RESUMO
We describe implementation of a point-of-care system for simultaneous acquisition of patient photographs along with portable radiographs at a large academic hospital. During the implementation process, we observed several technical challenges in the areas of (1) hardware-automatic triggering for photograph acquisition, camera hardware enclosure, networking, and system server hardware and (2) software-post-processing of photographs. Additionally, we also faced cultural challenges involving workflow issues, communication with technologists and users, and system maintenance. We describe our solutions to address these challenges. We anticipate that these experiences will provide useful insights into deploying and iterating new technologies in imaging informatics.
Assuntos
Gestão de Mudança , Sistemas Automatizados de Assistência Junto ao Leito , Humanos , Radiografia , Fotografação , InformáticaRESUMO
OBJECTIVE: Follow established management guidelines from the ACR and improve adherence to follow-up recommendations for incidental liver lesions (ILLs) for all patients undergoing CT abdomen and pelvis with contrast (CTAPw) examinations, with advocacy from a multidisciplinary care team. METHODS: A mandatory structured radiology reporting module was developed for use in CTAPw reports for ILL recommendations. Data from the electronic medical record describing patients with radiology-reported ILLs and their clinical risk diagnosis categories were tabulated in a queryable electronic database. A nurse co-ordinator initiated workflow to communicate the need for ILL follow-up MRI to ordering physicians and primary care providers. MRIs were ordered by the ILL team. An interactive process was undertaken with continuous review to improve identification of eligible patients and adherence to recommendations. RESULTS: During the initial launch phase from December 2020 to March 2021, 1,577 ILLs were detected on 20,667 CTAPw examinations, and for those with the characterize now recommendation, 36 of 114 (31.6%) received follow-up in 30 days. Between January 2021 and June 2022, 117,520 CTAPws were performed and 4,371 ILLs were detected. Using the ILL workflow, in the MRI now cohort, follow-up occurred within 30 days in 202 of 542 (36.2%) patients, and a total of 368 of 542 (67.9%) patients have completed their follow-up to date. DISCUSSION: Using a focused effort to close a gap in ILL care, adherence to follow-up recommendations improved over the long term, although there remains a gap in adherence to short-term interventions. A multidisciplinary approach, radiology reporting, and software solutions were leveraged to improve a complex process.
Assuntos
Achados Incidentais , Neoplasias Hepáticas , Humanos , Fluxo de Trabalho , Seguimentos , Tomografia Computadorizada por Raios X , Neoplasias Hepáticas/diagnóstico por imagemRESUMO
Radiology procedure workflow is a summation of individual workflows for scheduling, precertification, preprocedure clinic visits, and day of procedure, representing a complex total process with many opportunities for inefficiencies and waste. At the authors' institution, a lack of standard work and communication gaps in a pre- and postprocedure care area (PPCA) workflow were identified as factors in bottlenecks, waits and delays, and staff and patient frustrations. Using "lean" process improvement tools, these workflows were targeted in a rapid improvement event (RIE). A cross-functional team was formed to work on the PPCA workflow RIE. Using lean management principles, process gaps were identified and changes were instituted to improve patient and information flow. Three projects were implemented over a course of 4 months. These included a 5S, a lean methodology of workplace organization to optimize supply cabinets; standardization of nursing preprocedure documentation and process; and standard work confirmation in daily management system huddles. At baseline, 45% of patients were prepared within 60 minutes of their arrival in the PPCA. After the RIE and instituting the changes from the RIE, 80% of patients were prepared within 60 minutes of their arrival in the PPCA. Implementing lean management strategies, such as daily management systems and huddles, and establishing standard work confirmation help to eliminate waste and create systems and teams that sustain and improve complex workflows. © RSNA, 2022.
Assuntos
Hospitais , Melhoria de Qualidade , Humanos , Fluxo de Trabalho , Eficiência OrganizacionalRESUMO
Artificial intelligence has become a ubiquitous term in radiology over the past several years, and much attention has been given to applications that aid radiologists in the detection of abnormalities and diagnosis of diseases. However, there are many potential applications related to radiologic image quality, safety, and workflow improvements that present equal, if not greater, value propositions to radiology practices, insurance companies, and hospital systems. This review focuses on six major categories for artificial intelligence applications: study selection and protocoling, image acquisition, worklist prioritization, study reporting, business applications, and resident education. All of these categories can substantially affect different aspects of radiology practices and workflows. Each of these categories has different value propositions in terms of whether they could be used to increase efficiency, improve patient safety, increase revenue, or save costs. Each application is covered in depth in the context of both current and future areas of work. Keywords: Use of AI in Education, Application Domain, Supervised Learning, Safety © RSNA, 2022.
RESUMO
PURPOSE: Social determinants of health, including race and insurance status, contribute to patient outcomes. In academic health systems, care is provided by a mix of trainees and faculty members. The optimal staffing ratio of trainees to faculty members (T/F) in radiology is unknown but may be related to the complexity of patients requiring care. Hospital characteristics, patient demographics, and radiology report findings may serve as markers of risk for poor outcomes because of patient complexity. METHODS: Descriptive characteristics of each hospital in an urban five-hospital academic health system, including payer distribution and race, were collected. Radiology department T/F ratios were calculated. A natural language processing model was used to classify multimodal report findings into nonacute, acute, and critical, with report acuity calculated as the fraction of acute and critical findings. Patient race, payer type, T/F ratio, and report acuity score for hospital 1, a safety net hospital, were compared with these factors for hospitals 2 to 5. RESULTS: The fraction of patients at hospital 1 who are Black (79%) and have Medicaid insurance (28%) is significantly higher than at hospitals 2 to 5 (P < .0001), with the exception of hospital 3 (80.1% black). The T/F ratio of 1.37 at hospital 1 as well as its report acuity (28.9%) were significantly higher (P < .0001 for both). CONCLUSIONS: T/F ratio and report acuity are highest at hospital 1, which serves the most at-risk patient population. This suggests a potential overreliance on trainees at a site whose patients may require the greatest expertise to optimize care.
Assuntos
Radiologia , Determinantes Sociais da Saúde , Hospitais Urbanos , Humanos , Medicaid , Estados Unidos , Recursos HumanosRESUMO
OBJECTIVES: Determine the rate of positive extremity ultrasound exams for DVT in patients with COVID-19 and assess for differences in laboratory values in patients with and without DVT, which could be used as a surrogate to decide the need for further evaluation with ultrasound. METHODS: Retrospective case control study with 1:2 matching of cases (COVID-19+ patients) to controls (COVID-19- patients) based on age, gender, and race. Laboratory values assessed were serum D-dimer, fibrinogen, prothrombin time, international normalized ratio, and C-reactive protein. Demographic variables, comorbidities, and clinical variables including final disposition were also evaluated. P-values for categorical variables were calculated with the chi-square test or Fisher's exact test. P-values for continuous variables were compared with the use of a two-tailed unpaired t-test. RESULTS: The rate of extremity ultrasound exams positive for DVT were similar in patients with (14.7%) and without (19.3%) COVID-19 (P = .423). No significant difference was observed in laboratory values including the D-dimer level in COVID-19 patients without (mean 9523.9 ng/mL (range 339 to >60,000)) or with DVT (mean 13,663.7 ng/mL (range 1193->60,000)) (P = .475). No differences were found in demographic variabilities or co-morbidities among COVID-19 patients with and without extremity DVT. CONCLUSIONS: We found no statistically significant difference in rate of positive DVT studies between COVID-19+ and COVID-19- patients. D-dimer levels are elevated, in some cases markedly, in COVID-19 patients with and without DVTs and therefore these data do not support their use as a surrogate when assessing the need for ultrasound evaluation.
Assuntos
COVID-19 , Trombose Venosa , COVID-19/complicações , Estudos de Casos e Controles , Extremidades/diagnóstico por imagem , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Estudos Retrospectivos , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagemRESUMO
RATIONALE AND OBJECTIVES: Imaging Informatics is an emerging and fast-evolving field that encompasses the management of information during all steps of the imaging value chain. With many information technology tools being essential to the radiologists' day-to-day work, there is an increasing need for qualified professionals with clinical background, technology expertise, and leadership skills. To answer this, we describe our experience in the development and implementation of an Integrated Imaging Informatics Track (I3T) for radiology residents at our institution. MATERIALS AND METHODS: The I3T was created by a resident-driven initiative funded by an intradepartmental resident grant. Its curriculum is delivered through a combination of monthly small group discussions, operational meetings, recommended readings, lectures, and early exposure to the National Imaging Informatics Course. The track is steered and managed by the I3T Committee, including trainees and faculty advisors. Up to two first-year residents are selected annually based on their curriculum vitae and an interest application. Successful completion of the program requires submission of a capstone project and at least one academic deliverable (national meeting presentation, poster, exhibit, manuscript and/or grant). RESULTS: In our three-year experience, the seven I3T radiology residents have reported a total of 58 scholarly activities related to Imaging Informatics. I3T residents have assumed leadership roles within our organization and nationally. All residents have successfully carried out their clinical responsibilities. CONCLUSION: We have developed and implemented an I3T for radiology residents at our institution. These residents have been successful in their clinical, scholarship and leadership pursuits.
Assuntos
Internato e Residência , Radiologia , Bolsas de Estudo , Humanos , Informática , Liderança , Radiologia/educaçãoRESUMO
The appropriate evaluation of adrenal masses is strongly dependent on the clinical circumstances in which it is discovered. Adrenal incidentalomas are masses that are discovered on imaging studies that have been obtained for purposes other than adrenal disease. Although the vast majority of adrenal incidentalomas are benign, further radiological and biochemical evaluation of these lesions is important to arrive at a specific diagnosis. Patients with a history of malignancy or symptoms of excess hormone require different imaging evaluations than patients with incidentalomas. This document reviews imaging approaches to adrenal masses and the various modalities utilized in evaluation of adrenal lesions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Neoplasias das Glândulas Suprarrenais , Radiologia , Diagnóstico por Imagem , Humanos , Sociedades Médicas , Estados UnidosRESUMO
BACKGROUND: Secondary interpretations of diagnostic imaging examinations are increasingly performed to improve care for complex patients. We sought to determine associated patient-billed liabilities and out-of-pocket payments and to identify patient and imaging study characteristics that correlate with higher patient bills and out-of-pocket payments. METHODS: Data extracted for 7,740 secondary imaging interpretations performed across our large metropolitan health system over 25 months included total professional charges, insurance payments, patient-billed liabilities, and patient out-of-pocket payments. Multivariable linear regression analyses were performed to identify patient and imaging factors associated with higher patient bills and out-of-pocket payments. RESULTS: Mean secondary interpretation professional charges, insurance payments, patient-billed liabilities, and patient out-of-pocket payments were $306.50, $108.02, $27.80, and $14.55, respectively. Patients received bills for 47.5% of services and made out-of-pocket payments for 17.1%. Patient-billed liabilities and out-of-pocket payments were higher for patients who were younger and uninsured and for secondary interpretations requested for patients seen in outpatient (versus inpatient) settings. Patient-billed liabilities and out-of-pocket payments were lower for patients who were Black (versus White) and had government-sponsored (versus commercial) insurance and for secondary interpretations performed during the second, third, or fourth (versus first) quarter of each calendar year. CONCLUSION: Observed differences between patient-billed liabilities and out-of-pocket payments suggest that secondary interpretations of diagnostic imaging examinations can result in small but real patient financial burdens. Improved price transparency and enhanced patient communication about the value of secondary interpretations could reduce potential surprises when patients receive these bills.
Assuntos
Gastos em Saúde , Pessoas sem Cobertura de Seguro de Saúde , Diagnóstico por Imagem , HumanosRESUMO
Renal failure can be divided into acute kidney injury and chronic kidney disease. Both are common and result in increased patient morbidity and mortality. The etiology is multifactorial and differentiation of acute kidney injury from chronic kidney disease includes clinical evaluation, laboratory tests, and imaging. The main role of imaging is to detect treatable causes of renal failure such as ureteral obstruction or renovascular disease and to evaluate renal size and morphology. Ultrasound is the modality of choice for initial imaging, with duplex Doppler reserved for suspected renal artery stenosis or thrombosis. CT and MRI may be appropriate, particularly for urinary tract obstruction. However, the use of iodinated and gadolinium-based contrast should be evaluated critically depending on specific patient factors and cost-benefit ratio. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Insuficiência Renal , Sociedades Médicas , Medicina Baseada em Evidências , Humanos , Imageamento por Ressonância Magnética , Ultrassonografia , Estados UnidosRESUMO
Background Emergency departments (EDs) rely on advanced imaging such as CT for diagnosis. Owing to increased ED volumes at the authors' institution, CT image acquisition became a significant bottleneck in ED patient throughput. Methods A multidisciplinary team was formed to solve this complex patient flow issue. Lean management principles were leveraged to identify process gaps and institute changes to achieve workflow improvements, remove process wastes, and improve patient throughput in the ED CT scanner. Process metrics such as percentage of CT examinations completed within 120 minutes and monthly median examination turnaround time (TAT) were tracked on a monthly basis. To measure impact, outcome metrics such as time savings from elimination of wasted steps were developed. Interventions Four projects including development of an ideal staffing model, a patient flow worksheet, revision of the CT patient screening form, and examination prioritization efforts were tested. Just-do-it activities such as revision of the CT angiography protocol ordering tool, optimizing scanner utilization, and improving communication and collaboration between the radiology department and ED were also attempted. Results After a phased rollout of changes over 6 months, the percentage of ordered ED CT examinations completed within 120 minutes increased by 10% (61%-71%); however, this improvement was sustained for only 6 weeks. Elimination of process inefficiencies resulted in a monthly median TAT reduction from 90-109 minutes to 82-106 minutes, and approximately 6 weeks (268 hours) of annualized full-time technologist time was saved. Conclusion Lean management tools can be leveraged to solve complex ED CT patient flow issues and reduce TAT. Online supplemental material is available for this article. ©RSNA, 2021.
Assuntos
Serviço Hospitalar de Emergência , Tomografia Computadorizada por Raios X , Humanos , Fatores de Tempo , Fluxo de TrabalhoRESUMO
Renal failure can be divided into acute kidney injury and chronic kidney disease. Both are common and result in increased patient morbidity and mortality. The etiology is multifactorial and differentiation of acute kidney injury from chronic kidney disease includes clinical evaluation, laboratory tests, and imaging. The main role of imaging is to detect treatable causes of renal failure such as ureteral obstruction or renovascular disease and to evaluate renal size and morphology. Ultrasound is the modality of choice for initial imaging, with duplex Doppler reserved for suspected renal artery stenosis or thrombosis. CT and MRI may be appropriate, particularly for urinary tract obstruction. However, the use of iodinated and gadolinium-based contrast should be evaluated critically depending on specific patient factors and cost-benefit ratio. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Humanos , Diagnóstico por Imagem/métodos , Insuficiência Renal/diagnóstico por imagemRESUMO
OBJECTIVE. This article presents the perspectives of radiologists in different sub-specialties at three institutions across the United States regarding inpatient imaging of patients confirmed to have coronavirus disease (COVID-19) and persons under investigation (i.e., patients suspected to have COVID-19). CONCLUSION. The COVID-19 pandemic has prompted radiologists to become aware of imaging findings related to the disease and to develop workflows for the imaging of patients with COVID-19 and persons under investigation, to optimize care for all patients and preserve the health of health care workers.
Assuntos
COVID-19/diagnóstico por imagem , Diagnóstico por Imagem , Pacientes Internados , Pneumonia Viral/diagnóstico por imagem , Adulto , Idoso , COVID-19/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2 , Estados Unidos/epidemiologia , Fluxo de TrabalhoRESUMO
The radiology workflow can be segmented into three large groups: pre-interpretative processes, interpretation, and postinterpretative processes. Each stage of this workflow represents quality improvement opportunities for artificial intelligence and machine learning. Although the focus of recent research has been targeted toward optimization of image interpretation, this article describes significant use cases for artificial intelligence in both the pre-interpretative and postinterpretative aspects of radiology. We provide examples of how current applications of AI for quality improvement purposes across the radiology workflow have been implemented and how further integration of these technologies can significantly improve clinical efficiency, reduce radiologist work burden, and ultimately optimize patient care and outcomes.
Assuntos
Inteligência Artificial , Sistemas de Apoio a Decisões Clínicas , Algoritmos , Retroalimentação , Humanos , Melhoria de QualidadeRESUMO
Renal masses are increasingly detected in asymptomatic individuals as incidental findings. CT and MRI with intravenous contrast and a dedicated multiphase protocol are the mainstays of evaluation for indeterminate renal masses. A single-phase postcontrast dual-energy CT can be useful when a dedicated multiphase renal protocol CT is not available. Contrast-enhanced ultrasound with microbubble agents is a useful alternative for characterizing renal masses, especially for patients in whom iodinated CT contrast or gadolinium-based MRI contrast is contraindicated. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.