RESUMO
INTRODUCTION: ChatGPT is an artificial intelligence platform available to patients seeking medical advice. Traditionally, urology patients consulted official provider-created materials, particularly the Urology Care Foundation™ (UCF). Today, men increasingly go online due to the rising costs of health care and the stigma surrounding sexual health. Online health information is largely inaccessible to laypersons as it exceeds the recommended American sixth to eighth grade reading level. We conducted a comparative assessment of patient education materials generated by ChatGPT vs UCF regarding men's health conditions. METHODS: All 6 UCF men's health resources were identified. ChatGPT responses were generated using patient questions obtained from UCF. Adjusted ChatGPT responses were generated by prompting, "Explain it to me like I am in sixth grade." Textual analysis was performed using sentence, word, syllable, and complex word count. Six validated formulae were used for readability analysis. Two physicians independently scored responses for accuracy, comprehensiveness, and understandability. Statistical analysis involved Wilcoxon matched-pairs test. RESULTS: ChatGPT responses were longer and more complex. Both UCF and ChatGPT failed official readability standards, although ChatGPT performed significantly worse across all 6 topics (all P < .001). Conversely, adjusted ChatGPT readability typically surpassed UCF, even meeting the recommended level for 2 topics. Qualitatively, UCF and ChatGPT had comparable accuracy, although ChatGPT had better comprehensiveness and worse understandability. CONCLUSIONS: When comparing readability, ChatGPT-generated education is less accessible than provider-written content, although neither meets the recommended level. Our analysis indicates that specific artificial intelligence prompts can simplify educational materials to meet national standards and accommodate individual literacy.
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Letramento em Saúde , Masculino , Humanos , Estados Unidos , Inteligência Artificial , Saúde do Homem , Educação de Pacientes como Assunto , EscolaridadeRESUMO
Recent advances are allowing computed tomography (CT) and magnetic resonance imaging (MRI) to add diagnostic information derived from microscopic-scale brain structure, pathology, and physiology to the gross pathologic information that has been the core of brain imaging diagnosis since the 1980s. Physiologic imaging with MR perfusion weighted imaging has joined MR diffusion imaging as an essential components of stroke and brain tumor MRI. At the same time, the volume scanning revolution in CT technology has dramatically decreased the radiation doses required for CT perfusion imaging by allowing routine simultaneous CT perfusion and noninvasive dynamic bone subtracted CT angiography (CTA) without a significant increase in radiation dose over conventional head CT-CTA alone. Although ongoing research and clinical trials is needed to define more precisely how these techniques can best be exploited to improve clinical care and patient outcomes, in the acute stroke and subarachnoid hemorrhage populations the radiation risk associated with CT perfusion imaging is negligible and the physiologic information promises significant patient safety benefits.
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Transtornos Cerebrovasculares/diagnóstico , Imageamento por Ressonância Magnética/métodos , Imagem de Perfusão/métodos , Tomografia Computadorizada por Raios X/métodos , Animais , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Transtornos Cerebrovasculares/metabolismo , Humanos , Imageamento por Ressonância Magnética/tendências , Imagem de Perfusão/tendências , Tomografia Computadorizada por Raios X/tendênciasRESUMO
OBJECTIVE: The purpose of this article is to evaluate the accuracy of preliminary on-call radiology resident interpretation of CT angiography (CTA) compared with digital subtraction angiography (DSA) in detecting cerebral aneurysms in subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: A retrospective review compared resident interpretations of head CTA performed after hours for SAH to the results of DSA. The sensitivity and specificity of resident interpretations were classified on a per-patient and per-aneurysm basis. The accuracy of resident interpretations was also determined according to aneurysm location and number. RESULTS: Between January 2007 and December 2009, 83 patients with SAH underwent both CTA and DSA. DSA documented an aneurysm in 53 of 83 patients. Per patient, residents identified at least one aneurysm in 46 of 53 patients (87%). Per aneurysm, resident sensitivity and specificity for detecting aneurysms of any size were 62% and 91%, respectively, which improved for aneurysms 3 mm or larger to 73% and 97%, respectively. The posterior communicating and intracranial internal carotid arteries were resident "blind spots," with aneurysms 3 mm or larger detected with sensitivities of 33% and 50%, respectively. In contrast, anterior communicating artery aneurysms were correctly identified 95% of the time. In only 35% of cases with multiple aneurysms did residents correctly identify more than one aneurysm. CONCLUSION: The sensitivity of on-call resident interpretation of CTA for aneurysms in SAH is lower than expected, with a potential for delay in diagnosis and management in a small number of patients. Focused training to carefully review apparent blind spots and the frequency of multiple aneurysms may reduce inaccuracies.
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Angiografia Cerebral , Competência Clínica , Internato e Residência , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Angiografia Digital , Meios de Contraste , Feminino , Humanos , Imageamento Tridimensional , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Ácidos Tri-IodobenzoicosRESUMO
INTRODUCTION: Advances in specialized medical areas and updated clinical guidelines show a need for a focused approach for patients with specific disorders. OBJECTIVE: To describe a multidisciplinary tumor board for patients with endocrine tumors. METHODS: We established an endocrine tumor board at a large health maintenance organization and studied cases presented between September 2007 and August 2017. To resolve diagnostic and/or therapeutic questions, a multidisciplinary team of specialists discussed patients' clinical presentations. Cases were broken down into diagnostic categories, demographic characteristics (age, sex), and need for repeated presentations to the board. RESULTS: We included 608 patients: 401 female (66%) and 207 male (34%). Ages ranged from teens to more than 90 years, with the peak decade 50 to 59 years (26%). Although most patients needed only 1 presentation to the board, 151 (25%) required representation, for a total of 853 presentations. The diagnoses reflected the workup status with tumor identification and localization at the initial case presentation. Diagnoses included thyroid cancer (234 patients, 38.4%), adrenal mass (165 patients, 27.1%), primary hyperparathyroidism (120 patients, 19.7%), thyroid nodule (95 patients, 15.6%), and extrathyroidal mass (23 patients, 3.8%). Other diagnoses composed the remaining 14.6%. Tumor board attendees overwhelmingly supported the meetings' benefits, with all clinicians reporting frequently changing patient management because of the meetings. CONCLUSION: Patients with endocrine tumors may benefit from a specialized approach to care. A multidisciplinary tumor board can focus discussions efficiently, provide a forum to advance care, apply endocrine-related clinical guidelines, and lead to recommendations that clinicians often employed.
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Comunicação Interdisciplinar , Neoplasias , Equipe de Assistência ao Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Adulto JovemRESUMO
OBJECTIVE: The purpose of this study was to evaluate the feasibility of performing CT-guided interventional procedures with a very low radiation dose. MATERIALS AND METHODS: We performed 291 CT-guided interventional procedures using a low dose of radiation. The subjects were 165 men and 126 women 22-89 years old with a mean age of 65 years. CT fluoroscopy was not used. The procedures were 201 percutaneous biopsies and 90 percutaneous aspiration or drainage procedures. Before the procedure, images were obtained with standard mAs of 175-250 mAs. All subsequent CT was performed at a reduced mAs. Technical success of catheter placement and biopsy was calculated, and the results were compared with those of procedures performed over the previous 12 months with standard radiation doses. Patient weight, lesion size, and number of CT acquisitions needed to complete the procedure were recorded. RESULTS: All but three aspiration or drainage procedures performed at 30 mAs were successful, for a success rate of 96.7%. The technical success rate of biopsy performed at 30 mAs was 93.5%. In the cases of 13 patients undergoing biopsy, the masses were not identified with low-dose technique, and these procedures were completed at a higher dose. Results were independent of patient weight and lesion size. The technical success rate was 98% for percutaneous drainage performed at a standard radiation dose in the 12 months before introduction of the low-dose technique. The technical success rate was 87.5% for biopsy performed at a standard radiation dose in the 12 months before introduction of the low-dose technique. The complication rate of the low-dose technique was comparable to that of the standard-dose technique. CONCLUSION: Low-dose radiation technique using 30 mAs results in technical success for both catheter placement and percutaneous biopsy comparable to standard radiation dose.
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Biópsia/métodos , Drenagem/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiometria , Estudos RetrospectivosRESUMO
OBJECTIVE: The purpose of this study was to show the value of 2D and 3D reformations of CT data from abdominal and pelvic CT performed immediately at the workstation using a PACS-based software program to evaluate the lumbar spine and pelvis in patients with blunt abdominal trauma. MATERIALS AND METHODS: We reviewed the abdominopelvic CT scans and conventional radiographs of the lumbar spine or pelvis of 156 consecutive patients with blunt abdominal trauma. The CT data were compared with the radiographic findings and also with the findings of dedicated repeat CT of the spine or pelvis, when performed. RESULTS: CT depicted 80 fractures of the lumbar spine and 178 pelvic fractures. Radiography showed 40 fractures of the lumbar spine and 138 pelvic fractures. No additional fractures were identified on dedicated repeat CT. CONCLUSION: Conventional radiographs to clear the lumbar spine are no longer required when abdominopelvic CT data are available. CT and reformatted CT data show more fractures than radiography and miss no fractures compared with dedicated CT of the lumbar spine or pelvis. Having these images immediately available through the PACS workstation saves time for the trauma team in the management of critically ill patients.