103 Exploring the influence of quantitative magnetic resonance imaging on decision-making in multiple sclerosis clinical practice

2018 ◽  
Vol 89 (6) ◽  
pp. A41.1-A41
Author(s):  
Heidi N Beadnall ◽  
Linda Ly ◽  
Chenyu Wang ◽  
Thibo Billiet ◽  
Annemie Ribbens ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Resonance Imaging ◽  
Quantitative Magnetic Resonance Imaging ◽  
Report Data

IntroductionQuantitative magnetic resonance imaging (MRI) analysis is currently used in multiple sclerosis (MS) clinical trials. Quantitative MRI (QMRI) data derived using formal analysis techniques is not used in routine MS clinical practice and its effect on clinical decision-making is unknown. The study objective is to explore the influence that QMRI data has on clinical decision-making in real-world MS patients.MethodsClinical MS brain MRI scans (separated by one-year minimum, acquired on the same scanner from the same patient) were evaluated. All patients were on the same disease-modifying therapy (DMT) six months prior to and during the study. QMRI analyses were performed on scan pairs by; imaging analysts using specialised software [semi-automated], and MSmetrix [fully-automated]. Data was presented in two separate reports; local QMRI (semi-automated) and centralised QMRI (MSmetrix). Questionnaires were completed by the same neurologist for each subject using clinical data and standard MRI and QMRI reports.Results31 relapsing-MS patients (77.4% female), with baseline age 42.14 [10.70] years, disease duration 7.68 [4.89] years and EDSS score 1.40 (1.36), were evaluated. Injectable, oral and infusion DMTs were administered in 29.0%, 61.3% and 9.7% of patients respectively. According to questionnaire responses, 83.9% were predicted to have stable disease over the next year based on clinical reports alone and 67.7% with the addition of QMRI report data. DMT change would be considered in 16.1% based on clinical reports and 32.3% with QMRI report inclusion. Earlier clinical ±MRI follow up was considered in 51.6% (MRI only 41.9%;both 9.7%) when QMRI reports were reviewed.ConclusionThis preliminary retrospective study indicates that QMRI report data has the potential to influence clinical decision-making in relapsing-MS patients on DMT regarding disease stability assessment, therapy change contemplation, and consideration of earlier follow-up. This work supports a role for formal QMRI analysis and reporting as a clinical-decision support system in MS.

Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

2021 ◽  
pp. 136345932199674
Author(s):  
Rikke Torenholt ◽  
Henriette Langstrup
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Patient Reported ◽  
Pro Tools

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

Magnetic resonance imaging, knee arthroscopy, and clinical decision making: A descriptive study of five surgeons

2009 ◽  
Vol 25 (4) ◽  
pp. 577-583 ◽  
Author(s):  
Sarah Derrett ◽  
Gayle D. Walley ◽  
Stephen A. Bridgman ◽  
Paula Richards ◽  
Nicola Maffulli
Keyword(s):  
Magnetic Resonance Imaging ◽  
Decision Making ◽  
Magnetic Resonance ◽  
Clinical Decision Making ◽  
Knee Arthroscopy ◽  
Controlled Trial ◽  
Clinical Decision ◽  
Patient Choice ◽  
Resonance Imaging ◽  
Orthopedic Surgeons

Objectives: A randomized controlled trial (RCT) showed magnetic resonance imaging for patients waiting for knee arthroscopy did not reduce the number of arthroscopies. Our study aimed to identify decisions made by orthopedic surgeons about whether patients on a waiting list should proceed to arthroscopy, and to describe surgeons’ decisions.Methods: Five surgeons were asked to Think Aloud (TA) as they made their decisions for twelve patients from the original RCT. Audiotapes of the decision making were transcribed for analysis.Results: For five patients, surgeons agreed about proceeding with arthroscopy, although reasoning differed. In no cases did surgeons agree about not proceeding to arthroscopy. Agreement was more likely in patients with clinically diagnosed meniscal abnormality, and less likely in patients with osteoarthritis.Conclusions: Surgeons’ decisions were influenced by patient wishes. For some patients, the decision to proceed with arthroscopy was based solely on clinical diagnosis; MRI may not be advantageous in these instances. Surgeons disagreed more often than they agreed about the decision to proceed with arthroscopy, particularly when OA was diagnosed. This has implications for decision making in the current NHS patient choice environment. Patients may choose a treatment provider from a list of available providers at time of original clinical assessment and diagnosis. The treating surgeon does not necessarily re-examine the patient until the day of surgery. Given the variation between surgeons about the merits of proceeding with arthroscopy, surgeons may end up in the invidious position of providing surgery to patients whom they do not believe will benefit from arthroscopy.

The effect of shoulder magnetic resonance imaging on clinical decision making

1998 ◽  
Vol 7 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Jerry S. Sher ◽  
Joseph P. Iannotti ◽  
Gerald R. Williams ◽  
Richard J. Herzog ◽  
J.Bruce Kneeland ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Decision Making ◽  
Magnetic Resonance ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Resonance Imaging

scholarly journals Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making

2015 ◽  
Vol 48 (4) ◽  
pp. 249-259 ◽  
Author(s):  
Daian Miranda Ferreira ◽  
Régis Otaviano França Bezerra ◽  
Cinthia Denise Ortega ◽  
Roberto Blasbalg ◽  
Públio César Cavalcante Viana ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Decision Making ◽  
Magnetic Resonance ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Resonance Imaging ◽  
Contrast Resolution ◽  
Gynecological Diseases ◽  
The Many

Abstract Magnetic resonance imaging is a method with high contrast resolution widely used in the assessment of pelvic gynecological diseases. However, the potential of such method to diagnose vaginal lesions is still underestimated, probably due to the scarce literature approaching the theme, the poor familiarity of radiologists with vaginal diseases, some of them relatively rare, and to the many peculiarities involved in the assessment of the vagina. Thus, the authors illustrate the role of magnetic resonance imaging in the evaluation of vaginal diseases and the main relevant findings to be considered in the clinical decision making process.

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