Voice recognition dictation: radiologist as transcriptionist.

Continuous voice recognition dictation systems for radiology reporting provide a viable alternative to conventional transcription services with the promise of shorter report turnaround times and increased cost savings. While these benefits may be realized in academic institutions, it is unclear how voice recognition dictation impacts the private practice radiologist who is now faced with the additional task of transcription. In this article, we compare conventional transcription services with a commercially available voice recognition system with the following results: 1) Reports dictated with voice recognition took 50% longer to dictate despite being 24% shorter than those conventionally transcribed, 2) There were 5.1 errors per case, and 90% of all voice recognition dictations contained errors prior to report signoff while 10% of transcribed reports contained errors. 3). After signoff, 35% of VR reports still had errors. Additionally, cost savings using voice recognition systems in non-academic settings may not be realized. Based on average radiologist and transcription salaries, the additional time spent dictating with voice recognition costs an additional $6.10 per case or $76,250.00 yearly. The opportunity costs may be higher. Informally surveyed, all radiologists expressed dissatisfaction with voice recognition with feelings of frustration, and increased fatigue. In summary, in non-academic settings, utilizing radiologists as transcriptionists results in more error ridden radiology reports and increased costs compared with conventional transcription services.

Anatomic dissection tractography: a new method for precise MR localization of white matter tracts.

BACKGROUND AND PURPOSE: Several white matter tracts in the brain cannot be identified on MR studies because they are indistinguishable from the surrounding white matter. We sought to develop a method to precisely localize white matter tracts by correlating anatomic dissections with corresponding MR images. METHODS: MR imaging was used to guide anatomic dissection of the uncinate fasciculus. Formalin-preserved brains were imaged before and after several stages of dissection. Progressive dissection was guided by using volume-rendered and cross-sectional images of the dissected specimens. To precisely define the location of a tract, its surface was traced on the corresponding three-dimensional MR image of the dissected specimen. MR images of the dissected and intact specimens were coregistered to allow the tracings to be projected onto multiplanar reformatted images of the intact specimen. RESULTS: The uncinate fasciculus in the anterior temporal lobe and external and extreme capsules was dissected without destroying adjacent structures. Coregistration of the MR images from intact and dissected specimens permitted precise MR identification of the surface of this tract. These methods were successful for two additional tracts. (The dissected anatomy, MR anatomy, and clinical examples of the three tracts are described in a companion article.) CONCLUSION: MR-assisted anatomic dissection permits limited removal of brain tissue so that important anatomic and surgical relationships can be demonstrated on correlated MR studies. This method can be applied to other white matter tracts that are indistinguishable on MR studies and to situations in which anatomic validation of normal and abnormal diffusion tractographic studies is needed.

MR imaging of the temporal stem: anatomic dissection tractography of the uncinate fasciculus, inferior occipitofrontal fasciculus, and Meyer's loop of the optic radiation.

BACKGROUND AND PURPOSE: The MR anatomy of the uncinate fasciculus, inferior occipitofrontal fasciculus, and Meyer's loop of the optic radiation, which traverse the temporal stem, is not well known. The purpose of this investigation was to study these structures in the anterior temporal lobe and the external and extreme capsules and to correlate the dissected anatomy with the cross-sectional MR anatomy. METHODS: Progressive dissection was guided by three-dimensional MR renderings and cross-sectional images. Dissected segments of the tracts and the temporal stem were traced and projected onto reformatted images. The method of dissection tractography is detailed in a companion article. RESULTS: The temporal stem extends posteriorly from the level of the amygdala to the level of the lateral geniculate body. The uncinate and inferior occipitofrontal fasciculi pass from the temporal lobe into the extreme and external capsules via the temporal stem. Meyer's loop extends to the level of the amygdala, adjacent to the uncinate fasciculus and anterior commissure. These anatomic features were demonstrated on correlative cross-sectional MR images and compared with clinical examples. CONCLUSION: This study clarified the MR anatomy of the uncinate and inferior occipitofrontal fasciculi and Meyer's loop in the temporal stem and in the external and extreme capsules, helping to explain patterns of tumor spread. The inferior occipitofrontal fasciculus is an important yet previously neglected tract. These results provide a solid anatomic foundation for diffusion tractography of the normal temporal stem and its tracts, as well as their abnormalities in brain disorders such as epilepsy, postoperative complications, trauma, schizophrenia, and Alzheimer disease.