In community settings, radiologists commonly function as multispecialty radiologists, interpreting examinations outside of their area of fellowship training.
The purpose of this article was to ...compare discrepancy rates for preliminary interpretations of acute community-setting examinations that are concordant versus discordant with interpreting radiologists' area of fellowship training.
This retrospective study used the databank of a U.S. teleradiology company that provides preliminary interpretations for client community hospitals. The analysis included 5,883,980 acute examinations performed from 2012 to 2016 that were preliminarily interpreted by 269 teleradiologists with a fellowship of neuroradiology, abdominal radiology, or musculoskeletal radiology. When providing final interpretations, client on-site radiologists voluntarily submitted quality assurance (QA) requests if preliminary and final interpretations were discrepant; the teleradiology company's QA committee categorized discrepancies as major (
= 8444) or minor (
= 17,208). Associations among examination type (common vs advanced), relationship between examination subspecialty and the teleradiologist's fellowship (concordant vs discordant), and major and minor discrepancies were assessed using three-way conditional analyses with generalized estimating equations.
For examinations with a concordant subspecialty, the major discrepancy rate was lower for common than for advanced examinations (0.13% vs 0.26%; relative risk RR, 0.50, 95% CI, 0.42-0.60;
< .001). For examinations with a discordant subspecialty, the major discrepancy rate was lower for common than advanced examinations (0.14% vs 0.18%; RR, 0.81; 95% CI, 0.72-0.90;
< .001). For common examinations, the major discrepancy rate was not different between examinations with concordant versus discordant subspecialty (0.13% vs 0.14%; RR, 0.90; 95% CI, 0.81-1.01;
= .07). For advanced examinations, the major discrepancy rate was higher for examinations with concordant versus discordant subspecialty (0.26% vs 0.18%; RR, 1.45; 95% CI, 1.18-1.79;
< .001). The minor discrepancy rate was higher among advanced examinations for those with concordant versus discordant subspecialty (0.34% vs 0.29%; RR, 1.17; 95% CI, 1.00-1.36;
= .04), but not different for other comparisons (
> .05).
Major and minor discrepancy rates were not higher for acute community-setting examinations outside of interpreting radiologists' fellowship training. Discrepancy rates increased for advanced examinations.
The findings support multispecialty radiologist practice in acute community settings. Efforts to match examination and interpreting radiologist sub-specialty may not reduce diagnostic discrepancies.
Imaging Overuse in the Emergency Department Lexa, Frank; Nathan, Jennifer; Everett, Catherine J ...
Journal of the American College of Radiology
21, Issue:
5
Journal Article
Abstract Each year an open-microphone session is hosted by the Council Steering Committee. The committee invited an expert panel to discuss the use of effective communication in appropriate procedure ...selection and methods and resources to communicate the results of procedures performed in an actionable and clear manner to referring clinicians and patients, as well as downstream data systems. The ACR is actively encouraging radiologists to leverage existing and new technologies to increase their visibility in the health care system. Key features in Imaging 3.0 are results reporting through actionable reports, decision support for results reporting, guidelines for recommendations, tools for actionable reports, and tracking a radiologist’s recommendations. The final radiology report is an essential product of our service, but it is increasingly clear that the noninterpretive components of our profession will add the most value to patient care. The radiology report is not the only evidence of our work. Nonetheless, the information quality and content of the radiology report can and must be improved so that it can add value and clinical usefulness toward excellent patient care. We must use appropriate tools and “best knowledge” to deliver actionable and value-added high-quality reports.
Abstract
Introduction
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are a rare adverse cutaneous drug reaction that historically has a high risk of mortality. The use ...of corticosteroids (CS) to treat SJS/TENS remains controversial as the literature is limited to small cohort trials by the rarity of the condition. Some conflicting studies suggested that CS may increase mortality due to augmented infection risk. This study evaluated the incidence of sepsis and mortality following CS use in patients with SJS/TENS.
Methods
We performed a retrospective study utilizing a commercially available multi-institutional database derived from deidentified inpatient coding data to assess the incidence of sepsis and mortality within 30 days after diagnosis of SJS/TENS in patients >18 years old treated with CS within one week of their initial diagnosis. Data was analyzed from years 2000-2022. Patients treated with CS within 1 week of diagnosis (n=3930) and those treated without CS (n=6557) were propensity matched for age, race, gender, severe sepsis and SIRS (n=3723) and were assessed for relative risk of mortality and sepsis occurrence.
Results
Of the patients who received CS 171 of 3723 died vs 98 of 3723 of those that did not receive CS. They incurred a 1.961% relative risk (RR: 1.745, 1.367, 2.227 95% CI, p=< 0.0001) for mortality. Similarly, of the patients that received CS 245 of 3723 suffered sepsis vs 173 of 3723 that did not receive CS. This was a 1.934% relative risk (RR: 1.416, 1.172, 1.711 95% CI, p=0.0003) of developing sepsis. The number of instances and median days till instance were not statistically different between cohorts.
Conclusions
This study indicated that amongst adult patients diagnosed with SJS/TENS, the utilization of CS within the first week of diagnosis is affiliated with a statistically significant increased risk of sepsis and death within 30 days of diagnosis.
Applicability of Research to Practice
The application of CS therapy may enable the development of infections in patients such as sepsis, which may ultimately worsen prognosis, but the rarity of this condition prohibits effective single-institution assessment of this impact. Care should be taken to assess the risks and benefits of prescribing CS therapy in SJS/TENS patients.
Both the Jericho Forum and the newly-established Cloud Security Alliance (CSA) have grabbed many a headline lately in their respective attempts to assuage some of the widespread information security ...concerns around cloud computing. The question is, are such initiatives enough?
What are the information security risks posed by social media websites in general and Twitter in particular?
Cath Everett examines where the situation stands today, how quickly the threat is growing ...and how well the average organisation understands the challenges involved in tackling it. She also explores why social media is growing in appeal and what this scenario is likely to mean for information security professionals. Finally, she offers best practice advice on what enterprises should consider doing to try and guard against this potential threat.
Twitter appears to have been constantly in the headlines lately. If it's not one survey saying that usage is exploding, it's another claiming that harnessing its social networking potential has enabled x or y organisation to hugely boost its revenues despite the recession.
Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists. Lack of access to interventional radiologic services results in a failure to ...meet the needs of patients, hospitals, and other community stakeholders. Acknowledging this challenge, the ACR's Commission on General, Small, Emergency and/or Rural Practice and Commission on Interventional and Cardiovascular Imaging and the Society of Interventional Radiology partnered to establish a joint task force to study this issue and identify strategies the ACR and the Society of Interventional Radiology should take to improve small and rural practice recruitment and retention of interventional radiologists. This report describes the deliberations and recommendations of the task force.
The COVID-19 pandemic has dramatically altered the professional and personal lives of radiologists and radiation oncologists. This article summarizes the 2020 American Association for Women in ...Radiology (AAWR) Women's Caucus at the American College of Radiology (ACR) Annual Meeting. The caucus focused on the major challenges that women in radiology have faced during the pandemic.
The European Union has been firing warning shots about privacy across the bows of online vendors from Google to Facebook lately as it gears up for a wider clampdown in this increasingly controversial ...space.
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