Effectiveness and safety of two 18-gauge needle types on native and allograft renal biopsies.

Percutaneous biopsy is a key diagnostic tool for both native and allograft kidney diseases. Adequacy criteria vary, but at a minimum, a biopsy should allow the pathologist to reach a diagnosis and provide prognostic information such as the degree of interstitial fibrosis and tubular atrophy (IF/TA) and percentage of glomerulosclerosis. Whereas most studies use glomerular counts as a surrogate for biopsy adequacy, the amount and preservation of tubulointerstitium is equally important, considering IF/TA is a major prognostic parameter for most medical renal diseases. Many studies have compared the diagnostic adequacy of different gauge needles; however few have investigated performance differences between same gauge needles. In this study, we retrospectively analyzed 235 renal biopsies performed at a single center in Canada over 2years to compare the utilization, safety, diagnostic and prognostic performance of two 18-gauge needles in native and allograft kidney biopsies. We found no significant difference in needle utilization between native and allograft kidneys, or between trainees and staff radiologists. The total tissue yielded area, glomerular counts, percentage of inadequate biopsies and number of passes were similar; however the number of cases in which IF/TA evaluation was deemed not possible was higher for biopsies using disposable instrument needles (4.3% vs. 0%; p=0.01). These also showed greater number of tissue fragments (median 4 for reusable vs 3 for disposable; p=0.04). We postulate that the increased tissue fragmentation might have impaired the pathologists ability to accurately assess interstitial fibrosis and tubular atrophy in biopsies obtained with the disposable instrument needles.

Clinical impact of extending after-hours radiology coverage for emergency department computed tomography imaging.

BACKGROUND: Academic emergency departments (EDs) are often reliant on preliminary interpretation by radiology residents for after-hours computed tomography (CT) images. Identifying residents' errors in diagnostic interpretation and ensuring appropriate contact with affected patients are areas of continuing concern. OBJECTIVE: The Mount Sinai Hospital ED and Medical Imaging Department in Toronto, Canada sought to examine the clinical impact of extending reporting hours of senior attending radiologists for ED patients undergoing CT imaging. METHODS: All evening CT studies were read by the on-call sub-specialist staff radiologist before 10 pm; while studies done after 10 pm were read by 8 am, permitting review of final reports by the ordering ED physician. A retrospective review of radiology and ED metrics was performed on ED patients undergoing CT imaging 12 weeks before and 12 weeks after implementation of the extended reading hours. RESULTS: In the 12 weeks prior to implementation of extended senior attending radiologist coverage, 871 CT scans were performed as compared to 944 CT scans after implementation. Time from performance of CT scan to obtaining a dictated report decreased from 10.4 hours to 2.8 hours (P<0.001), and time from performance of CT scan to report verification by the radiologist decreased from 29.7 hours to 9.4 hours (P<0.001). There were no statistically significant changes in ED length of stay, rates of admission, or rates of consultation. However, there was a significant reduction in (median) time taken for ED physicians to resolve discrepant reports in the radiology information system queue (20.7 hours versus 13.3 hours, P<0.001). CONCLUSION: The extension of reporting hours reduced the time for ED physicians to review discrepant reports, while balancing educational needs of residents. This project has been considered a success by stakeholders and has now been implemented on a permanent basis.