American Board of Radiology certifying examination: oral versus computer-based format.

OBJECTIVE: This pilot study of a computer-based examination for primary certification by the American Board of Radiology was designed to acquire comparative data on candidates that were measures of individual performance on the oral examination compared with the computer-based examination. MATERIALS AND METHODS: The pilot computer-based pediatric radiology examination was designed by experienced oral board examiners and the pediatric subspecialty trustees. Images were chosen from the examination repository of the American Board of Radiology. The 20-minute examination was designed to include 8-10 cases with 26-31 scorable units covering all aspects of pediatric radiology. RESULTS: Among the 1,317 candidates taking the oral board examination, 1,048 candidates (79.6%) participated in the voluntary pilot examination. The scores of the two examinations were subjected to statistical analysis. The sensitivity and specificity of the pilot examination were 94.5% and 45.7%. The overall accuracy was 92.8%. Seventy-five candidates (7.2%) who participated in this study received different verdicts on the pilot examination and the pediatric radiology category of the oral examination. Fifty-six of these candidates (5.3%) failed the pilot examination but passed in the oral pediatric radiology category; 19 of the candidates (1.8%) passed the pilot examination but failed the oral pediatric radiology test. Pilot examination scores were higher for candidates who passed the oral pediatric radiology category (median score, 80; interquartile range, 74.1-85.2) than for candidates who failed (median score, 65.4; interquartile range, 58.6-71.0) (p < 0.0001). CONCLUSION: The pediatric pilot examination was useful for differentiating passing candidates from failing candidates when the score in the pediatric radiology category of the oral examination was used as the reference standard. The overall accuracy was 92.8%.

Challenges and opportunities in restructuring radiology residencies: the APDR Residency Restructuring Committee report.

Changes to the ABR certification process are imminent, with a core examination after 36 months of training and a certifying examination 15 months after the completion of training replacing the current examination structure for residents entering training in July 2010 and beyond. The Residency Restructuring Committee of the Association of Program Directors in Radiology was developed to analyze the challenges and opportunities of these upcoming changes and provide recommendations to programs. The guidelines included in this article represent a summary of the work of this committee to date.

American Board of Radiology Maintenance of Certification - Part IV: practice quality improvement for radiation oncology.

Maintenance of Certification is a physician-based response to public concerns about the quality of medical care and physician competency in a rapidly evolving, technically demanding specialty. The American Board of Radiology (ABR) has previously described the first three components of the Maintenance of Certification. The ABR is currently developing a program in practice performance, completing Part IV of the competencies. The Practice Quality Improvement (PQI) program is meant to critically evaluate meaningful aspects of a physician's practice in a simple manner, using identifiable metrics and self-assessment to include an action plan for quality improvement. Each diplomate will be expected to complete three PQI projects during a full 10-year Maintenance of Certification cycle. Current diplomates with time-limited certificates will find prorated requirements determined by their year of certification on the ABR Website. Diplomates will have the option of completing zero to two Type I PQI projects (assessing factors relevant to clinical practice by peer review and self-reporting) and one to three Type II projects (i.e., at least one Type II projects of the three required, assessing parameters of practice by comparison with evidence-based guidelines, consensus statements, or peer comparisons; Type II projects are initiated and managed by professional societies). Several examples of Type I projects that might be offered by societies or directly through the ABR are provided, as well as highlights of the two Type II projects that have sought ABR qualification: the American Society for Therapeutic Radiology and Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment program and American College of Radiology's RO-PEER program. An additional objective of the PQI is to develop national databases for future reference using aggregate data from the PQI projects.

Diseases associated with childhood obesity.

OBJECTIVE: Radiologists can play an active role in children's health by increasing awareness of diseases associated with obesity. This article reviews key imaging findings in obesity-related diseases, current issues in imaging obese children, and treatment strategies. CONCLUSION: There has been a well-documented pediatric obesity epidemic and a dramatic increase in clinical diseases associated with it. These serious health consequences affect nearly every organ system. Despite the increasing prevalence of obesity and the associated health hazards, pediatric obesity as a diagnosis is often overlooked by health care providers.

Establishing a program to promote professionalism and effective communication in radiology.

Effective health care delivery systems rely heavily on high degrees of skill in professionalism and communication. These skills are essential to all of the missions of a successful radiology department. Until recently, there was a lack of emphasis on the importance of these issues and a lack of efforts in setting expectations and measuring performance. Herein the authors describe the components of a program implemented to promote professionalism and effective communication in their radiology department.

The frequency of radiology reporting of childhood obesity.

OBJECTIVE: The purpose of our study was to review the current practice of radiologists with respect to dictating the presence of obesity in imaging reports. MATERIALS AND METHODS: Over 1 million radiology reports dictated at a large pediatric hospital from 1994 to 2002 were analyzed for several keywords relating to obesity. The number of cases in which the keywords appeared was recorded for each year, and a percentage was calculated. Reports done in 1999 and 2000 were further analyzed to determine where the keywords were positioned within the report. RESULTS: The number of reports containing a keyword ranged from 131 to 456 per year. During each year, documentation of obesity occurred in less than 0.4% of all reports. During that same time period, the national prevalence of pediatric obesity ranged from 6-16%. Detailed examination of the 1999 and 2000 reports showed that even in the reports that mentioned obesity, it was usually not listed in the diagnostic impression. CONCLUSION: Despite the increase in public awareness of obesity and increasing recognition of obesity-related disease, this study did not find a similar awareness among radiologists at a large pediatric radiology department. The reason for this discrepancy is speculative and likely multifactorial. Regardless, radiologists may be missing an opportunity to play a role in disease prevention and early recognition by documenting findings of obesity and thereby bringing them to the attention of referring physicians.

Performance-based assessment of radiology faculty: a practical plan to promote improvement and meet JCAHO standards.

OBJECTIVE: The objective of this article is to describe the process of implementing a program for performance-based assessment of clinical faculty. CONCLUSION: A performance-based assessment of clinical faculty program facilitated quality improvements in our department, improved communication concerning our reappointment process, and was well received by faculty. The presence of measures on a scorecard stresses what is important for clinical care and facilitates process improvement in these areas. Having practitioner-specific data compiled in an organized fashion helps meet the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

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.

The impact of a clinical guideline on imaging children with hypertrophic pyloric stenosis.

PURPOSE: The purpose of the study was to evaluate the impact of a clinical pathway on the volume of imaging studies performed in children with suspected clinical diagnosis of hypertrophic pyloric stenosis. The pathway suggested referral to surgeons for clinical evaluation for palpation of the olive prior to ordering imaging studies. Only those children in whom the olive could not be palpated would be referred for imaging, and it was anticipated that imaging volume would be reduced following guideline implementation. MATERIALS AND METHODS: The database of the Health Policy and Clinical Effectiveness Department was used to evaluate all patients who had surgery for hypertrophic pyloric stenosis. The presence of a palpable olive and the type of imaging were evaluated both prior to and after the implementation of the clinical guideline. RESULTS: Prior to the guideline, 85 infants had surgery for pyloric stenosis, with 83 of the 85 (97%) having imaging. After the implementation of the guideline, 90 infants had surgery for pyloric stenosis with 84 of 90 patients imaged (92%). A chi-square analysis demonstrated no significant difference in the percentage of children imaged in the two groups (P = 0.104). Approximately one in five children referred for vomiting were diagnosed with hypertrophic pyloric stenosis. CONCLUSION: No significant change in imaging volume occurred following initiation of a guideline which recommended clinical evaluation for palpation of the olive prior to ordering imaging studies. Multiple factors probably contributed to the lack of demonstrated changes.

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.

Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?

BACKGROUND: In our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed. OBJECTIVE: To determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children. MATERIALS AND METHODS: Three radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs. A majority interpretation of at least two radiologists for the frontal views alone was compared with majority interpretation of the frontal and lateral combined views for the radiographic diagnosis of pneumonia. "Pneumonia" was defined as a focus of streaky or confluent lung opacity. RESULTS: For the radiographic diagnosis of pneumonia, the sensitivity and specificity of the frontal view alone were 85% and 98%, respectively. For the confluent lobar type of pneumonia, the sensitivity and specificity increased to 100%. CONCLUSION: When the frontal view alone yields a diagnosis of confluent lobar pneumonia, this is highly reliable. However, nonlobar types of infiltrates will be underdiagnosed in 15% of patients using the frontal view alone. The clinical impact of these radiographically underdiagnosed pneumonias needs to be assessed prior to implementing the practice of using only frontal radiographs for diagnosing pneumonia.