Design, implementation, and assessment of a radiology workflow management system.

OBJECTIVE: The objective of this article is to describe the development, launch, and outcomes studies of a paperless workflow management system (WMS) that improves radiology workflow in a filmless and speech-recognition environment. MATERIALS AND METHODS: The WMS prioritizes cases automatically on the basis of medical and operational acuity factors, automatically facilitates communication of critical radiology results, and provides permanent documentation of these results and communications. It runs in parallel with an integrated radiology information system (RIS)-PACS and speech-recognition system. Its effects on operations, staff stress and satisfaction, and patient satisfaction were studied. RESULTS: Despite an increase in caseload volume after the launch of the WMS, case turnaround times, defined as the time between case availability on PACS and signing of the final radiology staff interpretation, decreased for all case types. Median case turnaround time decreased by 33 minutes (22%) for emergency department, 47 minutes (37%) for inpatient, and 22 minutes (38%) for outpatient radiology cases. All reductions were significant at a p value of < 0.05. Interruptions were reduced, consuming an estimated 28% less radiology staff time, after implementation. Patient perceptions of radiology service timeliness showed modest improvement after the WMS was implemented. Staff satisfaction showed no significant change. CONCLUSION: There is room for improvement in radiology workflow even in departments with integrated RIS-PACS and speech-recognition systems. This study has shown that software tools that coordinate decentralized workflow and dynamically balance workloads can increase the efficiency and efficacy of radiologists. Operational benefits, such as reduced reading times, improvements in the timeliness of care (both actual and as perceived by patients), and reduced interruptions to radiologists, further reinforce the benefits of such a system. Secondary benefits, such as documenting communication about a case and facilitating review of results, can also promote more timely and effective care. Although use of the system did not result in a substantial improvement in staff perceptions, neither did it reduce their satisfaction, suggesting that these operational improvements were not achieved as a trade-off against the quality of the work environment.

Use of computer databases to reduce radiograph reading errors.

Errors in reading radiologic images create health risks to patients and can adversely affect physicians through litigation and increased insurance costs. This study assessed the usefulness of a radiology teaching database for training physicians to improve their diagnostic accuracy. This tool is particularly important in pediatric radiology because children have unique anatomies and pathologies, and most physicians are generally more familiar with adults. The case collection consisted of normal cases and cases that had changes in the initial interpretations from an existing database of pediatric radiologic images at the Cincinnati Children's Hospital Medical Center. Physicians in the radiology department were surveyed regarding their opinions on the case collections. The most frequent users of the collection were residents and fellows, who used the collection primarily for learning and reference. Attending radiologists used the collection for teaching and daily film reading. The most commonly used cases involved head computed tomography, brain magnetic resonance, and skull radiography. All respondents recognized the value of the database for the enhancement of residents' and fellows' training. Residents and fellows expressed the desire to add complete abnormal and frequently missed case collections to the normal collection. Physicians who used the collections did so very frequently, but many experienced physicians never accessed the collection. Inexperienced physicians' reliance on reference books compared with Internet resources highlights a need for computer-based teaching and reference tools. This study illustrates that easy-to-use computer-based teaching files are useful for training physicians and as reference tools for experienced physicians.

Radiologist recruitment and retention: how can we improve?

Although recent data suggest that the shortage of radiologists is beginning to ease, radiologists remain in high demand. Academic and private radiology practices can take specific steps both to encourage the recruitment of new radiologists and to enhance the retention of existing staff members. The authors review the history of the current workforce shortage and describe steps they have taken within their own practice that have proved successful in helping fill staff positions and prevent the significant loss of staff members over the past several years. The authors believe that these steps can be helpful to any institution, private or academic, seeking to recruit and retain radiologists.

Development of an interactive model for teaching emergency pediatric radiography: preliminary report.

PURPOSE: The authors describe the development of an interactive digital teaching module designed to help prepare residents to diagnose emergency pediatric radiology cases. METHODS: Cases were identified using the authors' own dictation search software. Cases were selected that depicted common conditions that had been misdiagnosed by the radiology resident who had first interpreted them clinically. Normal cases involving similar anatomic regions were also collected. Images from these cases were captured from the picture archiving and communication system. "Hotspots" were superimposed on abnormalities to highlight them. Example dictations were captured. A simple user interface was developed for the teaching module, and a database was built to log all user responses. RESULTS: The system has been well received at the authors' institution. It has been incorporated into the standard orientation for all incoming residents. Residents' diagnostic performance has subjectively improved since the module was launched. CONCLUSIONS: The module is interactive, easy to use, and subjectively improves incoming residents' diagnostic accuracy. A prospective, controlled study assessing its impact on short-term and long-term diagnostic performance is under way.

Oral contrast agents for CT of abdominal trauma in pediatric patients: a comparison of dilute hypaque and water.

OBJECTIVE: Dilute Hypaque Sodium is generally well accepted as an oral contrast agent for CT of pediatric patients who have experienced recent blunt abdominal trauma. However, Hypaque can cause complications. Using water as a substitute contrast agent eliminates these potential complications. The purpose of our study was to compare the performance of water with that of dilute Hypaque as an oral contrast agent. Our hypothesis was that we would find no significant difference in performance between the two agents in defining anatomic details of the hollow gastrointestinal tract. MATERIALS AND METHODS: We performed a retrospective review of 74 CT scans obtained in infants and children who had received blunt abdominal trauma, scoring the quality of visualization of bowel structures, the presence of non-bowel-related findings, and the confidence level in making each assessment. The date range of the scans reviewed overlapped with the period in which the oral contrast material used for scanning such patients was switched from dilute Hypaque to water. Of the 74 CT scans that we reviewed, 53 were obtained with dilute Hypaque and 21 were obtained with water. The sex distribution between the two groups was compared using a chi-square test, whereas the mean age was compared using a two-sample two-sided Student's t test. A two-sample one-sided Student's t test of equivalence was used to analyze the data. RESULTS: Sex distribution for the two groups of patients was not significantly different (69.81% of the group who received dilute Hypaque were boys; 68.18% of the group who received water were boys). Furthermore, the difference in the mean age for the two groups was not statistically significantly (dilute Hypaque group, 8.86 years; water group, 10.18 years). No statistically significant difference in performance of the contrast agents was found with respect to the detection of intraabdominal abnormality. As an oral contrast material, water performed as well as dilute Hypaque in facilitating visualization of all intraabdominal anatomic structures. CONCLUSION: In defining anatomic details of the hollow gastrointestinal tract, water is as effective as dilute Hypaque as an oral contrast agent for CT in the setting of acute blunt abdominal trauma in pediatric patients.

Diagnostic errors by radiology residents in interpreting pediatric radiographs in an emergency setting.

BACKGROUND: There are few data regarding the frequency and type of diagnostic errors made by radiology residents and fellows ("trainees"). However, increasing interest in reducing medical errors highlights the need to analyze which areas of medical knowledge are most problematic for physicians-in-training, including radiology trainees. Once these areas are identified, they can be emphasized during training. OBJECTIVE: To quantify the diagnostic errors made by radiology trainees interpreting radiographs from a pediatric emergency department. MATERIALS AND METHODS: A total of 23,273 dictations of emergency radiographs performed over a 1-year period at a pediatric hospital were analyzed for corrections after staff interpretation and for type and incidence of missed abnormalities by radiology trainees. Errors were categorized by type of pathology and anatomic region. RESULTS: Of the 80 errors detected, 90% were false negatives and 69% were recurrent. Most errors (69%) involved the diagnosis of fractures and/or dislocations. Sixty-one percent of all recurrent errors involved buckle, Salter II, avulsion, and transverse fractures-yet these cases constituted only 3% of all cases seen during the study period. CONCLUSION: The most common errors made by radiology trainees can be identified. By targeting these errors, training programs can improve the quality and relevance of the education they provide.

The cochlear cleft.

BACKGROUND AND PURPOSE: Recent advances in the display of medical images permit the routine study of temporal bone CT images at high magnification. We noted an unfamiliar structure, which we now call the "cochlear cleft," in the otic capsule. To our knowledge, this report represents the first description of this structure in the medical imaging literature. METHODS: Temporal bone CT performed in 100 pediatric patients without sensorineural hearing loss were examined for the presence of cochlear clefts. Incidence of cochlear clefts as well as the relationship between age and incidence was examined. RESULTS: Cochlear clefts were present in 41% of the subjects. Incidence decreased with age. CONCLUSION: We describe a cleft in the otic capsule that is frequently seen on magnified images of temporal bone CT studies in children. The cleft may be the fissula ante fenestram.

Improving patient care: the use of a digital teaching file to enhance clinicians' access to the intellectual capital of interdepartmental conferences.

OBJECTIVE: We describe a simple method for creating teaching cases from clinical data, radiologic images, surgical images, and images from pathologic slides that are presented at tumor board conferences. CONCLUSION: The resulting interdisciplinary case files are of educational value both during and after conference presentations and can be used by clinicians to gather appropriate historical, laboratory, imaging, surgical, and pathologic data on their patients. This system improves the efficiency and accuracy in gathering patient histories when care is transferred among clinics, the emergency department, and wards.

Changing radiology resident education to meet today's and tomorrow's needs.

Radiology education has evolved significantly in the past several decades, but there is considerable room for improvement. While some improvements depend on the availability of new technology, others are low tech, requiring merely that we be aware of and apply findings in the education literature. We teachers of radiology could benefit from recent studies investigating the processes underlying adult learning to improve the methods we use to train residents and fellows, and to improve the way we teach our colleagues and even ourselves. In this review, adult learning and the expert learner are briefly discussed, as are the important elements of effective learning tools. The strengths and weaknesses of radiology education as it is commonly practiced today are explored. Specific suggestions for improving education in radiology using both low tech and high tech methods are then discussed.

Temporal bone abnormalities associated with hearing loss in Waardenburg syndrome.

OBJECTIVES/HYPOTHESIS: The objectives were to correlate audiometric thresholds with radiological findings and to determine the prevalence of inner ear radiological abnormalities in patients with hearing loss and Waardenburg syndrome. STUDY DESIGN: The study was a retrospective review of patients with Waardenburg syndrome identified in a pediatric hearing-impaired population and human genetics clinic. METHODS: Nine children with Waardenburg syndrome were identified. Eighty-nine children without sensorineural hearing loss served as control subjects. Clinical data, audiometric thresholds, and radiographic temporal bone measurements in these children were analyzed. RESULTS: Seven children were identified with hearing loss and Waardenburg syndrome. Four children had Waardenburg syndrome type 1, and three children had Waardenburg syndrome type 2. The overall prevalence of hearing loss in the total study population with Waardenburg syndrome was 78%. The mean pure-tone average was 99 dB. All of the children had sensorineural hearing loss. The hearing outcome was stable in 86% of the children. Twelve temporal bones were available for radiological analysis by computed tomography. Enlargement of the vestibular aqueduct was found in 50% of the CT scans. There was a significant difference in measurements of vestibular aqueduct width at the midpoint between the patients with Waardenburg syndrome and the control group (P <.05). There were also significant differences in the measurements of the vestibule (P =.0484), internal auditory canal (P =.0092), and modiolus (P =.0045) between the children with Waardenburg syndrome and the control group. CONCLUSION: A profound sensorineural hearing loss was characteristic of the study population with Waardenburg syndrome. Overall, 100% of patients with hearing loss and Waardenburg syndrome had temporal bone anomalies on at least one measurement of their inner ear, and 50% had an enlargement of the vestibular aqueduct at the midpoint. As shown by computed tomography, enlargement of the vestibular aqueduct and the upper vestibule, narrowing of the internal auditory canal porus, and hypoplasia of the modiolus are features of Waardenburg syndrome.

Reversible MR imaging and MR spectroscopy abnormalities in association with metronidazole therapy.

We present a report of MRI and proton MR spectroscopy (MRS) findings in an adolescent patient with Down syndrome and Crohn disease treated with metronidazole. MRI revealed signal abnormalities within the corpus callosum, basal ganglia, and brainstem. Proton MRS examination demonstrated a persistent lactate elevation during metronidazole treatment. Clinical, spectroscopic, and imaging abnormalities resolved with discontinuation of metronidazole.

A simple method of capturing PACS and other radiographic images for digital teaching files or other image repositories.

OBJECTIVE: We sought to develop an easy-to-use method of capturing and storing radiographic images. CONCLUSION: The method that we developed can capture any digital image-including an image from a picture archiving and communication system (PACS)-using widely available, inexpensive software. Our method is easy to learn, simple to use, and inexpensive to implement. It is adaptable in a wide range of networking environments and can capture and store images rapidly for a variety of uses. It can be used without interfering with clinical workflow at the PACS workstation.