Current problems in diagnostic radiology最新文献

Objective: To compare Prostate Imaging Reporting and Data System (PI-RADS) scores derived from a standard multiparametric prostate MRI (mpMRI) protocol with those from a protocol consisting only of T2-weighted and dynamic contrast-enhanced images (T2+DCE MRI).

Methods: In this retrospective, single-center, cross-sectional study approved by the IRB and compliant with HIPAA, 492 MRI exams performed in 2022 were analyzed. PI-RADS scores from mpMRIs were extracted from medical records, and new scores were generated for T2+DCE MRI following PI-RADS guidelines. Score differences were evaluated using Wilcoxon signed-rank and McNemar's tests, stratified by lesion location (peripheral zone, PZ, and transition zone, TZ). Diagnostic accuracies of the two methods were compared using ROC curves, and logistic regression was employed to identify predictors of score changes.

Results: Notable differences in PI-RADS scores were observed were observed in the PZ (P = 0.03) and TZ (P < 0.001). 4.8 % of PZ and 4.0 % of TZ PI-RADS 3-5 lesions were misclassified as PI-RADS 1-2 on T2W+DCE MRI (PZ vs TZ, P = 0.64). However, ROC curve analyses revealed no significant difference in diagnostic accuracy between mpMRI (Az = 0.77) and T2+DCE MRI (Az = 0.75, P = 0.07). PSA density was identified as a predictor of score changes from PI-RADS 3-5 to 1-2, although the effect size was modest.

Conclusions: Although T2+DCE MRI yields different PI-RADS scores compared to mpMRI, the clinical impact on diagnostic accuracy and decision-making is overall small. This supports the continued use of T2+DCE MRI, particularly when diffusion-weighted imaging is compromised.

Purpose: Recent competency-based medical education (CBME) implementation within Canadian radiology programs has required faculty to conduct more assessments. The rise of narrative feedback in CBME, coinciding with the rise of large language models (LLMs), raises questions about the potential of these models to generate informative comments matching human experts and associated challenges. This study compares human-written feedback to GPT-3.5-generated feedback for radiology residents, and how well raters can differentiate between these sources.

Methods: Assessments were completed by 28 faculty members for 10 residents within a Canadian Diagnostic Radiology program (2019-2023). Comments were extracted from Elentra, de-identified, and parsed into sentences, of which 110 were randomly selected for analysis. 11 of these comments were entered into GPT-3.5, generating 110 synthetic comments that were mixed with actual comments. Two faculty raters and GPT-3.5 read each comment to predict whether it was human-written or GPT-generated.

Results: Actual comments from humans were often longer and more specific than synthetic comments, especially when describing clinical procedures and patient interactions. Source differentiation was more difficult when both feedback types were similarly vague. Low agreement (k=-0.237) between responses provided by GPT-3.5 and humans was observed. Human raters were also more accurate (80.5 %) at identifying actual and synthetic comments than GPT-3.5 (50 %).

Conclusion: Currently, GPT-3.5 cannot match human experts in delivering specific, nuanced feedback for radiology residents. Compared to humans, GPT-3.5 also performs worse in distinguishing between actual and synthetic comments. These insights could guide the development of more sophisticated algorithms to produce higher-quality feedback, supporting faculty development.

Purpose: To assess radiology residents' diagnostic accuracy in interpreting thoracic emergency cases using the Wisdom in Diagnostic Imaging Simulation (WIDI SIM) platform and identify potential areas for educational improvement.

Methods: In this retrospective study, 761 radiology residents were assessed on five thoracic emergency cases using WIDI SIM over four years. Cases included bronchial disruption, septic emboli, ventricular perforation, pulmonary embolism, and a negative pulmonary CTA. Residents provided free-text interpretations, which were scored by faculty using a standardized point system. Scores and errors were analyzed using descriptive statistics and the Kruskal-Wallis test.

Results: Residents' performance varied across the five cases, with the highest average score on the negative pulmonary CTA (9.59) and the lowest on bronchial disruption (6.59). Observational errors were more common than interpretive errors. The Kruskal-Wallis test revealed significant differences in median scores across the cases (p < 0.0001), with pairwise comparisons showing significant differences in all but two comparisons.

Conclusion: This study reveals significant variability in radiology residents' diagnostic accuracy in interpreting thoracic emergency cases, with a high prevalence of observational errors. Our observations emphasize the need for targeted educational strategies to address specific areas of weakness and improve diagnostic accuracy in this critical area of radiology practice.

Personnel wellness in professional environments is often perceived as a secondary concern wherein efficiency and productivity are prioritized. The Blue Zones philosophy challenges this traditional approach. We propose implementing consistent wellness practices that are based on the Blue Zones principles and believe that these will primarily benefit providers and organizations as a whole. By fostering an environment where all interactions and activities nurture the collective, we can reimagine wellness as an integral part of professional life.

Purpose: To evaluate radiology resident performance in diagnosing four non-traumatic musculoskeletal (MSK) pathologies that have historically yielded low scores on the Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM).

Materials and methods: This multi-institutional, retrospective study analyzed WIDI SIM data collected from 2015 to 2021. A total of 351 radiology residents (R1-R4) interpreted 65 de-identified imaging cases, four of which focused on septic arthritis/osteomyelitis of the shoulder, septic arthritis/osteomyelitis of the hip, acetabular neoplasm, and Legg-Calve-Perthes disease. Each case was scored using a standardized 10-point rubric (0-2 = critical error, 3-6 = problematic omissions, 7-10 = effective report). Scores were further categorized into observational (missed findings) and interpretive (incorrect conclusion despite correct identification) errors. The Kruskal-Wallis test with Dunn's multiple comparisons was used to assess performance differences across postgraduate years.

Results: Among these four MSK pathologies, only hip osteomyelitis demonstrated a statistically significant difference across training levels (p = 0.0063), although no specific pairwise comparisons were significant. Average scores remained relatively low across all cases, with observational errors surpassing interpretive errors in frequency.

Conclusion: Radiology residents struggled to accurately diagnose non-traumatic MSK pathologies in a simulated on-call setting, predominantly due to missed imaging findings. Implementation of enhanced training strategies, such as targeted case review, high-yield simulations, and systematic visual search protocols, may improve MSK diagnostic competency and reduce the risk of clinically significant oversights.

There are increasing requests and benefits of providing formal written reports for second opinions of outside imaging in part due to medical legal concerns supporting appropriate documentation and concerns that misunderstandings from verbal curbside consults on the part of the requesting physician may lead to suboptimal patient care and potential liability for the radiologist and hospital. Verbal communication of findings on outside imaging is thus often considered insufficient with recommendations from undocumented consultations less likely to be acted upon. The increased work associated with performance of second-opinion interpretations may be substantial, raising concern that if curbside consults are not properly compensated, some second opinion interpretations may be performed more expeditiously than primary interpretations due to their more direct impact upon the daily work load, income, and relative value units. Since 2016, our quaternary-care academic pediatric hospital system has provided and billed for formal second-opinion imaging interpretations upon request for MRI, CT, and Nuclear Medicine exams, and disallowed the process of informal curbside consultations on such studies. This study aims to offer insight into our second opinion interpretation workflows and our experience in obtaining reimbursement for pediatric second opinion interpretations. Our findings indicate a formal second-opinion interpretation program can be financially viable and may help offset the additional resources required, and can serve as a guide to inform other departments attempting to establish a similar process.

Vascular anomalies arise during embryologic development due to errors in vasculogenesis. They are associated with sporadic or inherited mutations in receptors, growth factors or enzymes within various vasculogenic pathways such as mTOR, VEGF, and PI3K. Vascular anomalies have the capability to cause significant symptoms and disability, especially when located in the distal extremities. These symptoms often include local pain, swelling, and decreased range of motion and functionality of the affected area. This article intends to provide a concise overview of vascular anomalies in the distal extremities and their treatment options. The categorization of the vascular anomalies, key clinical features, diagnostic approaches, and potential significance of when they occur in the extremities and how that makes them unique are discussed. An overview of the six major management options used to treat vascular anomalies in general is reviewed in the context of vascular anomalies in the extremities, including observation, pharmacotherapy, sclerotherapy, embolization, cryoablation, and surgery. Each section discusses the role of the treatment approach and associated benefits and risks.

The evolving landscape of graduate medical education (GME) necessitates innovative approaches to residency program evaluation and improvement. At Detroit Medical Center/Wayne State University, a novel resident-led Program Improvement Committee (PIC) was established in June 2022 within the Diagnostic Radiology Residency Program. The PIC serves as a flexible, resident-driven structure designed to enhance engagement, provide continuous feedback, and implement actionable solutions in collaboration with residency leadership. Unlike traditional Program Evaluation Committees (PECs) and Clinical Competency Committees (CCCs), the PIC promotes a more democratized approach, empowering residents to take ownership of their training. By convening monthly and fostering fluid subcommittees, the PIC has successfully driven initiatives including increased research engagement, mentorship programs, social media enhancement, and system-level improvements such as the establishment of a dedicated WiFi network for hospital employees. The PIC represents a paradigm shift in residency enhancement, offering a responsive, adaptable mechanism for fostering innovation, inclusivity, and collaboration. Further research is needed to evaluate its broader impact, but the PIC has the potential to revolutionize residency training and improve medical education.

Objectives: To assess medical student authorship in radiology research, focusing on the prevalence and impact of student articles, demographic trends, and potential barriers and opportunities for involvement.

Methods: We retrospectively assessed original research and review papers from 2018 to 2022 in the top five radiology journals based on their 2022 Impact Factor. Three reviewers manually validated and classified articles by medical student (MS) and non-MS authorship. Data collected included publication and authorship metrics. Thematic analysis of articles was performed from keywords and SCOPUS topic clusters. Significant associations were identified using chi-squared and two-tailed z-tests.

Results: Of the 2533 publications from all five journals, only 0.47 % were MS-authored, of which 83.3 % had a Field Weighted Citation Impact (FWCI) > 1. Of the 19 MS authors, 68.42 % had prior publications, with the same proportion holding prior first authorship. Female students averaged a higher FWCI (2.47 ± 2.31) but comprised only 26.32 % of all students. Only 16.67 % of MS articles had a female senior author (SA). This was consistent in non-MS articles, with females representing 19.9 % to 25.2 % of SAs across all journals. Of the 2521 non-MS articles, 92 % were classified into themes, revealing that 47.89 % of publications primarily focused on machine learning, while another 42.26 % incorporated some machine learning concepts.

Conclusion: Compared to non-medical student publications in radiology, those by medical students were disproportionately limited but impactful. Both demographic and academic factors hinder student engagement in publishing. Hence promoting, supporting, and sponsoring student involvement in research is pivotal for the discipline.

At our institution, a backlog of unread screening mammograms accumulated with a peak turnaround time of 198 h (8.25 days). Three major root causes of workflow inefficiencies were identified: radiologist interruptions, paper-based workflow, and a cumbersome report dictation workflow. A batched, digitized workflow with reporting assistance called "Uninterrupted with Assistant" was implemented. Following the intervention, the mean report turnaround time (TAT) was significantly decreased by 38.8 % (51.0 ± 16.0 vs 83.3 ± 46.6 h, p = 0.014) and the institutional goal for TAT (72 h) was met more often (93.3 %, 14/15 weeks vs 35.3 %, 6/17 weeks). Radiologist distraction in the new assignment was significantly lower (2.0 ± 1.4 SD) compared to the traditional "Interrupted" setting (5.6 ± 2.8 SD, t = -4.956, p < 0.01). Radiologist fatigue in the new assignment (2.6 ± 1.6 SD) was also significantly lower compared to the "Interrupted" setting (4.8 ± 2.2 SD, t = -5.159, p < 0.01). The average daily volume of screening mammograms interpreted in the "Uninterrupted with Assistant" assignment (50.3 ± 13.9 SD) was greater than in the "Interrupted" setting (21.0 ± 11.3). These interventions offer strategies to improve productivity and address practical issues of burnout and workforce retention.