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van den Broek-Altenburg EM, Benson JS, Atherly AJ, DeStigter KK. Patient preferences for diagnostic imaging services: Decentralize or not? PLoS One 2025; 20:e0301404. [PMID: 40378352 DOI: 10.1371/journal.pone.0301404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 03/25/2025] [Indexed: 05/18/2025] Open
Abstract
The objective of this study was to identify patient preferences for outpatient diagnostic imaging services and analyze how patients make trade-offs between attributes of these services using a discrete choice experiment (DCE). We used a DCE with 14 choice questions asking which imaging locations patients would prefer. We used latent class analysis to analyze preference heterogeneity between different patient groups and to estimate the relative value they assign to different attributes of imaging services. Our analysis showed that the "Experienced Patients" subgroup generally value diagnostic imaging services in both acute and chronic situations and had a strong preference for hospital outpatient radiology departments (HORD) that would provide services at lower costs, where their images would be interpreted by a specialty radiologist, the clinic would be recommended by their PCP, online scheduling would be available, service rating were higher, and travel and wait times would be shorter. New Patients significantly valued the service rating of the (HORD and online scheduling. HORDs can be more competitive by providing services that live up to expectations better than available retail radiology clinics (RRCs). Most RRCs do not currently offer online scheduling so ease of use may also steer patients towards HORDs. HORDs have the advantage of being linked to the main medical center which has the reputation of having clinical expertise and more sophisticated technology. We conclude that there is room for medical centers to build HORDs that provide an appealing and competitive alternative to current RRC.
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Affiliation(s)
| | - Jamie S Benson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Adam J Atherly
- College of Health Professions, Virginia Commonwealth University, Richmond, USA
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2
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Rodríguez-Chiaradía DA, Torres-Castro R, Piccari L, García-Ortega A, Perez-Peñate GM, de Miguel-Díez J, Perez-Rojo R, Cano-Pumarega I, Mora-Cuesta V, Blanco I, Figueira-Gonçalves JM, Del Pozo R, López-Meseguer M, Martínez-Meñaca A, Tenes A, Molina-Molina M, Barberà JA. A Systematic Review and Expert Recommendation on the Diagnosis of Pulmonary Hypertension Associated With Lung Disease: A Position Paper of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2025:S0300-2896(25)00112-7. [PMID: 40222881 DOI: 10.1016/j.arbres.2025.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 03/21/2025] [Accepted: 03/24/2025] [Indexed: 04/15/2025]
Abstract
Pulmonary hypertension (PH) is a common complication of chronic respiratory diseases (CRD) associated with increased morbidity and mortality. Early and individualized identification of PH in these patients is crucial to better understand the evolution of the disease and to assess the application of therapeutic measures aimed at its control. However, there is no consensus on how to approach the diagnostic process. The scarce scientific evidence in this field justifies the creation of this SEPAR position paper, which aims to become a tool to aid in the diagnosis of PH associated with CRD that facilitates decision making for the benefit of patients and the optimization of resources. A panel of 16 SEPAR experts has identified three critical questions. The answers to these questions were developed by the panel members, who were divided into three groups according to their expertise in the underlying disease in question: chronic obstructive pulmonary disease, interstitial lung disease and obesity hypoventilation syndrome. Prior to the discussion and drafting of the document by each group, a systematic review of the literature was performed according to the guidelines recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). We generated a schematic proposal adjusted to the characteristics of each disease for the diagnostic approach to PH associated with respiratory disease.
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Affiliation(s)
- Diego A Rodríguez-Chiaradía
- Pulmonology Department, Hospital del Mar, Hospital del Mar Research Institute, Universitat Pompeu Fabra, CIBERES, (ISCIII), Barcelona, Spain.
| | - Rodrigo Torres-Castro
- Pulmonology Department, Hospital Clínic de Barcelona-FCRB-IDIBAPS, Universitat de Barcelona, Departamento de Kinesiología, Universidad de Chile, Santiago, Chile
| | - Lucilla Piccari
- Pulmonology Department, Hospital del Mar, Hospital del Mar Research Institute, Universitat Pompeu Fabra, CIBERES, (ISCIII), Barcelona, Spain
| | - Alberto García-Ortega
- Pulmonology Department, Hospital Doctor Peset, Fundación para el Fomento de la Investigación Sanitaria de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | | | - Javier de Miguel-Díez
- Pulmonology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Raquel Perez-Rojo
- Pulmonology Department, Hospital Universitario 12 de Octubre, Fundación Investigación Biomédica Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Cano-Pumarega
- Pulmonology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; IRYCIS, Instituto Ramón y Cajal de investigación sanitaria, CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Mora-Cuesta
- Pulmonology Department, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Cantabria, Spain; ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
| | - Isabel Blanco
- Pulmonology Department, Hospital Clínic de Barcelona-FCRB-IDIBAPS, Universitat de Barcelona, Spain; CIBERES, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
| | | | - Roberto Del Pozo
- Pulmonology Department, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Manuel López-Meseguer
- Pulmonology Department, Hospital Vall d'Hebron, Barcelona, CIBERES, Spain; ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
| | - Amaya Martínez-Meñaca
- Pulmonology Department, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Cantabria, Spain; ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
| | - Andrés Tenes
- Pulmonology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; IRYCIS, Instituto Ramón y Cajal de investigación sanitaria, CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Molina-Molina
- Interstitial Lung Diseases Unit (UFIP), Pulmonology Department, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Joan Albert Barberà
- Pulmonology Department, Hospital Clínic de Barcelona-FCRB-IDIBAPS, Universitat de Barcelona, Spain; CIBERES, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Spain
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Almanaa M. Impact of Computerized Physician Order Entry (CPOE) Coupled With Clinical Decision Support (CDS) on Radiologic Services. Cureus 2024; 16:e69470. [PMID: 39411619 PMCID: PMC11479669 DOI: 10.7759/cureus.69470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2024] [Indexed: 10/19/2024] Open
Abstract
Medical imaging is an essential component of healthcare, enabling accurate diagnoses and facilitating effective treatment plans. However, the field is not without its challenges, including medical imaging errors, overutilization of procedures, and adverse reactions to contrast agents. This review explores the impact of computerized physician order entry (CPOE) systems coupled with clinical decision support (CDS) on radiologic services. By analyzing the findings from various studies, this paper highlights how CPOE coupled with CDS can significantly reduce inappropriate imaging, enhance adherence to clinical guidelines, and improve overall patient safety. The implementation of CPOE with CDS optimizes the utilization of radiologic procedures, thereby reducing healthcare costs and minimizing patients' exposure to unnecessary radiation. Despite its benefits, the adoption of CPOE with CDS encounters challenges such as high implementation costs, changes in workflow, and alert fatigue among healthcare providers. Addressing these challenges requires careful system design, including the customization of alerts to reduce override rates and improve the specificity of CDS recommendations. This review underscores the potential of CPOE with CDS to transform radiologic services, enhancing both the quality and safety of patient care. Further research is needed to explore the system's effectiveness in preventing adverse reactions to contrast media and to identify best practices for overcoming the barriers to its broader adoption.
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Affiliation(s)
- Mansour Almanaa
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, SAU
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Garrahy D, Doran S, O'Neill H, Dennan S, Beddy P. Towards 24/7 MRI: the effect of routine weekend inpatient MRI scanning on patient waiting times. Ir J Med Sci 2024; 193:1697-1701. [PMID: 38461226 PMCID: PMC11294432 DOI: 10.1007/s11845-024-03647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/12/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Demand for inpatient MRI outstrips capacity which results in long waiting lists. The hospital commenced a routine weekend MRI service in January 2023. AIM The aim of this study was to investigate the effect of a limited routine weekend MRI service on MRI turnaround times. METHODS Waiting times for inpatient MRI scans performed before and after the introduction of weekend MRI from January 1 to August 31, 2022, and January 1 to August 31, 2023, were obtained. The turnaround time (TAT) and request category for each study were calculated. Category 1 requests were required immediately, category 2 requests were urgent and category 3 requests were routine. RESULTS There was a 6% (n = 128) increase in MRI inpatient scanning activity in 2023 (n = 2449) compared to 2022 (n = 2322). There was a significant improvement in overall mean TAT for inpatient MRIs (p < .001) in 2023 (mean 65.2 h, range 0-555 h) compared to 2022 (mean 98.3 h, range 0-816 h). There was no significant difference in the mean waiting time for category 1 MRIs between 2022 and 2023. There was a significant improvement (p < .001) in mean waiting time in 2023 (mean 37.2 h, range 0-555) compared to 2022 (mean 55.4 h, range 0-816) for category 2 MRI. The mean waiting time for category 3 studies also significantly improved (p < .001) in 2023 (mean 93.4 h, range 1-2663) when compared to 2022 (mean 154.8, range 1-1706). CONCLUSION Routine weekend inpatient MRI significantly shortens inpatient waiting times.
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Affiliation(s)
- Darragh Garrahy
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Simon Doran
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Hazel O'Neill
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Suzanne Dennan
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Peter Beddy
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland.
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Jang JH, Chang C, Manatunga AK, Taylor AT, Long Q. An integrative latent class model of heterogeneous data modalities for diagnosing kidney obstruction. Biostatistics 2024; 25:769-785. [PMID: 37494883 PMCID: PMC11247177 DOI: 10.1093/biostatistics/kxad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023] Open
Abstract
Radionuclide imaging plays a critical role in the diagnosis and management of kidney obstruction. However, most practicing radiologists in US hospitals have insufficient time and resources to acquire training and experience needed to interpret radionuclide images, leading to increased diagnostic errors. To tackle this problem, Emory University embarked on a study that aims to develop a computer-assisted diagnostic (CAD) tool for kidney obstruction by mining and analyzing patient data comprised of renogram curves, ordinal expert ratings on the obstruction status, pharmacokinetic variables, and demographic information. The major challenges here are the heterogeneity in data modes and the lack of gold standard for determining kidney obstruction. In this article, we develop a statistically principled CAD tool based on an integrative latent class model that leverages heterogeneous data modalities available for each patient to provide accurate prediction of kidney obstruction. Our integrative model consists of three sub-models (multilevel functional latent factor regression model, probit scalar-on-function regression model, and Gaussian mixture model), each of which is tailored to the specific data mode and depends on the unknown obstruction status (latent class). An efficient MCMC algorithm is developed to train the model and predict kidney obstruction with associated uncertainty. Extensive simulations are conducted to evaluate the performance of the proposed method. An application to an Emory renal study demonstrates the usefulness of our model as a CAD tool for kidney obstruction.
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Affiliation(s)
- Jeong Hoon Jang
- Quantitative Risk Management, Yonsei University, Incheon 21983, South Korea
| | - Changgee Chang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Amita K Manatunga
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322, USA
| | - Andrew T Taylor
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Qi Long
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
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Al-Ghetaa RK, Alabousi M, You JJ, Emary PC, Riva JJ, Dufton J, Kagoma YK, Rampersaud R, Goytan MJ, Feasby TE, Reed M, Busse JW. Temporal Trends in Spinal Imaging in Ontario (2002-2019) and Manitoba (2001-2011), Canada. Cureus 2024; 16:e63267. [PMID: 39070358 PMCID: PMC11282485 DOI: 10.7759/cureus.63267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background Several studies have reported the overuse of spinal imaging, which, in Canada, led to several provincial pathways aimed at optimizing the use of imaging. We assessed temporal trends in spine imaging in two Canadian provinces. Methods We explored the use of X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) examinations of the cervical, thoracic, and lumbar spine regions among adults in Ontario (April 1, 2002, to March 31, 2019) and in Manitoba, Canada (April 1, 2001, to March 31, 2011) using linked Ontario Health Insurance Plan administrative databases and data from Manitoba Health. We calculated the age- and sex-adjusted rates of spinal X-ray, CT, and MRI examinations by dividing the number of imaging studies by the population of each province for each year and estimated the use of each imaging modality per 100,000 persons. Results The total cost of spine imaging in Ontario increased from $45.8 million in 2002/03 to $70.3 million in 2018/19 (a 54% increase), and in Manitoba from $2.2 million in 2001/02 to $5 million in 2010/11 (a 127% increase). In Ontario, rates of spine X-rays decreased by 12% and spine CT scans decreased by 28% over this time period, while in Manitoba, rates of spine X-rays and CT scans remained constant. Age- and sex-adjusted utilization of spinal MRI scans per 100,000 persons markedly increased over time in both Ontario (277%) and Manitoba (350%). Conclusion Despite efforts to reduce the use of inappropriate spinal imaging, both Ontario and Manitoba have greatly increased utilization of spine MRI in the past two decades.
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Affiliation(s)
- Rayeh K Al-Ghetaa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, CAN
| | | | - John J You
- Medicine, Trillium Health Partners, Mississauga, CAN
| | | | - John J Riva
- Family Medicine, McMaster University, Hamilton, CAN
| | - John Dufton
- Imaging, University Hospital of Northern British Columbia, Prince George, CAN
| | | | | | | | | | - Martin Reed
- Radiology, University of Manitoba, Winnipeg, CAN
| | - Jason W Busse
- Health Research Methodology, McMaster University, Hamilton, CAN
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Horný M, Chang D, Christensen EW, Rula EY, Duszak R. Decomposition of medical imaging spending growth between 2010 and 2021 in the US employer-insured population. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae030. [PMID: 38756926 PMCID: PMC10986240 DOI: 10.1093/haschl/qxae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 05/18/2024]
Abstract
Medical imaging, identified as a potential driver of unsustainable US health care spending growth, was subject to policies to reduce prices and use in low-value settings. Meanwhile, the Affordable Care Act increased access to preventive services-many involving imaging-for employer-sponsored insurance (ESI) beneficiaries. We used a large insurance claims database to examine imaging spending trends in the ESI population between 2010 and 2021-a period of considerable policy and benefits changes. Nominal spending on imaging increased 35.9% between 2010 and 2021, but as a share of total health care spending fell from 10.5% to 8.9%. The 22.5% growth of nominal imaging prices was below inflation, 24.3%, as measured by the Consumer Price Index. Other key contributors to imaging spending growth were increased use (7.4 percentage points [pp]), shifts toward advanced modalities (4.0 pp), and demographic changes (3.5 pp). Shifts in care settings and provider network participation resulted in 2.5-pp and 0.3-pp imaging spending decreases, respectively. In sum, imaging spending decreased as a share of all health care spending and relative to inflation, as intended by concurrent cost-containment policies.
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Affiliation(s)
- Michal Horný
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA 30322, United States
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Daniel Chang
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA 30322, United States
| | - Eric W Christensen
- Harvey L. Neiman Health Policy Institute, Reston, VA 20191, United States
- Health Services Management, University of Minnesota, St. Paul, MN 55108, United States
| | - Elizabeth Y Rula
- Harvey L. Neiman Health Policy Institute, Reston, VA 20191, United States
| | - Richard Duszak
- Department of Radiology, School of Medicine, University of Mississippi, Jackson, MS 39216, United States
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Al-Sadawi M, Tao M, Frye J, Dianati-Maleki N, Mann N. The Use of Quality Improvement Interventions in Reducing Rarely Appropriate Cardiac Imaging. Am J Cardiol 2023; 207:349-355. [PMID: 37774477 DOI: 10.1016/j.amjcard.2023.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023]
Abstract
The use of cardiac imaging has become increasingly prevalent over the last decade. Approximately 10% to 15% of noninvasive cardiac imaging is ordered for rarely appropriate indications. The appropriate use criteria (AUC) for cardiac imaging were issued to decrease unnecessary testing and reduce health care costs. However, it remains unclear whether these efforts have been successful. This meta-analysis evaluates whether AUC quality improvement (QI) interventions effectively reduce inappropriate cardiac imaging. Databases were searched for studies reporting QI intervention effect aiming to reduce rarely appropriate noninvasive cardiac imaging based on AUC. Imaging modalities assessed include transthoracic echocardiography, stress echocardiography, and myocardial perfusion imaging. We searched Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The primary end point was a decrease of rarely appropriate testing. The search was not restricted to time or publication status. The literature search identified 2,391 possible studies, 13 studies and 26,557 patients were included. Mean follow-up was 12 months (1 to 60 months). QI interventions were statistically significant in reducing rarely appropriate tests after the intervention compared with the control group (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.41 to 0.64, p <0.01). The QI interventions were also assessed for persistence based on short-term (<3 months) and long-term (>3 months) efficacy. Both the short-term effect and long-term effect were persistent (OR 0.6, 95% CI 0.47 to 0.77, p <0.01 and OR 0.47, 95% CI 0.37 to 0.61, p <0.01, respectively). AUC QI interventions are associated with the successful decrease of inappropriate noninvasive cardiac testing with these effects persisting over time.
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Affiliation(s)
- Mohammed Al-Sadawi
- Department of Cardiovascular Medicine, University of Michigan Hospital, Ann Arbor, Michigan.
| | - Michael Tao
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
| | - Jesse Frye
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
| | - Neda Dianati-Maleki
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
| | - Noelle Mann
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
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Huang W, Zhang H, Cheng Y, Quan X. DRCM: a disentangled representation network based on coordinate and multimodal attention for medical image fusion. Front Physiol 2023; 14:1241370. [PMID: 38028809 PMCID: PMC10656763 DOI: 10.3389/fphys.2023.1241370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Recent studies on medical image fusion based on deep learning have made remarkable progress, but the common and exclusive features of different modalities, especially their subsequent feature enhancement, are ignored. Since medical images of different modalities have unique information, special learning of exclusive features should be designed to express the unique information of different modalities so as to obtain a medical fusion image with more information and details. Therefore, we propose an attention mechanism-based disentangled representation network for medical image fusion, which designs coordinate attention and multimodal attention to extract and strengthen common and exclusive features. First, the common and exclusive features of each modality were obtained by the cross mutual information and adversarial objective methods, respectively. Then, coordinate attention is focused on the enhancement of the common and exclusive features of different modalities, and the exclusive features are weighted by multimodal attention. Finally, these two kinds of features are fused. The effectiveness of the three innovation modules is verified by ablation experiments. Furthermore, eight comparison methods are selected for qualitative analysis, and four metrics are used for quantitative comparison. The values of the four metrics demonstrate the effect of the DRCM. Furthermore, the DRCM achieved better results on SCD, Nabf, and MS-SSIM metrics, which indicates that the DRCM achieved the goal of further improving the visual quality of the fused image with more information from source images and less noise. Through the comprehensive comparison and analysis of the experimental results, it was found that the DRCM outperforms the comparison method.
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Affiliation(s)
| | - Han Zhang
- College of Artificial Intelligence, Nankai University, Tianjin, China
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Zhao H, Liu Z, Tang J, Gao B, Qin Q, Li J, Zhou Y, Yao P, Xi Y, Lin Y, Qian H, Wu H. Energy-efficient high-fidelity image reconstruction with memristor arrays for medical diagnosis. Nat Commun 2023; 14:2276. [PMID: 37081008 PMCID: PMC10119144 DOI: 10.1038/s41467-023-38021-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
Medical imaging is an important tool for accurate medical diagnosis, while state-of-the-art image reconstruction algorithms raise critical challenges in massive data processing for high-speed and high-quality imaging. Here, we present a memristive image reconstructor (MIR) to greatly accelerate image reconstruction with discrete Fourier transformation (DFT) by computing-in-memory (CIM) with memristor arrays. A high-accuracy quasi-analogue mapping (QAM) method and generic complex matrix transfer (CMT) scheme was proposed to improve the mapping precision and transfer efficiency, respectively. High-fidelity magnetic resonance imaging (MRI) and computed tomography (CT) image reconstructions were demonstrated, achieving software-equivalent qualities and DICE scores after segmentation with nnU-Net algorithm. Remarkably, our MIR exhibited 153× and 79× improvements in energy efficiency and normalized image reconstruction speed, respectively, compared to graphics processing unit (GPU). This work demonstrates MIR as a promising high-fidelity image reconstruction platform for future medical diagnosis, and also largely extends the application of memristor-based CIM beyond artificial neural networks.
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Affiliation(s)
- Han Zhao
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Zhengwu Liu
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Jianshi Tang
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China.
- Beijing Innovation Center for Future Chips (ICFC), Tsinghua University, Beijing, 100084, China.
| | - Bin Gao
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
- Beijing Innovation Center for Future Chips (ICFC), Tsinghua University, Beijing, 100084, China
| | - Qi Qin
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Jiaming Li
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Ying Zhou
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Peng Yao
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Yue Xi
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Yudeng Lin
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - He Qian
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
- Beijing Innovation Center for Future Chips (ICFC), Tsinghua University, Beijing, 100084, China
| | - Huaqiang Wu
- School of Integrated Circuits, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
- Beijing Innovation Center for Future Chips (ICFC), Tsinghua University, Beijing, 100084, China
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Pourvaziri A, Mojtahed A, Hahn PF, Gee MS, Kambadakone A, Sahani DV. Renal lesion characterization: clinical utility of single-phase dual-energy CT compared to MRI and dual-phase single-energy CT. Eur Radiol 2023; 33:1318-1328. [PMID: 36074261 DOI: 10.1007/s00330-022-09106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the impact of dual-energy CT (DECT) utilization in practice by measuring the readers' confidence, the need for additional image requests, and diagnostic performance in renal lesion assessment, compared to single-energy CT (SECT) using contrast-enhanced MRI to establish the reference standard. MATERIALS AND METHODS Sixty-nine patients (M/F = 47/22) who underwent a dual-phase renal SECT (n = 34) or DECT (n = 35) and had a contrast-enhanced MRI within 180 days were retrospectively collected. Three radiologists assessed images on different sessions (SECT, DECT, and MRI) for (1) likely diagnosis (enhancing/non-enhancing); (2) diagnostic confidence (5-point Likert scale); (3) need for additional imaging test (yes/no); and (4) need for follow-up imaging (yes/no). Diagnostic accuracy was compared using AUC; p value < 0.05 was considered significant. RESULTS One hundred fifty-six lesions consisting of 18% enhancing (n = 28/156, mean size: 30.37 mm, range: 9.9-94 mm) and 82% non-enhancing (n = 128/156, mean size: 23.91 mm, range: 5.0-94.2 mm) were included. The confidence level was significantly lower for SECT than their MRI (4.50 vs. 4.80, p value < 0.05) but not significantly different for DECT and the corresponding MRI (4.78 vs. 4.78, p > 0.05). There were significantly more requests for additional imaging in the SECT session than the corresponding MRI (20% vs. 4%), which was not significantly different between DECT and their MRI counterpart session (5.7% vs. 4.9%). Inter-reader agreement was almost perfect for DECT and MRI (kappa: 0.8-1) and substantial in SECT sessions (kappa: 0.6-0.8) with comparable diagnostic accuracy between SECT, DECT, and MRI (p value > 0.05). CONCLUSION Single-phase DECT allows confident and reproducible characterization of renal masses with fewer recommendation for additional and follow-up imaging tests than dual-phase SECT and a performance similar to MRI. KEY POINTS • DECT utilization leads to similar additional image requests to MRI (5.7% vs. 4.9%, p value > 0.05), whereas single-energy CT utilization leads to significantly higher image requests (20% vs. 4%, p value < 0.05). • DECT and MRI utilization bring highly reproducible results with almost perfect inter-reader agreement (kappa: 0.8-1), better than the inter-reader agreement in SECT utilization (kappa: 0.6-0.8). • Readers' confidence was not significantly altered between DECT and their MRI readout session (p value > 0.05). In contrast, confidence in the diagnosis was significantly lower in the SECT session than their MRI readout (p value < 0.05).
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Affiliation(s)
- Ali Pourvaziri
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA.
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
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12
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Koenig S, Morcos G, Gopinath R, Wang K, Henn F, Leong NL. Is MRI Overutilized for Evaluation of Knee Pain in Veterans? J Knee Surg 2023; 36:305-309. [PMID: 34474493 PMCID: PMC9925228 DOI: 10.1055/s-0041-1733880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
MRI is an essential diagnostic imaging modality for many knee conditions; however, it is not indicated in the setting of advanced knee arthritis. Inappropriate MRI imaging adds to health care costs and may delay definitive management for many patients. The primary purpose of this study was to ascertain the frequency of inappropriate MRI scans performed at one Veterans' Administration Medical Center (VAMC). We performed a retrospective chart review of all knee MRIs ordered over a 6-month period. Inappropriate MRI was defined as MRI performed prior to radiographs (XRs), or in the presence of XRs demonstrating severe osteoarthritis, without leading to a nonarthroplasty procedure of the knee. Of the 304 cases reviewed, 36.8% (112) of the MRIs were deemed inappropriate, 33 were ordered by orthopedists, and 79 were ordered by other health care providers. Of the 33 ordered by orthopedists, 25 were ordered by retired/nonsurgical orthopedists. Obtaining an MRI delayed care by an average of 29.2 days. Of the 252 cases that had XR prior to MRI, none included all four views in the standard knee XR series and only four had weightbearing images. Over a third of knee MRIs performed at this VAMC were inappropriate and delayed care. Additionally, no XRs in our study contained all the necessary views to properly assess knee arthritis. These concerning findings signify a potential opportunity for education in diagnostic strategies, to better patient care and resource utilization in the VAMC.
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Affiliation(s)
- Scott Koenig
- University of Maryland School of Medicine, Orthopaedics, Baltimore, Maryland
| | - George Morcos
- University of Maryland School of Medicine, Orthopaedics, Baltimore, Maryland
| | - Rohan Gopinath
- University of Maryland School of Medicine, Orthopaedics, Baltimore, Maryland
| | - Kenneth Wang
- Department of Radiology, Veterans Affairs Commission, Baltimore, Maryland
| | - Frank Henn
- University of Maryland School of Medicine, Orthopaedics, Baltimore, Maryland
| | - Natalie L. Leong
- University of Maryland School of Medicine, Orthopaedics, Baltimore, Maryland
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13
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Irkham I, Ibrahim AU, Nwekwo CW, Al-Turjman F, Hartati YW. Current Technologies for Detection of COVID-19: Biosensors, Artificial Intelligence and Internet of Medical Things (IoMT): Review. SENSORS (BASEL, SWITZERLAND) 2022; 23:426. [PMID: 36617023 PMCID: PMC9824404 DOI: 10.3390/s23010426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Despite the fact that COVID-19 is no longer a global pandemic due to development and integration of different technologies for the diagnosis and treatment of the disease, technological advancement in the field of molecular biology, electronics, computer science, artificial intelligence, Internet of Things, nanotechnology, etc. has led to the development of molecular approaches and computer aided diagnosis for the detection of COVID-19. This study provides a holistic approach on COVID-19 detection based on (1) molecular diagnosis which includes RT-PCR, antigen-antibody, and CRISPR-based biosensors and (2) computer aided detection based on AI-driven models which include deep learning and transfer learning approach. The review also provide comparison between these two emerging technologies and open research issues for the development of smart-IoMT-enabled platforms for the detection of COVID-19.
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Affiliation(s)
- Irkham Irkham
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Padjadjaran University, Bandung 40173, Indonesia
| | | | - Chidi Wilson Nwekwo
- Department of Biomedical Engineering, Near East University, Mersin 99138, Turkey
| | - Fadi Al-Turjman
- Research Center for AI and IoT, Faculty of Engineering, University of Kyrenia, Mersin 99138, Turkey
- Artificial Intelligence Engineering Department, AI and Robotics Institute, Near East University, Mersin 99138, Turkey
| | - Yeni Wahyuni Hartati
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Padjadjaran University, Bandung 40173, Indonesia
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14
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Strom JB, Zhao Y, Shen C, Wasfy JH, Xu J, Yucel E, Tanguturi V, Hyland PM, Markson LJ, Kazi DS, Cui J, Hung J, Yeh RW, Manning WJ. Development and validation of an echocardiographic algorithm to predict long-term mitral and tricuspid regurgitation progression. Eur Heart J Cardiovasc Imaging 2022; 23:1606-1616. [PMID: 34849685 PMCID: PMC9989598 DOI: 10.1093/ehjci/jeab254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Prediction of mitral (MR) and tricuspid (TR) regurgitation progression on transthoracic echocardiography (TTE) is needed to personalize valvular surveillance intervals and prognostication. METHODS AND RESULTS Structured TTE report data at Beth Israel Deaconess Medical Center, 26 January 2000-31 December 2017, were used to determine time to progression (≥1+ increase in severity). TTE predictors of progression were used to create a progression score, externally validated at Massachusetts General Hospital, 1 January 2002-31 December 2019. In the derivation sample (MR, N = 34 933; TR, N = 27 526), only 5379 (15.4%) individuals with MR and 3630 (13.2%) with TR had progression during a median interquartile range) 9.0 (4.1-13.4) years of follow-up. Despite wide inter-individual variability in progression rates, a score based solely on demographics and TTE variables identified individuals with a five- to six-fold higher rate of MR/TR progression over 10 years (high- vs. low-score tertile, rate of progression; MR 20.1% vs. 3.3%; TR 21.2% vs. 4.4%). Compared to those in the lowest score tertile, those in the highest tertile of progression had a four-fold increased risk of mortality. On external validation, the score demonstrated similar performance to other algorithms commonly in use. CONCLUSION Four-fifths of individuals had no progression of MR or TR over two decades. Despite wide interindividual variability in progression rates, a score, based solely on TTE parameters, identified individuals with a five- to six-fold higher rate of MR/TR progression. Compared to the lowest tertile, individuals in the highest score tertile had a four-fold increased risk of mortality. Prediction of long-term MR/TR progression is not only feasible but prognostically important.
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Affiliation(s)
- Jordan B Strom
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yuansong Zhao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Changyu Shen
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jason H Wasfy
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jiaman Xu
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Evin Yucel
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Varsha Tanguturi
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick M Hyland
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Lawrence J Markson
- Harvard Medical School, Boston, MA, USA
- Information Systems, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dhruv S Kazi
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jinghan Cui
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Judy Hung
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert W Yeh
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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15
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Sapadin J, Campbell L, Bajaj K, Moskovitz JB. Reducing thoracic and lumbar radiographs in an urban emergency department through a clinical champion led quality improvement intervention. BMC Emerg Med 2022; 22:69. [PMID: 35488199 PMCID: PMC9052451 DOI: 10.1186/s12873-022-00611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain is a common emergency department (ED) complaint that does not always necessitate imaging. Unnecessary imaging drives medical overuse with potential to harm patients. Quality improvement (QI) interventions have shown to be an effective solution. The purpose of this QI intervention was to increase the percentage of appropriately ordered radiographs for low back pain while reducing the absolute number. Methods A multi-component intervention led by a clinician champion including staff education, patient education, electronic medical record modification, audit and peer-feedback, and clinical decision support tools was implemented at an urban public hospital Emergency Department. In addition to the total number ordered, Choosing Wisely and American College of Radiology recommendations were used to assess appropriateness of all ED thoracic and lumbar conventional radiographs by chart review over eight months. Results The percent of appropriately ordered radiographs increased from 5.8 to 53.9% and the monthly number of radiographs ordered decreased from 86 to 47 over the eight-month initiative. There were no compensatory increases in thoracic or lumbar computed tomography (CT) scans during this time frame. Conclusion A multi-component QI intervention led by a clinician champion is an effective way to reduce the overutilization of thoracic and lumbar radiographs in an urban public hospital emergency department.
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Affiliation(s)
- Joshua Sapadin
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA
| | - Linelle Campbell
- Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Komal Bajaj
- Department of Obstetrics and Gynecology, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Joshua B Moskovitz
- Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA. .,Department of Public Health, Hofstra University School of Health Sciences, Hempstead NY 11549 College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA.
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16
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Lam DH, Tiwana J, Li S, Kirkpatrick JN, Cheng RK. Appropriate use of multimodality stress testing for chest pain in new patient referrals to cardiologists. Coron Artery Dis 2021; 32:184-190. [PMID: 32804780 DOI: 10.1097/mca.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In response to the growing use of imaging-based cardiac stress tests in the evaluation of stable ischemic heart disease, professional societies have developed appropriate use criteria (AUC). AUC will soon be linked to reimbursement of advanced diagnostic imaging for Medicare beneficiaries via Clinical Decision Support Mechanisms (CDSMs). We sought to characterize the frequency and type of stress test utilization for chest pain referrals evaluated by cardiologists and determine appropriateness. METHODS We conducted a retrospective review of new patient referrals seen by general cardiologists at an academic medical center between 2016 and 2017 for a diagnosis of chest pain or angina. Type of stress test ordered, if any, and its appropriateness (Appropriate, May be appropriate, and Rarely appropriate) were ascertained based on the 2013 multimodality AUC guideline document. RESULTS There were 535 total outpatients. After applying exclusion criteria, there were 349 patients in the sample; the average age was 52 ± 15 years and 53% were female. Most chest pain was nonanginal (65%). Pretest probability of CAD was most commonly intermediate (54%). A total of 183 patients (52%) were referred for stress testing. The majority of stress tests were considered appropriate (82%) by AUC. CONCLUSION Most patients referred to cardiologists for evaluation of chest pain or angina had nonanginal chest pain and an intermediate pretest probability of CAD. Stress testing was ordered in about half of these patients and the majority were considered appropriate by AUC. These findings suggest that indiscriminate use of CDSMs may not be warranted.
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Affiliation(s)
- David H Lam
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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17
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Barrera CA, Otero HJ, Fenlon EP, Francavilla ML, Ellison AM, Kaplan SL. CTA utilization for evaluation of suspected pulmonary embolism in a tertiary pediatric emergency department. Clin Imaging 2021; 75:105-110. [PMID: 33524937 DOI: 10.1016/j.clinimag.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/01/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate changes in the utilization of computed tomography angiography (CTA) for evaluating suspected pulmonary embolism (PE) and the positive rate of ancillary for those studies negative for PE in the last 13 years. MATERIALS AND METHODS A retrospective review of patient ≤ 20 years of age who underwent a chest CT angiography to rule out PE was performed in a 13-year-period. CT angiographies were grouped into three categories: Positive for PE, negative for PE and positive for ancillary findings, and negative for any pathology. From the exams with ancillary findings, we examined how many of these had a chest radiograph perform within 24 h prior to the CTA and how many of them had an impression stating the same conclusion as the CTA. RESULTS 307 chest CT angiographies for suspected PE were included. 50 (16%) were reported as positive for PE and 91 (30%) were negative for PE but positive for ancillary findings. The most frequent ancillary findings were pneumonia (n = 26) and pleural effusion (n = 11). Out of 91, 73 patients had a previous chest radiograph and 28 of them reported a similar diagnosis than the CTA. The number of CT angiographies indicated for PE increased by 3.2 studies per year. The rate of CT angiographies positive for ancillary findings (slope = 1.5) and positive for PE (slope = 0.3) remained similar throughout the same period. CONCLUSIONS CTA orders for PE have been increasing without any increased detection of PE or ancillary findings in children.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States of America.
| | - Hansel J Otero
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States of America
| | - Edward P Fenlon
- Department of Radiology, Columbia University Medical Center, 630 W 168th St, MC 28, New York, NY 10032, United States of America
| | - Michael L Francavilla
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States of America
| | - Angela M Ellison
- Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Summer L Kaplan
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States of America
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18
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Halpern DJ, Clark-Randall A, Woodall J, Anderson J, Shah K. Reducing Imaging Utilization in Primary Care Through Implementation of a Peer Comparison Dashboard. J Gen Intern Med 2021; 36:108-113. [PMID: 32885372 PMCID: PMC7859117 DOI: 10.1007/s11606-020-06164-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND High clinical variation has been linked to decreased quality of care, increased costs, and decreased patient satisfaction. We present the implementation and analysis of a peer comparison intervention to reduce clinical variation within a large primary care network. OBJECTIVE Evaluate existing variation in radiology ordering within a primary care network and determine whether peer comparison feedback reduces variation or changes practice patterns. DESIGN Radiology ordering data was analyzed to evaluate baseline variation in imaging rates. A utilization dashboard was shared monthly with providers for a year, and imaging rates pre- and post-intervention were retrospectively analyzed. PARTICIPANTS Providers within the primary care network spanning 1,358,644 outpatient encounters and 159 providers over a 3-year period. INTERVENTIONS The inclusion of radiology utilization data as part of a provider's monthly quality and productivity dashboards. This information allows providers to compare their practice patterns with those of their colleagues. MAIN MEASURES We measured provider imaging rates, stratified by modality, as well as order variation over time. KEY RESULTS We observed significant variation in imaging rates among providers in the network, with the top decile ordering an average of 4.2 times more than the lowest decile in the two years prior to intervention. Provider experience and training were not significantly associated with imaging utilization. In the first year after sharing utilization data with providers, we saw a 17.3% decrease in median imaging rate (p < 0.001) and a 21.4% reduction in provider variation between top and bottom deciles. Median ordering rate for more costly cross-sectional imaging, including CT, MRI, and nuclear medicine studies, decreased by 30.4% (p < 0.001), 20.2% (p = 0.008), and 41.8% (p = 0.002), respectively. CONCLUSIONS Peer comparison feedback can shape provider imaging behavior even in the absence of targets or financial incentives. Peer comparison is a low-touch, low-cost intervention for influencing provider ordering and may have applicability in other clinical areas.
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Affiliation(s)
- David J Halpern
- Duke University, Durham, NC, USA. .,Duke Primary Care, Durham, NC, USA.
| | | | | | - John Anderson
- Duke University, Durham, NC, USA.,Duke Primary Care, Durham, NC, USA
| | - Kevin Shah
- Duke University, Durham, NC, USA.,Duke Primary Care, Durham, NC, USA
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19
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Pritchard C, Porters S, Rosenorn-Lanng E, Williams R. Mortality in the USA, the UK and Other Western Countries, 1989-2015: What Is Wrong With the US? INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2021; 51:59-66. [PMID: 33059529 PMCID: PMC7756066 DOI: 10.1177/0020731420965130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This population-based study compares U.S. effectiveness with 20 Other Western Countries (OWC) in reducing mortality 1989-1991 and 2013-2015 and, responding to criticisms of Britain's National Health Service, directly compares U.S. with U.K. child (0-4), adult (55-74), and 24 global mortality categories. World Health Organization Age-Standardized Death Rates (ASDR) data are used to compare American and OWC mortality over the period, juxtaposed against national average percentages of Gross Domestic Product (GDP) Expenditure on Health (%GDPEH) drawn from World Bank data. America's average %GDPEH was highest at 13.53% and Britain's the lowest at 7.68%. Every OWC had significantly greater ASDR reductions than America. Current U.S. child and adult mortality rates are 46% and 19% higher than Britain's. Of 24 global diagnostic mortalities, America had 16 higher rates than Britain, notably for Circulatory Disease (24%), Endocrine Disorders (70%), External Deaths (53%), Genitourinary (44%), Infectious Disease (65%), and Perinatal Deaths (34%). Conversely, U.S. rates were lower than Britain's for Neoplasms (11%), Respiratory (12%), and Digestive Disorder Deaths (11%). However, had America matched the United Kingdom's ASDR, there would have been 488,453 fewer U.S. deaths. In view of American %GDPHE and their mortality rates, which were significantly higher than those of the OWC, these results suggests that the U.S. health care system is the least efficient in the Western world.
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Affiliation(s)
- Colin Pritchard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sam Porters
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Richard Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Park JC, Park JG, Jung GS, Kang H, Jun S. Usefulness of 18F-FDG PET/CT and Multiphase CT in the Differential Diagnosis of Hepatocellular Carcinoma and Combined Hepatocellular Carcinoma-Cholangiocarcinoma. TAEHAN YONGSANG UIHAKHOE CHI 2020; 81:1424-1435. [PMID: 36237710 PMCID: PMC9431843 DOI: 10.3348/jksr.2019.0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/12/2019] [Accepted: 01/28/2020] [Indexed: 05/31/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of multiphasic CT and 18F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC). MATERIALS AND METHODS From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement). RESULTS cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern. CONCLUSION The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18F-FDG PET/CT can be useful for the differentiation of cHCC-CCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.
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21
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Wong CK, Hai J, Chan KYE, Un KC, Zhou M, Huang D, Cheng YY, Li WH, Yin LX, Yue WS, Tse HF, Yeung P, Yip PS, Li VKS, Chan A, Cheung M, Cheung CW, Lau CP, Siu CW. Point-of-care ultrasound augments physical examination learning by undergraduate medical students. Postgrad Med J 2020; 97:10-15. [PMID: 33055193 DOI: 10.1136/postgradmedj-2020-137773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/14/2020] [Accepted: 06/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the impact of the provision of handheld point-of-care ultrasound (POCUS) devices on physical examination skills of medical students. METHODS We describe an educational initiative that comprised a POCUS workshop followed by allocation of a POCUS device to medical students for use over the subsequent 8 weeks. They were encouraged to scan patients and correlate their physical examination findings. A mobile instant messaging group discussion platform was set to provide feedback from instructors. Physical examination skills were assessed by means of clinical examination. RESULTS 210 final-year medical students from the University of Hong Kong participated in the programme. 46.3% completed the end of programme electronic survey: 74.6% enjoyed using the POCUS device, 50.0% found POCUS useful to validate physical examination findings and 47.7% agreed that POCUS increased their confidence with physical examination. 93.9% agreed that the programme should be incorporated into the medical curriculum and 81.9% would prefer keeping the device for longer time from 16 weeks (45.6%) to over 49 weeks (35.3%). Medical students who participated in the POCUS programme had a higher mean score for abdominal examination compared with those from the previous academic year with no POCUS programme (3.65±0.52 vs 3.21±0.80, p=0.014), but there was no statistically significant difference in their mean score for cardiovascular examination (3.62±0.64 vs 3.36±0.93, p=0.203). CONCLUSION The POCUS programme that included provision of a personal handheld POCUS device improved students' attitude, confidence and ability to perform a physical examination.
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Affiliation(s)
- Chun Ka Wong
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - JoJo Hai
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kwong Yue Eric Chan
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ka Chun Un
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mi Zhou
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Duo Huang
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Affiliated Hospital of North Sichuan Medical College and Medical Imaging Key Laboratory, Nanchong, China
| | - Yang Yang Cheng
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wen Hua Li
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Echocardiography, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Li Xue Yin
- Department of Echocardiography, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Wen Sheng Yue
- Affiliated Hospital of North Sichuan Medical College and Medical Imaging Key Laboratory, Nanchong, China
| | - Hung Fat Tse
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Pauline Yeung
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Pok Siu Yip
- Department of Medicine, Tung Wah Hospital, Hong Kong, Hong Kong SAR, China
| | | | - Arren Chan
- Department of Radiology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Michelle Cheung
- Department of Radiology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Chi Wai Cheung
- Department of Radiology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Chu Pak Lau
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chung Wah Siu
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
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22
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Tambe J, Mbuagbaw L, Nguefack-Tsague G, Foyet J, Ongolo-Zogo P. Multidetector computed tomography utilization in an urban sub-Saharan Africa setting: user characteristics, indications and appropriateness. Pan Afr Med J 2020; 37:42. [PMID: 33209169 PMCID: PMC7648473 DOI: 10.11604/pamj.2020.37.42.21176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 08/28/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction multidetector computed tomography (MDCT) is a widely used cross-sectional imaging modality despite increasing concerns about radiation exposure and overuse. The aim of this study was to describe the socio-demographic characteristics of MDCT users in an urban city in Cameroon and to assess the clinical indications for appropriateness. Methods we conducted a survey of MDCT users and collected data on demographic attributes and socialization patterns, clinical indications for MDCT and time to obtain MDCT. MDCT appropriateness was assessed using the American College of Radiologists Appropriateness Criteria®. Frequencies, percentages, odds ratios and 95% confidence intervals were used to summarize the data. Results with a response rate of 79%, 511 MDCT users were surveyed. The mean (standard deviation) age was 45(19) years and male to female sex ratio 1:1. Seventy-eight percent (95% confidence interval [CI]: 74-83%) of respondents reported not having any health insurance. Head scans accounted for 52% (95%CI: 47-56%) of all scans with trauma (19% [95%CI: 15-22%]), low back pain (18% [95%CI: 14-21%]) and suspected stroke (10% [95%CI: 7-13%]) being the most frequent indications. Sixteen percent (95%CI: 13-20%) of the scans were judged to be inappropriate. Predictors of MDCT appropriateness after multivariable logistic regression modeling were age (aOR=0.97; P=0.009; 95%CI=0.94-0.99), health insurance ownership (aOR=0.40; P=0.034; 95%CI=0.18-0.94) and being referred by non-specialist physicians (aOR=0.20; P<0.001; 95%CI=0.09-0.47). Conclusion people from all social strata use MDCT, mostly appropriately and especially for head scans after trauma in this urban setting. However, the proportion of inappropriate studies was considerable suggesting the need for control measures.
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Affiliation(s)
- Joshua Tambe
- Post-Graduate School for Life Sciences, Health and Environment, The University of Yaoundé I, Yaoundé, Cameroon.,Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.,Division of Radiology, University of Buea, Buea, Cameroon
| | - Lawrence Mbuagbaw
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, Canada
| | - Georges Nguefack-Tsague
- Biostatistics Unit, Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Joseph Foyet
- Deido Radiology and Ultrasonography Centre, Douala, Cameroon
| | - Pierre Ongolo-Zogo
- Post-Graduate School for Life Sciences, Health and Environment, The University of Yaoundé I, Yaoundé, Cameroon.,Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
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Munn Z, McArthur A, Mander GTW, Steffensen CJ, Jordan Z. The only constant in radiography is change: A discussion and primer on change in medical imaging to achieve evidence-based practice. Radiography (Lond) 2020; 26 Suppl 2:S3-S7. [PMID: 32713823 DOI: 10.1016/j.radi.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
Medical imaging is an ever changing field with significant advancements in techniques and technologies over the years. Despite being constantly challenged by change, it can be difficult to introduce changes into healthcare settings. In this article we introduce the principles of change management to achieve an evidence-based practice in radiography.
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Affiliation(s)
- Z Munn
- JBI, University of Adelaide, Australia.
| | | | - G T W Mander
- Dept Medical Imaging, Toowoomba Hospital, Darling Downs Health, QLD Health, Australia
| | | | - Z Jordan
- JBI, University of Adelaide, Australia
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24
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Goyal A, Pagidipati N, Hill CL, Alhanti B, Udelson JE, Picard MH, Pellikka PA, Hoffmann U, Mark DB, Douglas PS. Clinical and Economic Implications of Inconclusive Noninvasive Test Results in Stable Patients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. Circ Cardiovasc Imaging 2020; 13:e009986. [PMID: 32268807 DOI: 10.1161/circimaging.119.009986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inconclusive noninvasive tests complicate the care of patients with suspected coronary artery disease, but their prevalence and impact on management, outcomes, and costs are not well described. METHODS PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) patients were randomized to stress testing (n=4533) or computed tomographic angiography (CTA; n=4677). We assessed relationships between inconclusive results, subsequent testing, a composite outcome (death, myocardial infarction, or hospitalization for unstable angina), and healthcare expenditures. RESULTS Overall, 8.0% of tests were inconclusive (9.7% stress, 6.4% CTA). Compared with negative tests, inconclusive tests were more often referred to a second noninvasive test (stress: 14.6% versus 8.5%, odds ratio [OR], 1.91; CTA: 36.5% versus 8.4%, OR, 5.95; P<0.001) and catheterization (stress: 5.5% versus 2.4%, OR, 2.36; CTA: 23.4% versus 4.1%, OR, 6.49; P<0.001), and composite outcomes were higher for both inconclusive tests (stress: 3.7% versus 2.0%, hazard ratio, 1.81, P=0.034; CTA: 5.0% versus 2.2%, hazard ratio, 1.85; P=0.044) and positive tests (stress: 8.3% versus 2.0%, hazard ratio, 3.50; CTA: 9.2% versus 2.2%, hazard ratio, 3.66; P<0.001). Twenty-four-month costs were higher for inconclusive tests than negative tests by $2905 (stress) and $4030 (CTA). CONCLUSIONS Among patients with stable chest pain undergoing a noninvasive test, inconclusive results occurred in 6% of CTA and 10% of stress tests. Compared with those with conclusive negative tests, individuals with inconclusive results more often underwent subsequent testing, had increased medical costs, and experienced worse outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01174550.
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Affiliation(s)
- Akash Goyal
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Neha Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - James E Udelson
- Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U.)
| | - Michael H Picard
- Department of Cardiology (M.H.P.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Udo Hoffmann
- Department of Radiology (U.H.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.G., N.P., C.L.H., B.A., D.B.M., P.S.D.)
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25
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Hynes JP, Hunter K, Rochford M. Utilization and appropriateness in cervical spine trauma imaging: implementation of clinical decision support criteria. Ir J Med Sci 2020; 189:333-336. [DOI: 10.1007/s11845-019-02059-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/02/2019] [Indexed: 11/30/2022]
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26
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Chang C, Jang JH, Manatunga A, Taylor AT, Long Q. A Bayesian Latent Class Model to Predict Kidney Obstruction in the Absence of Gold Standard. J Am Stat Assoc 2020; 115:1645-1663. [PMID: 34113054 DOI: 10.1080/01621459.2019.1689983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Kidney obstruction, if untreated in a timely manner, can lead to irreversible loss of renal function. A widely used technology for evaluations of kidneys with suspected obstruction is diuresis renography. However, it is generally very challenging for radiologists who typically interpret renography data in practice to build high level of competency due to the low volume of renography studies and insufficient training. Another challenge is that there is currently no gold standard for detection of kidney obstruction. Seeking to develop a computer-aided diagnostic (CAD) tool that can assist practicing radiologists to reduce errors in the interpretation of kidney obstruction, a recent study collected data from diuresis renography, interpretations on the renography data from highly experienced nuclear medicine experts as well as clinical data. To achieve the objective, we develop a statistical model that can be used as a CAD tool for assisting radiologists in kidney interpretation. We use a Bayesian latent class modeling approach for predicting kidney obstruction through the integrative analysis of time-series renogram data, expert ratings, and clinical variables. A nonparametric Bayesian latent factor regression approach is adopted for modeling renogram curves in which the coefficients of the basis functions are parameterized via the factor loadings dependent on the latent disease status and the extended latent factors that can also adjust for clinical variables. A hierarchical probit model is used for expert ratings, allowing for training with rating data from multiple experts while predicting with at most one expert, which makes the proposed model operable in practice. An efficient MCMC algorithm is developed to train the model and predict kidney obstruction with associated uncertainty. We demonstrate the superiority of the proposed method over several existing methods through extensive simulations. Analysis of the renal study also lends support to the usefulness of our model as a CAD tool to assist less experienced radiologists in the field.
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Affiliation(s)
- Changgee Chang
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Jeong Hoon Jang
- Department of Biostatistics and Bioinformatics, Emory University
| | - Amita Manatunga
- Department of Biostatistics and Bioinformatics, Emory University
| | - Andrew T Taylor
- Department of Radiology and Imaging Sciences, Emory University
| | - Qi Long
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
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27
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Strom JB, Tanguturi VK, Nagueh SF, Klein AL, Manning WJ. Demonstrating the Value of Outcomes in Echocardiography: Imaging-Based Registries in Improving Patient Care. J Am Soc Echocardiogr 2019; 32:1608-1614. [PMID: 31563437 PMCID: PMC6899196 DOI: 10.1016/j.echo.2019.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jordan B Strom
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Varsha K Tanguturi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sherif F Nagueh
- Department of Cardiology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - Allan L Klein
- The Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Sandoval GA, Brown AD, Wodchis WP, Anderson GM. The relationship between hospital adoption and use of high technology medical imaging and in-patient mortality and length of stay. J Health Organ Manag 2019; 33:286-303. [PMID: 31122120 DOI: 10.1108/jhom-08-2018-0232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI) machines and in-patient mortality and length of stay. DESIGN/METHODOLOGY/APPROACH This study used panel data (2007-2010) from 124 hospital corporations operating in Ontario, Canada. Imaging use focused on medical patients accounting for 25 percent of hospital discharges. Main outcomes were in-hospital mortality rates and average length of stay. A model for each outcome-technology combination was built, and controlled for hospital structural characteristics, market factors and patient characteristics. FINDINGS In 2010, 36 and 59 percent of hospitals had adopted MRI machines and CT scanners, respectively. Approximately 23.5 percent of patients received CT scans and 3.5 percent received MRI scans during the study period. Adoption of these technologies was associated with reductions of up to 1.1 percent in mortality rates and up to 4.5 percent in length of stay. The imaging use-mortality relationship was non-linear and varied by technology penetration within hospitals. For CT, imaging use reduced mortality until use reached 19 percent in hospitals with one scanner and 28 percent in hospitals with 2+ scanners. For MRI, imaging use was largely associated with decreased mortality. The use of CT scanners also increased length of stay linearly regardless of technology penetration (4.6 percent for every 10 percent increase in use). Adoption and use of MRI was not associated with length of stay. RESEARCH LIMITATIONS/IMPLICATIONS These results suggest that there may be some unnecessary use of imaging, particularly in small hospitals where imaging is contracted out. In larger hospitals, the results highlight the need to further investigate the use of imaging beyond certain thresholds. Independent of the rate of imaging use, the results also indicate that the presence of CT and MRI devices within a hospital benefits quality and efficiency. ORIGINALITY/VALUE To the authors' knowledge, this study is the first to investigate the combined effect of adoption and use of medical imaging on outcomes specific to CT scanners and MRI machines in the context of hospital in-patient care.
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Affiliation(s)
- Guillermo A Sandoval
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
| | - Adalsteinn D Brown
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
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Mendoza D, Bertino FJ. Why Radiology Residents Experience Burnout and How to Fix It. Acad Radiol 2019; 26:555-558. [PMID: 30243891 DOI: 10.1016/j.acra.2018.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
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Elsamadicy AA, Lubkin DT, Sergesketter AR, Adil SM, Charalambous LT, Drysdale N, Williamson T, Camara-Quintana J, Abd-El-Barr MM, Goodwin CR, Karikari IO. Rate of instrumentation changes on postoperative and follow-up radiographs after primary complex spinal fusion (five or more levels) for adult deformity correction. J Neurosurg Spine 2019; 30:376-381. [PMID: 30641841 DOI: 10.3171/2018.9.spine18686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIn the United States, healthcare expenditures have been soaring at a concerning rate. There has been an excessive use of postoperative radiographs after spine surgery and this has been a target for hospitals to reduce unnecessary costs. However, there are only limited data identifying the rate of instrumentation changes on radiographs after complex spine surgery involving ≥ 5-level fusions.METHODSThe medical records of 136 adult (≥ 18 years old) patients with spine deformity undergoing elective, primary complex spinal fusion (≥ 5 levels) for deformity correction at a major academic institution between 2010 and 2015 were reviewed. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient. The authors reviewed the first 5 subsequent postoperative and follow-up radiographs, and determined whether revision of surgery was performed within 5 years postoperatively. The primary outcome investigated in this study was the rate of hardware changes on follow-up radiographs.RESULTSThe majority of patients were female, with a mean age of 53.8 ± 20.0 years and a body mass index of 27.3 ± 6.2 kg/m2 (parametric data are expressed as the mean ± SD). The median number of fusion levels was 9 (interquartile range 7-13), with a mean length of surgery of 327.8 ± 124.7 minutes and an estimated blood loss of 1312.1 ± 1269.2 ml. The mean length of hospital stay was 6.6 ± 3.9 days, with a 30-day readmission rate of 14.0%. Postoperative and follow-up change in stability on radiographs (days from operation) included: image 1 (4.6 ± 9.3 days) 0.0%; image 2 (51.7 ± 49.9 days) 3.0%; image 3 (142.1 ± 179.8 days) 5.6%; image 4 (277.3 ± 272.5 days) 11.3%; and image 5 (463.1 ± 525.9 days) 15.7%. The 3rd year after surgery had the highest rate of hardware revision (5.55%), followed by the 2nd year (4.68%), and the 1st year (4.54%).CONCLUSIONSThis study suggests that the rate of instrumentation changes on radiographs increases over time, with no changes occurring at the first postoperative image. In an era of cost-conscious healthcare, fewer orders for early radiographs after complex spinal fusions (≥ 5 levels) may not impact patient care and can reduce the overall use of healthcare resources.
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Affiliation(s)
- Aladine A Elsamadicy
- 1Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - David T Lubkin
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | | | - Syed M Adil
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Lefko T Charalambous
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Nicolas Drysdale
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Theresa Williamson
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Joaquin Camara-Quintana
- 1Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut; and
| | | | - C Rory Goodwin
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Isaac O Karikari
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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Impact of an Advanced Imaging Utilization Review Program on Downstream Health Care Utilization and Costs for Low Back Pain. Med Care 2019; 56:520-528. [PMID: 29668650 DOI: 10.1097/mlr.0000000000000917] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants. OBJECTIVES To assess the impact of a state policy implemented in June 2010 that required prospective utilization review (UR) for early MRI among workers' compensation claimants with LBP. RESEARCH DESIGN Interrupted time series. SUBJECTS In total, 76,119 Washington State workers' compensation claimants with LBP between 2006 and 2014. MEASURES Proportion of workers receiving imaging per month (MRI, computed tomography, radiographs) and lumbosacral injections and surgery; mean total health care costs per worker; mean duration of disability per worker. Measures were aggregated monthly and attributed to injury month. RESULTS After accounting for secular trends, decreases in early MRI [level change: -5.27 (95% confidence interval, -4.22 to -6.31); trend change: -0.06 (-0.01 to -0.12)], any MRI [-4.34 (-3.01 to -5.67); -0.10 (-0.04 to -0.17)], and injection [trend change: -0.12 (-0.06 to -0.18)] utilization were associated with the policy. Radiograph utilization increased in parallel [level change: 2.46 (1.24-3.67)]. In addition, the policy resulted in significant decreasing changes in mean costs per claim, mean disability duration, and proportion of workers who received disability benefits. The policy had no effect on computed tomography or surgery utilization. CONCLUSIONS The UR policy had discernable effects on health care utilization, costs, and disability. Integrating evidence-based guidelines with UR can improve quality of care and patient outcomes, while reducing use of low-value health services.
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Geel KV, Kok EM, Aldekhayel AD, Robben SGF, van Merriënboer JJG. Chest X-ray evaluation training: impact of normal and abnormal image ratio and instructional sequence. MEDICAL EDUCATION 2019; 53:153-164. [PMID: 30474292 PMCID: PMC6587445 DOI: 10.1111/medu.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Medical image perception training generally focuses on abnormalities, whereas normal images are more prevalent in medical practice. Furthermore, instructional sequences that let students practice prior to expert instruction (inductive) may lead to improved performance compared with methods that give students expert instruction before practice (deductive). This study investigates the effects of the proportion of normal images and practice-instruction order on learning to interpret medical images. It is hypothesised that manipulation of the proportion of normal images will lead to a sensitivity-specificity trade-off and that students in practice-first (inductive) conditons need more time per practice case but will correctly identify more test cases. METHODS Third-year medical students (n = 103) learned radiograph interpretation by practising cases with, respectively, 30% or 70% normal radiographs prior to expert instruction (practice-first order) or after expert instruction (instruction-first order). After training, students performed a test (60% normal) and sensitivity (% of correctly identified abnormal radiographs), specificity (% of correctly identified normal radiographs), diagnostic performance (% of correct diagnoses) and case duration were measured. RESULTS The conditions with 30% of normal images scored higher on sensitivity but the conditions with 70% of normal images scored higher on specificity, indicating a sensitivity and specificity trade-off. Those who participated in inductive conditions took less time per practice case but more per test case. They had similar test sensitivity, but scored lower on test specificity. CONCLUSIONS The proportion of normal images impacted the sensitivity-specificity trade-off. This trade-off should be an important consideration for the alignment of training with future practice. Furthermore, the deductive conditions unexpectedly scored higher on specificity when participants took less time per case. An inductive approach did not lead to higher diagnostic performance, possibly because participants might already have relevant prior knowledge. Deductive approaches are therefore advised for the training of advanced learners.
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Affiliation(s)
- Koos van Geel
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ellen M Kok
- Department of Education, Utrecht University, Utrecht, the Netherlands
| | - Abdullah D Aldekhayel
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jeroen J G van Merriënboer
- School of Health Professions Education, Department of Educational Research and Development, Maastricht University, Maastricht, the Netherlands
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Radiologists' recommendations for additional imaging (RAI) in the inpatient setting. Radiol Med 2019; 124:432-437. [PMID: 30600436 DOI: 10.1007/s11547-018-0982-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of our study was to measure the rate of radiologists' additional recommended imaging examinations (RAI) at a hospital-based inpatient setting and to estimate the influence on RAI of clinical variables. MATERIALS AND METHODS This retrospective study was approved by the institutional review board. Inpatients CT and US examinations interpreted by fifteen radiologists between October and December 2016 were studied. Information about RAI from radiology report texts was extracted manually. The analytic data set included the interpreting radiologists' years of experience, patient age, patient gender, radiologist gender, ordering service and "clinical question to be answered" as collected from the radiology request forms. RESULTS Of the 1996 US and CT examinations performed between October and December 2016 in the inpatient setting, 34% (683 examinations) had a radiologists' RAI. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT and abdominal MRI. Patient age and gender had no impact on RAI. Radiologists' years of experience were inversely correlated to RAI. "Pneumonia" showed the highest rate of RAI due to follow-up of lung nodules. CONCLUSION A high percentage of RAI resulted from CT and US radiologists' reports. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT, and abdominal MRI. Radiologists' years of experience play an important role in the number of the requested RAI. Further studies with a larger cohort of radiologists are needed to confirm the role of radiologists' experience in RAI. Also, follow-up studies are warranted to assess the number of RAI that are actually acted upon by the referring physicians.
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Sandoval GA, Brown AD, Wodchis WP, Anderson GM. Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework. Int J Health Plann Manage 2018; 33. [PMID: 29770971 DOI: 10.1002/hpm.2547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/11/2022] Open
Abstract
Measuring the value of medical imaging is challenging, in part, due to the lack of conceptual frameworks underlying potential mechanisms where value may be assessed. To address this gap, this article proposes a framework that builds on the large body of literature on quality of hospital care and the classic structure-process-outcome paradigm. The framework was also informed by the literature on adoption of technological innovations and introduces 2 distinct though related aspects of imaging technology not previously addressed specifically in the literature on quality of hospital care: adoption (a structural hospital characteristic) and use (an attribute of the process of care). The framework hypothesizes a 2-part causality where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors, and hospital outcomes (ie, quality and efficiency). The first part indicates that hospital structural characteristics and market factors influence or facilitate the adoption of high technology medical imaging within an institution. The presence of this technology, in turn, is hypothesized to improve the ability of the hospital to deliver high quality and efficient care. The second part describes this ability throughout 3 main mechanisms pointing to the importance of imaging use on patients, to the presence of staff and qualified care providers, and to some elements of organizational capacity capturing an enhanced clinical environment. The framework has the potential to assist empirical investigations of the value of adoption and use of medical imaging, and to advance understanding of the mechanisms that produce quality and efficiency in hospitals.
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Affiliation(s)
- Guillermo A Sandoval
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Adalsteinn D Brown
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
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Al Shahrani A, Al-Surimi K. Daily routine versus on-demand chest radiograph policy and practice in adult ICU patients- clinicians' perspective. BMC Med Imaging 2018; 18:4. [PMID: 29614962 PMCID: PMC5883277 DOI: 10.1186/s12880-018-0248-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 01/24/2018] [Indexed: 11/19/2022] Open
Abstract
Background Chest radiographs are taken daily as a part of routine investigations in Intensive care unit (ICU) patients. They are less effective and unlikely to alter the management of the majority of these patients compared to the radiographs obtained when indicated. According to the American College of Radiology (ACR) Appropriateness criteria, only selective ordering of chest radiographs is recommended, including elderly or high risk patients. The aim of this study was to identify and assess the clinician’s perspective in abandoning the current practice of daily routine chest radiograph and replacing with the on-demand radiograph in Saudi hospitals. Methods This was a cross-sectional study. A valid self-administered questionnaire was distributed to all clinical staff members working in ICUs in the major tertiary hospitals in Saudi Arabia. The study population was primarily the ICU intensivists (physicians), nurses and respiratory therapists (RT). The data collected were statistically processed using SPSS version 20.0; descriptive and inferential analyses were done. Results Out of 730 questionnaires sent, we received only 495 completed questionnaires with a response rate of 67.8%. Majority of them (n = 351) are working at academic hospitals. About half of the respondents (n = 247) are working in an open-format ICUs. Findings showed that the daily routine chest X-ray was performed in almost 96.8% of ICUs patients, which the majority of the clinical staff members (73%) thought that this current daily routine CXR protocol in the ICUs should be replaced with the on-demand CXR policy. Interestingly, the differences in demographic and work-related characteristics had no significant impact on the clinician’s view and supported moving to on-demand CXR policy and practice. Conclusions The daily routine CXR is still a common practice in most of the Saudi hospitals ICUs although enough empirical evidence shows that it can be avoided. We observed that intensivists support the change of the current practice and recommend an on-demand CXR policy likely to be followed in intensive care management. Electronic supplementary material The online version of this article (10.1186/s12880-018-0248-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdullah Al Shahrani
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Khaled Al-Surimi
- Department of Health Systems and Quality Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Primary Care and Public Health Department, School of Public health, Imperial College London, London, UK.
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Schwarcz TH, Gatz VL, Little S, Geddings CF. Arterial Duplex Ultrasound is the Most Cost-Effective, Noninvasive Diagnostic Imaging Modality before Treatment of Lower-Extremity Arterial Occlusive Disease. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431670903300203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Multiple noninvasive imaging modalities (duplex ultrasound, magnetic resonance angiography, and computed tomographic angiography) are now available for diagnostic evaluation of lower-extremity arterial occlusive disease (LEOD). This study was performed to determine the effectiveness of duplex ultrasound as the primary diagnostic imaging test before endovascular treatment and to estimate the potential cost-savings compared with the use of other technologies. Methods The diagnostic evaluations of all patients treated for LEOD by a single vascular specialist between July 2004 and February 2008 were reviewed. The medical records were reviewed for the initial noninvasive diagnostic imaging study, type of intervention, and patency of revascularization. Medicare reimbursement rates (2007) for each imaging modality were used to compare costs of diagnostic testing. Results A total of 128 endovascular interventions were performed in 89 patients. Arterial duplex imaging was the primary and only diagnostic study performed prior to endovascular treatment in 108 (84%) of procedures. If preintervention magnetic resonance angiography or computed tomographic angiography had been used in these patients instead of duplex, the costs for diagnostic imaging alone would have increased by $96,064 and $44,762, respectively. Conclusion Arterial duplex ultrasound can be effectively used as the preferred modality for noninvasive imaging of LEOD, resulting in substantial cost savings.
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Affiliation(s)
| | - Vicki L. Gatz
- Lexington Surgeons, Vascular Laboratory, Lexington, Kentucky
| | - Stephen Little
- Lexington Surgeons, Vascular Laboratory, Lexington, Kentucky
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Health IT and inappropriate utilization of outpatient imaging: A cross-sectional study of U.S. hospitals. Int J Med Inform 2018; 109:87-95. [DOI: 10.1016/j.ijmedinf.2017.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022]
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Alkhalili K, Zenonos G, Tataryn Z, Amankulor N, Engh J. The Utility of Early Postoperative Head Computed Tomography in Brain Tumor Surgery: A Retrospective Analysis of 755 Cases. World Neurosurg 2017; 111:e206-e212. [PMID: 29258936 DOI: 10.1016/j.wneu.2017.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Scheduled early postoperative computed tomography (EPOCT) after craniotomy for brain tumor resection is standard at many institutions. We analyzed utility of preplanned EPOCT after elective craniotomy for brain tumor resection. METHODS We retrospectively analyzed 755 brain tumor resections for which EPOCT was performed within 4 hours of surgery. Postoperative clinical neurologic examination results were classified into expected (baseline or predicted postoperative examination), changed (from baseline examination), and unreliable (sedated or baseline comatose patient). Scans were analyzed for unexpected and/or worrisome findings (e.g., hemorrhagic or ischemic stroke). In cases of unexpected findings, management changes were correlated to patient's neurologic examination. Demographic information, tumor histology, and tumor location were analyzed to determine risk factors for unexpected findings. RESULTS Rate of unexpected EPOCT findings was 4.1%. Patients with expected postoperative examinations were at significantly lower risk of abnormal findings (odds ratio [OR] = 0.074, P < 0.001). Patients with intraventricular tumors (OR = 5.7, P = 0.001) were at higher risk compared with patients with metastatic tumors (OR = 0.24, P = 0.06). No unexpected EPOCT findings led to management changes in patients with expected postoperative neurologic examinations. All unexpected EPOCT findings in patients with changed postoperative neurologic examinations led to management changes. Patients with nonreliable neurologic examinations were at significantly higher risk for unexpected findings on EPOCT (OR = 6.33, P < 0.001) and subsequent management changes. CONCLUSIONS Routine EPOCT is not indicated for patients undergoing brain tumor resection if postoperative neurologic examination is unchanged, as imaging is unlikely to result in management changes. EPOCT should be obtained in all patients with worrisome changes in examination or nonreliable examinations, as both groups have high rates of unexpected findings on imaging that lead to management changes.
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Affiliation(s)
- Kenan Alkhalili
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary Tataryn
- Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Nduka Amankulor
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Johnathan Engh
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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The Utility of Routine Postoperative Radiographs After Pinning of Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2017; 37:e309-e312. [PMID: 28441278 DOI: 10.1097/bpo.0000000000001000] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to determine the frequency with which postoperative radiographs resulted in a change in management following closed reduction and percutaneous pinning of displaced pediatric supracondylar humerus fractures. We hypothesize that only the initial postoperative radiograph will lead to changes in management of operative supracondylar humerus fractures. METHODS A retrospective review was performed at 2 level I pediatric trauma centers. Inclusion criteria were patients below 18 years of age who sustained supracondylar humerus fractures (Gartland type II, III, IV) who were operatively treated from 2008 to 2013 with adequate radiographic follow-up. Patients with flexion type, intra-articular, transphyseal, and open fractures were excluded from the study. Routine radiographs were taken at initial follow-up (1 wk postoperatively) and at pin removal (3 to 4 wk postoperatively). RESULTS The final analysis included 572 patients. Initial postoperative radiographs changed treatment in 9 patients (1.6%), including revision surgeries, 2 pin adjustments, and 2 early pin removals. At the time of pin removal, 20 (3.5%) patients required further immobilization. There were no changes to the initial plan for continued nonoperative treatment at final follow-up (6 to 8 wk postoperatively). CONCLUSIONS In this large retrospective series of patients treated with closed reduction and percutaneous pinning of displaced supracondylar humerus fractures, radiographs at 3 weeks do not reveal a need to return to the operating room or other significant pathology. These findings suggest that radiographs should be obtained within 7 to 10 days postoperatively for type III fractures and may only need to be repeated if the clinical situation warrants it, such as severe fracture pattern, persistent pain, or clinical deformity. LEVEL OF EVIDENCE Level IV-case series.
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Comparative Effectiveness Trials of Imaging-Guided Strategies in Stable Ischemic Heart Disease. JACC Cardiovasc Imaging 2017; 10:321-334. [PMID: 28279380 DOI: 10.1016/j.jcmg.2016.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 12/21/2022]
Abstract
The evaluation of patients with suspected stable ischemic heart disease is among the most common diagnostic evaluations with nearly 20 million imaging and exercise stress tests performed annually in the United States. Over the past decade, there has been an evolution in imaging research with an ever-increasing focus on larger registries and randomized trials comparing the effectiveness of varying diagnostic algorithms. The current review highlights recent randomized trial evidence with a particular focus comparing the effectiveness of cardiac imaging procedures within the stable ischemic heart disease evaluation for coronary artery disease detection, angina, and other quality of life measures, and major clinical outcomes. Also highlighted are secondary analyses from these trials on the economic findings related to comparative cost differences across diagnostic testing strategies.
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Boissonneau S, Tabouret É, Graillon T, Meyer M, Velly L, Girard N, Brunel H, Bruder N, Fuentes S, Dufour H. Rational use of systematic postoperative CT scans after neurosurgical craniotomy. J Neurosurg Sci 2017; 64:335-340. [PMID: 28959872 DOI: 10.23736/s0390-5616.17.04082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the relevance of a systematic postoperative CT scan after neurosurgical craniotomy and to identify predictive factors of complications. METHODS This retrospective analysis included all the patients at our institution who benefited from a cerebral postoperative CT scan within 24 hours post-craniotomy. Patient characteristics and neuroimaging abnormalities were recorded. Predictive factors were identified using a recursive partitioning analysis. RESULTS A total of 633 patients were included. Of these, 17.9% of patients suffered from postoperative complications and 7.4% of them required a new surgery. The decision for reoperation was based on the neurological deterioration and the CT scan, but never on the CT scan alone. The mortality rate was 1.1%. The risk to be reoperated was correlated to the occurrence of a new postoperative neurological deficit (P<0.001, HR=4.60) and in situ hemorrhage (P<0.001, HR=4.19). The risk of postoperative hematoma was correlated to the supratentorial location versus infratentorial (P=0.027, HR=2.50). With clinical factors, such as location and etiology of the lesion, schedule type of surgery, and the age of patients, we proposed six classes with the risk to present with hemorrhage or midline shift on postoperative CT scans. CONCLUSIONS The post-craniotomy CT scan did not impact patient management as an independent decisional tool. We identified several variables associated with the risk of clinical modification that can impact the decision to reoperate and allow establishment of a risk score. This score could be an interesting tool in order to reduce the systematic use of CT scans in the post-surgical period but has to be validated in a prospective study.
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Affiliation(s)
- Sébastien Boissonneau
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France -
| | - Émeline Tabouret
- Department of Neuro-Oncology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,INSERM Unit of Research UMR S911, Biologic Oncology and Oncologic Pharmacology Research Center (CRO2), Faculty of Medical and Paramedical Sciences, Aix-Marseille University, Marseille, France
| | - Thomas Graillon
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,Center for Research in Neurobiology and Neurophysiology of Marseille (CRN2M), National Center of Scientific Research (CNRS), Aix-Marseille University, Marseille, France
| | - Mikael Meyer
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Intensive Care, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Nadine Girard
- Service of Neuroradiology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Hervé Brunel
- Service of Neuroradiology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Intensive Care, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,Center for Research in Neurobiology and Neurophysiology of Marseille (CRN2M), National Center of Scientific Research (CNRS), Aix-Marseille University, Marseille, France
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Roifman I, Austin PC, Qiu F, Wijeysundera HC. Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population-Based Study. J Am Heart Assoc 2017; 6:JAHA.117.005961. [PMID: 28584072 PMCID: PMC5669192 DOI: 10.1161/jaha.117.005961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Concern regarding overutilization of cardiac imaging has led to the development of appropriate use criteria (AUC). Myocardial perfusion imaging (MPI) is one of the most commonly used cardiac imaging modalities worldwide. Despite multiple iterations of AUC, there is currently no evidence regarding their real-world impact on population-based utilization rates of MPI. Our goal was to assess the impact of the AUC on rates of MPI in Ontario, Canada. We hypothesized that publication of the AUC would be associated with a significant reduction in MPI rates. METHODS AND RESULTS We conducted a retrospective cohort study of the adult population of Ontario from January 1, 2000, to December 31, 2015. Age- and sex-standardized rates were compared from 4 different periods intersected by 3 published iterations of the AUC. Overall, 3 072 611 MPI scans were performed in Ontario during our study period. The mean monthly rate increased from 14.1/10 000 in the period from January 2000 to October 2005 to 18.2/10 000 between November 2005 and June 2009. After this point in time, there was a reduction in rates, falling to a mean monthly rate of 17.1/10 000 between March 2014 and December 2015. Time series analysis revealed that publication of the 2009 AUC was associated with a significant reduction in MPI rates (P<0.001). This translated into ≈88 849 fewer MPI scans at a cost savings of ≈72 million Canadian dollars. CONCLUSIONS Our results reflect a potential real-world impact of the 2009 MPI AUC by demonstrating evidence of a significant effect on population-based rates of MPI.
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Affiliation(s)
- Idan Roifman
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Toronto, Ontario, Canada .,Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Toronto, Ontario, Canada
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Toronto, Ontario, Canada.,Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Imaging tests in staging and surveillance of non-metastatic breast cancer: changes in routine clinical practice and cost implications. Br J Cancer 2017; 116:821-827. [PMID: 28170371 PMCID: PMC5355929 DOI: 10.1038/bjc.2017.24] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/27/2016] [Accepted: 01/15/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Although guidelines do not recommend computerised tomography (CT), positron emission tomography (PET) or magnetic resonance imaging (MRI) for the staging or follow-up of asymptomatic patients with non-metastatic breast cancer, they are often requested in routine clinical practice. The aim of this study was to determine the staging and follow-up patterns, and relative costs in a large population of breast cancer patients living and treated in a Southern Italian region. Methods: We analysed the clinical computerised information recorded by 567 primary-care physicians assisting about 650 000 inhabitants in the Campania region. Patients with non-metastatic breast cancer were identified and divided into calendar years from 2001 to 2010. The number of diagnostic tests prescribed per 100 patients (N/Pts) and the mean cost per patient was determined 3 months before diagnosis and up to 1 year after diagnosis. Costs are expressed in constant 2011 euros. Results: We identified 4680 newly diagnosed cases of asymptomatic non-metastatic breast cancer. N/Pts increased significantly (P<0.0001) from 2001 to 2010. The mean number of prescribed mammograms, bone scans, abdominal ultrasound and chest X-rays (‘routine tests'), and costs was unchanged. However, the number of CT, PET scans and MRI (‘new tests')prescriptions almost quadrupled and the mean cost per patient related to these procedures significantly increased from €357 in 2001 to €830 in 2010 (P<0.0001). Conclusions: New test prescriptions and relative costs significantly and steadily increased throughout the study period. At present there is no evidence that the delivery of new tests to asymptomatic patients improves breast cancer outcome. Well-designed clinical trials are urgently needed to shed light on the impact of these tests on clinical outcome and overall survival.
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Yan Z, Ip IK, Raja AS, Gupta A, Kosowsky JM, Khorasani R. Yield of CT Pulmonary Angiography in the Emergency Department When Providers Override Evidence-based Clinical Decision Support. Radiology 2016; 282:717-725. [PMID: 27689922 DOI: 10.1148/radiol.2016151985] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the frequency of, and yield after, provider overrides of evidence-based clinical decision support (CDS) for ordering computed tomographic (CT) pulmonary angiography in the emergency department (ED). Materials and Methods This HIPAA-compliant, institutional review board-approved study was performed at a tertiary care, academic medical center ED with approximately 60 000 annual visits and included all patients who were suspected of having pulmonary embolism (PE) and who underwent CT pulmonary angiography between January 1, 2011, and August 31, 2013. The requirement to obtain informed consent was waived. Each CT order for pulmonary angiography was exposed to CDS on the basis of the Wells criteria. For patients with a Wells score of 4 or less, CDS alerts suggested d-dimer testing because acute PE is highly unlikely in these patients if d-dimer levels are normal. The yield of CT pulmonary angiography (number of positive PE diagnoses/total number of CT pulmonary angiographic examinations) was compared in patients in whom providers overrode CDS alerts (by performing CT pulmonary angiography in patients with a Wells score ≤4 and a normal d-dimer level or no d-dimer testing) (override group) and those in whom providers followed Wells criteria (CT pulmonary angiography only in patients with Wells score >4 or ≤4 with elevated d-dimer level) (adherent group). A validated natural language processing tool identified positive PE diagnoses, with subsegmental and/or indeterminate diagnoses removed by means of chart review. Statistical analysis was performed with the χ2 test, the Student t test, and logistic regression. Results Among 2993 CT pulmonary angiography studies in 2655 patients, 563 examinations had a Wells score of 4 or less but did not undergo d-dimer testing and 26 had a Wells score of 4 or less and had normal d-dimer levels. The yield of CT pulmonary angiography was 4.2% in the override group (25 of 589 studies, none with a normal d-dimer level) and 11.2% in the adherent group (270 of 2404 studies) (P < .001). After adjustment for the risk factor differences between the two groups, the odds of an acute PE finding were 51.3% lower when providers overrode alerts than when they followed CDS guidelines. Comparison of the two groups including only patients unlikely to have PE led to similar results. Conclusion The odds of an acute PE finding in the ED when providers adhered to evidence presented in CDS were nearly double those seen when providers overrode CDS alerts. Most overrides were due to the lack of d-dimer testing in patients unlikely to have PE. © RSNA, 2016.
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Affiliation(s)
- Zihao Yan
- From the Center for Evidence-Based Imaging (Z.Y., I.K.I., A.S.R., A.G., R.K.), Department of Radiology (A.S.R., A.G., R.K.), Department of Medicine (I.K.I.), and Department of Emergency Medicine (A.G., J.M.K.), Brigham and Women's Hospital, Harvard Medical School, 20 Kent St, 2nd Floor, Boston, MA 02120; and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass (A.S.R.)
| | - Ivan K Ip
- From the Center for Evidence-Based Imaging (Z.Y., I.K.I., A.S.R., A.G., R.K.), Department of Radiology (A.S.R., A.G., R.K.), Department of Medicine (I.K.I.), and Department of Emergency Medicine (A.G., J.M.K.), Brigham and Women's Hospital, Harvard Medical School, 20 Kent St, 2nd Floor, Boston, MA 02120; and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass (A.S.R.)
| | - Ali S Raja
- From the Center for Evidence-Based Imaging (Z.Y., I.K.I., A.S.R., A.G., R.K.), Department of Radiology (A.S.R., A.G., R.K.), Department of Medicine (I.K.I.), and Department of Emergency Medicine (A.G., J.M.K.), Brigham and Women's Hospital, Harvard Medical School, 20 Kent St, 2nd Floor, Boston, MA 02120; and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass (A.S.R.)
| | - Anurag Gupta
- From the Center for Evidence-Based Imaging (Z.Y., I.K.I., A.S.R., A.G., R.K.), Department of Radiology (A.S.R., A.G., R.K.), Department of Medicine (I.K.I.), and Department of Emergency Medicine (A.G., J.M.K.), Brigham and Women's Hospital, Harvard Medical School, 20 Kent St, 2nd Floor, Boston, MA 02120; and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass (A.S.R.)
| | - Joshua M Kosowsky
- From the Center for Evidence-Based Imaging (Z.Y., I.K.I., A.S.R., A.G., R.K.), Department of Radiology (A.S.R., A.G., R.K.), Department of Medicine (I.K.I.), and Department of Emergency Medicine (A.G., J.M.K.), Brigham and Women's Hospital, Harvard Medical School, 20 Kent St, 2nd Floor, Boston, MA 02120; and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass (A.S.R.)
| | - Ramin Khorasani
- From the Center for Evidence-Based Imaging (Z.Y., I.K.I., A.S.R., A.G., R.K.), Department of Radiology (A.S.R., A.G., R.K.), Department of Medicine (I.K.I.), and Department of Emergency Medicine (A.G., J.M.K.), Brigham and Women's Hospital, Harvard Medical School, 20 Kent St, 2nd Floor, Boston, MA 02120; and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass (A.S.R.)
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Resnick MJ, Graves AJ, Reynolds WS, Barocas DA, Van Horn RL, Buntin MB, Penson DF. Anticipating the Unintended Consequences of Closing the Door on Physician Self-Referral. J Urol 2016; 196:444-50. [DOI: 10.1016/j.juro.2016.01.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | - Amy J. Graves
- Vanderbilt University Medical Center, Nashville, Tennessee
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Parikh JR, Brown J, Yang WT, Tannir H. Network Collaboration of an Academic Institution and a Community Health Organization. J Am Coll Radiol 2016; 14:282-285. [PMID: 27451116 DOI: 10.1016/j.jacr.2016.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 05/28/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jay R Parikh
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Jim Brown
- Memorial Hermann Health System, Houston, Texas
| | - Wei T Yang
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Habib Tannir
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Cournane S, Conway R, Creagh D, Byrne DG, Sheehy N, Silke B. Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions. Clin Radiol 2016; 71:912-8. [PMID: 27210242 DOI: 10.1016/j.crad.2016.03.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 11/28/2022]
Abstract
AIM To investigate the extent to which the time to completion for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound could be shown to influence the length of stay and costs incurred while in hospital, while accounting for patient acuity. MATERIALS AND METHODS All emergency admissions, totalling 25,326 imaging investigations between 2010-2014 were evaluated. The 50(th), 75(th), and 90(th) centiles of completion times for each imaging type was entered into a multivariable truncated Poisson regression model predicting the length of hospital stay. Estimates of risk (odds or incidence rate ratios [IRRs]) of the regressors were adjusted for acute illness severity, Charlson comorbidity index, chronic disabling disease score, and sepsis status. Quantile regression analysis was used to examine the impact of imaging on total hospital costs. RESULTS For all imaging examinations, longer hospital lengths of stay were shown to be related to delays in imaging time. Increased delays in CT and MRI were shown to be associated with increased hospital episode costs, while ultrasound did not independently predict increased hospital costs. The magnitude of the effect of imaging delays on episode costs were equivalent to some measures of illness severity. CONCLUSION CT, MRI, and ultrasound are undertaken in patients with differing clinical complexity; however, even with adjustment for complexity, the time delay in a more expeditious radiological service could potentially shorten the hospital episode and reduce costs.
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Affiliation(s)
- S Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland.
| | - R Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Creagh
- Information Management Systems, St James's Hospital, Dublin 8, Ireland
| | - D G Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - N Sheehy
- Diagnostic Imaging Department, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Surgical wound assessment by sonography in the prediction of surgical wound infections. J Trauma Acute Care Surg 2016; 80:229-36. [PMID: 26502211 DOI: 10.1097/ta.0000000000000908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are important sources of morbidity, prolonged hospital stays, and readmissions, so they have become a major economic burden. We hypothesized that surgical wound assessment by sonography (SWATS) used at the bedside would detect wound fluid collections and that the presence of such collections would predict SSI better than standard clinical examination. If so, SWATS might be used to indicate early intervention that could prevent SSI morbidity. METHODS A prospective, single-institution observational study was conducted on adult inpatients following open abdominal surgery for trauma, gastrointestinal pathology, or biliary pathology at high risk (>5%) for SSI using traditional wound classifications. After informed consent was obtained, SWATS was performed using a smartphone-based ultrasound system on postoperative Day 2 to 4 and again before discharge or at postoperative Day 30, whichever came first. Primary treating physicians delivered standard wound care and were blinded to SWATS. SSI was diagnosed if treatment was implemented for suspected or documented wound infection by the treating physician. Results were analyzed by χ test and two-sample pooled variance t test where appropriate, with significance set at p < 0.05. RESULTS Forty-nine patients were studied. Nineteen patients had peri-incisional fluid collections found by SWATS. Eight of these patients went on to develop an SSI. SSI was significantly associated with the presence of fluid collections on SWATS (p = 0.009). SWATS had a sensitivity of 72.7% (0.43-0.92), a specificity of 71.1% (0.62-0.77), a positive predictive value of 42.1% (0.25-0.53), and a negative predictive value of 90.0% (0.79-0.97). CONCLUSION SWATS has a high negative predictive value that may allow it be an effective screening tool for developing SSI in high-risk surgical wounds. SWATS has the potential to be a useful and cost-effective adjunct to the clinician by objectively suggesting need for early therapy. Further study with larger sample sizes and randomized, SWATS-based interventions are required to validate this small study and determine its place in clinical care. LEVEL OF EVIDENCE Diagnostic study, level IV.
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Abstract
Cholangiocarcinomas are neoplasms that involve the epithelial cells of the bile duct, also known as cholangiocytes. This disease is difficult to diagnose early, as most symptoms present late in the disease. In addition, the specific anatomic position can cause periductal extension and result in a very low radical excision rate and a very poor prognosis. Improved understanding of the features underlying the onset of cholangiocarcinoma and its carcinogenic mechanism may lead to early diagnosis and better prognosis. With the development of molecular biology, much has been learned about oncogenes, tumor-suppressor genes, DNA methylation, microRNAs, and the molecular mechanisms of tumor invasion and metastasis. Based on our research and others, this review article will discuss the current status and prospects of early diagnosis of cholangiocarcinoma.
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Affiliation(s)
- Xiao-Fang Liu
- Department of Hepatobiliary Surgery, Affiliated Yantai Yuhuangding Hospital, Qingdao University Medical College, Yantai, China
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Appropriate use criteria in clinical routine practice: implications in a nuclear cardiology lab. Int J Cardiovasc Imaging 2016; 32:1003-9. [DOI: 10.1007/s10554-016-0864-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/17/2016] [Indexed: 11/28/2022]
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