Current Radiological Practice Research Articles

The 2021 ACR/RBMA Workforce Survey: Practice Types, Employment Trends, and Hiring Needs

PurposeThe aim of this study was to analyze current radiology practice types, specific subspecialty needs, employment trends, and retirement trends. MethodsACR members, nonmembers, and Radiology Business Management Association members were surveyed using predominantly structured closed-ended questions about a variety of current and recent radiology practice characteristics. Responses were group practice deduplicated and weighted. ResultsOf 1,702 survey respondents, 64% were men, with a median age of 51 years. In 2021, 62% of responding practices hired radiologists, with the average practice hiring 2 radiologists and academic practices on average hiring the most (3.5). Most radiologists (87%) were hired for full-time positions, with independent practices hiring the largest proportion of part-time positions. Body and breast imagers represented the largest numbers of hired radiologists (17% each). Practices anticipated similar hiring patterns in 2022, prioritizing breast (37%) and body (35%) imaging. Of all practice types, academic groups were least likely to prioritize general radiologist hiring. A large majority (82%) of radiology practices permit remote work (teleradiology), more common at academic than other practices. Of currently employed radiologists, 16% plan to seek new employment in the next year; early-career radiologists indicated the highest likelihood (92%) and academic radiologists the lowest (66%) of remaining in the same practice for at least 5 years. A large majority of practices (80%) reported no radiologist retirements in 2021. Of those retiring, the average age was 75 years, and 66% worked full-time until retirement. ConclusionsRadiologist recruiting remains robust. Current information on practice characteristics may help inform radiology practice leaders seeking to right-size their groups.

Current practice of emergency radiology in Turkey and future expectations: a survey study

The development of emergency radiology (ER) in Turkey has accelerated with the increase in the number of patients admitted to emergency departments. We aimed to present and discuss the responses to a survey distributed to radiologists in Turkey, which included questions about the current practice of ER and future expectations. A survey with 29 questions enquiring about the infrastructure of respondents' hospitals and radiology units, information about emergency services and ER (including patient volume), the number of staff and equipment, the ER working plan and reporting method, and training in the field of ER were distributed to members of the Turkish Radiological Society by email. The response rate was 21.97% (328/1.493). The presence of distinct ER units in radiology departments was confirmed by 40.55% of respondents, while for 34.25%, ER was located inside the emergency room. Of the respondents, 26.96% stated they believed that emergency cases should be reported by emergency radiologists, and the necessity for an ER subunit in the emergency room was agreed upon by 58.64% of contributors. The majority of respondents (69.54%) agreed with the opinion that residents should receive their ER training in an ER unit. Keeping abreast of current ER practices and radiologists' expectations may be helpful for improving national ER practices and academic studies.

Acknowledging and Understanding Our Radiology Heritage of Change

One of the common refrains I have heard discussed among radiologists is that there has been a significant deleterious change in the current practice of radiology. This has led many to despair about the future of radiology. Many radiologists appear despondent because for them, nothing remains the same, and we all appear to be on a treadmill that we can’t seem to stop. Perhaps these feelings have led many toward increased professional dissatisfaction and individual burnout. However, when I was studying the 127-year history of New Orleans radiology, it became apparent that a greater appreciation for the continuously changing nature of our profession might help relieve some of the distress [1,2].

Sequential multiblock partial least squares discriminant analysis for assessing prostate cancer aggressiveness with multiparametric magnetic resonance imaging

In current radiology practice, multi-parametric magnetic resonance imaging (mpMRI) has recently become a key tool in diagnostic and therapeutic decisions. Although it is based on the subjective assessment of T2-weighted images, as well as perfusion-weighted and diffusion-weighted sequences, further quantitative parameters can also be derived from them for improving lesion phenotyping. Despite these parameters are usually exploited in a univariate way, ignoring the benefits of a real multivariate approach, still it is the gold standard imaging technique to assess prostate cancer location and probability of malignancy. In this paper, pharmacokinetic (perfusion) and exponential (diffusion) clinical models, as well as latent variable-based multivariate statistical models like multivariate curve resolution-alternating least squares (MCR-ALS), have been calculated and analyzed with sequential multi block-partial least squares discriminant analysis (SMB-PLS-DA) including technique-block differentiation, in order to better assess for cancer aggressiveness based on Gleason scales. The best prediction result was achieved by the ordered combination of diffusion blocks (MCR-ALS and exponential models) and normalized T2 values. The perfusion blocks did not improve the results obtained by diffusion and T2-weighted based parameters alone, so they can be removed from the SMB-PLS-DA model.

The impact of dependence on advanced imaging techniques on the current radiology practice

Medical imaging techniques are a helpful tool for physicians to diagnose and treat diseases. Some of these techniques are conventional and include X-rays, Ultrasounds while others are advanced imaging modalities such as MRI and CT scans. Recently, more and more physicians are relying on these advanced imaging modalities because of advancements in technology, increased patient demand, greater finances, and the fear of any malpractice suits in case of missed diagnosis. While these techniques, no doubt, offer a quicker and correct diagnosis owing to their sharp resolution and sensitivity, they do expose the patient to a great source of radiation, are expensive, time consuming, and are not an ideal means to be used in all situations. Thus, it is crucial to mitigate their unnecessary use. The following article focuses on the growing use of such techniques, their advantages and disadvantages and how to alleviate their exaggerated use.

Application of qisas and diyat act's terms for reporting in current forensic radiology practice.

To determine the practical use of the application of Qisas and Diyat Act's terms for medicolegal x-ray reporting in the context of present local forensic radiology practice. A cross-sectional study. Place and Duration of the Study: Radiology Department, Dow University of Health Sciences (DUHS) and Civil Hospital, Karachi (CHK), from January to December 2004. The study included all cases referred to radiology department, DUHS and CHK for medicolegal X-ray reporting during the study period where a skeletal injury was suspected. Those X-rays conducted outside Karachi, burns-injury cases, pregnant ladies' cases and technically faulty X-rays were excluded. The studied variables were the demographic characteristics of each case, the mode of injury as alleged, the region and the extent of injury as visible on these x-rays; and the ancillary imaging techniques done to further evaluate the injury. Each injury was reported as per Qisas and Diyat Act 1990's terms and confirmed with medicolegal officer's final report. The frequency distribution, percentages and means were determined for each variable. There were 281/1972 (0.42%) cases of radiographically visible skeletal injury. Those with major degree of trauma (fracture-displaced or otherwise), the injury could be explicitly termed as required by the said ordinance, Jurh Jaifah (fractured ribs), "Jurh Ghair Jaifa Munaqillah' and Hashimah' (peripheral fracture), and 'Shajjah Hashimah' (head and face fractures). 'Shajah Damighah' and 'Ammah' (fractures meninges with intracranial hematoma) could only be diagnosed with CT. 'Jurh-Ghair Jaifah Mudiah' could only be decided by combining physical examination with MRI in two cases-plain x-rays being unhelpful. Radionuclide scan was not called for in a single case. The presently recommended legal terminology for fracture reporting and sub classification is comprehensive, however, reporting the trauma short of fracturing the bone, requires the use of advanced imaging techniques such as the CT scan and the MRI. In the absence of these techniques, the application of the present terms depends mainly on the examination findings of the first examining medical officer rather than radiological evidence such as X-rays. So forensic radiology referrals should utilize CT scan, MRI in skeletal trauma.

Evaluation of radiologist's knowledge about the Artificial Intelligence in diagnostic radiology: a survey-based study.

BackgroundAdvanced developments in diagnostic radiology have provided a rapid increase in the number of radiological investigations worldwide. Recently, Artificial Intelligence (AI) has been applied in diagnostic radiology. The purpose of developing such applications is to clinically validate and make them feasible for the current practice of diagnostic radiology, in which there is less time for diagnosis.PurposeTo assess radiologists’ knowledge about AI’s role and establish a baseline to help in providing educational activities on AI in diagnostic radiology in Saudi Arabia.Material and MethodsAn online questionnaire was designed using QuestionPro software. The study was conducted in large hospitals located in different regions in Saudi Arabia. A total of 93 participants completed the questionnaire, of which 32 (34%) were trainee radiologists from year 1 to year 4 (R1–R4) of the residency programme, 33 (36%) were radiologists and fellows, and 28 (30%) were consultants.ResultsThe responses to the question related to the use of AI on a daily basis illustrated that 76 (82%) of the participants were not using any AI software at all during daily interpretation of diagnostic images. Only 17 (18%) reported that they used AI software for diagnostic radiology.ConclusionThere is a significant lack of knowledge about AI in our residency programme and radiology departments at hospitals. Due to the rapid development of AI and its application in diagnostic radiology, there is an urgent need to enhance awareness about its role in different diagnostic fields.

The quantitative neuroradiology initiative framework: application to dementia.

There are numerous challenges to identifying, developing and implementing quantitative techniques for use in clinical radiology, suggesting the need for a common translational pathway. We developed the quantitative neuroradiology initiative (QNI), as a model framework for the technical and clinical validation necessary to embed automated segmentation and other image quantification software into the clinical neuroradiology workflow. We hypothesize that quantification will support reporters with clinically relevant measures contextualized with normative data, increase the precision of longitudinal comparisons, and generate more consistent reporting across levels of radiologists' experience. The QNI framework comprises the following steps: (1) establishing an area of clinical need and identifying the appropriate proven imaging biomarker(s) for the disease in question; (2) developing a method for automated analysis of these biomarkers, by designing an algorithm and compiling reference data; (3) communicating the results via an intuitive and accessible quantitative report; (4) technically and clinically validating the proposed tool pre-use; (5) integrating the developed analysis pipeline into the clinical reporting workflow; and (6) performing in-use evaluation. We will use current radiology practice in dementia as an example, where radiologists have established visual rating scales to describe the degree and pattern of atrophy they detect. These can be helpful, but are somewhat subjective and coarse classifiers, suffering from floor and ceiling limitations. Meanwhile, several imaging biomarkers relevant to dementia diagnosis and management have been proposed in the literature; some clinically approved radiology software tools exist but in general, these have not undergone rigorous clinical validation in high volume or in tertiary dementia centres. The QNI framework aims to address this need. Quantitative image analysis is developing apace within the research domain. Translating quantitative techniques into the clinical setting presents significant challenges, which must be addressed to meet the increasing demand for accurate, timely and impactful clinical imaging services.

A retrospective study analyzing missed diagnosis of lung metastases at their early stages on computed tomography.

Lungs are one of the target organs of metastases of primary lung, breast, liver, colorectal, and esophageal cancer. While computed tomography (CT) is the most widely used modality for detecting lung metastases, it is still very challenging to detect them at the earlier stages. If lung metastases could be found on CT scans at the earliest time points, patients would benefit by beginning treatment earlier. The objective of this study was to demonstrate that CT can reveal lung metastases in many cases at even earlier stages than current radiological practice may find. One hundred patients with lung metastases were randomly selected and their surveillance CT scans were analyzed retrospectively. The patients had primary cancer in the breasts, lungs, esophagus, colorectum, and liver. All patients had multiple CT examinations of the lungs and their metastases, if any, were confirmed by subsequent CT scans. The earliest CT scans were examined to determine whether lung metastases at the same locations had been diagnosed or missed. Missed lung metastases, categorized by type of the primary cancer and adjacency to nearby blood vessels, were statistically analyzed. There were 36/100 (36%) cases of missed lung metastases, including 15 cases of single metastasis and 21 cases of multiple metastases. There were a total of 174 missed loci of lung metastases. Where metastases were missed, there was a statistically significant difference (P<0.001) in their distribution within the sub-regions of the lungs. Adjacency to blood vessels appeared to be a significant factor in metastases being missed during diagnosis (P<0.001). There was a considerable percentage of early lung metastases that were missed by radiologists but actually appeared on CT scans. The capability of CT to reveal such early metastases opens up an opportunity to move up the time points of detecting lung metastases through clinical and training improvement and technology development such as computer-aided detection.

It is About "Time": Academic Neuroradiologist Time Distribution for Interpreting Brain MRIs

Efficiency is central to current radiology practice. Knowledge of report generation timing is essential for workload optimization and departmental staffing decisions. Yet little research evaluates the distribution of activities performed by neuroradiologists in daily work. This observational study tracked radiologists interpreting 358 brain magnetic resonance imaging (MRI) in an academic practice over 9 months. We measured the total duration from study opening to report signing and times for five activities performed during this period: image viewing, report transcription, obtaining clinical data, education, and other. Attendings, fellows, and residents reading studies independently and attendings over-reading trainee-previewed studies were observed. Ten attendings, 12 fellows, and 13 residents spent a mean of 11, 18, and 16 minutes reading brain MRIs independently. Mean duration was significantly different comparing attendings in all assignments to fellows (18.36 ± 1.05 minutes, p = 0.0001) or residents (16.31 ± 1.11 minutes, p = 0.001) but not between fellows/residents. Mean duration among attendings reading independently versus over-reading trainees was not statistically different. Attendings spent the same time on image viewing (4.07-5.33 minutes) with or without trainees. Attending transcription time was shortest when over-reading trainees (2.24 minutes) and longest when reading independently (4.20 minutes), demonstrating benefit of the draft report. Fellows and Residents spent longer on image viewing (7.14 minutes and 8.06 minutes, respectively) and transcription (7.02 minutes and 5.40 minutes, respectively) than attendings reading independently. Neuroradiologist time/activity distributions for reading brain MRI studies were measured, setting the stage to establish a benchmark for future reference and suggesting opportunities for greater efficiency. Furthermore, report production time can be decreased when a draft report is available.

Volumetric image interpretation in radiology: scroll behavior and cognitive processes

The interpretation of medical images is a primary task for radiologists. Besides two-dimensional (2D) images, current imaging technologies allow for volumetric display of medical images. Whereas current radiology practice increasingly uses volumetric images, the majority of studies on medical image interpretation is conducted on 2D images. The current study aimed to gain deeper insight into the volumetric image interpretation process by examining this process in twenty radiology trainees who all completed four volumetric image cases. Two types of data were obtained concerning scroll behaviors and think-aloud data. Types of scroll behavior concerned oscillations, half runs, full runs, image manipulations, and interruptions. Think-aloud data were coded by a framework of knowledge and skills in radiology including three cognitive processes: perception, analysis, and synthesis. Relating scroll behavior to cognitive processes showed that oscillations and half runs coincided more often with analysis and synthesis than full runs, whereas full runs coincided more often with perception than oscillations and half runs. Interruptions were characterized by synthesis and image manipulations by perception. In addition, we investigated relations between cognitive processes and found an overall bottom-up way of reasoning with dynamic interactions between cognitive processes, especially between perception and analysis. In sum, our results highlight the dynamic interactions between these processes and the grounding of cognitive processes in scroll behavior. It suggests, that the types of scroll behavior are relevant to describe how radiologists interact with and manipulate volumetric images.

Artificial Intelligence: Threat or Boon to Radiologists?

The development and integration of machine learning/artificial intelligence into routine clinical practice will significantly alter the current practice of radiology. Changes in reimbursement and practice patterns will also continue to affect radiology. But rather than being a significant threat to radiologists, we believe these changes, particularly machine learning/artificial intelligence, will be a boon to radiologists by increasing their value, efficiency, accuracy, and personal satisfaction.

The radiology informed consent form: recommendations from the European Society of Cardiology position paper

Every radiological and nuclear medicine examination confers a definite long-term risk of cancer, but most patients undergoing such examinations receive no or inaccurate information about radiation dose and corresponding risk related to the dose received. Informed consent is a procedure to support (not substitute) the physician/patient dialogue and relationship, facilitating a free, informed and aware expression of the patient’s will in the principle of patient autonomy. Physicians are responsible for providing patients with all the information on risks, benefits and alternatives useful to the patient to make the decision. In current radiological practice the information on the radiation dose and long-term cancer risks is difficult to find and not easy to understand. The form using plain language should spell-out the type of examination, the effective dose (mSv), the effective dose expressed in number of chest radiographs and the risk of cancer. The current practice clashes against the guidelines and the law.

Functional Neuroimaging: Fundamental Principles and Clinical Applications.

Functional imaging modalities, such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), are rapidly changing the scope and practice of neuroradiology. While these modalities have long been used in research, they are increasingly being used in clinical practice to enable reliable identification of eloquent cortex and white matter tracts in order to guide treatment planning and to serve as a diagnostic supplement when traditional imaging fails. An understanding of the scientific principles underlying fMRI and DTI is necessary in current radiological practice. fMRI relies on a compensatory hemodynamic response seen in cortical activation and the intrinsic discrepant magnetic properties of deoxy- and oxyhemoglobin. Neuronal activity can be indirectly visualized based on a hemodynamic response, termed neurovascular coupling. fMRI demonstrates utility in identifying areas of cortical activation (i.e., task-based activation) and in discerning areas of neuronal connectivity when used during the resting state, termed resting state fMRI. While fMRI is limited to visualization of gray matter, DTI permits visualization of white matter tracts through diffusion restriction along different axes. We will discuss the physical, statistical and physiological principles underlying these functional imaging modalities and explore new promising clinical applications.

Results of a survey on the implementation of diagnostic reference levels for X-rays among Dutch hospitals.

Diagnostic reference levels (DRLs) for medical x-ray procedures are being implemented currently in the Netherlands. By order of the Dutch Healthcare Inspectorate, a survey has been conducted among 20 Dutch hospitals to investigate the level of implementation of the Dutch DRLs in current radiological practice. It turns out that hospitals are either well underway in implementing the DRLs or have already done so. However, the DRLs have usually not yet been incorporated in the QA system of the department nor in the treatment protocols. It was shown that the amount of radiation used, as far as it was indicated by the hospitals, usually remains below the DRLs. A procedure for comparing dose levels to the DRLs has been prescribed but is not always followed in practice. This is especially difficult in the case of children, as most general hospitals receive few children.

RSNA Centennial Article: Gone but Not Completely forgotten— pictorial review of "antiquated" radiologic procedures [corrected

The field of diagnostic and therapeutic radiology has always been characterized by constant innovation and creativity to evolve to its current form. There are numerous imaging techniques that were once prevalent but have become outdated and were replaced by the current examinations and modalities, which improve diagnostic accuracy and patient outcomes. Many of these outdated examinations were first described in the journal Radiology during its first 100 years of existence and were subsequently able to be disseminated across its vast readership to become the standard of care across the nation and the world. These earlier techniques, such as pneumoencephalography as it applies to neuroimaging and neurosurgery; kymography, a predecessor of cardiac imaging; contrast agents such as Thorotrast; and miscellaneous cultural tools, such as the shoe-fitting fluoroscope, left lasting impressions on the current practice of radiology and reflect a small subset of the imaging examinations of our predecessors. Knowledge of historic radiologic examinations and procedures is important to understand how we have arrived at the current practice of radiology we embrace today and how our field can continue to evolve to improve our diagnostic and therapeutic abilities to fit the changing needs of our patients.

Adaptation of the Immune Related Response Criteria: Irrecist

ABSTRACT Aim: The immune related response criteria were published in November 2009, based on results and clinical findings of the ipilimumab® program. RECIST as published in 2000 had its shortcomings for targeted immunotherapy in oncology and still has with its successor version RECIST 1.1. Investigators may declare progressive disease (PD) too early, when the treatment effect is not yet fully evident. With this paper we introduce irRECIST to further clarify and reduce assessment criteria ambiguity and minimize discordance between sites and independently read results. Methods: The adaptations from RECIST 1.1 and/or irRC, as applicable in an immunotherapy clinical study, are documented in the irRECIST Modifications and Clarifications column in a comparative table format within the charter for Blinded Independent Central Review (BICR). However, typically these independent review details and specifications are not available for investigators at sites. The modifications we introduce represent adaptations of the published criteria based on current radiology practice and clinical trial experience and with that aim to provide more objective and reproducible response assessments for investigators and also central independent image review. Results: Bearing industry demands and RECIST shortcomings in mind we introduce a modification of the irRC to better address patients' treatment, investigators' patient management and sponsors' analysis needs for targeted immunotherapy developments in oncology with irRECIST, based on adaptation of unidimensional measurements aligned with RECIST 1.1. irRECIST will reduce site:central discordance in patient assessment and contains guidance for ambiguous cases and also describes how to evaluate patients with non-measurable non target disease only. Conclusions: RECIST published in 2000 and its successor version RECIST 1.1 from 2009 has its shortcomings for targeted immunotherapy in oncology. With these adapted irRECIST criteria we introduce the needed adjustment to the irRC criteria to allow for treatment evaluations and assessments that better meets both investigators' and patients' needs and with that better reflects sponsors' demands for more reliable and reproducible study data analyses. Disclosure: All authors have declared no conflicts of interest.

Adaptation and modification of the immune related response criteria (IRRC): IrRECIST.

e22121 Background: The immune related response criteria were published in November 2009. RECIST published in 2000 had its shortcomings for targeted immunotherapy in oncology and still has with its successor version RECIST 1.1, also from 2009. Investigators may declare a patient PD too early, when the treatment effect is not yet fully evident. Methods: The irRECIST modifications represent adaptations of the published criteria based on current radiology practice and clinical trial experience and aim to provide more objective and reproducible response assessments for investigators and central independent image review. A rationale for the clarifications and modifications is provided. Results: RECIST published in 2000 and its successor version RECIST 1.1 from 2009 has its shortcomings for targeted immunotherapy in oncology. Patients with an increase in tumor burden by either ≥ 20% of measured target lesions’ diameters or with an unequivocal new lesion are considered a progressor and as such a treatment failure, irrespective of time interval considerations since first treatment. Conclusions: Bearing industry demands and RECIST shortcomings in mind we introduce a modification of the irRC to better address patients’ treatment and sponsors’ analysis needs for targeted immunotherapy developments in oncology with irRECIST, based on adaptation of unidimensional measurements aligned with RECIST 1.1. Sponsors developing monoclonal antibodies for oncology patients are aware that with RECIST 1.1, as the most common assessment criteria, investigators may declare a patient progressive disease too early, when the compound did not have sufficient time to show its treatment effect.

Voice recognition is here comma like it or not period

Voice recognition (VR) technology needs improvement, but is as integral to the current practice of radiology as Radiology Information Systems and Picture Archival and Communication Systems. In the 1990s, the radiology community gave VR technology a rather lukewarm reception, but since then it has emerged as the predominant method of radiology reporting in the United States. In this article, we examine how VR technology works, outline the positive and negative aspects of VR technology on work flow, identify common VR transcription errors and review the discussion on VR adoption in the recent literature. We add to the discussion our personal experiences in an international teleradiology group.

Toward the Era of a One-Stop Imaging Service Using an Angiography Suite for Neurovascular Disorders

Transportation of patients requiring multiple diagnostic and imaging-guided therapeutic modalities is unavoidable in current radiological practice. This clinical scenario causes time delays and increased risk in the management of stroke and other neurovascular emergencies. Since the emergence of flat-detector technology in imaging practice in recent decades, studies have proven that flat-detector X-ray angiography in conjunction with contrast medium injection and specialized reconstruction algorithms can provide not only high-quality and high-resolution CT-like images but also functional information. This improvement in imaging technology allows quantitative assessment of intracranial hemodynamics and, subsequently in the same imaging session, provides treatment guidance for patients with neurovascular disorders by using only a flat-detector angiographic suite—a so-called one-stop quantitative imaging service (OSIS). In this paper, we review the recent developments in the field of flat-detector imaging and share our experience of applying this technology in neurovascular disorders such as acute ischemic stroke, cerebral aneurysm, and stenoocclusive carotid diseases.