Development of Report Turnaround Times in a University Department of Radiology during Implementation of a Reformed Curriculum for Undergraduate Medical Education.

PURPOSE: The implementation of a reformed curriculum for undergraduate medical education with a problem-oriented focus and more bedside teaching in small groups increases the academic teaching workload. The aim of this study was to investigate whether this increase in teaching duties is associated with an increase in report turnaround times of radiologists or increased unplanned absence during term times compared with term breaks (lecture-free periods) and over the whole period under investigation. MATERIALS AND METHODS: The database of all radiological examinations performed at a large German university hospital was retrospectively analyzed for a two-year period from the winter term 2011/12 to the summer term 2013. A total of 192 984 radiological examinations performed during this period were included in an analysis of reporting times (i. e., time from end of examination to completion of report) during term times versus term breaks. Reporting times were analyzed for all radiological examinations and for intensive care unit (ICU) patients. In addition, radiologists' schedules were analyzed in terms of teaching duties, unplanned absence, vacation days, and days away from work for education and training. RESULTS: During the period under investigation, the teaching load increased from overall 1.75 hours/day in the winter term 2011/12 to 6.49 hours/day in the summer term 2013 and in the term break from overall 0.10 hours/day in the winter term 2011/12 to 0.71 hours/day in the summer term 2013. Reporting time increased during this period (p < 0.05) but remained shorter during term times than during term breaks. The difference between term and term break for ICU patients was not significant. There was no increase in unplanned absences during term times. CONCLUSION: Overall, radiologists' reporting times increased during the period when the reformed curriculum for undergraduate medical education was implemented. As this was observed both during term and during term breaks, increased teaching duties alone cannot serve as a sole causal explanation. KEY POINTS: · Digital high-quantitative parameters can be used to evaluate workflow in radiology.. · Reporting time can be a criterion for efficient staffing.. · The acquisition and evaluation of parameters such as reporting times could lead to a more efficient resource allocation by providing hints of changed framework conditions and changing working intensities and/or capicity reserves - which may not be immediately apparent.. · During the period under investigation with the implementation of a teaching-intensive reformed curriculum for undergraduate medical education there was an increase in reporting time, which was not significant in intense care units.. · Since during the period under investigation the increase in reporting times can be stated both during term time and in the lecture free period, the implementation of the reformed curriculum for undergraduate medical education alone cannot serve as a sole causal explanation.. CITATION FORMAT: · Albrecht L, Maurer MH, Seithe T et al. Development of the Report Turnaround Times in a University Department of Radiology during Implementation of a Reformed Curriculum for Undergraduate Medical Education. Fortschr Röntgenstr 2018; 190: 259 - 264.

Initial experience with imaging of the lower extremity arteries in an open 1.0 Tesla MRI system using the triggered angiography non-contrast-enhanced sequence (TRANCE) compared to digital subtraction angiography (DSA).

PURPOSE: The aim of this study was to evaluate the feasibility and validity of arterial lower limb imaging with triggered angiography non-contrast enhanced (TRANCE) in an open MRI at 1.0 Tesla (T) compared to digital subtraction angiography (DSA). MATERIAL AND METHODS: ECG-gated, non-contrast-enhanced magnetic resonance angiography (MRA) was performed in a 1.0-T high-field open magnetic resonance imaging (MRI) system which generates a vertical magnetic field. Three acquisition levels were defined (abdominal and pelvic level, arterial segments above the knee and segments below the knee) and a total of 1782 vessel diameter measurements were taken on a total of 11 patients with suspected peripheral arterial occlusive disease (PAOD) (8 men, 3 women; average age 66 years). In each patient, 162 vessel segments (81 each with TRANCE and DSA) were defined and measured. Pearson correlation coefficients were calculated. RESULTS: At the abdominal/pelvic level, all mean values measured with DSA exceeded the mean values obtained with TRANCE. Above the knee, mean vessel diameters were measured smaller in DSA in six, equal in three, and larger in two vessel segments. Below the knee, all measured averages, except for the tibiofibular tract (TFT) measurements, were larger in TRANCE. In total, two small (≤0.3), two moderate (>0.3), 11 good (>0.5), 10 high (>0.7) and 13 very high (>0.8) correlations were obtained. CONCLUSIONS: Non-contrast-enhanced imaging of the lower limb arteries using a TRANCE-sequence in a 1.0 T open MRI system is feasible with the protocol presented; however, TRANCE tends to underestimate larger vessels and overestimate smaller vessels compared to DSA.

Interactive near-real-time high-resolution imaging for MR-guided lumbar interventions using ZOOM imaging in an open 1.0 Tesla MRI system--initial experience.

PURPOSE: Different techniques for magnetic resonance-guided lumbar interventions have been introduced in recent years. Appropriate pulse sequence design is crucial since high spatial resolution often comes at the cost of lower temporal resolution. The purpose of this study was to evaluate the value of accelerated reduced field of view (ZOOM)-based imaging sequences for lumbar interventions. METHODS: ZOOM imaging was used in 31 interventions (periradicular, facet joint, epidural infiltrations, and discography) performed in 24 patients (10 women, 14 men; age 43 ± 13.3 years). Signal-to-noise ratio and contrast-to-noise ratio (CNR) were determined and retrospectively compared with standard preinterventional (T2 weighted), peri-interventional (proton density), and postinterventional (spectral presaturation with inversion recovery [SPIR]) imaging. Needle artifacts were assessed by direct measurement as well as with parallel and perpendicular needle profiles. Puncture times were compared to similar interventions previously performed in our department. RESULTS: No significant differences in signal intensities (standard/ZOOM: 152.0/151.6; p=0.136) and CNR values (2.0/4.0; p=0.487) were identified for T2-weighted sequences. The needle artifact signal intensity was comparable (648.1/747.5; p=0.172) for peri-interventional imaging. Standard interventional (fat needle: 43.8/23.4; p<0.001; muscle needle: 6.2/2.4; p<0.001) and SPIR sequences (43.3/13.9; p=0.010) showed a higher CNR than corresponding ZOOM sequences did. Needle artifacts were larger in ZOOM (2.4 mm/2.9 mm; p=0.005). The profiles revealed that ZOOM imaging delivers more overall signal intensity. The turning points of both profiles were comparable. ZOOM reduced intervention times significantly (329.1 s/228.5 s; p=0.026). CONCLUSION: ZOOM imaging is a feasible interactive sequence for lumbar interventions. It ameliorates the tradeoff between image quality and temporal resolution. Moreover, the sequence design reduces intervention times significantly.

Non-invasive ECG-triggered 2D TOF MR angiography of the pelvic and leg arteries in an open 1.0-tesla high-field MRI system in comparison to conventional DSA.

OBJECTIVES: A non-contrast-enhanced 2D time-of-flight magnetic resonance angiography (TOF-MRA) protocol was compared with the gold standard of planar digital subtraction angiography (DSA) by calculating correlations of vessel diameters. METHODS: A total of 1134 vascular diameters in 81 corresponding sites were prospectively measured by TOF-MRA and DSA in seven patients (four women, three men; mean age, 68 years). For a total of 162 vascular segments per patient, 81 Spearman's ρ correlation coefficients were calculated, consolidated to 41 due to consideration of symmetry (right/left), and assessed by correlation quality. RESULTS: In the 41 consolidated segments, correlations were good, very good, and excellent in 25 segments (n=10>0.5, n=4>0.7, and n=11>0.8), moderate to poor in seven segments (n=4>0.3 and 0

Fluid preinjection for microwave ablation in an ex vivo bovine liver model assessed with volumetry in an open MRI system.

PURPOSE: We aimed to detect possible differences in microwave ablation (MWA) volumes after different fluid preinjections using magnetic resonance imaging (MRI). MATERIALS AND METHODS: MWA volumes were created in 50 cuboid ex vivo bovine liver specimens (five series: control [no injection], 10 mL water, 10 mL 0.9% NaCl, 10 mL 6% NaCl, and 10 mL 12% NaCl preinjections; n=10 for each series). The operating frequency (915 megahertz), ablation time (7 min), and energy supply (45 watts) were constant. Following MWA, two MR sequences were acquired, and MR volumetry was performed for each sequence. RESULTS: For both sequences, fluid preinjection did not lead to significant differences in MWA ablation volumes compared to the respective control group (sequence 1: mean MWA volumes ranged from 7.0±1.2 mm [water] to 7.8±1.3 mm [12% NaCl] vs. 7.3±2.1 mm in the control group; sequence 2: mean MWA volumes ranged from 4.9±1.4 mm [12% NaCl] to 5.5±1.9 mm [0.9% NaCl] vs. 4.7±1.6 mm in the control group). The ablation volumes visualized with the two sequences differed significantly in general (P < 0.001) and between the respective groups (control, P ≤ 0.001; water, P < 0.001; 0.9% NaCl, P < 0.001; 6% NaCl, P ≤ 0.001; 12% NaCl, P < 0.001). The volumes determined with sequence 1 were closer to the expected ablation volume of 8 mL compared to those determined with sequence 2. CONCLUSION: For the fluid qualities and concentrations assessed, there is no evidence that fluid preinjection results in larger coagulation volumes after MWA. Because ablation volumes determined by MRI vary with the sequence used, interventionalists should gain experience in how to interpret postinterventional imaging findings (with the MR scanner, sequences, and parameters used) to accurately estimate the outcome of the interventions they perform.