Improving Automating Quality Control in Radiology: Leveraging Large Language Models to Extract Correlative Findings in Radiology and Operative Reports.

Radiology Imaging plays a pivotal role in medical diagnostics, providing clinicians with insights into patient health and guiding the next steps in treatment. The true value of a radiological image lies in the accuracy of its accompanying report. To ensure the reliability of these reports, they are often cross-referenced with operative findings. The conventional method of manually comparing radiology and operative reports is labor-intensive and demands specialized knowledge. This study explores the potential of a Large Language Model (LLM) to simplify the radiology evaluation process by automatically extracting pertinent details from these reports, focusing especially on the shoulder's primary anatomical structures. A fine-tuned LLM identifies mentions of the supraspinatus tendon, infraspinatus tendon, subscapularis tendon, biceps tendon, and glenoid labrum in lengthy radiology and operative documents. Initial findings emphasize the model's capability to pinpoint relevant data, suggesting a transformative approach to the typical evaluation methods in radiology.

A novel 3D MRI-based approach for assessing supraspinatus muscle length.

Rotator cuff (RC) tears are a common source of pain and decreased shoulder strength. Muscle length is known to affect muscle strength, and therefore evaluating changes in supraspinatus muscle length associated with RC pathology, surgical repair, and post-operative recovery may provide insights into functional deficits. Our objective was to develop a reliable MRI-based approach for assessing supraspinatus muscle length. Using a new semi-automated approach for identifying 3D location of the muscle-tendon junction (MTJ), supraspinatus muscle length was calculated as the sum of MTJ distance (distance between 3D MTJ position and glenoid plane) and supraspinatus fossa length (distance between root of the scapular spine and glenoid plane). Inter- and intra-operator reliability of this technique were assessed with intraclass correlation coefficient (ICC) and found to be excellent (ICCs > 0.96). Muscle lengths of 6 patients were determined before RC repair surgery and at 3- and 12-months post-surgery. Changes in normalized muscle length (muscle length as a percentage of pre-surgical muscle length) at 3 months post-surgery varied considerably across patients (16.1 % increase to 7.0 % decrease) but decreased in all patients from 3- to 12-months post-surgery (0.3 % to 17.2 %). This study developed a novel and reliable approach for quantifying supraspinatus muscle length and provided preliminary demonstration of its utility by assessing muscle length changes associated with RC pathology and surgical repair. Future studies can use this technique to evaluate changes over time in supraspinatus muscle length in response to clinical intervention, and associations between muscle length and shoulder function.

Radiology Resident Diagnostic In-Training Exam Scores: Impact of Subspecialty Imaging Volume and Rotation Scheduling.

PURPOSE: To determine the relationship between resident imaging volumes and number of subspecialty rotations with Diagnostic Radiology In-Training (DXIT) subspecialty scores. METHODS: DXIT-scaled subspecialty scores from a single large diagnostic radiology training program from 2014 to 2020 were obtained. The cumulative number of imaging studies dictated by each resident and specific rotations were mapped to each subspecialty for each year of training. DXIT subspecialty scores were compared against the total subspecialty imaging volume and the total number of rotations in a subspecialty for each resident year. A total of 52 radiology residents were trained during the study period and included in the dataset. RESULTS: There was a positive linear relationship between the number of neuro studies and scaled neuro DXIT scores for R1s (Pearson coefficient: 0.29; p-value: 0.034) and between the number of breast studies and the number of neuro studies with DXIT scores for R2s (Pearson coefficients: 0.50 and 0.45, respectively; p-values: 0.001 and 0.003, respectively). Furthermore, a positive significant linear relationship between the total number of rotations in cardiac, breast, neuro, and thoracic subspecialties and their scaled DXIT scores for R2 residents (Pearson coefficients: 0.34, 0.49, 0.33, and 0.32, respectively; p-value: 0.025, 0.001, 0.03, and 0.036, respectively) and between the total number of nuclear medicine rotations with DXIT scores for R3s (Pearson coefficient: 0.41; p-value: 0.016). CONCLUSION: Resident subspecialty imaging volumes and rotations have a variable impact on DXIT scores. Understanding the impact of study volume and the number of subspecialty rotations on resident medical knowledge will help residents and program directors determine how much emphasis to place on these factors during residency.

Automation of Protocoling Advanced MSK Examinations Using Natural Language Processing Techniques.

Imaging examination selection and protocoling are vital parts of the radiology workflow, ensuring that the most suitable exam is done for the clinical question while minimizing the patient's radiation exposure. In this study, we aimed to develop an automated model for the revision of radiology examination requests using natural language processing techniques to improve the efficiency of pre-imaging radiology workflow. We extracted Musculoskeletal (MSK) magnetic resonance imaging (MRI) exam order from the radiology information system at Henry Ford Hospital in Detroit, Michigan. The pretrained transformer, "DistilBERT" was adjusted to create a vector representation of the free text within the orders while maintaining the meaning of the words. Then, a logistic regression-based classifier was trained to identify orders that required additional review. The model achieved 83% accuracy and had an area under the curve of 0.87.

Predictors of infraspinatus muscle degeneration in individuals with an isolated supraspinatus tendon tear.

OBJECTIVE: Determine the demographic and clinical factors that predict infraspinatus muscle degeneration in individuals with an isolated supraspinatus tendon tear. MATERIALS AND METHODS: A retrospective analysis was performed using the medical records of patients who had a shoulder MRI interpreted by 1 of 3 fellowship-trained musculoskeletal radiologists since the implementation of a standardized MRI 3 T protocol within our healthcare system. Demographic (e.g., age, sex) and clinical data (e.g., tear size, muscle degeneration, co-morbidities) were collected. Patients with an isolated supraspinatus tendon tear (n = 121) were assigned to one of two groups based on whether any infraspinatus muscle degeneration was present. Logistic regression was used to assess the univariate relationships between infraspinatus muscle degeneration and patient and clinical data, while least absolute shrinkage and selector operator (LASSO) logistic regression was used to assess the multivariable relationship. RESULTS: Of the patients with an isolated supraspinatus tendon tear, 16.5% had evidence of infraspinatus muscle degeneration. The presence of infraspinatus muscle degeneration was independently associated with cardiovascular disease (P = 0.01), supraspinatus muscle degeneration (P < 0.01), and subscapularis muscle degeneration (P = 0.01). When the multivariable relationship is assessed, supraspinatus muscle degeneration emerged as the only variable of significant importance for detecting infraspinatus muscle degeneration (specificity: 87.1%, sensitivity: 80.0%). CONCLUSION: Infraspinatus muscle degeneration is not uncommon in individuals with an isolated supraspinatus tear and is most associated with concomitant supraspinatus muscle degeneration. These findings highlight the need for clinicians to specifically assess the status of each rotator cuff muscle, even when the tendon itself is intact.

The sonographic quantitative assessment of the deltoid muscle to detect type 2 diabetes mellitus: a potential noninvasive and sensitive screening method?

BACKGROUND: In our previous published study, we demonstrated that a qualitatively assessed elevation in deltoid muscle echogenicity on ultrasound was both sensitive for and a strong predictor of a type 2 diabetes (T2DM) diagnosis. This study aims to evaluate if a sonographic quantitative assessment of the deltoid muscle can be used to detect T2DM. METHODS: Deltoid muscle ultrasound images from 124 patients were stored: 31 obese T2DM, 31 non-obese T2DM, 31 obese non-T2DM and 31 non-obese non-T2DM. Images were independently reviewed by 3 musculoskeletal radiologists, blinded to the patient's category. Each measured the grayscale pixel intensity of the deltoid muscle and humeral cortex to calculate a muscle/bone ratio for each patient. Following a 3-week delay, the 3 radiologists independently repeated measurements on a randomly selected 40 subjects. Ratios, age, gender, race, body mass index, insulin usage and hemoglobin A1c were analyzed. The difference among the 4 groups was compared using analysis of variance or chi-square tests. Both univariate and multivariate linear mixed models were performed. Multivariate mixed-effects regression models were used, adjusting for demographic and clinical variables. Post hoc comparisons were done with Bonferroni adjustments to identify any differences between groups. The sample size achieved 90% power. Sensitivity and specificity were calculated based on set threshold ratios. Both intra- and inter-radiologist variability or agreement were assessed. RESULTS: A statistically significant difference in muscle/bone ratios between the groups was identified with the average ratios as follows: obese T2DM, 0.54 (P < 0.001); non-obese T2DM, 0.48 (P < 0.001); obese non-T2DM, 0.42 (P = 0.03); and non-obese non-T2DM, 0.35. There was excellent inter-observer agreement (intraclass correlation coefficient 0.87) and excellent intra-observer agreements (intraclass correlation coefficient 0.92, 0.95 and 0.94). Using threshold ratios, the sensitivity for detecting T2DM was 80% (95% CI 67% to 88%) with a specificity of 63% (95% CI 50% to 75%). CONCLUSIONS: The sonographic quantitative assessment of the deltoid muscle by ultrasound is sensitive and accurate for the detection of T2DM. Following further studies, this process could translate into a dedicated, simple and noninvasive screening method to detect T2DM with the prospects of identifying even a fraction of the undiagnosed persons worldwide. This could prove especially beneficial in screening of underserved and underrepresented communities.

Sonographic Finding of Medial Ankle Subcutaneous Edema and Its Association with Posterior Tibial Tenosynovitis.

Background: To evaluate if the sonographic finding of medial ankle subcutaneous (subQ) edema is associated with posterior tibial tenosynovitis (PTTS). Methods: Sonographic images of the medial ankle soft tissues from 40 patients with PTTS and 37 patients with a normal posterior tibial tendon (PTT) were randomized and independently evaluated by two musculoskeletal radiologists for the presence or absence of subQ edema. Both radiologists were blinded to the images and status of the PTT and the patient's history. Statistical analyses included the Chi-square test and Cohen's Kappa statistics for inter-observer agreement. Results: A statistically significant association was seen for the presence of medial ankle subQ edema and PTTS among both radiologists' findings. Of the 40 patients with PTTS, 33 (82.5%) were found positive by the first radiologist for medial ankle subQ edema, while no subQ edema was found in 28 of the 37 (75.7%) patients with a normal PTT (P < 0.001). Similarly, the second radiologist found that 33 of the 40 (82.5%) with PTTS were positive for subQ edema, while no subQ edema was found in 24 of the 37 (64.9%) patients with a normal PTT (P < 0.001). There was also substantial inter-observer agreement between the 2 radiologists (κ-value = 0.79; 95% confidence intervals: 0.65, 0.93). Conclusion: A statistically significant association was present for the association of the sonographic finding of medial ankle subQ edema and the presence of PTTS. Further studies could evaluate if the sonographic finding of medial ankle subQ edema is an early predictor of PTT dysfunction.

Sonographic evaluation of the association between calcific tendinopathy and rotator cuff tear: a case-controlled comparison.

OBJECTIVES: To compare the incidence of rotator cuff (RC) tears on shoulder ultrasounds of patients with RC calcific tendinopathy (CaT) to that of a control group without CaT. METHOD: In this retrospective case-control study, 50 shoulder ultrasounds of patients with CaT were compared independently by 2 musculoskeletal radiologists to 50 patients from a control group without CaT to catalog the number and type of RC tears. RC tears in the CaT group were further characterized based on location, into tears in the specific tendon(s) containing calcium versus all tendon tears. RESULTS: RC tears were diagnosed in 38% (19/50) of the control group (16 full-thickness) as compared to 22% (11/50) with CaT (6 full-thickness). The fewer full-thickness tears in the CaT group (12%, 6 of 50) compared to that in the control group (32%, 16 of 50) was statistically significant (P = 0.016, odds ratio 0.29). Only 7 of the 11 tears in the CaT group were in a calcium-containing tendon (3 full-thickness). The fewer calcium-containing tendon tears compared to tears in the control group was also statistically significant (P = 0.006, odds ratio 0.27). Furthermore, the fewer full-thickness calcium-containing tendon tears (6%, 3/50) compared to full-thickness tears in the control group (32%, 16/50) were yet more statistically significant (P = 0.001, odds ratio 0.14). CONCLUSIONS: In patients with shoulder pain and CaT, we observed a decreased number of RC tears and especially calcium-containing tendon tears, as compared to similar demographic patients with shoulder pain but without CaT. Key Points • Patients with rotator cuff calcific tendinopathy have few rotator cuff tears, especially full-thickness tears, compared to a control group without calcific tendinopathy. • The tendons containing the calcium hydroxyapatite deposition were the least likely to have a rotator cuff tear. • Future studies could evaluate if calcium hydroxyapatite deposition provides a protective mechanism against rotator cuff tears. • Musculoskeletal ultrasound is more sensitive than MRI in the evaluation of rotator cuff calcific tendinopathy.

Deep COVID DeteCT: an international experience on COVID-19 lung detection and prognosis using chest CT.

The Coronavirus disease 2019 (COVID-19) presents open questions in how we clinically diagnose and assess disease course. Recently, chest computed tomography (CT) has shown utility for COVID-19 diagnosis. In this study, we developed Deep COVID DeteCT (DCD), a deep learning convolutional neural network (CNN) that uses the entire chest CT volume to automatically predict COVID-19 (COVID+) from non-COVID-19 (COVID-) pneumonia and normal controls. We discuss training strategies and differences in performance across 13 international institutions and 8 countries. The inclusion of non-China sites in training significantly improved classification performance with area under the curve (AUCs) and accuracies above 0.8 on most test sites. Furthermore, using available follow-up scans, we investigate methods to track patient disease course and predict prognosis.

Elbow Torque Is Reduced in Asymptomatic College Pitchers With Elbow Laxity: A Dynamic Ultrasound Study.

PURPOSE: To determine the relation between medial elbow torque, as measured by wearable sensor technology, and adaptations of the medial elbow structures on dynamic ultrasound imaging in asymptomatic collegiate pitchers. METHODS: Thirty-four pitchers from National Collegiate Athletic Association Division II universities were eligible for preseason testing. The exclusion criteria included age younger than 18 years, history of surgery, non-pitcher, or current restrictions. Pitchers were fitted with a wearable sensor sleeve that recorded elbow torque, arm slot, arm speed, and arm rotation. Pitchers threw 5 fastballs in a standardized manner off the mound at game-speed effort. They also underwent dynamic ultrasound imaging of the elbow by a musculoskeletal sonographer, with standardized valgus loading. Images were deidentified, and measurements of the ulnar collateral ligament (UCL) and ulnohumeral joint space (UHJS), to assess elbow laxity, were performed by a musculoskeletal radiologist. RESULTS: The final analysis included 28 pitchers with an average age of 20.1 years (standard deviation, 1.3 years; range, 18-23 years) and playing experience of 15.3 years (standard deviation, 1.8 years; range, 11-19 years). The dominant UCL thickness (P < .001), loaded UHJS (P = .039), and delta UHJS (P < .001) were significantly greater than the nondominant measurements. An inverse correlation was found between loaded UHJS and medial elbow torque (r = -0.4, P < .001). Additionally, every 1-mm increase in UHJS significantly reduced medial elbow torque by 2.27 Nm (P = .032) and arm slot by 8.8° (P = .019) and increased arm rotation by 5.3° (P = .043). Pitchers with a loaded UHJS of 4.4 mm or greater and delta UHJS of 1.25 mm or greater had significantly reduced medial elbow torque (P < .001). Pitchers with a UCL thickness of 1.65 mm or greater had significantly increased medial elbow torque (47.4 Nm vs 44.8 Nm, P = .006). CONCLUSIONS: Pitchers with increased dynamic elbow laxity were found to experience reduced medial elbow torque while pitching. Additionally, pitchers with greater UCL thickness on ultrasound were found to experience increased medial elbow torque while pitching. This study's findings suggest a relation between anatomic adaptations found on ultrasound of the pitching elbow and medial elbow torque. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty.

OBJECTIVE: To determine the type and frequency of incidental findings detected on preoperative computed tomography (CT) imaging obtained for robotic-assisted joint replacements and their effect on the planned arthroplasty. MATERIALS AND METHODS: All preoperative CT examinations performed for a robotic-assisted knee or total hip arthroplasty were obtained. This resulted in 1432 examinations performed between September 2016 and February 2020 at our institution. These examinations were initially interpreted by 1 of 9 fellowship-trained musculoskeletal radiologists. Using a diagnosis search, the examination reports were then reviewed to catalog all incidental findings and further classify as significant or non-significant findings. Demographic information was obtained. In those with significant findings, a chart review was performed to record the relevant workup, outcomes, and if the planned arthroplasty was affected. RESULTS: Incidental findings were diagnosed in 740 (51.7%) patients. Of those with incidental findings, 41 (5.5%) were considered significant. A significant finding was more likely to be detected in males (P = 0.007) and on the hip protocol CT (P = 0.014). In 8 patients, these diagnoses resulted in either delay or cancelation of the arthroplasty. A planned total hip arthroplasty was more likely to be altered as compared to a knee arthroplasty (P = 0.018). CONCLUSION: Incidental findings are commonly detected by radiologists on preoperative CT imaging obtained for robotic-assisted joint replacement. Several were valuable findings and resulted in a delay or even cancelation of the planned arthroplasty after the detection of critical diagnoses, which if not identified may have resulted in devastating outcomes.

Elbow Torque May be Predictive of Anatomic Adaptations to the Elbow After a Season of Collegiate Pitching: A Dynamic Ultrasound Study.

PURPOSE: To determine whether elbow torque was associated with anatomic adaptations of the medial elbow following a season of competitive pitching. METHODS: Pitchers from 3 collegiate baseball teams were recruited during the preseason for participation. Before the season, pitchers were recorded throwing 5 "game-speed" fastball pitches from a standard distance off a mound while wearing a wearable sensor baseball compression sleeve that calculates elbow torque, arm speed, arm slot, and arm rotation. Participants subsequently underwent dynamic ultrasound imaging of the medial elbow, including measurements of the ulnar collateral ligament (UCL) and ulnohumeral joint space to assess elbow laxity. Following a full season of competitive pitching, all testing was repeated, and statistical analysis comparing preseason to postseason sonographic findings was performed. RESULTS: Twenty-eight collegiate pitchers underwent preseason sonographic and kinematic testing. Nineteen pitchers were available for postseason testing. The average age (standard deviation) and playing experience was 19.9 (1.2) and 14.7 (1.5) years. Compared with preseason, there were significant increases in postseason UCL thickness (1.92 ± 0.09 vs 1.56 ± 0.09 mm, P < .01) and elbow laxity (1.77 ± 0.23 vs 1.15 ± 0.22 mm, P = .028) after a season of pitching. No significant changes in pitching kinematic measurements were observed between preseason and postseason testing. Preseason pitching kinematic measurements were significantly associated with increased UCL thickness (arm slot: beta estimate -0.03 ± 0.01, P = .011) and reduction in elbow laxity (elbow torque: beta estimate -0.03 ± 0.01, P = .04) after a season of pitching. Pitchers with increased body weight and arm length demonstrated reduced medial elbow torque during pitching (P < .05). CONCLUSIONS: After a season of competitive pitching, adaptive changes of the medial elbow were demonstrated on dynamic ultrasound. However, the influence of pitching kinematic measurements on these adaptations are of small magnitude and unknown clinical significance. Although wearable sensor technology may have value in trending individual pitcher kinematics, no discrete threshold appears to predict the development of adaptive changes at the elbow. LEVEL OF EVIDENCE: Level II, prospective observational study.

Impact of the COVID-19 pandemic on radiology physician work RVUs at a large subspecialized radiology practice.

PURPOSE: As the COVID-19 pandemic continues, efforts by radiology departments to protect patients and healthcare workers and mitigate disease spread have reduced imaging volumes. This study aims to quantify the pandemic's impact on physician productivity across radiology practice areas as measured by physician work Relative Value Units (wRVUs). MATERIALS AND METHODS: All signed diagnostic and procedural radiology reports were curated from January 1st to July 1st of 2019 and 2020. Physician work RVUs were assigned to each study type based on the Medicare Physician Fee Schedule. Utilizing divisional assignments, radiologist schedules were mapped to each report to generate a sum of wRVUs credited to that division for each week. Differential impact on divisions were calculated relative to a matched timeframe in 2019 and a same length pre-pandemic time period in 2020. RESULTS: All practice areas saw a substantial decrease in wRVUs from the 2020 pre- to intra-pandemic time period with a mean decrease of 51.5% (range 15.4%-76.9%). The largest declines were in Breast imaging, Musculoskeletal, and Neuroradiology, which had decreases of 76.9%, 75.3%, and 67.5%, respectively. The modalities with the greatest percentage decrease were mammography, MRI, and non-PET nuclear medicine. CONCLUSION: All radiology practice areas and modalities experienced a substantial decrease in wRVUs. The greatest decline was in Breast imaging, Neuroradiology, and Musculoskeletal radiology. Understanding the differential impact of the pandemic on practice areas will help radiology departments prepare for the potential depth and duration of the pandemic by better understanding staffing needs and the financial effects.

COVID-19 and Radiology Resident Imaging Volumes-Differential Impact by Resident Training Year and Imaging Modality.

RATIONALE AND OBJECTIVES: The COVID-19 pandemic has greatly impacted radiology departments across the country. The pandemic has also disrupted resident education, both due to departmental social distancing efforts and reduced imaging volumes. The purpose of this study was to assess the differential impact the pandemic had on radiology resident imaging volumes by training year and imaging modality. MATERIALS AND METHODS: All signed radiology resident reports were curated during defined prepandemic and intrapandemic time periods. Imaging case volumes were analyzed on a mean per resident basis to quantify absolute and percent change by training level. Change in total volume by imaging modality was also assessed. The number of resident workdays assigned outside the normal reading room was also calculated. RESULTS: Overall percent decline in resident imaging interpretation volume from the prepandemic to intrapandemic time period was 62.8%. R1s and R2s had the greatest decline at 87.3% and 64.3%, respectively. Mammography, MRI and nuclear medicine had the greatest decline in resident interpretation volume at 92.0%, 73.2%, and 73.0%, respectively. During the intrapandemic time period, a total of 478 resident days (mean of 14.5 days per resident) were reassigned outside of the radiology reading room. CONCLUSION: The COVID-19 pandemic caused a marked decrease in radiology resident imaging interpretation volume and has had a tremendous impact on resident education. The decrease in case interpretation, as well as in-person teaching has profound implications for resident education. Knowledge of this differential decrease by training level will help residency programs plan for the future.

Interobserver and Intraobserver Variability in the CT Assessment of COVID-19 Based on RSNA Consensus Classification Categories.

PURPOSE: To assess the interobserver and intraobserver agreement of fellowship trained chest radiologists, nonchest fellowship-trained radiologists, and fifth-year radiology residents for COVID-19-related imaging findings based on the consensus statement released by the Radiological Society of North America (RSNA). METHODS: A survey of 70 chest CTs of polymerase chain reaction (PCR)-confirmed COVID-19 positive and COVID-19 negative patients was distributed to three groups of participating radiologists: five fellowship-trained chest radiologists, five nonchest fellowship-trained radiologists, and five fifth-year radiology residents. The survey asked participants to broadly classify the findings of each chest CT into one of the four RSNA COVID-19 imaging categories, then select which imaging features led to their categorization. A 1-week washout period followed by a second survey comprised of randomly selected exams from the initial survey was given to the participating radiologists. RESULTS: There was moderate overall interobserver agreement in each group (κ coefficient range 0.45-0.52 ± 0.02). There was substantial overall intraobserver agreement across the chest and nonchest groups (κ coefficient range 0.61-0.67 ± 0.06) and moderate overall intraobserver agreement within the resident group (κ coefficient 0.58 ± 0.06). For the image features that led to categorization, there were varied levels of agreement in the interobserver and intraobserver components that ranged from fair to perfect kappa values. When assessing agreement with PCR-confirmed COVID status as the key, we observed moderate overall agreement within each group. CONCLUSION: Our results support the reliability of the RSNA consensus classification system for COVID-19-related image findings.

Peripheral Polyneuropathy Associated with COVID-19 in Two Patients: A Musculoskeletal Ultrasound Case Report.

As coronavirus disease 2019 (COVID-19) spreads, we are encountering multiple different symptoms and related complications. Although the vast majority of literature is focused on its pulmonary manifestations, recent reports have mentioned neurologic manifestations but typically those related to the central nervous system and diagnosed utilizing magnetic resonance imaging. We present two cases of COVID-19-associated peripheral polyneuropathy diagnosed utilizing musculoskeletal ultrasound (US), which to our knowledge is the first such case report. US is an instrumental portable modality that can be used for COVID-19 patients in isolation. As this virus continues to spread, understanding and recognizing these COVID-19 related complications and their sonographic findings are crucial.

Sonographic Diagnosis of Velamentous and Marginal Placental Cord Insertion.

Routine second trimester ultrasound (US) examinations include an assessment of the umbilical cord given its vital role as a vascular conduit between the maternal placenta and fetus during fetal development. Placental cord insertion abnormalities can be identified during prenatal US screening and are increasingly recognized as independent risk factors for various complications during pregnancy and delivery. The purpose of this pictorial review is to illustrate examples of velamentous and marginal placental cord insertion with an emphasis on how to differentiate their morphology using color Doppler US.

Chest Radiographic Appearance of Minimally Invasive Cardiac Implants and Support Devices: What the Radiologist Needs to Know.

Minimally invasive implantable cardiac devices used in valve repair and replacement, cardiovascular support, and partial chamber and appendageal occlusion represent a burgeoning area of both bioengineering and clinical innovation. In addition to familiarizing the reader with the radiographic appearance of the most commonly utilized and encountered newer devices, this review will also address the relevant clinical and pathophysiological indications for usage and deployment as well as potentially encountered complications.

Order Entry Protocols Are an Amenable Target for Workflow Automation.

PURPOSE: Order entry protocol selection of advanced imaging studies is labor-intensive, can disrupt workflow, and may displace staff from more valuable tasks. The aim of this study was to explore and compare the behaviors of radiologic technologists and radiologists when determining protocol to identify opportunities for workflow automation. METHODS: A data set of over 273,000 cross-sectional examination orders from four hospitals within our health system was created. From this data set, we isolated the 12 most frequently requested examinations, which represent almost 50% of the entirety of advanced imaging volume. Intergroup comparisons were made between behavior of radiologic technologists and radiologists or residents when determining protocol. Frequencies of changes were calculated. Common parameters of changed examinations were identified. RESULTS: The overall change rate for both radiologists and residents (4%) is very low and comparable to the overall change rate of radiologic technologists (1%). The change rates for the 12 most ordered examinations were calculated and compared individually. Most examinations that underwent change involved a patient with a low estimated glomerular filtration rate, a patient with a contrast allergy, or a provider ordering a general examination but in fact wanting an organ-specific protocol or an angiographic study. CONCLUSION: Order entry protocol selection of the most frequently ordered advanced imaging examinations was rarely a value-added activity because these examinations are rarely changed. Changes follow predictable patterns that make order entry protocol selection of most radiology orders for advanced imaging amenable to workflow automation.