In recent decades, teleradiology has expanded considerably, and many radiology practices now engage in intraorganizational or extraorganizational teleradiology. In this era of patient primacy, ...optimizing patient care and care delivery is paramount. This article provides an update on recent changes, current challenges, and future opportunities centered around the ability of teleradiology to improve temporal and geographic imaging access. We review licensing and regulations and discuss teleradiology in providing services to rural areas and assisting with disaster response, including the response to the coronavirus disease (COVID-19) pandemic.
Teleradiology can help increase imaging efficiency and mitigate both geographic and temporal discrepancies in imaging care. Technologic limitations and regulatory hurdles hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.
To evaluate radiology residents' perspectives regarding inclusion of artificial intelligence/ machine learning (AI/ML) education in the residency curriculum.
An online anonymous survey was sent to ...759 residents at 21 US radiology residency programs. Resident demographics, sub-specialty interests, educational background and research experiences, as well as the awareness, availability, and usefulness of various resources for AI/ML education were collected.
The survey response rate was 27% (209/759). A total of 74% of respondents were male, 80% were training at large university programs, and only a minority (<20) had formal education or research experience in AI/ML. All four years of training were represented (range: 20%-38%). The majority of the residents agreed or strongly agreed (83%) that AI/ML education should be a part of the radiology residency curriculum and that such education should equip them with the knowledge to troubleshoot an AI tool in practice / determine whether a tool is working as intended (82%). Among the residency programs that offer AI/ML education, the most common resources were lecture series (43%), national informatics courses (28%), and in-house/institutional courses (26%). About 24% of the residents reported no AI/ML educational offerings in their residency curriculum. Hands on AI/ML laboratory (67%) and lecture series (61%) were reported as the most beneficial or effective. The majority of the residents preferred AI/ML education offered as a continuous course spanning the radiology residency (R1 to R4) (76%), followed by mini fellowship during R4 (32%) and as a course during PGY1 (21%).
Residents largely favor the inclusion of formal AI/ML education in the radiology residency curriculum, prefer hands-on learning and lectures as learning tools, and prefer a continuous AI/ML course spanning R1-R4.
The volume of emergency department (ED) visits and the number of neuroimaging examinations have increased since the start of the century. Little is known about this growth in the commercially insured ...and Medicare Advantage populations.
The purpose of our study was to evaluate changing ED utilization of neuroimaging from 2007 through 2017 in both commercially insured and Medicare Advantage enrollees.
Using patient-level claims from Optum's deidentified Clinformatics Data Mart database, which annually includes approximately 12-14 million commercial and Medicare Advantage health plan enrollees, annual ED utilization rates of head CT, head MRI, head CTA, neck CTA, head MRA, neck MRA, and carotid duplex ultrasound (US) were assessed from 2007 through 2017. To account for an aging sample population, utilization rates were adjusted using annual relative proportions of age groups and stratified by patient demographics, payer type, and provider state.
Between 2007 and 2017, age-adjusted ED neuroimaging utilization rates per 1000 ED visits increased 72% overall (compound annual growth rate CAGR, 5%). This overall increase corresponded to an increase of 69% for head CT (CAGR, 5%), 67% for head MRI (CAGR, 5%), 1100% for head CTA (CAGR, 25%), 1300% for neck CTA (CAGR, 27%), 36% for head MRA (CAGR, 3%), and 52% for neck MRA (CAGR, 4%) and to a decrease of 8% for carotid duplex US (CAGR, -1%). The utilization of head CT and CTA of the head and neck per 1000 ED visits increased in enrollees 65 years old or older by 48% (CAGR, 4%) and 1011% (CAGR, 24%).
Neuroimaging utilization in the ED grew considerably between 2007 and 2017, with growth of head and neck CTA far outpacing the growth of other modalities. Unenhanced head CT remains by far the dominant ED neuroimaging examination.
The rapid growth of head and neck CTA observed in the fee-for-service Medicare population is also observed in the commercially insured and Medicare Advantage populations. The appropriateness of this growth should be monitored as the indications for CTA expand.
Foreign bodies can gain entrance to the body through several mechanisms, ie, ingestion, aspiration, and purposeful insertion. For each of these common entry mechanisms, this article examines the ...epidemiology, clinical presentation, anatomic considerations, and key imaging characteristics associated with clinically relevant foreign bodies seen in the emergency department (ED) setting. We detail optimal use of multiple imaging techniques, including radiography, ultrasonography, fluoroscopy, and computed tomography to evaluate foreign bodies and their associated complications. Important imaging and clinical features of foreign bodies that can alter clinical management or may necessitate emergency intervention are discussed.
Increases in the use of CT to evaluate patients presenting with trauma have raised concern about inappropriate imaging. The evolving utilization of CT for trauma evaluation may be impacted by injury ...severity.
The purpose of this study was to explore patterns in utilization of chest and abdominopelvic CT among trauma-related emergency department (ED) visits across the United States.
This retrospective study was conducted with national commercial claims information extracted from the MarketScan Commercial Database. Trauma-related ED encounters were identified from the 2011-2018 MarketScan database files and classified by injury severity score (minor, intermediate, and major injuries) on the basis of International Classification of Diseases codes. ED encounters were also assessed for chest CT, abdominopelvic CT, and single-encounter chest and abdominopelvic CT examinations. Utilization per 1000 trauma-related ED encounters was determined. Multivariable Poisson regression models were used to determine incidence rate ratios (IRRs) as a measure of temporal changes in utilization.
From 2011 to 2018, 8,369,092 trauma-related ED encounters were identified (5,685,295 for minor, 2,624,944 for intermediate, and 58,853 for major injuries). Utilization of chest CT per 1000 trauma-related ED encounters increased from 4.9 to 13.5 examinations (adjusted IRR, 1.15 per year; minor injuries, from 2.2 to 7.7 adjusted IRR, 1.17; intermediate injuries, from 8.5 to 21.5 adjusted IRR, 1.16; major injuries, from 117.8 to 200.1 adjusted IRR, 1.08). Utilization of abdominopelvic CT per 1000 trauma-related ED encounters increased from 7.5 to 16.4 (adjusted IRR, 1.12; minor injuries, 4.8 to 12.2 adjusted IRR, 1.13; intermediate injuries, 10.6 to 21.7 adjusted IRR, 1.13; major injuries, 134.8 to 192.6 adjusted IRR, 1.07). Utilization of single-encounter chest and abdominopelvic CT per 1000 trauma-related ED encounters increased from 3.4 to 8.9 adjusted IRR, 1.16; minor injuries, 1.1 to 4.6 adjusted IRR, 1.18; intermediate injuries, 6.4 to 16.4 adjusted IRR, 1.16; major injuries, 99.6 to 179.9 adjusted IRR, 1.08).
National utilization of chest and abdominopelvic CT for trauma-related ED encounters increased among commercially insured patients from 2011 to 2018, particularly for single-encounter chest and abdominopelvic CT examinations and for minor injuries.
Given concerns about increased cost and detection of incidental findings, further investigation is warranted to explore the potential benefit of single-encounter chest and abdominopelvic CT examinations of patients with minor injuries and to develop strategies for optimizing appropriateness of imaging orders.
Purpose
To evaluate the feasibility of adding pathology to recent radiologist error characterization schemes of modality and anatomic region and the potential of this data to more specifically inform ...peer review and peer learning.
Methods
Quality assurance data originating from 349 radiologists in a national teleradiology practice were collected for 2019. Interpretive errors were simply categorized as
major
or
minor
. Reporting or communication errors were classified as
administrative
errors. Interpretive errors were then divided by modality, anatomic region and placed into one of 64 pathologic categories.
Results
Out of 1,628,464 studies, the discrepancy rate was 0.5% (8181/1,634,201). The 8181 total errors consisted of 2992 major errors (0.18%) and 5189 minor errors (0.32%). Precisely, 3.1% (257/8181) of total errors were administrative. Of major interpretive errors, 75.5% occurred on CT, with CT abdomen and pelvis accounting for 40.4%. The most common pathologic discrepancy for all exams was in the category of mass, nodule, or adenopathy (1583/8181), the majority of which were minor (1315/1583). The most common pathologic discrepancy for the 2937 major interpretive errors was fracture or dislocation (27%; 793/2937), followed by bleed (10.7%; 315/2937).
Conclusion
The addition of error-related pathology to peer review is both feasible and practical and provides a more detailed guide to targeted individual and practice-wide peer learning quality improvement efforts. Future research is needed to determine if there are measurable improvements in detection or interpretation of specific pathologies following error feedback and educational interventions.
Abstract Based on its intrinsic mass and velocity, a bullet has an upper limit of wounding potential. Actual wound severity is a function of the bullet construction and trajectory, as well as the ...properties of the tissues traversed. Interpreting physicians must evaluate the bullet trajectory and describe patterns of injury resulting from the effect of energy transfer from the projectile into living tissue. A basic understanding of firearms, projectiles, and wound ballistics can help the interpreting physicians in conceptualizing these injuries and interpreting these cases.
The purpose of our study was to assess potential disparities in the utilization of advanced imaging during emergency department (ED) visits.
This retrospective study was conducting using 5% Research ...Identifiable Files. All CT and MRI (together defined as "advanced imaging") examinations associated with ED visits in 2015 were identified for continuously enrolled Medicare beneficiaries. Individuals with medical claims 30 days before the index ED event were excluded, and encounters that occurred in hospitals without advanced imaging capabilities were also excluded. Patient characteristics were identified using Medicare files and hospital characteristics using the American Hospital Association Annual Survey of Hospitals. Multivariate logistic regression was used for the analysis.
Of 86,976 qualifying ED encounters, 52,833 (60.74%) ED encounters were for female patients; 29.03% (
= 25,245) occurred at rural hospitals and 15.81% (
= 13,750) at critical access hospitals. Race distribution was 83.13% White, 11.05% Black, and 5.82% Other. Compared with ED patients at urban hospitals, those at rural and critical access hospitals were 6.9% less likely (odds ratio OR = 0.931,
= 0.015) and 18.0% less likely (OR = 0.820,
< 0.0001), respectively, to undergo advanced imaging. Compared with White patients, Black patients were 31.6% less likely (OR = 0.684,
< 0.0001) to undergo advanced imaging. Relative to their urban counterparts, both White (OR = 0.941,
= 0.05) and Black (OR = 0.808,
= 0.047) rural ED patients were less likely to undergo advanced imaging.
Among Medicare beneficiaries receiving care in U.S. EDs, significant disparities exist in advanced imaging utilization. Although imaging appropriateness was not investigated, these findings suggest inequity. Further research is necessary to understand why consistent health benefits do not translate into consistent imaging access among risk-adjusted ED patients.
Because of the increase in the use of 24-hour-a-day 7-day-a-week real-time radiologic interpretation, radiologists more frequently perform after-hours work. The purpose of this article was to examine ...the challenges arising from after-hours work and describe evidence-based strategies meant to limit the adverse physical and psychologic stresses of after-hours work.
Working nontraditional hours affects a radiologist's health, social life, professional productivity, and possibly interpretive accuracy. Appropriate attention to these factors and targeted countermeasures can optimize the professional development and personal well-being of radiologists working after hours.
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