Quantifying and Reducing Errors in Vascular Imaging Examination Orders Through a Multistage Quality Improvement Intervention.

PURPOSE: The aims of this study were to quantify order error rates for vascular imaging examinations and to assess the effects of a multistage quality improvement intervention on those rates. METHODS: In this prospective, institutional review board-exempt project at a large academic quaternary care hospital, the authors aimed to quantify and reduce the order error rate by 50%. The authors analyzed 844 orders for all vascular imaging examinations placed before the intervention (July 19 to August 1, 2021, and September 13 to September 26, 2021), after an intervention in the cardiac surgery department consisting of a new customized order option in the electronic health record for routine preoperative patients (postintervention 1, February 28 to March 27, 2022); and after an educational and feedback campaign (postintervention 2, May 23 to June 5, 2022). Incorrect orders were identified by a radiology trainee during protocoling if the reasons for ordered examination and imaging examination were discordant and subsequently confirmed with the ordering provider. The primary outcome, order error rate, was compared across the project periods using the χ2 test and by ordering department using the χ2 and Fisher exact tests. RESULTS: The preintervention order error rate of 16% (50 of 306) decreased by 83% to 3% (10 of 353) at postintervention 1 (P < .001) and was durable at 3% (6 of 185) by project end. Chest CT with or without contrast constituted the majority of incorrect orders (44%, 22 of 50); "Pre-Op" was the most common examination reason (32% [16 of 50]). Cardiac surgery orderers were responsible for the most incorrect orders (32% [16 of 50]). All four most common ordering departments, including cardiac surgery, reduced their order error rates after the intervention (P < .001). CONCLUSIONS: Incorrect orders for imaging examinations can be reduced through targeted quality improvement interventions combining tailored electronic health record order options with education and feedback on practice habits.

Identification and Characterization of Leptomeningeal Metastases Using SPINE, A Web-Based Collaborative Platform.

BACKGROUND AND PURPOSE: Leptomeningeal metastases (LMs) carry a poor prognosis. Existing LM scoring systems show limited reproducibility. We assessed the contribution of education level on the reproducibility of LM scoring using structured planning and implementation of new experiments (SPINE), a novel web-based platform. METHODS: Stringent radiological definitions of LM and a customized interactive scoring system were implemented in SPINE. Five patients with brain LM and 3 patients with spine, but no brain LM, were selected. Each patient's baseline post-contrast T1-weighted brain MRI was analyzed by three attending neuroradiologists, two neuroradiology fellows, and two radiology residents. Raters identified and characterized all LMs based on: (1) location (cerebrum, cerebellum, brainstem, ventricle, and/or cranial nerves); (2) shape (nodular and/or linear/curvilinear); (3) size (≥ or <5mm in two orthogonal diameters); (4) spatial extension (focal or diffuse). Inter-rater agreement and association of LM with patient survival were investigated. RESULTS: On average, 6.5 LMs per case were detected. Forty-nine percent of LMs were cerebral, 77.7% were nodular, 86.6% were focal, and 66% were <5 × 5 mm. Agreement on the total number of LMs and the above-mentioned common LM characteristics was higher between attendings (intra-class correlation [ICC] = 0.8-0.94) than fellows (ICC = 0.6-0.82) or residents (ICC = 0.43-0.73). Agreement on ventricular, cranial nerve, and nodular + linear LM was low even between attendings. The number of brainstem LMs showed significant correlation with survival. CONCLUSION: Structured education using SPINE may improve consistency in LM reporting. Future work should address the impact of the presented approach on the reproducibility of longitudinal analyses directly relevant to the assessment of treatment-response.

Round ligament leiomyoma: a rare manifestation of a common entity.

A 68-year-old woman with a history of multifocal uterine leiomyomas presented with left groin pain and was referred for cross-sectional imaging to assess for the presence of an inguinal hernia. In this patient, MRI demonstrated a round ligament leiomyoma encased in the proximal left inguinal canal. Leiomyomas are the most common benign gynecologic tumors, however round ligament leiomyomas are very rare. The purpose of this case report is to highlight a rare manifestation of a common entity.

Association between corneal hysteresis and the magnitude of intraocular pressure decrease after cataract surgery.

PURPOSE: To evaluate the relationship between baseline corneal hysteresis (CH) and the change in intraocular pressure (IOP) before and after cataract extraction in patients without glaucoma. SETTING: Private practice, New York City, New York, USA. DESIGN: Retrospective cohort study. METHODS: Charts of consecutive patients who had phacoemulsification cataract extraction with posterior chamber intraocular lens implantation were analyzed. All included patients had preoperative and postoperative measurements with the Ocular Response Analyzer 2 to 4 months and 10 to 12 months postoperatively. Data collected included age, baseline CH, baseline central corneal thickness (CCT), and IOP. RESULTS: Thirty nine (65 eyes) of the 230 patients met the inclusion criteria. The mean patient age was 70.8 years ± 8.6 (SD). The mean preoperative, 2- to 4-month and 10- to 12- month postoperative IOP values were 14.8 ± 3.5 mm Hg, 11.9 ± 3.4 mm Hg, and 12.6 ± 3.1 mm Hg, respectively (P < .05 for comparisons with preoperative IOP). The baseline CH was not predictive of the IOP reduction at 2 to 4 months (ß = -0.3; 95% confidence interval [CI], -0.7 to 0.01; P = .06). However, the baseline CH (but not the baseline CCT) was statistically associated with the magnitude of IOP reduction at 10 to 12 months when controlling for patient age (ß = -0.5; 95% CI, -0.8 to -0.1; P = .01). CONCLUSION: A low baseline CH was associated with a larger magnitude of IOP reduction after cataract extraction. FINANCIAL DISCLOSURE: Dr. Radcliffe is a consultant to Reichert Technologies and Glaukos Corp.; a consultant to and speaker for Allergan, Inc., Alcon Laboratories, Inc., Iridex Corp., Merge Healthcare, Carl Zeiss Meditec AG; and a speaker for Merck Pharmaceuticals. No other author has a financial or proprietary interest in any material or method mentioned.