Errors and discrepancies in radiology practice are uncomfortably common, with an estimated day-to-day rate of 3–5% of studies reported, and much higher rates reported in many targeted studies. ...Nonetheless, the meaning of the terms “error” and “discrepancy” and the relationship to medical negligence are frequently misunderstood. This review outlines the incidence of such events, the ways they can be categorized to aid understanding, and potential contributing factors, both human- and system-based. Possible strategies to minimise error are considered, along with the means of dealing with perceived underperformance when it is identified. The inevitability of imperfection is explained, while the importance of striving to minimise such imperfection is emphasised.
Teaching Points
•
Discrepancies between radiology reports and subsequent patient outcomes are not inevitably errors
.
•
Radiologist reporting performance cannot be perfect, and some errors are inevitable
.
•
Error or discrepancy in radiology reporting does not equate negligence
.
•
Radiologist errors occur for many reasons, both human- and system-derived
.
•
Strategies exist to minimise error causes and to learn from errors made
.
Key Points
•
Radiology has developed into a central and important part of patient care
.
•
A combination of technological developments, increasing workload and radiologists' behaviour run the risk of ...diminishing the visibility of radiologists to referrers and patientsRadiology has developed into a central and important part of patient care
.
•
It is vital for the successful future of radiology that we remain conscious of the need to maintain visibility of who we are and what we contribute to patient care
.
The job of the diagnostic radiologist is two-fold: identifying and interpreting the information available from diagnostic imaging studies and communicating that interpretation meaningfully to the ...referring clinician. However skilled our interpretive abilities, our patients are not well served if we fail to convey our conclusions effectively. Despite the central importance of communication skills to the work of radiologists, trainees rarely receive significant formal training in reporting skills, and much of the training given simply reflects the trainer’s personal preferences. Studies have shown a preference among referrers for reports in a structured form, with findings given in a standard manner, followed by a conclusion. The technical competence to incorporate structured report templates into PACS/RIS systems is growing, "...and radiology societies (including the European Society of Radiology (ESR)) are active in producing and validating templates for a wide range of modalities and clinical circumstances. While some radiologists may prefer prose format reports, and much literature has been produced addressing “dos and don’ts” for such prose reports, it seems likely that structured reporting will become the norm in the near future. Benefits will include homogenisation and standardisation of reports, certainty that significant information has not been omitted, and capacity for data-mining of structured reports for research and teaching purposes.
Teaching Points
• The radiologist’s job includes interpretation of imaging studies AND communication.
• Traditionally, communication has taken the form of a prose report.
• Referrers have been shown to prefer reports in a structured format.
• Structured reports have many advantages over traditional prose reports.
• It is likely that structured reports represent the future standard.
Artificial intelligence (AI) is poised to change much about the way we practice radiology in the near future. The power of AI tools has the potential to offer substantial benefit to patients. ...Conversely, there are dangers inherent in the deployment of AI in radiology, if this is done without regard to possible ethical risks. Some ethical issues are obvious; others are less easily discerned, and less easily avoided. This paper explains some of the ethical difficulties of which we are presently aware, and some of the measures we may take to protect against misuse of AI.
This is a condensed summary of an international multisociety statement on ethics of artificial intelligence (AI) in radiology produced by the ACR, European Society of Radiology, RSNA, Society for ...Imaging Informatics in Medicine, European Society of Medical Imaging Informatics, Canadian Association of Radiologists, and American Association of Physicists in Medicine. AI has great potential to increase efficiency and accuracy throughout radiology, but it also carries inherent pitfalls and biases. Widespread use of AI-based intelligent and autonomous systems in radiology can increase the risk of systemic errors with high consequence and highlights complex ethical and societal issues. Currently, there is little experience using AI for patient care in diverse clinical settings. Extensive research is needed to understand how to best deploy AI in clinical practice. This statement highlights our consensus that ethical use of AI in radiology should promote well-being, minimize harm, and ensure that the benefits and harms are distributed among stakeholders in a just manner. We believe AI should respect human rights and freedoms, including dignity and privacy. It should be designed for maximum transparency and dependability. Ultimate responsibility and accountability for AI remains with its human designers and operators for the foreseeable future. The radiology community should start now to develop codes of ethics and practice for AI that promote any use that helps patients and the common good and should block use of radiology data and algorithms for financial gain without those two attributes. This article is a simultaneous joint publication in
,
,
, and
. Published under a CC BY-NC-ND 4.0 license.
Type I interferons (IFNs) are critical for anti-viral responses, and also drive autoimmunity when dysregulated. Upon viral sensing, monocytes elicit a sequential cascade of IFNβ and IFNα production ...involving feedback amplification, but how exactly this cascade is regulated in human cells is incompletely understood. Here we show that the PYHIN protein myeloid cell nuclear differentiation antigen (MNDA) is required for IFNα induction in monocytes. Unlike other PYHINs, this is not due to a pathogen sensing role, but rather MNDA regulated expression of IRF7, a transcription factor essential for IFNα induction. Mechanistically, MNDA is required for recruitment of STAT2 and RNA polymerase II to the IRF7 gene promoter, and in fact MNDA is itself recruited to the IRF7 promoter after type I IFN stimulation. These data implicate MNDA as a critical regulator of the type I IFN cascade in human myeloid cells and reveal a new role for human PYHINs in innate immune gene induction.
•QuADRANT was a multiprofessional research project, conducted on behalf of the European Commission, examining clinical audit across the three core specialties – radiology, radiotherapy and nuclear ...medicine – with an emphasis on radiation protection.•QuADRANT aimed to provide an overview of the status of European clinical audit uptake and implementation and to identify good practice and barriers to implementation.•For Radiotherapy there is a long tradition of dosimetry audit and comprehensive IAEA QUATRO audits, however comprehensive clinical audit has not been widely implemented in individual European Countries.•QuADRANT recommendations include increased prioritisation and resourcing of clinical audit, use of enablers, education and training of staff, motivation of staff and call for role development of the national professional societies in clinical audit uptake and promotion.
QuADRANT was a research project funded by the European Commission to evaluate clinical audit uptake and implementation across Europe, with an emphasis on clinical audit as mandated within the BSSD (Basic Safety Standards Directive).
Focusing on the QuADRANT objectives – to obtain an overview of European clinical audit activity; identify good practices, resources, barriers and challenges; provide guidance and recommendations going forwards; identify the potential for European Union action on quality and safety focusing on the field of radiotherapy.
A pan-European survey, expert interviews and a literature review conducted within the framework of the QuADRANT project indicated that developments in national clinical audit infrastructure are required. While in radiotherapy, there is a strong tradition and high level of experience of dosimetry audits and well-established practice through the IAEA’s QUATRO audits, few countries have a well-established comprehensive clinical audit programme or international/national initiatives on tumour specific clinical audits. Even if sparse, the experience from countries with established system of quality audits can be used as role-models for national professional societies to promote clinical audit implementation. However, resource allocation and national prioritisation of clinical audit are needed in many countries. National and international societies should take the initiative to promote and facilitate training and resources (guidelines, experts, courses) for clinical audits. Enablers used to enhance clinical audit participation are not widely employed. Development of hospital accreditation programmes can facilitate clinical audit uptake. An active and formalised role for patients in clinical audit practice and policy development is recommended. Because there is a persisting variation in European awareness of BSSD clinical audit requirements, work is needed to improve dissemination of information on the legislative requirements relating to clinical audit in the BSSD and in relation to inspection processes. The aim is to ensure these include clinical audit and that they encompass all clinics and specialties involved in medical applications using ionising radiation.
QuADRANT provided an overarching view of clinical audit practice in Europe, with all its related aspects. Unfortunately, it showed that the awareness of the BSSD requirements for clinical audit are highly variable. Therefore, there is an urgent need to dedicate efforts towards ensuring that regulatory inspections also incorporate an assessment of clinical audit program(s), affecting all aspects of clinical work and specialties involved in patient exposure to ionising radiation.
PDF
