'Scanxiety': Content analysis of pre-MRI patient experience on Instagram.

INTRODUCTION: Distress and anxiety are commonly reported during the Magnetic Resonance Imaging (MRI) experience with prior studies suggesting the pre-MRI period is a time of heightened distress. There is a paucity of literature exploring preprocedural distress and anxiety, in particular qualitative research analysing patient experience. Instagram is rapidly becoming an important social media platform though which to conduct health research. A gradually increasing number of studies have examined social media to gain insight into patient experience within medical radiation science (MRS). This study is considered as the first to explore patient experience of MRI using Instagram as a data source. METHODS: This study investigated the patient experience during the pre-MRI period by performing a content analysis on open-source Instagram posts. Ethical approval for the study was sought and approved by the Charles Sturt University, Human Research Ethics Committee. RESULTS: Six themes emerged from the extracted data; Journey to the MRI, Waiting, Anticipating the MRI procedure, Preparing for the MRI procedure, Negative interaction, and Fear of the results. CONCLUSION: The findings of this study provide novel self-reported and unsolicited insight into the diverse, multifactorial, and often concomitant nature of preprocedural MRI anxiety and distress. IMPLICATIONS FOR PRACTICE: This study adds to a growing body of literature advocating for a compassionate, holistic, and person-centered approach when caring for patients in MRI that also considers their emotional and psychological wellbeing.

Holistic processing only? The role of the right fusiform face area in radiological expertise.

Radiologists can visually detect abnormalities on radiographs within 2s, a process that resembles holistic visual processing of faces. Interestingly, there is empirical evidence using functional magnetic resonance imaging (fMRI) for the involvement of the right fusiform face area (FFA) in visual-expertise tasks such as radiological image interpretation. The speed by which stimuli (e.g., faces, abnormalities) are recognized is an important characteristic of holistic processing. However, evidence for the involvement of the right FFA in holistic processing in radiology comes mostly from short or artificial tasks in which the quick, 'holistic' mode of diagnostic processing is not contrasted with the slower 'search-to-find' mode. In our fMRI study, we hypothesized that the right FFA responds selectively to the 'holistic' mode of diagnostic processing and less so to the 'search-to-find' mode. Eleven laypeople and 17 radiologists in training diagnosed 66 radiographs in 2s each (holistic mode) and subsequently checked their diagnosis in an extended (10-s) period (search-to-find mode). During data analysis, we first identified individual regions of interest (ROIs) for the right FFA using a localizer task. Then we employed ROI-based ANOVAs and obtained tentative support for the hypothesis that the right FFA shows more activation for radiologists in training versus laypeople, in particular in the holistic mode (i.e., during 2s trials), and less so in the search-to-find mode (i.e., during 10-s trials). No significant correlation was found between diagnostic performance (diagnostic accuracy) and brain-activation level within the right FFA for both, short-presentation and long-presentation diagnostic trials. Our results provide tentative evidence from a diagnostic-reasoning task that the FFA supports the holistic processing of visual stimuli in participants' expertise domain.

Announcing fetal pathology: Challenges encountered by physicians and potential role of simulation in training for breaking bad news.

BACKGROUND: Informing couples about the diagnosis of severe fetal pathologies is part of the daily routine in fetal medicine. This situation is usually complex and can put untrained professionals in an uncomfortable position. The aim of this study was to assess the perception of health care professionals when faced with the need to announce a fetal pathology in order to target their training gaps in this domain. MATERIALS AND METHODS: A questionnaire was created and disseminated on a national level among physicians practicing or collaborating with the multidisciplinary centers of prenatal diagnosis in France. The questionnaire focused on the difficulties encountered by practitioners when announcing fetal pathologies, and their potential interest in simulation sessions regarding the delivery of bad news. RESULTS: 193 participants filled the questionnaire. 65 % report not receiving any theoretical courses in this field during their initial training, 49 % admit feeling uncomfortable when a fetal anomaly needs to be announced, 79.5 % think that role-play could help them, 87.5 % believe that training sessions in communication skills would help improve their methods and 73.1 % support teaching the delivery of bad news by simulation sessions. CONCLUSION: This survey illustrates the significance of announcing a fetal pathology for fetal medicine professionals. Many of them report not being properly trained to cope with this situation and would like to improve with a more practical way of teaching. Simulation would be the ideal educational tool to meet this demand.

Exploring the Usability of Mobile Apps Supporting Radiologists' Training in Diagnostic Decision Making.

PURPOSE: The objective of this study was to conduct a usability evaluation of mobile apps for supporting education and training in radiologic diagnostic decision-making processes. METHODS: Of 381 mobile apps available at two major stores (Google Play and iTunes), eight iOS apps were selected for laboratory-based usability tests. Six staff radiologists completed eight app-specific task sets, using a think-aloud strategy. The triangular methods approach included quantitative performance measures, System Usability Scale (SUS), and qualitative thematic analysis using heuristic usability principles of usability issues. RESULTS: Overall, radiologists achieved higher than 70% success, with favorable SUS scores, in completing the tasks for seven of the eight apps. However, task success rate and SUS score had a weak relation (r = 0.23), indicating that the perceived usability may not reflect the holistic usability of the app. Task analysis and self-report revealed 108 usability issues, which were condensed to 55 unique issues and categorized by nine usability themes and mapped to ten usability heuristics. Nonintuitive functionality (eg, nonintuitive or misleading labels) was the most frequent theme observed, leading to inefficient navigation. These usability findings were consistent with the 13 improvements the radiologists suggested. CONCLUSIONS: This study demonstrates the feasibility of usability evaluation of radiology mobile apps and suggests potential improvements in the development of radiology mobile apps. This study also suggests that proficiency with mobile devices may not be equivalent to being an expert user, proficient in using the apps.

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.

The state of radiologic teaching practice in preclinical medical education: survey of American medical, osteopathic, and podiatric schools.

PURPOSE: This study describes the state of preclinical radiology curricula in North American allopathic, osteopathic, and podiatric medical schools. METHODS: An online survey of teaching methods, radiology topics, and future plans was developed. The Associations of American Medical Colleges, Colleges of Osteopathic Medicine, and Colleges of Podiatric Medicine listing for all US, Canadian, and Puerto Rican schools was used for contact information for directors of anatomy and/or radiology courses. Letters were sent via e-mail to 198 schools, with a link to the anonymous survey. RESULTS: Of 198 schools, 98 completed the survey (48%). Radiology curricula were integrated with other topics (91%), and taught by anatomists (42%) and radiologists (43%). The majority of time was spent on the topic of anatomy correlation (35%). Time spent teaching general radiology topics in the curriculum, such as physics (3%), modality differences (6%), radiation safety (2%), and contrast use (2%) was limited. Most schools had plans to implement an innovative teaching method in the near future (62%). The major challenges included limits on: time in the curriculum (73%); resources (32%); and radiology faculty participation (30%). A total of 82% reported that their curriculum did not model the suggestions made by the Alliance of Medical Student Educators in Radiology. CONCLUSIONS: This survey describes the current state of preclinical radiology teaching: curricula were nonstandard, integrated into other courses, and predominantly used for anatomy correlation. Other important contextual principles of the practice of radiology were seldom taught.

Benefits of integration of radiology services across a pediatric health care system with locations in multiple states.

BACKGROUND: Integration was implemented of previously independently practicing pediatric radiology services across a pediatric health care system with sites 1,000 miles apart. OBJECTIVE: The purpose of this manuscript is to describe the process utilized to integrate imaging services across our enterprise and to study the direct effects on report turnaround time and other parameters. MATERIALS AND METHODS: Parameters were evaluated both the year before integration as well as the 2 years following integration and compared for improvement. Parameters studied included report turnaround time, academic productivity (as measured by peer review publications per year), and degree of sub-subspecialization within pediatric radiology (as measured by the percentage of neuroimaging CT and MRI studies read by pediatric neuroradiologists). RESULTS: Comparing pre- to post-integration measures, the median report turnaround time decreased from 2.3 h to 1.1 h (52.1% improvement), the percentage of neuroimaging studies read by neuroimaging faculty increased from 15.0% to 86.6% (477% improvement), and peer review publication by calendar year increased from 3 to 30 (1,000% improvement). Other benefits included increased hours of in-house coverage and execution on multiple quality improvement efforts. CONCLUSION: A pediatric health care system successfully integrated radiology services across multiple previously non-integrated locations into one functional group. This integration was associated with a positive effect on multiple parameters.

Personalized technologist dose audit feedback for reducing patient radiation exposure from CT.

PURPOSE: The aim of this study was to determine whether providing radiologic technologists with audit feedback on doses from CT examinations they conduct and education on dose-reduction strategies reduces patients' radiation exposure. METHODS: This prospective, controlled pilot study was conducted within an integrated health care system from November 2010 to October 2011. Ten technologists at 2 facilities received personalized dose audit reports and education on dose-reduction strategies; 9 technologists at a control facility received no intervention. Radiation exposure was measured by the dose-length product (DLP) from CT scans performed before (n = 1,630) and after (n = 1,499) the intervention and compared using quantile regression. Technologists were surveyed before and after the intervention. RESULTS: For abdominal CT, DLPs decreased by 3% to 12% at intervention facilities but not at the control facility. For brain CT, DLPs significantly decreased by 7% to 12% at one intervention facility; did not change at the second intervention facility, which had the lowest preintervention DLPs; and increased at the control facility. Technologists were more likely to report always thinking about radiation exposure and associated cancer risk and optimizing settings to reduce exposure after the intervention. CONCLUSIONS: Personalized audit feedback and education can change technologists' attitudes about, and awareness of, radiation and can lower patient radiation exposure from CT imaging.

Multidisciplinarity and medical decision, impact for patients with cancer: sociological assessment of two tumour committees' organization.

PURPOSE: Medical practices in oncology are expected to be multidisciplinary, yet few articles studied how this may be concretely applied. In the present study, we evaluated the organization of two multidisciplinary committees, one for breast cancer and one for sarcoma, in a French Comprehensive Cancer Centre. METHODS: Both tumours were specifically chosen so as to emphasise substantial differences in relation with incidence, histological subtypes, management strategy, and scientific evidence. Between 2003 and 2004, 404 decision processes were observed, 210 for sarcoma (26 meetings) and 194 for breast cancer (10 meetings). The number of physicians who took part in the discussions and their medical specialties were systematically noted as well as the number of contradictory discussions, medical specialties represented in these contradictory discussions and the topics of contradiction. The last measured data was whether the final committee's decision was in conformity with the referent preferences or not. All these measures were related to the referent's medical speciality and working place, to the stage of the disease and to the disease management stage. RESULTS: Committees' specificities concerned their organization, referent's medical specialties, the number of participants in discussions and their medical specialties. Discussions in the sarcoma committee tended to be more multidisciplinary, involving more specialties. Initial strategy proposal for one patient was modified during the discussions for 86 patients out of 210 (41%) and for 62 out of 194 (32%) respectively for sarcoma and breast cancer. However, there was no significant difference in the rate of contradictory discussions between breast cancer and sarcoma committees (32% versus 41% respectively; P = 0.08). The rates of contradictory discussions were similar for localized cancers, local relapse and metastasis disease (37%, 41% and 34% respectively; P = 0.86). CONCLUSIONS: The present study reports more than 30% of changes concerning strategy for patient with cancer due to multidisciplinary discussions. This indicates that, providing tumour committees are adapted to the pathologies' characteristics, they can promote a collective and multidisciplinary approach to oncology.

ACR Appropriateness Criteria on colorectal cancer screening.

Colorectal cancer remains one of the most common causes of cancer death in this country. This malignancy is ideally suited for screening because the detection and removal of the precursor adenomatous polyp can prevent most colorectal cancers from ever forming. The choice of a test for screening involves consideration of various individual parameters, including patient age and the presence of risk factors for the development of colorectal cancer. Computed tomographic colonography (CTC) has emerged as the leading imaging technique for colorectal cancer screening in average-risk individuals on the basis of the evidence presented in this paper. The double-contrast barium enema is an alternative imaging test that is appropriate particularly when CTC is not available. In 2008, the American Cancer Society guideline for colorectal cancer screening was revised jointly with the US Multi-Society Task Force on Colorectal Cancer and the ACR to include CTC every 5 years as an option for average-risk individuals. Computed tomographic colonography is also the preferred test for colon evaluation after an incomplete colonoscopy. Imaging tests including CTC and the double-contrast barium enema are usually not indicated for colorectal cancer screening in high-risk patients with polyposis syndromes or inflammatory bowel disease. This paper presents the new colorectal cancer imaging test ratings and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Gastrointestinal Imaging.

[DRG and OPS-301: effects on the acquisition performance in radiology]. / DRG und OPS-301: Auswirkungen auf die Leistungserfassung in der Radiologie.

Reimbursement for inpatient services rendered based on comparable daily care rates, case-based flat rates, and special fees as practiced until now has been replaced by the system of diagnosis-related groups. Up until 2004, operation and procedure system (OPS 301) codes could be processed completely automatically by appropriate adaptation of the radiology information system (RIS). Because of further differentiation of OPS codes in the 2005 version, it is no longer possible to unambiguously determine OPS codes automatically. Our goal was to fulfill these additional requirements with as little extra effort as possible. In 36 of 2138 procedures during an observation period of 12 days, i.e., 4/day, manual input on the part of the radiology technical assistant and quality assurance by the diagnosing physician were necessary. This is only needed in complicated procedures for which the minor added effort is negligible in comparison to the entire effort expended for the procedure. We were thus able to achieve the goal of near automation of ascertaining OPS codes.

Reliability and validity of lumbosacral spine radiograph reading by chiropractors, chiropractic radiologists, and medical radiologists.

STUDY DESIGN: A cross-sectional diagnostic study was conducted in two sessions. OBJECTIVE: To determine and compare the reliability and validity of contraindications to chiropractic treatment (infections, malignancies, inflammatory spondylitis, and spondylolysis-listhesis) detected by chiropractors, chiropractic radiologists, and medical radiologists on plain lumbosacral radiographs. SUMMARY OF BACKGROUND DATA: Plain radiography of the spine is an established part of chiropractic practice. Few studies have assessed the ability of chiropractors to read plain radiographs. METHODS: Five chiropractors, three chiropractic radiologists and five medical radiologists read a set of 300 blinded lumbosacral radiographs, 50 of which showed an abnormality (prevalence, 16.7%), in two sessions. The results were expressed in terms of reliability (percentage and kappa) and validity (sensitivity and specificity). RESULTS: The interobserver agreement in the first session showed generalized kappas of 0.44 for the chiropractors, 0.55 for the chiropractic radiologists, and 0.60 for the medical radiologists. The intraobserver agreement showed mean kappas of 0.58, 0.68, and 0.72, respectively. The difference between the chiropractic radiologists and medical radiologists was not significant. However, there was a difference between the chiropractors and the other professional groups. The mean sensitivity and specificity of the first round, respectively was 0.86 and 0.88 for the chiropractors, 0.90 and 0.84 for the chiropractic radiologists, and 0.84 and 0.92 for the medical radiologists. No differences in the sensitivities were found between the professional groups. The medical radiologists were more specific than the others. CONCLUSIONS: Small differences with little clinical relevance were found. All the professional groups could adequately detect contraindications to chiropractic treatment on radiographs. For this indication, there is no reason to restrict interpretation of radiographs to medical radiologists. Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors.

[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.

Trends in the prescription of radiographs for comprehensive care patients in U.S. and Canadian dental schools.

Results of this 1992 survey are compared to results from 1977 and 1987 surveys to establish long-term trends in radiographic prescribing practices for dentulous adult comprehensive care patients in U.S. and Canadian dental schools. The major trends include a decline in prescribing both an intraoral full-mouth series and panoramic radiograph (46 percent to 19 percent to 9 percent of schools from 1977 to 1987 to 1992, respectively). These changes were complemented by an increase in prescribing a full-mouth series only (32 percent to 48 percent to 57 percent, respectively), and an increase in the use of selection criteria (2 percent to 19 percent to 26 percent, respectively). Between 1987 and 1992 there was little change in the preferred examination for the edentulous adult patient, and small changes in the preferred examination for the child patient.