Full Resolution Simulation for Evaluation of Critical Care Imaging Interpretation; Part 2: Random Effects Reveal the Interplay Between Case Difficulty, Resident Competence, and the Training Environment.

Rationale And Objectives: To further characterize empirical data from a full-resolution simulation of critical care imaging coupled with post hoc grading of resident's interpretations by senior radiologists. To present results from estimating the random effects terms in a comprehensive mixed (hierarchical) regression model.

Materials And Methods: After accounting for 9 fixed effects detailed in Part 1 of this paper, we estimated normally distributed random effects, expressed in terms of score offsets for each case, resident, program, and grader.

Full Resolution Simulation for Evaluation of Critical Care Imaging Interpretation; Part 1: Fixed Effects Identify Influences of Exam, Specialty, Fatigue, and Training on Resident Performance.

Rationale And Objectives: To describe our full-resolution simulation of critical care imaging coupled with posthoc grading of resident's interpretations and present results from the fixed effects terms in a comprehensive mixed regression model of the resulting scores.

Materials And Methods: The system delivered full resolution DICOM studies via clinical-grade viewing software integrated with a custom built web-based workflow and reporting system. The interpretations submitted by participating residents from 47 different programs were graded (scores of 0-10) on a case by case basis by a cadre of faculty members from our department.

Behavioral Health Factors as Predictors of Emergency Department Use in the High-Risk, High-Cost Medicare Population.

Objective: This study measured the presence, extent, and type of behavioral health factors in a high-cost Medicare population and their association with the probability and intensity of emergency department (ED) use.

Methods: Retrospective claims analysis and a comprehensive electronic medical record-based review were conducted for patients enrolled in a 65-month prospective care management program at an academic tertiary medical center (N=3,620). A two-part model used multivariable logistic regression to evaluate the effect of behavioral health factors on the probability of ED use, complemented by a Poisson model to measure the number of ED visits.

Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma.

Purpose: To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response.

Methods: Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative (< 190 Gy) TARE delivered in a segmental, lobar, or combined fashion as a surgical neoadjuvant or bridge to transplantation. Both targeted tumor and treatment angiosome were analyzed before and after TARE utilizing hepatocyte-specific contrast-enhanced MRI or contrast-enhanced CT.

Images of imaging: how to process and display imaging utilization for large populations.

Objective: We propose a method of processing and displaying imaging utilization data for large populations.

Conclusion: The comprehensive and finely grained picture of imaging utilization yielded by our methods is a first step toward population-based imaging utilization management. We believe that our methods for the categorization and display of imaging utilization will prove to be widely useful.

Provider Feedback about Imaging Appropriateness by Using Scores from Order Entry Decision Support: Raw Rates Misclassify Outliers.

Purpose: To determine the relevant physician- and practice-related factors that jointly affect the rate of low-utility imaging examinations (score of 1-3 out of 9) ordered by means of an order entry system that provides normative appropriateness feedback.

Materials And Methods: This HIPAA-compliant study was approved by the institutional review board under an expedited protocol for analyzing anonymous aggregated administrative data. This is a retrospective study of approximately 250 000 consecutive scheduled outpatient advanced imaging examinations (computed tomography, magnetic resonance imaging, nuclear medicine) ordered by 164 primary care and 379 medical specialty physicians from 2008 to 2012.

Use of imaging in the emergency department: physicians have limited effect on variation.

Purpose: To quantify interphysician variation in imaging use during emergency department (ED) visits and examine the contribution of factors to this variation at the patient, visit, and physician level.

Materials And Methods: This study was HIPAA compliant and approved by the institutional review board of Partners Healthcare System (Boston, Mass), with waiver of informed consent. In this retrospective study of 88 851 consecutive ED visits during 2011 at a large urban teaching hospital, a hierarchical logistic regression model was used to identify multiple predictors for the probability that low- or high-cost imaging would be ordered during a given visit.

Email notification combined with off site signing substantially reduces resident approval to faculty verification time.

Rationale And Objectives: Attending radiologist signature time (AST) is a variable and modifiable component of overall report turnaround time. Delays in finalized reports have potential to undermine radiologists' value as consultants and adversely affect patient care. This study was performed to evaluate the impact of notebook computer distribution and daily automated e-mail notification on reducing AST.

A framework for improving radiology reporting.

The interpretative reports rendered by radiologists are the only tangible manifestation of their expertise, training, and experience. These documents are very often the primary means by which radiologists provide patient care. Radiology reports are extremely variable in form, content, and quality.

The ACR appropriateness criteria: translation to practice and research.

The ACR Appropriateness Criteria (ACRAC) are now just about a decade old. Along with a continued commitment to update and add to these guidelines, the author advocates that the ACR undertake the task of converting the current text-based contents into a comprehensive, multipurpose relational database. A candidate structure for such a database is described, and several uses for it are articulated.

Free text versus structured format: information transfer efficiency of radiology reports.

Objective: We discuss the effect of radiology report format on the accuracy and speed with which reviewers can extract case-specific information.

Materials And Methods: A Web-based testing mechanism was used to present radiology reports to each of 16 senior medical students and record their answers to 10 multiple choice questions about specific medical content for each of 12 cases. Subjects were randomly assigned to view the reports in either free text or structured format.

Conceptual approach for the design of radiology reporting interfaces: the talking template.

Within the coming decade, traditional dictation supported by human transcription for radiology reports will be replaced by one or more computerized methods. This paper discusses the cognitive and process efficiency problems arising from currently available technology including speech recognition and menu-driven interfaces. A specific concept for interaction with the reporting interface is proposed.

Relational data model for the American College of Radiology Appropriateness Criteria.

This article describes a data model for encoding the American College of Radiology Appropriateness Criteria (ACRAC) for selection of diagnostic imaging procedures. These guidelines are recognized widely as an authoritative repository of "best evidence" concerning appropriate radiology tests for a large number of clinical conditions. In its current text document format, the ACRAC is of limited utility for electronic use.