Audit of radiology communication systems for critical, urgent, and unexpected significant findings.

AIM: To determine the compliance of UK radiology departments and trusts/healthcare organisations with National Patient Safety Agency and Royal College of Radiologist's published guidance on the communication of critical, urgent, and unexpected significant radiological findings. MATERIALS AND METHODS: A questionnaire was sent to all UK radiology department audit leads asking for details of their current departmental policy regarding the issuing of alerts; use of automated electronic alert systems; methods of notification of clinicians of critical, urgent, and unexpected significant radiological findings; monitoring of results receipt; and examples of the more common types of serious pathologies for which alerts were issued. RESULTS: One hundred and fifty-four of 229 departments (67%) responded. Eighty-eight percent indicated that they had a policy in place for the communication of critical, urgent, and unexpected significant radiological findings. Only 34% had an automated electronic alert system in place and only 17% had a facility for service-wide electronic tracking of radiology reports. In only 11 departments with an electronic acknowledgement system was someone regularly monitoring the read rate. CONCLUSION: There is wide variation in practice across the UK with regard to the communication and monitoring of reports with many departments/trusts not fully compliant with published UK guidance. Despite the widespread use of electronic systems, only a minority of departments/trusts have and use electronic tracking to ensure reports have been read and acted upon.

Induced synthesis of oestrogens by glia in the songbird brain.

Studies on birds have long provided landmarks and touchstones in the fields of neuroendocrinology, immunology and neuroplasticity. The passerine brain is an excellent model for studying the actions of hormones, including steroids, on a diversity of behavioural endpoints. Oestrogens, for example, have profound effects on avian neuroanatomy and neurophysiology throughout life and, importantly, are synthesised at high levels within neurones of the songbird brain. More recently, aromatisation in another set of neural cells has been identified. Specifically, aromatase expression is induced in astrocytes and radial glia following disruption of the neuropil by multiple forms of perturbation. The avian brain, therefore, can be provided with high levels of oestrogens constitutively or via induction, by aromatisation in neurones and glia, respectively. In this review, we begin with the initial discovery of aromatisation by non-neuronal cells and discuss the mechanisms underlying the induction of aromatase expression in glial cells. We then focus on the emerging interactions between the neuroendocrine and neuroimmune systems with respect to brain injury. Next, we briefly review the extensive literature on the influence of glial aromatisation on neuroplasticity, and end with some recent data on sex differences in the induction of glial aromatase in the zebra finch. Throughout this review, we consider the unanswered questions and future studies that may emerge from these findings.

Staging cancer of the uterus: a national audit of MRI accuracy.

AIM: To report the results of a nationwide audit of the accuracy of magnetic resonance imaging (MRI) staging in uterine body cancer when staging myometrial invasion, cervical extension, and lymph node spread. MATERIALS AND METHODS: All UK radiology departments were invited to participate using a web-based tool for submitting anonymized data for a 12 month period. MRI staging was compared with histopathological staging using target accuracies of 85, 86, and 70% respectively. RESULTS: Of the departments performing MRI staging of endometrial cancer, 37/87 departments contributed. Targets for MRI staging were achieved for two of the three standards nationally with diagnostic accuracy for depth of myometrial invasion, 82%; for cervical extension, 90%; and for pelvic nodal involvement, 94%; the latter two being well above the targets. However, only 13/37 (35%) of individual centres met the target for assessing depth of myometrial invasion, 31/36 (86%) for cervical extension and 31/34 (91%) for pelvic nodal involvement. Statistical analysis demonstrated no significant difference for the use of intravenous contrast medium, but did show some evidence of increasing accuracy in assessment of depth of myometrial invasion with increasing caseload. CONCLUSION: Overall performance in the UK was good, with only the target for assessment of depth of myometrial invasion not being met. Inter-departmental variation was seen. One factor that may improve performance in assessment of myometrial invasion is a higher caseload. No other clear factor to improve performance were identified.

Is film-reading performance related to the number of films read? The Scottish experience.

AIM: To determine whether a drop-off in reading performance occurred with high-volume caseloads in Scotland. MATERIALS AND METHODS: The reading performance figures for all eligible film readers over a 36 month period were reviewed to determine the number of films read as first and second reader, the recall rates, the cancers detected, and the cancers missed by each reader. RESULTS: During the 3 year period, screen-reading volumes varied from 7009 to 53,598. There were six low-volume readers, 16 medium-volume readers, and 15 high-volume readers (>25,000 cases in the 3 year period). No statistically significant differences were found in the first read specificity or the recall rate between the three groups. CONCLUSION: The present results do not support the suggestion that reading performance drops off with a three year case volume of greater than 25,000 reads.

The effect of voice recognition software on comparative error rates in radiology reports.

This study sought to confirm whether reports generated in a department of radiology contain more errors if generated using voice recognition (VR) software than if traditional dictation-transcription (DT) is used. All radiology reports generated over a 1-week period in a British teaching hospital were assessed. The presence of errors and their impact on the report were assessed. Data collected included the type of report, site of dictation, the experience of the operator, and whether English was the first language of the operator. 1887 reports were reviewed. 1160 (61.5%) were dictated using VR and 727 reports (38.5%) were generated by DT. 71 errors (3.8% of all reports) were identified. 56 errors were made using VR (4.8% of VR reports), whereas 15 errors were identified in DT reports (2.1% of transcribed reports). The difference in report errors between these two dictation methods was statistically significant (p = 0.002). Of the 71 reports containing errors, 37 (52.1%) had errors that affecting understanding. Other factors were also identified that significantly increased the likelihood of errors in a VR-generated report, such as working in a busy inpatient environment (p<0.001) and having a language other than English as a first language (p = 0.034). Operator grade was not significantly associated with increased errors. In conclusion, using VR significantly increases the number of reports containing errors. Errors using VR are significantly more likely to occur in noisy areas with a high workload and are more likely to be made by radiologists for whom English is not their first language.

Antenatal renal pelvic dilatation; the long-term outlook.

AIM: The purpose of this study was twofold: first to provide data for more accurate counselling of parents with regard to prognosis, and second, to ensure that by following a policy of selective micturating cystourethography (MCUG), significant pathology is not missed, in particular vesicoureteric reflux (VUR). (MCUG is only undertaken if the renal pelvic diameter (RPD) is >/= 10 mm or if there is calyceal or ureteric dilatation.) MATERIAL AND METHODS: Data were collected prospectively over a 6-year period. Pre and postnatal imaging findings were collected for all infants in whom a RPD of >/= 5 mm was identified at any gestational age. The imaging records of all patients were reviewed in 2005 for evidence of pathology detected after re-presentation with symptoms. The age range at review varied from 2-8 years. RESULTS: Complete data were available in 527 infants. The risk of significant pathology was related to the degree of antenatal renal pelvic dilatation varying from 6% for a RPD of 5 mm at 20 weeks gestation to 38% at 10 mm. At 28-33 weeks gestation the risk varied from 5% at 5mm to 15% at 10 mm. Subsequent imaging record review revealed only one patient with grade II VUR in the study population not picked up by our selective MCUG policy. CONCLUSION: The present study provides prognostic information that can be given to parents both antenatally and postnatally, and reassurance that a selective MCUG policy is appropriate.

The financial abuse of mentally incompetent older adults: a canadian study.

ABSTRACT This article reports the results of a pilot study on the financial abuse of mentally incompetent seniors. The objectives of the study were to: (1) establish the incidence of suspected financial abuse among the clientele of the Office of Public Trustee, Province of Manitoba, (2) identify the characteristics of mentally incompetent older adults most at risk, and (3) identify indicators of financial abuse. Approximately 20% of the cases opened in a one year period were under suspicion of abuse. Findings were consistent with those of other research projects on elder abuse, in general, showing an over-representation of women over the age of eighty as victims of financial abuse. Unpaid personal care home bills when money should have been available was the most common indicator. In addition to providing a list of indicators of financial abuse that are of potential use to professionals, devising prevention programs, practical implications for service providers are presented.

The diagnostic acceptability of low-bandwidth transmission for tele-ultrasound.

Ultrasound recordings were made of 100 consecutive patients attending for obstetric examination in Peterhead and 100 patients attending for non-obstetric examination in Aberdeen. Two identical video-conferencing machines were used to transmit and receive the original ultrasound images at data rates of 384 kbit/s and 128 kbit/s, thus producing a total of three tapes for each case. Four experienced observers, who were blinded to the transmission bandwidth, each viewed 300 examinations and decided whether the images were acceptable or not for diagnosis. Almost 100% of the obstetric ultrasound images on the original recordings were considered diagnostically acceptable, compared with 93% of the 384 kbit/s transmissions and 44% of the 128 kbit/s transmissions. Similarly, 99% of the non-obstetric ultrasound images were considered acceptable, compared with 87% of the 384 kbit/s transmissions and 21% of the 128 kbit/s transmissions. For the obstetric ultrasound images the intra-observer diagnostic agreement was 93% (kappa = 0.89) between the original and the 384 kbit/s transmissions, and 78% (kappa = 0.63) between the original and the 128 kbit/s transmissions. For the non-obstetric ultrasound images the respective intra-observer diagnostic agreements were 77% (kappa = 0.62) and 78% (kappa = 0.63). The quality of dynamic ultrasound images transmitted at 384 kbit/s was diagnostically acceptable, but was unsatisfactory at 128 kbit/s.