Availability Of Radiologists Research Articles

General practitioners translating ultrasonography into clinical practice in rural Nepal: rewarding practices and challenges

Ultrasound has been increasingly implemented in general practice for its diagnostic and therapeutic purposes. The recent introduction of Point of Care Ultrasound (POCUS) has changed the intended management plans reducing referrals and morbidity and mortality. Inadequate numbers and less availability of radiologists in peripheral setting is a major challenge for coverage of ultrasonography services in remote Nepal. MD General Practitioner (MDGPs) in district hospitals have performed and interpreted large variety of cases for better clinical outcome. Regular communication, coordination and collaboration meeting between MDGPs and radiologists, specific updates and training programs are needed for MDGPs to further strengthen their skills. 

Effects of Changing the Reporting System from Decentralized/Modality-Based to Centralized/Subspecialized Radiology on Radiologists, Radiologic Technicians and Referring Physicians of a Multi-Center Radiology Network.

Objectives:To determine the effects of reorganizing a radiology institute from decentralized/modality-based to centralized/subspecialized radiology on radiologists, radiologic technicians, and referring physicians at a multi-center radiology network.Material and Methods:In 2017/2018 our multi-center radiology network was changed from decentralized/modality-based to centralized/subspecialized reporting. A survey was conducted among radiologists, technicians and two groups of referring physicians (main hospital and non-main hospitals). The following items were tested: Overall satisfaction, perceived quality of radiological reports, subjective productivity/efficiency, confidence of radiologists in their subspecialty, availability of radiologists and turnaround time. Two of five answering options on a 5-point Likert scale were considered to represent agreement. The Mann-Whitney-U-test served for statistical analyses in agreement before and after reorganization in each group.Results:For radiologists, a significant difference was observed in perceived quality of radiological reports 42/46 (91.3%) compared to 51/52 (98.1%; p = 0.013).For technicians, no significant differences were observed. In the group of main hospital referring physicians, significant differences were observed in overall satisfaction 129/152 (84.9%) compared to 164/174 (94.3%; p < 0.001) and in perceived quality of radiological reports 125/148 (72.8%) compared to 157/170 (92.4%; p = 0.001). In the group of non-main hospital referring physicians no significant differences were observed.Conclusion:The reorganization resulted in a significantly higher perceived quality of radiological reports for the groups of radiologists and main hospital referring physicians besides overall satisfaction for main hospital referring physicians. Specialized main hospital referring physicians value reports of specialized radiology, whereas less specialized, non-main hospital referring physicians did not experience any significant effect.

The Value of Interpretation of Intraoperative Fluoroscopy by Radiologists During Pediatric Fracture Treatment

Orthopaedic surgeons frequently use intraoperative fluoroscopy to aid in the real-time decision-making process during fracture treatment. Radiologists routinely interpret and report on these fluoroscopic images. The goal of this combined retrospective and prospective study was to assess the value of this practice of having radiologists interpret intraoperative fluoroscopy for pediatric fracture treatment. In 500 consecutive pediatric patients who underwent fracture treatment in the operating room during a 1-year period, the following 4 parameters were retrospectively reviewed: (1) time between completion of procedure and availability of radiologist's report, (2) discrepancies between the surgeon-dictated operative report and the radiologist's report on the fluoroscopic images, (3) recommendations or unexpected findings in the radiologist's report, and (4) charges and reimbursement for the radiologist to report on the fluoroscopic images. In an additional 76 consecutive pediatric trauma patients, the number of intraoperative fluoroscopy images taken during fracture treatment and the number saved and sent to the radiologist were collected in a prospective and blinded manner. In 500 consecutive cases, 89% of radiologist reports were not available until after the end of the procedure. There was no discrepancy between the surgeon-dictated operative report on use of fluoroscopy and the radiologist's interpretation of the fluoroscopic images. Three (0.6%) patients had an unexpected finding on the radiologist's report but that did not change the fracture treatment. The mean charge by the radiologist was $166.96±11.84 and the mean reimbursement was $5.83±7.01. For the prospective arm of the study, 41.9% of all intraoperative fluoroscopy images taken were saved and sent to the radiologist. For the majority of procedures, the radiologist report was not available until after the end of the procedure. The radiologist's interpretation of intraoperative fluoroscopy did not alter fracture treatment in any patient. Because of limited benefit and low reimbursement, this study suggests that the practice of having a radiologist interpret intraoperative fluoroscopy during fracture treatment adds little value to patient care. Decision Analysis Level II.

Teleradiology and emerging business models

A number of new diagnostic radiology services have emerged which use teleradiology. The main themes include: (1) stand-alone teleradiology practice; (2) the "Nighthawk"/on-call coverage; (3) solo radiologist practice; (4) expert/second-opinion teleradiology; (5) a global virtual radiology service based on workload sharing and reallocation. More applications of teleradiology can be expected due to the continuing shortages and uneven distribution of radiologists, and the increasing use of radiological imaging for diagnosis. In a large enterprise, such as the US army, teleradiology will allow the creation of a global diagnostic organization where diagnostic images are distributed according to the availability of radiologists. Eventually the distinction between picture archiving and communication systems and teleradiology will be blurred and radiology will be provided by virtual organizations with distributed capabilities. As teleradiology services claim a bigger share of radiology practice, various legal and regulatory issues will need to be solved. Ultimately the successful business model will depend on the ability to produce the highest-quality product at the lowest cost.

MAGNETIC RESONANCE IMAGING OF THE CARDIOVASCULAR SYSTEM AND AIRWAY

Cardiovascular MR imaging is unique in its ability to combine anatomic, physiologic, and functional information in a single examination. Established applications in the pediatric population include the evaluation of the child with a suspected thoracic aortic arch anomaly, vascular compression of the airway, coarctation of the aorta, pulmonary arterial and venous abnormalities, and cardiac or paracardiac masses. The increasing availability of radiologists with the knowledge and commitment to cardiac imaging will allow this exciting technique to thrive in the future, to the benefit of our patients.