DOI: 10.3348/kjr.2018.0416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/09/2018] [Indexed: 01/01/2023] Open
Abstract
The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.
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Affiliation(s)
- Raja Rizal Azman
- Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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User-Interface and Operators: Evolution in the Perception of Computed Tomography (CT). ADVANCES IN INTELLIGENT SYSTEMS AND COMPUTING 2019. [DOI: 10.1007/978-3-319-96077-7_63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Repeat CT Performed Within One Month of CT Conducted in the Emergency Department for Abdominal Pain: A Secondary Analysis of Data From a Prospective Multicenter Study. AJR Am J Roentgenol 2018; 212:382-385. [PMID: 30512995 DOI: 10.2214/ajr.18.20060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to determine both the frequency of repeat CT performed within 1 month after a patient visits the emergency department (ED) and undergoes CT evaluation for abdominal pain and the frequency of worsened or new CT-based diagnoses. SUBJECTS AND METHODS Secondary analysis was performed on data collected during a prospective multicenter study. The parent study included patients who underwent CT in the ED for abdominal pain between 2012 and 2014, and these patients constituted the study group of the present analysis. The proportion of patients who underwent (in any setting) repeat abdominal CT within 1 month of the index CT examination was calculated. For each of these patients, results of the index and repeat CT scans were compared by an independent panel and categorized as follows: no change (group 1); same process, improved (group 2); same process, worse (group 3); or different process (group 4). The proportion of patients in groups 1 and 2 versus groups 3 and 4 was calculated, and patient and ED physician characteristics were compared. RESULTS The parent study included 544 patients (246 of whom were men [45%]; mean patient age, 49.4 years). Of those 544 patients, 53 (10%; 95% CI, 7.5-13%) underwent repeat abdominal CT. Patients' CT comparisons were categorized as follows: group 1 for 43% of patients (23/53), group 2 for 26% (14/53), group 3 for 15% (8/53), and group 4 for 15% (8/53). New or worse findings were present in 30% of patients (16/53) (95% CI, 19-44%). When patients with findings in groups 1 and 2 were compared to patients with findings in groups 3 and 4, no significant difference was noted in patient age (p = 0.25) or sex (p = 0.76), the number of days between scans (p = 0.98), and the diagnostic confidence of the ED physician after the index CT scan was obtained (p = 0.33). CONCLUSION Short-term, repeat abdominal CT was performed for 10% of patients who underwent CT in the ED for abdominal pain, and it yielded new or worse findings for 30% of those patients.
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Characterization of Small Incidental Indeterminate Hypoattenuating Hepatic Lesions: Added Value of Single-Phase Contrast-Enhanced Dual-Energy CT Material Attenuation Analysis. AJR Am J Roentgenol 2018; 211:571-579. [DOI: 10.2214/ajr.17.19170] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
OBJECTIVE This study aimed to develop a diagnostic model that predicts acute pancreatitis (AP) risk before imaging. METHODS Emergency department patients with serum lipase elevated to 3 times the upper limit of normal or greater were identified retrospectively (September 1, 2013-August 31, 2015). An AP diagnosis was established by expert review of full hospitalization records. Candidate predictors included demographic and clinical characteristics at presentation. Using a derivation set, a multivariable logistic regression model and corresponding point-based scoring system was developed to predict AP. Discrimination accuracy and calibration were assessed in a separate validation set. RESULTS In 319 eligible patients, 182 (57%) had AP. The final model (area under curve, 0.92) included 8 predictors: number of prior AP episodes; history of cholelithiasis; no abdominal surgery (prior 2 months); time elapsed from symptom onset; pain localized to epigastrium, of progressively worsening severity, and severity level at presentation; and extent of lipase elevation. At a diagnostic risk threshold of 8 points or higher (≥99%), the model identified AP with a sensitivity of 45%, and a specificity and a positive predictive value of 100%. CONCLUSIONS In emergency department patients with lipase elevated to 3 times the upper limit of normal or greater, this model helps identify AP risk before imaging. Prospective validation studies are needed to confirm diagnostic accuracy.
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Ketelaars R, Van Heumen E, Baken LP, Witten M, Scheffer GJ, Engels Y, Hoogerwerf N. Emergency physicians’ attitudes to implementing ultrasound in Dutch emergency departments after a 2-day training: A qualitative study. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918771812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Diagnostic ultrasound is increasingly used by nonradiologists in trauma victims and critically ill patients. In the emergency department, the extended focused assessment with sonography for trauma and Polytrauma Rapid Echo-evaluation Program protocol are often used to assess these patients. Dutch Polytrauma Rapid Echo-evaluation Program-trained Emergency physicians are implementing the use of ultrasound in the emergency department but might encounter barriers to overcome. Objectives: This study aims to explore individual experiences of Dutch emergency physicians. Methods: We performed a qualitative study by conducting semi-structured interviews in Dutch emergency physicians working in a Level 2 emergency department that completed the 2-day Polytrauma Rapid Echo-evaluation Program course at least 1 year before the interviews. Data were analyzed using directed content analysis. Results: Eight emergency physicians employed by eight different hospitals were interviewed. Thirteen categories were identified in the transcribed interviews and these were combined into four general themes: (1) the desire to develop the Emergency Medicine specialty, both nationally and local; (2) incentives to start using ultrasound; (3) exploring practical applications of ultrasound; and (4) barriers faced while implementing emergency physician-performed ultrasound on the emergency department. The interviewees regard the course to be a solid base and are eager to independently perform ultrasound examinations, although challenges are faced. Conclusion: This exploratory study provides essential insight in Dutch emergency physicians implementing ultrasound in their emergency department. It shows that there is a need to develop a quality assurance system and it identified barriers that have to be dealt with.
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Affiliation(s)
- Rein Ketelaars
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
| | - Esther Van Heumen
- Department of Radiology, Haga Hospital, The Hague, The Netherlands
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lambert P Baken
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Marja Witten
- Emergency Department, Flevoziekenhuis, Almere, The Netherlands
| | - Gert Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Nico Hoogerwerf
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
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Bedside Ultrasound Diagnosis of Complete Achilles Tendon Tear in a 25-Year-Old Man with Calf Injury. J Emerg Med 2018; 54:694-696. [PMID: 29627350 DOI: 10.1016/j.jemermed.2018.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/05/2018] [Accepted: 01/19/2018] [Indexed: 12/28/2022]
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43
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Gottumukkala RV, Glover M, Yun BJ, Sonis JD, Kalra MK, Otrakji A, Raja AS, Prabhakar AM. Allergic-like contrast reactions in the ED: Incidence, management, and impact on patient disposition. Am J Emerg Med 2018; 36:825-828. [DOI: 10.1016/j.ajem.2017.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/07/2017] [Accepted: 10/10/2017] [Indexed: 11/15/2022] Open
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44
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Increasing utilization of emergency department neuroimaging in Medicare beneficiaries from 1994 to 2015. Am J Emerg Med 2018; 36:680-683. [DOI: 10.1016/j.ajem.2017.12.057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/25/2017] [Accepted: 12/26/2017] [Indexed: 11/23/2022] Open
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45
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Bellolio MF, Bellew SD, Sangaralingham LR, Campbell RL, Cabrera D, Jeffery MM, Shah ND, Hess EP. Access to primary care and computed tomography use in the emergency department. BMC Health Serv Res 2018; 18:154. [PMID: 29499700 PMCID: PMC5834877 DOI: 10.1186/s12913-018-2958-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/21/2018] [Indexed: 01/17/2023] Open
Abstract
Background The decision to obtain a computed tomography CT scan in the emergency department (ED) is complex, including a consideration of the risk posed by the test itself weighed against the importance of obtaining the result. In patients with limited access to primary care follow up the consequences of not making a diagnosis may be greater than for patients with ready access to primary care, impacting diagnostic reasoning. We set out to determine if there is an association between CT utilization in the ED and patient access to primary care. Methods We performed a cross-sectional study of all ED visits in which a CT scan was obtained between 2003 and 2012 at an academic, tertiary-care center. Data were abstracted from the electronic medical record and administrative databases and included type of CT obtained, demographics, comorbidities, and access to a local primary care provider (PCP). CT utilization rates were determined per 1000 patients. Results A total of 595,895 ED visits, including 98,001 visits in which a CT was obtained (16.4%) were included. Patients with an assigned PCP accounted for 55% of all visits. Overall, CT use per 1000 ED visits increased from 142.0 in 2003 to 169.2 in 2012 (p < 0.001), while the number of annual ED visits remained stable. CT use per 1000 ED visits increased from 169.4 to 205.8 over the 10-year period for patients without a PCP and from 118.9 to 142.0 for patients with a PCP. Patients without a PCP were more likely to have a CT performed compared to those with a PCP (OR 1.57, 95%CI 1.54 to 1.58; p < 0.001). After adjusting for age, gender, year of visit and number of comorbidities, patients without a PCP were more likely to have a CT performed (OR 1.20, 95% CI 1.18 to 1.21, p < 0.001). Conclusions The overall rate of CT utilization in the ED increased over the past 10 years. CT utilization was significantly higher among patients without a PCP. Increased availability of primary care, particularly for follow-up from the ED, could reduce CT utilization and therefore decrease costs, ED lengths of stay, and radiation exposure.
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Affiliation(s)
- M Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA. .,Kern Center for the Science of Heath Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Shawna D Bellew
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lindsey R Sangaralingham
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Kern Center for the Science of Heath Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Molly M Jeffery
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Nilay D Shah
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Kern Center for the Science of Heath Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Erik P Hess
- Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Trends and Variation in the Utilization and Diagnostic Yield of Chest Imaging for Medicare Patients With Suspected Pulmonary Embolism in the Emergency Department. AJR Am J Roentgenol 2018; 210:572-577. [DOI: 10.2214/ajr.17.18586] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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47
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Sonis JD, Gottumukkala RV, Glover M, Yun BJ, White BA, Kalra MK, Otrakji A, Raja AS, Prabhakar AM. Implications of iodinated contrast media extravasation in the emergency department. Am J Emerg Med 2018; 36:294-296. [DOI: 10.1016/j.ajem.2017.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/06/2017] [Indexed: 11/27/2022] Open
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Catapano M, Albano D, Pozzi G, Accetta R, Memoria S, Pregliasco F, Messina C, Sconfienza LM. Differences between orthopaedic evaluation and radiological reports of conventional radiographs in patients with minor trauma admitted to the emergency department. Injury 2017; 48:2451-2456. [PMID: 28882380 DOI: 10.1016/j.injury.2017.08.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/03/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION During night and on weekends, in our emergency department there is no radiologist on duty or on call: thus, X-ray examinations (XR) are evaluated by the orthopaedic surgeon on duty and reported the following morning/monday by radiologists. The aim of our study was to examine the discrepancy rate between orthopaedists and radiologists in the interpretation of imaging examinations performed on patients in our tertiary level orthopaedic institution and the consequences of delayed diagnosis in terms of patient management and therapeutic strategy. MATERIALS AND METHODS We retrospectively reviewed all cases of discrepancy between orthopaedists and radiologists, which were categorized according to anatomical location of injury, initial diagnosis and treatment, change in diagnosis and treatment. We used the Chi square test to compare the frequencies of discrepancies between patients ≤14 and >14years of age. RESULTS From January to December 2016, 19,512 patients admitted to our emergency department performed at least an imaging examination; among these patients, 13,561 underwent XR in absence of an attending radiologist. A discrepant diagnosis was found in 337/13,561 (2.5%; 184 males; mean age: 36.7±23.7, range 2-95); 151/337 (45%) discrepancies were encountered in the lower limbs, with ankle being the most common site of misdiagnosis (64/151), and 103/337 (30%) in the upper limbs, with the elbow being the most frequent site in this district (35/103). We found 293/337 false negatives (87%) and 44/337 false positives (13%), with 134 and 13 patients needing treatment change, respectively. We found 85/337 discrepancies (25%) in patients ≤14 years of age, and 252/337 (75%) in those >14years. The distribution of discrepancies per anatomic district was significantly different (P<0.001) in these two groups of patients. CONCLUSIONS A low rate of discrepancy between orthopaedists and radiologists in evaluating images of patients admitted to our emergency department was found, although treatment change occurred in about half of cases. A thorough and accurate clinical evaluation is crucial to provide a correct treatment and prognosis.
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Affiliation(s)
- Michele Catapano
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Domenico Albano
- Sezione di Scienze Radiologiche, Di.Bi.Med., Università degli Studi di Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Grazia Pozzi
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Riccardo Accetta
- Unità Operativa di Traumatologia, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Sergio Memoria
- Unità Operativa di Traumatologia, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Fabrizio Pregliasco
- Direzione Sanitaria, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
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Mills AM, Ip IK, Langlotz CP, Raja AS, Zafar HM, Khorasani R. Clinical decision support increases diagnostic yield of computed tomography for suspected pulmonary embolism. Am J Emerg Med 2017; 36:540-544. [PMID: 28970024 DOI: 10.1016/j.ajem.2017.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 07/31/2017] [Accepted: 09/02/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Determine effects of evidence-based clinical decision support (CDS) on the use and yield of computed tomographic pulmonary angiography for suspected pulmonary embolism (CTPE) in Emergency Department (ED) patients. METHODS This multi-site prospective quality improvement intervention conducted in three urban EDs used a pre/post design. For ED patients aged 18+years with suspected PE, CTPE use and yield were compared 19months pre- and 32months post-implementation of CDS intervention based on the Wells criteria, provided at the time of CTPE order, deployed in April 2012. Primary outcome was the yield (percentage of studies positive for acute PE). Secondary outcome was utilization (number of studies/100 ED visits) of CTPE. Chi-square and statistical process control chart assessed pre- and post-intervention differences. An interrupted time series analysis was also performed. RESULTS Of 558,795 patients presenting October 2010-December 2014, 7987 (1.4%) underwent CTPE (mean age 52±17.5years, 66% female, 60.1% black); 34.7% of patients presented pre- and 65.3% post-CDS implementation. Overall CTPE diagnostic yield was 9.8% (779/7987 studies positive for PE). Yield increased a relative 30.8% after CDS implementation (8.1% vs. 10.6%; p=0.0003). There was no statistically significant change in CTPE utilization (1.4% pre- vs. 1.4% post-implementation; p=0.25). A statistical process control chart demonstrated immediate and sustained improvement in CTPE yield post-implementation. Interrupted time series analysis demonstrated the slope of PE findings versus time to be unchanged before and after the intervention (p=0.9). However, there was a trend that the intervention was associated with a 50% increased probability of PE finding (p=0.08), suggesting an immediate rather than gradual change after the intervention. CONCLUSIONS Implementing evidence-based CDS in the ED was associated with an immediate, significant and sustained increase in CTPE yield without a measurable decrease in CTPE utilization. Further studies will be needed to assess whether stronger interventions could further improve appropriate use of CTPE.
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Affiliation(s)
- Angela M Mills
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Ivan K Ip
- Center for Evidence Based Imaging, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Curtis P Langlotz
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ali S Raja
- Center for Evidence Based Imaging, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hanna M Zafar
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ramin Khorasani
- Center for Evidence Based Imaging, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Buller M, Karis JP. Introduction of a Dedicated Emergency Department MR Imaging Scanner at the Barrow Neurological Institute. AJNR Am J Neuroradiol 2017; 38:1480-1485. [PMID: 28495948 DOI: 10.3174/ajnr.a5210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/23/2017] [Indexed: 11/07/2022]
Abstract
Use of advanced imaging in the emergency department has been increasing in the United States during the past 2 decades. This trend has been most notable in CT, which has increased concern over the effects of increasing levels of medical ionizing radiation. MR imaging offers a safe, nonionizing alternative to CT and is diagnostically superior in many neurologic conditions encountered in the emergency department. Herein, we describe the process of developing and installing a dedicated MR imaging scanner in the Neuroscience Emergency Department at the Barrow Neurological Institute and its effects on neuroradiology and the emergency department in general.
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Affiliation(s)
- M Buller
- From the Neuroradiology Department, Barrow Neurological Institute, Phoenix, Arizona
| | - J P Karis
- From the Neuroradiology Department, Barrow Neurological Institute, Phoenix, Arizona.
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