Journal of the American College of Radiology最新文献

Purpose

The goal of this article is to provide technical and operational blueprints for two successful global telehealth programs.

Methods

The authors designed a physician-to-physician consultation program to provide subspecialty expertise to physicians in war-torn Ukraine. Leveraging secure web applications, telehealth platforms, and image-sharing platforms, the authors repeatedly iterated upon infrastructure and workflows, which in turn facilitated the development of a parallel international program for US Department of State (DOS) employees and families. The authors provide descriptive statistics and metrics of both programs’ successes and failures and detail iterative improvements with workflow visuals. To measure the added value of subspecialty imaging consultation, two radiologists performed a retrospective comparative review of the DOS program imaging reports, comparing the initial report to the consult report in consensus, measuring diagnostic report agreement, and rating the clinical impact of identified discrepancies on a three-point scale (mild, moderate, or major). Bivariate analyses using χ² tests were conducted to assess associations between diagnostic discrepancies and patient or imaging factors. P values <.05 were considered to indicate statistical significance.

Results

The Ukraine program (May 2022 to August 2023) provided 114 patient consultations with 77 subspecialty radiology consults, >50 WhatsApp chats, and >1,000 messages exchanged, with a 92% overall consult request response rate. The DOS program (November 2022 to July 2023) provided 275 consultations with 70 subspecialty radiology consults and a 36% to 38% rate of alternative diagnoses, with 20% rated as incurring moderate or major clinical impact. Bivariate analyses demonstrated no significant patient or imaging association with diagnostic disagreements (P > .05 for all).

Conclusions

Global telehealth infrastructure and multiple applications and platforms can be optimized in a workflow to provide efficient, high-level clinical and imaging consultation services across the globe.

The topic of CT radiation dose management is receiving renewed attention since the recent approval by CMS for new CT dose measures. Widespread variation in CT dose persists in practices across the world, suggesting that current dose optimization techniques are lacking. The author outlines a proposed strategy for facilitating global CT radiation dose optimization. CT radiation dose optimization can be defined as the routine use of CT scan parameters that consistently produce images just above the minimum threshold of acceptable image quality for a given clinical indication, accounting for relevant patient characteristics, using the most dose-efficient techniques available on the scanner. To accomplish this, an image quality–based target dose must be established for every protocol; for nonhead CT applications, these target dose values must be expressed as a function of patient size. As variation in outcomes is reduced, the dose targets can be decreased to more closely approximate the minimum image quality threshold. Maintaining CT radiation dose optimization requires a process control program, including measurement, evaluation, feedback, and control. This is best accomplished by local teams made up of radiologists, medical physicists, and technologists, supported with protected time and needed tools, including analytics and protocol management applications. Other stakeholders critical to facilitating CT radiation dose management include researchers, funding agencies, industry, regulators, accreditors, payers, and the ACR. Analogous coordinated approaches have transformed quality in other industries and can be the mechanism for achieving the universal goal of CT radiation dose optimization.

Breast cancer incidence and mortality continue to increase in Africa. In Tanzania, breast cancer is the second leading cause of cancer death for women, and breast cancer incidence and mortality are projected to increase by 80% by 2030. Education gaps among health care workers, delayed presentation, limited screening, and low health literacy all pose significant challenges to providing optimal breast cancer care. Considering these factors, it is imperative to train expert breast radiologists. We present a collaborative breast radiology training program in Tanzania aimed at building local capacity to address national breast cancer challenges. Although cancer control in Africa faces many challenges, developing customized training programs for breast radiology, in conjunction with national cancer programs, may represent a key strategy for addressing breast cancer.

By training nurses and midwives on the basics of obstetric ultrasound, high-risk pregnancies in remote Nepalese villages can be identified and triaged. American radiology residents traveling to Nepal can improve their real-time, hands-on ultrasound scanning skills while learning the intricacies of practicing medicine in a low- and middle-income country. Global outreach work is increasing in popularity among US radiologists, emphasizing the importance of training radiology residents in point-of-care ultrasound.