Radiology Information System Research Articles

Imaging volumes during COVID-19: A Victorian health service experience.

BACKGROUNDThe World Health Organisation declared the coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. While globally, the relative caseload has been high, Australia’s has been relatively low. During the pandemic, radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes. AIMTo investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODSA retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves. Weekly volumes across patient class, modality and mobile imaging were summed for periods: wave 1 (weeks 11 to 16 for 2019; weeks 63 to 68 for 2020) and wave 2 (weeks 28 to 43 for 2019; weeks 80 to 95 for 2020). Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTSSummed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8% in adult outpatient imaging volumes and 46.3% in paediatric emergency department imaging volumes. Adult nuclear medicine demonstrated the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 47.8%, with angiography increasing by 50%. The pandemic’s second wave demonstrated the greatest decrease of 23.5% in adult outpatient imaging volumes, with an increase of 18.2% in inpatient imaging volumes. The greatest decrease was 28.5% in paediatric emergency department imaging volumes. Nuclear medicine showed the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 36.7%. Mobile imaging utilisation increased between 57.8% and 135.1% during the first and second waves. A strong correlation was observed between mobile and non-mobile imaging in the emergency setting (Spearman’s correlation coefficient = -0.743, P = 0.000). No correlation was observed in the inpatient setting (Spearman’s correlation coefficient = -0.059, P = 0.554).CONCLUSIONNuclear medicine was most impacted, while computed tomography and angiography were the least affected by the pandemic. The impact was less during the pandemic’s second wave. Mobile imaging shows continuous growth during both waves.

Computed tomography-derived fractional flow reserve (FFRCT) has no additional clinical impact over the anatomical Coronary Artery Disease - Reporting and Data System (CAD-RADS) in real-world elective healthcare of coronary artery disease

To evaluate the impact of computed tomography-derived fractional flow reserve (FFRCT) compared to the anatomical Coronary Artery Disease - Reporting and Data System (CAD-RADS) in the elective assessment of coronary artery disease in real-world cardiology practise. A retrospective review was undertaken of 1,239 coronary CT examinations from August 2018 to December 2019 with a minimum follow-up period of 1 year. Coronary disease was classified according to the CAD-RADS system. A non-occlusive ≥30% maximum diameter stenosis was considered eligible for FFRCT. Lesion-specific FFRCT and FFR were considered positive if≤0.80. The patients were followed up using the hospital radiology information system and the electronic patient record. A positive outcome was defined by a subsequent invasive angiogram (ICA) showing disease requiring revascularisation or FFR ≤0.80 or a positive stress test or medical therapy for angina in CAD-RADS 4. Of the 1,145 analysable studies (mean follow up 618±153 days) the incidence of a positive result was 7% with a 5.4% elective revascularisation rate. Two hundred and forty-five patients (CAD-RADS 2-4) had FFRCT. FFRCT reduced the accuracy of the CAD-RADS grade from 91% to 78.4% (p<0.001). In CAD-RADS 2, the accuracy is reduced from 99% to 90.7% (p=0.005), and in CAD-RADS 3 from 93.9% to 67.7% (p<0.001). In CAD-RADS 4, FFRCT increases accuracy from 69.4% to 75.5% (p=0.025), but 89.8% of FFRCT are positive and specificity is low (26.7%). In the present "real-world" practise, FFRCT does not improve standard radiological assessment of coronary disease graded by the CAD-RADS alone.

Teleradiology in Tripura: Effectiveness of a Telehealth Model for the Rural Health Sector

With the aim of facilitating early diagnosis and improving health care outcomes in the rural areas of northeast India, Teleradiology Solutions in Bangalore, Karnataka established an alliance with 26 Community Healthcare Centers (CHC), District (DH), and Sub-district (SDH) hospitals located over 3000 km away in Tripura. Digital Imaging and Communications in Medicine (DICOM) images of radiographs of patients from the sites were uploaded to a cloud-based Radiology Information System and Picture Archiving and Communication System (RIS-PACS) for interpretation by expert radiologists at a Teleradiology reporting hub in Bangalore. Over a period of 3 years, starting from January 2018, 78622 studies were interpreted via teleradiology. All age groups and study types were included. The mean turnaround time (TAT) for the report to reach the site once the images had been received in Bangalore for all studies was 3.19 hours (95% confidence interval [CI]: 3.22 - 3.16). This meant that patients could consult their physician with the report on the same day, enabling delivery of optimal care at the same visit. We conclude that teleradiology has proven to be a value-added service in rural healthcare in the remote North East of India.

Body computed tomography in sepsis: predictors of CT findings and patient outcomes in a retrospective medical ICU cohort study

BackgroundSepsis is a life-threatening condition that requires immediate focus identification and control. However, international sepsis guidelines do not provide information on imaging choice.PurposeTo identify predictors of CT findings and patient outcomes in a population of septic patients from a medical ICU.Material and methodsA full-text search in the radiological information system (RIS) retrieved 227 body CT examinations conducted to identify infectious sources in 2018. CT reports were categorized according to identified foci and their diagnostic certainty. Diagnostic accuracy of CT was compared to microbiological results. Clinical and laboratory information was gathered. Statistical analysis was performed using nonparametric tests and logistic regression analysis.ResultsCT revealed more positive infectious foci 52.4% (n = 191/227) than microbiological tests 39.3% (n = 79/201). There were no significant differences between focus-positive CT scans with regard to positive microbiological testing (p = 0.32). Sequential organ failure assessment (SOFA) scores were slightly but nonsignificantly higher in patients with a focus-positive CT, odds ratio (OR) = 0.999 (95% CI 0.997–1.001) with p = 0.52. Among C-reactive protein (CRP), procalcitonin (PCT), and leukocytes, in focus-positive versus focus-negative CT scans, CRP showed a minor but statistically significant elevation in the group with focus-positive CT scans (OR = 1.004, 95% CI = 1.000–1.007, p = 0.04). No significant association was found for PCT (OR = 1.007, 95% CI = 0.991–1.023; p = 0.40) or leukocytes (OR = 1.003, 95% CI = 0.970–1.038; p = 0.85). In 33.5% (n = 76/227) of cases, the CT findings had at least one therapeutic consequence. In 81.6% (n = 62/76), the CT findings resulted in one consequence, in 14.5% (n = 11/76) in two consequences, and in 3.9% (n = 3/76) in three consequences. There was no significant association between focus-positive CT scans and mortality (p = 0.81).ConclusionIn this population of septic patients in medical intensive care, microbiological analysis complemented CT findings. Both clinical and laboratory parameters were not predictive of CT findings. While therapeutic consequences of CT findings in this study population underline the role of CT for decision making in septic patients, CT findings do not predict patient outcomes in this retrospective analysis.

Urinary excretion of low-osmolar contrast media during small-bowel follow-through studies in infants is not definitive evidence of bowel perforation.

Presence of contrast agent in the urinary system in infants after small-bowel follow-through study with low-osmolar contrast media has been described as a sign of bowel perforation. To evaluate how often the presence of contrast agent in the bladder after small-bowel follow-through is a reliable sign of bowel perforation or necrosis. From the radiology information system, we retrieved imaging reports of infants evaluated with small-bowel follow-through and findings of contrast agent in the bladder. We retrieved demographic and clinical information from the medical records. Presence of bladder contrast medium was considered true-positive evidence of bowel perforation or necrosis if confirmed by pneumoperitoneum, extraluminal contrast agent, surgery or pathology within 3days of the small-bowel follow-through. False-positives for bowel perforation or necrosis were based on surgical findings or clinical follow-up. Of the 207 infants who had small-bowel follow-through, 18 infants (12 boys; mean age 50days, range 14days to 8.5months) had contrast medium in the bladder after the small-bowel follow-through. Fifteen of the 18 (83.3%) had a history of prematurity and 11 had prior abdominal surgery. Four of the 18 (22.2%) had bowel perforation or necrosis at surgery or pathology performed more than 3days after the small-bowel follow-through and were considered indeterminate and excluded. Eight of the remaining 14 infants (57.1%) had bowel perforation or necrosis based on surgical evidence of perforation or pathology confirmation of necrosis (n=6), pneumoperitoneum (n=1) or contrast agent leakage from enterocutaneous fistula (n=1). Six of the 14 (42.9%) were false-positives, without evidence of bowel perforation or necrosis based on clinical follow-up (n=4) or surgery (n=2). Demonstration of urinary contrast agent post small-bowel follow-through with low-osmolar contrast medium in newborns/infants with complex medical problems is not a definitive indication of bowel perforation or necrosis. More than one-third of our patients with contrast medium in the bladder did not have bowel perforation or necrosis.

Time Is Money: Considerations for Measuring the Radiological Reading Time.

Timestamps in the Radiology Information System (RIS) are a readily available and valuable source of information with increasing significance, among others, due to the current focus on the clinical impact of artificial intelligence applications. We aimed to evaluate timestamp-based radiological dictation time, introduce timestamp modeling techniques, and compare those with prospective measured reporting. Dictation time was calculated from RIS timestamps between 05/2010 and 01/2021 at our institution (n = 108,310). We minimized contextual outliers by simulating the raw data by iteration (1000, vector size (µ/sd/λ) = 100/loop), assuming normally distributed reporting times. In addition, 329 reporting times were prospectively measured by two radiologists (1 and 4 years of experience). Altogether, 106,127 of 108,310 exams were included after simulation, with a mean dictation time of 16.62 min. Mean dictation time was 16.05 min head CT (44,743/45,596), 15.84 min for chest CT (32,797/33,381), 17.92 min for abdominal CT (n = 22,805/23,483), 10.96 min for CT foot (n = 937/958), 9.14 min for lumbar spine (881/892), 8.83 min for shoulder (409/436), 8.83 min for CT wrist (1201/1322), and 39.20 min for a polytrauma patient (2127/2242), without a significant difference to the prospective reporting times. In conclusion, timestamp analysis is useful to measure current reporting practice, whereas body-region and radiological experience are confounders. This could aid in cost–benefit assessments of workflow changes (e.g., AI implementation).

10,589 CT pulmonary angiograms: evaluating the yield of acute pulmonary embolism.

To evaluate the change in the number of CT pulmonary angiograms (CTPAs) performed and the change in the yield of acute pulmonary embolism (PE) on CTPA at a busy tertiary teaching hospital from 2016 to 2019. All CTPA examinations for both in-patients and emergency department patients performed at our busy tertiary teaching hospital between 1 January 2016 and 31 December 2019 were identified from the radiology information system. A natural language processing technique called phrase matching was employed to assign each of the examination reports a result of either positive, negative or equivocal for acute PE. This algorithm was validated on a sample of 200 reports. The number of CTPAs performed increased 59% from 2016 to 2019. The overall yield of acute PE has remained steady averaging 15.9%, ranging from 15.0% to 17.2%. Over 3 years, there has been a significant increase in the demand for CTPA examinations. The yield of acute PE has remained steady indicating a justified increase in demand. The yield of acute PE on CTPA within our centre is higher than the Royal College of Radiologists' suggested minimum of 15.4% which suggests the current guidelines used for the investigation of suspected acute PE within our centre are appropriate. The guidelines and subsequent yield of acute PE on CTPA at our tertiary teaching hospital can be used as a reference standard for other similar institutes.

Neural Network Detection of Pacemakers for MRI Safety

Flagging the presence of cardiac devices such as pacemakers before an MRI scan is essential to allow appropriate safety checks. We assess the accuracy with which a machine learning model can classify the presence or absence of a pacemaker on pre-existing chest radiographs. A total of 7973 chest radiographs were collected, 3996 with pacemakers visible and 3977 without. Images were identified from information available on the radiology information system (RIS) and correlated with report text. Manual review of images by two board certified radiologists was performed to ensure correct labeling. The data set was divided into training, validation, and a hold-back test set. The data were used to retrain a pre-trained image classification neural network. Final model performance was assessed on the test set. Accuracy of 99.67% on the test set was achieved. Re-testing the final model on the full training and validation data revealed a few additional misclassified examples which are further analyzed. Neural network image classification could be used to screen for the presence of cardiac devices, in addition to current safety processes, providing notification of device presence in advance of safety questionnaires. Computational power to run the model is low. Further work on misclassified examples could improve accuracy on edge cases. The focus of many healthcare applications of computer vision techniques has been for diagnosis and guiding management. This work illustrates an application of computer vision image classification to enhance current processes and improve patient safety.

Comparison of Anterior-Cruciate Ligament Tear in Adults and Adolescent Patients

Objective: To compare the anterior-cruciate ligament tear in adults and adolescent patients. Study Design: Retrospective study Place and Duration of Study: Department of Orthopaedics, Pak Red Crescent Medical &amp; Dental College, Dina Nath from 1st January 2020 to 31st December 2021. Methodology: One hundred patients were enrolled and they divided into two groups, each having 50 patients. Group I had patients within the age group 12-20 years while in Group II had patients within the age of &gt;20 years. Demographic details of each patient and their clinical history was recorded. A radiological information system applied for imaging interpretation with neutral-rotation of knee up to 10-15ᵒ flexion. Results: The mean age of group I patients was 17.5±1.5 years and group II patients was 31.2±2.1 years with more males between both groups than females. There were 19 right and 31 left knees in group I and 21 right and 29 left knees in group II respectively. The tibial-internal rotation had a comparatively significant degree increase in group II in comparison with group I. Conclusion: In adults the tibial-internal rotation had a comparatively significant degree increase than adolescents. Keywords: Anterior-cruciate ligament, Knee, Tibial rotation

Is there a correlation between urolithiasis in horseshoe kidneys and isthmus thickness or renal angulation?

Stone disease is a common complication of horseshoe kidneys (HSK). There are currently limited studies that examine the relationship between HSK anatomy and stone formation. We aim to determine if there is such an association by measuring the isthmus size and renal angulation in both stone and non-stone forming HSK using computed tomography (CT). This is a retrospective study performed at a single tertiary centre. Using the radiological information system, all CT reports between 01 January 2010 and 31 December 2015 were searched for the keyword 'horseshoe' on the radiological information system. This produced a list of 285 reports. Each report and image packet of these 285 studies were reviewed to confirm the presence of an HSK and duplicate patients from multiple examinations were highlighted. One hundred and thirty-eight unique HSK patients were obtained and the studies were assessed for the presence or absence of stones. A total of 112 HSK were found; 88 of which contained no stone and 24 with stone. Angle measurements and isthmus size were measured on these kidneys. As axial images are obtained as standard in all cases, these measurements were all obtained in the axial plane. All parameters were measured and recorded manually by one person so as to reduce inter-observer variability. Isthmus size varied widely, measuring from 2 to 39 mm. Right renal angle ranged from 51 to 158°, left 38 to 152°. The isthmus size and renal angle measurements were not found to be significant determinants for stone disease in our patient population.

Clinical and pathologic characteristics of long-term glioblastoma survivors.

e14040 Background: Glioblastoma (GBM) is an aggressive brain tumor with a mean survival of 14 months. A small subset of patients live &gt; 3 years and are classified as long-term survivors (LTS). To better understand factors influencing prognosis, we conducted a large retrospective single institution study using a novel method to identify LTS characteristics. Methods: Using a combination of regular expression (RegEx) search and natural language processing (NLP) in Python, data extracted from the radiology information system (RIS) was used to identify 4425 patients who presented at MD Anderson Cancer Center from 2006-2021 with a pathology-confirmed diagnosis of glioblastoma. Reports mentioning GBM were extracted using RegEx, and we defined overall survival (OS) as the duration between the date of the first CT or MRI report mentioning GBM and the last report on record. To verify the accuracy of this method, we performed a chart review where OS was defined as the date of pathological GBM diagnosis to the current date or date of death. Results: Cases with &lt; 4 imaging reports were filtered to ensure high quality data yielding 2430 patients. The validation of NLP survival determination revealed a sensitivity and specificity of 94.7% and 97.6%, respectively and a mean absolute error percentage of 19.40% when tested against manual chart review. Mean OS of the GBM patients was 631 days. 38.9% (n = 946) of patients were female with average survival of 22.56±27.94 months while 61.1% (n = 1484) were male with an average survival of 19.55±25.96 months (p = 0.008). 61.1% (n = 1485) survived ≤1 year, 28.1% (n = 682) survived 1-3 years, and 10.8% (n = 263) survived ≥3 years. Average age for short-term survivors (STS) (&lt; 1 year) was 52.42 ± 13.698 months and average age for LTS (&gt; 3 years) was 54.75±13.965 months (p &lt; 0.001). IDH mutants had a mean survival of 38.20 months while IDH wildtype patients survived 17.69 months (p &lt; 0.0001). MGMT unmethylated patients had a mean survival of 13.70 months while methylated MGMT patients survived 23.99 months (p &lt; 0.0001). Conclusions: Our OS statistics align with past literature. IDH mutants had better survival than wildtype and MGMT methylated tumors had better survival than unmethylated tumors. There was a significant difference in OS between male and female patients and in age between LTS and STS. Filtering patients with &lt; 4 imaging reports removed poor quality patient data and likely left-skewed our data as the appearance of poor-quality patient data overlaps with those with exceptionally short survival. Our NLP method is a reliable method by which to large oncologic population trends. Understanding differences between LTS and STS can help with improving individualized treatment strategies. Our database is also well positioned for future studies, especially those relating the effects of radiation, chemotherapy, extent of resection, and imaging characteristics on survival.

Report of the 2020 British Nuclear Medicine Society survey of nuclear medicine equipment, workforce and workload.

The British Nuclear Medicine Society (BNMS) survey represents the only resource that brings together detailed information on equipment, workforce and workload from the practice of nuclear medicine in the UK. This article is a report of the most recent BNMS survey which was collected during 2019 and 2020. The survey used two methods to collect data: for equipment and workforce, participants created or updated existing online records; for workload information, respondees were asked to submit 12 months of data from local radiology information systems. Following the survey, the BNMS database contained a total of 191 sites (63% of known sites) having either equipment or workforce data or both. In total 39 centres provided workload data which included over 175 000 examinations. A combination of automated tools and visual inspection were used to clean, sort and validate submitted data into formats that allowed further analysis and extraction of useful parameters. Results are presented that the authors believe may be useful for nuclear medicine professionals and other stakeholders. Potential applications include benchmarking for service review and equipment replacement/updating. The survey represents a valuable resource that might be used by the BNMS secretariat to respond to specific queries from BNMS members.

Diyabetik Retinopatili Hastalarda Vitreus Mizah Değişikliklerinin Difüzyon MRG ile Değerlendirilmesi

Aim: The objective of this study was to use diffusion-weighted imaging (DWI) to determine changes in the vitreous humor in diabetic retinopathy patients.Materials and Methods: All diabetic retinopathy patients over the age of 18 who had brain diffusion magnetic resonance imaging between May 1, 2019, and May 1, 2021, and whose images were available in the radiological information system were retrospectively scanned on our database. The study included 51 diabetic retinopathy patients and 51 non-diabetic control group patients. The t-test was used to compare the values of the vitreous humor apparent diffusion coefficient (ADC) in diabetic retinopathy patients with control group patients.Results: Patients with diabetic retinopathy had significantly higher minimum, median, and maximum ADC mean values in the right eye than the control group (p=0.011, p=0.007, p=0.026). Patients with diabetic retinopathy had significantly higher median and maximum ADC averages in the left eye than those in the control group (p=0.020, p=0.012). Although the mean minimum ADC of the left eye was higher in diabetic retinopathy patients than in the control group, the difference was not statistically significant (p=0.387).Conclusion: Because of the rise in ADC values in diabetic retinopathy patients compared to the normal control group, we detected that DWI could be used to assess if the vitreous humor is affected in this disease.

Isolated pathologies of Tensor Fasciae Latae: Retrospective cohort analysis from a tertiary referral centre

IntroductionTensor Fasciae Latae (TFL) and the iliotibial band (ITB) act as a single functional unit in maintaining pelvic stability whilst standing, walking, or running in human beings. The Tensor Fasciae Latae (TFL) muscle acts across the hip and the knee joint. Consequently, though its pathologies traditionally present with lateral hip pain, identifying the precise clinical diagnosis can be a challenge. Patients and methodsA retrospective search for the keyword ‘Tensor Fasciae Latae’/iliotibial band (ITB) was performed of our Radiology Information System (RIS) and Picture Archiving and Communication System (PACS), Computerised Radiology Information System (CRIS) at our tertiary orthopaedic referral centre of a for orthopaedic oncology over a period of 13 years (2007–2020). Data was collected from RIS, oncology database and local histopathology laboratory records. Patient demographics, clinical characteristics, complementary imaging and clinical management outcome were documented. ResultsWe identified 35 patients with a mean age of 66 years (range 19–94 years). There were 18 female and 17 male patients. Lateral hip lump and pain were the most frequent clinical finding/presentation features. A variety of pathologies such as benign and malignant tumours, including vascular and tumour mimic lesions involving the TFL muscle were identified. Atrophy and pseudohypertrophy of TFL was the commonest pathology found; accounting for two thirds of the cases. ConclusionTensor Fasciae Latae (TFL) can be afflicted with a broad spectrum of pathologies. Radiological imaging especially cross-sectional imaging modality is crucial in guiding appropriate patient management of TFL conditions. Our analysis suggests isolated TFL lesion are more likely to be benign conditions, presenting commonly as hip pain and swelling.

Liver iron quantification in children and young adults: comparison of a volumetric multi-echo 3-D Dixon sequence with conventional 2-D T2* relaxometry.

Magnetic resonance imaging (MRI)-based liver iron quantification is the standard of care to guide chelation therapy in children at risk of hemochromatosis. T2* relaxometry is the most widely used technique but requires third-party software for post-processing. Vendor-provided three-dimensional (3-D) multi-echo Dixon techniques are now available that allow inline/automated post-processing. The purpose of our study was to evaluate the diagnostic accuracy of a volumetric multi-echo Dixon technique using conventional T2* relaxometry as the reference standard in a pediatric and young adult population. In this retrospective study, we queried the radiology information system to identify all MRIs performed for liver iron quantification from July 2015 to January 2020. All patients had undergone T2* relaxometry on a 1.5-tesla (T) scanner for liver iron concentration (LIC) estimation. In addition, a 3-D multi-echo Dixon was performed using Siemens Healthineers LiverLab (Erlangen, Germany). Two readers independently estimated liver R2* and T2* on the multi-echo Dixon by drawing free-hand regions of interest on the scanner-generated R2* and T2* maps. Conventional T2*-relaxometry-based LIC was the reference standard. We estimated interobserver agreement by concordance correlation coefficient (CCC). We used Bland-Altman analysis and Pearson correlation coefficient (r) to compare LIC by the two methods. Fifty-four MRIs on 38 patients (22 females) were available for analysis. Mean patient age was 11.8years (standard deviation [SD] 5.3years). Reference standard LIC ranged 1.1-21.1 (median 6.8) mg/g dry weight of liver. The concordance between readers for T2* estimation using 3-D multi-echo Dixon was substantial (CCC 0.99, confidence interval 0.99-1.00). Bland-Altman plot showed that all observations were clustered around the zero bias line if the LIC average was ≤8mg/g, and r was very strong (reader 1 r=0.93, reader 2 r=0.92, both P-values <0.001). With increasing LIC, there was a pattern of poor agreement on the Bland-Altman plot, with observations crossing the lower limits of agreement, and r was very weak (reader 1 r=0.05, P-value 0.84; reader 2 r=0.17, P-value 0.44). Vendor-based 3-D multi-echo Dixon allows for excellent interobserver correlation in liver T2* estimation. LIC estimated by this method has a very strong correlation with conventional T2* relaxometry if liver iron overload is mild-moderate (LIC ≤8mg/g).

Adopting low dose CT in evaluating renal calculi-progress from 2008-18 in a large UK tertiary hospital

Background: Computed tomography (CT) of the urinary tract is a commonly performed investigation and it is crucial to adhere to low dose protocols to avoid unnecessary radiation burden. Aims: To review the adoption of low-dose techniques over time, defined as a dose length product (DLP) &lt; 200mGy.cm, in a large teaching hospital over three locations with 12 CT scanners. Methods: Data were obtained from the radiology information system for exams completed under the coding for unenhanced CT evaluation for renal calculi between 14 Feb 2008 and 31 December 2018. Examinations where the DLP was not correctly recorded, was below 40mGy.cm, or where the equipment used could not be identified were excluded. The distribution of doses and the median DLP per scanner was calculated. Results: In all, 20,080 studies were available across 12 CT scanners in the 10- year period. The average Median DLP has reduced from 501mGy.cm in 2008 to 178mGy.cm in 2018. Conclusions: Improvements in CT technology and implementation of low-dose protocols have resulted in significantly lower doses for evaluation of kidney stones since 2008. Although this study demonstrates significant variation between scanners, the overall adoption of low dose techniques is excellent. Level of evidence: Not applicable

A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting.

BackgroundBilious vomiting in children requires an urgent evaluation with upper gastrointestinal (UGI) fluoroscopy as it may herald life-threatening midgut malrotation with volvulus (MMWV). There are no published data available on the duration of time-critical UGI workflow steps.ObjectivesA digital audit of workflow in emergency UGI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital.MethodA retrospective study was conducted from 01 May 2012 – 31 May 2019. A customised search of the institutional radiology information system (RIS) defined all children with bilious vomiting who underwent emergency UGI fluoroscopy. Extracted RIS timestamps were used to calculate the median duration of the ‘approval’, ‘waiting’, ‘study’ and ‘reporting’ times. One-way analysis of variance and Chi-squared tests assessed the association between key parameters and the duration of workflow steps, with 5% significance (p < 0.05).ResultsThirty-seven patients (n = 37) with median age 0.8 months were included, of whom 20 (54%) had an abnormal C-loop. The median ‘total time’ from physician request to report distribution was 107 min (interquartile range [IQR]: 67−173). The median ‘approval’ (6 min; IQR: 1–15) and ‘reporting’ (38 min; IQR: 17–91) times were the shortest and longest workflow steps, respectively. Abnormal C-loops (p = 0.04) and consultant referrals (p = 0.03) were associated with shorter ‘approval’ times. The neonatal ‘waiting’ time was significantly longer than that for older patients (p = 0.02).ConclusionThe modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery.

Business intelligence applied to the consumption of iodinated contrast agents in computed tomography scans

BackgroundThe management of the use of iodinated contrast agents (ICA) in the computed tomography (CT) has clinical and financial impacts; however, the approaches in the current research setting have limitations with regard to their exploration of the theme. This work describes the application of the stages of a process of business intelligence (BI), from the formulation of business questions, the building of a research database, and the adaptation of a multidimensional model, to the creation of dashboards to give support to the decision-making process in a hospital. This research aims to apply and document a BI process that provides support to the decision making of managers, so the use of ICA can be better managed, allowing for the identification of situations in which the material was wasted using a study applied to the hospital field.MethodsAn applied exploratory research with a quantitative approach in a database made up by 24 variables and 35,388 records extracted from the RIS (Radiology Information System) that is used by the General Hospital of Porto Alegre—HCPA. The software used, supplied by AGFA Healthcare, were the Qdoc system (version 6.2.0) and the Impax BI (Version 11.1.1) for, respectively, data entry and data exploration. At the end of the process, a total of 48 variables was considered.ResultsThe BI process applied allowed for the identification of situations in which ICA was being wasted during the operationalization of the volume/mass ratio of the agent injected in the patient. It also offered the necessary substantiation for the managers to formulate plans, actions, and controls associated to the use of the material. This work made it possible to diminish in 15.65% the total consumption of ICA injected in the patients who underwent the CTAB1 exam (full CT scan of the abdomen), with a projected economy of US$ 10,039.95, for the performance of this exam from 2020 on. The measuring of the impact and the relevance of the process was 99.6% positive, according to the evaluation of the managers.ConclusionsThis research generated clinical and financial benefits for the HCPA, a positive evaluation by the managers and the generation of new knowledge, which can be shared with other public or private health organizations.

Assessment of the influence of the liver shape on the accuracy of volume measurement and diagnosis of hepatomegaly using computed tomography

The aim of the study is to determine the influence of liver shapes on the accuracy of estimating the organ volume and assessment of hepatomegaly on CT. To develop approaches to improve the accuracy of calculations for various forms of liver.Material and methods. The work is based on the analysis of the results of 603 abdominal CT examinations available in the radiological information systems of the city of Moscow. Six dimensions of the liver were measured: transverse, vertical and anteroposterior dimensions of the right and left lobes. Using automatic segmentation, performed in special software systems IntelliSpase Portal (Philips) and Synapse 3D (Fuji), the maximum close to the true liver volume was calculated. This made it possible to carry out a mathematical analysis to obtain various formulas for calculating the liver volume, depending on its shape. A comparative assessment of the sensitivity and specificity of the developed formulas and the standard one, which does not take into account the shape of the liver, was carried out in relation to the diagnosis of hepatomegaly.Results. During the study, the four most common types of liver forms were identified, for each of which, based on mathematical approaches, formulas for calculating the organ volume were developed. Comparative analysis of these formulas and the previously developed by us standard one showed that the root-mean-square error decreases using the formula for a certain type of liver shape. However, the sensitivity and specificity of the diagnosis of hepatomegaly in the differential approach do not change compared with the standard formula.Conclusion. The existing difference in the forms of the patients’ liver does not significantly affect the approaches to determine the organ volume and establishing the fact of hepatomegaly during CT. Therefore, the standard formula for determining liver can be used in clinical practice: V = (HRL+TRL)3/21, (V – volume, HRL – high of right lobe, TRL – thickness of right lobe).

Radio-Frequency Identifier Devices (RFIDs): Our Experience With Wireless Localisation in Non-palpable Breast Masses at a UK Tertiary Breast Imaging Unit.

The aim of this report is to evaluate the impact of the percutaneous ultrasound-guided placement of wireless radio-frequency identifier devices (RFIDs; Hologic LOCalizer, Marlborough, Massachusett) and its impact in our practice of preoperative localisation of biopsy-proven breast cancers, post-vacuum assisted biopsy-site hematoma, and lymph nodes for targeted dissection pre-operatively.A single institutional retrospective analysis of RFID usage for preoperative localisation in screening and symptomatic patients with non-palpable biopsy-proven breast carcinoma was reviewed from the radiology information system at our tertiary breast imaging unit. Its impact on the radiological and surgical team practice was reviewed, including the number of appointments, the interval between scheduling image-guided localisation and intraoperative localisation, procedure failure, average deployment, and surgical time. Feedback from surgeons and pathologists practice was also taken into consideration.Fifty-nine RFID clips were placed for wireless localisation of breast cancers, lymph nodes, and post-vacuum-assisted biopsy hematoma over nine months. Seventy-three per cent (73%; n=43/59) of RFID devices were placed in biopsy-proven carcinomas under direct ultrasound guidance. The learning curve was small, as the delivery system was similar to the commonly used localisation clips.The pilot process involved RFID with radioisotope injections for the breast mass for the initial 28% (n=12 /43) cases, which were gradually transitioned into RFID only. Radioisotope was used for sentinel node purposes if required. For targeted node dissection, 3% (n=2/59) patients received RFID for biopsy-proven metastatic node localisation, with one of two with adjunct radioisotope injection. Post-vacuum-assisted biopsy (VAB) hematoma was localised in 24% (n=14/59) cases, four of which received adjunct radioisotope in the pilot phase.The average procedure time for RFID deployment was five minutes. The average time for surgery was 20 minutes. 1.6% (n=1/59) incidence of RFID slipping from the surface of the site through surgical exposure attributed to the superficial and immediate pre-operative placement of the RFID. This was salvageable with adjunct radioisotope injection within the pilot phase. There were no incidences of repeat localisation or repeat exploration surgeries.Planned pre-operative localisation with RFID allows for better planning and less pressured service delivery and a success rate of 98-99%. This ultimately avoids lost theatre time and patient demotivation. Surgeons have reported excellent intra-operative detectability in their approach. There has been no difficulty in the detection of the RFID within the surgical cavity despite hematoma. RFID localisers are expensive compared to our usual practice of radioisotope injection but this can be recuperated through uncoupled tariffs like gain in slots of one-stop clinics, flexibility for placement, and avoiding lost theatre time, as these can be placed up to 30 days before surgery.