Quality of chest radiograph reports.

BACKGROUND: Examination requests and imaging reports are the most important communication instruments between clinicians and radiologists. An accurate and clear report helps referring physicians make care decisions for their patients. PURPOSE: To evaluate the contents of initial and re-reported chest reports, assess the inter-observer agreement, and evaluate the clarity of the report contents from the viewpoint of the referring physicians. MATERIAL AND METHODS: The content and agreement of the reports were analyzed by comparing the initial reports with re-reports prepared by a chest radiologist. The referring physicians evaluated the contents of 50 reports regarding their medical facts, clarity, and intelligibility. The results were analyzed using cross-over tables, the Pearson Chi-Square, and kappa statistics. RESULTS: Radiologists mostly addressed the questions posed by the referring physicians. General radiologists included separate conclusions in their reports more frequently (22%) than the chest radiologist in her re-reports. Reports prepared by the chest radiologist contained nearly 50% more findings than the general radiologists' reports. Inter-observer agreement between the initial and specialist re-reported reports was 66%, but the kappa value was 0.31. The reports were considered clear/intelligible by the referring physicians in 68% of the initial reports by the general radiologists and in 94% of the re-reported studies by the chest radiologist. CONCLUSION: Radiology report quality was rather high despite their contents varying depending on the radiologist. Inter-observer agreement of the chest radiographs was low due to the non-structured reports containing different quantities of information, thus complicating the comparison. Referring physicians considered both short and long radiology reports to be clear.

Transition in occupational radiation exposure monitoring methods in diagnostic and interventional radiology.

Radiation exposure monitoring is a traditional keystone of occupational radiation safety measures in medical imaging. The aim of this study was to review the data on occupational exposures in a large central university hospital radiology organisation and propose changes in the radiation worker categories and methods of exposure monitoring. An additional objective was to evaluate the development of electronic personal dosimeters and their potential in the digitised radiology environment. The personal equivalent dose of 267 radiation workers (116 radiologists and 151 radiographers) was monitored using personal dosimeters during the years 2006-2010. Accumulated exposure monitoring results exceeding the registration threshold were observed in the personal dosimeters of 73 workers (59 radiologists' doses ranged from 0.1 to 45.1 mSv; 14 radiographers' doses ranged from 0.1 to 1.3 mSv). The accumulated personal equivalent doses are generally very small, only a few angiography radiologists have doses >10 mSv per 5 y. The typical effective doses are <10 µSv y(-1) and the highest value was 0.3 mSv (single interventional radiologist). A revised categorisation of radiation workers based on the working profile of the radiologist and observed accumulated doses is justified. Occupational monitoring can be implemented mostly with group dosimeters. An active real-time dosimetry system is warranted to support radiation protection strategy where optimisation aspects, including improving working methods, are essential.

Clinical audits and regulatory inspections--double efforts and expenses for radiation protection?

BACKGROUND: Clinical audit as a systematic examination of medical procedures improves the quality and outcome of patient care. The purpose of a regulatory inspection is to check and verify that the operation and facilities are in full conformance with all legal requirements. PURPOSE: To examine the content of the clinical audits and regulatory inspections of radiological procedures and whether these overlap, and to evaluate the costs to radiological units. MATERIAL AND METHODS: Clinical audits were carried out at each imaging unit of Helsinki University Hospital (HUS) Medical Imaging Center in Finland in 2004 and 2005. The regulatory inspections were carried out after the clinical audits from 2005 to late 2007. The contents of the clinical audit and inspection reports were analyzed statistically and by content analysis. The results of the audits and the inspections were compared to analyze the overlaps, differences, and costs. RESULTS: The validity and conditions of the safety license, lines of authority, and responsibilities for the use of radiation and patient doses caused by different examinations were evaluated in both audits and inspections. The coverage and frequency of quality control procedures were monitored in every audit and inspection, but inspectors, in addition, checked radiation output. The costs of clinical audit and inspection were under 20 cents per radiological procedure. The auditors gave 98 recommendations, while inspectors gave 62 recommendations and 25 requirements. In clinical audits most of the recommendations concerned guidelines for examining a patient. In the inspections most recommendations were in the category of quality assurance activities. CONCLUSION: The clinical audits and regulatory inspections were cheap and had few overlapping topics, but several differences were apparent: in clinical audits, a broader and deeper view of the clinical procedures was taken by comparison with good practices, while regulatory inspections have mainly verified conformance to basic regulatory requirements.