RESUMEN
Our aim was to determine the effect of wearing a surgical mask on the number and type of dictation errors in unedited radiology reports. IRB review was waived for this prospective matched-pairs study in which no patient data was used. Model radiology reports (n = 40) simulated those typical for an academic medical center. Six randomized radiologists dictated using speech-recognition software with and without a surgical mask. Dictations were compared to model reports and errors were classified according to type and severity. A statistical model was used to demonstrate that error rates for all types of errors were greater when masks are worn compared to when they are not (unmasked: 21.7 ± 4.9 errors per 1000 words, masked: 27.1 ± 2.2 errors per 1000 words; adjusted p < 0.0001). A sensitivity analysis was performed, excluding a reader with a large number of errors. The sensitivity analysis found a similar difference in error rates for all types of errors, although significance was attenuated (unmasked: 16.9 ± 1.9 errors per 1000 words, masked: 20.1 ± 2.2 errors per 1000 words; adjusted p = 0.054). We conclude that wearing a mask results in a near-significant increase in the rate of dictation errors in unedited radiology reports created with speech-recognition, although this difference may be accentuated in some groups of radiologists. Additionally, we find that most errors are minor single incorrect words and are unlikely to result in a medically relevant misunderstanding.
Asunto(s)
COVID-19 , Sistemas de Información Radiológica , Radiología , Humanos , Máscaras , Estudios Prospectivos , SARS-CoV-2RESUMEN
OBJECTIVE: Stroke is commonly caused by thromboembolic events originating from ruptured carotid plaque with vulnerable composition. This study assessed the performance of acoustic radiation force impulse (ARFI) imaging, a noninvasive ultrasound elasticity imaging method, for delineating the composition of human carotid plaque in vivo with histologic validation. METHODS: Carotid ARFI images were captured before surgery in 25 patients undergoing clinically indicated carotid endarterectomy. The surgical specimens were histologically processed with sectioning matched to the ultrasound imaging plane. Three radiologists, blinded to histology, evaluated parametric images of ARFI-induced peak displacement to identify plaque features such as necrotic core (NC), intraplaque hemorrhage (IPH), collagen (COL), calcium (CAL), and fibrous cap (FC) thickness. Reader performance was measured against the histologic standard using receiver operating characteristic curve analysis, linear regression, Spearman correlation (ρ), and Bland-Altman analysis. RESULTS: ARFI peak displacement was two-to-four-times larger in regions of NC and IPH relative to regions of COL or CAL. Readers detected soft plaque features (NC/IPH) with a median area under the curve of 0.887 (range, 0.867-0.924) and stiff plaque features (COL/CAL) with median area under the curve of 0.859 (range, 0.771-0.929). FC thickness measurements of two of the three readers correlated with histology (reader 1: R2 = 0.64, ρ = 0.81; reader 2: R2 = 0.89, ρ = 0.75). CONCLUSIONS: This study suggests that ARFI is capable of distinguishing soft from stiff atherosclerotic plaque components and delineating FC thickness.
Asunto(s)
Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/patología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/patología , Diagnóstico por Imagen de Elasticidad , Placa Aterosclerótica , Anciano , Área Bajo la Curva , Calcio/análisis , Arterias Carótidas/química , Colágeno/análisis , Femenino , Fibrosis , Hemorragia/diagnóstico por imagen , Hemorragia/patología , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Variaciones Dependientes del Observador , Proyectos Piloto , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Curva ROC , Reproducibilidad de los Resultados , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/patologíaRESUMEN
While in vivo acoustic radiation force impulse (ARFI)-induced peak displacement (PD) has been demonstrated to have high sensitivity and specificity for differentiating soft from stiff plaque components in patients with carotid plaque, the parameter exhibits poorer performance for distinguishing between plaque features with similar stiffness. To improve discrimination of carotid plaque features relative to PD, we hypothesize that signal correlation and signal-to-noise ratio (SNR) can be combined, outright or via displacement variance. Plaque feature detection by displacement variance, evaluated as the decadic logarithm of the variance of acceleration and termed "log(VoA)," was compared to that achieved by exploiting SNR, cross correlation coefficient, and ARFI-induced PD outcome metrics. Parametric images were rendered for 25 patients undergoing carotid endarterectomy, with spatially matched histology confirming plaque composition and structure. On average, across all plaques, log(VoA) was the only outcome metric with values that statistically differed between regions of lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), collagen (COL), and calcium (CAL). Further, log(VoA) achieved the highest contrast-to-noise ratio (CNR) for discriminating between LRNC and IPH, COL and CAL, and grouped soft (LRNC and IPH) and stiff (COL and CAL) plaque components. More specifically, relative to the previously demonstrated ARFI PD parameter, log(VoA) achieved 73% higher CNR between LRNC and IPH and 59% higher CNR between COL and CAL. These results suggest that log(VoA) enhances the differentiation of LRNC, IPH, COL, and CAL in human carotid plaques, in vivo, which is clinically relevant to improving stroke risk prediction and medical management.
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Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad/métodos , Interpretación de Imagen Asistida por Computador/métodos , Placa Aterosclerótica/diagnóstico por imagen , Anciano , Arterias Carótidas/patología , Arterias Carótidas/cirugía , Estenosis Carotídea/patología , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/patología , Placa Aterosclerótica/cirugía , Relación Señal-RuidoRESUMEN
RATIONALE AND OBJECTIVES: To evaluate the effect of a modified abdominal multislice computed tomography (CT) protocol for obese patients on image quality and radiation dose. MATERIALS AND METHODS: An adult female anthropomorphic phantom was used to simulate obese patients by adding one or two 4-cm circumferential layers of fat-equivalent material to the abdominal portion. The phantom was scanned with a subcutaneous fat thickness of 0, 4, and 8 cm using the following parameters (detector configuration/beam pitch/table feed per rotation/gantry rotation time/kV/mA): standard protocol A: 16 x 0.625 mm/1.75/17.5 mm/0.5 seconds/140/380, and modified protocol B: 16 x 1.25 mm/1.375/27.5 mm/1.0 seconds/140/380. Radiation doses to six abdominal organs and the skin, image noise values, and contrast-to-noise ratios (CNRs) were analyzed. Statistical analysis included analysis of variance, Wilcoxon rank sum, and Student's t-test (P < .05). RESULTS: Applying the modified protocol B with one or two fat rings, the image noise decreased significantly (P < .05), and simultaneously, the CNR increased significantly compared with protocol A (P < .05). Organ doses significantly increased, up to 54.7%, comparing modified protocol B with one fat ring to the routine protocol A with no fat rings (P < .05). However, no significant change in organ dose was seen for protocol B with two fat rings compared with protocol A without fat rings (range -2.1% to 8.1%) (P > .05). CONCLUSIONS: Using a modified abdominal multislice CT protocol for obese patients with 8 cm or more of subcutaneous fat, image quality can be substantially improved without a significant increase in radiation dose to the abdominal organs.
Asunto(s)
Obesidad , Radiografía Abdominal/normas , Tomografía Computarizada por Rayos X/normas , Análisis de Varianza , Calibración , Femenino , Humanos , Fantasmas de Imagen , Dosis de Radiación , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: To evaluate the age-stratified prevalence of upper tract urothelial malignancies diagnosed on computed tomography urography in a large cohort of patients referred for initial evaluation of hematuria. MATERIALS AND METHODS: A total of 1123 consecutive adults without a history of urothelial cancer underwent initial computed tomography urography for gross hematuria (n = 652), microscopic hematuria (n = 457), or unspecified hematuria (n = 14) at a single institution from October 2006 to October 2012. Imaging findings suggestive of urothelial lesions were correlated with clinical information, including cystoscopy, cytology, and surgical pathology reports. Patients subsequently diagnosed with urothelial cancer following a normal radiographic evaluation were identified and analyzed. Age, gender, smoking history, and location and type of malignancy were analyzed. RESULTS: Upper tract urothelial cancer was detected in 4 (0.36%) patients, with a mean age of 66.5 years. All 4 patients presented with gross hematuria and were current or former smokers. None of the 535 patients under age 55 who underwent computed tomography urography were diagnosed with upper tract disease regardless of age, smoking history, or degree of hematuria. Likewise, no upper tract cancers were detected in patients referred for microscopic hematuria, regardless of age. CONCLUSION: Detection of upper tract urothelial cancer by computed tomography urography is exceedingly rare in patients presenting at a tertiary referral center with hematuria, particularly in the lower risk strata (younger age, microscopic hematuria). Further investigation into risk-stratified approaches to imaging for hematuria workup is warranted to minimize unnecessary costs and radiation exposure.
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Carcinoma de Células Transicionales/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Neoplasias Ureterales/diagnóstico por imagen , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Carcinoma de Células Transicionales/complicaciones , Carcinoma de Células Transicionales/epidemiología , Femenino , Hematuria/etiología , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Derivación y Consulta , Estudios Retrospectivos , Centros de Atención Terciaria , Tomografía Computarizada por Rayos X , Neoplasias Ureterales/complicaciones , Neoplasias Ureterales/epidemiología , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/epidemiología , Urografía/métodosRESUMEN
Institutional review board approval and waiver of consent were obtained for the patient component of this retrospective HIPAA-compliant study. By using an anthropomorphic phantom and metal oxide semiconductor field effect transistor detectors, radiation dose was determined for one eight-detector row and two 16-detector row computed tomographic (CT) protocols. A custom phantom was scanned by using the three protocols to identify isotropy. Contrast-to-noise ratios (CNRs) were determined for the same protocols by using a third phantom. Seven patients had undergone isotropic 16-detector row CT of the abdomen and pelvis. Anonymized coronal reformations at various thicknesses were ranked qualitatively by three radiologists. Effective dose equivalents were similar for the eight- and 16-detector row protocols. When transverse and coronal reformations of data acquired in the custom phantom were compared, coronal reformations obtained with the 16-detector row and 0.625-mm section thickness protocol were found to be nearly identical to the transverse image for all sets of line pairs. CNRs were consistently highest on 5-mm-thick coronal reformations (CNR range, 1.2-3.3). For qualitative assessment, 2- and 3-mm-thick coronal reformations were consistently preferred.