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.
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.
RADPEER is a product developed by the ACR that aims to assist radiologists with quality assessment and improvement through peer review. The program opened in 2002, was initially offered to physician ...groups in 2003, developed an electronic version in 2005 (eRADPEER), revised the scoring system in 2009, and first surveyed the RADPEER membership in 2010. In 2012, a survey was sent to 16,000 ACR member radiologists, both users and nonusers of RADPEER, with the goal of understanding how to make RADPEER more relevant to its members. A total of 31 questions were used, some of which were repeated from the 2010 survey. The ACR's RADPEER committee has published 3 papers on the program since its inception. In this report, the authors summarize the survey results and suggest future opportunities for making RADPEER more useful to its membership.
Strip sensor performance in prototype modules built for ATLAS ITk Helling, C.; Allport, P.; Affolder, A.A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
10/2020, Volume:
978, Issue:
C
Journal Article
Peer reviewed
Open access
ATLAS experiment is preparing an upgrade of its detector for High-Luminosity LHC (HL-LHC) operation. The upgrade involves installation of the new all-silicon Inner Tracker (ITk). In the context of ...the ITk preparations, more than 80 strip modules were built with prototype barrel sensors. They were tested with electrical readout on a per-channel basis. In general, an excellent performance was observed, consistent with previous ASIC-level and sensor-level tests. However, the lessons learned included two phenomena important for the future phases of the project. First was the need to store and test the modules in a dry environment due to humidity sensitivity of the sensors. The second was an observation of high noise regions for 2 modules.
The high noise regions were tested further in several ways, including monitoring the performance as a function of time and bias voltage. Additionally, direct sensor-level tests were performed on the affected channels. The inter-strip resistance and bias resistance tests showed low values, indicating a temporary loss of the inter-strip isolation. A subsequent recovery of the noise performance was observed. We present the test details, an analysis of how the inter-strip isolation affects the module noise, and the relationship with sensor-level quality control tests.
Humidity sensitivity of large area silicon sensors: Study and implications Fernández-Tejero, J.; Allport, P.P.; Aviñó, O. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
10/2020, Volume:
978, Issue:
C
Journal Article
Peer reviewed
Open access
The production of large area sensors is one of the main challenges that the ATLAS collaboration faces for the new Inner-Tracker full-silicon detector. During the prototype fabrication phase for the ...High Luminosity Large Hadron Collider upgrade, several ATLAS institutes observed indications of humidity sensitivity of large area sensors, even at relative humidities well below the dew point. Specifically, prototype Barrel and End-Cap silicon strip sensors fabricated in 6-inch wafers manifest a prompt decrease of the breakdown voltage when operating under high relative humidity, adversely affecting the performance of the sensors. In addition to the investigation of these prototype sensors, a specific fabrication batch with special passivation is also studied, allowing for a deeper understanding of the responsible mechanisms.
This work presents an extensive study of this behaviour on large area sensors. The locations of the hotspots at the breakdown voltage at high humidity are revealed using different infrared thermography techniques. Several palliative treatments are attempted, proving the influence of sensor cleaning methods, as well as baking, on the device performance, but no improvement on the humidity sensitivity was achieved. Furthermore, a study of the incidence of the sensitivity in different batches is also presented, introducing a hypothesis of the origins of the humidity sensitivity associated to the sensor edge design, together with passivation thickness and conformity. Several actions to be taken during sensor production and assembly are extracted from this study, in order to minimize the impact of humidity sensitivity on the performance of large area silicon sensors for High Energy Physics experiments.
The inner tracker of the ATLAS detector is scheduled to be replaced by a completely new silicon-based inner tracker (ITk) for the Phase-II of the CERN LHC (HL-LHC). The silicon strip detector covers ...the volume 40<R<100 cm in the radial and |z|<300 cm in the longitudinal directions. The silicon sensors for the detector will be fabricated using the n+-on-p 6-inch wafer technology, for a total of 22,000 wafers. Intensive studies were carried out on the final prototype sensors ATLAS17LS fabricated by Hamamatsu Photonics (HPK). The charge collection properties were examined using penetrating 90Sr β-rays and the ALIBAVA fast readout system for the miniature sensors of 1 cm ×1 cm in area. The samples were irradiated by protons in the 27 MeV Birmingham Cyclotron, the 70 MeV CYRIC at Tohoku University, and the 24 GeV CERN-PS, and by neutrons at Ljubljana TRIGA reactor for fluence values up to 2 × 1015 neq/cm2. The change in the charge collection with fluence was found to be similar to the previous prototype ATLAS12, and acceptable for the ITk. Sensors with two active thicknesses, 300μm (standard) and 240μm (thin), were compared and the difference in the charge collection was observed to be small for bias voltages up to 500 V. Some samples were also irradiated with gamma radiation up to 2 MGy, and the full depletion voltage was found to decrease with the dose. This was caused by the Compton electrons due to the 60Co gamma radiation. To summarize, the design of the ATLAS17LS and technology for its fabrication have been verified for implementation in the ITk. We are in the stage of sensor pre-production with the first sensors already delivered in January of 2020.
The ACR Council passed Resolution 47 at its 2020 annual meeting establishing a representative task force (TF) to explore the concept of the "multispecialty radiologist," previously proposed in 2012. ...The TF held eight virtual meetings over 8 months, considered data from a 2020 ACR Membership Tracking Survey, conducted a review of current literature, and collected anecdotal experience from TF members and ACR leadership. ACR legal counsel and a cross-section of ACR Commissions and Committees also provided input. The TF concluded that there is scant interest from the radiology community in the multispecialty radiologist title and no agreed-upon definition for the term. Radiologists may identify as diagnostic or subspecialty radiologists; however, the roles they fill in clinical practice include general, multispecialty, and subspecialized radiology. The TF proposes definitions for each of these terms to support radiologist recruitment aligned with optimal patient care in the practice community and to improve the quality of data collection about the field. To reduce ambiguity, the TF proposes adoption of the defined terms by the radiology community, including radiologist recruiters and employers, and suggests ways in which resident training and the ABR board examination can be adapted to support this new structure. Additionally, as part of an exploration of hyperspecialization and trainee preparedness for clinical practice, the TF discussed the challenges faced by community-based practices seeking to provide a full range of high-quality, radiologist-delivered diagnostic and interventional services to their patient populations.
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