Current problems in diagnostic radiology最新文献

Background: The practice of paying referral fees, in which radiology service providers offer a percentage of the cost of radiology tests to referring clinicians, is known to exist in India; however, the extent of this practice is not well documented. This study aims to explore how common is this practice and how it affects the cost and quality of radiology services. The study also investigates if this practice varies between the private hospitals and diagnostic centers.

Method: An anonymous online survey was distributed between November 2024 and January 2025 to radiologists currently practicing in India. Total 440 responses were received and the survey data were analyzed using descriptive and comparative statistics.

Results: 85.88% radiologists have witnessed referral fee payment and 80.6% of radiologists believe that at least 20% of cost of any radiology investigation is paid as commission. 58.55% radiologists are of view that referral fee incentivizes clinicians to order unnecessary radiology investigations. Majority of radiologists think that kickback both increases the cost of radiology services for patients and reduces the net radiology revenue per test, which in turn compels them to perform more investigations in shorter timeframe. 75.28% radiologists believe that referral fee reduces the quality of radiology services. Referral fee is more common in diagnostic centres in comparison to the hospitals.

Conclusion: As per perception of practicing radiologists, referral fee payment for diagnostic radiology tests is very common practice in India, which prompts clinicians to order unnecessary radiology tests, increases costs for patients, adds to burnout of radiologists, ultimately negatively impacting the quality of radiology services.

Establishing a Fair and Just Culture (FJC) in healthcare is foundational for enhancing reporting of patient safety events and human errors, driving quality outcomes, and establishing shared accountability among healthcare professionals. Accordingly, we developed and implemented an engaging 3-hour in-person training on FJC that was customized to radiology practice. In the inaugural year, we trained 118 physicians, staff, and operations leaders in radiology and demonstrated that the program results in increased knowledge, skills and attitude ratings collectively by 67.1%. We are sustaining this training program to date and plan to expand it based on participant feedback and interest from stakeholders outside of radiology at our academic institution.

Purpose: Differences in severity and complexity among polytrauma patients remain a major challenge for clinicians and radiologists worldwide. We aimed to provide a descriptive analysis of patient characteristics, trauma mechanisms, and severity in connection with the need for intensive care in polytrauma patients undergoing computed tomography (CT).

Methods: This retrospective monocentric analysis consecutively included 1993 patients (1305 males, mean age 50.67±23.40 years) with 2002 emergency room cases between 12/2015 and 06/2021. Nine patients were examined twice during the study period. CT was performed in 1897/2002 cases (94.8%). Additional magnetic resonance imaging (MRI) was obtained in 438/2002 cases. For subgroup analysis, trauma mechanisms were compared. Besides conventional trauma causes also critically ill non-trauma patients (CINT) were included. Admission time, day of the week, and month were also analyzed.

Results: Traffic accidents constituted the largest trauma group, accounting for 847/2002 cases (42.3%). CINT with non-traumatic emergency died significantly more often (p < 0.001) than patients within the other trauma subgroups. In patients with an injury at the neck area, significantly more often an intubation was registered (p < 0.001). MRI was significantly more frequently performed in cases involving injuries to the cranium (p < 0.001), face (p < 0.001), or neck (p < 0.001). Mean time spent in the hospital was 9.96±13.49 days, and the mean time in the intensive care unit (ICU) was 6.58±9.67 days. Overall, 1171/2002 patients (58.5%) required at least one night in the ICU. A total of 233 patients died following trauma (11.6%), with a mean age of 69.92±18.67years.

Conclusion: Imaging strategies in polytrauma patients vary depending on the mechanism of injury and the affected body region. Especially additional MRI was more often needed when brain, face, or neck trauma was present.

Objective: This study aimed to compare the quantitative image quality and radiation exposure of dual-energy CT pulmonary angiography (CTPA) with reduced contrast media volume versus conventional single-energy CTPA.

Materials and methods: This single-centre prospective observational study included patients who underwent CTPA with a clinical suspicion of pulmonary embolism between August 2024 and March 2025. Of the 177 patients included in the final analysis, 92 patients underwent dual-energy CTPA with 45 mL of contrast media, and 85 patients underwent single-energy CTPA with 60 mL of contrast media. Attenuation and image noise were measured in five pulmonary artery segments (main pulmonary artery, left and right pulmonary arteries, and right and left posterior basal segmental arteries). Primary endpoints were signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR), which were calculated from these five segments. Attenuation, SNR, CNR, along with radiation exposure metrics, such as volume computed tomography dose index (CTDIvol), dose length product (DLP), and size-specific dose estimate (SSDE) were compared between the dual-energy CTPA group and single-energy CTPA group.

Results: Compared with conventional single-energy CTPA, dual-energy CTPA with a significant reduction in contrast media, demonstrated comparable attenuation in all five pulmonary artery segments (all p>0.05), higher pooled SNR, and higher CNR across all pulmonary artery segments (all p<0.05). Radiation exposure parameters, CTDIvol, DLP and SSDE, were also comparable between dual-energy CTPA and single-energy CTPA (all p>0.05).

Conclusion: Dual-energy CTPA enables a 25 % reduction in contrast media volume compared to conventional single-energy CTPA, while providing improved quantitative image quality without increasing radiation exposure.

Internal mammary lymph nodes (IMLNs) play a pivotal role in breast cancer staging, prognosis, and therapeutic planning, yet challenges in detection and ongoing controversies regarding their management persist. This review consolidates current evidence on the anatomy, lymphatic function, imaging features, biopsy considerations, and clinical implications of IMLNs. These nodes, visualized in 1-48% of patients depending on imaging modality, serve as secondary lymphatic drainage sites, particularly for medially or deeply located tumors. Metastatic involvement, observed in 1-5% of cases, is classified as N3b according to the AJCC 8th edition. Advanced imaging tools such as ultrasound and MRI facilitate differentiation between benign IMLNs (oval with a central fatty hilum) and malignant ones (round with cortical thickening >3 mm). While ultrasound may assist in detecting suspicious IMLNs, percutaneous biopsy is generally not recommended due to anatomical proximity to major vessels and the risk of complications. Internal mammary sentinel lymph node biopsy (IM-SLNB) offers a minimally invasive staging option, with reported visualization rates of 63-72%. Select studies suggest that IMLN irradiation may reduce recurrence and mortality, although survival benefits remain debated. Emerging predictive models-including nomograms and AI-based radiomics-show promise in preoperative risk stratification. This review highlights the need for standardized diagnostic protocols, routine evaluation of IMLNs in high-risk patients, and large-scale prospective trials to validate the utility of IM-SLNB and optimize therapeutic strategies. Integrating advanced imaging with precision medicine may ultimately enhance detection, tailor treatment, and improve outcomes in breast cancer management.

Objectives: To compare the diagnostic accuracy and longitudinal outcomes of PI-RADS 3 lesions assessed with biparametric (bpMRI) versus multiparametric MRI (mpMRI), in a multi-reader setting.

Methods: This retrospective single-center study included 196 patients, of whom 49 presented with at least one PI-RADS 3 lesion. Three radiologists with varying levels of experience independently reviewed both biparametric (bpMRI) and multiparametric (mpMRI) datasets. Diagnostic performance, inter-reader agreement, lesion evolution over time, and detection rates were analyzed in relation to lesion location and MRI protocol. Receiver operating characteristic (ROC) curve analysis, Cohen's kappa and intraclass correlation coefficients (ICCs) were used for statistical evaluation.

Results: Reader 1 showed the highest diagnostic accuracy (AUC = 0.767), followed by Reader 2 (AUC = 0.637) and Reader 3 (AUC = 0.504). There were no significant differences between bpMRI and mpMRI for any reader and intra-reader concordance was excellent for all readers (κ > 0.8). Detection was significantly lower in the peripheral zone across all readers. Inter-reader agreement was substantial between Readers 1 and 2 (ICC = 0.704), and poor between the other pairs (ICC < 0.4). During follow-up, 84-92 % of PI-RADS 3 lesions remained stable, 6-8 % decreased, and 8-16 % increased in size. Seven lesions were biopsied based on PSA progression or dimensional growth, all of which were confirmed as clinically significant cancer.

Conclusion: BpMRI provided comparable diagnostic performance to mpMRI for PI-RADS 3 lesions. Reader experience and lesion location significantly affected detection. Most lesions remained stable over time, supporting surveillance strategies in selected cases.

Artificial intelligence has emerged as a transformative technology in lung cancer diagnosis, with multiple large-scale meta-analyses demonstrating its significant clinical potential. Based on extensive research encompassing over 7 systematic reviews and meta-analyses from 2023 to 2025, AI models consistently achieve high diagnostic accuracy across various imaging modalities and clinical applications.

This study aimed to examine the experience of patients who often attempt to understand the results of a radiologic exam without physician assistance. This experience is a common scenario that occurs when patients access radiology reports through an electronic medical record (EMR). We conducted twenty qualitative interviews with participants aged 20 to 79. Each participant was provided with an electronic copy of a coronary calcium CT scan report and asked to read it, as if it were their own. They were then asked to reflect on that experience as if they were the patient receiving the report. Additionally, they were asked to provide suggestions for improving the reporting process. The notable sample report findings included a coronary calcium score of zero with an incidental finding of pulmonary nodule. Interview transcripts were independently coded by two MD-MPH students. Directed content analysis was used to identify themes in participant responses. When presented with the sample report, eighty-five percent of the participants shared that if it were their report, they would be concerned or overwhelmed by the information. Many participants were unable to explain the findings and about half shared that if the report was theirs, they would feel "fear". Scoring systems and medical jargon were a major cause of confusion. Commonly suggested solutions included: adding a lay summary statement, including visual explanations and removing citations. The overwhelming majority of participants felt confused or distressed after receiving the sample report. Many participants felt unsure of the next steps and wanted guidance from a provider regarding follow-up. Noting that in a real-world scenario receiving emotionally charged results in this manner would cause distress. These study findings underscore the need for patient centered reporting in radiology and provide suggestions to improve report clarity.

Background: Fetal Magnetic Resonance Imaging (MRI) is a vital tool for characterizing abnormalities detected on prenatal ultrasound, but receiving results can be emotionally challenging for patients. Patients typically receive imaging results from the ordering provider, however, in our practice radiologists traditionally conducted immediate face-to-face image review sessions with patients. The aim of this project was to improve patient-centered delivery of image results while optimizing the efficiency of the fetal MRI service workflow by removing direct radiologist review of images and results with patients. After the intervention was implemented, there was a significant reduction in average time radiologists spent per patient exam by 32 % and average report turnaround time by 55 %. Patient surveys indicated that most patients preferred receiving results from their maternal-fetal medicine specialist or obstetrician rather than the radiologist. Eliminating radiologist-patient image review sessions in the fetal MRI service improved efficiency while prioritizing patient-centered care.

Objective: To review the utilisation of radiology administrative assistants in supporting radiologists with daily tasks that are not directly related to image interpretation.

Methods: Records of all tasks delegated to radiology administrative assistants in a multi-centre radiological institution between 2021 and 2022 were collected. The number of tasks, types of task performed, and duration spent on each task were reviewed.

Results: 5455 tasks were assigned to and completed by radiology administrative assistants over the course of 12 months. 50 % of the tasks pertained to conveying significant or unexpected findings to clinicians, whilst the remaining 50 % accounted for tasks not related to results-communication, such as sourcing external imaging.

Conclusion: A substantial amount of radiologist's time is spent on ancillary tasks that are not related to reporting. Employing the help of radiology administrative assistants helps mitigate this, facilitates closed-loop communication and an overall improved radiologist workflow.