Impact of MRI to clear the cervical spine after a negative CT for suspected spine trauma.

PURPOSE: To describe the clinical presentation of trauma patients receiving a negative cervical spine MRI (CSMRI) after cervical spine CT (CSCT) without acute findings and calculate the associated costs. METHODS: Our cohort consisted of 55 retrospectively reviewed consecutive trauma patients with CSMRI performed between October 2016 and March 2020, who had negative CSCT within 7 days of CSMRI and no other clinically significant injuries. Our outcome was the cost related to CSMRI, estimated by CSMRI charges and the charges related to additional hours of prolonged hospital stay from CT until MRI. RESULTS: The most common presenting mechanisms of injury were fall from standing (20/55, 36%), followed by motor vehicle accident (18, 33%). Indications for CSMRI included persistent neck pain (32/55, 58%), followed by recommendation from the radiologist (12, 22%), and neurological symptoms concerning for spine injury (9, 16%). An average of 11.2 h (median: 8.5, range: 0.2-25.4 h) passed from CSCT to CSMRI. Fifty-four (98%) of the CSMRI exams were completed within 24 h of the CSCT. The Medicare reimbursement for non-contrast CSMRI is $309 with the average cost for waiting in ED observation of $907. The total cost of CSMRI and associated wait time ranged from $325 to $2366 with an average of $1216 per patient. CONCLUSIONS: The cost of negative CSMRI following a negative CSCT for cervical spine clearance in trauma patients without other significant injury is substantial. The length of time that trauma patients remain in observation in the cervical collar prior to the finalized MRI exam is not only distressing to the patient but also adds costs to health care systems in both time and resources.

Pirated Manuscripts From Radiology's Most Impactful Journals: An International Analysis of Copyright-Infringing Downloads.

OBJECTIVES: The world's largest scholarly literature pirate website, Sci-Hub, permits readers to bypass journal paywalls, thus facilitating no-cost copyright-infringing article downloads. We studied download characteristics of internationally pirated radiology journal articles. METHODS: All download request events between September 2015 and February 2016 were retrieved from Sci-Hub's public server logs. Focusing on high-impact factor radiology journals, we targeted uniquely identifiable diagnostic imaging and radiation oncology journals with a 2015 Thompson Reuters impact factor of ≥2. Pirated article download characteristics were assessed at the individual article, journal, and geographic level. RESULTS: Of all 27,819,965 pirated article downloads, 105,075 (0.4%) were from 49 radiology journals with high impact factor. Total monthly radiology downloads ranged from 6,715 to 24,449. Downloads were most frequent for papers from Radiology (10,357 of 105,075; 9.9%), NeuroImage (10,121; 9.6%), and the International Journal of Radiation Oncology Biology (8,025; 7.6%). The most downloaded articles were published in European Radiology, RadioGraphics, and NeuroImage. By country, download requests were most frequent from China (17,975 of 105,075; 17.1%), India (7,969; 7.6%), and Iran (7,327; 7.0%), but on a per capita basis, were most common in Portugal (210.8 per 1,000,000 population), Chile (135.4), and Tunisia (113.8). Only 4,450 (4.2%) of download requests were from the United States. CONCLUSIONS: Copyright-infringing downloading of pirated radiology journal articles occurs frequently across the world and impacts nearly all top impact-factor journals. New publisher pricing and business models, akin to those for digital music, may be necessary to disincentivize pirating and ensure journal financial sustainability.

Gender Reporting in Radiology Human Subjects Research.

PURPOSE: The aim of this report was to study the presence and extent of gender bias and reporting in radiology human subjects research. METHODS: For this bibliometric analysis, the authors reviewed all articles published between January 1, 2016, and June 30, 2016, in seven of the most cited general radiology journals. From each original research article studying human subjects, the number and gender of participants and whether gender-based results were reported were manually extracted. Articles evaluating gender-specific body parts were excluded. Article-level subject gender matching percentages were calculated and descriptive statistics reported. RESULTS: Of all 1,065 target journal articles during the study window, 522 met the human subjects research inclusion criteria. Of these, 48 (9.2%) made no mention at all of research subjects' gender. Of the 473 articles mentioning gender, 147 (31.1%) had more female and 308 (65.1%) more male subjects. But in aggregate, 105,763 of 254,102 (41.6%) of all subjects were male and 142,069 (55.9%) were female. By quartile distribution, subject gender matching was very variable (12.9% of articles with <25% match, 23.7% with 25%-50%, 29.4% with 50%-75%, and 34.0% with ≥75%). Of articles including subjects of both genders, however, only 27.5% (126 of 458) reported any gender-based results. CONCLUSIONS: In human subjects research published in the most cited general radiology journals, the gender of human subjects is a poorly controlled, and frequently neglected, variable. In an emerging era of personalized medicine, initiatives to ensure transparent reporting of gender-specific results may help catalyze otherwise overlooked discoveries to advance the health of all.

Code Conversion Impact Factor and Cash Flow Impact of International Classification of Diseases, 10th Revision, on a Large Multihospital Radiology Practice.

PURPOSE: The 2015 conversion of the International Classification of Diseases (ICD) system from the ninth revision (ICD-9) to the 10th revision (ICD-10) was widely projected to adversely impact physician practices. We aimed to assess code conversion impact factor (CCIF) projections and revenue delay impact to help radiology groups better prepare for eventual conversion to ICD, 11th revision (ICD-11). METHODS: Studying 673,600 claims for 179 radiologists for the first year after ICD-10's implementation, we identified primary ICD-10 codes for the top 90th percentile of all examinations for the entire enterprise and each subspecialty division. Using established methodology, we calculated CCIFs (actual ICD-10 codes ÷ prior ICD-9 codes). To assess ICD-10's impact on cash flow, average monthly days in accounts receivable status was compared for the 12 months before and after conversion. RESULTS: Of all 69,823 ICD-10 codes, only 7,075 were used to report primary diagnoses across the entire practice, and just 562 were used to report 90% of all claims, compared with 348 under ICD-9. This translates to an overall CCIF of 1.6 for the department (far less than the literature-predicted 6). By subspecialty division, CCIFs ranged from 0.7 (breast) to 3.5 (musculoskeletal). Monthly average days in accounts receivable for the 12 months before and after ICD-10 conversion did not increase. CONCLUSION: The operational impact of the ICD-10 transition on radiology practices appears far less than anticipated with respect to both CCIF and delays in cash flow. Predictive models should be refined to help practices better prepare for ICD-11.

Radiologists and Social Media: Do Not Forget About Facebook.

PURPOSE: Facebook (Facebook, Inc, Menlo Park, California, USA) is the most popular social networking platform worldwide. Facebook groups are virtual communities of people who share a common interest. Breast Imaging Radiologists is a Facebook group for radiologists with an interest in breast imaging. The purpose of this study was to analyze the membership and activity of the Breast Imaging Radiologists Facebook group (BIRFG) for 2 years since its inception. METHODS: Using both the Grytics (www.grytics.com) and Sociograph (www.sociograph.io) analytic engines, the activity of the BIRFG was analyzed retrospectively from its inception on February 11, 2015, through February 12, 2017. Activity data were exported for further qualitative and quantitative analysis using Excel (Microsoft, Redmond, Washington, USA). Member demographic data were obtained by querying public Facebook profiles, US News Doctor Finder (US News & World Report, Washington, DC, USA), Doximity (Doximity, San Francisco, California, USA), and Google (Google Inc, Mountain View, California, USA). RESULTS: Membership grew from 1 to 774 over the study period, and 84% of the members were female. There were 493 posts, 3,253 comments, and 1,732 reactions; 92% of posts received either comments or reactions. Each post received an average of 6.6 comments, and 55% of members were active over the study period. There was an increase in all measures of activity from year 1 to year 2. CONCLUSIONS: Our findings indicate that radiologists find value in using Facebook groups as a forum to network and exchange information about breast imaging. This may be generalizable to other radiology subspecialties. Given the popularity and accessibility of Facebook for personal use, it may prove a more comfortable social medium for radiologists to interact professionally.