scholarly journals Utility and costs of radiologist interpretation of perioperative imaging in patients with traumatic single-level thoracolumbar fractures

2017 ◽  
Vol 27 (5) ◽  
pp. 578-583 ◽  
Author(s):  
Michael H. Weber ◽  
Lojan Sivakumaran ◽  
Maryse Fortin ◽  
Alisson R. Teles ◽  
Jeff D. Golan ◽  
...  
Keyword(s):  
Incidental Findings ◽  
Health Centre ◽  
Image Interpretation ◽  
Ct Scans ◽  
Thoracolumbar Fractures ◽  
Potential Cost ◽  
Single Level ◽  
Radiology Reports ◽  
The Cost ◽  
The Impact

OBJECTIVEThe cost of spine management is rising. As diagnostic imaging accounts for approximately 10% of total patient care spending, there is interest in determining if economies could be made with regard to the routine consultation of radiology for image interpretation. In the context of spine trauma, both the spine surgeon and the radiologist interpret perioperative imaging. Authors of the present study investigated the impact of radiologist interpretation of perioperative imaging from patients with traumatic single-level thoracolumbar fractures given that spine surgeons are expected to be comfortable interpreting pathologies of the musculoskeletal system.METHODSThe authors conducted a retrospective review of all patients presenting with a single-level thoracolumbar fracture treated at the McGill University Health Centre in the period from January 2003 to December 2010. The time between image capture and radiologist interpretation as well as the number of extraskeletal and/or incidental findings was extracted from the radiology reports on all perioperative images including radiographic, fluoroscopic, and CT images. The cost of interpretation was obtained from the provincial health insurance entity of Quebec.RESULTSEighty-two patients met the study inclusion criteria. Radiologists took a median of 1 day (IQR 0–5.5 days) to interpret preoperative radiographs. Intraoperative fluoroscopic images and postoperative radiographs were read by the radiologist a median of 19 days (IQR 4–56.75 days) and 34 days (IQR 1–137.5 days) after capture, respectively (p < 0.05). Preoperative radiologist dictations reported extraskeletal and/or incidental findings for 8.1% of radiographs; there were no intraoperative or postoperative extraskeletal findings beyond those previously reported on the preoperative radiographs. Radiologists took a median of 1 day (IQR 0–1 day) to read both preoperative and postoperative CT scans; extraskeletal and/or incidental findings were present in 46.2% of preoperative reports and 4.5% of postoperative reports. There were no intraoperative or postoperative radiological findings that provoked reoperation. A total of 66 intraoperative fluoroscopy images and 225 postoperative radiographs were read for a cost of $1399.20 and $1867.50 (Canadian dollars), respectively, for radiologist interpretation. This cost amounted to 40.3% of all perioperative image interpretation spending.CONCLUSIONSIn the management of single-level thoracolumbar fractures, radiologists add information to the diagnostic picture when interpreting preoperative radiographs and perioperative CT scans; however, the interpretation of intraoperative fluoroscopic images and postoperative radiographs comes with significant delay, does not add additional information, and represents an area of potential cost and professional-resource reduction.

scholarly journals Preliminary model assessing the cost-effectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254698
Author(s):  
Mwayi Kachapila ◽  
Adesoji O. Ademuyiwa ◽  
Bruce M. Biccard ◽  
Dhruva N. Ghosh ◽  
James Glasbey ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cost Effectiveness ◽  
Abdominal Surgery ◽  
Postoperative Pneumonia ◽  
Decision Analytic Model ◽  
Complication Rates ◽  
Parameter Uncertainties ◽  
Potential Cost ◽  
The Cost ◽  
The Impact

Background Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients. Methods A decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves. Results In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds. Conclusions Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an urgent need for a robust clinical trial on the intervention on non-cardiac surgery.

Quality and value of subspecialty reinterpretation of outside thoracic CT scans of patients referred to a tertiary cancer center.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 265-265
Author(s):  
Brett W. Carter ◽  
Jeremy J. Erasmus ◽  
Mylene Truong ◽  
Reginald F. Munden ◽  
Jo-Anne O. Shepard ◽  
...  
Keyword(s):  
Poor Quality ◽  
Chest Ct ◽  
Ct Scans ◽  
Cancer Center ◽  
Management Change ◽  
Nccn Guidelines ◽  
Radiology Reports ◽  
The Impact ◽  
Tertiary Cancer Center

265 Background: At tertiary cancer centers, physicians frequently request reinterpretation of imaging studies performed at outside institutions. The purposes of this study were to determine the quality of outside computed tomography (CT) scans of the chest and compare the accuracy of accompanying radiology reports from outside institutions and our multidisciplinary cancer center. Methods: Two thoracic radiologists graded the quality of 59 outside chest CT scans and generated independent reports for 52 of the scans. A third thoracic radiologist scored the outside reports and reinterpretations for quality. Fisher’s exact tests were used to compare the frequency with which crucial items appeared in outside reports and reinterpretations. Next, two outside thoracic radiologists identified discrepancies between outside reports and reinterpretations (first radiologist) and determined whether the outside report or reinterpretation was more accurate in each case (second radiologist). Finally, the impact of discrepancies on management was evaluated, largely based on NCCN guidelines. Results: Of the 59 outside CT scans, 35 (59%) were of poor quality. Reinterpretations were more likely than outside reports to include information about lymph nodes, adrenal and liver metastasis, tumor nodules, and tumor texture. In 19 of 52 cases (37%), discrepancies were identified between outside reports and reinterpretations. In 17 of these cases, the reinterpretation was superior; in 2 cases, the reinterpretation and outside report were of equal quality. Among these 17 cases, reinterpretation allowed staging in nine cases that could not be staged with information from the outside reports; resulted in upstaging without management change in one case and upstaging with management change in four cases among the five cases with staging information present in both sets of reports; and revealed a significant omission (2 cases) or error (1 case) that changed management in three cases. In total, reinterpretation resulted in significant changes to 16 of 52 (31%) of CT scans. Conclusions: Subspecialty reinterpretation of chest CT scans can substantially improve clinical management.

scholarly journals Deep-learning algorithms for the interpretation of chest radiographs to aid in the triage of COVID-19 patients: A multicenter retrospective study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242759
Author(s):  
Se Bum Jang ◽  
Suk Hee Lee ◽  
Dong Eun Lee ◽  
Sin-Youl Park ◽  
Jong Kun Kim ◽  
...  
Keyword(s):  
Deep Learning ◽  
Retrospective Study ◽  
Image Interpretation ◽  
Area Under The Curve ◽  
Ground Glass Opacity ◽  
Community Treatment ◽  
Ct Scans ◽  
Treatment Center ◽  
Automatic Interpretation ◽  
Radiology Reports

The recent medical applications of deep-learning (DL) algorithms have demonstrated their clinical efficacy in improving speed and accuracy of image interpretation. If the DL algorithm achieves a performance equivalent to that achieved by physicians in chest radiography (CR) diagnoses with Coronavirus disease 2019 (COVID-19) pneumonia, the automatic interpretation of the CR with DL algorithms can significantly reduce the burden on clinicians and radiologists in sudden surges of suspected COVID-19 patients. The aim of this study was to evaluate the efficacy of the DL algorithm for detecting COVID-19 pneumonia on CR compared with formal radiology reports. This is a retrospective study of adult patients that were diagnosed as positive COVID-19 cases based on the reverse transcription polymerase chain reaction among all the patients who were admitted to five emergency departments and one community treatment center in Korea from February 18, 2020 to May 1, 2020. The CR images were evaluated with a publicly available DL algorithm. For reference, CR images without chest computed tomography (CT) scans classified as positive for COVID-19 pneumonia were used given that the radiologist identified ground-glass opacity, consolidation, or other infiltration in retrospectively reviewed CR images. Patients with evidence of pneumonia on chest CT scans were also classified as COVID-19 pneumonia positive outcomes. The overall sensitivity and specificity of the DL algorithm for detecting COVID-19 pneumonia on CR were 95.6%, and 88.7%, respectively. The area under the curve value of the DL algorithm for the detection of COVID-19 with pneumonia was 0.921. The DL algorithm demonstrated a satisfactory diagnostic performance comparable with that of formal radiology reports in the CR-based diagnosis of pneumonia in COVID-19 patients. The DL algorithm may offer fast and reliable examinations that can facilitate patient screening and isolation decisions, which can reduce the medical staff workload during COVID-19 pandemic situations.

A Cost-Benefit Analysis of Reducing Surgical Site Infections

2018 ◽  
Vol 84 (2) ◽  
pp. 254-261
Author(s):  
Alexander Rosemurgy ◽  
Jacqueline Whitaker ◽  
Kenneth Luberice ◽  
Christian Rodriguez ◽  
Darrell Downs ◽  
...  
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Surgical Site Infections ◽  
Potential Cost ◽  
Pancreatic Resections ◽  
Before And After ◽  
Abdominal Operations ◽  
The Cost ◽  
The Impact

Surgical Site Infections (SSI) represent an onerous burden on our health-care system. This study was undertaken to determine the impact of a protocol aimed at reducing SSIs on the frequency and cost of SSIs after abdominal surgery. Beginning in 2013, 811 patients undergoing gastrointestinal operations were prospectively followed. In 2014, we initiated a protocol to reduce SSIs. SSIs were monitored before and after protocol implementation, and differences in SSI incidence and associated costs were determined. Before protocol initiation, standardized operative preparation cost was $40.85 to $126.94 per patient depending on the results of methicillin-resistant Staphylococcus aureus screen; after protocol initiation, the cost was $43.85 per patient, saving up to $83.09 per patient. With the protocol in place, SSI rate was reduced from 4.9 to 3.4 per cent (13 of 379) representing a potential prevention of eight infections that would have cost payers $166,280 ($20,785 per infection). Notably, the SSI rate after pancreatectomy was reduced by 63 per cent ( P = 0.04). With preparation and diligence, SSI rate can be meaningfully reduced and potential cost savings can be achieved. In particular, SSI rate reduction for major abdominal operations and especially pancreatic resections can be achieved. A protocol to reduce SSI is a “win-win” for all stakeholders and should be encouraged with thoughtful and active participation from all hospital disciplines.

scholarly journals An Economic Evaluation of the Impact of Using Rapport-Based Interviewing Approaches With Child Sexual Abuse Suspects

2021 ◽  
Vol 12 ◽  
Author(s):  
Susan Giles ◽  
Laurence Alison ◽  
Paul Christiansen ◽  
Michael Humann ◽  
Emily Alison ◽  
...  
Keyword(s):  
Sexual Abuse ◽  
Child Sexual Abuse ◽  
Motivational Interviewing ◽  
Cost Savings ◽  
Potential Cost ◽  
Unit Costs ◽  
Lifetime Costs ◽  
The Cost ◽  
Interviewing Technique ◽  
The Impact

Two studies examined whether rapport-based interviewing with child sexual abuse (CSA) suspects provides greater interview yield that could result in overall cost-savings to the investigation. First, multi-level modelling was applied to 35 naturalistic CSA suspect interviews to establish whether rapport-based interviewing techniques increase “yield” – defined as information of investigative value. The Observing Rapport Based Interviewing Technique (ORBIT coding manual was used to code interviews; it includes an assessment of both interpersonal adaptive and maladaptive rapport-based interviewer engagement as well as motivational interviewing (MI) strategies. The impact of these two strands (interpersonal and MI) on extracting information of investigative value (including strengthening a case for court and safeguarding) were examined. Adaptive interpersonal strategies increased case strengthening and safeguarding yield, with motivational interviewing having the largest impact on safeguarding yield. Both strategies increase the likelihood of gaining additional types of economic yield. Maladaptive interviewer strategies reduced case strengthening and different types of economic yield. In study two, literature-based economic estimates were applied to establish the potential cost benefits from following national ORBIT rapport training. Further training in adaptive and motivational interviewing could contribute cost savings between £19 and £78 million (annual unit costs) increasing to £238–£972 million (lifetime costs) for online CSA across England and Wales; and £157–£639 million (annual unit costs) increasing to £2–£8 billion (lifetime costs) for all CSA. Failure to commit training resource to this, or an alternative strategy, could mean the cost burden attributable to maladaptive interviewing (between £1 and £6 million for online CSA and £12 and £48 million for all CSA) is not successfully averted.

scholarly journals Redesign of an upwind rotor for a downwind configuration: design changes and cost evaluation

2021 ◽  
Vol 6 (1) ◽  
pp. 203-220
Author(s):  
Gesine Wanke ◽  
Leonardo Bergami ◽  
Frederik Zahle ◽  
David Robert Verelst
Keyword(s):  
Cost Model ◽  
Cost Savings ◽  
Rotor Blades ◽  
Cost Evaluation ◽  
Potential Cost ◽  
Pure Material ◽  
Cost Of Energy ◽  
Design Changes ◽  
The Cost ◽  
The Impact

Abstract. Within this work, an existing model of a Suzlon S111 2.1 MW turbine is used to estimate potential cost savings when the conventional upwind rotor concept is changed into a downwind rotor concept. A design framework is used to get realistic design updates for the upwind configuration, as well as two design updates for the downwind configuration, including a pure material cost out of the rotor blades and a new planform design. A full design load basis according to the standard has been used to evaluate the impact of the redesigns on the loads. A detailed cost model with load scaling is used to estimate the impact of the design changes on the turbine costs and the cost of energy. It is shown that generally lower blade mass of up to 5 % less than the upwind redesign can be achieved with the downwind configurations. Compared to an upwind baseline, the upwind redesign shows an estimated cost of energy reduction of 2.3 %, and the downwind designs achieve a maximum reduction of 1.3 %.

Applications of Artificial Intelligence in Musculoskeletal Imaging: From the Request to the Report

2020 ◽  
pp. 084653712094714
Author(s):  
Natalia Gorelik ◽  
Soterios Gyftopoulos
Keyword(s):  
Artificial Intelligence ◽  
Value Chain ◽  
Image Interpretation ◽  
Bone Age ◽  
Acquisition Time ◽  
Clinical Implementation ◽  
Musculoskeletal Radiology ◽  
Radiology Reports ◽  
Spine Pathology ◽  
The Impact

Artificial intelligence (AI) will transform every step in the imaging value chain, including interpretive and noninterpretive components. Radiologists should familiarize themselves with AI developments to become leaders in their clinical implementation. This article explores the impact of AI through the entire imaging cycle of musculoskeletal radiology, from the placement of the requisition to the generation of the report, with an added Canadian perspective. Noninterpretive tasks which may be assisted by AI include the ordering of appropriate imaging tests, automatic exam protocoling, optimized scheduling, shorter magnetic resonance imaging acquisition time, computed tomography imaging with reduced artifact and radiation dose, and new methods of generation and utilization of radiology reports. Applications of AI for image interpretation consist of the determination of bone age, body composition measurements, screening for osteoporosis, identification of fractures, evaluation of segmental spine pathology, detection and temporal monitoring of osseous metastases, diagnosis of primary bone and soft tissue tumors, and grading of osteoarthritis.

Assessing the Impact of Incidental Findings in a Lung Cancer Screening Study by Using Low-dose Computed Tomography

2011 ◽  
Vol 62 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Michael J. Kucharczyk ◽  
Ravi J. Menezes ◽  
Alexander McGregor ◽  
Narinder S. Paul ◽  
Heidi C. Roberts
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Incidental Findings ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
High Risk Population ◽  
Radiology Reports ◽  
Screening Study ◽  
The Impact

Purpose To assess the prevalence and nature of incidental findings (IF) seen in low-dose computed tomographies (LDCT) from a lung cancer screening study for at-risk individuals. Materials and Methods Radiology reports from LDCTs of 4073 participants of a lung cancer screening study were retrospectively reviewed for findings other than lung nodules, that is, IFs, which were regarded as actionable. The frequency, nature, and expected cost of these IFs, and their anticipated follow-up were estimated. Results There were 880 IFs described in 782 study participants (19%); the median age of the participants was 62 years (range, 46–80 years). More IFs were found in men (55%) than in women. The majority of these findings were noncardiovascular (76%), for which imaging was suggested for 74%. There were 7 severe IFs (0.8%) that merited immediate attention. Seven known cancers were diagnosed from follow-ups of the IFs. The majority of IFs ( n = 486 [55%]) would require imaging follow-up if clinically indicated, with an estimated total a cost of CAN$45,500 to CAN$51,000 to provide initial diagnostic workup. Conclusion IFs on lung cancer screening studies are not uncommon and frequently require imaging or other follow-up for definitive diagnoses and to assess their clinical relevance. The implication of IFs has to be considered when determining a cost-effective and ethical protocol for the utilisation of LDCT in a high-risk population.

Incidental Findings on Computed Tomography Scans for Acute Appendicitis: Prevalence, Costs, and Outcome

2011 ◽  
Vol 77 (11) ◽  
pp. 1502-1509 ◽  
Author(s):  
Junko Ozao-Choy ◽  
Unsup Kim ◽  
Ulrich Vieux ◽  
Tehillah S. Menes
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Incidental Findings ◽  
Incidental Finding ◽  
High Rate ◽  
Ct Scans ◽  
Computed Tomography Scans ◽  
The Cost ◽  
Hospital Center

CT scan is increasingly being used to diagnose appendicitis due to its specificity and literature suggesting its cost-effectiveness. CT scans are associated with incidental findings. We sought to investigate the rates of incidental findings identified on CT scans, the follow-up of these findings, and the added cost associated with this follow-up. A retrospective review of patients who underwent appendectomies for acute appendicitis between 2003 and 2005 was completed at Elmhurst Hospital Center (Elmhurst, NY). Incidental findings were grouped into low and high significance, based on workup or follow-up needed. The diagnostic workup and cost of each incidental finding was ascertained. For patients who did not receive a workup due to lack of follow-up, an estimate of the minimum workup was calculated. Of 1142 patients with acute appendicitis, 876 (77%) had a CT scan. This rate increased over time (from 66% in 2003 to 85% in 2005, P < 0.01) and with age (70% in patients under 20 and 98% in patients over 50, P < 0.001). Incidental findings were common and increased with age (23% in the youngest group vs 78% in patients older than 50, P < 0.001). The cost associated with workup of these incidental findings increased with age as well. The increased use of CT scans is associated with a high rate of incidental findings. These findings are usually of low clinical significance but may require further workup and follow-up. Physicians need to be aware of the high rate of incidental findings, the need for further workup, and the associated costs.

scholarly journals Re-design of an upwind rotor for a downwind configuration: design changes and cost evaluation

2020 ◽  
Author(s):  
Gesine Wanke ◽  
Leonardo Bergami ◽  
Frederik Zahle ◽  
David Robert Verelst
Keyword(s):  
Cost Model ◽  
Cost Savings ◽  
Rotor Blades ◽  
Cost Evaluation ◽  
Potential Cost ◽  
Pure Material ◽  
Cost Of Energy ◽  
Design Changes ◽  
The Cost ◽  
The Impact

Abstract. Within this work, an existing model of a Suzlon S111 2.1 MW turbine is used to estimate potential cost savings when the conventional upwind rotor concept is changed into a downwind rotor concept. A design framework is used to get realistic design updates for the upwind configuration as well as two design updates for the downwind configuration, including a pure material cost-out on the rotor blades and a new planform design. A full design load basis according to the standard has been used to evaluate the impact of the redesigns on the loads. A detailed cost model with load scaling is used to estimate the impact of the design changes on the turbine costs and the cost of energy. It is shown that generally lower blade mass can be achieved with the downwind configurations of up to 5 % less than the upwind redesign. Compared to an upwind baseline, the upwind redesign shows an estimated cost of energy reduction of 2.3 % where the downwind designs achieve a maximum reduction of 1.3 %.

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