Radiology Staff Research Articles

Radiation protection in the operating room: Need for training, qualification and accompaniment for the professionals

The objective of this work was to evaluate the knowledge of the professionals working in the operating room about the risks associated to exposure to X-rays, and the radiation protection practices. To meet this objective, we conducted a multicenter study in three Moroccan hospitals. Data collection was carried out with a self-administered questionnaire to the professionals. The results showed that more than a third of the participants ignore the ionizing nature of X-rays; and that the effects of exposure to ionizing radiation are related to cumulative dose. Three percent of the participants were aware about the effective dose limit of ionizing radiation for workers for a year and the annual dose limits to the extremities or to the skin. 45.50% of participants had no knowledge about the most irradiating technique when using the amplifier; 58.21% felt that continuous fluoroscopy mode was the most irradiating. All of the participants declared the absence of a radiation protection referent, and did not use any written procedures guide for the most common radiological examinations in interventional imaging. Multidisciplinary cooperation, at least, between radiology staff and operating room staff appears imperative, and seems to strengthen the system of vigilance and protection against the harmful effects of ionizing radiation.

Nontargeted Native Renal Biopsy Adequacy: Preintervention Data From a Province-Wide, Multicentre, and Interdepartmental Audit.

Nontargeted renal biopsy is essential to diagnosis, classification, and prognostication of medical renal disease. Inadequate biopsies delay diagnosis, expose the patient to repeated biopsy, and increase costs. The purpose of this project is to characterize nontargeted renal biopsy specimen adequacy and identify areas for improvement. This project was designed as a clinical audit of specimen adequacy rates of nontargeted renal biopsies from 13 hospitals, as well as a questionnaire of radiology and pathology department staff regarding current practices surrounding renal biopsies. Retrospective analysis of 2188 adult native renal biopsies was performed from January 1, 2018, to September 9, 2021, across 13 hospitals. Adult patients with medical renal disease undergoing a nontargeted renal biopsy were included. Retrospective analysis of 2188 adult native renal biopsies was performed from January 1, 2018, to September 9, 2021, across 13 hospitals. Adequacy was divided into 4 categories based on number of glomeruli received: ideally adequate (≥25 glomeruli), minimally adequate (15-24), suboptimal (<15 and diagnosis rendered), and inadequate (<15 and no diagnosis rendered). Two targets were chosen; target 1, to achieve a combined suboptimal and inadequate rate ≤ 10%, and target 2, to attain an ideally adequate rate ≥80%. Radiology department heads in the province were surveyed on biopsy equipment, technique, technologist support, and feasibility of possible interventions to enhance biopsy adequacy. Pathology department staff were surveyed on their education and experience. Adequacy was as follows: ideally adequate 64.7%, minimally adequate 26.0%, suboptimal 7.9%, and inadequate 1.4%. The province (and 8/13 hospitals) met target 1 for native biopsies (9.3%). Two hospitals achieved target 2 for native biopsies. A key finding was that the 2 hospitals with the lowest target 1 scores did not have a technologist present at biopsy. Survey data was used to assess biopsy technique at each hospital, and specific technique for each biopsy was not recorded. As such, a multivariate statistical analysis of specimen adequacy rates was not feasible. Data on complications was not collected. Preintervention the province was at target for limiting inadequate and suboptimal native biopsies. There was a substantial shortfall in the ideally adequate rate from the proposed target. Using insight from survey data, interventions with the greatest expected impact were identified and those that are feasible given limited resources will be implemented to improve sample adequacy. Not registered.

A Descriptive Study to Assess the Knowledge of Radiation Safety among the Radiological and Other Departmental Staff of Different Hospital in Haryana and Delhi Ncr Region

A Descriptive Study to Assess the Knowledge of Radiation Safety among the Radiological and Other Departmental Staff of Different Hospital in Haryana and Delhi Ncr Region

Comparison of Hematological Parameters between Diagnostic Radiation Workers and Non-Radiation Workers

Purpose: Radiation workers are exposed to chronic effects due to long-term exposure to low levels of ionizing radiation. One of the biological indicators to evaluate these chronic radiation effects is the study of the hematopoietic system. The purpose of this study is to compare the changes in blood parameters of radiology staff and staff of other wards of the hospital.&#x0D; Materials and Methods: In this study, 47 radiology staff working in the radiology department of the hospital as the study group and 94 personnel in other departments as the control group were included. Demographic data including age, gender, and work experience were obtained. Hematological parameters were extracted from the complete blood count tests of participants.&#x0D; Results: The results of this study showed that the Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC) parameters significantly decreased in the male study group, whereas no significant differences were observed in the blood parameters of the female study group in comparison to those of the control group. There was a significant positive correlation between the parameters of Hemoglobin and age. There was a significant negative correlation between work experience and white blood cells, while there was a significant positive correlation between work experience and Hemoglobin.&#x0D; Conclusion: Correlation between collective absorbed dose and changes in blood parameters is suggested for future studies. Based on the results of this study and other studies, it can be concluded that long-term exposure to low levels of radiation may change blood parameters. Therefore, regular and periodic complete blood count tests along with absorbed dose monitoring of radiation workers are recommended.

Fostering an inclusive workplace for LGBTQIA+ people in radiology and radiation oncology.

The inclusion and celebration of LGBTQIA+ staff in radiology and radiation oncology departments is crucial in developing a diverse and thriving workplace. Despite the substantial social change in Australia, LGBTQIA+ people still experience harassment and exclusion, negatively impacting their well-being and workplace productivity. We need to be proactive in creating policies that are properly implemented and translate to a safe and inclusive space for marginalised groups. In this work, we outline the role we all can play in creating inclusive environments, for both individuals and leaders working in radiology and radiation oncology. We can learn how to avoid normative assumptions about gender and sexuality, respect people's identities and speak out against witnessed discrimination or slights. Robust policies are needed to protect LGBTQIA+ members from discrimination and provide equal access across other pertinent parts of work life such as leave entitlements, representation in data collection and safe bathroom access. We all deserve to feel safe and respected at work and further effort is needed to ensure this extends to LGBTQIA+ staff in the radiology and radiation oncology workforces.

Pemilihan Indikator Mutu Prioritas Unit “Pengulangan Foto X-Ray” Sebagai Aspek Fundamental Proteksi dan Budaya Keselamatan Radiasi di Instalasi Radiologi RS Indriati Solobaru

An essential aspect of a diagnostic radiology quality assurance program is X-ray image repeat analysis, a systematic process to record rejected or repeated images to determine the cause so we can minimize that image repetition in the future. Some of the disadvantages caused by repeated X-ray photo examinations are giving additional doses to patients (unnecessary exposure), ineffective time for radiology staff and patients (wasting time), and financial losses due to electricity for the X-ray machine and the DR system (unit costs). In January 2021, at the Radiology Installation of Indriati Hospital, repeated X-Ray photos analysis was chosen as one of the quality indicators by Decree No. 031/PER-RSIND/2021. The goal is to look for improvements to minimize repeated X-ray photos occurrence and prevent unnecessary exposure. Monitoring is carried out daily through SISMADAK V5.0.3 and is reported monthly to the KMRS committee. The step for selecting quality indicators for X-ray photo examination repetition has greatly impacted the aspects of radiation protection and safety because it can reduce the number of X-ray photo inspection repetitions by 0.6% from 2020. The continuous improvement step based on the root cause of the fishbone method is with the supervision of a radiographer intensively with OPPE assessment and credentials in the hope of minimizing the repetition of X-ray photos. It can become a fundamental aspect of radiation protection and culture safety, especially in the radiology installation of Indriati-Solobaru Hospital, Sukoharjo, Central Java. Keywords: X-ray photo repetition, quality indicators, fishbone method, radiation safety culture.

Evaluating Satisfaction of the Radiologist Assistant within an Academic Pediatric Institution: Comparing Reviews from Staff Radiologic Technologists, Radiologists, and Radiology Residents

Evaluating Satisfaction of the Radiologist Assistant within an Academic Pediatric Institution: Comparing Reviews from Staff Radiologic Technologists, Radiologists, and Radiology Residents

The 2022 AUR Academic Radiology and Industry Leaders Roundtable

The Association of University Radiologists (AUR) convened its sixth annual Academic-Industry Roundtable in a hybrid fashion in March 2022, with academic radiology and radiology industry leaders gathered in person and via remote videoconference. The open discussion centered around on challenges facing radiology and specifically focused on the people in our field, including patients, radiologists, and radiology staff. Participants identified numerous opportunities for industry and radiology departments to collaborate to improve equitable access to healthcare, communication with patients, use of appropriate imaging, and the state of the radiology workforce.

Use of YEARS Algorithm in Military Health Care Beneficiaries to Evaluate Use of Computed Tomography Pulmonary Angiography.

Pulmonary embolism (PE) can be difficult to rule out without computed tomography pulmonary angiograms (CTPAs), as presentations vary. Multiple clinical decision rules (CDRs) exist to risk-stratify patients to avoid unnecessary CTPAs. However, the currently used CDRs are complex, and research has shown low compliance with their usage. The YEARS algorithm is less complex and excludes patients from CTPA if PE is not the most likely diagnosis, they do not have a history of hemoptysis, and no clinical signs of deep vein thrombosis, is less complex. However, no studies have evaluated YEARS in the U.S. Military health care beneficiary population. Therefore, this study sought to determine if implementing the YEARS algorithm could decrease the number of CTPAs ordered to rule out PE in low-risk patients. This retrospective, single-center cohort study applied the YEARS algorithm to low-risk military beneficiaries presenting to the emergency department in the calendar year 2020 at a single U.S. Army MTF. The primary outcome was the number of CTPAs indicated by the YEARS algorithm versus the number ordered via standard practice. We used chi-square testing to compare the number of subjects in whom YEARS indicated CTPA (meets criteria/does not meet criteria) versus the actual number of subjects who underwent CTPA (meets criteria/does not meet criteria). The secondary outcomes included applying YEARS similarly to the number of subjects >50 years of age (as opposed to age-adjusted d-dimer), determining the number of pregnant patients who could have avoided CTPA via application of YEARS, and assessing possible cost savings via reduction of CTPA. We included 353 subjects during the study period, 271 of whom underwent CTPA. YEARS would have only indicated 25 of them, P = .018. In patients >50 years of age, 164 underwent CTPA versus nine who met YEARS criteria, P = .014. Among pregnant patients, six underwent CTPA versus one who YEARS would have indicated, P = .130. Application of the YEARS algorithm would have led to a 90.8% reduction in CTPAs ordered with an overall known missed PE rate of 1.1%. Applying the YEARS algorithm in 2020 could have led to 246 fewer CTPAs at a minimum cost savings of $38,762.22 for the MTF based on the coded billing cost of $157.57 per CTPA when local staff radiologists performed image interpretation. This estimate does not consider the additional undisclosed cost of contracted radiologists interpreting after regular duty hours. For our military beneficiaries, our study indicates that the YEARS algorithm would have reduced CTPA utilization in all age ranges and potentially among pregnant patients with a known missed PE rate of 1.1%.

Attitude and perception of radiology staff towards artificial intelligence

Category: AI (artificial intelligence)

Misalignment of Values Associated With Radiology Staff Burnout.

Organizations within health care are now challenged to address burnout of all their health care workers [1], including in their radiology departments. Studies demonstrating widespread radiologist burnout and linking multiple adverse outcomes to physician burnout have established radiologist burnout as an issue to be addressed by radiology leaders [2]. Radiology, however, is a team sport, and successfully addressing burnout in a radiology practice also necessitates practice leaders addressing burnout of other health care workers in the radiology team.

Factors affecting patients’ waiting time at the Radiology Department

Aim of Study: To identify the extent and causes for prolonged patient waiting times and overcrowding at the Radiology Department (RD) in Aseer Central Hospital, Abha City, Saudi Arabia. Methods: A cross-sectional observational study design was followed. It included 107 staff members at the RD in Aseer Central Hospital. A data collection tool was designed by the researchers and used for data collection. Results: 51.4% of patients were referred to RD from the outpatient clinics, 27.3% were referred from the ED, while 21.3% were inpatients. Monday and Tuesday were the most overcrowded days at the RD (33.3% and 20.8%, respectively). Almost half of the patients (47%) stayed in the waiting area for 1-3 hours. Patient waiting times differed significantly according to their days of received radiologic services, with the longest waiting time being on Wednesday (44.4%, p=0.021), and according to patients provided radiologic services. The most frequently stated causes by the radiology staff for overcrowding at the RD were the “huge number of patients received directly from the community who did not go via a primary health care center”; “the large number of non-emergency patients” and the “socially recommended cases sent to RD via the ED” (45.8%, 32.7% and 29.9%, respectively). Conclusions: Patient waiting times are unduly prolonged. It is mostly 1-3 hours. The main bulk of overcrowding comes from patients referred from the outpatient clinics. The main causes for overcrowding are the excessive number of non-emergency, unscheduled patients, and the socially recommended cases, in addition to the shortage of specialist radiology physicians. Recommendations: There is a need to implement an elaborate system to organize unscheduled patients, who may crowd out other emergency patients and to allocate a special radiology section for patients referred from the ED. To increase the number of serving specialist radiologists at the RD of Aseer Central Hospital. To enforce provided radiology services at primary care centers in Aseer Region. Key Words: Waiting time, Radiology Department, Patient referrals

PREFACE

PREFACE

U"AI" Testing: User Interface and Usability Testing of a Chest X-ray AI Tool in a Simulated Real-World Workflow.

Purpose: To observe interactions of practicing radiologists with a chest x-ray AI tool and evaluate its usability and impact on workflow efficiency. Methods: Using a simulated clinical workflow and remote multi-monitor screensharing, we prospectively assessed the interactions of 10 staff radiologists (5-33years of experience) with a PACS-embedded, regulatory-approved chest x-ray AI tool. Qualitatively, we collected feedback using a think-aloud method and post-testing semi-structured interview; transcript themes were categorized by: (1) AI tool features, (2) deployment considerations, and (3) broad human-AI interactions. Quantitatively, we used time-stamped video recordings to compare reporting and decision-making efficiency with and without AI assistance. Results: For AI tool features, radiologists appreciated the simple binary classification (normal vs abnormal) and found the heatmap essential to understand what the AI considered abnormal; users were uncertain of how to interpret confidence values. Regarding deployment considerations, radiologists thought the tool would be especially helpful for identifying subtle diagnoses; opinions were mixed on whether the tool impacted perceived efficiency, accuracy, and confidence. Considering general human-AI interactions, radiologists shared concerns about automation bias especially when relying on an automated triage function. Regarding decision-making and workflow efficiency, participants began dictating 5seconds later (42% increase, P = .02) and took 14seconds longer to complete cases (33% increase, P = .09) with AI assistance. Conclusions: Radiologist usability testing provided insights into effective AI tool features, deployment considerations, and human-AI interactions that can guide successful AI deployment. Early AI adoption may increase radiologists' decision-making and total reporting time but improves with experience.

Practice, Knowledge, and Awareness of the Diverse Effects of Diagnostic Radiology among Radiology Staff and Students in Saudi Arabia.

Diagnostic radiology has been linked to several health consequences. Thus, the present study aimed to assess the practice, knowledge, and awareness of the diverse effects of diagnostic radiology among radiology staff and students in Saudi Arabia. In this study, 107 participants were recruited from August to December 2020. The study included 56 radiology personnel (staff from Hail City Hospitals) and 51 radiology medical students (students from the University of Ha'il). To the question, "Have you ever been informed of radiation and its effects?" about 6/107 (5.6 %) answered "No," among which 5/6 (83.3 %) were the staff. In response to the question, "In your opinion, how hazardous is radiation to your body?" about 8/104 (7.7 %) indicated it as nonhazardous (3 were staff and 5 were students). To the question, "Do you believe that radiation in medical sites is harmful?" about 20/104 (19.2 %) answered, "No" (8 were staff and 12 were students). There is a lack of awareness, knowledge, and practice towards ionizing radiation protection measures among radiology medical students and radiology department staff in Northern Saudi Arabia. The paper notifies the health system advisors to include stressing guidelines regarding radiation hazards. More actions are deemed necessary for the safety of patients and radiation workers.

Acquiring and Implementing High-Cost and Complex Imaging Modalities

Large medical centers go through an extensive process for several key service departments to acquire imaging modalities. One such project involved the evaluation, planning, implementation, and go-live of a new mobile magnetic resonance imaging (MRI) for a newly built outpatient clinic. My role in this project was to lead the full procurement and installation process of the mobile MRI. The customer for this project was the radiology service at the new outpatient clinic. The radiology staff hopes to use the new mobile MRI to increase their overall patient caseload over the next several years and provide a much-needed service to a highly populated patient area. This should increase overall patient satisfaction while decreasing community-of-care costs for the hospital. The technology of an MRI is quite complicated, which made the acquisition of one that would meet the needs of the clinical staff that are more imperative for the biomedical engineering department to handle. The overall timeline for this project was about year and a half, and it had been planned extensively while also dealing with a few obstacles along the way. The technology assessment and procurement phases of this project brought new levels of education on the technology and the intense process that the medical center goes through to acquire imaging modalities. The medical center is currently waiting on the final vendor selection to proceed with the implementation of the mobile MRI. In the meantime, leading a separate fixed MRI replacement project at another outpatient facility has prepared me well for the mobile MRI project. Some of the challenges faced during this project included managing a team of different stakeholders, dealing with timeline issues, and understanding the different processes and procedures to accomplish certain tasks. The biggest learning opportunity was leading and managing both the procurement of the modality and its eventual installation. This project looks to improve the patient care and safety of the unique patient population at the new outpatient center.

Ultrasound may safely replace chest radiograph after tube thoracostomy removal in trauma patients

IntroductionA chest radiograph (CXR) is routinely obtained in trauma patients following tube thoracostomy (TT) removal to assess for residual pneumothorax (PTX). New literature supports the deference of a radiograph after routine removal procedure. However, many surgeons have hesitated to adopt this practice due to concern for patient welfare and medicolegal implications. Ultrasound (US) is a portable imaging modality which may be performed rapidly, without radiation exposure, and at minimal cost. We hypothesized that transitioning from CXR to US following TT removal in trauma patients would prove safe and provide superior detection of residual PTX. Materials and MethodsA practice management guideline was established calling for the performance of a CXR and bedside US 2 h after TT removal in all adult trauma patients diagnosed with PTX at a level 1 trauma center. Surgical interns completed a 30-minute, US training course utilizing a handheld US device. US findings were interpreted and documented by the surgical interns. CXRs were interpreted by staff radiologists blinded to US findings. Data was retrospectively collected and analyzed. ResultsEighty-nine patients met inclusion criteria. Thirteen (15%) post removal PTX were identified on both US and CXR. An additional 11 (12%) PTX were identified on CXR, and 5 (6%) were identified via US, for a total of 29 PTX (33%). One patient required re-intervention; the recurrent PTX was detected by both US and CXR. For all patients, using CXR as the standard, US displayed a sensitivity of 54.2%, specificity of 92.3%, negative predictive value of 84.5%, and positive predictive value of 72.2%. The cost of care for the study cohort may have been reduced over $9,000 should US alone have been employed. ConclusionBedside US may be an acceptable alternative to CXR to assess for recurrent PTX following trauma TT removal.

Classification of Musculoskeletal Radiograph Requisition Appropriateness Using Machine Learning.

Objective: Poor quality imaging requisitions lower report quality and impede good patient care. Manual control of such requisitions is time consuming and can be a source of friction with referring physicians. The purpose of this study was to determine if poor quality requisitions could be identified automatically using machine learning and natural language processing techniques in order to allow for more efficient workflow. Methods: Exam indications from 50000 musculoskeletal radiograph requisitions were manually classified, reviewed and deemed 'appropriate' or 'inappropriate' by two staff radiologists based on ACR appropriateness criteria. The requisitions were divided into training and test groups (80/20 split). The training set was pre-processed, converted to a bag-of-words model and used to train a Multinomial Naïve Bayes classifier which was then applied to the test set. Results: Out of 50000 requisitions, 12253 (24.5%) were deemed to contain an inappropriate indication. A Naive Bayes model correctly classified requisitions with an accuracy of 98%. In the test set, 107 of 7561 (1.4%) appropriate requisitions were incorrectly flagged and 92 of 2439 (3.8%) inappropriate requisitions were not flagged. Conclusions: Accurate automated identification of inappropriate indications on musculoskeletal requisitions is feasible using machine learning and natural language processing.

CURRENT TRENDS OF RADIATION PROTECTION EQUIPMENT IN INTERVENTIONAL RADIOLOGY.

Interventional radiology represents subspecialty of radiology, which does not use imaging modalities only for diagnostics, but mostly for therapeutic purposes. Realisation of interventional procedures is done through X-rays, which replaces direct visual control done by interventional radiologist or cardiologist. For the targeted reduction of the radiation exposure, the interventional radiology staff use personal protective equipment. Usually, aprons with lead-equivalent are used, which provide protection for 75% of the radiosensitive organs. As the eye lens and thyroid gland belong to the radiosensitive organs, lead eyeglasses and thyroid collar are commonly used for their protection. Cap and gloves with lead-equivalent can be utilised as an additional personal protective equipment, that is commercially available. Innovative protection systems, such as mobile radiation protection cabin and suspended radiation protection, have been designed to ensure better radiation protection and safety. These systems provide the comfort for the interventional radiologists at work, while offering better protection against ionising radiation.

Improving the patient experience during musculoskeletal interventional procedures.

In the patient-centered practice of musculoskeletal interventional radiology, pre-procedure, intra-procedure, and post-procedure factors impact the patient's overall experience. Opportunities to improve the patient experience begin before the patient procedure starts, with smooth scheduling of the appointment, a positive office environment, and appropriate communication by the musculoskeletal interventional radiology staff before the procedure, including clear expectations regarding wait times. The initial conversation between the radiologist and the patient, including the informed consent process, is a crucial opportunity for creating rapport with the patient and generating trust in the radiologist. Being able to interpret a patient's verbal and non-verbal cues during this conversation can reduce anxiety and enhance relaxation. During the procedure, there are interventions which can decrease anxiety and reduce the perception of pain by the patient. These include psychological interventions such as self-induced hypnosis, communication-based interventions such as empathic communication to mold a patient's interpretation of anxiety and painful stimuli, and the use of ancillary tools such as music or video stimulation. Finally, clear post-procedure expectations regarding post-procedure pain and its management and assurances of access to the musculoskeletal interventional radiology team can facilitate an uncomplicated post-procedure recovery.