BACKGROUND:
Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 ...readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients.
STUDY DESIGN:
A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10
pm
to 8
am
were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist’s interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared.
RESULTS:
A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001).
CONCLUSIONS:
This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.
Overnight radiology coverage for pediatric trauma patients (PTPs) is addressed with a combination of on-call radiology residents (RRs) and/or attending teleradiologists (ATs); however, the accuracy ...of these two groups has not been investigated for PTPs. We aimed to compare the accuracy of RRs vs AT interpretations of computed tomography (CT) scans for PTPs.
Pediatric trauma patients (<18 years old) at a single level-I adult/level-II pediatric trauma center were studied in a retrospective analysis (3/2019-5/2020). Computed tomography scans interpreted by both RRs and ATs were included. Radiology residents were compared to ATs for time to interpretation (TTI) and accuracy compared to faculty attending radiologist interpretation, using the validated RADPEER scoring system. Additionally, RR and AT accuracies were compared to a previously studied adult cohort during the same time-period.
42 PTPs (270 interpretations) and 1053 adults (8226 interpretations) were included. Radiology residents had similar rates of discrepancy (13.3% vs 13.3%), major discrepancy (4.4% vs 4.4%), missed findings (9.6% vs 12.6%), and overcalls (3.7% vs .7%) vs ATs (all
> .05). Mean TTI was shorter for RRs (55.9 vs 90.4 minutes,
< .001). Radiology residents had a higher discrepancy rate for PTPs (13.3% vs 7.5%,
= .01) than adults. Attending teleradiologists had a similar discrepancy rate for PTPs and adults (13.3% vs 8.9%,
= .07).
When interpreting PTP CT imaging, RRs had similar discrepancy rates but faster TTI than ATs. Radiology residents had a higher discrepancy rate for PTP CTs than RR interpretation of adult patients, indicating both RRs and ATs need more focused training in the interpretation of PTP studies.
Diagnostic radiology remains one of the least diverse medical specialties. Recent reports have found that the number of female and under-represented in medicine (URiM) residents have not increased ...despite efforts to increase representation over the last decade. Given the critical role of residency program directors in selecting diverse applicants, this study was performed to identify which strategies were most preferred to increase the number of female and/or URiM residents by directors of diagnostic radiology residency training programs.
This was an anonymous, cross-sectional study of diagnostic radiology residency program directors that included a survey about program characteristics, demographics, and strategies to increase the number of female and/or URiM residents.
The questionnaire was submitted to 181 potential participants with a 19.9% response rate. The most preferred strategies to increase diversity involved directly recruiting medical students, promoting mentorship, increasing the number of diverse teaching faculty, and unconscious bias training. The least supported strategies included deemphasizing exam scores, accepting more international graduates, accepting a minimum number of female and/or URiM applicants, and de-identifying applications. Female and/or URiM program directors indicated a statistically significant preference for medical student recruitment and providing an opportunity to discuss workplace issues for female and/or URiM trainees (p < 0.05).
Diagnostic radiology residency program directors endorsed a wide variety of strategies to increase diversity. Recruitment of female and/or URiM medical students and promoting the number of diverse faculty members and mentorship of trainees by these faculty appear to be the most preferred strategies to increase female and/or URiM residents. Female and/or URiM program directors placed a greater importance on recruiting diverse applicants and supporting safe discussion of workplace issues faced by female and/or URiM radiology residents.
Radiologists are often challenged to review CT examinations of the skull without pertinent clinical information or plain radiographs. Skull lesions of fibrous dysplasia (FD) may often be confused ...with Paget disease (PD). The purpose of this article is to evaluate radiographic similarities and to find the signs that can differentiate PD from FD of the skull on head CT and to describe the CT imaging features of PD and FD.
CT scans of the skull in eight cases of PD, 18 cases of FD (13 cases of skull and facial bones, five cases of only facial bones) and 10 normals were studied retrospectively.
Ten features were found to be similar in PD and FD and 10 other features were found to be dissimilar. The frequency of the 10 differentiating features was evaluated to determine their reliability in distinguishing one disorder from the other. The differentiating features in order of significance include: (1) "groundglass" appearance, (2) symmetry, (3) involvement of the paranasal sinuses, (4) thickness of the cranial cortices, (5) involvement of the sphenoid bone, (6) orbital involvement, (7) nasal cavity involvement, (8) presence of a soft tissue mass, (9) maxillary involvement, and (10) the presence of cyst-like changes.
These 10 signs improve the radiologist's skill in differentiating FD and PD.
Applicants to diagnostic radiology residencies often obtain advice regarding the process, typically from local individuals. Materials available on the Internet contribute to this process as well. We ...are a group of current and former Diagnostic Radiology Residency Program Directors and current Vice Chairs for Education who commonly advise medical students, including regarding radiology as a career. This work is meant to provide a "plain talk" resource for those considering a career in radiology via a radiology residency, written from the point of view of an advisor with lots of experience.
Objective
The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA).
Materials and ...methods
We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session.
Results
The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The “rheumatoid” type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%.
Conclusion
Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of the hands and wrists. Disease was more extensive in the wrists than in the hands.
The optimal method of assessing and reducing preprocedural patient anxiety remains uncertain in radiologic procedures. Previous research suggests that the role of radiology nurses is critical to ...optimally address preprocedural anxiety, but the preferences of radiology nurses remain understudied. A questionnaire was adapted from a previous cross-sectional study of interventional radiology to determine the views of current preferences of nurses with regards to addressing preprocedural anxiety. The questionnaire was disseminated to an e-mail list maintained by the Association for Radiologic and Imaging Nursing (ARIN) from July to September 2019. The survey included questions about the assessment, importance, and reduction of preprocedural patient anxiety. A post hoc scale was used to quantify degree of responsibility allocated to radiology nurses, radiologists, patients, family members, and other health care providers. A total of 370 responses were obtained (18.1% response rate). Most respondents found preprocedural anxiety to be very important in practice (n = 237, 4.4%) and to patients (n = 300, 81.7%). Nurses indicated that anxiety interfered with delivery of care (n = 220, 60.3%) and most respondents formally assessed it in their patients (n = 227, 61.7%). A variety of methods to reduce preprocedural patient were endorsed: patient education (n = 341, 94.2%); empathetic communication (n = 333, 92.0%); anxiety medication (n = 239, 66.0%); permitting family presence (n = 228, 63.0%); familiarization with the facility (n = 97, 26.8%); traditional, complementary, and alternative medication (n = 69, 19.1%). Nurses held themselves most responsible to manage patient anxiety followed by radiologists, patients, family members, primary care providers, and mental health care providers. This study suggests that radiology nurses acknowledge the importance of assessing and reducing preprocedural patient anxiety. Furthermore, radiology nurses use a variety of methods to manage patient anxiety and hold themselves most responsible to reduce anxiety but also allocate responsibility to others such as radiologists and patients.
•Radiology nurses acknowledge the importance of preprocedural anxiety.•Most radiology nurses assessed their patients' preprocedural anxiety levels.•Nurses supported patient education and other methods to reduce patient anxiety.•Nurses held themselves most responsible to reduce patient anxiety in radiology.
