Development of a patient safety checklist for use during Fluoroscopic or Image-guided, minimally-invasive procedure in the Department of Radiology, Philippine General Hospital

Objective@#This study aimed to develop a patient-safety checklist for use during fluoroscopic- or image-guided minimally-invasive procedures in the Department of Radiology, Philippine General Hospital. @*Methodology@#A comparison of the Radiological Patient Safety System (RADPASS) and the Cardiovascular and Interventional Society of Europe (CIRSE) checklists was done. Together with the knowledge of the workflow and through observation of the different procedures in the department, a checklist was developed to suit the appropriate hospital setting. This developed checklist was tested in several procedures, and was evaluated and modified during trial testing. @*Result@#A patient safety checklist for minimally-invasive and fluoroscopic procedures in the Department of Radiology, Philippine General Hospital was developed through the analysis of the workflow of the department, and observation during the data gathering and trial testing phases. @*Conclusion@#This simple tool was developed to ensure that all the necessary details before a procedure have been addressed. It has been made as simple as possible, to make it user-friendly. The developed checklist is a step forward in promoting and ensuring the safety of patients undergoing fluoroscopic and minimally-invasive procedures in the Department of Radiology, PGH.

Alberta Stroke Program Early CT Score (ASPECTS) in real time: A prospective study of its interobserver variation among radiologists in a training hospital from a low-resource setting

Background and Objectives: The Alberta Stroke Program Early CT Score (ASPECTS) is a standardized system used to quantify the extent of ischemic involvement in cases of acute middle cerebral artery (MCA) infarct. It aids in clinical decision-making to identify patients who are more likely to benefit from thrombolytic therapy. This study aimed to determine the interobserver variation of ASPECTS among training and expert radiologists in a real-time, low-resource setting.Patients and Methods: A prospective study was conducted on non-enhanced CT (NECT) images of 79 patients with acute stroke. Patients with hemorrhagic stroke, or ischemic stroke from territories other than the MCA, were excluded. The ASPECTS of each case was assessed by three groups of radiologists--residents, fellows, and an expert. The level of agreement among them was then analyzed.Results: ASPECT scores were dichotomized into >7 and ?7. With the expert's reading as gold standard, residents had sensitivity of 0.94 [95% CI: 0.85, 0.99] and specificity of 0.68 [95% CI: 0.46, 0.85], while fellows had sensitivity of 0.96 [95% CI: 0.87, 1.00] and specificity of 0.76 [95% CI: 0.55, 0.91]. There was substantial agreement between residents and expert in overall ASPECTS rating (? = 0.66 [95% CI: 0.48, 0.85]; AC1 = 0.77 [95% CI: 0.62, 0.91]), and substantial to almost perfect agreement between fellows and expert (? = 0.76 [95% CI: 0.59, 0.92]; AC1 = 0.83 [95% CI: 0.71, 0.95]). Differences between the ASPECTS of the expert and trainees were within 2 points in most cases.Conclusion: ASPECTS is a reliable tool for both training and expert radiologists to quantify the extent of MCA infarcts. Assessment by trainees is comparable with that of the expert reader and is useful for immediate clinical decision making in low-resource settings.

To do, or not to do, that is the question: Appropriateness of the requested CT and MR imaging studies in the Philippine General Hospital outpatient department based on the American College of Radiology Appropriateness Criteria

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the rate of the appropriateness of the requested CT and MRI procedures in the Outpatient Department of a tertiary hospital in the Philippines from January to June 2018 using the American College of Radiology Appropriateness Criteria (ACR-AC).</p><p style="text-align: justify;"><strong>Methods:</strong> This retrospective research reviewed outpatient CT and MR imaging requests and cross-referenced with the corresponding ACR-AC guideline available for the written clinical diagnosis.</p><p style="text-align: justify;"><strong>Results:</strong> Four hundred thirty-six (436) (56%) of the 774 retrieved requests were CT scan studies, while the remaining 338 (44%) are MR imaging procedures. Cross-referencing with ACR-AC, the rate of appropriateness across all patients is high at 96.6%, with a 95% confidence interval of 95.0% and 97.6%. The rates were not significantly different between MRI and CT (p-value = 0.4502). Likewise, there was no significant difference in rates of appropriateness for the body parts abdomen, cranial, chest, and spine (p-value = 0.6502).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Although the results were high, relative to the few available international studies, the importance and potential of the ACR-AC cannot be disregarded. The ACR-AC serves as a guide in selecting the appropriate imaging test given a clinical situation. This may equate to better patient management, considering all patient-related factors.</p><p style="text-align: justify;"><strong>Key Words:</strong> diagnostic imaging; reviews, appropriateness; practice guideline</p>

Inter-observer variation of the Alberta Stoke Program Early CT Score (ASPECTS) among radiologists in the Philippine General Hospital

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the inter-observer variation of ASPECTS among radiologists in the Philippine General Hospital (PGH), particularly between trainee radiologists and an expert reader.</p><p style="text-align: justify;"><strong>Methods:</strong> Thirty (30) cranial CT scan studies of clinically-diagnosed, non-hemorrhagic stroke patients were analyzed by 9 trainee radiologists (3 fellows, and 3 senior and 3 junior residents) and one expert reader. Data analysis involved determining the levels of agreement within and across groups, and against the expert reader.</p><p style="text-align: justify;"><strong>Results and Conclusion:</strong> There was moderate agreement (kappa = 0.60) between the junior residents and the expert reader, and substantial agreement between the senior residents and the expert reader (kappa = 0.70), as well as between the fellows and the expert reader (kappa = 0.63). Over-all, there was a substantial agreement between the trainee radiologists and the expert reader (kappa = 0.63). It can be concluded that the interpretation of trainee radiologists in PGH, particularly that of a senior resident or a fellow, is comparable with that of an expert reader, and can, thus, be useful in cases where an interpretation of a CT scan procedure in a clinically-diagnosed stroke patient is needed.</p>