Using Simulation Optimization to Solve Patient Appointment Scheduling and Examination Room Assignment Problems for Patients Undergoing Ultrasound Examination

This study investigates patient appointment scheduling and examination room assignment problems involving patients who undergo ultrasound examination with considerations of multiple examination rooms, multiple types of patients, multiple body parts to be examined, and special restrictions. Following are the recommended time intervals based on the findings of three scenarios in this study: In Scenario 1, the time interval recommended for patients’ arrival at the radiology department on the day of the examination is 18 min. In Scenario 2, it is best to assign patients to examination rooms based on weighted cumulative examination points. In Scenario 3, we recommend that three outpatients come to the radiology department every 18 min to undergo ultrasound examinations; the number of inpatients and emergency patients arriving for ultrasound examination is consistent with the original time interval distribution. Simulation optimization may provide solutions to the problems of appointment scheduling and examination room assignment problems to balance the workload of radiological technologists, maintain high equipment utilization rates, and reduce waiting times for patients undergoing ultrasound examination.

Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center

Purpose We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. Methods This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. Results The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). Conclusion Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.

Gender-Inclusive Fellowship Naming and Equity, Diversity, and Inclusion in Radiology: An Analysis of Radiology Department Websites in Canada and the United States

Purpose: Transgender and gender non-binary (TGNB) individuals face numerous inequalities in healthcare and there is substantial work to be done in fostering TGNB culturally competent care in radiology. A radiology department’s online presence and use of gender-inclusive language are essential in promoting an environment of equity, diversity, and inclusion (EDI). The naming of radiology fellowships and continuing medical education (CME) courses with terminology such as “Women’s Imaging” indicates a lack of inclusivity to TGNB patients and providers, which could result in suboptimal patient care. Methods: We conducted a cross-sectional analysis of all institutions in Canada and the United States (US) offering training in Breast Imaging, Women’s Imaging, or Breast and Body Imaging. Data was collected from each institution’s radiology department website pertaining to fellowship names, EDI involvement, and CME courses. Results: 8 Canadian and 71 US radiology fellowships were identified. 75% of Canadian and 90% of US fellowships had gender-inclusive names. One (12.5%) Canadian and 29 (41%) US institutions had EDI Committees mentioned on their websites. Among institutions publicly displaying CME courses about breast/body or women’s imaging, gender-inclusive names were used in only 1 (25%) of the Canadian CME courses, compared to 81% of the US institutions. Conclusions: Most institutions in Canada and the US have gender-inclusive names for their radiology fellowships pertaining to breast and body imaging. However, there is much opportunity to and arguably the responsibility for institutions in both countries to increase the impact and visibility of their EDI efforts through creation of department-specific committees and CME courses.

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

Background Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications. Results Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications. Conclusion Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

Acceptance of artificial intelligence (AI) and machine learning (ML) among radiologists in Saudi Arabia

Artificial intelligence (AI) and machine learning (ML), in the new age of technological progress, provide huge benefits to every area of employment, ranging from IT to health care. To assess the knowledge of, attitude towards, and in-practice use of artificial intelligence and machine learning among radiology residents and faculty radiologists. A web-based questionnaire was distributed via Google Drive to 55 radiologists in the central region of the Kingdom of Saudi Arabia. The questionnaire comprised two sections: three questions regarding demographics and three questions regarding the knowledge, attitudes, and practices (KAP) of AI and ML in radiology. A total of 55 respondents (100%) completed the survey. The majority of respondents claimed familiarity with AI and ML (61.8%). Most radiologists (54.5%) expressed mixed feelings regarding the benefits of AI and ML applications in radiology. Regarding usability, a mixed response was received: 49.1% supported its usability and 45.5% were uncertain of the usability of AI and ML in radiology. Several studies have been conducted which have suggested the usability of AI and ML and their incorporation into the radiology department. The majority of radiologists in Saudi Arabia support the use of AI and ML. Further investigation into the usability of these tools is needed.

Quality improvement project to improve patient outcomes by reducing door to CT and door to needle time and increasing appropriate referrals for endovascular thrombectomy.

This paper describes a stroke quality improvement (QI) project in a primary stroke centre in a 431-bed hospital serving a local population of 114 000 people. Approximately 170 acute strokes are treated each year in a seven-bed stroke unit managed by three geriatricians with a subspecialty interest in stroke. 24-hour CT radiology service is available. Endovascular thrombectomy (EVT) is performed by neuro-interventional radiology at one of two comprehensive stroke centres located 90–120 min away.In 2018, as part of a national collaborative QI initiative a new national thrombectomy referral pathway was introduced with an aim that all eligible patients be referred for EVT. This initiative included maximising timely access to CT and thrombolysis. Review of local data highlighted significant deficits in these areas.A local QI team convened and a multidisciplinary approach was employed to map the existing process for CT access and time to thrombolysis decision.We describe how focused timesaving interventions such as; new emergency and radiology department ‘pre-alerts’, dedicated acute stroke pagers, new ‘FAST’ registration by clerical staff, new CT ordering codes and new ‘FAST packs’ (including tissue plasminogen activator, paper National Institute of Health Stroke Scale scoring tools, consent forms and EVT patient selection tools) were created and incorporated into a multidisciplinary detailed clinical stroke care pathway.We describe how we achieved our SMART aims; to reduce our door to CT time and to reduce our door to needle time to the national target of less than 30 min. A third aim was to increase the number of patients referred for EVT from our centre.This project is an accurate description of how a multidisciplinary approach combined with teamwork and effective communication can create sustainable improved patient care and is generalisable to all institutions that require timely referral to external centres for EVT.

Canalis sinuosus approximation on an impacted maxillary canine: a case report

Objectives: This case report is aimed to report the finding of canalis sinuosus on an impacted maxillary canine using cone beam computed tomography (CBCT) examination. Case Report: A 21-year-old male was referred from orthodontic department to radiology department UNPAD Dental Hospital for CBCT to determine the treatment of malalignment asymptomatic maxillary canine. The case revealed the presence of canalis that was identified as a canalis sinuosus, a branch of the anterior superior alveolar nerve that rarely known by a practitioner, at the apex of impacted right maxillary canine. Conclusion: The information of this anatomical variation is important for professionals due to damage that may be caused during treatment. The use of advanced imaging examination is recommended to acknowledge the individual anatomical variation before determining the proper treatment planning.

Ocular ultrasonography for detection of posterior segment pathology in adult patients presenting with blurred vision

Background and objective: Ocular posterior segment lesions can affect individuals of both sexes at all ages. Such lesions can lead to serious manifestations such as retinal detachment and retinal hemorrhage, leading to permanent loss of eyesight. This study aimed to determine the association between age and gender and changes in ocular posterior segment based on ultrasonography findings. Methods: This prospective cross-sectional study included 50 patients with blurry vision who had been referred from ophthalmology outpatient clinics to the radiology department of Rizgary Teaching Hospital in Erbil, Kurdistan region in Iraq. Required data were collected using a researcher-designed questionnaire, and the patients were examined using a high resolution 7.5-10 MHz linear array ultrasound transducer. Results: The most frequent complications associated with ocular posterior segment pathologies were old vitreous hemorrhage (72%), posterior vitreous detachment (36%), and retinal detachment (34%). Diabetes and hypertension were the most frequent diseases associated with ocular posterior segment pathology. A significant association was seen between the patients' age with old vitreous hemorrhage (P = 0.003). A significant association was seen between the patients’ medical conditions with old vitreous hemorrhage and retinal detachment. There was no significant correlation between the patients’ gender and the studied ocular posterior segment pathologies. Conclusion: Age has a strong correlation with old vitreous hemorrhage, chronic medical conditions such as diabetes, and hypertension correlated with old vitreous hemorrhage and retinal detachment. Keywords: Ocular ultrasonography; Posterior segment pathology; Blurred vision; Age; Gender.

Role of Ultrasonography and Conventional Radiography in the Detection of Maxillofacial Fractures: A Comparative Study

Objective: With the collaboration of the trauma department, our study was designed to compare the effectiveness of ultrasonography (USG) and conventional radiography in the detection of bony fractures related to oral and maxillofacial regions. Methodology: This comparative study was conducted from March 2020 to March 2021 by the Radiology department of Sarghoda medical college hospital with the collaboration of the trauma department. Ultrasonography was performed by using GE- USG machine along with a linear extraoral transducer (frequency range 7-15 MHZ). Patients were asked to sit in a seated position facing the sinologist. Transducers were placed over the site by applying the sterile gel. Results: The overall sensitivity and specificity rate of ultrasonography was reported as 83.33% and 98.88% respectively in all sites whereas the sensitivity and specificity rate of conventional radiographs were reported as 70.24%, 100%. The negative predictive value of USG was reported as 96.17% along with 94.59% positive predictive value. In the contrast, conventional radiography gave a better positive predictive value (100%) than USG In our study we found better results of ultrasonography in terms of sensitivity and negative predictive value. Conclusion: In conclusion, our study depicts that ultrasonography is an economical, useful diagnostic tool for examining the bony fractures of facial trauma with a better sensitivity rate when compared to conventional radiographs.

Study on Work Safety for Employees in Radiology Department

Background: Working staff in the radiology department are exposed to harmful factors such as Radiation exposure, injuries; needle pricks while performing an investigation, leads to exposure to body fluids, muscle stress due to wearing heavy lead aprons, and while moving portable equipment for examinations. Strategies to prevent and reduce such harmful factors are guaranteed by taking regular inspections by radiation safety officers. Safety supervision in radiology is important in shielding the patients, radiologists and healthcare staff. Observational safety audits and regular inspections in the radiology department for staff safety are the main and important parts of this study. Objective: To assess and evaluate the current safety measures in Radiology Department and Scope of innovations and interventions in current working safety condition awareness. Methods: All employees working in radiology department satisfying the inclusion criteria are evaluated for the study. A survey carried out related to general working and routine procedures carried out in radiology department. Regular audits and inspection studies are covered in the study. The study consists of closed-ended questions regarding the profession and the knowledge of the basic safety measures in diagnostic and special scans in radiology department. Results: Employees in the radiology department are highly aware about work safety measures. There are regular safety audits and inspection studies are carried out by RSO and concerning departments. There is also scope for radiation workers to have introductory seminars on radiation safety before they start working with radiation. Conclusion: Working in the radiology department has several types of safety risks, which can be barred or compact if manage suitably. Informally with these types of risks and their penalty, agreement with policy and strategy on work ecological safety, and expansion of a traditions that supports supervision, treatment, and on time conduct will go far toward civilizing overall employee security for all employees in the radiology department.