Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BackgroundAn alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.MethodsWe evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.ResultsRadiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.ConclusionsGiven the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography

The impact of computed high b-value images on the diagnostic accuracy of DWI for prostate cancer: A receiver operating characteristics analysis.

To evaluate the performance of computed high b value diffusion-weighted images (DWI) in prostate cancer detection. 97 consecutive patients who had undergone multiparametric MRI of the prostate followed by biopsy were reviewed. Five radiologists independently scored 138 lesions on native high b-value images (b = 1200 s/mm2), apparent diffusion coefficient (ADC) maps, and computed high b-value images (contrast equivalent to b = 2000 s/mm2) to compare their diagnostic accuracy. Receiver operating characteristic (ROC) analysis and McNemar's test were performed to assess the relative performance of computed high b value DWI, native high b-value DWI and ADC maps. No significant difference existed in the area under the curve (AUC) for ROCs comparing B1200 (b = 1200 s/mm2) to computed B2000 (c-B2000) in 5 readers. In 4 of 5 readers c-B2000 had significantly increased sensitivity and/or decreased specificity compared to B1200 (McNemar's p < 0.05), at selected thresholds of interpretation. ADC maps were less accurate than B1200 or c-B2000 for 2 of 5 readers (P < 0.05). This study detected no consistent improvement in overall diagnostic accuracy using c-B2000, compared with B1200 images. Readers detected more cancer with c-B2000 images (increased sensitivity) but also more false positive findings (decreased specificity)

Faster magnetic resonance imaging in emergency room patients with right lower quadrant pain and suspected acute appendicitis

Purpose: Emergency Departments (ED) are becoming busier, with a resultant increase in the number of imaging referrals. The purpose of this study was to assess the diagnostic accuracy of an abbreviated two sequence magnetic resonance (MR) protocol for evaluating ED patients with right lower quadrant pain and suspected acute appendicitis, with a view to expediting patient turnaround times and imaging costs. Material and methods: Fifty patients (49 females, one male; mean age 25.4 ± 5.2 years) who underwent ED MR imaging from July 2014 to March 2015 for right lower quadrant pain were retrospectively reviewed. MR abdomen/pelvis was performed on 1.5 T MR obtaining axial T1 gradient echo in/out of phase, transverse fast spin echo T2 with fat sat/motion correction, axial/coronal T2 HASTE (half-Fourier acquisition single-shot turbo spin-echo), and axial DWI (diffusion-weighted imaging) sequences. Images were reviewed by two fellowship-trained radiologists on a five-point confidence scale. Mean acquisition/interpretation times for the standard departmental protocol and the proposed abbreviated MR protocol (comprising T2 HASTE and DWI images) were calculated. Sensitivity, specificity, and diagnostic accuracy for the abbreviated protocol against the full protocol were also calculated. Results: Mean scanning time for abbreviated protocol and standard protocol was calculated to be 21.1 minutes and 40.5 minutes, respectively. Mean interpretation time for abbreviated protocol for reader one and two was 4.1 ± 1.5 minutes and 4.5 ± 1.4 minutes, respectively, and for standard protocol was 8.1 ± 1.8 minutes and 7.1 ± 1.4 minutes, respectively. Sensitivity, specificity, and accuracy for the FAST protocol were calculated to be 100% each for reader one and 75%, 100%, and 94%, respectively, for reader two. Conclusions: The proposed abbreviated MR protocol has comparable diagnostic accuracy in diagnosing ED patients with right lower quadrant pain, with significant reduction in imaging/interpretation times. It thus has the potential to be implemented in ED imaging with significant reduction in patient turnaround times and costs

Machine Learning Decision Tree Models for Differentiation of Posterior Fossa Tumors Using Diffusion Histogram Analysis and Structural MRI Findings.

We applied machine learning algorithms for differentiation of posterior fossa tumors using apparent diffusion coefficient (ADC) histogram analysis and structural MRI findings. A total of 256 patients with intra-axial posterior fossa tumors were identified, of whom 248 were included in machine learning analysis, with at least 6 representative subjects per each tumor pathology. The ADC histograms of solid components of tumors, structural MRI findings, and patients' age were applied to construct decision models using Classification and Regression Tree analysis. We also compared different machine learning classification algorithms (i.e., naïve Bayes, random forest, neural networks, support vector machine with linear and polynomial kernel) for dichotomized differentiation of the 5 most common tumors in our cohort: metastasis (n = 65), hemangioblastoma (n = 44), pilocytic astrocytoma (n = 43), ependymoma (n = 27), and medulloblastoma (n = 26). The decision tree model could differentiate seven tumor histopathologies with terminal nodes yielding up to 90% accurate classification rates. In receiver operating characteristics (ROC) analysis, the decision tree model achieved greater area under the curve (AUC) for differentiation of pilocytic astrocytoma (p = 0.020); and atypical teratoid/rhabdoid tumor ATRT (p = 0.001) from other types of neoplasms compared to the official clinical report. However, neuroradiologists' interpretations had greater accuracy in differentiating metastases (p = 0.001). Among different machine learning algorithms, random forest models yielded the highest accuracy in dichotomized classification of the 5 most common tumor types; and in multiclass differentiation of all tumor types random forest yielded an averaged AUC of 0.961 in training datasets, and 0.873 in validation samples. Our study demonstrates the potential application of machine learning algorithms and decision trees for accurate differentiation of brain tumors based on pretreatment MRI. Using easy to apply and understandable imaging metrics, the proposed decision tree model can help radiologists with differentiation of posterior fossa tumors, especially in tumors with similar qualitative imaging characteristics. In particular, our decision tree model provided more accurate differentiation of pilocytic astrocytomas from ATRT than by neuroradiologists in clinical reads

Focal Spot, Spring 1994

https://digitalcommons.wustl.edu/focal_spot_archives/1066/thumbnail.jp

Interpretation of clinical imagingexaminations by radiographers:a programme of research

Background Studies which have investigated the interpretation of plain skeletal examinations by radiographers have demonstrated encouraging findings, however, the studies have not extended beyond this area of practice and radiographers' diagnostic performance for other more complex investigations has not been established. Comparisons of performance between groups of healthcare practitioners to date, has also been limited. Aim This research programme aimed to investigate the interpretation of clinical imaging examinations by radiographers, and other healthcare practitioners, in the provision of initial interpretations and/or definitive reports of plain imaging ( skeletal and chest) and crosssectional (magnetic resonance imaging [MRI] – lumbar/thoracic spine, knees and internal auditory meati [IAM]) investigations. Methods The eight studies utilised a variety of methodological approaches and included quasiexperimental and observational studies. One quasi-experimental study compared the performance of radiographers, nurses and junior doctors in initial image interpretation and another similar study included a training intervention; both utilised alternate free-response receiver operating characteristic curve (AFROC) methodology. Three of the observational studies investigated the ability of radiographers to provide definitive reports on a wide range of clinical examinations, including chest and MRI investigations, in a controlled environment. One large multi-centre observational study investigated the performance of radiographers, in clinical practice (A/E: skeletal examinations) during the implementation of a radiographic reporting service. The agreement between consultant radiologists' MRI reports of lumbar/thoracic spine, knee and IAM examinations was investigated in another observational study. The final study compared the reports of trained radiographers and consultant radiologists, with those of an index radiologist, when reporting on MRI examinations of the knee and lumbar spine, as part of a prospective pre-implementation agreement study. Results The first AFROC study demonstrated statistically significant improvements after training, for radiographers (A1=0.55 - 0.72) and nurses (A1=0.65 - 0.63), although the radiographers maintained a better overall performance post training (p=0.004) in providing an initial image interpretation of trauma radiographs of the appendicular skeleton. Radiographers also achieved statistically higher (p<0.01) AUC values (A1=0.75) than nurses (A1=0.58) and junior doctors (A1=0.54) in the second AFROC study. Three studies, which examined 11155 reports, were conducted under controlled conditions in an academic setting and provided evidence of radiographers’ high levels of accuracy in reporting of skeletal A/E (93.9%); skeletal non A/E (92.5%); chest (89.0%); MRI lumbar/thoracic spine (87.2%), knees (86.3%) and IAM (98.4%) examinations. In the multi-centre clinical study, the mean accuracy, sensitivity and specificity rates of the radiographers reports (n=7179) of plain examinations of the skeletal system in the trauma setting was found to be 99%, 98% and 99%, respectively. The considerable range of values for agreement, between consultant radiologists reports of MRI examinations of the thoracic/lumbar spine (k=0 – 0.8), knee (k=0.3 – 0.8) and IAM (k=1.0) was similar to other studies and resulted in a reasonable estimation of the performance, in the UK, of an average non specialist consultant radiologist in MRI reporting. In the final study, radiographers reported in clinical practice conditions, on a prospective random sample of knee and lumbar spine MRI examinations, to a level of agreement comparable with non-musculoskeletal consultant radiologists (Mean difference in observer agreement <1%, p=0.86). Less than 10% of observers' reports (radiographers and consultant radiologists) were found to be sufficiently discordant to be clinically important. Conclusion The outcomes of this research programme demonstrate that radiographers can provide initial interpretations of radiographic examinations of the appendicular skeleton, in the trauma setting, to a higher level of accuracy than A/E practitioners. The findings also provide evidence that selected radiographers with appropriate education and training can provide definitive reports on plain clinical examinations (A/E and non A/E referral sources) of the skeletal system and the chest; and MRI examinations of the knee, lumbar/thoracic spine and IAM to a level of performance comparable to the average non specialist consultant radiologist. Wider implementation of radiographer reporting is therefore indicated and future multi-centre research, including economic evaluations, to further inform practice at a national level, is recommended

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

Introduction: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. Methods: A selective review of the credible literature during the past decade (2005?2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. Findings: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140295/1/tmj.2016.0149.pd

The Application of Eye-Tracking Technology in the Assessment of Radiology Practices: A Systematic Review

The aim of this review is to provide an in-depth analysis of literature pertaining to the use of eye-tracking equipment in the evaluation of radiological image interpretation by professionals in clinical practice. A systematic search of current literature was conducted through the databases of CINAHL, Medline, ProQuest, PubMed, Scopus, Web of Science and Wiley Online Library. A total of 25 articles were included in the final analysis. The literature gathered referenced four main discussions, which were competency assessment, educational tools, visual search behaviour and assistive aid evaluations. The majority of articles (68%) referenced to the competency assessment of professional groups yet appeared to have conflicting results within the categories of speed and eye-metrics. Significant conclusions could be made pertaining to confidence (100%) and accuracy measurements (56%), which suggested a background of higher experience correlates to a higher rate of accuracy and a higher confidence level. Other findings regarding the main themes focused on eye-tracking as an educational tool, where the literature suggests that such equipment may be useful in improving educational repertoire and interpretation technique. Literature pertaining to the visual search behaviour analysis and the evaluation of assistive aids did not provide strong conclusions due to research limitations. Whilst the use of eye-tracking in the analysis of radiological practices is a promising new venture to quantify the interpretation patterns of professionals, undertaking future research is recommended to solidify conclusions and provide greater insight