Shift Volume Directly Impacts Neuroradiology Error Rate at a Large Academic Medical Center: The Case for Volume Limits.

BACKGROUND AND PURPOSE: Unlike in Europe and Japan, guidelines or recommendations from specialized radiological societies on workflow management and adaptive intervention to reduce error rates are currently lacking in the United States. This study of neuroradiologic reads at a large US academic medical center, which may hopefully contribute to this discussion, found a direct relationship between error rate and shift volume. MATERIALS AND METHODS: CT and MR imaging reports from our institution's Neuroradiology Quality Assurance database (years 2014-2020) were searched for attending physician errors. Data were collected on shift volume specific error rates per 1000 interpreted studies and RADPEER scores. Optimal cutoff points for 2, 3 and 4 groups of shift volumes were computed along with subgroups' error rates. RESULTS: A total of 643 errors were found, 91.7% of which were clinically significant (RADPEER 2b, 3b). The overall error rate (errors/1000 examinations) was 2.36. The best single shift volume cutoff point generated 2 groups: ≤ 26 studies (error rate 1.59) and > 26 studies (2.58; OR: 1.63, P < .001). The best 2 shift volume cutoff points generated 3 shift volume groups: ≤ 19 (1.34), 20-28 (1.88; OR: 1.4, P = .1) and ≥ 29 (2.6; OR: 1.94, P < .001). The best 3 shift volume cutoff points generated 4 groups: ≤ 24 (1.59), 25-66 (2.44; OR: 1.54, P < .001), 67-90 (3.03; OR: 1.91, P < .001), and ≥ 91 (2.07; OR: 1.30, P = .25). The group with shift volume ≥ 91 had a limited sample size. CONCLUSIONS: Lower shift volumes yielded significantly lower error rates. The lowest error rates were observed with shift volumes that were limited to 19-26 studies. Error rates at shift volumes between 67-90 studies were 226% higher, compared with the error rate at shift volumes of ≤ 19 studies.

Retrospective cohort study demonstrates that modified CT Severity Index directly correlates with lipase values at or above 600.

BACKGROUND: Elevated lipase is considered an important biomarker for pancreatitis. The aim of this study was to assess a potential correlation between elevated lipase and characteristic imaging findings, as per the well-established Modified CT Severity index (MCTSI). MATERIALS AND METHODS: This retrospective, single centre cohort study reviewed the radiologic findings and medical records of 200 consecutive patients with elevated lipase values. Subgroups were then created categorizing patients into low lipase elevation, medium lipase elevation, and high lipase elevation groups. CT exams evaluated by a single fellowship trained radiologist was used to establish MCTSI criteria. RESULTS: Statistical significance was calculated by an independent statistician using a linear regression model which demonstrated a statistically significant correlation between the high lipase group, (≥600 U/L) and MCTSI with p-value of <0.05. No significant correlation existed between MCTSI and lipase values below 600 U/L. CONCLUSIONS: The previously held notion that lipase values do not correlate with severity of pancreatitis does not hold true for lipase values ≥ 600 U/L. This suggests a likelihood of higher morbidity and may justify earlier use of contrast enhanced CT imaging in patients with pancreatitis whose lipase values are >600 U/L. This needs to be further validated with a multisite blinded prospective study.

Response of cervicogenic headaches and occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve.

OBJECTIVE: This article investigates the degree and duration of pain relief from cervicogenic headaches or occipital neuralgia following treatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves. It also addresses the procedure's complication rate and patient's willingness to repeat the procedure if severe symptoms recur. METHODS: This is a single-center retrospective observational study of 40 patients with refractory cervicogenic headaches and or occipital neuralgia. Patients were all referred by a headache specialty clinic for evaluation for radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves. After treatment, patients were followed for a minimum of 6 months to a year. Patient demographics and the results of radiofrequency ablation were recorded on the same day, after 3-4 days, and at 6 months to 1 year following treatment. RESULTS: Thirty-five percent of patients reported 100% pain relief and 70% reported 80% or greater pain relief. The mean duration of improvement is 22.35 weeks. Complication rate was 12-13%. 92.5% of patients reported they would undergo the procedure again if severe symptoms returned. CONCLUSIONS: Radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve can provide many months of greater than 50% pain relief in the vast majority of recipients with an expected length of symptom improvement of 5-6 months.