Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care.

The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians' specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists' training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of <6 weeks duration being the most common indication. Significant differences in inappropriate orders were found (P < .001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in training (27.8%), and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively. Approximately one-third of lumbar spine radiographs performed in the ED were inappropriately ordered by American College of Radiology guidelines; specialists training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce health care costs.

Singapore radiographers' perceptions and expectations of artificial intelligence - A qualitative study.

INTRODUCTION: With the emergence of artificial intelligence (AI) in medical imaging, radiographers are likely to be at the forefront of this technological advancement. Studies have therefore been conducted recently to understand radiographers' opinions on AI adoption. This study extends that work by using a qualitative approach to further explore radiographers' knowledge, perceptions, and expectations of AI. METHOD: Six online focus groups were conducted with 22 radiographers from the three public healthcare clusters in Singapore. They were purposively sampled, and participants were recruited from a broad demographic background with varying years of working experience and designations. The focus group sessions were transcribed verbatim and thematic analysis was performed on their responses. RESULTS: Participants demonstrated limited knowledge of AI. Their perceptions of AI were mixed, recognising its benefits in increasing efficiency and improving patient care, but also aware of its limitations in accuracy and bias. On how patients may perceive AI, participants felt that patients would accept AI if they felt it improves their care but may reject it once they lose trust in it. Expectations wise, participants envisioned several applications in pre-, peri­, and post-procedural workflows including order vetting, patient positioning, language translation, and artefact removal. On radiographers' role and career opportunities, some participants see an opportunity for radiographers to specialise in AI, becoming involved in algorithm development and its clinical implementation. DISCUSSION: Our findings suggest that widespread implementation of AI would require limited knowledge amongst radiographers and current AI limitations to be addressed. While radiographers are positively anticipating the integration of AI into their practices, they should also become actively involved in the development of AI tools such that those they envisioned. This would help align optimal use of AI tools and radiographer role changes. Patients' acceptance and reactions to AI also warrant further research.

Challenges and optimization strategies in medical imaging service delivery during COVID-19.

In coronavirus disease 2019 (COVID-19), medical imaging plays an essential role in the diagnosis, management and disease progression surveillance. Chest radiography and computed tomography are commonly used imaging techniques globally during this pandemic. As the pandemic continues to unfold, many healthcare systems worldwide struggle to balance the heavy strain due to overwhelming demand for healthcare resources. Changes are required across the entire healthcare system and medical imaging departments are no exception. The COVID-19 pandemic had a devastating impact on medical imaging practices. It is now time to pay further attention to the profound challenges of COVID-19 on medical imaging services and develop effective strategies to get ahead of the crisis. Additionally, preparation for operations and survival in the post-pandemic future are necessary considerations. This review aims to comprehensively examine the challenges and optimization of delivering medical imaging services in relation to the current COVID-19 global pandemic, including the role of medical imaging during these challenging times and potential future directions post-COVID-19.

Clinical placements for undergraduate diagnostic radiography students amidst the COVID-19 pandemic in Singapore: Preparation, challenges and strategies for safe resumption.

INTRODUCTION: The COVID-19 pandemic resulted in the suspension of clinical training for undergraduate radiography students in Singapore. Coordinated preparation plans and strategies between the university and hospitals were needed to safely resume clinical placements within national and hospitals' risk control measures against COVID-19 transmission. METHODS: Singapore Institute of Technology (SIT) and the Radiology Department of Singapore General Hospital (SGH) had collaborated to meet requirements for safe resumption of clinical placements. SIT prepared students by emphasising compliance to all risk measures, addressing concerns of risk transmission, meeting learning objectives, and reassessing infection control competencies. In tandem, SGH prepared an orientation programme and used technology for open communication among faculty, clinical educators and students which included monitoring of well-being and rapid dissemination of updates. Of note, SGH reorganised operating procedures and physical spaces to meet national standards of safe physical distancing, restricted movement between treatment areas and teams, and rosters to remain committed to the supervision and education of students. RESULTS: Clinical placements resumed 3 months following suspension. Clinical educators faced the challenge of the need for balance between increasing clinical load and student supervision. A solution was frequent engagement and support by faculty, with educators and students via video conferencing platforms. Students' well-being was frequently checked. There was less variation in cases which simulation training made up for some of the learning objectives. CONCLUSION: Adaptation and commitment to continue active and quality clinical education while ensuring students' safety were vital during a pandemic. Clinical training within stringent precautionary measures may shape the era of the new norm.