Lessons Learned in Change Management in Deploying Novel Informatics Solutions: Experience Implementing a Point-of-Care Patient Photography System with Radiography.

We describe implementation of a point-of-care system for simultaneous acquisition of patient photographs along with portable radiographs at a large academic hospital. During the implementation process, we observed several technical challenges in the areas of (1) hardware-automatic triggering for photograph acquisition, camera hardware enclosure, networking, and system server hardware and (2) software-post-processing of photographs. Additionally, we also faced cultural challenges involving workflow issues, communication with technologists and users, and system maintenance.

Implementation of Incidental Liver Lesion Clinically Integrated Workflow Increases Compliance With ACR Follow-Up Guidelines, Closing Care Gaps.

Objective: Follow established management guidelines from the ACR and improve adherence to follow-up recommendations for incidental liver lesions (ILLs) for all patients undergoing CT abdomen and pelvis with contrast (CTAPw) examinations, with advocacy from a multidisciplinary care team.

Methods: A mandatory structured radiology reporting module was developed for use in CTAPw reports for ILL recommendations. Data from the electronic medical record describing patients with radiology-reported ILLs and their clinical risk diagnosis categories were tabulated in a queryable electronic database.

Quality Improvement Report: Improving Pre- and Postprocedure Care Area Workflows at a Busy Urban Academic Hospital Using Lean Management Principles.

Radiology procedure workflow is a summation of individual workflows for scheduling, precertification, preprocedure clinic visits, and day of procedure, representing a complex total process with many opportunities for inefficiencies and waste. At the authors' institution, a lack of standard work and communication gaps in a pre- and postprocedure care area (PPCA) workflow were identified as factors in bottlenecks, waits and delays, and staff and patient frustrations. Using "lean" process improvement tools, these workflows were targeted in a rapid improvement event (RIE).

Balancing the Scales: An Analysis of Social Determinants of Health, Radiology Report Acuity, and Radiology Staffing Models in an Academic Health System.

Purpose: Social determinants of health, including race and insurance status, contribute to patient outcomes. In academic health systems, care is provided by a mix of trainees and faculty members. The optimal staffing ratio of trainees to faculty members (T/F) in radiology is unknown but may be related to the complexity of patients requiring care.

ACR Appropriateness Criteria® Adrenal Mass Evaluation: 2021 Update.

The appropriate evaluation of adrenal masses is strongly dependent on the clinical circumstances in which it is discovered. Adrenal incidentalomas are masses that are discovered on imaging studies that have been obtained for purposes other than adrenal disease. Although the vast majority of adrenal incidentalomas are benign, further radiological and biochemical evaluation of these lesions is important to arrive at a specific diagnosis.

Ultrasound Evaluation for Extremity Deep Vein Thrombus in COVID-19-Positive Patients: Exam Positivity Rate and Association With D-Dimer Level.

Objectives: Determine the rate of positive extremity ultrasound exams for DVT in patients with COVID-19 and assess for differences in laboratory values in patients with and without DVT, which could be used as a surrogate to decide the need for further evaluation with ultrasound.

Methods: Retrospective case control study with 1:2 matching of cases (COVID-19+ patients) to controls (COVID-19- patients) based on age, gender, and race. Laboratory values assessed were serum D-dimer, fibrinogen, prothrombin time, international normalized ratio, and C-reactive protein.

Secondary Interpretations of Diagnostic Imaging Examinations: Patient Liabilities and Out-of-Pocket Costs.

Background: Secondary interpretations of diagnostic imaging examinations are increasingly performed to improve care for complex patients. We sought to determine associated patient-billed liabilities and out-of-pocket payments and to identify patient and imaging study characteristics that correlate with higher patient bills and out-of-pocket payments.

Methods: Data extracted for 7,740 secondary imaging interpretations performed across our large metropolitan health system over 25 months included total professional charges, insurance payments, patient-billed liabilities, and patient out-of-pocket payments.

ACR Appropriateness Criteria® Renal Failure.

Renal failure can be divided into acute kidney injury and chronic kidney disease. Both are common and result in increased patient morbidity and mortality. The etiology is multifactorial and differentiation of acute kidney injury from chronic kidney disease includes clinical evaluation, laboratory tests, and imaging.

Decreasing CT Acquisition Time in the Emergency Department through Lean Management Principles.

Background Emergency departments (EDs) rely on advanced imaging such as CT for diagnosis. Owing to increased ED volumes at the authors' institution, CT image acquisition became a significant bottleneck in ED patient throughput. Methods A multidisciplinary team was formed to solve this complex patient flow issue.

COVID-19: preparing for second surge and getting back on track for radiology.

In this opinion piece derived from a webinar organized by the Radiological Society of North America and conducted in the spring of 2020 during the COVID-19 pandemic, leaders from three large North American and Asian academic radiology programs review the strategies employed at their respective institutions to address the impact of the pandemic on their departments. In the first segment, the author describes the approach taken in the radiology department at an 1800-bed Asian hospital system which focuses on the creation of capacity to accommodate over 5000 COVID-19 patients in early 2020, the sustaining of services during the surge, and the development of adaptive mechanisms to address future surges and pandemics. In the second segment, a large southwestern medical system addresses the creation of a long-term strategy to provide imaging services safely for staff and patients while simultaneously utilizing technology to maintain interprofessional connections.

Development and Implementation of an Integrated Imaging Informatics Track for Radiology Residents: Our 3-Year Experience.

Rationale And Objectives: Imaging Informatics is an emerging and fast-evolving field that encompasses the management of information during all steps of the imaging value chain. With many information technology tools being essential to the radiologists' day-to-day work, there is an increasing need for qualified professionals with clinical background, technology expertise, and leadership skills. To answer this, we describe our experience in the development and implementation of an Integrated Imaging Informatics Track (I3T) for radiology residents at our institution.

Artificial Intelligence in Quality Improvement: Reviewing Uses of Artificial Intelligence in Noninterpretative Processes from Clinical Decision Support to Education and Feedback.

The radiology workflow can be segmented into three large groups: pre-interpretative processes, interpretation, and postinterpretative processes. Each stage of this workflow represents quality improvement opportunities for artificial intelligence and machine learning. Although the focus of recent research has been targeted toward optimization of image interpretation, this article describes significant use cases for artificial intelligence in both the pre-interpretative and postinterpretative aspects of radiology.

Multiinstitutional U.S. Academic Radiology Perspectives on Inpatient Diagnostic Imaging of Patients With Coronavirus Disease (COVID-19) and Persons Under Investigation.

This article presents the perspectives of radiologists in different sub-specialties at three institutions across the United States regarding inpatient imaging of patients confirmed to have coronavirus disease (COVID-19) and persons under investigation (i.e., patients suspected to have COVID-19).

Reporting on Renal Masses, Recommendations for Terminology, and Sample Templates.

Given the incidence of small renal masses, from benign cysts to malignancy, most radiologists encounter these lesions multiple times during their career. Radiologists have an opportunity to provide critical data that will further refine the understanding of the impact of these masses on patient outcomes. This article summarizes and describes recent updates and understanding of the critical observations and descriptors of renal masses.

ACR Appropriateness Criteria® Hematuria.

Hematuria is a common reason for patients to be referred for imaging of the urinary tract. All patients diagnosed with hematuria should undergo a thorough history and physical examination, urinalysis, and serologic testing prior to any initial imaging. Ultrasound, CT, and MRI are the most common imaging modalities used to evaluate hematuria.

Improving Billing Accuracy Through Enterprise-Wide Standardized Structured Reporting With Cross-Divisional Shared Templates.

Objective: We describe our experience in implementing enterprise-wide standardized structured reporting for chest radiographs (CXRs) via change management strategies and assess the economic impact of structured template adoption.

Methods: Enterprise-wide standardized structured CXR reporting was implemented in a large urban health care enterprise in two phases from September 2016 to March 2019: initial implementation of division-specific structured templates followed by introduction of auto launching cross-divisional consensus structured templates. Usage was tracked over time, and potential radiologist time savings were estimated.

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions.

Background: In 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.

Methods: Data on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017.

ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Cancer.

Renal cell carcinoma (RCC) accounts for most malignant renal tumors and is considered the most lethal of all urologic cancers. For follow-up of patients with treated or untreated RCC and those with neoplasms suspected to represent RCC, radiologic imaging is the most useful component of surveillance, as most relapses and cases of disease progression are identified when patients are asymptomatic. Understanding the strengths and limitations of the various imaging modalities for the detection of disease, recurrence, or progression is important when planning follow-up regimens.

Shared Decision Making: Radiology's Role and Opportunities.

The purpose of this article is to present a targeted literature review describing the current state of radiology initiatives in support of shared decision making and gaps that offer opportunities for innovation and improvement. Breaking down the shared decision-making process into its four major components (access to information, comprehension of the information, appraisal of the information, application of knowledge in care decisions) reveals the role of radiologists in the decision-making process and opportunities for expanding this role.