Natural Language Processing to Identify Pulmonary Nodules and Extract Nodule Characteristics From Radiology Reports.

BACKGROUND: There is an urgent need for population-based studies on managing patients with pulmonary nodules. RESEARCH QUESTION: Is it possible to identify pulmonary nodules and associated characteristics using an automated method? STUDY DESIGN AND METHODS: We revised and refined an existing natural language processing (NLP) algorithm to identify radiology transcripts with pulmonary nodules and greatly expanded its functionality to identify the characteristics of the largest nodule, when present, including size, lobe, laterality, attenuation, calcification, and edge. We compared NLP results with a reference standard of manual transcript review in a random test sample of 200 radiology transcripts. We applied the final automated method to a larger cohort of patients who underwent chest CT scan in an integrated health care system from 2006 to 2016, and described their demographic and clinical characteristics. RESULTS: In the test sample, the NLP algorithm had very high sensitivity (98.6%; 95% CI, 95.0%-99.8%) and specificity (100%; 95% CI, 93.9%-100%) for identifying pulmonary nodules. For attenuation, edge, and calcification, the NLP algorithm achieved similar accuracies, and it correctly identified the diameter of the largest nodule in 135 of 141 cases (95.7%; 95% CI, 91.0%-98.4%). In the larger cohort, the NLP found 217,771 reports with nodules among 717,304 chest CT reports (30.4%). From 2006 to 2016, the number of reports with nodules increased by 150%, and the mean size of the largest nodule gradually decreased from 11 to 8.9 mm. Radiologists documented the laterality and lobe (90%-95%) more often than the attenuation, calcification, and edge characteristics (11%-14%). INTERPRETATION: The NLP algorithm identified pulmonary nodules and associated characteristics with high accuracy. In our community practice settings, the documentation of nodule characteristics is incomplete. Our results call for better documentation of nodule findings. The NLP algorithm can be used in population-based studies to identify pulmonary nodules, avoiding labor-intensive chart review.

Artificial Intelligence and Clinical Decision Support for Radiologists and Referring Providers.

Recent advances in artificial intelligence (AI) are providing an opportunity to enhance existing clinical decision support (CDS) tools to improve patient safety and drive value-based imaging. We discuss the advantages and potential applications that may be realized with the synergy between AI and CDS systems. From the perspective of both radiologist and ordering provider, CDS could be significantly empowered using AI. CDS enhanced by AI could reduce friction in radiology workflows and can aid AI developers to identify relevant imaging features their tools should be seeking to extract from images. Furthermore, these systems can generate structured data to be used as input to develop machine learning algorithms, which can drive downstream care pathways. For referring providers, an AI-enabled CDS solution could enable an evolution from existing imaging-centric CDS toward decision support that takes into account a holistic patient perspective. More intelligent CDS could suggest imaging examinations in highly complex clinical scenarios, assist on the identification of appropriate imaging opportunities at the health system level, suggest appropriate individualized screening, or aid health care providers to ensure continuity of care. AI has the potential to enable the next generation of CDS, improving patient care and enhancing providers' and radiologists' experience.

Hospitalization for cancer among radiologists in Taiwan.

BACKGROUND: Population aging and the incremental use of high-tech instruments increase the demand for radiological examinations and treatments in medical services. The exposure of radiologists and other medical workers to medical treatment radiation may thus be increased. OBJECTIVES: The aim of the study was to explore the average number of cancer hospitalizations and use of hospitalization as cancer treatment for radiologists compared with that for family medicine physicians, as well as the trends in the annual average number of cancer hospitalizations among radiologists. METHODS: Research data were obtained from the 2000-2010 Taiwan National Health Insurance Research Database. These samples collected for this study were unbalanced panel data. RESULTS: The average number of cancer hospitalizations for radiologists from 2000 to 2010 ranged between 3.67 and 28.26‰. After controlling the effects of gender, age, hospital accreditation level and year using generalized estimating equations with a binomial distribution and logit link function, our study found that radiologists had non significant higher risk of cancer hospitalizations compared with family medicine physicians. However, the average number of cancer hospitalizations for radiologists showed an annual decline from 2000 to 2010. CONCLUSIONS: Compared with family medicine physicians, radiologists had non significant higher risk of cancer hospitalizations. The data period examined in this study was only 11 years. Considering the numerous new radiological procedures currently in use in modern medical treatments, the health status of medical radiation workers should be continuously monitored in the future.

[Status and integration of radiology in a large clinical center]. / Stellung und Einbindung der Radiologie in einem Grossklinikum.

Radiology has undergone enormous technological and hence organizational changes in the last few decades. These changes occurred more or less in unison with total state expenditures for healthcare, whereas individual disposable income increased twice as much in the same timeframe (1988-2003). Costs for medical technology account for approximately 3-5% of national healthcare expenditures. On the national level, but also in a central hospital setting, radiology does not constitute a major cost factor. Tomographic investigations have increased by 2-3% in recent years and currently represent 30% of all radiological procedures. Increasing sophistication of diagnostics and treatment using genetic and molecular techniques, novel information technologies, and a critical evidence-based approach to all functional activity will result in a further explosion of knowledge. Radiology must meet these challenges head on by intensifying all forms of training, from basics to continuing professional education.

[Complaints against radiologists in Italy]. / Denunce contro i radiologi in Italia.

INTRODUCTION: Legal claims against radiologists are a relevant phenomenon also in our country and represent an increasing risk for a radiologist's professional activity. MATERIAL AND METHODS: We reviewed the 1993-1998 insurance claims against Italian radiologists. We found 259 claims subdivided by type into: 1) misdiagnosis; 2) complications of the examination; 3) missed referral for further examinations/treatment; 4) (non)ionizing radiation treatment; 5) slip-and-fall injuries; 6) miscellaneous cases. All claims were reviewed anonymously. RESULTS AND DISCUSSION: Most of the 259 malpractice claims were filed late after the event, which makes the actual incidence of the phenomenon difficult to evaluate. Nevertheless the incidence of malpractice claims can be estimated at 32 per thousand people a year, meaning that an Italian radiologist's risk of being sued by a patient at least once in his/her professional life exceeds 1. Alleged misdiagnosis was the most frequent claim category. Missed bone abnormalities of any type, including fractures, dislocations, malignant lesions and other nonspecific conditions accounted for 52.9% of cases. Missed abnormalities on breast and chest examinations accounted for 17.5% and 15.3%, respectively. Within this claim category, missed breast lesions exhibited the most increasing trend. Alleged complications from radiological examinations accounted for 20% of cases and mostly involved i.v. contrast agent administration, interventional procedures and barium enema. Slip-and-fall injuries, where the patients falls off the examination table, slips on the floor, bumps into a piece of equipment and so on, accounted for 7% of cases. Missed referral to further examinations accounted for 1.5% only. Finally, radiologists were frequently sued as one of many defendants, together with medical/surgical doctors, in case of patient's death, in 20% of all cases. CONCLUSIONS: Italian radiologists currently run the same risk of being sued for malpractice as their American colleagues. Strict compliance with radiological standards is recommended to try to decrease the risk and to obviate litigation.

Intestinal intussusception survey about diagnostic and nonsurgical therapeutic procedures.

OBJECTIVE: To provide an overview of the diagnostic and therapeutic procedures performed by European paediatric radiologists in the management of intussusception. MATERIALS AND METHODS: A postal survey was sent to the European members of ESPR. Items surveyed included diagnostic imaging procedures (plain films, US, contrast enema [CE]), contrast medium used (barium, iodine, air, saline solution), and imaging technique used for monitoring during reduction (films, fluoroscopy, US). Multiple answers were possible. Other data, including contraindications, maximum pressure, pressure and irradiation monitoring, presence of a surgeon, sedation, number and duration of attempts, and hospitalisation were also obtained and analysed. RESULTS: There were 204 respondents (60.2 %). Regarding diagnosis, 72.5 % of respondents used plain radiographs, 93 % US, and 34 % CE. Reduction was performed using air (55 %), a barium suspension (32 %), iodinated contrast medium (24 %), or a saline solution (10 %). Reduction was monitored using fluoroscopy alone (46 %), fluoroscopy and radiographs (49.5 %), US alone (9.5 %), or a combination of radiology and US (18 %). Pressure was monitored by 81 % of respondents. Most respondents (82.4 %) used a maximum pressure between 100 and 120 mm Hg. CONCLUSIONS: US is widely used for diagnosing intussusception. For treatment, contrast medium and air reduction are used almost equally. A large number of radiologists are now performing intussusception reduction using US monitoring.

The future of barium radiology.

Barium radiology of the gastrointestinal tract has had a long history but its survival into the next century will be a challenge. The numbers of barium studies performed has declined in recent decades due to several factors; also, health care reforms in the United States will further impact on the use of barium examinations. The future status of these radiological procedures will change depending on these factors and the organ system being examined; an increased emphasis on functional evaluation of the gastrointestinal tract will also have an effect on the evolving role of barium radiology. We provide a brief historical review of the evolution of barium radiology in the twentieth century, discuss the present and changing status of the various gastrointestinal examinations, and offer our thoughts concerning the potential future of this specialty.

Tromboembolia pulmonar / Lung thromboembolism

35 pacientes (20 hombres, 15 mujeres) con edad media de 61 (29-91) con factores de riesgo, clinica, radiografia, de torax y electrocardiograma caracteristico de TEP. Fueron divididos en 2 grupos: el primero con 10 pacientes, que tenian gamagrafia pulmonar y 1 arteriografia pulmonar. Grupo 2 con 24 casos que carecian de esos metodos confirmatorios. Los resultados en el grupo 1; la disnea, dolor toracico y tos fueron sintomas mas frecuentes; estertores y condensacion pulmonar cianosis, fueron los signos mas predominantes. En la radiologia, se presento mas frecuentemente: zonas hipovasculares opacidades y cardiomegalia. en el electrocardiograma, la isquemia subepicardica, dextrorotacion e imagen S1Q3T3m se ibservaron mas frecuentemente. Los factores de riesgo mas frecuentes en ambos grupos fueron: trombosis venosa, inmovilización y edad mayor a 50 años. No se encontro diferencias estadisticamente significativas entre los 2 grupos, cuando se comparo la frecuencia de alteraciones radiologicas o electrocardiograficas, factores de riesgo o manifestaciones clinicas. 4 pacientes tuvieron recidivas y fallecieron 13 (37,1]. Como conclusion el TEP, se debe sospechar, cuando exista cuadro clinico, radiologico y electrocargiografico, caracteristico, procurando confirmar con la gamagrafia o arteriografia pulmonar.