Just in Time Radiology Decision Support Using Real-time Data Feeds.

Ready access to relevant real-time information in medical imaging offers several potential benefits. Knowing both when important information will be available and that important information is available can facilitate optimization of workflow and management of time. Unexpected findings, as well as deficiencies in reporting and documentation, can be immediately managed. Herein, we present our experience developing and implementing a real-time web-centric dashboard system for radiologists, clinicians, and support staff. The dashboards are driven by multi-sourced HL7 message streams that are monitored, analyzed, aggregated, and transformed into multiple real-time displays to improve operations within our department. We call this framework Pipeline. Ruby on Rails, JavaScript, HTML, and SQL serve as the foundations of the Pipeline application. HL7 messages are processed in real-time by a Mirth interface engine which posts exam data into SQL. Users utilize web browsers to visit the Ruby on Rails-based dashboards on any device connected to our hospital network. The dashboards will automatically refresh every 30 seconds using JavaScript. The Pipeline application has been well received by clinicians and radiologists.

Compliance With Skeletal Surveys for Child Abuse in General Hospitals: A Statewide Quality Improvement Process.

OBJECTIVE. The purpose of this study is to perform a statewide quality improvement process to improve compliance with the American College of Radiology (ACR) guidelines in performing skeletal surveys for suspected child abuse. SUBJECTS AND METHODS. We prospectively identified all outside hospital skeletal surveys for suspected child abuse in children younger than 3 years referred to our tertiary children's hospital in 2016-2017. We included a 3-month baseline and 21-month intervention period. The quality improvement process was based on sending educational material to all ACR member radiologists in the state and making telephone calls to radiology technologist team leaders whenever the surveys were not compliant, followed by e-mails with guidance on performing skeletal surveys. We documented the views obtained and compared them with the ACR guidelines. The percentage of compliance with each individual view was assessed with the chi-square test. The total number of compliant views per survey was evaluated with ANOVA. RESULTS. Two hundred twenty-seven patients (105 female) with a mean age of 0.8 year (SD, 0.67 year; range, 0.01-3 years) were evaluated. These 227 surveys (baseline, n = 27; postintervention, n = 200) were performed at 69 different outside hospitals. Compliance significantly (p = 0.006) improved from 25.9% (7/27) during baseline to 54.0% (108/200) after intervention. There was a nonsignificant trend of improved compliance between the first (51.9%; 41/79) and last 7-month (62.3%; 33/53) periods of intervention. Among individual views, only rib oblique views showed significantly (p = 0.02) improved compliance after the intervention, from 51.9% (14/27) to 73.5% (147/200). CONCLUSION. The compliance rate with ACR guidelines for skeletal surveys in suspected child abuse at outside general hospitals significantly increased after implementation of a quality improvement process.

The state of structured reporting: the nuance of standardized language.

Radiology reports are the principal form of communication with the referring provider. Unfortunately, they can be a form of communication riddled with errors and inscrutable statements burying the intended meaning, failing to achieve the main task for which it was made: communicating key imaging findings as they pertain to the clinical question being posed. Structured reporting is a multifaceted and modular solution to problematic reports, with variable iterations and benefits. Structured reports have been adapted across departments and even national societies, with standardized format, content and language. Newer developments include contextual reporting and common data elements. Herein, we discuss the various forms and levels of structured reporting and the latest advancements, as well as the general acceptance within radiology. We also discuss some areas for improvement as the practice of structured reporting matures.

Fetal MRI in management of complicated meconium ileus: Prenatal and surgical imaging.

OBJECTIVE: To review fetal MRI cases surgically proven to have meconium ileus (MI) and obstruction, describe the common fetal MRI findings that distinguish cases of complicated MI, and to compare these findings with surgical images and perinatal outcomes. METHOD: We performed a retrospective review of all fetal MRI examinations and the corresponding medical record from our tertiary care children's hospital over an 18-month period. Postnatal management and outcomes were reviewed for these patients, and those patients with surgical or postmortem diagnosis of complicated MI were included in the study. RESULTS: Our analysis revealed 7 cases. In this cohort, 3 imaging features of the fetal bowel were repeatedly seen: gradient appearance of intraluminal bowel contents, abnormally localized meconium signal, and collapsed appearance of the colon on MRI. Surgical diagnoses confirmed MI. All live-born infants underwent surgical repair. CONCLUSION: Fetal MRI should be included in the diagnostic algorithm of any pregnancy where fetal bowel obstruction is suspected to better risk stratify patients.

Transportation Use and Barriers for Employed and Unemployed Autistic Adults.

Background: Autistic adults are significantly unemployed or underemployed even compared with other disability groups. Employment is a social determinant that, when satisfied, closely influences health-related quality of life. For autistic adults, environmental barriers to transportation can impact the ability to get to employment resulting in limited employment opportunities. This study provides a closer examination of the association between transportation use and employment status. Objective: To examine the use of different types of transportation and barriers to public transit by employed and unemployed autistic adults. Method: The data were from a large statewide study conducted between May 2017 and June 2018 using the Pennsylvania Autism Needs Assessment (PANA), in which information about employment and transportation use was obtained from autistic adults who were residents of Pennsylvania. The study sample included 1120 autistic adults (Mage = 28.03 years, standard deviation = 9.84; 70% men; 82% non-Hispanic White). Results: Participants who were employed were more likely to drive themselves than those who were unemployed (45% vs. 21%, p < 0.001), while they were less likely to take rides from others (62% vs. 75%, p < 0.001) or use service transportation (11% vs. 18%, p = 0.001). For barriers to public transit, the results identified that employed participants reported fewer barriers to public transportation than unemployed participants with a small effect size (1.98 vs. 2.54, d = 0.22). Conclusion: Employed autistic adults exercise more transportation independence. Unemployed autistic adults report more barriers to participation and lower ability to independently use public transportation. Future transportation and employment studies are necessary.

Why is this an important issue? Employment is important for income, quality of life, and the ability to get the supports or services a person needs. Autistic adults are more likely to be unemployed or underemployed when compared with neurotypical adults and people with other disabilities. There are many environmental barriers to participating in adult activities in the community, but issues with transportation are a primary barrier. In previous research, a high number of autistic adults (72%) reported that they had missed some of their desired activities due to lack of transportation. It is important to understand the relationship between transportation and employment to know how to overcome barriers and improve employment options for autistic adults who want to work. What was the purpose of this research? The purpose of this research was to look at transportation and employment status (i.e., employed or unemployed). Specifically, this study compared types of transportation used and perceived barriers to transportation between autistic adults who were employed and those who were unemployed. What did the researchers do? Information was collected from 1120 autistic adults through a large statewide survey, which included questions about employment and transportation. Information from autistic adults who were employed and those who were not employed was compared. What were the results of the study? Results of this comparison showed that participants who were employed were more likely to drive themselves and less likely to take rides from other people or to use service transportation. Those who were employed also reported fewer barriers to public transportation. Barriers such as crime, planning a trip, treatment by fellow passengers, cost, knowledge on how to use public transportation, and sensory overload were identified by more people who were unemployed than by people who were employed. How will these findings help autistic adults now or in the future? The study identified specific barriers to transportation for autistic adults who are unemployed. This information can help to guide supports and policies to reduce barriers for travel needed for employment. In addition, results of this study can help guide future research to develop or identify the transportation skills needed for travel to work for autistic adults.

Creating the Global Criminal Justice Survey: A Questionnaire Designed to Gather Perspectives from the Autism Community and Criminal Justice Professionals.

Autistic people's perceptions of their interactions with criminal justice professionals are predominantly negative; however, little is known about the state of interactions on a global scale. To further understanding, a comprehensive stakeholder questionnaire was created. Aspects of reliability and validity including evidence for test content and internal structure were gathered using expert reviews, cognitive interviewing, pilot data collection, and a larger data collection effort (N = 1618). Data was gathered from the autism community through perspectives of parents/caregivers as well as from self-reported autistic adults. Criminal justice professionals included law enforcement officers, corrections professionals, probation and parole officers, forensic psychologists and legal professionals. The scale development process was detailed in order to sufficiently document the initial psychometric evidence and share the steps taken to gain diverse stakeholder input. This study is a critical first step in generating further information to facilitate policy and program development with wide applicability.

ACR Appropriateness Criteria® Ataxia-Child.

Childhood ataxia may be due to multifactorial causes of impairment in the coordination of movement and balance. Acutely presenting ataxia in children may be due to infectious, inflammatory, toxic, ischemic, or traumatic etiology. Intermittent or episodic ataxia in children may be manifestations of migraine, benign positional vertigo, or intermittent metabolic disorders. Nonprogressive childhood ataxia suggests a congenital brain malformation or early prenatal or perinatal brain injury, and progressive childhood ataxia indicates inherited causes or acquired posterior fossa lesions that result in gradual cerebellar dysfunction. CT and MRI of the central nervous system are the usual modalities used in imaging children presenting with ataxia, based on the clinical presentation. This document provides initial imaging guidelines for a child presenting with acute ataxia with or without a history of recent trauma, recurrent ataxia with interval normal neurological examination, chronic progressive ataxia, and chronic nonprogressive ataxia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Superior vena cava syndrome in a patient with locally advanced lung cancer with good response to definitive chemoradiation: a case report.

BACKGROUND: The incidence of superior vena cava syndrome within the United States is roughly 15,000 cases per year. Superior vena cava syndrome is a potentially life-threatening medical condition; however, superior vena cava syndrome is not fatal in the majority of cases. Superior vena cava syndrome encompasses a collection of signs and symptoms resulting from obstruction of the superior vena cava, including swelling of the upper body of the head, neck, arms, and/or breast. It is also associated with cyanosis, plethora, and distended subcutaneous vessels. Lung cancer, including both non-small cell lung cancer and small cell lung cancer, is the most common extrinsic cause of superior vena cava syndrome. Intrinsic disruption of superior vena cava flow can also precipitate superior vena cava syndrome. This case report describes an unusual presentation and potential etiology of superior vena cava syndrome. CASE PRESENTATION: Our patient was a 51-year-old black woman with locally advanced, stage IIIB non-small cell lung cancer who had no clinical symptoms of superior vena cava syndrome at the time of diagnosis. However, she did have radiographic evidence of superior vena cava stenosis caused by extrinsic compression from her large right hilar primary tumor. She was treated with definitive chemoradiation, receiving 60 Gy of external beam radiation therapy given concurrently with chemotherapy. Three months after completion of radiotherapy, she developed signs of superior vena cava syndrome, including breast and supraclavicular swelling. She had a chest computed tomography scan showing over 50% reduction in the size of a right hilar mass; however, she had continued radiographic stenosis of the superior vena cava. The distribution of stenosis appeared to be inferior to the caudal extent of pretreatment tumor volume. She had no other radiographic indications for superior vena cava syndrome. CONCLUSIONS: Generally, superior vena cava syndrome is the result of extrinsic compression of the superior vena cava by tumor. Our patient's case represents the development of superior vena cava syndrome after an excellent response of tumor with near-complete tumor response. We suspect chemoradiation therapy as a potential etiology for the precipitation of the superior vena cava syndrome, which is currently not well reported in the medical literature.