ABSTRACT
Computer-based voice-recognition software has many potential advantages in producing reports of radiology procedures. Using voice-recognition systems, however, necessitates increased involvement of the radiologist in the process of producing the report. The radiologist, previously responsible only for recording a report onto tape and ensuring the integrity of the final report now becomes obligated to interact with the computer and to ensure the integrity of the transcription process as well as the accuracy of the final report. Two attending radiologists and one first-year radiology resident at an academic medical center timed the production of reports using both the voice recognition system and tape transcription of reports of plain films (n = 27), mammograms (n = 25), and GI/GU exams (n = 17). In addition, the taped dictations were transcribed and then corrected by the physicians. The additional correction time (determined as an average) was added to the tape times to produce a "corrected" tape time. Paired T-Test procedures were used to determine if pairs of readings (voice recognition vs. corrected tape transcription) differed in length of time. In addition, the data was stratified into three groupings--plain film, mammography, and GI/GU--in order to assess for differences between modalities. The length of time required to produce a radiology report using the commercial radiology voice recognition system employed at our center is significantly longer than that required by the traditional corrected tape transcription system. One motivation to use a voice recognition system is the cost savings achieved by eliminating transcriptionists and replacing them with the radiologist using the voice recognition system. In our institution this cost savings is estimated to be $100,000 annually. This apparent cost savings is reduced by the cost of the lost productivity of the radiologist. Compared to tape transcription, our data demonstrate a significant increase in the amount of time necessary for radiologists to produce a radiology report when using the voice recognition system currently employed in our hospital. While it is likely that future systems will require less extra time, this factor needs to be accounted for when departments consider using such systems to replace transcriptionists with radiologists.
Subject(s)
Radiology Department, Hospital/organization & administration , Radiology Information Systems/organization & administration , Time and Motion Studies , User-Computer Interface , Voice , Academic Medical Centers , Humans , New York City , Software , Tape Recording , WorkloadABSTRACT
We examined the relation between language dominance and regional cerebral blood flow (rCBF) during the intracarotid amobarbital procedure (IAP). A previous report limited to three patients suggested that dominant rather than nondominant hemisphere IAP may have a differential effect on rCBF. Behavioral assessment during the IAP also suggests that dominant hemisphere injection results in a differential effect on memory and affective symptoms rather than nondominant injection. Thirteen patients were assessed using single-photon emission CT (SPECT) brain imaging during both left and right IAP. The SPECTs were coregistered with the individual's MRI. Changes in rCBF during each IAP were compared with the patient's baseline SPECT. Nine patients had left hemisphere dominance, two were right dominant, and two had bilateral speech representation. In the left dominant subjects, left-hemisphere injection had a consistently greater effect on rCBF than right-hemisphere injection in the anterior (p < 0.005) and posterior (p < 0.01) temporal neocortex. There was also a trend for greater hypoperfusion in the frontal lobe of the left hemisphere. rCBF in the ipsilateral hippocampus was not significantly different after each injection (p > 0.05). In the two patients with right hemisphere speech, the reverse pattern was seen, with greater hypoperfusion after right (dominant) hemisphere injection. There was no consistent asymmetry in the two patients with bilateral speech. Dominant hemisphere IAP results in significantly greater hypoperfusion than does nondominant injection. These data provide a physiologic basis for behavioral differences noted after dominant versus nondominant IAP.
Subject(s)
Amobarbital/administration & dosage , Cerebrovascular Circulation/physiology , Dominance, Cerebral/physiology , Hypnotics and Sedatives/administration & dosage , Language , Adolescent , Adult , Carotid Arteries , Cerebral Cortex/blood supply , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/drug effects , Cerebrovascular Circulation/drug effects , Dominance, Cerebral/drug effects , Electroencephalography , Female , Humans , Injections, Intra-Arterial , Male , Middle Aged , Oximes , Tomography, Emission-Computed, Single-PhotonABSTRACT
We studied the functional effect of injection of sodium amobarbital (SA) in 10 patients with intractable epilepsy. During the intracarotid amobarbital procedure, we measured delta activity in EEG recording from implanted electrodes and regional cerebral blood flow (rCBF) using HMPAO-SPECT co-registered with MRI. SA injection resulted in an increase in delta activity and a decrease in rCBF in all areas examined. Direct functional changes were observed in structures perfused by the carotid artery injected. In addition, we observed indirect effects, probably owing to deafferentation of neuronal pathways connecting these structures to ipsilateral and contralateral regions, including middle and posterior hippocampus.