Evaluation of radiological contribution to patient management: the orthopedist's point of view

Background Orthopedists prefer imaging studies for the diagnosis, treatment, and follow-up of patients. Purpose To determine the effect of orthopedists’ characteristics, including subspecialty, age, education, and professional experience, in collaboration with radiologists and the usefulness of radiology reports for orthopedists in diagnosis and patient management. Material and Methods Questionnaires, consisting of 21 questions investigating the orthopedists’ characteristics, their behavior with radiology reports, their thoughts on communication, and collaboration with radiologists, were distributed to 205 orthopedists. Descriptive analysis was performed, and the effects of orthopedist characteristics on the outcomes was evaluated. Results In total, 161 out of 205 enrolled participants were included in the analysis. A total of 156 (96.9%) participants stated that they reviewed at least one official radiology report, with MRI receiving the highest rate (92.4%). The main reason provided for not reviewing the radiology reports and requests regarding changes to radiology report formats seemed to be mostly related to time pressure. Despite a significant portion of the participants stating that clinical and surgical findings were inconsistent with radiology reports, less than half were inclined to contact the radiologist most of the time or always. Increasing age ( P = 0.005), experience ( P = 0.016), and university hospital specialization ( P = 0.007) increased the tendency to form multidisciplinary team meetings. Communication with radiologists increased with age ( P < 0.001), while more experience reduced the impact of radiology reports on decision-making ( P = 0.035). Conclusion Increasing cooperation between orthopedists and radiologists will make a significant contribution to decision-making and treatment processes. Orthopedists’ characteristics are influential factors in establishing this communication.

Deep learning algorithm in detecting intracranial hemorrhages on emergency computed tomographies

Background Highly accurate detection of intracranial hemorrhages (ICH) on head computed tomography (HCT) scans can prove challenging at high-volume centers. This study aimed to determine the number of additional ICHs detected by an artificial intelligence (AI) algorithm and to evaluate reasons for erroneous results at a level I trauma center with teleradiology services. Methods In a retrospective multi-center cohort study, consecutive emergency non-contrast HCT scans were analyzed by a commercially available ICH detection software (AIDOC, Tel Aviv, Israel). Discrepancies between AI analysis and initial radiology report (RR) were reviewed by a blinded neuroradiologist to determine the number of additional ICHs detected and evaluate reasons leading to errors. Results 4946 HCT (05/2020-09/2020) from 18 hospitals were included in the analysis. 205 reports (4.1%) were classified as hemorrhages by both radiology report and AI. Out of a total of 162 (3.3%) discrepant reports, 62 were confirmed as hemorrhages by the reference neuroradiologist. 33 ICHs were identified exclusively via RRs. The AI algorithm detected an additional 29 instances of ICH, missed 12.4% of ICH and overcalled 1.9%; RRs missed 10.9% of ICHs and overcalled 0.2%. Many of the ICHs missed by the AI algorithm were located in the subarachnoid space (42.4%) and under the calvaria (48.5%). 85% of ICHs missed by RRs occurred outside of regular working-hours. Calcifications (39.3%), beam-hardening artifacts (18%), tumors (15.7%), and blood vessels (7.9%) were the most common reasons for AI overcalls. ICH size, image quality, and primary examiner experience were not found to be significantly associated with likelihood of incorrect AI results. Conclusion Complementing human expertise with AI resulted in a 12.2% increase in ICH detection. The AI algorithm overcalled 1.9% HCT. Trial registration German Clinical Trials Register (DRKS-ID: DRKS00023593).

Don’t blink: inattentional blindness in radiology report interpretation

Objectives: Medical errors attributable to inattentional blindness (IAB) may contribute to adverse patient outcomes. IAB has not been studied in the context of reviewing written radiological reports. This cross-sectional, deception-controlled study measures IAB of physicians towards an unexpected stimulus while interpreting written radiological reports. Methods: Physicians and residents from multiple fields were asked to interpret four radiology text reports. Embedded in one was an unexpected stimulus (either an abnormally placed medical exam finding or a non-medical quote from the popular television show Doctor Who). Primary outcomes were differences in detection rates for the two stimuli. Secondary outcomes were differences in detection rates based on level of training and specialty. Results: The unexpected stimulus was detected by 47.8% (n = 43) of participants; the non-medical stimulus was detected more often than the medical stimulus (75.0% vs 21.7%, OR 10.8, 95% CI 4.1–28.7; p < 0.0001,). No differences in outcomes were observed between training levels or specialties. Conclusion: Only a minority of physicians successfully detected an unexpected stimulus while interpreting written radiological reports. They were more likely to detect an abnormal non-medical stimulus than a medical stimulus. Findings were independent of the level of training or field of medical practice. Advances in knowledge: This study is the first to show that IAB is indeed present among internal medicine, family medicine, and emergency medicine providers when interpreting written radiology reports.

The rule of two in Radiology: An Update

There are 10 rules used in medicine/radiology that taught to students so they can remember certain points that they have to do to have an accurate diagnosis. These rules are:- 1- Two views: One view is too few; 2- Two joints: Above and below the injured bone; 3- Two sides: Compare with the other normal side; 4- Two abnormalities:Find a second abnormality; 5- Two occasions: Compare the current x-ray with a previous one (especially in CXR); 6- Two visits: Repeat after an interval or a procedure; 7- Two opinions: Ask for a second opinion or use the red dot system; 8- Two records: Write down the radiographic and clinical finings; 9- Two specialists: Get a radiology report; 10- Two examinations: Ask for CT, MRI, US, NM, etc.

EP.FRI.376 Early Routine CT Scans for All Surgical Admissions for Abdominal Pain May Improve Patient Outcomes

Aim Acute abdominal pain remains a diagnostic challenge in the Emergency Department (ED) as pathologies can involve various surgical craft groups. Computed tomography (CT) enables accurate diagnosis of abdominal pathologies. However, with pressures on ED such as the “4 hour rule” established by the Australian NSW Health Emergency Performance Plan, there may be resistance or omission of early CT in ED. We hypothesise that early, routine CT in adult patients presenting with acute abdominal pain requiring hospital admission improves patient outcomes by increasing diagnostic and referral accuracy. This study compares the proportion of correct ED diagnosis of abdominal pain presentations with and without formal imaging reports. Methods Data from 118 patients presenting with abdominal pain are collected prospectively in a regional hospital and analysed. Patient demographics, imaging results, initial ED diagnosis and final discharge diagnosis are further examined. Results Out of the 118 patients who had abdominal pain, 32 patients obtained complete imaging with a radiology report whilst 86 patients either did not have any imaging performed or was referred to a general surgical unit prior to obtaining a formal report. Among the patients who had imaging reported, 78% (n = 25/32) had the correct diagnosis, whilst those without a radiology report had a 52% (n = 45/86) diagnostic accuracy. This demonstrates an improved accuracy of diagnosis or reduced error rate of 26% when a scan report is available (p = 0.01). Conclusion Early, routine CT with formal reporting significantly reduces diagnostic error rates and increases accurate referral. This allows accurate diagnosis and improves patient outcomes.

PICTORIAL REVIEW OF INCIDENTAL FINDINGS ON BRAIN IMAGING- LEAVE THEM ALONE, REFER OR FOLLOW

The increasing availability of cross-sectional imaging, incredibly magnetic resonance imaging, detects ndings in the patient's scan unrelated to the reason the scan is initially acquired. These ndings refer to the so-called incidental ndings mentioned in the radiology report as "Note made of" without any good impression about their clinical signicance or further management. This type of report leads to anxiety among patients. The radiologist is the rst person to encounter these incidental ndings. Therefore, it is an essential duty of the radiologist to communicate to the clinician about the signicance and urgency/non-urgency of these ndings so that clinicians can decide timely appropriate management. Therefore, this review discusses the prevalence and spectrum of these incidental ndings and the available guidelines for their management.