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BACKGROUND: To assess the effect of a commercial artificial intelligence (AI) solution implementation in the emergency department on clinical outcomes in a single level 1 trauma center. METHODS: A retrospective cohort study for two time periods-pre-AI (1.1.2017-1.1.2018) and post-AI (1.1.2019-1.1.2020)-in a level 1 trauma center was performed. The ICH algorithm was applied to 587 consecutive patients with a confirmed diagnosis of ICH on head CT upon admission to the emergency department. Study variables included demographics, patient outcomes, and imaging data. Participants admitted to the emergency department during the same time periods for other acute diagnoses (ischemic stroke (IS) and myocardial infarction (MI)) served as control groups. Primary outcomes were 30- and 120-day all-cause mortality. The secondary outcome was morbidity based on Modified Rankin Scale for Neurologic Disability (mRS) at discharge. RESULTS: Five hundred eighty-seven participants (289 pre-AI-age 71 ± 1, 169 men; 298 post-AI-age 69 ± 1, 187 men) with ICH were eligible for the analyzed period. Demographics, comorbidities, Emergency Severity Score, type of ICH, and length of stay were not significantly different between the two time periods. The 30- and 120-day all-cause mortality were significantly reduced in the post-AI group when compared to the pre-AI group (27.7% vs 17.5%; p = 0.004 and 31.8% vs 21.7%; p = 0.017, respectively). Modified Rankin Scale (mRS) at discharge was significantly reduced post-AI implementation (3.2 vs 2.8; p = 0.044). CONCLUSION: The added value of this study emphasizes the introduction of artificial intelligence (AI) computer-aided triage and prioritization software in an emergent care setting that demonstrated a significant reduction in a 30- and 120-day all-cause mortality and morbidity for patients diagnosed with intracranial hemorrhage (ICH). Along with mortality rates, the AI software was associated with a significant reduction in the Modified Ranking Scale (mRs).
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OBJECTIVE. This study evaluates the prevalence of an abnormal international normalized ratio (INR) and platelet count before image-guided percutaneous needle biopsies over a 10-year period, comparing data from patients with and those without known conditions predisposing to coagulopathy. MATERIALS AND METHODS. A review of electronic medical records identified patients who were scheduled for a biopsy in a single institution's radiology department for the period of 2007-2016. The following information was recorded: demographic data, patient history of conditions that predispose to bleeding (e.g., liver disease, anticoagulant therapy, history of coagulopathy), and INR and platelet values within 30 days before biopsy. Data were stratified by biopsies that were performed versus those that were cancelled. RESULTS. Over 10 years, 3864 percutaneous biopsies were performed, and 6371 were cancelled. Approximately half of the biopsies (48.2%) were performed in patients without a predisposing condition; of those patients, 0.8% and 0.1% had an INR greater than 1.5 and greater than 1.8, respectively, and 0.4% had a platelet count of 50,000/µL or less (≤ 50 × 109/L). In patients with no known predisposing condition, 0.6% and 0.0% of biopsies cancelled were in patients who had an INR greater than 1.5 and greater than 1.8, respectively, and 0.1% of biopsies cancelled were in patients who had a platelet count of 50,000/µL or less. Ordering prebiopsy testing of patients with no predisposing conditions for the 1864 percutaneous biopsies performed over the 10-year study period resulted in more than $850,000 in laboratory-related health care costs. Our results suggest that the cost of identifying one abnormal INR is nearly $700,000. CONCLUSION. For patients without any known bleeding risks who are scheduled to undergo image-guided percutaneous biopsies, identifying an abnormal INR or abnormal platelet count is rare. Eliminating this testing in patients without predisposing conditions has the potential to create savings in costs and time for both physicians and patients.
Subject(s)
Blood Coagulation Disorders/diagnosis , International Normalized Ratio , Platelet Count , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Needle/adverse effects , Biopsy, Needle/methods , Female , Hemorrhage/epidemiology , Hemorrhage/prevention & control , Humans , Image-Guided Biopsy/adverse effects , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Preoperative Period , Retrospective Studies , Risk Assessment , Young AdultABSTRACT
OBJECTIVE. This series of patients presented to the emergency department (ED) with abdominal pain, without the respiratory symptoms typical of coronavirus disease (COVID-19), and the abdominal radiologist was the first to suggest COVID-19 infection because of findings in the lung bases on CT of the abdomen. CONCLUSION. COVID-19 infection can present primarily with abdominal symptoms, and the abdominal radiologist must suggest the diagnosis when evaluating the lung bases for typical findings.
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Abdominal Pain/diagnostic imaging , Abdominal Pain/virology , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Adult , COVID-19 , Humans , Lung/pathology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Tomography, X-Ray ComputedSubject(s)
Students, Medical , Artificial Intelligence , Automation , Canada , Humans , Surveys and QuestionnairesSubject(s)
Deep Learning , Radiology , Body Composition , Machine Learning , Tomography, X-Ray ComputedABSTRACT
RATIONALE AND OBJECTIVES: Artificial intelligence (AI) has the potential to transform the clinical practice of radiology. This study investigated Canadian medical students' perceptions of the impact of AI on radiology, and their influence on the students' preference for radiology specialty. MATERIALS AND METHODS: In March 2018, an anonymous online survey was distributed to students at all 17 Canadian medical schools. RESULTS: Among 322 respondents, 70 students considered radiology as the top specialty choice, and 133 as among the top three choices. Only a minority (29.3%) of respondents agreed AI would replace radiologists in foreseeable future, but a majority (67.7%) agreed AI would reduce the demand for radiologists. Even among first-choice respondents, 48.6% agreed AI caused anxiety when considering the radiology specialty. Furthermore, one-sixth of respondents who would otherwise rank radiology as the first choice would not consider radiology because of the anxiety about AI. Prior significant exposure to radiology and high confidence in understanding of AI were shown to decrease the anxiety level. Interested students valued the opinions of local radiologists, radiology conferences, and journals. Students were most interested in "expert opinions on AI" and "discussing AI in preclinical radiology lectures" to understand the impact of AI. CONCLUSION: Anxiety related to "displacement" (not "replacement") of radiologists by AI discouraged many medical students from considering the radiology specialty. The radiology community should educate medical students about the potential impact of AI, to ensure radiology is perceived as a viable long-term career choice.
Subject(s)
Artificial Intelligence , Career Choice , Radiology , Students, Medical , Canada , Humans , Radiology/education , Radiology/methods , Radiology/trends , Students, Medical/psychology , Students, Medical/statistics & numerical data , Surveys and QuestionnairesABSTRACT
PURPOSE: Thyroid nodules incidentally identified on imaging are thought to contribute to the increasing incidence of thyroid cancer. We aim to determine the true rate of incidental thyroid nodule reporting, malignancy rates of these nodules, and to compare these findings with rates of detection by dedicated radiology review. METHODS: A cross-sectional analysis was done to determine the prevalence of thyroid nodules in radiologist reports by analyzing all reports for CT, PET, and MRI scans of the head, neck, and chest as well as neck ultrasounds performed at a tertiary care center from 2007 to 2012. Retrospective chart review was performed on patients with a reported thyroid nodule to determine clinical outcomes of these nodules. Radiology reports were compared with dedicated radiology review of 500 randomly selected CT scans from the study group to determine the difference between clinical reporting and actual prevalence of thyroid nodules. RESULTS: 97,908 imaging studies met inclusion criteria, and 387 (0.4%) thyroid incidentalomas were identified on radiology report. One hundred and sixty three (42.1%) of these nodules were worked up with fine-needle aspiration, diagnosing 27 thyroid cancers (0.03% of all studies, 7.0% of reported incidentalomas). The prevalence of incidentalomas clinically reported was 142/100,000 CT scans, 638/100,000 MRIs, 358/100,000 PET scans, and 6,594/100,000 ultrasounds. In contrast, review of CT scans screening for thyroid nodules had a prevalence of 10%. CONCLUSION: Routine clinical reporting of incidental thyroid nodules is far less common than on dedicated review. IMPACT: These data contradict the notion that incidentalomas contribute significantly to rising thyroid cancer rates.
Subject(s)
Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/pathology , Thyroid Nodule/diagnosis , Thyroid Nodule/epidemiology , Adult , Aged , Biopsy, Fine-Needle , Chicago/epidemiology , Female , Humans , Incidental Findings , Magnetic Resonance Imaging , Male , Middle Aged , Positron-Emission Tomography , Prevalence , Retrospective Studies , Tertiary Care Centers , Thyroid Nodule/pathology , Tomography, X-Ray Computed , UltrasonographyABSTRACT
OBJECTIVE. Imaging provides evidence for the response to oncology treatment by the serial measurement of reference lesions. Unfortunately, the identification, comparison, measurement, and documentation of several reference lesions can be an inefficient process. We tested the hypothesis that optimized workflow orchestration and tight integration of a lesion tracking tool into the PACS and speech recognition system can result in improvements in oncologic lesion measurement efficiency. SUBJECTS AND METHODS. A lesion management tool tightly integrated into the PACS workflow was developed. We evaluated the effect of the use of the tool on measurement reporting time by means of a prospective time-motion study on 86 body CT examinations with 241 measureable oncologic lesions with four radiologists. RESULTS. Aggregated measurement reporting time per lesion was 11.64 seconds in standard workflow, 16.67 seconds if readers had to register measurements de novo, and 6.36 seconds for each subsequent follow-up study. Differences were statistically significant (p < 0.05) for each reader, except for one difference for one reader. CONCLUSION. Measurement reporting time can be reduced by using a PACS workflow-integrated lesion management tool, especially for patients with multiple follow-up examinations, reversing the onetime efficiency penalty at baseline registration.
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Efficiency , Neoplasms/diagnostic imaging , Radiology Information Systems , Software , Workflow , Follow-Up Studies , Humans , Prospective Studies , Radiography , Time and Motion StudiesABSTRACT
The clinical history and indication (CHI) provided with a radiological examination are critical components of a quality interpretation by the radiologist. A patient's chronic conditions offer the context in which acute symptoms and findings can be interpreted more accurately. Seven pertinent (potentially diagnosis altering) chronic conditions, which are fairly prevalent at our institution, were selected. We analyze if and how in 140 CHIs there was mention of a patient's previously reported chronic condition and if and how the condition was subsequently described in the radiology report using a four-item scheme (Mention/Specialization, Generalization, Common comorbidity, No mention). In 40.7% of CHIs, the condition was rated Mention/Specialization. Therefore, we reject our first hypothesis that the CHI is a reliable source for obtaining pertinent chronic conditions (≥ 90.0%). Non-oncological conditions were significantly more likely rated No mention in the CHI than oncological conditions (58.7 versus 8.3%, P < 0.0001). Stat cases were significantly more frequently No mention than non-stat cases (60.0 versus 31.3%, P = 0.0134). We accept our second hypothesis that the condition's rating in the CHI is significantly correlated with its rating of the final radiology report (χ(2) test, P < 0.00001). Our study demonstrates an alarming lack of communication of pertinent medical information to the radiologist, which may negatively impact interpretation quality. Presenting automatically aggregated patient information to the radiologist may be a potential avenue for improving interpretation and adding value of the radiology department to the care chain.
Subject(s)
Communication , Interprofessional Relations , Radiology , Referral and Consultation , Chronic Disease , Humans , Quality Control , Retrospective StudiesABSTRACT
RATIONALE AND OBJECTIVES: The aim of this study was to determine whether key radiology report "consumers" in our institution prefer structured measurement reporting in a dedicated report section over the current practice of embedding measurements throughout the "Findings" section, given the availability of new tools for quantitative imaging interpretation that enable automated structured reporting of measurement data. MATERIALS AND METHODS: Oncologic clinicians and radiologists at our institution were surveyed regarding their preferences for a standard report versus three reports each having uniquely formatted dedicated "Measurements" sections and regarding their impressions of various characteristics of report quality demonstrated by these reports. The online survey was completed by 25 radiologists, 16 oncologists, and 17 oncology nurses and research assistants (registrars). RESULTS: Aggregation of respondents' preferences by group into single orderings using the Kemeny-Young method revealed that both oncology groups preferred all proposed reports to the standard report but that radiologists only preferred two of the proposed reports to the standard report. All preferences for proposed reports in the two oncology groups were statistically significant based on Wilcoxon tests, but the preference for only one of the proposed reports was significant for radiologists. Additional results suggest that these preferences are driven by respondent favor for the readability of and confidence conveyed by the proposed reports compared to the standard report. CONCLUSIONS: Oncologic clinicians responding to our survey preferred communication of lesion measurements in a separate report section to the current practice of embedding measurements throughout the "Findings" section, based on their assessments of reports containing simulated measurement sections assembled from a single sample report using standardized formatting.
Subject(s)
Information Dissemination/methods , Interdisciplinary Communication , Medical Oncology/statistics & numerical data , Medical Staff, Hospital/statistics & numerical data , Radiology/statistics & numerical data , Surveys and Questionnaires , Attitude of Health Personnel , Humans , Radiology Department, Hospital/statistics & numerical data , Radiology Information Systems/statistics & numerical data , Statistics, NonparametricABSTRACT
RATIONALE AND OBJECTIVES: Managing and supervising the complex imaging examinations performed for clinical research in an academic medical center can be a daunting task. Coordinating with both radiology and research staff to ensure that the necessary imaging is performed, analyzed, and delivered in accordance with the research protocol is nontrivial. The purpose of this communication is to report on the establishment of a new Human Imaging Research Office (HIRO) at our institution that provides a dedicated infrastructure to assist with these issues and improve collaborations between radiology and research staff. MATERIALS AND METHODS: The HIRO was created with three primary responsibilities: 1) coordinate the acquisition of images for clinical research per the study protocol, 2) facilitate reliable and consistent assessment of disease response for clinical research, and 3) manage and distribute clinical research images in a compliant manner. RESULTS: The HIRO currently provides assistance for 191 clinical research studies from 14 sections and departments within our medical center and performs quality assessment of image-based measurements for six clinical research studies. The HIRO has fulfilled 1806 requests for medical images, delivering 81,712 imaging examinations (more than 44.1 million images) and related reports to investigators for research purposes. CONCLUSIONS: The ultimate goal of the HIRO is to increase the level of satisfaction and interaction among investigators, research subjects, radiologists, and other imaging professionals. Clinical research studies that use the HIRO benefit from a more efficient and accurate imaging process. The HIRO model could be adopted by other academic medical centers to support their clinical research activities; the details of implementation may differ among institutions, but the need to support imaging in clinical research through a dedicated, centralized initiative should apply to most academic medical centers.
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Academic Medical Centers/organization & administration , Biomedical Research/organization & administration , Diagnostic Imaging , Radiology/organization & administration , ChicagoABSTRACT
In the past decade, radiology has moved from being predominantly film based to predominantly digital. Although in clinical terms the transition has been relatively smooth, the method in which radiology is taught has not kept pace. Simulator programs have proved effective in other specialties as a method for teaching a specific skill set. Because many radiologists already work in the digital environment, a simulator could easily and safely be integrated with a picture archiving and communication system (PACS) and become a powerful tool for radiology education. Thus, a simulator program was designed for the specific purpose of giving residents practice in reading images independently, thereby helping them to prepare more fully for the rigors of being on call. The program is similar to a typical PACS, thus allowing a more interactive learning process, and closely mimics the real-world practice of radiology to help prepare the user for a variety of clinical scenarios. Besides education, other possible uses include certification, testing, and the creation of teaching files.
Subject(s)
Computer-Assisted Instruction/methods , Models, Biological , Radiology Information Systems , Radiology/education , Software , User-Computer Interface , Computer Simulation , OhioABSTRACT
As radiology departments transition to near-complete digital information management, work flows and their supporting informatics infrastructure are becoming increasingly complex. Digital dashboards can integrate separate computerized information systems and summarize key work flow metrics in real time to facilitate informed decision making. A PACS-integrated digital dashboard function designed to alert radiologists to their unsigned report queue status, coupled with an actionable link to the report signing application, resulted in a 24% reduction in the time between transcription and report finalization. The dashboard was well received by radiologists who reported high usage for signing reports. Further research is needed to identify and evaluate other potentially useful work flow metrics for inclusion in a radiology clinical dashboard.
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Computers , Documentation/standards , Radiology Department, Hospital/organization & administration , Radiology Information Systems/organization & administration , Software , Forms and Records Control/organization & administration , Time Factors , WorkforceABSTRACT
Commercial picture archiving and communication systems (PACS) are adept at supporting mainstream radiology work flow, but radiologists frequently encounter situations requiring additional functionality. For example, the incorporation of foreign or nonradiologic images and the deidentification of examinations for research purposes are useful tasks that do not fall within the purview of most commercial PACS. A suite of free, downloadable, vendor-independent software programs designed as PACS add-ons, the SimpleDICOM (Digital Imaging and Communications in Medicine) Suite, has been developed to aid radiologists in performing these tasks. Clinically relevant software design and informed administrative decisions during deployment allow optimal function of this software suite, which is available for download from the Internet.