Computed tomography or chest X-ray to assess pulmonary congestion in dyspnoeic patients with acute heart failure.

AIMS: While computed tomography (CT) is widely acknowledged as superior to chest radiographs for acute diagnostics, its efficacy in diagnosing acute heart failure (AHF) remains unexplored. This prospective study included consecutive patients with dyspnoea undergoing simultaneous low-dose chest CT (LDCT) and chest radiographs. Here, we aimed to determine if LDCT is superior to chest radiographs to confirm pulmonary congestion in dyspnoeic patients with suspected AHF. METHODS AND RESULTS: An observational, prospective study, including dyspnoeic patients from the emergency department. All patients underwent concurrent clinical examination, laboratory tests, echocardiogram, chest radiographs, and LDCT. The primary efficacy measure to compare the two radiological methods was conditional odds ratio (cOR). The primary outcome was adjudicated AHF, ascertained by comprehensive expert consensus. The secondary outcome, echo-bnp AHF, was an objective AHF diagnosis based on echocardiographic cardiac dysfunction, elevated cardiac filling pressure, loop diuretic administration, and NT-pro brain natriuretic peptide > 300 pg/mL. Of 228 dyspnoeic patients, 64 patients (28%) had adjudicated AHF, and 79 patients (35%) had echo-bnp AHF. Patients with AHF were older (78 years vs. 73 years), had lower left ventricular ejection fraction (36% vs. 55%), had higher elevated left ventricular filling pressures (98% vs. 18%), and had higher NT-pro brain natriuretic peptide levels (3628 pg/mL vs. 470 pg/mL). The odds to diagnose adjudicated AHF and echo-bnp AHF were up to four times greater using LDCT (cOR: 3.89 [2.15, 7.06] and cOR: 2.52 [1.45, 4.38], respectively). For each radiologic sign of pulmonary congestion, the LDCT provided superior or equivalent results as the chest radiographs, and the interrater agreement was higher using LDCT (kappa 0.88 [95% CI: 0.81, 0.95] vs. 0.73 [95% CI: 0.63, 0.82]). As first-line imaging modality, LDCT will find one additional adjudicated AHF in 12.5 patients and prevent one false-positive in 20 patients. Similar results were demonstrated for echo-bnp AHF. CONCLUSIONS: In consecutive dyspnoeic patients admitted to the emergency department, LDCT is significantly better than chest radiographs in detecting pulmonary congestion.

Artificial intelligence and multidisciplinary team meetings; a communication challenge for radiologists' sense of agency and position as spider in a web?

PURPOSE: This paper focuses on how the implementation of artificial intelligence algorithms (AI) challenges and changes the existing communication practice in radiology seen from a psychological communicative and clinical radiologist's perspective. METHOD: Based on thematic literature search across radiology, management, and information system technology research of AI implementation and robotics, we applied social- and cognitive psychological concepts in order to analyse and interpret these potential communication challenges that the introduction of AI potentially imposes. RESULTS AND DISCUSSION: We found that scepticism towards AI implementation is a well-documented reaction among medical professionals in general. We related this scepticism to the AI's potential transforming effect on the practice of communication in radiology. We found that the traditional communication practice to include and collaborate with AI is insufficiently developed. We propose using the multidisciplinary team meetings as an example of that at least two psychological mechanisms in this insufficiently developed communication practice can be both crucial barriers towards and drivers of the AI implementation, these mechanisms are: (1) (loss of) sense of agency, meaning the experience of being in control in one's job, and (2) (a threatened) self-image of being the expert when interacting with AI. CONCLUSION: AI implementation potentially transforms the existing professional and social positions of radiologists and other medical professionals in general which in multidisciplinary team meetings can hinder the intended use and benefit of the technology. We therefore recommend an increased focus on psychological and leadership processes in order to avoid these consequences and call for a development of co-creating communication practices with AI.