Radiologists Include Contact Telephone Number in Reports: Experience With Patient Interaction.

OBJECTIVE. The purpose of this study is to evaluate the experience of radiologists who include contact information in radiology reports in an era of open access to reports via patient portals. SUBJECTS AND METHODS. A prospective nonrandomized survey of all 61 radiologists in a single private practice group was conducted between July and August 2019. The survey, which consisted of 21 questions, was administered via a secure online survey software platform and distributed by e-mail. Participation was voluntary and anonymous. Data were analyzed using statistical analysis software. RESULTS. A total of 87% (53 of 61) of the radiologists completed the survey. Of these radiologists, 78% (41 of 52) indicated that they include their telephone number in radiology reports 75% or more of the time, with one radiologist not providing a response. Thirty-six percent of the radiologists are contacted once a year by patients, and 27% are contacted once a month. Of the 41 radiologists who include contact information 75% of the time or more, most (56% [23 of 41]) reported an increase in the frequency of patient contact. The reasons why radiologists had a patient contact them were to better understand the radiology report (95% of radiologists), to seek follow-up recommendations (39%), to express gratitude (34%), and to point out mistakes in the report (27%). Moreover, 98% (40 of 41) of radiologists reported never receiving complaints from a referring physician. Only 2% of radiologists stated that patient interaction was detrimental to workflow. Most radiologists found that interacting with patients was a satisfying experience and indicated that they would welcome more patient interaction. CONCLUSION. Including radiologist contact information in radiology reports increases patient-radiologist interaction. Despite this increased patient interaction, most radiologists indicated that they would welcome more interaction and found the communication satisfying.

Low-dose techniques in CT-guided interventions.

Computed tomography (CT)-guided interventions such as biopsy, drainage, and ablation may be significant sources of radiation exposure in both patients and radiologists. Simple CT techniques to reduce radiation dose may be employed without increasing the procedure time or significantly degrading image quality. To develop low-dose protocols, it is important to understand the key concepts of delivered radiation dose to patients and physicians during CT-guided interventions. Patient dose estimates are easily followed and are provided at CT workstations. Familiarity with dose estimates, which are expressed as CT dose index and dose-length product, is also important. Methods to reduce radiation exposure in patients and physicians include performing proper preprocedure planning and paying careful attention to technique during the planning stage, making use of personal protective equipment, performing CT fluoroscopy intermittently instead of in real time, and optimizing needle visualization. Representative examples of these techniques have resulted in dose reductions of as much as 89%. Alternative imaging technologies that do not use ionizing radiation, such as virtual and ultrasonographic guidance, may also be used to reduce radiation dose. Understanding dose contribution strategies to reduce radiation dose provides a safer, more efficient environment for patients and the radiology team.

Pancreas-protocol imaging at a high-volume center leads to improved preoperative staging of pancreatic ductal adenocarcinoma.

BACKGROUND: High-quality preoperative cross-sectional imaging is vital to accurately stage patients with pancreatic ductal adenocarcinoma (PDAC). We hypothesized that imaging performed at a high-volume pancreatic cancer center with pancreatic imaging protocols more accurately stages patients compared with pre-referral imaging. METHODS: We retrospectively reviewed data from all patients with PDAC who presented to the surgical oncology clinic at our institution between June 2005 and August 2009. Detailed preoperative imaging, staging, and operative data were collected for each patient. RESULTS: A total of 230 patients with PDAC were identified, of which 169 had pre-referral imaging. Patients were selectively reimaged at our institution based on the quality and timing of imaging at the outside facility: 108 (47%) patients were deemed resectable, 54 (23.5%) were deemed borderline-resectable, and 68 (29.5%) were deemed unresectable. Of the resectable patients, 99 opted for resection. Eighty-two of those 99 patients underwent preoperative imaging at our institution, and of these 27% had unresectable disease at the time of surgery compared with 47% of patients who only had pre-referral imaging (p = 0.14). Reimaging altered staging and changed management in 56% of patients. Among that group were 55 patients, categorized as resectable on pre-referral imaging, who on repeat imaging were deemed to be borderline resectable (n = 27) or unresectable (n = 28). CONCLUSIONS: Pancreas-protocol imaging at a high-volume center improves preoperative staging and alters management in a significant proportion of patients with PDAC who undergo pre-referral imaging. Thus, repeat imaging with pancreas protocols and dedicated radiologists is justified at high-volume centers.

A nomogram for estimating the probability of ovarian cancer.

OBJECTIVE: Accurate preoperative estimates of the probability of malignancy in women with adnexal masses are essential for ensuring optimal care. This study presents a new statistical model for combining predictive information and a graphic decision support tool for calculating risk of malignancy. METHODS: The study included 153 women treated with definitive surgery for adnexal mass between 2001 and 2007 with preoperative ultrasound testing and a serum CA125. Multivariable logistic regression was used to develop a statistical model for estimating the probability of ovarian cancer as a function of age, ultrasound score, and CA125 value, with adjustments for nonlinear and interactive relationships. RESULTS: A total of 20 cases of pathologically confirmed cancer (13 invasive malignancies, and 7 tumors of low malignant potential) were identified (20/153=13%). The model obtained excellent discrimination (ROC area=0.87), explained nearly half of the observed variation in the risk of malignancy (R²=0.43), and was well calibrated across the full range of malignancy probabilities. The model equation is represented in the form of a nomogram, which can be used to calculate preoperative probability of malignancy. At a 5% risk of malignancy threshold, the model has a sensitivity of 90% and a specificity of 73%. CONCLUSIONS: Statistical models for estimating the probability of adnexal mass malignancy are substantially improved by including adjustments for non-linear relationships among key variables. A clinically relevant nomogram provides an objective tool to further aid clinicians in counseling patients and ensuring proper referral to surgical sub-specialists when indicated.

Concave Margin Sign on CT as an Indication of Ascites.

Ascites is found in a variety of conditions, both acute and chronic, and computed tomography (CT) is usually successful in detecting its presence. We reviewed the CT images from a three-month window of patients in order to evaluate the prevalence and utility of a new radiographic sign for diagnosing ascites.