Program for Supporting Frontline Improvement Projects in an Academic Radiology Department.

OBJECTIVE. The purpose of this study was to describe the results of an ongoing program implemented in an academic radiology department to support the execution of small- to medium-size improvement projects led by frontline staff and leaders. MATERIALS AND METHODS. Staff members were assigned a coach, were instructed in improvement methods, were given time to work on the project, and presented progress to department leaders in weekly 30-minute reports. Estimated costs and outcomes were calculated for each project and aggregated. An anonymous survey was administered to participants at the end of the first year. RESULTS. A total of 73 participants completed 102 projects in the first 2 years of the program. The project type mix included 25 quality improvement projects, 22 patient satisfaction projects, 14 staff engagement projects, 27 efficiency improvement projects, and 14 regulatory compliance and readiness projects. Estimated annualized outcomes included approximately 4500 labor hours saved, $315K in supply cost savings, $42.2M in potential increased revenues, 8- and 2-point increase in top-box patient experience scores at two clinics, and a 60-incident reduction in near-miss safety events. Participant time equated to approximately 0.35 full-time equivalent positions per year. Approximately 0.4 full-time equivalent was required to support the program. Survey results indicated that the participants generally viewed the program favorably. CONCLUSION. The program was successful in providing a platform for simultaneously solving a large number of organizational problems while also providing a positive experience to frontline personnel.

Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the "First Wave". / Risiko radiologischer Mitarbeiter für eine COVID-19-Infektion in einer Hoch- und Niedrigrisikoregion in Deutschland: Lehren aus der "ersten Welle".

PURPOSE: The recent COVID-19 pandemic has resulted in an increasing overload of the medical system. Healthcare workers (HCW) in radiology departments are exposed to a high infection risk similar to HCWs in the ICU or dedicated COVID wards. The goal of our paper is to evaluate the prevalence of IgG antibody against SARS-CoV-2 among radiology HCWs in two different hospitals and regions in Germany with a low and high COVID-19 prevalence and to compare it to the prevalence in other clinical personnel. Additionally, we assessed the number of radiological procedures performed in patients with a positive PCR test (C+) followed by a short review of the risk for nosocomial infections of radiology HCWs. MATERIALS AND METHODS: During the first COVID-19 wave between March and July 2020, we evaluated a region with one of the highest COVID-19 rates (776-1570/100 000) in Germany (Hospital A). Additionally, we assessed Hospital B in a region with a low prevalence (65/100 000). We tested the serum prevalence of SARS-CoV-2 IgG antibodies among the whole staff with a subgroup analysis for radiology in both hospitals. We calculated the total number of different radiological procedures performed in C+ patients. RESULTS: In Hospital A 594 PCR-proven C+ patients were treated resulting in 2723 radiological procedures. 24 % (n = 6) of the radiology technicians and 13.35 (n = 2) of radiologists had a positive IgG test. The rates were similar to positive rates in HCWs in COVID-19 wards and ICUs within the hospital. The most frequently performed procedures in C+ patients were chest X-rays (3.17/patient) and CT examinations (1.15/patient). In Hospital B 50 C+ patients were treated, resulting in 64 radiological procedures. None of the HCWs tested IgG positive. The most frequently performed examinations were also chest X-rays (1.04/patient) and CT (0.2/patient). CONCLUSION: HCWs in radiology have a high occupational infection risk similar to that of HCWs in ICUs and dedicated COVID wards. KEY POINTS: · The risk of acquiring COVID-19 increases with the amount of contact with infected individuals.. · The occupational risk of a SARS-CoV-2 infection for radiology staff is similar to that of nurses and physicians in COVID wards.. · Hygiene concepts and medical resources have to be adapted for further COVID outbreaks.. · Reporting of an occupational disease can be considered in the case of seropositive staff.. CITATION FORMAT: · Finkenzeller T, Lenhart S, Reinwald M et al. Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the "First Wave". Fortschr Röntgenstr 2021; 193: 537 - 543.

Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time of Trauma-Related Imaging Studies Being Finalized Within 48 Hours in an Emergency Radiology Department, Offering a Perspective from a Tertiary Care Hospital.

OBJECTIVE: To offer an evidence-based account of the effect of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma-related radiographs finalized within 48 hours of exam completion, drawing data from an emergency radiology department of a tertiary care hospital in Vancouver, British Columbia. MATERIALS AND METHODS: This was a retrospective chart review, where TATs of imaging studies for a sample of trauma patients, who had visited the emergency department of the Vancouver General Hospital between two time periods, January 1 to September 30, 2013, and January 1 to September 30, 2017, were noted. RESULTS: In models adjusted for patient's age, sex, and seasonality, the 24/7/365 attending radiologist coverage was associated with an average of 19.1 (95% confidence interval [CI]: 18.7-19.4) hours of reduction in time from exam completion to report finalization by an attending radiologist. Approximately 11.3 (95% CI: 18.7-19.4) hours was due to reduction in time from exam completion to preliminary diagnosis of reports. When the impact of the increased number of radiology staff in 2017 was removed in the analysis, the overall TAT was reduced by 13.3 (95% CI: 13.0-13.6) hours and the time from exam completion to preliminary report was reduced by 7.8 (95% CI: 7.6-8.1) hours. LIMITATION: Since we have used a simple random sample (SRS) for this research, this study does not describe the burden of reports that are finalized in the emergency and trauma radiology department during the given time periods. CONCLUSION: Our pilot study demonstrates that the implementation of 24/7/365 attending radiology coverage significantly reduces TAT for finalized radiology reports of all modalities of trauma imaging studies in an emergency and trauma radiology department. POLICY IMPLICATION: This research serves the contemporary health-care administration, policymaking information needs by providing the evidence for significantly reduced TAT of finalized radiology reports from a Canadian perspective.

Evaluating Radiology Result Communication in the Emergency Department.

PURPOSE: To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting. METHODS: An institutional review board-approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regarding all result-reporting communication events that occurred over a 168-hour period. RESULTS: A total of 286 independent result communication events occurred during the study period, the vast majority of which occurred via telephone (232/286). Emergency radiologists spent 10% of their working time communicating results. Similar amounts of time were spent discussing negative and positive cross-sectional imaging examinations. In a small minority of communication events, additional information was gathered through communication that resulted in a change of interpretation from a normal to an abnormal study. CONCLUSIONS: Effective and efficient result communication is critical to care delivery in the emergency department setting. Discussion regarding abnormal cases, both in person and over the phone, is encouraged. However, in the emergency setting, time spent on routine direct communication of negative examination results in advance of the final report may lead to increased disruptions, longer turnaround times, and negatively impact patient care. In very few instances, does the additional information gained from the communication event result in a change of interpretation?

CT Volumes from 2,398 Radiology Practices in the United States: A Real-Time Indicator of the Effect of COVID-19 on Routine Care, January to September 2020.

PURPOSE: To determine the effect of coronavirus disease 2019 (COVID-19) on CT volumes in the United States during and after the first wave of the pandemic. METHODS: CT volumes from 2,398 US radiology practices participating in the ACR Dose Index Registry from January 1, 2020, to September 30, 2020, were analyzed. Data were compared to projected CT volumes using 2019 normative data and analyzed with respect to time since government orders, population-normalized positive COVID-19 tests, and attributed deaths. Data were stratified by state population density, unemployment status, and race. RESULTS: There were 16,198,830 CT examinations (2,398 practices). Volume nadir occurred an average of 32 days after each state-of-emergency declaration and 12 days after each stay-at-home order. At nadir, the projected volume loss was 38,043 CTs per day (of 71,626 CTs per day; 53% reduction). Over the entire study period, there were 3,689,874 fewer CT examinations performed than predicted (of 18,947,969; 19% reduction). There was less reduction in states with smaller population density (15% [169,378 of 1,142,247; quartile 1] versus 21% [1,894,152 of 9,140,689; quartile 4]) and less reduction in states with a lower insured unemployed proportion (13% [279,331 of 2,071,251; quartile 1] versus 23% [1,753,521 of 7,496,443; quartile 4]). By September 30, CT volume had returned to 84% (59,856 of 71,321) of predicted; recovery of CT volume occurred as positive COVID-19 tests rose and deaths were in decline. CONCLUSION: COVID-19 substantially reduced US CT volume, reflecting delayed and deferred care, especially in states with greater unemployment. Partial volume recovery occurred despite rising positive COVID-19 tests.

Radiology management of a 'breast unit' during COVID-19 pandemic: a single institution experience.

Aim: To describe the activity in the 'breast unit' at the department of radiology during the COVID-19 lockdown in a university hospital treating COVID-19 patients in a Middle-Eastern developing country. Materials: This was a retrospective study conducted from March 9 until 11 May 2020, in the breast unit at the department of radiology of a central university hospital in a Middle-Eastern developing country. Data were collected from 205 patients visiting the breast unit during the lockdown period and compared with the activity in the same period in the previous year. Results: Reduction of the breast unit activity was estimated at 73%. In addition, 153 mammograms, 205 ultrasounds, and 16 breast MRIs were done. Indications for mammogram were screening (41.5%), follow-up (22%), clinical symptoms (20%) and breast cancer surveillance (16.5%). MRI was performed mostly for preoperative surgical management. The rate of positive biopsies was 41%. All staff members and patients have accommodated to new adjustments. Conclusion: Activity in the breast unit dropped during the lockdown period. Staff should continue to seek their own and their patient's safety without diminishing the quality of healthcare.

A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran.

BACKGROUND: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. OBJECTIVES: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019. RESULTS: A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19. CONCLUSION: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

Managing patient flows in radiation oncology during the COVID-19 pandemic : Reworking existing treatment designs to prevent infections at a German hot spot area University Hospital.

PURPOSE: The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV­2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS: The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS: Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV­2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION: In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.

Coronavirus Disease 2019 (COVID-19) Pandemic Shifts Inpatient Imaging Utilization.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on imaging utilization across practice settings. The purpose of this study was to quantify the change in the composition of inpatient imaging volumes for modality types and Current Procedural Terminology-coded groups during the COVID-19 pandemic. METHODS: A retrospective study of inpatient imaging volumes in a large health care system was performed, analyzing weekly imaging volumes by modality types (radiography, CT, MRI, ultrasound, interventional radiology, nuclear medicine) in years 2020 and 2019. The data set was split to compare pre-COVID-19 (weeks 1-9) and post-COVID-19 (weeks 10-16) periods. Further subanalyses compared early post-COVID-19 (weeks 10-13) and late post-COVID-19 (weeks 14-16) periods. Statistical comparisons were performed using χ2 and independent-samples t tests. RESULTS: Compared with 2019, total inpatient imaging volume in 2020 post-COVID-19, early and late post-COVID-19 periods, declined by 13.6% (from 78,902 to 68,168), 16.6% (from 45,221 to 37,732), and 9.6% (from 33,681 to 30,436), respectively. By week 16, inpatient imaging volume rebounded and was only down 4.2% (from 11,003 to 10,546). However, a statistically significant shift (P < .0001) in the 2020 composition mix was observed largely comprised of radiography (74.3%), followed by CT (12.7%), ultrasound (8%), MRI (2.4%), interventional radiology (2.3%), and nuclear medicine (0.4%). Although the vast majority of imaging studies declined, few Current Procedural Terminology-coded groups showed increased trends in imaging volumes in the late post-COVID-19 period, including CT angiography chest, radiography chest, and ultrasound venous duplex. DISCUSSION: During the COVID-19 pandemic, we observed a decrease in inpatient imaging volumes accompanied by a shift away from cross-sectional imaging toward radiography. These findings could have significant implications in planning for a potential resurgence.

Optimising after-hours workflow of computed tomography orders in the emergency department.

Ordering and protocolling CT scans after-hours from the emergency department (ED) at our institution previously required discussion between the ED physician and radiology resident, which led to workflow inefficiency. Our intervention consisted of creating an electronic list of CT requests that radiology residents would monitor. Radiology protocolled straightforward requests and contacted the ordering physician for more details when required. We aimed to improve workflow efficiency, increase provider satisfaction and reduce CT turnaround time without significantly affecting CT utilisation. Plan-do-study-act cycles were used to plan and evaluate the intervention. The intervention was initiated on weekday evenings and then expanded to weekend hours after an interim analysis. Qualitative outcomes were measured via electronic survey, and quantitative outcomes were collected from administrative data and analysed via control charts and other statistical methods. Survey response was high from ED physicians (76%, n=82/108) and radiology residents (79%, n=30/38). After the intervention, the majority of ED staff and radiology residents perceived improved workflow efficiency (96.3%, 73.3%), radiology residents noted a subjective decrease in disruptions (83.3%) and most ED staff felt that scans were performed more quickly (84.1%). Radiology residents received fewer pages per shift, adjusted for scan volume. There was a reduction in time from order entry to protocol on weekday shifts only, with no statistically significant effect on time from order entry to scan. Segmented regression analysis demonstrated a background increase in utilisation over time (0.7-2.0 CT/100 ED visits/year, p<0.0005), but the intervention itself did not contribute to an overall increase in CT utilisation. In conclusion, our intervention led to improved perceived workflow efficiency and reduced pages. Scans were protocoled more quickly on weekdays, but turnaround times were otherwise not significantly affected by the intervention. Background CT utilisation increased over time, but this increase was not attributable to our intervention.

Determining the Need for After-Hours Diagnostic Radiological Reporting in Emergency Departments at Public Hospitals in South Africa: Perceptions of Emergency Physicians in KwaZulu-Natal.

BACKGROUND: Emergency departments in South African public hospitals have a high patient load after hours, with inadequate numbers of health care professionals available to satisfy patient influx. In addition, there is often no provision of after-hours diagnostic reporting services in public hospitals, to an extent that the emergency physician is responsible for interpreting all radiographic images requested themseves. Emergency physicians, in this study, can be described as any medical doctor registered with the Health Professions Council of South Africa and working in the emergency department as a registrar or consultant physician because there were no physicians specialized in emergency medicine working at the hospitals selected for this study. AIM: The aim of this study was to determine the views of emergency physicians on whether there is a need for an after-hours diagnostic radiological reporting service in selected public hospitals in KwaZulu-Natal Province, South Africa. METHODS: A descriptive cross-sectional quantitative research design was utilized, through means of a survey, to assess the emergency physicians' perceptions regarding the need for after-hours diagnostic radiological reporting. In addition, the study used a descriptive quantitative research design to record the number of conventional diagnostic radiographic examinations performed at the selected hospitals, after hours, and the proportional number of these radiographic examinations that were reported on by radiologists during office hours, the following day. The distribution of questionnaires and data collection, with regard to the number of examinations reported on, and those not reported on, were carried out simultaneously during the execution of this study. The study was conducted over a three-month period in 2017, at four public hospitals in KwaZulu-Natal-one of the nine provinces of South Africa. RESULTS: This study found that, during the study period, between 0.1% and 0.6% of the conventional diagnostic radiographic examinations performed, after hours, were reported on by radiologists during office hours, the following day. The surveyed emergency physicians felt that the interpretation of diagnostic images took up valuable time that could be spent on patient management, and there was near-total agreement, whereby 92% (n = 36) of the physicians would have preferred after-hours reporting to be performed by a radiologist. Physicians agreed that having a radiologist or reporting radiographer to provide radiological reports would allow for more effective and efficient patient management. CONCLUSION: The results of this study indicated that there is a need for after-hours radiographic reporting at the selected public hospitals and for the further training of emergency physicians in radiographic image interpretation. Based on the findings of this study, it is recommended that after-hours radiological reporting services be considered for public hospitals and that courses be offered to emergency physicians on the interpretation of diagnostic radiographic images. A hospital policy review may therefore be needed to adjust the focus of hospitals toward reducing the workload of emergency physicians, wherever possible, such as by incorporating support services like radiographic reporting and by providing further training on the interpretation of diagnostic radiographic images, which will both act to reduce the potential risk of misdiagnosis.

Radiotherapy during COVID-19 pandemic. How to create a No fly zone: a Northern Italy experience.

BACKGROUND: SARS-CoV-2 pandemic represents a troubling health emergency but also a main challenge for the clinical governance of the system. Discontinuation of radiation treatments is not desirable and potentially life-threatening. On the other hand, accesses to hospital expose cancer patients to an increased risk of COVID-19 infection. We report our extended protocol, draft to manage clinical activities in our radiotherapy department, by minimizing contagion risks. METHODS: We used telephonic screening to assess the need for patient admission. A telephonic triage was performed to identify the presence of COVID-19 infection risk factors or symptoms. New treatments were stratified according to priority codes. A reserved entrance to radiotherapy department was assured for patients and staff. Surgical disposable mask was required for patients and caregivers. The activities were distributed during the whole workday, avoiding overlap to reduce aggregation. RESULTS: From 1st February 2020 to 31 March 2020, we reported an increase in the number of first medical examinations and treatments, compared to the same period of the previous year. Outpatients first medical examinations have been spread over the 12 working hours. No COVID-19 cases were detected. CONCLUSION: During COVID-19 pandemic, we introduced procedures that allowed us to ensure the continuity in oncological cares, with limited risks of infection for patients and staff.

Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington.

The coronavirus disease 2019 (COVID-19) pandemic initially manifested in the United States in the greater Seattle area and has rapidly progressed across the nation in the past 2 months, with the United States having the highest number of cases in the world. Radiology departments play a critical role in policy and guideline development both for the department and for the institutions, specifically in planning diagnostic screening, triage, and management of patients. In addition, radiology workflows, volumes, and access must be optimized in preparation for the expected surges in the number of patients with COVID-19. In this article, the authors discuss the processes that have been implemented at the University of Washington in managing the COVID-19 pandemic as well in preparing for patient surges, which may provide important guidance for other radiology departments who are in the early stages of preparation and management.

Appropriateness of Radiology Test Requests by an Emergency Department: A Retrospective Study.

INTRODUCTION: Imaging tests are essential for diagnosis in the emergency context and convey clinical information that is essential to assess the appropriateness of the tests and improve their interpretation. Therefore, we aimed to analyze the imaging tests requested by the Emergency Department in a district hospital. MATERIAL AND METHODS: We retrospectively analyzed computed tomography and ultrasound scans requested by the Emergency Department at the Centro Hospitalar Universitário do Algarve and considered the following variables: requested test, clinical information provided (complete/incomplete), appropriateness of the test (appropriate/inappropriate), outcome (presence/absence of relevant findings) and findings related to the clinical information (yes/no). Pearson's chi-squared and odds ratio association tests were used to evaluate the statistical association between the variables. RESULTS: Out of 1427 requests, only 219 (15.3%) were considered to have complete clinical information. Nonetheless, 1075 (75.3%) requests were considered appropriate. Relevant findings were present in about one-third (n = 453; 31.7%) and most of these findings were related to the clinical context (n = 410; 90.5%). There was a significant association between test appropriateness and the presence of relevant findings in the test (p < 0.001). The odds ratio of having a relevant finding was 5.0 times higher in the tests considered appropriate when compared with those classified as inappropriate (CI = 3.4 - 7.3; p < 0.001). DISCUSSION: The fact that appropriate tests potentiate the probability of having a relevant finding emphasizes the importance of defining guidelines so that only the adequate tests are performed. CONCLUSION: Creating guidelines should improve the appropriateness of imaging tests requested in the Emergency Department, yielding their result, with the consequent rationalization of the available resources.

Introdução: Os exames de imagem são essenciais para o diagnóstico em contexto de emergência, sendo a informação clínica determinante para verificar a sua adequação e melhorar a sua interpretação. O nosso objetivo compreendeu a análise dos exames de imagem requisitados pelo Departamento de Emergência num hospital distrital. Material e Métodos: Realizámos uma análise retrospetiva das tomografias computorizadas e ecografias requeridas pelo Departamento de Emergência no Centro Hospitalar Universitário do Algarve considerando as seguintes variáveis: exame requisitado, informação clínica fornecida (completa/incompleta), adequação do exame (adequado/não adequado), resultado (presença/ausência de achados relevantes) e relação dos achados com contexto clínico (relacionados/não relacionados). A associação entre variáveis foi avaliada utilizando as análises qui-quadrado de Pearson e razão de possibilidades. Resultados: Das 1427 requisições, apenas 219 (15,3%) foram consideradas como contendo informação clínica completa. No entanto, 1075 (75,3%) requisições foram consideradas adequadas. Cerca de um terço dos exames continha achados relevantes (n = 453; 31,7%) e a maioria destes achados estavam relacionados com o contexto clínico (n = 410; 90,5%). Encontrámos associações significativas entre a adequação do pedido e presença de achados clínicos relevantes (p < 0,001). A razão de possibilidades de ter um achado relevante é 5,0 vezes maior nos pedidos adequados relativamente aos não adequados (IC = 3,4 - 7,3; p < 0,001). Discussão: O facto de os exames adequados potenciarem a probabilidade de existir um achado relevante enfatiza a importância da definição de diretrizes para que só os exames adequados sejam realizados. Conclusão: A criação destas diretrizes deverá aumentar a adequação dos exames de imagem solicitados no Departamento de Emergência, otimizando o seu resultado, com a consequente racionalização dos recursos disponíveis.

Recommendations for additional imaging of abdominal imaging examinations: frequency, benefit, and cost.

OBJECTIVES: To investigate the frequency, determinants, clinical implications, and costs of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations. METHODS: This retrospective study included 2225 abdominal imaging examinations from outside institutions that were reinterpreted as part of standard clinical care at a tertiary care center in a one-year time frame. RESULTS: Two hundred forty-six RAIs were present in 231 of 2225 reports (10.4%) of secondary abdominal imaging interpretations. Patient age and experience of the radiologist who performed the secondary interpretation were independently significantly associated with the presence of an RAI (both p = 0.002), with odds ratios of 0.99 per year increase in patient age (95% confidence interval [CI], 0.98-1.00) and 1.06 per year increase in experience of the radiologist (95% CI, 1.02-1.10). If followed, RAIs changed clinical management in 31.2%. Total costs of all 246 RAIs, whether performed or not by the referring physicians, amounted to €71,032.21, thus resulting in €31.92 per secondary abdominal imaging interpretation. Total costs of the 140 RAIs that were actually performed by the referring physicians amounted to €42,683.08, resulting in €19.18 per secondary abdominal imaging interpretation. CONCLUSIONS: The frequency of RAIs in reports of secondary interpretations of abdominal imaging examinations (which appear to be affected by patients' age and radiologists' experience) and associated costs are non-negligible. However, RAIs not infrequently change clinical management. The presented data may be helpful to radiology departments and healthcare policy makers to make well-informed decisions on the value and facilitation of the practice of secondary interpretations. KEY POINTS: • Frequency of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations at a tertiary care center is approximately 10.4%. • RAIs appear to be more frequently issued in younger patients and by more experienced radiologists, and if followed by referring clinicians, change clinical management in about one third of cases. • RAI costs per secondary interpretation in the Dutch Healthcare system are €31.92 (considering all RAIs) or €19.18 (considering only those RAIs that are actually performed).

Reject rate analysis in digital radiography: an Australian emergency imaging department case study.

INTRODUCTION: Reject analysis in digital radiography (DR) helps guide the education and training of staff, influences department workflow, reduces patient dose and improves department efficiency. The purpose of this study was to investigate rejected radiographs at a major metropolitan emergency imaging department to help form a benchmark of reject rates for DR and to assess what radiographs are being rejected and why. METHODS: A retrospective longitudinal study was undertaken as an in-depth clinical audit. The data were collected using automated reject analysis software from two digital x-ray systems from June 2015 to April 2017. The overall reject rate, reasons for rejection as well as the reject rates for individual radiographers, examination types and projections were analysed. RESULTS: A total of 90,298 radiographic images were acquired and included in the analysis. The average reject rate was 9%, and the most frequent reasons for image rejection were positioning error (49%) and anatomy cut-off (21%). The reject rate varied between radiographers as well as for individual examination types and projections. CONCLUSIONS: The variation in radiographer reject rates and the high reject rate for some projections indicate that reject analysis is still necessary as a quality assurance tool for DR. A feedback system between radiologists and radiographers may reduce the high percentage of positioning errors by standardising the technical factors used to assess image quality. Future reject analysis should be conducted regularly incorporating an exposure indicator analysis as well as retrospective assessment of individual rejected images.

How the Workload and Outcome of Imaging Examinations Changed During the COVID-19 Pandemic Lockdown.

BACKGROUND: On March 9th, 2020, the Italian government decided to go into lockdown due to the COVID-19 pandemic, which led to changes in the workflow of radiological examinations. AIMS: Aim of the study is to illustrate how the workload and outcome of radiological exams changed in a community hospital during the pandemic. METHODS AND MATERIAL: The exams performed in the radiology department from March 9th to March 29th, 2020 were retrospectively reviewed and compared to the exams conducted during the same time-period in 2019. Only exams coming from the emergency department (ED) were included. Two radiologists defined the cases as positive or negative findings, based on independent blind readings of the imaging studies. Categorical measurements are presented as frequency and percentages, and p-values are calculated using the Chi-squared test. RESULTS AND CONCLUSIONS: There was a significant reduction in the amount of exams performed in 2020: there were 143 (93|65% male, 60.7±21.5 years) patients who underwent radiological examinations from the ED vs. 485 (255|53% male, 51.2±24.8 years) in 2019. Furthermore, the total number of ED exams dropped from 699 (2019) to 215 (2020). However, the percentage of patients with a positive result was significantly higher in 2020 (69|48%) compared to 2019 (151|31%) (p<.001). The reduction of emergency radiological examinations might be a result of the movement restrictions enforced during the lockdown, and possible fear of the hospital as a contagious place. This translated to a relative increase of positive cases as only patients with very serious conditions were accessing the ED.

Variation in pelvic radiography practice: Why can we not standardise image acquisition techniques?

INTRODUCTION: Pelvic radiographs remain an essential investigation in orthopaedic practice. Although it is recognised that acquisition techniques can affect image appearances and measurement accuracy, it remains unclear what variation in practice exists and what impact this could have on decision making. METHOD: This was a cross sectional survey of UK radiology departments utilising an electronic tool. An introductory letter and link was distributed. Responses were received from 69 unique hospital sites within the specified timeframe, a response rate of 37.9%. RESULTS: There was no consistent technique for the positioning of patients for pelvic radiographs. The distance varied between 90 and 115 cm and 10 different centering points were described. In relation to leg position, the feet are usually internally rotated (65 of 69 [94.2%]). Only 1 teaching hospital (1 of 69 [1.4%]) uses a weight-bearing position as standard. Orthopaedic calibration devices were not in routine use, with only 21 using on pelvic x-rays (30.4%). Further, the type of device and application criteria were inconsistent. CONCLUSIONS: To our knowledge this is the first study to directly compare radiographic positioning across hospital sites. Our data demonstrated marked variation in technique for pelvis radiographs with associated implications for clinical decision making. Research is required to determine the standard technique and quality outcome measures to provide confidence in diagnostic interpretation particularly for serial radiographs.

Reducing diagnostic errors in emergency department with the help of radiographers.

A radiographer has the unique advantage of directly seeing the patient and presenting injury at the time of imaging. Extending this skill set to further evaluate the image acquired and document the findings may be helpful in reducing diagnostic errors in emergency department.