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Alsulimani L, AlRasheed B, Saeed A, Alabsi H. The Competency of Emergency Medicine Residents in Interpreting Hand X-rays Across the Three Major Regions of Saudi Arabia. Cureus 2024; 16:e59270. [PMID: 38686103 PMCID: PMC11057336 DOI: 10.7759/cureus.59270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/02/2024] Open
Abstract
Background Interpreting hand X-rays is crucial for emergency medicine residents to accurately diagnose traumatic injuries and conditions affecting the hand. This study aimed to assess the competency of emergency medicine residents in interpreting hand X-rays across three major regions in Saudi Arabia. Methodology We conducted a cross-sectional study involving 100 emergency medicine residents from the Central, Eastern, and Western regions of Saudi Arabia. Participants were presented with 10 clinical case scenarios each accompanied by hand X-rays and were asked to provide their interpretations. Assessment scores were calculated based on the proportion of correct answers for each case. Results Half of the participants (50 residents) fell within the age range of 25 to 27 years, with 61 male and 39 female participants, respectively. Residents in the third year of training (R3) exhibited the highest mean score of 74.83% ± 20.46%. Participants using desktops to view the images achieved the highest mean score of 75% ± 10.49% compared to those using smartphones or tablets. Significant associations were found between age (F = 4.072, p = 0.020), training level (F = 3.161, p = 0.028), and choice of viewing device (F = 7.811, p = 0.001) and assessment scores. Conclusions Our study highlighted that emergency medicine residents in Saudi Arabia demonstrate competent proficiency in interpreting hand X-rays, with higher competency observed among senior residents (R3 and R4), those aged 28 to 30 years, and those using desktops for image viewing.
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Affiliation(s)
- Loui Alsulimani
- Emergency Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Basma AlRasheed
- Emergency Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Afnan Saeed
- Emergency Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Hatim Alabsi
- Radiology, King Abdulaziz University Hospital, Jeddah, SAU
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Factor S, Albagli A, Bebin A, Druckmann I, Bulkowstein S, Stahl I, Shichman I. Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study. Eur J Trauma Emerg Surg 2023; 49:2589-2597. [PMID: 37573536 DOI: 10.1007/s00068-023-02347-0] [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: 05/13/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority. METHODS A multicenter study which evaluated orthopedic surgery, emergency medicine (EM), and radiology residents, through a test set of common MSK XR. Residents were classified as "beginner" or "advanced" according to postgraduate year per residency. Residents were asked to answer whether the radiograph shows normal or pathological findings (success rate) and what is the diagnosis ("diagnosis accuracy"). Residents' answers were analyzed and assessed compared to experts' consensus. RESULTS A total of 100 residents (62% beginners) participated in this study. Fifty-four were orthopedic surgeons, 29 were EM residents and 17 were radiologists. The entire cohort's overall success rate was 88.5%. The overall mean success rates for orthopedic, EM, and radiology residents were 93.2%, 82.8%, and 83.3%, respectively, and were significantly different (p < 0.0001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p < 0.001). Advanced orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to beginner residents (p = 0.001 and p = 0.03, respectively). CONCLUSION Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Assaf Albagli
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alex Bebin
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
| | - Shlomi Bulkowstein
- Division of Orthopedics, Soroka University Medical Center, Beer-Sheva, P.O. Box 151, 84101, Beer-Sheva, Israel
- Affiliated to the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ido Stahl
- Division of Orthopedic Surgery, Rambam Healthcare Campus, 3109601, Haifa, Israel
- Affiliated to the Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Haifa, Israel
| | - Ittai Shichman
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lind Plesner L, Müller FC, Brejnebøl MW, Laustrup LC, Rasmussen F, Nielsen OW, Boesen M, Brun Andersen M. Commercially Available Chest Radiograph AI Tools for Detecting Airspace Disease, Pneumothorax, and Pleural Effusion. Radiology 2023; 308:e231236. [PMID: 37750768 DOI: 10.1148/radiol.231236] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Background Commercially available artificial intelligence (AI) tools can assist radiologists in interpreting chest radiographs, but their real-life diagnostic accuracy remains unclear. Purpose To evaluate the diagnostic accuracy of four commercially available AI tools for detection of airspace disease, pneumothorax, and pleural effusion on chest radiographs. Materials and Methods This retrospective study included consecutive adult patients who underwent chest radiography at one of four Danish hospitals in January 2020. Two thoracic radiologists (or three, in cases of disagreement) who had access to all previous and future imaging labeled chest radiographs independently for the reference standard. Area under the receiver operating characteristic curve, sensitivity, and specificity were calculated. Sensitivity and specificity were additionally stratified according to the severity of findings, number of findings on chest radiographs, and radiographic projection. The χ2 and McNemar tests were used for comparisons. Results The data set comprised 2040 patients (median age, 72 years [IQR, 58-81 years]; 1033 female), of whom 669 (32.8%) had target findings. The AI tools demonstrated areas under the receiver operating characteristic curve ranging 0.83-0.88 for airspace disease, 0.89-0.97 for pneumothorax, and 0.94-0.97 for pleural effusion. Sensitivities ranged 72%-91% for airspace disease, 63%-90% for pneumothorax, and 62%-95% for pleural effusion. Negative predictive values ranged 92%-100% for all target findings. In airspace disease, pneumothorax, and pleural effusion, specificity was high for chest radiographs with normal or single findings (range, 85%-96%, 99%-100%, and 95%-100%, respectively) and markedly lower for chest radiographs with four or more findings (range, 27%-69%, 96%-99%, 65%-92%, respectively) (P < .001). AI sensitivity was lower for vague airspace disease (range, 33%-61%) and small pneumothorax or pleural effusion (range, 9%-94%) compared with larger findings (range, 81%-100%; P value range, > .99 to < .001). Conclusion Current-generation AI tools showed moderate to high sensitivity for detecting airspace disease, pneumothorax, and pleural effusion on chest radiographs. However, they produced more false-positive findings than radiology reports, and their performance decreased for smaller-sized target findings and when multiple findings were present. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Yanagawa and Tomiyama in this issue.
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Affiliation(s)
- Louis Lind Plesner
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
| | - Felix C Müller
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
| | - Mathias W Brejnebøl
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
| | - Lene C Laustrup
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
| | - Finn Rasmussen
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
| | - Olav W Nielsen
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
| | - Mikael Boesen
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
| | - Michael Brun Andersen
- From the Department of Radiology, Herlev and Gentofte Hospital, Borgmester Ib, Juuls vej 1 Herlev, Copenhagen 2730, Denmark (L.L.P., F.C.M., M.W.B., L.C.L., M.B.A.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (L.L.P., M.W.B., O.W.N., M.B., M.B.A.); Radiological Artificial Intelligence Testcenter, RAIT.dk, Capital Region of Denmark (L.L.P., F.C.M., M.W.B., M.B., M.B.A.); Departments of Radiology (M.W.B., M.B.) and Cardiology (O.W.N.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; and Department of Radiology, Aarhus University Hospital, Aarhus, Denmark (F.R.)
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Dreyer RG, van der Merwe CM, Nicolaou MA, Richards GA. Assessing and comparing chest radiograph interpretation in the Department of Internal Medicine at the University of the Witwatersrand medical school, according to seniority. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i1.265. [PMID: 37476657 PMCID: PMC10354876 DOI: 10.7196/ajtccm.2023.v29i1.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/17/2023] [Indexed: 07/22/2023] Open
Abstract
Background Chest radiographs are a common diagnostic tool in the internal medicine department, and correct interpretation is imperative for adequate patient management. Objectives To determine the diagnostic accuracy of common pathologies in South Africa that are evident on chest radiographs, and to determine whether there are discrepancies according to different levels of qualification of doctors rotating through the internal medicine department, and which factors contribute to an accurate diagnosis. Methods Fifteen chest radiographs with common pathologies were given to all doctors rotating through the Department of Internal Medicine at Chris Hani Baragwanath Academic Hospital, and they were asked to interpret them. Information pertaining to their experience, designation and confidence in chest radiograph interpretation was also obtained. Results Diagnostic accuracy according to years of experience was as follows: 0 - 5 years 27.0%, 6 - 10 years 43.0%, and >10 years 47.9%. For different designations, accuracy was as follows: consultants 50.5%, registrars 40.9%, medical officers 36.4%, and interns 19.5%. Participants who were confident obtained a mean score of 39.4% and those who were not, a mean score of 31.6%. Conclusion Chest radiographs are readily accessible and used daily in clinical practice in numerous facilities. An accurate diagnosis is important to provide quality healthcare. Improved training in interpretation for all, but especially for junior doctors, should be a priority in our training facilities. Study synopsis What the study adds. This study tested the diagnostic accuracy with regard to common pathologies present on chest X ray by doctors rotating through, or stationed at the internal medicine department at an academic hospital. Implications of the findings. Interpretation of chest X-rays was generally poor but the study did find that this improves with experience and confidence in diagnostic ability. These findings are significant in that they indicate a need to implement improved teaching programs in radiological interpretation, especially at an undergraduate level.
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Affiliation(s)
- R G Dreyer
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - M A Nicolaou
- Van Rensburg and Partners and Honorary Lecturer, Department of Radiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg,
South Africa
| | - G A Richards
- Emeritus Professor of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sheikhtaheri A, Hasani N, Hosseini A. Effect of picture archiving and communication system on diagnosis accuracy in CT and radiography examinations in emergency departments. Int J Med Inform 2023; 170:104972. [PMID: 36566536 DOI: 10.1016/j.ijmedinf.2022.104972] [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: 05/22/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Picture archiving and communication system (PACS) affects the radiologists' and physicians' performance. We aimed to evaluate the effect of implementing PACS on the emergency department (ED) physicians' accuracy compared to a radiologist's diagnosis in Iran. METHODS We retrospectively collected data for three six-month periods before and after the implementation of PACS on CT scan and radiography examinations. We compared ED physicians' diagnoses of CT scan and radiography images with a radiologist's interpretations for the same images. We compared 374 CT scans and 346 radiography examinations before implementing PACS (July 2015 to December 2015); 507 CT scans and 480 radiography examinations immediately after PACS (July 2016 to December 2016); and 870 CT scans and 1137 radiography examinations one year after PACS (July 2017 to December 2017). RESULTS We found that diagnosis accuracy of ED physicians on CT scans increased from 75.9 % before implementing PACS to 84.4 % immediately after PACS and 94.9 % one year after PACS (p-value < 0.0001). Diagnosis accuracy for radiography images increased from 63.0 % before implementing PACS to 80.2 % immediately after PACS and 93.1 % one year after PACS (p-value < 0.0001). CONCLUSION Implementation of PACS technology increases ED physicians' diagnosis accuracy.
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Affiliation(s)
- Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Najmeh Hasani
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - AghaFatemeh Hosseini
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Petts A, Neep M, Thakkalpalli M. Reducing diagnostic errors in the emergency department at the time of patient treatment. Emerg Med Australas 2022; 35:466-473. [PMID: 36471902 DOI: 10.1111/1742-6723.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/03/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of the present study was to compare and combine the radiographic interpretation accuracy of emergency clinicians and radiographers in clinical practice. METHODS A total of 838 radiographic examinations were included for analysis from 1 August to 24 August 2020. The range of examinations reviewed included the appendicular and axial skeleton, chest and abdomen. Both paediatric and adult examinations were reviewed. The emergency clinician's and radiographer's interpretations for each examination were compared to the radiologist's report. This allowed mean sensitivity, specificity and diagnostic accuracy to be calculated. RESULTS The radiographer's interpretation demonstrated a mean sensitivity, specificity and accuracy of 80%, 98% and 92%, respectively. The emergency clinician's interpretation demonstrated a mean sensitivity, specificity and accuracy of 82%, 95% and 89%, respectively. When the radiographer's and emergency clinician's interpretations were combined, it yielded a mean sensitivity, specificity and accuracy of 90%, 93% and 92%, respectively. CONCLUSIONS This is the first study to directly compare and combine the accuracy of an emergency clinician's radiographic interpretation with a radiographer's interpretation within clinical practice. The present study demonstrated that with the addition of a radiographer's interpretation, an emergency clinician's interpretation can be more accurate than the emergency clinician's interpretation in isolation. This highlights the value of a radiographer's interpretation that can complement an emergency clinician's interpretation when a radiologist's report is unavailable.
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Affiliation(s)
- Abbie Petts
- Department of Medical Imaging Gold Coast University Hospital Gold Coast Queensland Australia
| | - Michael Neep
- Department of Medical Imaging Logan Hospital Logan City Queensland Australia
- School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia
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Ahn JS, Ebrahimian S, McDermott S, Lee S, Naccarato L, Di Capua JF, Wu MY, Zhang EW, Muse V, Miller B, Sabzalipour F, Bizzo BC, Dreyer KJ, Kaviani P, Digumarthy SR, Kalra MK. Association of Artificial Intelligence-Aided Chest Radiograph Interpretation With Reader Performance and Efficiency. JAMA Netw Open 2022; 5:e2229289. [PMID: 36044215 PMCID: PMC9434361 DOI: 10.1001/jamanetworkopen.2022.29289] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE The efficient and accurate interpretation of radiologic images is paramount. OBJECTIVE To evaluate whether a deep learning-based artificial intelligence (AI) engine used concurrently can improve reader performance and efficiency in interpreting chest radiograph abnormalities. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study was conducted from April to November 2021 and involved radiologists, including attending radiologists, thoracic radiology fellows, and residents, who independently participated in 2 observer performance test sessions. The sessions included a reading session with AI and a session without AI, in a randomized crossover manner with a 4-week washout period in between. The AI produced a heat map and the image-level probability of the presence of the referrable lesion. The data used were collected at 2 quaternary academic hospitals in Boston, Massachusetts: Beth Israel Deaconess Medical Center (The Medical Information Mart for Intensive Care Chest X-Ray [MIMIC-CXR]) and Massachusetts General Hospital (MGH). MAIN OUTCOMES AND MEASURES The ground truths for the labels were created via consensual reading by 2 thoracic radiologists. Each reader documented their findings in a customized report template, in which the 4 target chest radiograph findings and the reader confidence of the presence of each finding was recorded. The time taken for reporting each chest radiograph was also recorded. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were calculated for each target finding. RESULTS A total of 6 radiologists (2 attending radiologists, 2 thoracic radiology fellows, and 2 residents) participated in the study. The study involved a total of 497 frontal chest radiographs-247 from the MIMIC-CXR data set (demographic data for patients were not available) and 250 chest radiographs from MGH (mean [SD] age, 63 [16] years; 133 men [53.2%])-from adult patients with and without 4 target findings (pneumonia, nodule, pneumothorax, and pleural effusion). The target findings were found in 351 of 497 chest radiographs. The AI was associated with higher sensitivity for all findings compared with the readers (nodule, 0.816 [95% CI, 0.732-0.882] vs 0.567 [95% CI, 0.524-0.611]; pneumonia, 0.887 [95% CI, 0.834-0.928] vs 0.673 [95% CI, 0.632-0.714]; pleural effusion, 0.872 [95% CI, 0.808-0.921] vs 0.889 [95% CI, 0.862-0.917]; pneumothorax, 0.988 [95% CI, 0.932-1.000] vs 0.792 [95% CI, 0.756-0.827]). AI-aided interpretation was associated with significantly improved reader sensitivities for all target findings, without negative impacts on the specificity. Overall, the AUROCs of readers improved for all 4 target findings, with significant improvements in detection of pneumothorax and nodule. The reporting time with AI was 10% lower than without AI (40.8 vs 36.9 seconds; difference, 3.9 seconds; 95% CI, 2.9-5.2 seconds; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that AI-aided interpretation was associated with improved reader performance and efficiency for identifying major thoracic findings on a chest radiograph.
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Affiliation(s)
| | - Shadi Ebrahimian
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, New York
| | - Shaunagh McDermott
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Laura Naccarato
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John F. Di Capua
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Markus Y. Wu
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric W. Zhang
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Victorine Muse
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Benjamin Miller
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Data Science Office, Mass General Brigham, Boston, Massachusetts
| | - Farid Sabzalipour
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Data Science Office, Mass General Brigham, Boston, Massachusetts
| | - Bernardo C. Bizzo
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Data Science Office, Mass General Brigham, Boston, Massachusetts
| | - Keith J. Dreyer
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Data Science Office, Mass General Brigham, Boston, Massachusetts
| | - Parisa Kaviani
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Subba R. Digumarthy
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mannudeep K. Kalra
- Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Data Science Office, Mass General Brigham, Boston, Massachusetts
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Kaur N, Mittal A. CADxReport: Chest x-ray report generation using co-attention mechanism and reinforcement learning. Comput Biol Med 2022; 145:105498. [DOI: 10.1016/j.compbiomed.2022.105498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
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Li W, Stimec J, Camp M, Pusic M, Herman J, Boutis K. Pediatric Musculoskeletal Radiographs: Anatomy and Fractures Prone to Diagnostic Error Among Emergency Physicians. J Emerg Med 2022; 62:524-533. [PMID: 35282940 DOI: 10.1016/j.jemermed.2021.12.021] [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: 10/22/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pediatric musculoskeletal (pMSK) radiograph interpretations are common, but the specific radiograph features at risk of incorrect diagnosis are relatively unknown. OBJECTIVE We determined the radiograph factors that resulted in diagnostic interpretation challenges for emergency physicians (EPs) reviewing pMSK radiographs. METHODS EPs interpreted 1850 pMSK radiographs via a web-based platform and we derived interpretation difficulty scores for each radiograph in 13 body regions using one-parameter item response theory. We compared the difficulty scores by presence or absence of a fracture and, where applicable, by fracture location and morphology; significance was adjusted for multiple comparisons. An expert panel reviewed the 65 most commonly misdiagnosed fracture-negative radiographs to identify imaging features mistaken for fractures. RESULTS We included data from 244 EPs, which resulted in 185,653 unique interpretations. For elbow, forearm, wrist, femur, knee, and tibia-fibula radiographs, those without a fracture had higher interpretation difficulty scores relative to those with a fracture; the opposite was true for the hand, pelvis, foot, and ankle radiographs (p < 0.004 for all comparisons). The descriptive review demonstrated that specific normal anatomy, overlapping bones, and external artefact from muscle or skin folds were often mistaken for fractures. There was a significant difference in difficulty score by anatomic locations of the fracture in the elbow, pelvis, and ankle (p < 0.004 for all comparisons). Ankle and elbow growth plate, fibular avulsion, and humerus condylar fractures were more difficult to diagnose than other fracture patterns (p < 0.004 for all comparisons). CONCLUSIONS We identified actionable learning opportunities in pMSK radiograph interpretation for EPs.
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Affiliation(s)
- Winny Li
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Stimec
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark Camp
- Division of Orthopedic Surgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Martin Pusic
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Joshua Herman
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Kathy Boutis
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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10
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Kim JH, Han SG, Cho A, Shin HJ, Baek SE. Effect of deep learning-based assistive technology use on chest radiograph interpretation by emergency department physicians: a prospective interventional simulation-based study. BMC Med Inform Decis Mak 2021; 21:311. [PMID: 34749731 PMCID: PMC8573755 DOI: 10.1186/s12911-021-01679-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/01/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Interpretation of chest radiographs (CRs) by emergency department (ED) physicians is inferior to that by radiologists. Recent studies have investigated the effect of deep learning-based assistive technology on CR interpretation (DLCR), although its relevance to ED physicians remains unclear. This study aimed to investigate whether DLCR supports CR interpretation and the clinical decision-making of ED physicians. METHODS We conducted a prospective interventional study using a web-based performance assessment system. Study participants were recruited through the official notice targeting board for certified emergency physicians and residents working at the present ED. Of the eight ED physicians who volunteered to participate in the study, seven ED physicians were included, while one participant declared withdrawal during performance assessment. Seven physicians' CR interpretations and clinical decision-making were assessed based on the clinical data from 388 patients, including detecting the target lesion with DLCR. Participant performance was evaluated by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy analyses; decision-making consistency was measured by kappa statistics. ED physicians with < 24 months of experience were defined as 'inexperienced'. RESULTS Among the 388 simulated cases, 259 (66.8%) had CR abnormality. Their median value of abnormality score measured by DLCR was 59.3 (31.77, 76.25) compared to a score of 3.35 (1.57, 8.89) for cases of normal CR. There was a difference in performance between ED physicians working with and without DLCR (AUROC: 0.801, P < 0.001). The diagnostic sensitivity and accuracy of CR were higher for all ED physicians working with DLCR than for those working without it. The overall kappa value for decision-making consistency was 0.902 (95% confidence interval [CI] 0.884-0.920); concurrently, the kappa value for the experienced group was 0.956 (95% CI 0.934-0.979), and that for the inexperienced group was 0.862 (95% CI 0.835-0.889). CONCLUSIONS This study presents preliminary evidence that ED physicians using DLCR in a clinical setting perform better at CR interpretation than their counterparts who do not use this technology. DLCR use influenced the clinical decision-making of inexperienced physicians more strongly than that of experienced physicians. These findings require prospective validation before DLCR can be recommended for use in routine clinical practice.
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Affiliation(s)
- Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Preventive Medicine , Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Sang Gil Han
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Ara Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hye Jung Shin
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Song-Ee Baek
- Department of Radiology, Division of Emergency Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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11
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Fernández-Miranda PM, Bellón PS, Del Barrio AP, Iglesias LL, García PS, Aguilar-Gómez F, González DR, Vega JA. Developing a Training Web Application for Improving the COVID-19 Diagnostic Accuracy on Chest X-ray. J Digit Imaging 2021; 34:242-256. [PMID: 33686526 PMCID: PMC7939450 DOI: 10.1007/s10278-021-00424-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/06/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
In December 2019, a new coronavirus known as 2019-nCoV emerged in Wuhan, China. The virus has spread globally and the infection was declared pandemic in March 2020. Although most cases of coronavirus disease 2019 (COVID-19) are mild, some of them rapidly develop acute respiratory distress syndrome. In the clinical management, chest X-rays (CXR) are essential, but the evaluation of COVID-19 CXR could be a challenge. In this context, we developed COVID-19 TRAINING, a free Web application for training on the evaluation of COVID-19 CXR. The application included 196 CXR belonging to three categories: non-pathological, pathological compatible with COVID-19, and pathological non-compatible with COVID-19. On the training screen, images were shown to the users and they chose a diagnosis among those three possibilities. At any time, users could finish the training session and be evaluated through the estimation of their diagnostic accuracy values: sensitivity, specificity, predictive values, and global accuracy. Images were hand-labeled by four thoracic radiologists. Average values for sensitivity, specificity, and global accuracy were .72, .64, and .68. Users who achieved better sensitivity registered less specificity (p < .0001) and those with higher specificity decreased their sensitivity (p < .0001). Users who sent more answers achieved better accuracy (p = .0002). The application COVID-19 TRAINING provides a revolutionary tool to learn the necessary skills to evaluate COVID-19 on CXR. Diagnosis training applications could provide a new original manner of evaluation for medical professionals based on their diagnostic accuracy values, and an efficient method to collect valuable data for research purposes.
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Affiliation(s)
- P Menéndez Fernández-Miranda
- Departamento de Radiología, Hospital Universitario "Marqués de Valdecilla", Santander, Spain. .,Departamento Morfología y Biología Celular, Universidad de Oviedo, Oviedo, Spain.
| | - P Sanz Bellón
- Departamento de Radiología, Hospital Universitario "Marqués de Valdecilla", Santander, Spain.,Departamento Morfología y Biología Celular, Universidad de Oviedo, Oviedo, Spain
| | - A Pérez Del Barrio
- Departamento de Radiología, Hospital Universitario "Marqués de Valdecilla", Santander, Spain.,Departamento Morfología y Biología Celular, Universidad de Oviedo, Oviedo, Spain
| | - L Lloret Iglesias
- Grupo de Computación Avanzada y e-Ciencia, Instituto de Física de Cantabria, (IFCA), Consejo Superior de Investigaciones Científicas (CSIC), Santander, Spain
| | | | - F Aguilar-Gómez
- Grupo de Computación Avanzada y e-Ciencia, Instituto de Física de Cantabria, (IFCA), Consejo Superior de Investigaciones Científicas (CSIC), Santander, Spain
| | - D Rodríguez González
- Grupo de Computación Avanzada y e-Ciencia, Instituto de Física de Cantabria, (IFCA), Consejo Superior de Investigaciones Científicas (CSIC), Santander, Spain
| | - J A Vega
- Departamento de Morfología y Biología Celular, Universidad de Oviedo, Oviedo, Spain. .,Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Santiago, Chile.
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12
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Clinical Validation of a Deep Learning Algorithm for Detection of Pneumonia on Chest Radiographs in Emergency Department Patients with Acute Febrile Respiratory Illness. J Clin Med 2020; 9:jcm9061981. [PMID: 32599874 PMCID: PMC7356293 DOI: 10.3390/jcm9061981] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 01/09/2023] Open
Abstract
Early identification of pneumonia is essential in patients with acute febrile respiratory illness (FRI). We evaluated the performance and added value of a commercial deep learning (DL) algorithm in detecting pneumonia on chest radiographs (CRs) of patients visiting the emergency department (ED) with acute FRI. This single-centre, retrospective study included 377 consecutive patients who visited the ED and the resulting 387 CRs in August 2018-January 2019. The performance of a DL algorithm in detection of pneumonia on CRs was evaluated based on area under the receiver operating characteristics (AUROC) curves, sensitivity, specificity, negative predictive values (NPVs), and positive predictive values (PPVs). Three ED physicians independently reviewed CRs with observer performance test to detect pneumonia, which was re-evaluated with the algorithm eight weeks later. AUROC, sensitivity, and specificity measurements were compared between "DL algorithm" vs. "physicians-only" and between "physicians-only" vs. "physicians aided with the algorithm". Among 377 patients, 83 (22.0%) had pneumonia. AUROC, sensitivity, specificity, PPV, and NPV of the algorithm for detection of pneumonia on CRs were 0.861, 58.3%, 94.4%, 74.2%, and 89.1%, respectively. For the detection of 'visible pneumonia on CR' (60 CRs from 59 patients), AUROC, sensitivity, specificity, PPV, and NPV were 0.940, 81.7%, 94.4%, 74.2%, and 96.3%, respectively. In the observer performance test, the algorithm performed better than the physicians for pneumonia (AUROC, 0.861 vs. 0.788, p = 0.017; specificity, 94.4% vs. 88.7%, p < 0.0001) and visible pneumonia (AUROC, 0.940 vs. 0.871, p = 0.007; sensitivity, 81.7% vs. 73.9%, p = 0.034; specificity, 94.4% vs. 88.7%, p < 0.0001). Detection of pneumonia (sensitivity, 82.2% vs. 53.2%, p = 0.008; specificity, 98.1% vs. 88.7%; p < 0.0001) and 'visible pneumonia' (sensitivity, 82.2% vs. 73.9%, p = 0.014; specificity, 98.1% vs. 88.7%, p < 0.0001) significantly improved when the algorithm was used by the physicians. Mean reading time for the physicians decreased from 165 to 101 min with the assistance of the algorithm. Thus, the DL algorithm showed a better diagnosis of pneumonia, particularly visible pneumonia on CR, and improved diagnosis by ED physicians in patients with acute FRI.
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13
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Messman AM, Malik A, Ehrman R. An Asynchronous Curriculum for Teaching Practical Interpretation Skills of Clinical Images to Residents in Emergency Medicine. J Emerg Med 2020; 58:299-304. [PMID: 32220547 DOI: 10.1016/j.jemermed.2019.11.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/24/2019] [Accepted: 11/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interpretation of radiologic images is a critical skill for resident physicians in emergency medicine (EM), however, few training programs offer formal training in this realm. Time and money also need to be considered when adding to the curriculum of trainees. OBJECTIVE We sought to determine the utilization and benefit of an asynchronous curriculum in the interpretation of diagnostic imaging. METHODS Radiologic images were obtained from emergency department patients and presented to the trainees on a weekly basis from April to December 2017; discussion questions regarding the images were posed, all via the online workplace platform Slack. Trainees were surveyed prior to and 8 months after initiation of the curriculum to ascertain their confidence with radiologic image interpretation and their use of Slack. RESULTS Of the 36 potential resident physician participants in this study, 31 (86%) completed the pre-intervention survey and 28 (78%) completed the post-intervention survey. The curriculum was found to be beneficial to all respondents (100%) and increased their confidence with image interpretation from 2.93 ± 0.89 pre-intervention (5-point Likert scale) to 3.46 ± 0.83 post-intervention (p < 0.02). Seventy-five percent noted that they viewed the material "often" or "anytime new material was posted." CONCLUSIONS Use of an asynchronous curriculum in image interpretation increased the confidence of trainees and was well-utilized. The implications of this are far-reaching, given that a similar intervention could be undertaken for any topic in any specialty in medicine, and with no cost of money or didactic time.
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Affiliation(s)
- Anne M Messman
- Department of Emergency Medicine, Detroit Receiving Hospital/Sinai-Grace Hospital, Wayne State University School of Medicine, Detroit, Michigan
| | - Adrienne Malik
- Department of Emergency Medicine, Detroit Receiving Hospital/Sinai-Grace Hospital, Wayne State University School of Medicine, Detroit, Michigan
| | - Robert Ehrman
- Department of Emergency Medicine, Detroit Receiving Hospital/Sinai-Grace Hospital, Wayne State University School of Medicine, Detroit, Michigan
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14
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Al‐Sani F, Prasad S, Panwar J, Stimec J, Khosroawshahi A, Mizzi T, Camp M, Colaco K, Kramer A, Boutis K. Adverse Events from Emergency Physician Pediatric Extremity Radiograph Interpretations: A Prospective Cohort Study. Acad Emerg Med 2020; 27:128-138. [PMID: 31702075 DOI: 10.1111/acem.13884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We determined how often emergency physician pediatric musculoskeletal (MSK) radiograph interpretations were discordant to that of a radiologist and led to an adverse event (AE). We also established the variables independently associated with this outcome. METHODS This prospective cohort study was conducted in an urban, tertiary care children's emergency department (ED). We enrolled children who presented to an ED with an extremity injury and received radiographs. ED physicians documented their radiograph interpretation, which was compared to a radiology reference standard. Patients received telephone follow-up and had institutional medical records reviewed in 3 weeks. An AE occurred if there were clinical sequelae and/or repeat health care visits due to a delay in correct radiograph interpretation. RESULTS We enrolled 2,302 children (mean [±SD] age = 9.0 [4.4] years; 1,288 (56.0%) male]. Of these, 180 (7.8%; 95% confidence interval = 6.8 to 9.0) ED physician discordant interpretations resulted in an AE. Specifically, there were no negative clinical outcomes; however, relative to cases diagnosed correctly at the index ED, patients whose fracture was not initially identified encountered 77.2% more subsequent ED visits, while those falsely diagnosed with a fracture experienced 41.5% additional orthopedic clinic visits. Odds of an ED discrepant interpretation was significantly higher if a physician's pretest probability of a fracture was ≤ 20% versus> 20% (adjusted odds ratio [aOR] = 1.6), patient's pain score was ≤ 2 versus> 2 (aOR = 1.6), and injury was located in a joint versus other location (aOR = 1.7). CONCLUSIONS Emergency physician discordant pediatric MSK radiograph interpretations that resulted in an AE occurred with regular frequency in a pediatric ED setting. AEs were primarily an increase in subsequent health care visits. Importantly, a low clinical suspicion for a fracture or injury located in the joint were risk factors for ED physician discordant interpretations.
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Affiliation(s)
- Faisal Al‐Sani
- Division of Pediatric Emergency Medicine Department of Pediatrics Royal University Hospital University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Soni Prasad
- Division of Pediatric Emergency Medicine Department of Pediatrics Hospital for Sick Children Toronto Ontario Canada
| | - Jyoti Panwar
- Department of Radiology Christian Medical College and Hospital Vellore Tamil Nadu India
| | - Jennifer Stimec
- Department of Diagnostic Imaging Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Arash Khosroawshahi
- Division of Pediatric Emergency Medicine Department of Pediatrics Hospital for Sick Children Toronto Ontario Canada
| | - Trent Mizzi
- Division of Pediatric Emergency Medicine Department of Pediatrics Hospital for Sick Children Toronto Ontario Canada
| | - Mark Camp
- Division of Orthopedic Surgery Department of Surgery Child Health Evaluative Sciences, Research Institute Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Keith Colaco
- Division of Pediatric Emergency Medicine Department of Pediatrics Hospital for Sick Children Toronto Ontario Canada
| | - Adam Kramer
- Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Kathy Boutis
- Division of Pediatric Emergency Medicine Department of Pediatrics Child Health Evaluative Sciences, Research Institute Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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15
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Abstract
Cancer diagnosis frequently relies on the interpretation of medical images such as chest X-rays and mammography. This process is error prone; misdiagnoses can reach a rate of 15% or higher. Of particular interest are false negatives-tumors that are present but missed. Previous research has identified several perceptual and attentional problems underlying inaccurate perception of these images. But how might these problems be reduced? The psychological literature has shown that presenting multiple, duplicate images can improve performance. Here we explored whether redundant image presentation can improve target detection in simulated X-ray images, by presenting four identical or similar images concurrently. Displays with redundant images, including duplicates of the same image, showed reduced false-negative rates, compared with displays with a single image. This effect held both when the target's prevalence rate was high and when it was low. Eye tracking showed that fixating on two or more images in the redundant condition speeded target detection and prolonged search, and that the latter effect was the key to reducing false negatives. The redundancy gain may result from both perceptual enhancement and an increase in the search quitting threshold.
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16
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Hwang EJ, Nam JG, Lim WH, Park SJ, Jeong YS, Kang JH, Hong EK, Kim TM, Goo JM, Park S, Kim KH, Park CM. Deep Learning for Chest Radiograph Diagnosis in the Emergency Department. Radiology 2019; 293:573-580. [DOI: 10.1148/radiol.2019191225] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Eui Jin Hwang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ju Gang Nam
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Woo Hyeon Lim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Sae Jin Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Yun Soo Jeong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ji Hee Kang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Eun Kyoung Hong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Taek Min Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Jin Mo Goo
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Sunggyun Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ki Hwan Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
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Radiology residents’ skill level in chest x-ray reading. Diagn Interv Imaging 2018; 99:361-370. [DOI: 10.1016/j.diii.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/26/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
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National Trends in the Utilization of Skeletal Radiography From 2003 to 2015. J Am Coll Radiol 2018; 15:1408-1414. [PMID: 29580717 DOI: 10.1016/j.jacr.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/23/2017] [Accepted: 10/03/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Examine recent trends in the use of skeletal radiography and assess the roles of various nonradiologic specialties in the interpretations. METHODS Medicare Part B fee-for-service claims data files from 2003 to 2015 were analyzed for all Current Procedural Terminology, version 4 (CPT-4) procedure codes related to skeletal radiography. The files provide examination volume, and we calculated utilization rates per 1,000 Medicare beneficiaries. Medicare's physician specialty codes were used to determine the specialties of the providers. Total utilization rate trends were analyzed, as well as those for radiologists and nonradiologists. We determined which nonradiologist specialties were the highest users of skeletal radiography. Medicare place-of-service codes were used to identify the locations where the services were provided. RESULTS The total utilization rate per 1,000 of skeletal radiography within the Medicare population increased 9.5% from 2003 to 2015. The utilization rate for radiologists increased 5.5% from 2003 to 2015 versus 11.1% for nonradiologists as a group. Among nonradiologist specialties in all health care settings over the study period, orthopedic surgeons increased 10.6%, chiropractors and podiatrists together increased 14.4%, nonphysician providers (primarily nurse practitioners and physician assistants) increased 441%, and primary care physicians' rate decreased 33.5%. Although radiologists do almost all skeletal radiography interpretation in hospital settings, nonradiologists do the majority in private offices. There has been strong growth in skeletal radiography in emergency departments, but a substantial drop in inpatient settings. CONCLUSIONS The utilization of skeletal radiography has increased more rapidly among nonradiologists than among radiologists. This raises concerns about self-referral and quality.
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19
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Urbaneja A, Dodin G, Hossu G, Bakour O, Kechidi R, Gondim Teixeira P, Blum A. Added Value of Bone Subtraction in Dual-energy Digital Radiography in the Detection of Pneumothorax: Impact of Reader Expertise and Medical Specialty. Acad Radiol 2018; 25:82-87. [PMID: 28800950 DOI: 10.1016/j.acra.2017.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to determine the value of dual-energy thoracic radiography in the diagnosis of pneumothorax considering the reader's experience. MATERIALS AND METHODS Forty patients with a suspected pneumothorax, imaged with dual-energy chest radiographs, were divided into two groups: those with pneumothorax as the final diagnosis (n = 19) and those without (n = 21). The images were analyzed by 36 readers (5 interns, 16 residents, 15 senior physicians) for the presence or absence of pneumothorax during three readout sessions at 2-week intervals: standard images alone (session 1), dual-energy images with bone subtraction alone (session 2), and a combination of the two (session 3). RESULTS The number of correct responses increased 13.3% between sessions 1 and 2 (P < .001) and 9.4% between sessions 1 and 3 (P < .001). The mean sensitivity for pneumothorax detection was higher in sessions 2 (82%) and 3 (79%) compared to session 1 (70%). There was no statistically significant difference in specificity between the sessions. The number of correct responses for small volume pneumothoraces was higher in sessions 2 (10.6 ± 1.8) and 3 (10.1 ± 2.0) than in session 1 (8.9 ± 2.3), with a statistically significant difference between sessions 1 and 2 (P = .002) and between sessions 1 and 3 (P = .048). CONCLUSION Bone subtracted dual-energy thoracic radiographs improve the detection sensitivity of pneumothorax, including in cases of small pneumothoraces, regardless of the reader's level or expertise.
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Affiliation(s)
- Ayla Urbaneja
- Radiology and Imaging Department Guilloz, 29 Ave du Maréchal de Lattre de Tassigny, 54000 Nancy, France.
| | - Gauthier Dodin
- Radiology and Imaging Department Guilloz, 29 Ave du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Gabriela Hossu
- Radiology and Imaging Department Guilloz, 29 Ave du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Omar Bakour
- Radiology and Imaging Department Guilloz, 29 Ave du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Rachid Kechidi
- Radiology and Imaging Department Guilloz, 29 Ave du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Pedro Gondim Teixeira
- Radiology and Imaging Department Guilloz, 29 Ave du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Alain Blum
- Radiology and Imaging Department Guilloz, 29 Ave du Maréchal de Lattre de Tassigny, 54000 Nancy, France
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Zwaan L, Kok EM, van der Gijp A. Radiology education: a radiology curriculum for all medical students? Diagnosis (Berl) 2017. [DOI: 10.1515/dx-2017-0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Diagnostic errors in radiology are frequent and can cause severe patient harm. Despite large performance differences between radiologists and non-radiology physicians, the latter often interpret medical images because electronic health records make images available throughout the hospital. Some people argue that non-radiologists should not diagnose medical images at all, and that medical school should focus on teaching ordering skills instead of image interpretation skills. We agree that teaching ordering skills is crucial as most physicians will need to order medical images in their professional life. However, we argue that the availability of medical images is so ubiquitous that it is important that non-radiologists are also trained in the basics of medical image interpretation and, additionally in recognizing when radiological consultancy should be sought. In acute situations, basic image interpretations skills can be life-saving. We plead for a radiology curriculum for all medical students. This should include the interpretation of common abnormalities on chest and skeletal radiographs and a basic distinction of normal from abnormal images. Furthermore, substantial attention should be given to the correct ordering of radiological images. Finally, it is critical that students are trained in deciding when to consult a radiologist.
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Binay S, Arbak P, Safak AA, Balbay EG, Bilgin C, Karatas N. Does periodic lung screening of films meets standards? Pak J Med Sci 2017; 32:1506-1511. [PMID: 28083054 PMCID: PMC5216310 DOI: 10.12669/pjms.326.11267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To determine whether the workers’ periodic chest x-ray screening techniques in accordance with the quality standards is the responsibility of physicians. Evaluation of differences of interpretations by physicians in different levels of education and the importance of standardization of interpretation. Methods: Previously taken chest radiographs of 400 workers who are working in a factory producing the glass run channels were evaluated according to technical and quality standards by three observers (pulmonologist, radiologist, pulmonologist assistant). There was a perfect concordance between radiologist and pulmonologist for the underpenetrated films. Whereas there was perfect concordance between pulmonologist and pulmonologist assistant for over penetrated films. Results: Pulmonologist (52%) has interpreted the dose of the films as regular more than other observers (radiologist; 44.3%, pulmonologist assistant; 30.4%). The frequency of interpretation of the films as taken in inspiratory phase by the pulmonologist (81.7%) was less than other observers (radiologist; 92.1%, pulmonologist assistant; 92.6%). The rate of the pulmonologist (53.5%) was higher than the other observers (radiologist; 44.6%, pulmonologist assistant; 41.8%) for the assessment of the positioning of the patients as symmetrical. Pulmonologist assistant (15.3%) was the one who most commonly reported the parenchymal findings (radiologist; 2.2%, pulmonologist; 12.9%). Conclusion: It is necessary to reorganize the technical standards and exposure procedures for improving the quality of the chest radiographs. The reappraisal of all interpreters and continuous training of technicians is required.
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Affiliation(s)
- Songul Binay
- Dr. Songul Binay, MD. Department of Chest Diseases, Yildirim Beyazit University, Medical School, Ankara, Turkey
| | - Peri Arbak
- Prof. Dr. Peri Arbak, MD. Department of Chest Diseases, Duzce University, Medical School, Duzce, Turkey
| | - Alp Alper Safak
- Prof. Dr. Alp Alper Safak, MD. Department of Radiology, Duzce University, Medical School, Duzce, Turkey
| | - Ege Gulec Balbay
- Dr. Ege Gulec Balbay, MD. Associate Professor, Department of Chest Diseases, Duzce University, Medical School, Duzce, Turkey
| | - Cahit Bilgin
- Dr. Cahit Bilgin, MD. Assistant Professor, Department of Chest Diseases, Sakarya University, Medical School, Sakarya, Turkey
| | - Naciye Karatas
- Dr. Naciye Karatas, MD. Department of Chest Diseases, Antakya Goverment Hospital, Hatay, Turkey
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Moffett BK, Panchabhai TS, Nakamatsu R, Arnold FW, Peyrani P, Wiemken T, Guardiola J, Ramirez JA. Comparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions. Am J Emerg Med 2016; 34:2402-2407. [PMID: 27793503 DOI: 10.1016/j.ajem.2016.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND It is unclear whether anteroposterior (AP) or posteroanterior with lateral (PA/Lat) chest radiographs are superior in the early detection of clinically relevant parapneumonic effusions (CR-PPEs). The objective of this study was to identify which technique is preferred for detection of PPEs using chest computed tomography (CCT) as a reference standard. METHODS A secondary analysis of a pneumonia database was conducted to identify patients who received a CCT within 24 hours of presentation and also received AP or PA/Lat chest radiographs within 24 hours of CCT. Sensitivity and specificity were then calculated by comparing the radiographic diagnosis of PPEs of both types of radiographs compared with CCT by using the existing attending radiologist interpretation. Clinical relevance of effusions was determined by CCT effusion measurement of >2.5 cm or presence of loculation. RESULTS There was a statistically significant difference between the sensitivity of AP (67.3%) and PA/Lat (83.9%) chest radiography for the initial detection of CR-PPE. Of 16 CR-PPEs initially missed by AP radiography, 7 either required drainage initially or developed empyema within 30 days, whereas no complicated PPE or empyema was found in those missed by PA/Lat radiography. CONCLUSIONS PA/Lat chest radiography should be the initial imaging of choice in pneumonia patients for detection of PPEs because it appears to be statistically superior to AP chest radiography.
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Affiliation(s)
- Bryan K Moffett
- Robley Rex Veterans Administration Medical Center, Louisville, KY; University of Louisville, School of Medicine, Department of Medicine, Division of General Internal Medicine, Palliative Care and Medical Education, Louisville, KY.
| | - Tanmay S Panchabhai
- Robley Rex Veterans Administration Medical Center, Louisville, KY; Cleveland Clinic Foundation, Respiratory Institute. Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland, OH.
| | - Raul Nakamatsu
- Robley Rex Veterans Administration Medical Center, Louisville, KY; University of Louisville, School of Medicine, Department of Medicine, Division of Infectious Diseases, Louisville, KY.
| | - Forest W Arnold
- Robley Rex Veterans Administration Medical Center, Louisville, KY; University of Louisville, School of Medicine, Department of Medicine, Division of Infectious Diseases, Louisville, KY.
| | - Paula Peyrani
- Robley Rex Veterans Administration Medical Center, Louisville, KY; University of Louisville, School of Medicine, Department of Medicine, Division of Infectious Diseases, Louisville, KY.
| | - Timothy Wiemken
- University of Louisville, School of Medicine, Department of Medicine, Division of Infectious Diseases, Louisville, KY.
| | - Juan Guardiola
- Robley Rex Veterans Administration Medical Center, Louisville, KY; University of Louisville, School of Medicine, Department of Medicine, Division of Pulmonary Critical Care and Sleep Disorders Medicine, Louisville, KY.
| | - Julio A Ramirez
- Robley Rex Veterans Administration Medical Center, Louisville, KY; University of Louisville, School of Medicine, Department of Medicine, Division of Infectious Diseases, Louisville, KY.
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Assaf D, Amar E, Marwan N, Neuman Y, Salai M, Rath E. Dynamic Patterns of Expertise: The Case of Orthopedic Medical Diagnosis. PLoS One 2016; 11:e0158820. [PMID: 27414794 PMCID: PMC4945032 DOI: 10.1371/journal.pone.0158820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/22/2016] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts’ process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts’ scanning is simultaneously both structured (i.e. deterministic) and unpredictable.
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Affiliation(s)
- Dan Assaf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Orthopedics Division, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Norbert Marwan
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Yair Neuman
- Department of Education, Homeland Security Institute, Center for the Study of Conversion and Inter-Religious Encounters, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moshe Salai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Orthopedics Division, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Ehud Rath
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Orthopedics Division, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
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Gan G, Harkey P, Hemingway J, Hughes DR, Duszak R. Changing Utilization Patterns of Cervical Spine Imaging in the Emergency Department: Perspectives From Two Decades of National Medicare Claims. J Am Coll Radiol 2016; 13:644-8. [DOI: 10.1016/j.jacr.2016.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/04/2016] [Indexed: 11/30/2022]
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Kwon JM, Kim J, Kim K, Kim T, Jo YH, Lee JH, Lee JH, Kim YJ, Jung JY. Can emergency physicians reliably interpret cardiac CT images? A prospective observational study. Clin Exp Emerg Med 2015; 2:38-43. [PMID: 27752571 PMCID: PMC5052854 DOI: 10.15441/ceem.14.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Cardiac computed tomography (CCT) is useful for evaluation of acute chest pain in the emergency department (ED). Though the test needs proper interpretation by someone with expertise in cardiovascular imaging, the critical nature of the information the test provides frequently lead emergency physicians (EPs) to act on their own interpretation. We performed this study to assess how often EPs' interpretations are in agreement with radiologists'. METHODS This study is a prospective observational study. The target population was patients assessed with CCT for acute chest pain or discomfort. EPs with at least one year CCT experience underwent a one-hour training session before study participation. The most significant lesion, if any, in each arterial segment was assessed for coronary stenosis and plaque calcification. The agreement between EPs' and radiologists' interpretation was assessed with Cohen's kappa and Gwet's AC1. RESULTS One hundred and three patients were enrolled and 412 segments were analyzed. Stenosis grading was identical in 363 segments (88.1%) and the interrater agreement was good (kappa=0.6439, AC1=0.8810). Similarly, the plaque calcification grading was identical in 354 segments (86.6%) and the kappa and AC1 values were 0.5660 and 0.8501, respectively. EPs classified 6 of the 17 arterial segments with significant stenosis reported by radiologists as non-significant stenosis (n=5) or clear (n=2), all of which were proved to be significant by following subsequent invasive coronary angiography. CONCLUSION There was substantial discordance of CCT interpretation between EPs and radiologists. For now, EPs need more education prior to independent CCT reading.
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Affiliation(s)
- Joon-Myoung Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeyun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Safari S, Baratloo A, Negida AS, Sanei Taheri M, Hashemi B, Hosseini Selkisari S. Comparing the interpretation of traumatic chest x-ray by emergency medicine specialists and radiologists. ARCHIVES OF TRAUMA RESEARCH 2014; 3:e22189. [PMID: 25738133 PMCID: PMC4329230 DOI: 10.5812/atr.22189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 08/08/2014] [Accepted: 09/22/2014] [Indexed: 11/16/2022]
Abstract
Background: Discrepancy between X-ray readings of emergency physicians (EPs) versus radiologists was reported between 0.95% and 16.8% in different studies. The discordance was even higher when specific studies such as chest X-rays (CXR) were probed. Objectives: This prospective study was conducted to assess the discrepancies between emergency and radiology departments with respect to interpretation of the traumatic chest X-rays. Patients and Methods: This prospective study was conducted in Shohadaye Tajrish Hospital, Tehran, Iran, from March to April 2014. Based on Advanced Trauma Life Support (ATLS) guidelines, plain chest radiography (CXR) was ordered for all patients in two standard views of posterior-anterior and lateral. All CXRs were interpreted by a corresponding emergency medicine specialist and a radiologist blind to the clinical findings of the patients. Finally, the results of two interpretations were compared. Accuracy, sensitivity, specificity, and predictive values of traumatic CXR interpretation were calculated by EPs with 95% of confidence interval (CI). Results: The evaluation of EPs was identical to that of the radiologists in 89.5% of the cases. Ninety-eight percent (98%) indicated total agreement and 1.5 percent total disagreement. Conclusions: There is a high agreement between EPs and radiologists in CXR interpretations in Shohadaye Tajrish Hospital. Thus, EPs can substitute radiologists in the emergency department. More improvements are recommended to achieve the standard level of agreement.
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Affiliation(s)
- Saeed Safari
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Alireza Baratloo
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Alireza Baratloo, Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9122884364, Fax: +98-2122721155, E-mail:
| | - Ahmed Said Negida
- Faculty of Medicine, Zagazig University of Medical Sciences, Zagazig, Egypt
| | - Morteza Sanei Taheri
- Department of Radiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Behrooz Hashemi
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Woznitza N, Piper K, Rowe S, West C. Optimizing patient care in radiology through team-working: A case study from the United Kingdom. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2014.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Woznitza N, Piper K, Burke S, Patel K, Amin S, Grayson K, Bothamley G. Adult chest radiograph reporting by radiographers: Preliminary data from an in-house audit programme. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2014.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Tappenden R, Hegarty J, Broughton R, Butler A, Coope I, Renaud P. X-ray image enhancement via determinant based feature selection. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2013; 36:449-55. [PMID: 24104449 DOI: 10.1007/s13246-013-0221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
Previous work has investigated the feasibility of using Eigenimage-based enhancement tools to highlight abnormalities on chest X-rays (Butler et al in J Med Imaging Radiat Oncol 52:244-253, 2008). While promising, this approach has been limited by computational restrictions of standard clinical workstations, and uncertainty regarding what constitutes an adequate sample size. This paper suggests an alternative mathematical model to the above referenced singular value decomposition method, which can significantly reduce both the required sample size and the time needed to perform analysis. Using this approach images can be efficiently separated into normal and abnormal parts, with the potential for rapid highlighting of pathology.
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Affiliation(s)
- R Tappenden
- School of Mathematics, The University of Edinburgh, Mayfield Road, Edinburgh, EH9 3JZ, Scotland, UK
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Arhami Dolatabadi A, Baratloo A, Rouhipour A, Abdalvand A, Hatamabadi H, Forouzanfar M, Shojaee M, Hashemi B. Interpretation of Computed Tomography of the Head: Emergency Physicians versus Radiologists. Trauma Mon 2013; 18:86-9. [PMID: 24350159 PMCID: PMC3860675 DOI: 10.5812/traumamon.12023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 05/29/2013] [Accepted: 06/13/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many patients are brought to crowded emergency departments (ED) of hospitals every day for evaluation of head injuries, headaches, neurologic deficits etc. CT scan of the head is the most common diagnostic measure used to search for pathologies. In many EDs the initial interpretation of images are performed by emergency physicians (EP). Since most decisions are made based on the initial interpretation of the images by emergency physicians and not the radiologists, it is necessary to assess the accuracy of interpretations made by the former group. OBJECTIVES The objective of this study was to compare the findings reported in the interpretation of head CTs by emergency physicians and compare to radiologists (the gold standard). MATERIALS AND METHODS This was a prospective cross sectional study conducted from March to May 2009 in a teaching hospital in Tehran, Iran. All non-contrast head CTs obtained during the study period were copied on DVDs and sent separately to a radiologist, 6 emergency medicine (EM) attending physicians and 14 senior EM residents for interpretation. Clinical information pertaining to each patient was also sent with each CT. The radiologist's interpretation was considered as the gold standard and reference for comparison. Data from EM physicians and residents were compared with the reference as well as with each other and statistical analysis was performed using SPSS 18.5. RESULTS Out of 544 CT scans, EM physicians had 35 false negatives and 53 false positives compared with radiologist's interpretations (P < 0.0001). EM residents had 74 false negatives and 12 false positives compared with radiologist's interpretations (P < 0.0001). CONCLUSIONS Both EPs and ER residents either missed or falsely called a significant number of pathologies in their interpretations. The interpretations of EPs and ER residents were more sensitive and more specific, respectively. These findings revealed the need for increased training time in head CT reading for residents and the necessity of attending continuing medical education workshops for emergency physicians.
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Affiliation(s)
- Ali Arhami Dolatabadi
- Department of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Alireza Baratloo
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Alireza Baratloo, Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2122718000, Fax: +98-2122721155, E-mail:
| | - Alaleh Rouhipour
- Department of Pediatrics, Valiasr Hospital, Ghazvin University of Medical Sciences, Abyek, IR Iran
| | - Ali Abdalvand
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Hamidreza Hatamabadi
- Department of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammadmehdi Forouzanfar
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Majid Shojaee
- Department of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Behrooz Hashemi
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Friedman SM, Merman E, Chopra A. Clinical impact of diagnostic imaging discrepancy by radiology trainees in an urban teaching hospital emergency department. Int J Emerg Med 2013; 6:24. [PMID: 23866048 PMCID: PMC3716958 DOI: 10.1186/1865-1380-6-24] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To characterize clinically significant diagnostic imaging (DI) discrepancies by radiology trainees and the impact on emergency department (ED) patients. METHODS Consecutive case series methodology over a 6-month period in an urban, tertiary care teaching hospital. Emergency physicians (EPs) were recruited to flag discrepant DI interpretations by radiology trainees that the EP deemed clinically significant. Cases were characterized using chart review and EP interview. RESULTS Twenty-eight discrepant reports were identified (representing 0.1% of 18,185 images interpreted). The mean time between provisional discrepant diagnosis (PDDx) and revised diagnosis (RDx) by attending radiology staff was 8.6 h (median 4.8 h, range 1.1-48.4), and 67.9% (n = 19) of the patients had left the ED by time of notification. The most frequently reported PDDx was CT abd/pelvis (32.1%, n = 9) and CT head (28.6%, n = 8). The impact of RDx was deemed major in 57.1% (n = 16) for reasons including altered admitting status (32.1%, n = 9), immediate subspecialty referral (n = 16, 57.1%), impact on management (25%, n = 7), and surgical management (21.4%, n = 6). EPs reported likely perceived impact of PDDx as resulting in increased pain (17. 9%, n = 5), morbidity (10.7%, n = 3), and prolonged hospitalization (25%, n = 7), but not altered long-term outcome or mortality. CONCLUSIONS Relatively few clinically important discrepant reads were reported. Revised diagnosis (RDx) was associated with major clinical impact in 57.1% of reports, but few patients experienced increased morbidity, and none increased mortality. The importance of expedient communication of discrepant reports by staff radiologists is stressed, as is EP verification of patient contact information prior to discharge.
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Affiliation(s)
- Steven Marc Friedman
- Emergency Medicine - University Health Network, Faculty of Medicine, University of Toronto, RFE G-S434, 200 Elzaibeth Street, Toronto, Ontario M5G 2C4, Canada.
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Valdés Solís P, Morales Santos Á, González Álvarez I, Martínez Serrano C. El informe de la radiología simple. Algo más que un imperativo legal. RADIOLOGIA 2013; 55:279-82. [DOI: 10.1016/j.rx.2013.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 03/10/2013] [Accepted: 03/23/2013] [Indexed: 12/01/2022]
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Abstract
Turf issues in medicine affect policy, practice, and, most importantly, patients. This article explores turf issues from several perspectives. The issue and scope of the problem is first discussed, followed by a brief history of turf delineation. Contributing and connected factors are considered, taking into account some consequences of turf battles and their impact on related topics. Finally, this article focuses on proposed strategies to successfully confront the questions, if not overcome the problems encountered. To better inform the deliberation and strengthen the credibility of any conclusions, the evidence and controversies must be regarded from beyond merely the radiology perspective.
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Affiliation(s)
- Jacqueline Bello
- Department of Radiology, Montefiore Medical Center, Bronx, NY 10467-2490, USA.
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Durand DJ, Carrino JA, Fayad LM, Huisman TAGM, El-Sharkawy AMM, Edelstein WA. MRI pyschophysics: an experimental framework relating image quality to diagnostic performance metrics. J Magn Reson Imaging 2012; 37:1402-8. [PMID: 23172743 DOI: 10.1002/jmri.23922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/27/2012] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the minimal image quality needed to preserve diagnostic performance relative to arthroscopy in the knee. MATERIALS AND METHODS Synthetic noise was added to images from clinical MRI scans (three-dimensional SPACE pulse sequence; Siemens) from five patients who had undergone knee MRI with arthroscopic follow-up, resulting in 25 simulated sets of images with standardized signal-to-noise ratios (SNRs) of 1, 2, 5, 10, or 20. All cases were scored by four musculoskeletal radiologists progressing from low to high SNR and grading all cartilage surfaces, major ligaments and menisci on a 5-point scale. Receiver operator characteristic (ROC) curves were constructed for the detection of meniscal tears and cartilage abnormalities. The area under the ROC curve (AUC) was determined for each structure at each SNR level. In addition, reader confidence was measured and pairwise comparisons across SNR levels were performed. Results were compared with arthroscopy as the reference standard. RESULTS ROC AUC was maximized for meniscal tears at SNR = 5 (structure specific CNR = 3.2) and for cartilage abnormalities at SNR = 10 (CNR = 4.2). Observer confidence was maximized for menisci at SNR = 5 (CNR = 8.0), for ligaments at SNR = 10 (CNR = 13.6) and cartilage at SNR = 10 (CNR = 8.2). CONCLUSION For 3D isotropic imaging in the knee, images with SNR < 10 or CNR < 10 should be rejected as nondiagnostic.
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Affiliation(s)
- Daniel J Durand
- Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Cardinale L, Volpicelli G, Lamorte A, Martino J. Revisiting signs, strengths and weaknesses of Standard Chest Radiography in patients of Acute Dyspnea in the Emergency Department. J Thorac Dis 2012; 4:398-407. [PMID: 22934143 PMCID: PMC3426742 DOI: 10.3978/j.issn.2072-1439.2012.05.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 05/12/2012] [Indexed: 11/14/2022]
Abstract
Dyspnoea, defined as an uncomfortable awareness of breathing, together with thoracic pain are two of the most frequent symptoms of presentation of thoracic diseases in the Emergency Department (ED). Causes of dyspnoea are various and involve not only cardiovascular and respiratory systems. In the emergency setting, thoracic imaging by standard chest X-ray (CXR) plays a crucial role in the diagnostic process, because it is of fast execution and relatively not expensive. Although radiologists are responsible for the final reading of chest radiographs, very often the clinicians, and in particular the emergency physicians, are alone in the emergency room facing this task. In literature many studies have demonstrated how important and essential is an accurate direct interpretation by the clinician without the need of an immediate reading by the radiologist. Moreover, the sensitivity of CXR is much impaired when the study is performed at bedside by portable machines, particularly in the diagnosis of some important causes of acute dyspnoea, such as pulmonary embolism, pneumothorax, and pulmonary edema. In these cases, a high inter-observer variability of bedside CXR reading limits the diagnostic usefulness of the methodology and complicates the differential diagnosis. The aim of this review is to analyze the radiologic signs and the correct use of CXR in the most important conditions that cause cardiac and pulmonary dyspnoea, as acute exacerbation of chronic obstructive pulmonary disease, acute pulmonary oedema, acute pulmonary trombo-embolism, pneumothorax and pleural effusion, and to focus indications and limitations of this diagnostic tool.
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Affiliation(s)
- Luciano Cardinale
- Istitute of Radiology, San Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
| | - Alessandro Lamorte
- Department of Emergency Medicine, San Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
| | - Jessica Martino
- Istitute of Radiology, San Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
| | - Andrea Veltri
- Istitute of Radiology, San Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
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Wallace D, Hussain A, Khan N, Wilson Y. A systematic review of the evidence for telemedicine in burn care: With a UK perspective. Burns 2012; 38:465-80. [DOI: 10.1016/j.burns.2011.09.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/18/2011] [Accepted: 09/21/2011] [Indexed: 01/18/2023]
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Comparison between different cost devices for digital capture of X-ray films: an image characteristics detection approach. J Digit Imaging 2012; 25:91-100. [PMID: 21614654 DOI: 10.1007/s10278-011-9391-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A common teleradiology practice is digitizing films. The costs of specialized digitizers are very high, that is why there is a trend to use conventional scanners and digital cameras. Statistical clinical studies are required to determine the accuracy of these devices, which are very difficult to carry out. The purpose of this study was to compare three capture devices in terms of their capacity to detect several image characteristics. Spatial resolution, contrast, gray levels, and geometric deformation were compared for a specialized digitizer ICR (US$ 15,000), a conventional scanner UMAX (US$ 1,800), and a digital camera LUMIX (US$ 450, but require an additional support system and a light box for about US$ 400). Test patterns printed in films were used. The results detected gray levels lower than real values for all three devices; acceptable contrast and low geometric deformation with three devices. All three devices are appropriate solutions, but a digital camera requires more operator training and more settings.
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A study to determine the added value of 740 screening panoramic radiographs compared to intraoral radiography in the management of adult (>18 years) dentate patients in a primary care setting. J Dent 2012; 40:661-9. [PMID: 22542499 DOI: 10.1016/j.jdent.2012.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 04/18/2012] [Accepted: 04/19/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To measure the added value of panoramic radiography in new dentate patients attending for routine treatment. METHODS Thirty-seven general dental practitioners using panoramic radiographs routinely were recruited. Twenty dentate patients were identified prospectively by each participating dentist if they were new to the practice, attending for an examination and requesting any treatment deemed necessary. A panoramic radiograph was taken with appropriate intraoral radiographs in line with national guidelines. Each dentist completed a radiological report for the panoramic radiograph only and these 20 reports were forwarded to the researchers along with the 20 panoramic radiographs, their accompanying bitewing and periapical radiographs and twenty completed clinical assessment sheets. RESULTS 740 panoramic, 1418 bitewing and 325 periapical radiographs were assessed by the researchers. Only 32 panoramic films provided any additional diagnostic value when compared to intraoral films when guidelines had been observed resulting from the poor technical and processing quality of the accompanying intraoral films. Assessment of the number of caries and periapical lesions and the degree of periodontal bone loss from the intraoral films provided a greater diagnostic yield at the p<0.001 level of significance. The research found that dentists underestimated the number of caries lesions present and level of periodontal bone loss when compared to the researchers but overestimated the presence of periapical pathology, at the level of significance at p<0.001. CONCLUSIONS The study found that there was no support for the use of panoramic radiographs in routine screening as there was no net diagnostic benefit to the patient.
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Hurlen P. Teleradiologi - muligheter og utfordringer. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:2622-4. [DOI: 10.4045/tidsskr.12.0876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Reading and interpretation of chest X-ray in adults with community-acquired pneumonia. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70248-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Babiarz LS, Yousem DM. Quality control in neuroradiology: discrepancies in image interpretation among academic neuroradiologists. AJNR Am J Neuroradiol 2011; 33:37-42. [PMID: 22033725 DOI: 10.3174/ajnr.a2704] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prior studies have found a 3%-6% clinically significant error rate in radiology practice. We set out to assess discrepancy rates between subspecialty-trained university-based neuroradiologists. Over 17 months, university neuroradiologists randomly reviewed 1000 studies and reports of previously read examinations of patients in whom follow-up studies were read. The discrepancies between the original and "second opinion" reports were scored according to a 5-point scale: 1, no change; 2, clinically insignificant detection discrepancy; 3, clinically insignificant interpretation discrepancy; 4, clinically significant detection discrepancy; and 5, clinically significant interpretation discrepancy. Of the 1000 studies, 876 (87.6%) showed agreements with the original report. The neuroradiology division had a 2.0% (20/1000; 95% CI, 1.1%-2.9%) rate of clinically significant discrepancies involving 8 CTs and 12 MR images. Discrepancies were classified as vascular (n = 7), neoplastic (n = 9), congenital (n = 2), and artifacts (n = 2). Individual neuroradiologist's scores ranged from 0% to 7.7% ± 2.3% (n = 18). Both CT and MR imaging studies had a discrepancy rate of 2.0%. Our quality assessment study could serve as initial data before intervention as part of a PQI project.
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Affiliation(s)
- L S Babiarz
- Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Zwingenberger AL, Bouma JL, Saunders HM, Nodine CF. Expert interpretation compensates for reduced image quality of camera-digitized images referred to radiologists. Vet Radiol Ultrasound 2011; 52:591-5. [PMID: 21831251 DOI: 10.1111/j.1740-8261.2011.01836.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We compared the accuracy of five veterinary radiologists when reading 20 radiographic cases on both analog film and in camera-digitized format. In addition, we compared the ability of five veterinary radiologists vs. 10 private practice veterinarians to interpret the analog images. Interpretation accuracy was compared using receiver operating characteristic curve analysis. Veterinary radiologists' accuracy did not significantly differ between analog vs. camera-digitized images (P = 0.13) although sensitivity was higher for analog images. Radiologists' interpretation of both digital and analog images was significantly better compared with the private veterinarians (P < 0.05).
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Affiliation(s)
- Allison L Zwingenberger
- Matthew J. Ryan Department of Clinical Studies, Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Babiarz LS, Yousem DM, Parker L, Rao VM, Levin DC. Volume of Neuroradiology Studies Read by Neurologists: Implications for Fellowship Training. J Am Coll Radiol 2011; 8:477-82. [DOI: 10.1016/j.jacr.2010.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 12/02/2010] [Indexed: 11/28/2022]
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Salazar AJ, Camacho JC, Aguirre DA. Comparison between differently priced devices for digital capture of X-ray films using computed tomography as a gold standard: a multireader-multicase receiver operating characteristic curve study. Telemed J E Health 2011; 17:275-82. [PMID: 21457011 DOI: 10.1089/tmj.2010.0189] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Film digitizers are a specialized technology that is available for scanning X-ray radiographs; however, their cost makes them unaffordable for developing countries. Thus, less expensive alternatives are used. The purpose of this study was to compare three devices for digital capture of X-ray films: a film digitizer (US $15,000), a flatbed scanner (US $1800), and a 10-megapixel digital camera (US $450), in terms of diagnostic accuracy, defined as the area under the receiver operating characteristic curves and computed tomography as the gold standard. MATERIALS AND METHODS The sample included 136 chest X-ray cases with computed tomography confirmation of the presence or absence of pneumothorax, interstitial opacities, or nodules. The readers were six radiologists who made observations of eight variables for each digital capture of the X-ray films: three main variables to determine the accuracy in the detection of the above-mentioned pathologies, four secondary variables to categorize other pathological classifications, and one variable regarding digital image quality. RESULTS The receiver operating characteristic curves for each device and pathology were very similar. For the main variables, there was no significant statistical difference in diagnostic accuracy between the devices. For the secondary variables, >84% of cases were correctly classified, even those that were classified with the lowest image quality. High accuracy was determined for the three main variables (0.75 to 0.96), indicating good performance for all tested devices, despite their very different prices. CONCLUSIONS Choosing a device for a teleradiology service should involve additional factors, such as capture time, maintenance concerns, and training requirements.
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Affiliation(s)
- Antonio J Salazar
- Department of Electrical and Electronic Engineering, University of Los Andes, Bogotá, Colombia.
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Silva VMCD, Luiz RR, Barreto MM, Rodrigues RS, Marchiori E. [Competence of senior medical students in diagnosing tuberculosis based on chest X-rays]. J Bras Pneumol 2010; 36:190-6. [PMID: 20485939 DOI: 10.1590/s1806-37132010000200006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 10/27/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the competence of senior medical students in diagnosing tuberculosis (TB) based on their reading of chest X-rays, as well as to identify the factors associated with high scores for the overall interpretation of chest X-rays. METHODS In October 2008, a convenience sample of senior medical students who had undergone formal training in radiology at the Federal University of Rio de Janeiro School of Medicine, in the city of Rio de Janeiro, Brazil, were invited to participate in the study. Six chest X-rays (three of TB patients and three of patients without TB) were selected. Participants were asked to choose one of the three probable radiological interpretations, and one of the four subsequent suitable clinical approaches. They also completed a questionnaire designed to collect data related to demographics, career of interest, time spent in emergency rooms and year of study. The sensitivity and specificity related to competence in the radiological diagnosis of TB, as well as a score for the overall interpretation of chest X-rays, were calculated. RESULTS The sensitivity of the probable radiological diagnosis of pulmonary TB, based on the three chest X-rays of patients with TB (minimal, moderate and extensive) was 86.5%, 90.4% and 94.2%, respectively, and the specificity was 90%, 82% and 42%. The only factor associated with a high score for the overall radiological interpretation was the year of study. CONCLUSIONS In this sample of medical students, who had received formal training in radiology early in their medical school course, the competence in interpreting the chest X-rays of TB patients was good. The year of study seems to influence overall chest X-ray reading skill.
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Hurlen P, Borthne A, Dahl FA, Ostbye T, Gulbrandsen P. Does PACS improve diagnostic accuracy in chest radiograph interpretations in clinical practice? Eur J Radiol 2010; 81:173-7. [PMID: 20888718 DOI: 10.1016/j.ejrad.2010.08.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/27/2010] [Accepted: 08/30/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the impact of a Picture Archiving and Communication System (PACS) on the diagnostic accuracy of the interpretation of chest radiology examinations in a "real life" radiology setting. MATERIALS AND METHODS During a period before PACS was introduced to radiologists, when images were still interpreted on film and reported on paper, images and reports were also digitally stored in an image database. The same database was used after the PACS introduction. This provided a unique opportunity to conduct a blinded retrospective study, comparing sensitivity (the main outcome parameter) in the pre and post-PACS periods. We selected 56 digitally stored chest radiograph examinations that were originally read and reported on film, and 66 examinations that were read and reported on screen 2 years after the PACS introduction. Each examination was assigned a random number, and both reports and images were scored independently for pathological findings. The blinded retrospective score for the original reports were then compared with the score for the images (the gold standard). RESULTS Sensitivity was improved after the PACS introduction. When both certain and uncertain findings were included, this improvement was statistically significant. There were no other statistically significant changes. CONCLUSION The result is consistent with prospective studies concluding that diagnostic accuracy is at least not reduced after PACS introduction. The sensitivity may even be improved.
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Affiliation(s)
- Petter Hurlen
- Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Sykehusveien 27, NO-1478 Lørenskog, Norway.
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van der Linden C, Reijnen R, de Vos R. Diagnostic Accuracy of Emergency Nurse Practitioners Versus Physicians Related to Minor Illnesses and Injuries. J Emerg Nurs 2010; 36:311-6. [DOI: 10.1016/j.jen.2009.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 07/26/2009] [Accepted: 08/11/2009] [Indexed: 11/28/2022]
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Nesterova GV, Leftridge CA, Natarajan AR, Appel HJ, Bautista MV, Hauser GJ. Discordance in interpretation of chest radiographs between pediatric intensivists and a radiologist: impact on patient management. J Crit Care 2009; 25:179-83. [PMID: 19682850 DOI: 10.1016/j.jcrc.2009.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 03/06/2009] [Accepted: 05/22/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE When radiologists are not available, chest radiographs (CXRs) of pediatric intensive care unit (PICU) patients are commonly interpreted by pediatric intensivists. We prospectively investigated the frequency of errors in CXR interpretation by pediatric intensivists and their impact on patient management. MATERIALS AND METHODS Chest radiographs of PICU patients were evaluated by 5 pediatric intensivists then by a pediatric radiologist (the "gold standard"). If the interpretation of the radiologist and intensivist differed, an independent intensivist determined whether a management change took place. A pediatric pulmonologist determined how many intensivist interpretations were different from the radiologist's interpretations. RESULTS Seven hundred twenty-eight radiographic findings were identified by the radiologist in 460 CXRs. There were 33 interpretation errors by the intensivists (4.5% of the findings in 7.1% of the CXRs). Only 3/33 error corrections (0.45% of the findings in 0.7% of the CXRs) resulted in change in patient management. CONCLUSIONS Errors in interpretation of CXRs by pediatric intensivists were common but less than that in other series, probably because of education of the pediatric intensivists through daily rounds with the radiologist. Although interpretation errors that affected patient management were rare, their clinical importance supports the growing practice of 24/7 remote radiograph reading by radiologists.
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Affiliation(s)
- Galina V Nesterova
- Division of Pediatric Critical Care and Pulmonary Medicine, Georgetown University Children's Medical Center, Washington, DC 20007, USA
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Rushton VE, Qualtrough AJE, Al-Masserah Y, Rushton MN. The influence of coronal tooth tissue in the diagnosis of apical pathosis. Int Endod J 2009; 42:603-8. [DOI: 10.1111/j.1365-2591.2009.01554.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Re: “Payment for X-Ray Interpretation in the ED: Solving the Dilemma”. J Am Coll Radiol 2009; 6:383-4. [DOI: 10.1016/j.jacr.2009.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 02/09/2009] [Indexed: 11/20/2022]
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