The disproportionate impact of peer learning on emergency radiology.

PURPOSE: The use of peer learning methods in radiology continues to grow as a means to constructively learn from past mistakes. This study examined whether emergency radiologists receive a disproportionate amount of peer learning feedback entered as potential learning opportunities (PLO), which could play a significant role in stress and career satisfaction. Our institution offers 24/7 attending coverage, with emergency radiologists interpreting a wide range of X-ray, ultrasound and CT exams on both adults and pediatric patients. MATERIALS AND METHODS: Peer learning submissions entered as PLO at a single large academic medical center over a span of 3 years were assessed by subspecialty distribution and correlated with the number of attending radiologists in each section. Total number of studies performed on emergency department patients and throughout the hospital system were obtained for comparison purposes. Data was assessed using analysis of variance and post hoc analysis. RESULTS: Emergency radiologists received significantly more (2.5 times) PLO submissions than the next closest subspeciality division and received more yearly PLO submissions per attending compared to other subspeciality divisions. This was found to still be true when normalizing for increased case volumes; Emergency radiologists received more PLO submissions per 1000 studies compared to other divisions in our department (1.59 vs. 0.85, p = 0.04). CONCLUSION: Emergency radiologists were found to receive significantly more PLO submissions than their non-emergency colleagues. Presumed causes for this discrepancy may include a higher error rate secondary to wider range of studies interpreted, demand for shorter turn-around times, higher volumes of exams read per shift, and hindsight bias in the setting of follow-up review.

Help, I've been sued! Demystifying the steps of malpractice litigation for the emergency radiologist.

Being sued can have significant emotional and psychological impact and has implications on the wellness of emergency radiologists. A better understanding of the steps involved in a medical malpractice suit can help defuse some of the anxiety of litigation. This process starts with the inception of the case, the summons, and complaint, then progresses to discovery, including document production, interrogatories, and deposition, and thereafter to settlement or trial. The discussion includes a number of tips and outlines a number of pitfalls inherent in litigation. It is hoped that this discussion will alleviate some of the anxiety that accompanies this long and arduous process.

Clinical Implementation of a Combined Artificial Intelligence and Natural Language Processing Quality Assurance Program for Pulmonary Nodule Detection in the Emergency Department Setting.

OBJECTIVE: This quality assurance study assessed the implementation of a combined artificial intelligence (AI) and natural language processing (NLP) program for pulmonary nodule detection in the emergency department setting. The program was designed to function outside of normal reading workflows to minimize radiologist interruption. MATERIALS AND METHODS: In all, 19,246 CT examinations including at least some portion of the lung anatomy performed in the emergent setting from October 1, 2021, to June 1, 2022, were processed by the combined AI-NLP program. The program used an AI algorithm trained on 6-mm to 30-mm pulmonary nodules to analyze CT images and an NLP to analyze radiological reports. Cases flagged as negative for pulmonary nodules by the NLP but positive by the AI algorithm were classified as suspected discrepancies. Discrepancies result in secondary review of examinations for possible addenda. RESULTS: Out of 19,246 CT examinations, 50 examinations (0.26%) resulted in secondary review, and 34 of 50 (68%) reviews resulted in addenda. Of the 34 addenda, 20 patients received instruction for new follow-up imaging. Median time to addendum was 11 hours. The majority of reviews and addenda resulted from missed pulmonary nodules on CT examinations of the abdomen and pelvis. CONCLUSION: A background quality assurance process using AI and NLP helped improve the detection of pulmonary nodules and resulted in increased numbers of patients receiving appropriate follow-up imaging recommendations. This was achieved without disrupting in-shift radiologist workflow or causing significant delays in patient follow for the diagnosed pulmonary nodule.

Is Artificial Intelligence (AI) a Pipe Dream? Why Legal Issues Present Significant Hurdles to AI Autonomy.

Proponents of artificial intelligence (AI) technology have suggested that in the near future, AI software may replace human radiologists. Although assimilation of AI into the specialty has occurred more slowly than predicted, developments in machine learning, deep learning, and neural networks suggest that technologic hurdles and costs will eventually be overcome. However, beyond these technologic hurdles, formidable legal hurdles threaten the impact of AI on the specialty. Legal liability for errors committed by AI will influence the ultimate role of AI within radiology and also influence whether AI remains a simple decision support tool or develops into an autonomous member of the health care team. Additional areas of uncertainty include the potential application of products liability law to AI and the approach taken by the U.S. FDA in potentially classifying autonomous AI as a medical device. The current ambiguity of the legal treatment of AI will profoundly influence development of autonomous AI given that vendors, radiologists, and hospitals will be unable to reliably assess their liability associated with implementing such tools. Advocates of AI in radiology and health care in general need to lobby for legislative action to better clarify the liability risks of AI in a way that does not deter technologic development.

Financial and medicolegal implications of focused/fast abdominopelvic MRI exams.

PURPOSE: Abbreviated MRI offers significant advantages in terms of MRI throughput, patient tolerance and expediency, and is being utilized for a variety of abdominopelvic imaging applications. However questions abound with respect to financial and medicolegal treatment of these relatively new protocols. METHODS: A review of the relevant literature was performed. RESULTS: There is no Current Procedural Terminology code for a "limited" MRI study, but it may not be appropriate to bill an abbreviated study the same as a more comprehensive study. With respect to medicolegal concerns, the risk of liability when missing or misinterpreting medically significant findings due to use of an abbreviated scan will turn on whether abbreviated MRI has become the standard of care. CONCLUSION: In light of these ambiguities, it would behoove abdominopelvic imagers to advocate for their professional and subspecialty organizations to issue practice parameters/guidelines with respect to the utilization of abbreviated MRI protocols, and for the subspecialty to bill these abbreviated scans at objectively reasonable rates.

The impact of COVID-19 quarantine efforts on emergency radiology and trauma cases.

OBJECTIVE: Amidst COVID-19 pandemic, many states have issued stay at home advisories and non-essential business closures to limit public exposure. During this "quarantine" period, it is important to understand the volume and types of emergency/trauma radiology cases to better prepare for the continuing and future pandemics. This study demonstrates new trends in pathologies and an overall increase in positive exams. METHODS: A retrospective review of emergency department's imaging during the initial two weeks of this state's quarantine period, 3/23/2020-4/5/2020 was compared to similar dates of the previous year ("pre-quarantine" period), 3/25/2019-4/7/2019. One thousand emergency radiology and 991 trauma cases were evaluated. Of the emergency radiology cases 500 studies from each period were assessed, and from the trauma cases, 783 cases from pre-quarantine and 315 from the quarantine period were examined. Chi-square analysis was performed to assess for statistical significance. RESULTS: Overall there were 43.0% fewer emergency radiology studies performed during the quarantine period (n = 4530) compared to pre-quarantine period (n = 2585). Additionally, the number of positive cases was significantly higher (P = 0.0001) during the quarantine period (43.0%) compared to the pre-quarantine period (30.2%). Several trends in types of trauma were observed, including a significant increase in domestic violence during the quarantine period (P = 0.0081). DISCUSSION: Different volumes and types of emergency/trauma imaging cases were observed during the recent quarantine period. Findings may assist emergency radiology departments to plan for future pandemics or COVID-19 resurgences by offering evidence of the types and volume of emergency radiology cases one might expect.

Patient Electronic Access to Final Radiology Reports: What Is the Current Standard of Practice, and Is an Embargo Period Appropriate?

Patients have a right to their medical records, and it has become commonplace for institutions to set up online portals through which patients can access their electronic health information, including radiology reports. However, institutional approaches vary on how and when such access is provided. Many institutions have advocated built-in "embargo" periods, during which radiology reports are not immediately released to patients, to give ordering clinicians the opportunity to first receive, review, and discuss the radiology report with their patients. To understand current practices, a telephone survey was conducted of 83 hospitals identified in the 2019-2020 U.S. News & World Report Best Hospitals Rankings. Of 70 respondents, 91% (64 of 70) offered online portal access. Forty-two percent of those with online access (27 of 64 respondents) reported a delay of 4 days or longer, and 52% (33 of 64 respondents) indicated that they first send reports for review by the referring clinician before releasing to the patient. This demonstrates a lack of standardized practice in prompt patient access to health records, which may soon be mandated under the final rule of the 21st Century Cures Act. This article discusses considerations and potential benefits of early access for patients, radiologists, and primary care physicians in communicating health information and providing patient-centered care. © RSNA, 2021.

Hiding in the Hedges: Tips to Minimize Your Malpractice Risks as a Radiologist.

OBJECTIVE. Although few radiologists dwell on the notion of malpractice risk during their daily practice, the risk of malpractice within the specialty is real. CONCLUSION. This article provides an overview of the elements of a malpractice claim, discusses key ingredients for avoiding malpractice liability, touches on several topics interconnected with mitigating malpractice risks (hedging, apologies, and pace), and provides a series of tips a radiologist might consider in practice to decrease liability risk.

Curbside consults: Practices, pitfalls and legal issues.

OBJECTIVE: "Curbside consults" are informal opinions provided by one physician to another. In radiology, it often refers to opinions rendered on imaging performed at outside facilities and has evolved from being a targeted response to a discrete clinical question to a complete over-read in recent years. Given that the consults are usually sought for patients with complex conditions, the potential for error increases with informal reads, often due to the time constraint and lack of adequate information. Misinterpretations and inaccurate documentation by the referring clinician are also more likely. This study assesses the policies and views on curbside consults at academic centers in the United States. MATERIALS AND METHODS: An online survey (via SurveyMonkey.com) was circulated to the 319 active radiologist members of the Association of Program Directors. There were 80 responses, representing a 25% response rate. RESULTS: While most facilities provided second reads (92%), only a few (23%) provided written reports and read the case entirely. The majority (77%) tailored their read to answer specific clinical questions. Approximately two-thirds did not require the outside radiologist's report to be available before their interpretation. Seventy-nine percent were at least mildly concerned about liability. Up to 45% billed for the study; 39% were not aware of the billing practice. CONCLUSION: Curbside consults are widely provided at U.S. academic institutions with only a minority documenting their opinions. The majority are concerned about the legal implications and this paper puts forth recommendations to minimize the potential for errors in patient care and decrease liability.