Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

<p>Abstract</p> <p>Background</p> <p>One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS).</p> <p>Methods</p> <p>Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups.</p> <p>Results</p> <p>There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence.</p> <p>Conclusion</p> <p>Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.</p

Comparison of different computed radiography systems: Physical characterization and contrast detail analysis

Purpose: In this study, five different units based on three different technologies\u2014traditional computed radiography (CR) units with granular phosphor and single-side reading, granular phosphor and dual-side reading, and columnar phosphor and line-scanning reading\u2014are compared in terms of physical characterization and contrast detail analysis. Methods: The physical characterization of the five systems was obtained with the standard beam condition RQA5. Three of the units have been developed by FUJIFILM (FCR ST-VI, FCR ST-BD, and FCR Velocity U), one by Kodak (Direct View CR 975), and one by Agfa (DX-S). The quantitative comparison is based on the calculation of the modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). Noise investigation was also achieved by using a relative standard deviation analysis. Psychophysical characterization is assessed by performing a contrast detail analysis with an automatic reading of CDRAD images. Results: The most advanced units based on columnar phosphors provide MTF values in line or better than those from conventional CR systems. The greater thickness of the columnar phosphor improves the efficiency, allowing for enhanced noise properties. In fact, NPS values for standard CR systems are remarkably higher for all the investigated exposures and especially for frequencies up to 3.5 lp/mm. As a consequence, DQE values for the three units based on columnar phosphors and line-scanning reading, or granular phosphor and dual-side reading, are neatly better than those from conventional CR systems. Actually, DQE values of about 40% are easily achievable for all the investigated exposures. Conclusions: This study suggests that systems based on the dual-side reading or line-scanning reading with columnar phosphors provide a remarkable improvement when compared to conventional CR units and yield results in line with those obtained from most digital detectors for radiography

Characterization of a clinical unit for digital radiography based on irradiation side sampling technology

Purpose: A characterization of a clinical unit for digital radiography (FUJIFILM FDR D-EVO) is presented. This system is based on the irradiation side sampling (ISS) technology and can be equipped with two different scintillators: one traditional gadolinium-oxysulphide phosphor (GOS) and a needle structured cesium iodide (CsI) phosphor panel. Methods: The characterization was achieved in terms of response curve, modulation transfer function (MTF), noise power spectra (NPS), detective quantum efficiency (DQE), and psychophysical parameters (contrast-detail analysis with an automatic reading of CDRAD images). For both scintillation screens the authors accomplished the measurements with four standard beam conditions: RAQ3, RQA5, RQA7, and RQA9. Results: At the Nyquist frequency (3.33 lp/mm) the MTF is about 35% and 25% for CsI and GOS detectors, respectively. The CsI scintillator has better noise properties than the GOS screen in almost all the conditions. This is particularly true for low-energy beams, where the noise for the GOS system can go up to a factor 2 greater than that found for CsI. The DQE of the CsI detector reaches a peak of 60%, 60%, 58%, and 50% for the RQA3, RQA5, RQA7, and RQA9 beams, respectively, whereas for the GOS screen the maximum DQE is 40%, 44%, 44%, and 35%. The contrast-detail analysis confirms that in the majority of cases the CsI scintillator is able to provide improved outcomes to those obtained with the GOS screen. Conclusions: The limited diffusion of light produced by the ISS reading makes possible the achievement of very good spatial resolution. In fact, the MTF of the unit with the CsI panel is only slightly lower to that achieved with direct conversion detectors. The combination of very good spatial resolution, together with the good noise properties reached with the CsI screen, allows achieving DQE on average about 1.5 times greater than that obtained with GOS. In fact, the DQE of unit equipped with CsI is comparable to the best alternative methods available which are based on the same technology, and similar to others based on an a-Se direct conversion detectors

Modeling glioblastoma response to radiotherapy by combining a two-compartment kinetic model and multiparametric NMR data

Glioblastoma are the most common and malignant primary brain tumor, and actual treatments consist of surgery (when possible), radiotherapy and chemotherapy. Recent discoveries in biology revealed the important role of radioresistant cancer stem cell in the tumor proliferation and also showed that differentiated tumor cells can revert to a stem-like state because of radiation. These discoveries can be used to create mathematical models to study and plan new optimized radiotherapy schedules. In literature, some models have already been developed on murine population. The aim of this study was to reproduce these models, to perform a sensitivity analysis to find the most sensitive parameters and to adapt them to standard schedules used with human patients. We found that the most sensitive parameters are those involving tumor cell proliferation, radio-sensibility and quiescence times of both stem and tumor cells

Physical characterization and contrast-detail analysis of different mammography units

The purpose of this study is to evaluate the physical characteristics of various apparatus dedicated to mammography: a film-based cassette system and three clinical digital mammography equipments. Their image quality has been assessed, by performing a physical characterization and a contrast-detail analysis. We considered three different FFDM systems: a Computed Radiography unit, the Fuji \u201cFCR 5000 MA Plus\u201d, and two diverse flat-panel units, the indirect conversion a-Si based GE \u201cSenographe 2000D\u201d and the direct conversion a-Se based IMS \u201cGiotto Image MD\u201d. The physical characterization has been estimated, by measuring the MTF, NPS and DQE of the detectors with no anti-scatter grid and in a clinical range of exposures. The contrast-detail analysis has been achieved, by using a CDMAM 3.4 phantom and an in-house made software, for the automatic computation of the contrast-detail curves. The performance of the different systems are presented, in terms of MTF, DQE and contrast-detail curves

Patient-centred care with self-compression mammography in clinical practice: a randomized trial compared to standard compression

Objective: To test the efficacy of self- compared to radiographer-led compression to reduce the average glandular dose without affecting image quality and compliance to follow-up mammography. Materials and methods: Women presenting for mammography for breast cancer follow-up, symptoms, opportunistic screening, or familial risk were asked to participate and, if willing, were randomized to self-compression or radiographer-led compression. Image quality was assessed blindly by two independent radiologists and two radiographers. Pain and discomfort were measured immediately after mammography and their recall was asked when the women participated in the follow-up mammogram, 1 or 2 years later. Results: In total, 495 women (mean age 57 years +/-14) were enrolled, 245 in the self-compression and 250 radiographer-compression arms. Image quality was similar in the two arms (radiologists’ judgement p = 0.90; radiographers’ judgement p = 0.32). A stronger compression force was reached in the self- than in the radiographer-arm (114.5 vs. 10.25 daN, p &lt;.001), with a 1.7-mm reduction in thickness (p =.14), and almost no impact on dose per exam (1.90 vs. 1.93 mGy, p =.47). Moderate/severe discomfort was reported by 7.8% vs 9.6% (p =.77) and median pain score was 4.0 in both arms (p =.55). Median execution time was 1 min longer with self-compression (10.0 vs. 9.1 min, p &lt; 0.001). No effect on subsequent mammography was detectable (p = 0.47). Conclusion: Self-compression achieved stronger compression of the breast, with comparable image quality, but did not substantially reduce glandular dose. The proportion of women who attended follow-up mammography was also similar in the two groups. Trial registration: clinicaltrials.gov NCT04009278 Key Points: • In mammography, appropriate compression is essential to obtain high image quality and reduce dose. Compression causes pain and discomfort. • Self-compression has been proposed to reach better compression and possibly increase participation in mammography. • In a randomized trial, self-compression reached stronger compression of the breast, with comparable image quality but with no glandular dose reduction or impact on participation in follow-up mammography