Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time in an Emergency and Trauma Radiology Department.

OBJECTIVE: To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department. PATIENTS AND METHODS: This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to September 30, 2013, and (2) January 1, 2017, to January 30, 2018, and whose reports were read by an attending emergency and trauma radiologist was noted. RESULTS: The 24/7/365 radiology coverage was associated with a significant reduction in TAT of computed tomography reports, and the time reduction was comparable between trauma and nontrauma cases. In adjusted models, the extension of radiology coverage was associated with an average of 7.83 hours reduction in overall TAT (95% confidence interval [CI]: 7.44-8.22) for reports related to trauma, in which 2.73 hours were due to reduction in completion to transcription time (TC; 95% CI: 2.53-2.93), and 5.10 hours were due to reduction in transcription to finalization time (TF; 95% CI: 4.75-5.44). For reports related to nontrauma cases, 24/7/365 coverage was associated with an average of 6.07 hours reduction in overall TAT (95% CI: 3.54-8.59), 2.91 hours reduction in TC (95% CI: 1.55-4.26), and 3.16 hours reduction in TF (95% CI: 0.90-5.42). CONCLUSION: Our pilot study demonstrates that the implementation of on-site 24/7/365 attending emergency radiology coverage at a tertiary care center was associated with a reduced TAT for trauma and nontrauma patients imaging studies. Although the magnitude and precision of estimates were slightly higher for trauma cases as compared to nontrauma cases. Trauma examinations stand to benefit the most from 24/7/365 attending level radiology coverage.

Management and Reconfiguration of a Radiology Department under the Threat of Coronavirus Disease 2019: Experience from Wuhan.

The corona virus disease 2019 (COVID-19) is an emerging respiratory infectious disease caused by SARS-CoV-2, which first occurred in December 2019 in Wuhan, China. These days, in China, chest CT is used for diagnosis of COVID-19, as an important complement to the reverse-transcription polymerase chain reaction (RT-PCR) test. Because of contacting with a large number of suspected or probable cases closely during chest CT examination, radiographers are easily infected with COVID-19. This article included the rearrangement of CT examination room in fever clinic, the rearrangement of human resources in radiology department, and the drafting of new operating procedures for radiologists who carry out CT examination on COVID-19 patients. This article also introduced the emergency management procedures of the department of radiology during the outbreak, and the experience of infection prevention for the staff of the department of radiology.

Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement.

This multidisciplinary update of the Society of Radiologists in Ultrasound consensus statement on liver elastography incorporates the large volume of new information available in the literature since the initial publication. The recommended procedure for acquiring stiffness measurements is reviewed. There has been substantial improvement in the acoustic radiation force impulse (ARFI) technology-most notably the addition of a quality assessment of the shear wave propagation. Due to the efforts of the Quantitative Imaging Biomarkers Alliance, or QIBA, the variability of liver stiffness measurements between systems had decreased. There are now effective treatments for hepatitis B and hepatitis C, and follow-up after effective treatment should be based on the use of the delta change of the value obtained at viral eradication or suppression. Because the detection of compensated advanced chronic liver disease (cACLD) is very important, the new guidelines are made based on the probability of cACLD for given stiffness values. The panel recommends a vendor-neutral rule of four for interpretation for ARFI techniques. This new method simplifies interpretation of liver stiffness results and is more clinically relevant.

COVID-19 in the radiology department: What radiographers need to know.

OBJECTIVES: The aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases. KEY FINDINGS: Medical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive. CONCLUSION: As radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital, as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan. IMPLICATIONS FOR PRACTICE: At the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments.

Saturday multidisciplinary hemodialysis access clinics to enhance patient care.

Fragmentation of outpatient care is a substantial barrier to creation and maintenance of hemodialysis access. To improve patient accessibility, satisfaction, and multidisciplinary provider communication, we created a monthly Saturday multidisciplinary vascular surgery and interventional nephrology access clinic at a tertiary care hospital in a major urban area for the complicated hemodialysis patient population. The study included patients presenting for new access creation as well as those who had previously undergone access surgery. Staffing included two to three interventional nephrologists, two to three vascular surgeons, one medical assistant, one research assistant, and one practice assistant. Patient satisfaction and perception of the clinic was measured using surveys during six of the monthly Saturday hemodialysis clinics. A total of 675 patient encounters were completed (18.2 average/clinic ±6.3 standard deviation) from August 2016 to August 2019. All patients were seen by both disciplines. The average no-show rate was 19.9% throughout the study period. Patient satisfaction in all measures was consistently high with the Saturday clinic. Providers were also assayed, and they generally valued the real-time, multidisciplinary care plan generation, and its subsequent efficient execution. Saturday multidisciplinary hemodialysis access clinics offer high provider and patient satisfaction and streamlined patient care. However, no-show rates remain relatively high for this challenging patient population.

Collaboration is Key - Bridging the Gap and Building an IR Endoscopy Practice.

While the tools and techniques employed by interventional radiologists on a day-to-day basis translate well to learning the skills required to perform basic endoscopic interventions, collaboration with other specialties is crucial to the success of an interventional radiology endoscopy program. As in any field in medicine, the paramount goal is to improve patient care. Adding the ability to directly visualize structures through an endoscope to certain interventional radiologic procedures may greatly augment the efficacy, safety, and success of interventional radiology procedures. Colleagues in urology, gastroenterology, and surgery should be involved in decision-making and treatment planning to ensure that a shared vision for optimal patient care is achieved.

Incentivizing Physician Diversity in Radiology.

In this article, the authors review the evolving state of diversity in the field of radiology. The authors discuss several early and recent historical legislative milestones that increased the equitable delivery of health care in the United States, such as Title VI of the Civil Rights Act of 1964, which ensured that funds for Medicare reimbursement would be available only to desegregated hospitals. Furthermore, the authors examine the current state of diversity and representation in radiology, in which underrepresented minorities represent 8.3% of training and practicing radiologists, and women represent 27.8% of radiologists. Finally, the authors present arguments for diversity in the current medical education system, analyze hurdles to increasing representation in radiology, and consider the future of diversity and inclusiveness in the field.

Strategic Talent Management: Implementation and Impact of a Leadership Development Program in Radiology.

The rapidity of change and increasing complexity of the academic medical center environment require a talented and engaged workforce with competencies in adaptability, capacity for working in empowered and diverse interprofessional teams, and self-efficacy. Radiology-a crosscutting field that interfaces with most other biomedical disciplines and that is often at the forefront of technological disruption-is a potentially ideal venue to focus professional and leadership development to create positive organizational value. In this report, we detail the design of and 9-year experience with a departmental leadership academy at a large academic center intended to foster team-based skills in early to midcareer faculty and staff. Over the past decade, 100 participants have completed the program with 80% retention, substantial professional growth, and increased capacity for mentoring others. This in-house, customized leadership development program is aligned with our strategic and cultural imperative to promote nimble, engaged, and empowered teams in a diverse and inclusive setting.

Establishing IR in Emerging Countries-A Skill Development Initiative.

Integrating interventional radiology (IR) into clinical practice faces challenges in emerging countries in Asia and Africa. Overcoming them requires innovative solutions customized to local needs. After an in-depth gap analysis of these challenges, we began an organized skill development initiative in late 2015 offering radiologists and their supporting staff fully paid scholarships for IR training. Its concept, structure, and progress are reported here. This initiative covered 8 countries, IR specialists (n = 51), senior residents (n = 24), and 15 educational events (training institute [n = 3]; participating countries [n = 12]). This initiative is intended to develop a global network of trained personnel who can support IR programs in challenging locations of emerging countries.

Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens.

BACKGROUND: Identification of incidental pancreatic lesions is increasing because of advancements in imaging. Diagnosis remains a challenge for clinicians, with intrapancreatic accessory spleens (IPAS) posing a unique dilemma. IPAS are frequently resected because of inability to exclude alternate diagnoses, subjecting patients to unnecessary risk. The purpose of this study was to examine our institutional experience with IPAS and develop a multidisciplinary algorithm to improve preoperative diagnosis. MATERIALS AND METHODS: Patients who underwent a distal pancreatectomy at a single institution from 2005 to 2018 were identified from a prospectively maintained database. Examination of final pathology for a diagnosis of IPAS yielded the final cohort. Demographics, preoperative workup, and operative course were reviewed and analyzed. A diagnostic algorithm was composed based on the consensus of a panel of expert pancreatic surgeons, a radiologist, and a pathologist. RESULTS: Ten patients of 303 patients who underwent a distal pancreatectomy were identified with a final pathology of IPAS. The average age was 54 y, 80% were white, and 60% were male. Lesions ranged in size from 7 mm to 5.1 cm in largest diameter (mean 2.2 cm). Lesions were described as round, well-marginated, and enhancing masses within the pancreatic tail. Preoperative workup was variable in terms of imaging and laboratory testing. Diagnostic workups were examined and combined with multidisciplinary input to create a diagnostic algorithm. CONCLUSIONS: Incidental pancreatic lesions like IPAS remain a diagnostic challenge for clinicians. Employing a diagnostic algorithm as proposed may aid in the distinction of malignant and premalignant pathology and prevent unwarranted pancreatic resections.

The Need for Practical and Accurate Measures of Value for Radiology.

Radiologists play a critical role in helping the health care system achieve greater value. Unfortunately, today radiology is often judged by simple "checkbox" metrics, which neither directly reflect the value radiologists provide nor the outcomes they help drive. To change this system, first, we must attempt to better define the elusive term value and, then, quantify the value of imaging through more relevant and meaningful metrics that can be more directly correlated with outcomes. This framework can further improve radiology's value by enhancing radiologists' integration into the care team and their engagement with patients. With these improvements, we can maximize the value of imaging in the overall care of patients.