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Abstract Objective: To demonstrate that positive predictive values (PPVs) for suspicious (category 4) magnetic resonance imaging (MRI) findings that have been stratified are equivalent to those stipulated in the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography and ultrasound. Materials and Methods: This retrospective analysis of electronic medical records generated between January 4, 2016 and December 29, 2021 provided 365 patients in which 419 suspicious (BI-RADS category 4) findings were subcategorized as BI-RADS 4A, 4B or 4C. Malignant and nonmalignant outcomes were determined by pathologic analyses, follow-up, or both. For each subcategory, the level 2 PPV (PPV2) was calculated and tested for equivalence/noninferiority against the established benchmarks. Results: Of the 419 findings evaluated, 168 (40.1%) were categorized as malignant and 251 (59.9%) were categorized as nonmalignant. The PPV2 for subcategory 4A was 14.2% (95% CI: 9.3-20.4%), whereas it was 41.2% (95% CI: 32.8-49.9%) for subcategory 4B and 77.2% (95% CI: 68.4-84.5%) for subcategory 4C. Multivariate analysis showed a significantly different cancer yield for each subcategory (p < 0.001). Conclusion: We found that stratification of suspicious findings by MRI criteria is feasible, and malignancy probabilities for sub-categories 4B and 4C are equivalent to the values established for the other imaging methods in the BI-RADS. Nevertheless, low suspicion (4A) findings might show slightly higher malignancy rates.
Resumo Objetivo: Demonstrar que os valores preditivos positivos (VPPs) para lesões suspeitas (categoria 4) identificadas por ressonância magnética (RM) são equivalentes aos estipulados no ACR BI-RADS para mamografia e ultrassonografia. Materiais e Métodos: Análise retrospectiva de dados em prontuário eletrônico, entre 4 de janeiro de 2016 e 29 de dezembro de 2021, resultou em 365 pacientes elegíveis, com 419 lesões classificadas como BI-RADS 4A, 4B ou 4C. Desfechos malignos e não malignos foram determinados por estudo patológico e/ou acompanhamento. Realizamos o cálculo do VPP nível 2 (VPP2) para cada subcategoria e testamos para não inferioridade/equivalência em relação aos valores de referência. Resultados: Dos 419 achados, 168 (40,1%) foram malignos e 251 (59,9%), não malignos. O VPP2 para subcategoria 4A foi 14,2% (IC 95%: 9,3-20,4%), para 4B foi 41,2% (IC 95%:, 32,8-49,9%) e para 4C foi 77,2% (IC 95%: 68,4-84,5%). Análise multivariada demonstrou diferenças estatisticamente significantes entre as subcategorias (p < 0,001). Conclusão: A estratificação de achados suspeitos por RM é factível, sendo que a probabilidade de malignidade das subcategorias 4B e 4C é equivalente à estabelecida para outros métodos de imagem pelo BI-RADS. Contudo, lesões de baixa suspeição (4A) podem apresentar taxas mais altas de malignidade.
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Abstract Objective Our purpose was to facilitate the simulation of preoperative correction to enable shared doctor-patient decision-making in individuals undergoing high tibial osteotomy (HTO). Methods A total of 22 patients underwent high tibial osteotomy using internal or external fixation devices for medial compartment osteoarthritis of the knee. Preoperatively, assessment of deformity parameters and simulation of the corrective osteotomy was done in the presence of the patient, using Bone Ninja. Postoperatively, the patient's satisfaction level with the quality of explanation provided by the use of this software was assessed using the Patient Satisfaction Questionnaire-short (PSQ-18). A comparison of the correction obtained using paper cuttings and the simulation software was performed. Results All patients were satisfied with their role in the decision-making process. They showed a good understanding and comprehension of the proposed surgery. There was no statistically significant difference between simulated preoperative Medial Proximal Tibial Angle (MPTA) obtained by paper cuttings and software-assisted correction. The PSQ-18 mean score for communication was 4.24 (0.88), for technical quality it was 4.11 (0.59) and for general satisfaction it was 3.11 (0.68). Conclusion Bone Ninja is an effective, convenient, user-friendly and cost-effective deformity planning tool that supersedes the arduous traditional method of paper tracings and scissors.
Resumo Objetivo Nosso objetivo foi facilitar a simulação da correção no pré-operatório para permitir a tomada de decisão médico-paciente compartilhada em indivíduos submetidos a osteotomia tibial alta (OTA). Método22 pacientes foram submetidos a osteotomia tibial alta usando dispositivos de fixação internos ou externos para osteoartrite do compartimento medial do joelho. No pré-operatório, a avaliação dos parâmetros de deformidade e a simulação da osteotomia corretiva foram realizadas na presença do paciente, utilizando Bone Ninja. No pós-operatório, o nível de satisfação do paciente com a qualidade da explicação fornecida pelo uso deste software foi avaliado usando o Questionário de Satisfação do Paciente (Patient Satisfaction Questionnaire-short, PSQ-18, na sigla em inglês). Foi realizada uma comparação da correção obtida com recortes de papel e com o software de simulação. Resultados Todos os pacientes ficaram satisfeitos com seu papel no processo de tomada de decisão. Eles mostraram uma boa compreensão e entendimento da cirurgia proposta. Não houve diferença estatisticamente significativamente entre o ângulo tibial proximal medial (ATPM) pré-operatório simulado obtido por recortes de papel e correção assistida por software. O escore médio do PSQ-18 para comunicação foi de 4,24 (0,88), para a qualidade técnica foi de 4,11 (0,59) e para a satisfação geral foi de 3,11 (0,68). Conclusão Bone Ninja é uma ferramenta de planejamento de deformidade eficaz, conveniente, fácil de usar e econômica que substitui o método tradicional árduo de traçar no papel e com tesoura.
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Humanos , Masculino , Femenino , Osteotomía , Satisfacción Personal , Encuestas y Cuestionarios , Sistemas de Información Radiológica , Satisfacción del Paciente , Osteoartritis de la RodillaRESUMEN
El Sistema para el Almacenamiento, Transmisión y Visualización de Imágenes Médicas XAVIA PACS, desarrollado por la Universidad de las Ciencias Informáticas, se utiliza en múltiples instituciones de salud de Cuba. El propósito de estas herramientas es manejar la imagen médica, por lo que no gestionan la información que se capta en los servicios de diagnóstico por imágenes, entre los que se encuentran los datos del paciente, del estudio imagenológico y el informe diagnóstico. En este trabajo se exponen los resultados del desarrollo de un sistema informático para la gestión de la información imagenológica integrado al sistema XAVIA PACS para garantizar el control automatizado de la información en los servicios de diagnóstico por imágenes. Para el desarrollo previsto fue determinante la necesidad de reutilizar el código fuente ya implementado en el sistema XAVIA PACS; se seleccionó Microsoft.NET Framework, ASP.NET 3.5, C# 3.5 como lenguaje de programación, PostgreSQL como sistema de gestión de Base de Datos. Adicionalmente, fueron tenidos en cuenta la portabilidad, el procesamiento complejo interno, la facilidad de la instalación, y la facilidad del cambio. El sistema desarrollado automatiza la gestión de las listas de trabajo en los servicios de diagnósticos por imágenes, la gestión de la información del paciente, las citaciones, la planificación del trabajo de las modalidades médicas, y especialistas de radiología. La implantación del sistema desarrollado en diferentes instituciones de salud que emplean el sistema XAVIA PACS, validó la pertinencia y aplicabilidad del mismo(AU)
The XAVIA PACS Medical Images Storage, Transmission and Visualization System, developed by the University of Computer Sciences is used in multiple Cuban health institutions. The purpose of these tools is to manage the medical image, so they do not manage the information that is captured in the diagnostic imaging services, among which are the patient's data, the imaging study and the diagnostic report. This article presents a computer system for the management of imaging information integrated into the XAVIA PACS system to ensure automated control of information in diagnostic imaging services. For the planned development, the need to reuse the source code already implemented in the XAVIA PACS system was decisive; Microsoft.NET Framework, ASP.NET 3.5, C # 3.5 were selected as the programming language, PostgreSQL as the Database management system. Additionally, portability, complex internal processing, ease of installation, and ease of change were considered. The developed system automates the management of work lists in diagnostic imaging services, the management of patient information, appointments, work planning of medical modalities, and radiology specialists. The implementation of the system developed in different health institutions that use the XAVIA PACS system, validated its relevance and applicability(AU)
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Humanos , Masculino , Femenino , Diseño de Software , Programas Informáticos , Diagnóstico por Imagen/métodos , Interpretación de Imagen Asistida por Computador , Sistemas de Información RadiológicaRESUMEN
Abstract Objective: To evaluate the effect that transitioning from a model of general radiology reporting to one of subspecialized radiology reporting has on report turnaround times (TATs) and on productivity in the radiology department of a hospital in a middle-income country. Materials and Methods: The reporting workflow in our radiology department was changed from general reporting (any radiologist reporting imaging studies for any specialty) to subspecialized reporting (radiologists exclusively reporting imaging studies that fall within their subspecialty-abdominal, musculoskeletal, cardiothoracic, emergency, or neurological imaging). This was a retrospective study in which we compared general reporting with subspecialized reporting in terms of the following variables: the TAT; the proportions of reports completed within 2 h and within 24 h (TAT-2h and TAT- 24 h, respectively); and productivity. Data were collected over two 24-month periods (2015-2016 for general reporting and 2017-2018 for subspecialized reporting). Results: A total of 208,516 reports were generated. The median report TAT decreased from 49.1 h and 52.9 h in 2015 and 2016, respectively, to 16.1 h and 15.2 h in 2017 and 2018, respectively (p < 0.001). The TAT-2h also improved, increasing from 8.7% and 7.9% in 2015 and 2016, respectively, to 52.0% and 61.3% in 2017 and 2018, respectively (p < 0.001), as did the TAT- 24 h, which increased from 12.1% and 14.1% in 2015 and 2016, respectively, to 74.3% and 78.7% in 2017 and 2018, respectively (p < 0.001). Between the two periods, the total number of scans performed increased by 33% (p = 0.001). Conclusion: The implementation of a subspecialized reporting system significantly improved the median TAT for radiology reports, as well as increasing the TAT-2h and TAT- 24 h, during a time of increased productivity.
Resumo Objetivo: Avaliar o efeito da transição de um modelo de laudos em radiologia realizados por radiologistas gerais para um modelo relatado por subespecialização no tempo de resposta de relatórios (TAT) em radiologia e produtividade em um departamento de radiologia em um país em desenvolvimento. Materiais e Métodos: O fluxo em nosso departamento foi modificado de um sistema de relatórios gerais (qualquer radiologista lauda exames de imagem de qualquer especialidade) para um sistema de subespecialização (radiologistas laudam exclusivamente exames de imagem pertencente a sua subespecialidade - abdominal, musculoesquelético, cardiotorácico, emergência e neurologia). Este estudo retrospectivo avaliou a TAT, TAT-2 horas e TAT-24 horas e a produtividade num período de 24 meses de relatórios gerais (2015-2016) comparado a um período de 24 meses do sistema de subespecialização (2017-2018). Resultados: No total, 208.516 laudos foram gerados. A TAT reportada reduziu de uma média de 49,1-52,9 horas durante o período geral para 15,2-16,1 horas durante o período de relatórios por subespecialidade (p < 0,001). TAT-2 horas e TAT- 24 horas aumentaram significativamente de 7,9-8,7% para 52,0-61,3% e de 12,1-14,1% para 74,3-78,7%, respectivamente (p < 0.001). O número total de exames aumentou em 33% (p = 0.001) comparando os dois períodos. Conclusão: A implementação de um sistema de laudos por subespecialidade aumentou o TAT em radiologia, incluindo benefícios no TAT-2 horas e TAT-24 horas durante um período de aumento da produtividade.
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Abstract Objective: To improve communication between attending physicians and radiologists by defining which information should be included in radiology reports and which reporting format is preferred by requesting physicians at a university hospital. Materials and Methods: Respondents were asked to choose among reports with different formats and levels of detail, related to three hypothetical cases, and questioned as to which characteristics commonly found in radiology reports are appropriate for inclusion. To assign the absolute order of preference of the different reports, the Kemeny-Young method was used. Results: Ninety-nine physicians completed the questionnaires (40.4% were resident physicians; 31.3% were preceptors of residency programs; and 28.3% were professors of medicine). For ultrasound with normal findings, ultrasound showing alterations, and computed tomography, respectively, 54%, 59%, and 53% of the respondents chose structured reports with an impression or comment. According to the respondents, the characteristics that should be included in the radiology report are the quality of the image, details of the clinical presentation, diagnostic impression, examination technique, and information about contrast administration, selected by 92%, 91%, 89%, 72%, and 68%, respectively. Other characteristics that were considered important were recommendations on follow-up and additional radiological or non-radiological investigation. Conclusion: Requesting physicians apparently prefer structured reports with a radiologist impression or comment. Information such as the quality of the examination, the contrast agent used, and suggestions regarding follow-up and additional investigation are valued.
Resumo Objetivo: Melhorar a comunicação entre médicos assistentes e radiologistas, definindo quais informações deveriam ser incluídas num relatório radiológico e qual o formato preferido dos solicitantes de um hospital universitário. Materiais e Métodos: Os participantes foram convidados a escolher a opção preferida entre relatórios com diferentes formatos e níveis de detalhamento de três casos hipotéticos e questionados se características comumente encontradas em um laudo radiológico são apropriadas ou não para inclusão. Para atribuição da ordem absoluta de preferência dos diferentes relatórios, o método Kemeny-Young foi utilizado. Resultados: Noventa e nove médicos responderam os questionários (40,4% médicos residentes, 31,3% preceptores dos programas de residência e 28,3% professores da faculdade de medicina). Laudos estruturados com impressão ou comentário foram selecionados nas situações de ultrassonografia normal por 54% dos participantes, ultrassonografia alterada por 59% e tomografia computadorizada por 53%. As informações que deveriam ser incluídas, de acordo com os solicitantes, foram qualidade da imagem (92%), detalhes do cenário clínico (91%), impressão diagnóstica (89%), técnica do exame (72%), informações sobre meio de contraste (68%). Opiniões sobre seguimento e investigação radiológica ou não radiológica se mostraram importantes. Conclusão: Relatórios estruturados com impressão ou comentário de um radiologista são prepostos. Informações como qualidade de exame, meio de contraste utilizado e sugestões de acompanhamento e investigação adicional são valorizadas pelos médicos solicitantes.
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Investigadores/psicología , Maniobras Políticas , Investigadores/economía , Apoyo a la Investigación como Asunto/economía , Apoyo a la Investigación como Asunto/legislación & jurisprudencia , Canadá , Gobierno FederalRESUMEN
Objective@#To explore the value of contrast-enhanced ultrasound in the biopsy of patients with breast imaging reporting and data system (BI-RADS) score of 4 lesions.@*Methods@#Total of 136 cases of breast BI-RADS scores of 4 lesions admitted to Dongguan People′s Hospital from June 2017 to May 2018 were enrolled and randomly divided into contrast-enhanced ultrasound group and general ultrasound group, 68 cases in both group. The contrast-enhanced ultrasound group received contrast-enhanced ultrasound-guided breast nodule biopsy, and the general ultrasound group received general ultrasound-guided breast nodule biopsy. The success rate of puncture, the number of puncture needles, the satisfaction rate of the materials, the diagnostic sensitivity, the diagnostic specificity, the diagnostic coincidence rate, and the incidence of adverse puncture reactions were compared between two groups.@*Results@#The puncture success rate of both groups were 100%. The number of puncture needles in contrast-enhanced ultrasound group was (2.89±0.56)times, and the general ultrasound group was (2.93±0.62)times, with no statistically significant difference (P>0.05). The satisfaction rate of materials in the contrast-enhanced ultrasound group was 100%(68/68), and the general ultrasound group was 94.12%(64/68), with no statistically significant difference (P>0.05). The sensitivity in the contrast-enhanced ultrasound group and the general ultrasound group were 88.89%(32/36) and 81.82%(27/33), respectively, with no statistically significant difference (P>0.05). The specificity and coincidence rate in contrast-enhanced ultrasound group were 100%(32/32) and 94.12%(64/68), which were higher than 80.65%(25/31) and 81.25%(52/64) of the general ultrasound group, with statistically significant difference (P<0.05). The incidence of adverse reactions in the general ultrasound group and the contrast-enhanced ultrasound group were 10.94%(7/64) and 2.94%(2/68), respectively, with no statistically significant difference (P>0.05).@*Conclusions@#The contrast-enhanced ultrasound-guided breast nodule biopsy can achieve high puncture success rate in patients with breast cancer with BI-RADS scores 4 lesions, and help to confirm lesion activity, necrotic liquefaction area, more accurate localization, improved material satisfaction rate and biopsy, diagnostic efficacy, with significant clinical value.
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OBJECTIVES: Conventional radiological processes have been replaced by digital images and information technology systems within South Africa and other developing countries. Picture Archiving and Communication Systems (PACS) technology offers many benefits to institutions, medical personnel and patients; however, the implementation of such systems can be a challenging task. It has been documented that South Africa has been using PACS for more than a decade in public hospitals with moderate success. The aim of this study was to identify and describe the PACS challenges endured by PACS vendors during implementation in the South African public healthcare sector. METHODS: This was achieved by engaging in a methodological approach that was qualitative in nature collecting data through semi structured interviews from 10 PACS experts/participants which were later analysed qualitatively. RESULTS: The findings show that PACS vendors have countless challenges, some of which include space, insufficient infrastructure, image storage capacity, system maturity and vendor related concerns. It was clear that the PACS experts readily offered contextually appropriate descriptions of their encounters during PACS implementations in South African public healthcare institutions. CONCLUSIONS: PACS vendors anticipate these challenges when facing a public healthcare institution and it is recommended that the hospital management and potential PACS stakeholders be made aware of these challenges to mitigate their effects and aid in a successful implementation.
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Humanos , Comercio , Atención a la Salud , Países en Desarrollo , Sector de Atención de Salud , Hospitales Públicos , Almacenamiento y Recuperación de la Información , Informática Médica , Computación en Informática Médica , Radiografía , Sistemas de Información Radiológica , SudáfricaRESUMEN
OBJECTIVE: To survey care providers' preference between structured reporting (SR) and free-text reporting (FTR) for appendiceal computed tomography (CT) in adolescents and young adults. MATERIALS AND METHODS: An ethical committee approved this prospective study. The requirement for participant consent was waived. We distributed the Likert scale-based SR form delivering the likelihood of appendicitis across 20 hospitals through a large clinical trial. In the final phase of the trial, we invited 706 potential care providers to participate in an online survey. The survey questions included usefulness in patient management, communicating the likelihood of appendicitis, convenience, style and format, and overall preference. Logistic regression analysis was performed for the overall preference. Three months after the completion of the trial, we checked if the use of the SR was sustained. RESULTS: Responses were analyzed from 594 participants (175 attendings and 419 trainees; 225 radiologists, 207 emergency physicians, and 162 surgeons). For each question, 47.3–64.8% of the participants preferred SR, 13.1–32.7% preferred FTR, and the remaining had no preference. The overall preference varied considerably across the hospitals, but slightly across the departments or job positions. The overall preference for SR over FTR was significantly associated with attendings, SR experience for appendiceal CT, hospitals with small appendectomy volume, and hospitals enrolling more patients in the trial. Five hospitals continued using the SR in usual care after the trial. CONCLUSION: Overall, the care providers preferred SR to FTR. Further investigation into the sustained use of the SR is needed.
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Adolescente , Humanos , Adulto Joven , Apendicectomía , Apendicitis , Urgencias Médicas , Modelos Logísticos , Estudios Prospectivos , Sistemas de Información Radiológica , CirujanosRESUMEN
Objective To explore the value of contrast-enhanced ultrasound in the biopsy of patients with breast imaging reporting and data system (BI-RADS) score of 4 lesions.Methods Total of 136 cases of breast BI-RADS scores of 4 lesions admitted to Dongguan People's Hospital from June 2017 to May 2018 were enrolled and randomly divided into contrast-enhanced ultrasound group and general ultrasound group,68 cases in both group.The contrast-enhanced ultrasound group received contrast-enhanced ultrasound-guided breast nodule biopsy,and the general ultrasound group received general ultrasound-guided breast nodule biopsy.The success rate of puncture,the number of puncture needles,the satisfaction rate of the materials,the diagnostic sensitivity,the diagnostic specificity,the diagnostic coincidence rate,and the incidence of adverse puncture reactions were compared between two groups.Results The puncture success rate of both groups were 100％.The number of puncture needles in contrast-enhanced ultrasound group was (2.89 ± 0.56) times,and the general ultrasound group was (2.93 ± 0.62) times,with no statistically significant difference (P ＞ 0.05).The satisfaction rate of materials in the contrast-enhanced ultrasound group was 100％ (68/68),and the general ultrasound group was 94.12％ (64/68),with no statistically significant difference (P ＞ 0.05).The sensitivity in the contrast-enhanced ultrasound group and the general ultrasound group were 88.89％ (32/36) and 81.82％ (27/33),respectively,with no statistically significant difference (P ＞ 0.05).The specificity and coincidence rate in contrast-enhanced ultrasound group were 100％ (32/32) and 94.12％ (64/68),which were higher than 80.65％ (25/31) and 81.25％ (52/64) of the general ultrasound group,with statistically significant difference (P ＜ 0.05).The incidence of adverse reactions in the general ultrasound group and the contrast-enhanced ultrasound group were 10.94％ (7/64) and 2.94％ (2/68),respectively,with no statistically significant difference (P ＞ 0.05).Conclusions The contrast-enhanced ultrasound-guided breast nodule biopsy can achieve high puncture success rate in patients with breast cancer with BI-RADS scores 4 lesions,and help to confirm lesion activity,necrotic liquefaction area,more accurate localization,improved material satisfaction rate and biopsy,diagnostic efficacy,with significant clinical value.
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Los informes estructurados contextualizados cumplen tres características fundamentales: tienen una estructura uniforme que responde una pregunta clínica, son el producto de listas de chequeo estandarizadas o de árboles de conocimiento previamente concertados con equipos clínicos multidisciplinarios y se construyen a partir de cuadros de selección de atributos incorporados en los sistemas de informe electrónicos, adicionalmente, el atributo contextualizado hace referencia a la capacidad del informe de responder las preguntas clínicas de la situación actual del paciente, otorgando información relevante de forma concisa y clara a los médicos tratantes. Dentro de las principales ventajas de migrar hacia el informe estructurado se encuentran la uniformidad y la alta calidad del informe, el aumento en la concordancia intra e interobservador, así como la reducción de las tasas de error diagnóstico y una mejora significativa en la comunicación con los médicos tratantes. Se presenta una revisión temática que abarca las características esenciales del informe estructurado contextualizado, los argumentos a favor y en contra de este, los pasos recomendados para su implementación y las oportunidades de mejora hacia el futuro.
Structured reporting in radiology fulfill three fundamental characteristics: they have a uniform structure that answers a clinical question, they are the product of standardized checklists or of knowledge trees previously arranged with multidisciplinary clinical teams, and they are incorporated in option-selection boxes available in electronic reporting systems. Among the main advantages of migrating towards structured reporting are the uniformity and high quality of the report, the increase in intra and interobserver concordance, as well as the reduction of the diagnostic error rates and a significant improvement in communication with the clinical practitioner. This thematic review covers the essential characteristics of the structured report, the arguments for and against it, the recommended steps for its implementation, and the future opportunities for improvement.
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Humanos , Sistemas de Información Radiológica , Informática Médica , Diagnóstico por ComputadorRESUMEN
Abstract Objective: To evaluate the opinion and perception of referring physicians regarding the radiology report, in order to develop tools that promote an improvement in its quality. Materials and Methods: We prepared a questionnaire containing ten multiple choice questions about the radiology report, administering it to 70 physicians (35 specialists and 35 residents working in specialties other than radiology). Results: Referring physicians (specialists and residents) showed a preference for structured reports, with a description explained in universal medical language and a complete conclusion listing the diagnostic possibilities with the degree of certainty. The examination technique should be described, and the final report is best presented when it contains the final chart, together with images, as hard copies and in digital format. The respondents also reported having confidence in the opinion of the radiologist and expressed the need for a direct channel of communication with the same. Conclusion: Referring physicians seek detailed reports (including a description of the examination technique), preferably structured, with objective language and relevant conclusions (the position of the radiologist on the case is important). It is necessary to discuss the differential diagnoses and provide a form of contact between the parties. Although referring physicians consider the radiologist opinion relevant, they also want to analyze the images on their own.
Resumo Objetivo: Avaliar a opinião e a percepção dos médicos solicitantes sobre o laudo radiológico e desenvolver ferramentas que promovam uma melhora de sua qualidade. Materiais e Métodos: Foi elaborado um questionário contendo dez questões de múltipla escolha acerca do laudo radiológico, o qual foi submetido a 35 médicos especialistas e 35 médicos residentes de outras especialidades. Resultados: Médicos referentes (especialistas e residentes) mostraram preferência por laudos estruturados, com uma descrição explicada em linguagem médica universal e conclusão completa contendo as possibilidades diagnósticas indicadas com probabilidade de certeza. A técnica do exame deve ser descrita e o relatório final é mais bem apresentado quando contém o laudo final associado a imagens impressas e em formato digital. Também foram relatadas a confiança na opinião do radiologista e a necessidade de um canal direto de comunicação com ele. Conclusão: Os médicos solicitantes buscam relatórios detalhados (inclusive com a descrição da técnica do exame), preferencialmente estruturados, com linguagem objetiva e conclusões pertinentes (o posicionamento do radiologista sobre o caso é importante). É necessário discutir os diagnósticos diferenciais e fornecer uma forma de contato entre as partes. Apesar de considerarem relevante a opinião do radiologista, eles também querem analisar as imagens por conta própria.
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Objective To study the frequencies of diagnostic exposure and distribution of examined patients in Jiangsu province and to evaluate the frequencies of commom diagnostic exposure and CT examination by investigating public hospitals in Jiangsu. Methods Public hospitals in 4 counties ( districts) were sampled, and the information of examined patients on sex, age, diagnostic type and exposure category were gathered through radiology information system ( RIS ) of the sampled hospitals. Results A total of 728196 records of diagnostic procedures were gathered from the sampled hospitals. Among them 479024 records were on common diagnostic procedures, whereas 249172 records were on CT diagnostic procedures. The sex ratio was relatively balanced. the above 40 years of age group amounted for 62% the highest proportion, among the three age groups. The diagnostic frequencies in level Ⅱ hospitals contributed the highest proportion although 70% of the sampled hospitals were level I hospitals. Such diagnostic procedures as barium enema and mammography were highly distributed in level Ⅲ hospitals. Diagnostic frequencies were estimated in 2015 at 303 common diagnostic examinations and 173 CT diagnostic procedures per 1000 persons in Jiangsu province. Conclusions Frequencies of diagnostic radiology in Jiangsu became increased since the last investigation of medical exposure examinations during the Ninth Five-year Plan, which was a challenge for health care. It is important to mobilize more resources in protection against medical radiation exposure.
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Objective To study the frequencies of diagnostic exposure and distribution of examined patients in Jiangsu province and to evaluate the frequencies of commom diagnostic exposure and CT examination by investigating public hospitals in Jiangsu. Methods Public hospitals in 4 counties ( districts) were sampled, and the information of examined patients on sex, age, diagnostic type and exposure category were gathered through radiology information system ( RIS ) of the sampled hospitals. Results A total of 728196 records of diagnostic procedures were gathered from the sampled hospitals. Among them 479024 records were on common diagnostic procedures, whereas 249172 records were on CT diagnostic procedures. The sex ratio was relatively balanced. the above 40 years of age group amounted for 62% the highest proportion, among the three age groups. The diagnostic frequencies in level Ⅱ hospitals contributed the highest proportion although 70% of the sampled hospitals were level I hospitals. Such diagnostic procedures as barium enema and mammography were highly distributed in level Ⅲ hospitals. Diagnostic frequencies were estimated in 2015 at 303 common diagnostic examinations and 173 CT diagnostic procedures per 1000 persons in Jiangsu province. Conclusions Frequencies of diagnostic radiology in Jiangsu became increased since the last investigation of medical exposure examinations during the Ninth Five-year Plan, which was a challenge for health care. It is important to mobilize more resources in protection against medical radiation exposure.
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Objective:To analyse the dataflow and clinical flow in Suzhou municipal hospital radiology information system and picture archiving system, presents a set of system integration messages, and describes the effect of each message for the communication. Methods: Follow the framework of IHE and HL7 protocol, the paper uses standard messages to integrate two different systems for patient and study status communication. The integration can meet clinical users’ requirements.Results: Based on many years practice, the integration reached designed target.Conclusion: With further research on standard, the seamless system integration between different systems can help customer to make full use of each system and save more cost in system purchase.
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Objective To explore the function of the regional medical image network consultation system in propelling the quality control of regional medical image.Methods Based on the regional medical image network con-sultation system,the unified standard of quality control was implemented to reach the integrated management of the imaging quality control in region.The imaging specialists checked the quality of image and report in real time.In addi-tion,the specialists and inspectors monthly examined the quality of image and report.Subsequently,the unqualified causes were analyzed and the improvement measures were used.Finally,the quality of image and report were continu-ously improved.Results After the homogeneity management was applied for one year,the rates of remaking photos and returning the report were significantly decreased from 10% to 2%,and 12% to 4% respectively.Additionally,the rates of good image and report were significantly increased from 83% to 98%,and 89% to 100% respectively.The objective of good rate ≥90% was excellently achieved.Conclusion Based on the regional medical image network consultation system,the management in quality control of the networking hospitals has been uniform,and the technique of examination and the report format have been consistent.The standardability and accuracy of image examination have been realized.
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Background: Radiology Information System (RIS) coordinates the organizational processes and administrative based on information. The present study was an attempt towards a performance assessment of the RISs used in general Isfahan hospitals. Methods: This study was descriptive cross-sectional in nature. Its statistical population consisted of the general teaching hospitals of Isfahan city (Iran). Due to the limitedness of the population of study, the sample size was the same as the population size. The data were collected using a self-designed checklist produced based on the royal college of radiologists’ guidelines, i.e. input components (13 items), process components (10 items) and output components (8 items). The researcher collected the data through observation and interview. The validity of the checklist was assessed by the health information system field’s valid authorities. Finally, the gathered data were put into SPSS 16 software and analyzed using descriptive statistics. Results: Among the RIS in the hospitals, Kashani, Isa Ibn Maryam and Nour & Ali Asghar had the highest rank for input components (mean score = 30.79%). As for process components, Al-zahra, Kashani and Isa Ibn Maryam gained the highest position (mean score = 38.9%). Finally, Al-zahra and Kashani hospitals with a mean score of 66.66% enjoyed the highest rank for output components. Conclusion: RIS must be capable of satisfying a number of requirements including satisfying the medical needs of the patients, producing the reports, image and report processing, patients’ appointment scheduling, the procedures for receiving and administrating the orders and other radiology procedures.
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Objective To ascertain the frequency distribution of CT examinations in children.Method A wide range of information was collected through the radiology information system (RIS),including ID,sex,birth date,examination time,the examined part of body and other relevant ones related to children who underwent CT examinations between Jan 1,2012 and Dec 31,2012.The SAS software was used for data processing and statistical analysis.Results A total of 1 542 children underwent 1 670 examinations,of which 67％ were male.Head CT examination was the most frequent,accounting for 71.9％ of all CT examinations,and followed by the abdomen/pelvis examinations.The number of examinations of children undergoing the repetitive examination accounted for 6.4％; 51.7％ of the examinations was for trauma.The positive rate of CT examination was 51％,dependent upon the age and examined body parts to some extent.The younger patients had lower positive rate,and the positive rate of head CT examination was lower than those in other parts.Conclusions To reduce the possible cancer risk to be induced by the ionizing radiation from CT,justification of CT examination should be considered for children.
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Hospital image information system is evolving from department-oriented to patient-oriented. This paper introduces the implementation of Beijing University People's Hospital image data center. The ideas, approaches and the technological standards for image data center's system integration are proposed. Additionally, the problems in practical application and the outlook for this system are discussed.
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OBJECTIVES: It is necessary to improve the pathology workflow. A workflow task analysis was performed using a pathology picture archiving and communication system (pathology PACS) in order to propose a user interface for the Pathology PACS considering user experience. METHODS: An interface analysis of the Pathology PACS in Seoul National University Hospital and a task analysis of the pathology workflow were performed by observing recorded video. Based on obtained results, a user interface for the Pathology PACS was proposed. RESULTS: Hierarchical task analysis of Pathology PACS was classified into 17 tasks including 1) pre-operation, 2) text, 3) images, 4) medical record viewer, 5) screen transition, 6) pathology identification number input, 7) admission date input, 8) diagnosis doctor, 9) diagnosis code, 10) diagnosis, 11) pathology identification number check box, 12) presence or absence of images, 13) search, 14) clear, 15) Excel save, 16) search results, and 17) re-search. And frequently used menu items were identified and schematized. CONCLUSIONS: A user interface for the Pathology PACS considering user experience could be proposed as a preliminary step, and this study may contribute to the development of medical information systems based on user experience and usability.
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Diagnóstico , Sistemas de Información , Registros Médicos , Patología , Sistemas de Información Radiológica , Seúl , Análisis y Desempeño de Tareas , Interfaz Usuario-Computador , Flujo de TrabajoRESUMEN
Antecedentes. Las fracturas de platillos tibiales suceden con alta frecuencia en grupos especiales como el personal de la policía, por su mayor exposición a mecanismos de trauma de alta energía y las características anatómicas y biomecánicas propias de la extremidad proximal de la tibia, que atribuyen a este tipo de fracturas una variabilidad importante en cuanto a abordaje terapéutico y su pronóstico. Materiales y métodos. Estudio tipo de serie de casos (nivel de evidencia IV), en pacientes adultos con fracturas de platillos tibiales, con atención inicial en el Hospital Central de la Policía desde enero de 2005 hasta diciembre de 2010, con diagnóstico confirmado por ortopedista y seguimiento mínimo de un año, a quienes se les aplicó una ficha de recolección de datos, con las variables estipuladas en el estudio. Resultados. De 93 pacientes seleccionados, el 82% fueron de sexo masculino y el 91% presentaron fracturas cerradas. A quienes se les realizó fijación interna más externa suplementaria tuvieron mayores tiempos de consolidación radiológica (180 días). Las secuelas más frecuentes fueron Artrosis (24%) y meniscopatía (21%), y las principales complicaciónes fueron las infecciones en un 6,4% de los pacientes, siendo las fracturas abiertas grado III (33%) las más afectadas. El promedio de consolidación radiológica fue de 125 días. Fueron manejadas quirúrgicamente el 69,9% de los casos. El grupo etáreo de 30 a 39 años fue el más comprometido. El principal mecanismo de trauma fueron los accidentes en moto (40%) y el tipo de fractura con mayor frecuencia fue la Shatzker tipo IV (28%) y las abiertas tipo Gustilo III (75%). Discusión. Las características propias del trabajo como agente de policía, en cuanto a su rango de edad, sexo predominante y actividades de riesgo como desplazamiento en moto, porte y utilización de armas de fuego, así como las actividades de riesgo propias de su trabajo, determinan mecanismos de trauma de moderada y alta energía predominantes en este tipo de fracturas, y en esto radica que la mayor parte de fracturas fueron tipo Shatzker IV. Conclusión. Se relacionaron mayores porcentajes de infección, complicaciones, secuelas y necesidad de manejo quirúrgico, con el grado de severidad de la fractura y compromiso de tejidos blandos, así como un mayor tiempo de consolidación.
Background. The fractures of tibial plateau happens with high frequency in special groups as well as the police, due to their greater exposition to mechanisms of trauma of high energy and its own anatomical and biomechanical characteristics of the proximal extremity of the tibia. These features acquire an important variability as far as therapeutic boarding and its prognosis. Materials and methods. A Study type is series of cases (level of evidence IV), in adult patients with fractures of tibial plateau, with initial attention in the Hospital Central de la Policía - Bogotá, from January of 2005 to December of 2010, with diagnosis confirmed by orthopaedist and minimum pursuit of a year, to those who had a card of data collection applied to them, with the variables stipulated in the study. Results. From 93 selected patients, 82% were of male gender and 91% presented closed fractures. Those who were practiced external and internal fixation had better times of radiological consolidation (180 days). The most frequent sequels were Arthrosis (24%) and meniscopathy (21%), and the main complication was the infections in a 6.4% of the patients. The open fractures degree III (33%) were the most affected. The average of radiological consolidation was of 125 days. Operative management happens in 69.9% of the cases. The age group of 30 to 39 years was the most affected. The main mechanism of trauma (40%) were the accidents in motorcycle, and the type of fracture most frequently were the Shatzker type IV (28%) and the Gustilo type III open fracture (75%). Discussion. The own characteristics of the police agent job, as far as their rank of age, predominant sex and activities of risk like motorcycle transportation, carry and use of firearms, as well as the own activities of risk of their job, determine mechanisms of moderate and high trauma of predominant magnitudes in this type of fractures, being the most frecuent fractures type the Shatzker IV. Conclusion. The percentage of infection, complications, sequels and necessity of surgical management, were related with the degree of severity of the fracture and soft weave commitment, as well as a greater time of consolidation.