Radiology Services Research Articles

Development and implementation of a breast imaging order panel in the electronic health record: Helping the ordering providers get it right

Appropriate ordering of breast imaging studies is complex due to the variety of clinical indications and available imaging modalities. Incorrect ordering affects radiology resource allocation due to the different workflows and personnel requirements of screening and diagnostic breast imaging. Through the collaborative efforts of stakeholders in Primary Care, Radiology, and Information Services & Solutions, we developed and implemented a breast imaging order panel in the electronic health record with integrated clinical decision support to facilitate correct order selection for screening patients at average-risk and high-risk of breast cancer and for diagnostic breast imaging of symptomatic patients.

Learning from experience - Radiology ancillary review of prospective research studies involving imaging

This report describes the operational process of a big academic children's hospital's Radiology Scientific Review Committee, with a focus on its role in integrating radiology services into pediatric clinical research. We define the step-by-step workflow used to assess research proposals involving imaging and share insights from the past three years of data collection. Trends in modalities, radiologist involvement, and interpretation possibilities are outlined in the data. This systematic methodology provides essential resource allocation concepts and promotes high-quality pediatric clinical research.

Imaging findings of the injured in the massive Beirut blast.

(1) Describe imaging utilization and findings within two weeks of the 2020 Beirut blast according to the mechanism of injury, (2) determine the appropriate imaging modality per organ/system, and (3) describe changes in the workflow of a radiology department to deal with massive crises. Two hundred sixty patients presented to the largest emergency department in Beirut and underwent imaging within 2 weeks of the blast. In this retrospective study, patients were divided into early (1) and late (2) imaging groups. Patients' demographic, outcome, type and time of imaging studies, body parts imaged, and mechanism and types of injuries were documented. Two hundred five patients in group 1 underwent 502 and 55 patients in group 2 underwent 145 imaging studies. Tertiary blast injuries from direct impact and falling objects were the most common type of injuries followed by secondary (shrapnel) injuries. Both types of injuries affected mostly the head and neck and upper extremities. Plain radiographs were adequate for the extremities and CT for the head and neck. A regularly updated and practiced emergency plan is essential to mobilize staff and equipment and efficiently deliver radiology services during crises. Because the powerful Beirut blast occurred at the port located in the periphery of the city, most injuries seen on imaging were of the upper extremities and head and neck caused by the severe blast wind or penetrating shrapnel and resulted from people using their arms to protect their heads and bodies from direct impact and falling objects.

New Challenges for Radiology Professionals during the COVID-19 Pandemic

Aims: Analyze the new challenges faced by radiology professionals in managing suspected or confirmed COVID-19 patients and understand their implications for the safety strategies of these professionals and patients.
 Methodology: The method used was an integrative literature review, conducted by searching for publications in indexed journals in the databases PubMed, SciELO, Scopus, and ScienceDirect, covering the years from 2015 to 2020.
 Results: In the data analysis, the articles were classified into 20 units of analysis, with information presented as sub-themes related to the publications of the selected studies, with a focus on the synthesis of the results.
 Conclusion: In conclusion, it is essential that not only all professionals involved in the process possess knowledge and preventive measures, but also that the entire radiology service is adequately prepared to receive patients, thereby ensuring greater stability in terms of environmental biosafety.

Dedicated to the Memory of Academician Grigory Vasilievich Bondar and the 80th Anniversary of the Oncological Service of Donbass

The oncological service of Donbass has a rich history. The path of its formation began in 1943, when on September 9, 1943, Professor M.K. Afanasiev signed an order to restore the activities of the Stalin X-ray station and the oncological hospital.The first organizer of the radiological service in the Donbass is considered to be Ekaterina Vladimirovna Stelling, who was appointed in 1946 to the post of head of the oncological hospital in Stalino. The radiological service appeared in 1947, when the Regional Oncological Dispensary was organized. Soon the institution was renamed the Donetsk Regional Oncological Dispensary (DROD). Soon the institution was renamed the Donetsk Regional Oncological Dispensary. In 1955, DROD, in order to increase the number of beds, was transferred to the base of the Regional Clinical Hospital. M.I. Kalinin.Under the leadership of Grigory Vasilyevich Bondar, in September 1968, an oncology course was organized, the clinical base of which was DROD. August 19, 1975 Grigory Vasilyevich headed the Department of Oncology, established at the Donetsk State Medical Institute. M. Gorky. October 12, 1992 Donetsk Regional Oncology Center received the status of an antitumor center. Academician of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Grigory Vasilyevich Bondar has been appointed its General Director.The center, which subsequently became the leading one in Ukraine, had the greatest experience in surgical and combined treatment of tumors of various localizations using the methods proposed in the clinic. In 2006, the first radiotherapy complex in Ukraine was installed in the Donetsk Regional Cancer Center.At the beginning of 2014, our teacher passed away. Students with dignity continue the work of Bondar Grigory Vasilyevich. At the end of 2014, on the basis of the Donetsk Regional Antitumor Center, the Republican Cancer Center of the Ministry of Health of the Donetsk People’s Republic was created, which was named after Professor Grigory Vasilyevich Bondar. The Center proudly bears the name of the great Teacher Grigory Vasilyevich Bondar! And in our present life, he is still a mentor and assistant!We are sure that the symbiosis of science and practice of a team of professionals who selflessly give their knowledge, experience and skills for the benefit of patients will give a powerful impetus to the further development of the oncological service of Donbass.

Improving On-Time Starts for Pediatric Cardiac MRI

PurposeDelayed start times for cardiac MRI examinations have resulted in longer patient fasts, extended wait times, and poor synchronization of anesthesia induction and contrast administration. The aim of this work was to improve on-time start rates from an initial baseline of 10%. MethodsA multidisciplinary team comprising members of the cardiac and radiology services used the Realizing Improvement Through Team Empowerment methodology to target the root causes of the delays and enhance workflow. The main factors identified as contributing to examination delays were late patient arrival, variations in patient preparation time, unavailability of equipment, and inefficient scheduling processes. ResultsThe implementation of various interventions, such as the use of standardized appointment scripts, ensuring timely patient preparation, and ensuring the availability of equipment when required, resulted in an increase in on-time start rates for cardiac MRI examinations to 34%. ConclusionsThe study’s systematic approach proved to be valuable in both understanding and resolving the identified problems. Through the continuous application of plan-do-study-act cycles, the authors effectively pinpointed obstacles and tested multiple potential measures to overcome them. This approach made it possible to comprehend the issue and to implement targeted interventions to address it.

Assessment of X-ray films and image quality in diagnostic radiology departments of teaching hospitals in Iraq

Background: Patients undergo repeated X-ray examinations after their initial X-ray radiographs are rejected due to poor image quality. Reject analysis in digital radiography (CR) helps guide the education and training of staff, influences department workflow, reduces patient dose and improves department efficiency. The role of reject analysis in providing relevant information that would help achieve a sound reduction in radiation exposure. Aims:To assess the reasons for X-ray film rejection and to analyze reasons for deletions to improve the radiological services. Methods: The data were collected from about 200 rejected films from different hospitals in Iraq from January 2021 to August 2021. The reject rate, reasons for rejection for individual radiographers, examination types and projections used a structured format on which investigators recorded relevant data for rejection. The results were then collected and entered into a database for analysis. Results: Reject rate and cause of rejection were measured across all plane X-ray examinations for the hospitals in Kirkuk General Hospital at 8.1%, Mosul General Hospital at 13.9% and Al-Jumhory Hospital at 6.4%. Study cases and (appointment) 16.1%, Mass & Kv with positioning error 3.7%. The examinations with the highest percentage of deleted images were the chest, lumber spine & knee joints, 13.2%, 3.2% and 1.7%, respectively. Conclusions: Creating awareness among the student reduces the overall reject rate. The outcome of this study can be used to set up training programs to improve radiological services and reduce unnecessary radiation exposure to patients.

Rising use of diagnostic imaging in Australia: An analysis of Medicare-funded radiology services between 2000 and 2021.

The use of diagnostic imaging services is increasing worldwide. This has important impacts on healthcare resource allocation and potential risks to the population. This study aimed to quantify trends in medical imaging in Australia over the past two decades. Data were extracted from the Australian Medicare Benefits Schedule (MBS) between 2000 and 2021. Simple linear regression analyses were performed to assess changes in absolute utilisation and utilisation rate per 100,000 population of total imaging services as well as by each imaging modality. Logistic regression analysis was performed to assess changes in total imaging services as a proportion of total Medicare services over time. Chi-squared test was used to assess for change in modality composition of imaging services. There were 436,255,500 imaging studies performed between 2000 and 2021. The absolute utilisation of total imaging services increased annually by an average of 864,404 (95% CI: 808,235-920,573, p < 0.001). For each consecutive year, the proportion of total Medicare services attributed to total imaging services increased by 0.01% (95% CI: 0.01-0.01, p < 0.01). There was also a statistically significant increase in the utilisation rates of imaging services per 100,000 population for each imaging modality. The number of imaging services per radiologist increased on average by 74 (95% CI: 26-122, p < 0.05) annually. The utilisation of diagnostic imaging services has increased in Australia between 2000 and 2021, outpacing the population growth, total healthcare services, and the radiologist workforce.

Evaluation of X-ray doses in paediatrics multislice computed tomography

The present paper aims to examine the doses delivered to children at the paediatric Computer Tomography (CT) unit in the radiology service of the Mother and Child Hospital (MCH) in the Mohammed VI University Hospital Centre (Med VI UHC) of Marrakech, Morocco, and to compare our values with the dosimetric data of the published literature. This investigation included 440 CT examinations of the head, chest, and abdomen-pelvis in paediatric patients whose ages ranged from 1 to 5 yr (AG1y­5y), 5 to 10 yr (AG5y­10y), and 10 to 15 yr (AG10y­15y). We estimated the 75th percentile values of the Volume Computed Tomography Dose Index CTDIvol (mGy) and the Dose-Length-Product DLP (mGy.cm). The obtained results showed that the calculated 75th percentile of DLP for head CT are less than the National Diagnostic Reference Levels (DRLs) observed in Japan, Belgium, Germany, French, United Kingdom, United State, and China. However, the proposed DRLs for the abdomen-pelvis, and chest CT are significantly higher compared with international DRLs.

Working with Hospital Administration: Strategies for Success.

Organizational structure has evolved over the past several decades, with physicians assuming more or fewer leadership positions over time. Regardless of the role of physicians in health care organizational leadership, constant meaningful communication with the hospital, radiology group, or greater physician group administrative leadership is vital for any group of IR physicians to be successful. Understanding what is considered important to hospital administration and, in particular, being closely aligned with the C-suite leadership, is paramount to having successful communication with these stakeholders. Although each situation will obligatorily be unique, certain themes can be followed to optimize the working relationship between an interventional radiology service and organizational administration. This article provides guidelines and suggestions specifically in communicating with health care system leadership.

CURRENT ISSUES OF ASSESSING THE EFFECTIVENESS OF RADIOLOGICAL STUDIES CONDUCTED WITHIN THE GUARANTEED VOLUME OF FREE MEDICAL CARE AND IN THE SYSTEM OF MANDATORY SOCIAL HEALTH INSURANCE

The purpose of the study is to analyze the effectiveness parameters of the radiological service on the example of Almaty in 2022. Literature review of foreign and domestic literature concerning the issues of organization of radiology service for the period from 2005 to 2022 was carried out. Conclusion. Thus, to increase the value of imaging, cost management is required, in addition to improving quality and outcomes. Radiologists should be involved in calculating the costs of radiology examinations, and a review of the parameters for assessing the effectiveness of the radiology service is necessary

Hubungan Pengetahuan dan Kepatuhan Penerapan Proteksi Radiasi: Studi pada Mahasiswa Praktik Klinik Jurusan Teknik Radiodiagnostik dan Radioterapi, Poltekkes Kemenkes Semarang

Background: Radiation protection is very important for patient and personnel safety in radiology services. It has been given in the college through classical lectures, including in Radiodiagnostic and Radiotherapy Department Poltekkes Kemenkes Semarang. The student’s knowledge is routinely evaluated but their compliance in the clinical activities has never been specifically observed. This study aims to find out the relationship between knowledge toward compliance of the application of radiation protection on clinical practice students.Methods: This is quantitative research with a cross-sectional design. Research was conducted on 90 second-year clinical internship students of the Radiodiagnostic and Radiotherapy Department. The level of knowledge was measured by written test, while the level of compliance was observed by clinical observation. The affecting factors are investigated through indepth interview. Data were analyzed by Spearman Rank Correlation.Results: The knowledge levels among the students were "excellent” (18%), "good" (68%), and "fair" (14%). The radiation protection compliance levels were "good" (73%) and "very good" (27%). There was a significant relationship between radiation protection knowledge level toward radiation protection compliance (p value 0.05). The strength of the relationship was low (coefficient interval = 0.257). Conclusions: There was a relationship between knowledge and the level of compliance, but it was not the only influencing factor. The environment tends to have an effect on the level of compliance. Radiographers and clinical instructors should be good role model in applying radiation protection.

From Pixels to Pathology: Employing Computer Vision to Decode Chest Diseases in Medical Images.

Radiology has been a pioneer in the healthcare industry's digital transformation, incorporating digital imaging systems like picture archiving and communication system (PACS) and teleradiology over the past thirty years. This shift has reshaped radiology services, positioning the field at a crucial junction for potential evolution into an integrated diagnostic service through artificial intelligence and machine learning. These technologies offer advanced tools for radiology's transformation. The radiology community has advanced computer-aided diagnosis (CAD) tools using machine learning techniques, notably deep learning convolutional neural networks (CNNs), for medical image pattern recognition. However, the integration of CAD tools into clinical practice has been hindered by challenges in workflow integration, unclear business models, and limited clinical benefits, despite development dating back to the 1990s. This comprehensive review focuses on detecting chest-related diseases through techniques like chest X-rays (CXRs), magnetic resonance imaging (MRI), nuclear medicine, and computed tomography (CT) scans. It examines the utilization of computer-aided programs by researchers for disease detection, addressing key areas: the role of computer-aided programs in disease detection advancement, recent developments in MRI, CXR, radioactive tracers, and CT scans for chest disease identification, research gaps for more effective development, and the incorporation of machine learning programs into diagnostic tools.

Compassionate, respectful care and associated factors among radiology clients at public hospitals in Addis Ababa, Ethiopia

BackgroundCompassionate and Respectful Care (CRC) is the basic radiology professional practice. Even though it is an essential component for all health practitioners, limited evidence was available in the study area, especially focusing on radiology services. Identifying levels of compassionate and respectful care and associated factors help in recommendations for improvement for radiology professionals to deliver service with a good habit of compassion and respect to their clients. Therefore, this study aimed to assess the level of compassionate and respectful care and associated factors among radiology clients. MethodsFacility-based cross-sectional study design was conducted from July 6 –27, 2022 in public hospitals in Addis Ababa, Ethiopia. Those hospitals were Tikur Anbessa Specialized Hospital, Armed Force Comprehensive Specialized Hospital, and St. Paulos Hospital. A systematic random sampling technique was used to select patients visited radiology departments and radiographers. Epi-Data version 6 and SPSS version 26 were used for data entry and analysis, respectively. Bi-variable and multivariable logistic regression analysis models are used to identify associated factors. Statistical significance was determined using a P-value of less than 0.05 and an adjusted odds ratio with a 95% confidence level. ResultsA total of 333 respondents were involved in the study with a response rate of 99.1%. Overall, compassionate and respectful care of radiology service providers were 66.7% and 70.9% respectively. Mode of transport (AOR (Adjusted Odd Ratio) =2.2, 95% CI (Confidence Interval): 1.00–4.81), waiting time (AOR= 4.10, 95% CI; 1.92–8.76), CRC training (AOR= 2.35, 95% CI; 1.34–4.12) and workload (AOR= 4.02, 95% CI; 1.9–8.51,) were significantly associated with compassionate care. Distance (AOR=2.98, 95% CI: 1.34–6.61), mode of transport (AOR=4.9, 95% CI; 2.09–11.5), number of service providers (AOR=0.52, 95% CI; 0.27–0.98), CRC training (AOR=2.15, 95% CI; 1.18–3.93) and workload (AOR=7.04, 95% CI; 3.13–15.8) were significantly associated with respectful care provision among radiology clients. ConclusionCompassionate and respectful care radiology service provision in Addis Ababa public hospitals was similar as compared with other studies. Waiting time, transportation, the number of service providers, Compassionate and respectful care training, and workload were significantly associated with compassionate and respectful care service provision. Providing adequate compassionate and respectful care training for service providers, reducing waiting time, and balancing the service provider-to-client ratio should enhance compassionate and respectful care service provision.

Patient satisfaction with radiology services in the UAE: A comprehensive analysis of care, comfort, service, and accessibility

IntroductionThis paper analyses patient satisfaction with radiology services in the United Arab Emirates (UAE). The study evaluates the care, comfort, service, and accessibility of the services and patient satisfaction with imaging procedures. MethodsThe research design employed a descriptive, cross-sectional approach, and data were collected through a survey consisting of eight sections. A total of 444 participants completed the survey, providing valuable insights into their demographics, appointment experiences, waiting times, staff attitudes and overall satisfaction. Results70.4% of the participants stated that it was easy to make appointments, and 66.1% stated that they were satisfied with the efficiency of check-ins. 54.9% felt they waited the right amount of time to make an appointment, and 56.1% were satisfied with the time waiting to receive the imaging report. The findings indicate that waiting times and staff attitudes significantly influence patient satisfaction, while demographic factors, such as nationality, education, and age, do not significantly impact them. The study concludes that healthcare providers should prioritise efficient appointment scheduling, reduce waiting times and foster positive patient–staff interactions to enhance patient satisfaction. The open-ended feedback provided by the participants also offers valuable suggestions for improving service quality. ConclusionThis study is a foundation for future research and provides healthcare organisations with valuable insights to enhance patient satisfaction in UAE radiology services. Implications for practiceHealthcare providers should focus on patient satisfaction to improve retention and loyalty, attract new patients and enhance their reputation.

932 Provision of a 7 Day Radiology Service for Emergency Laparotomy Patients: Are We Compliant with Current Standards?

Abstract Introduction According to “NHS services, Seven Days a week Forum”, a radiological scan should be reported within 1 hour for “critical” requests and within 12 hours for “urgent “ones. Requests are considered critical when the test will alter patient’s management at the time; and urgent if the test will alter management but not necessarily that day. Aim The aim was to audit whether the above standards were met for urgent and critical requests for patients undergoing emergency laparotomy. Method A single centre retrospective audit of adults undergoing emergency laparotomy between 01/02/2014 to 30/12/2021 was performed. Data was collected from the National Emergency Laparotomy Audit database. A total of 1748 patient records were analysed out of which 1309 were included. Patients who underwent pre-operative CT scan in the same admission were included. Patients who had CT prior to admission for laparotomy and those who had more than one operative intervention were excluded. CT time was calculated as time taken from CT examination to reporting. Results Standards were met for 27.5% of all investigations ordered. 0.16% of Critical, and 53% of urgent scans were reported within required times. There was no difference in standards met between weekends and weekdays. Conclusions Limitations include the retrospective nature of data collection and amendment time being recorded instead of original reporting time for some scans. Recommendations include allowing time frames for standards and retaining interim report times.

The Landscape of Rural and Remote Radiology in Canada: Opportunities and Challenges.

Diagnostic and interventional radiology play a crucial role in healthcare, facilitating diagnosis of disease, treatment planning, interventional therapies, and assessment for response to treatment. However, many rural and remote regions are disproportionately limited in accessing high-quality radiological services. Challenges include limited imaging infrastructure in these communities, geographic isolation, and workforce shortages impacting provision of interventional image-guided procedures and subspecialty imaging in particular. However, a career in rural or remote radiology also presents unique opportunities including a deep sense of community, broad scope of practice, and immense benefit to patient care. This review aims to explore the landscape of rural and remote radiology with a focus on Canada, including opportunities, challenges, and potential strategies. Some of the challenges are shared by both rural and remote communities while others are distinct. Factors that have contributed to challenges in recruitment and retention of rural and remote radiologists include workload burden, inadequate or suboptimal imaging and interventional equipment, and limited exposure during training. Additionally, strategies to improve the provision of radiology services in rural and remote communities are highlighted, addressing both the workforce shortage and the lack of essential equipment and other resources.

Assessment of Required Patient Travel to Receive Interventional Radiology Services in the Resource-Limited Setting of Tanzania

This study aimed to evaluate the geographic patient profile of a country’s first interventional radiology (IR) service in sub-Saharan Africa. From October 2018 to August 2022, travel time (1,339 patients) and home region (1,184 patients) were recorded from 1,434 patients who underwent IR procedures at Tanzania’s largest referral center. Distances traveled by road were calculated from the administrative capital of each region using a web mapping platform (google.com/maps). The effect of various factors on distance and time traveled were assessed. Patients from all 31 regions in Tanzania underwent IR procedures. The mean and maximum calculated distance traveled by patients were 241.6 km and 1,387 km, respectively (Sk2 = 1.66); 25.0% of patients traveled for over 6 hours for their procedure. Patients traveled furthest for genitourinary procedures (mean = 293.4 km) and least for angioplasty and stent placement (mean = 123.9 km) (P < .001). To increase population access and reduce travel times, geographic data should be used to decentralize services.

INCIDENTAL FINDINGS AND CLINICAL SIGNIFICANCE OF PREOPERATIVE CT IMAGING FOR THE PLANNING OF ROBOTIC ARTHROPLASTY

AbstractIntroductionTotal joint arthroplasty (TJA) is one of the commonest and most successful orthopaedic procedures, used for the management of end-stage arthritis. With the recent introduction of robotic assisted joint replacement, Computed Tomography (CT) has become part of required pre-operative planning.The aim of this study is to quantify and characterise incidental CT findings, their clinical significance, and their effect on planned joint arthroplasty.MethodologyAll consecutive patients undergoing an elective TJR (hip or knee arthroplasty) were retrospectively identified, over a 3-year period (December 2019 and December 2022). Data documented and analysed included patient demographics, type of joint arthroplasty, CT findings, their clinical significance, as well as potential delays to the planned arthroplasty because of these findings and subsequent further investigation.ResultsA total of 624 patients (637 studies, 323 (51.8%) female, 301 (48.2%) male) were identified of which 163 (25.6%) showed incidental findings within the long bones or pelvis. Of these 52 (8.2%) were significant, potentially requiring further management, 32 (5.0%) represented potential malignancy and 4 (0.6%) resulted in a new cancer diagnosis.ConclusionIt is not currently national standard practice to report planning CT imaging as it is deemed an unnecessary expense and burden on radiology services. Within the study cohort 52 (8.2%) of patients had a significant incidental finding that required further investigation or management and 4 (0.6%) had a previously undiagnosed malignancy. In order to avoid the inevitability of a missed malignancy on a planning CT, we must advocate for formal reports in all cases.

An analysis of the status of diagnostic radiology equipment in China

ObjectiveTo analyze the current situation of diagnostic radiology equipment in Chinese mainland and to understand changes in the past 20 years, including gaps with other countries, in order to provide a scientific basis for the government to formulate relevant policies and regulations, and supplement Chinese data for international organizations. MethodsThis survey adopted a uniformly designed questionnaire, which was completed by the investigators or the respondents. The survey was distributed to all medical institutions that provided diagnostic radiology services in 31 provinces, autonomous regions, and municipalities, excluding Hong Kong, Macao, Taiwan, and military, China. ResultsThe survey showed that in the past 20 years, the number of medical institutions and diagnostic radiology equipment per million population in China has increased substantially. Dental radiology equipment increased nine-fold, and mammography equipment and computed tomography scanners showed a nearly five-fold increase. The four types of diagnostic radiology equipment, general diagnostic, fluoroscopic, mammography, and computed tomography, were associated with the population. Dental radiology equipment and bone mineral densitometers were related only to the gross domestic product (GDP). A large gap remains in the diagnostic radiology equipment per million population between China and the equipment of health-care level (HCL) I countries. ConclusionsAn imbalance in the number of units of diagnostic radiology equipment per million population was observed in the different regions, China. Various types of diagnostic radiology equipment, especially mammography equipment and computed tomography scanners, need to be deployed to meet the medical needs of different populations.