Transformation to subspecialization, second opinion of radiological findings and identification of optimization potential in the use of MRI scanners

Hintergrund und Zielstellung: Die Radiologie, als bedeutendes klinisches Querschnittsfach mit vielseitiger Interaktion mit anderen medizinischen Fachdisziplinen, kann als eine prozessorientierte, fortgeschrittene digitalisierte Disziplin in einem sich stetig wandelnden Gesundheitswesen angesehen werden. In der Medizin ist aktuell fachdisziplinübergreifend ein Trend zur (Sub-)Spezialisierung festzustellen, wobei von Zuweisenden zunehmend höhere, spezifische Anforderungen an die Bildgebung und Befundqualität erwartet werden. Ziel der Dissertation war es daher zu ermitteln, wie sich radiologische Subspezialisierung auf das Befundspektrum auswirkt, welcher Zeitaufwand mit einer Zweitbegutachtung radiologischer Befunde einhergeht und inwieweit Optimierungspotenzial bei der Nutzung klinischer MRT-Scanner besteht. Methodik: Alle drei Studien wurden in der Radiologie am Universitätsklinikum Bern (Schweiz) durchgeführt. Neben der Analyse des Befundspektrums vor und nach Einführung der Subspezialisierung, wurde der Zeitaufwand eines Peer-Review-Verfahrens gemessen und mittels einer Software-Applikation der Fokus auf die tatsächliche Dauer von MRT-Untersuchungen gerichtet. Ergebnisse: Eine subspezialisierte Befundung reduzierte den Anteil an Untersuchungsarten innerhalb des Befundspektrums bis zu 34% (p < 0,05) und erlaubt somit eine Fokussierung auf spezifische Kompetenzfelder. Die durchschnittlichen Befundlaufzeiten stiegen bei Anwendung einer Subspezialisierung mitunter signifikant an. Bei 60% der Befundungen verlängerten sich deren Laufzeiten. Die durchschnittliche Zeit einer Zweitbegutachtung betrug 60,4 Sekunden und wurde durch klinische Erfahrung, (Nicht-)Übereinstimmung zum Erstbefund und verschiedene Untersuchungsarten beeinflusst. Das untersuchte Befundspektrum einer Zweitbegutachtung zu unterziehen würde jährlich 1221 Stunden radiologischer Fachexpertise in Anspruch nehmen. Die verwendete Software-Applikation ermöglicht einen detaillierten Überblick auf MRT-Untersuchungen, in Bezug auf Untersuchungsarten, die jeweilige Untersuchungsdauer und Wechselzeiten. Optimierungspotenzial besteht in einer massvollen Anpassung von Planzeiten, um bestehende MRT-Kapazitäten effizienter zu nutzen. Ein für unterschiedliche Untersuchungsarten notwendiger Austausch von MRT-Spulen hatte einen geringen Effekt auf die Wechselzeiten. Diskussion: Durch fachliche Fokussierung auf ein bestimmtes Befundspektrum kann die Weiterentwicklung in der Radiologie mitgestaltet werden. Eine systematische Zweitbegutachtung ist mit hohem zeitlichen Mehraufwand verbunden. Aufgrund knapper Personalressourcen kann diskutiert werden, ob lediglich ein bestimmter Anteil des Gesamtbefundvolumens zweitbegutachtet werden sollte. Vorteile liegen in erster Linie in einer höheren Befundungsqualität. Inwieweit sich der Mehraufwand rechtfertigen lässt, welcher aufgrund einer Zweitbegutachtung entsteht, bedarf weiterführender Forschung. Schliesslich kann ein effizienter Einsatz von MRT-Scannern die Weiterentwicklung in der Radiologie positiv begünstigen. Planzeiten von MRT-Untersuchungen gemäss ihrer tatsächlichen Untersuchungsdauer zu definieren und entsprechend anzupassen, kann zu einer Reduzierung von Leerstandszeiten führen.Background and objective: Radiology is an important clinical cross-disciplinary field with varied interaction across medical disciplines, known as a process-oriented, advanced digitized discipline in an evolving healthcare system. In medicine, there is a trend towards (sub)specialization across all disciplines. Accordingly, referring physicians expect increasingly higher, more specific demands on imaging and diagnostic quality. The dissertation aim was to investigate the impact of radiological subspecialization across several findings, the time required for second opinions, and the potential for optimizing usage of clinical MRI scanners. Methods: All three studies were performed in the radiology department of the University Hospital of Bern (Switzerland). In addition to analyzing the spectrum of findings before and after the introduction of subspecialization, the time required for peer review process was measured and a software-application used to focus on the actual duration of MRI examinations. Results: Subspecialized reporting reduced the proportion of exam types within the reporting spectrum by up to 34% (p < 0.05), allowing a focus on specific areas of expertise. The average duration of findings increased significantly with the use of subspecialization. In 60% of the evaluations, the duration increased. The average time of a second opinion was 60.4 seconds and was influenced by clinical experience, (dis)agreement with the initial findings and different types of examinations. Performing second opinions on investigated spectrum findings requires 1221 hours of radiological expertise annually. The software-application used provides a detailed overview of MRI examinations with regard to types of examination, the respective duration of the examination and change-over times. Optimization potential exists in a moderate adjustment of scheduled times in order to use existing MRI capacities more efficiently. An exchange of MRI coils necessary for different types of examinations had a minor effect on the changeover times. Discussion: By focusing on a certain spectrum of findings, enhancements of radiology can be influenced. A systematic second opinion is associated with high additional time expenditure. Due to scarce personnel resources, it is debatable whether certain proportion of the total volume of findings require second opinioned. The advantages lie primarily in the higher quality of the findings. Further research is required to justify the extent of additional workload resulting from a second opinion. Finally, efficient usage of MRI scanners can positively benefit enhancements in radiology. Defining scheduled times of MRI examinations according to their actual duration and adjusting them accordingly can lead to a reduction in idle times

[Software-Based Evaluation of Optimization Potential for Clinical MRI Scanners in Radiology].

OBJECTIVE  The aim of the study was to use a software application to analyze the examination times and changeover times of two clinically highly applied MRI scanners at a university hospital for radiology and to evaluate whether this could result in optimization potential for examination planning in the daily clinical routine of MRI diagnostics. MATERIALS AND METHODS  Based on the newly developed software application "Teamplay Usage" (Siemens Healthineers, Germany), the examinations carried out on two MRI scanners (1.5 T and 3 T) were investigated within an analysis period of 12 months with regard to the type of examination and its duration. In addition, compliance with the previously defined planning time (30, 45, 60 min.) was checked and deviations were analyzed. In addition, the changeover times between the examinations were determined and a possible influence due to the exchange of MRI coils was investigated for a selection of change combinations. RESULTS  For the total of 7184 (1.5T: 3740; 3T: 3444) examinations included in the study, the median examination time was 43:02 minutes (1.5T: 43:17 min.; 3T: 42:45 min.). The ten most frequent types of examinations per MRI scanner were completed within the predefined plan time of 54.5 % (1.5 T) and 51.9 % (3 T), taking into account a previously defined preparation and post-processing time of 9 minutes per examination. Overall, more time was spent on examinations with a planned time of 30 minutes, whereas the majority of the examinations planned with 45 minutes were also completed within this time. Examinations with a planned time of 60 minutes usually took less time. A comparison between the planned time and the determined examination duration of the most common types of examinations showed overall a slight potential for optimization. Coil exchanges between two examinations had a small, but statistically not significant effect on the median changeover time (p = 0.062). CONCLUSION  Utilizing a software-based analysis, a detailed overview of the type of examination, examination duration, and changeover times of frequently used clinical MRI scanners could be obtained. In the clinic examined, there was little potential for optimization of examination planning. An exchange of MRI coils necessary for different types of examination only had a small effect on the changeover times

Time Requirement and Feasibility of a Systematic Quality Peer Review of Reporting in Radiology.

OBJECTIVE  To estimate the human resources required for a retrospective quality review of different percentages of all routine diagnostic procedures in the Department of Radiology at Bern University Hospital, Switzerland. MATERIALS AND METHODS  Three board-certified radiologists retrospectively evaluated the quality of the radiological reports of a total of 150 examinations (5 different examination types: abdominal CT, chest CT, mammography, conventional X-ray images and abdominal MRI). Each report was assigned a RADPEER score of 1 to 3 (score 1: concur with previous interpretation; score 2: discrepancy in interpretation/not ordinarily expected to be made; score 3: discrepancy in interpretation/should be made most of the time). The time (in seconds, s) required for each review was documented and compared. A sensitivity analysis was conducted to calculate the total workload for reviewing different percentages of the total annual reporting volume of the clinic. RESULTS  Among the total of 450 reviews analyzed, 91.1 % (410/450) were assigned a score of 1 and 8.9 % (40/450) were assigned scores of 2 or 3. The average time (in seconds) required for a peer review was 60.4 s (min. 5 s, max. 245 s). The reviewer with the greatest clinical experience needed significantly less time for reviewing the reports than the two reviewers with less clinical expertise (p < 0.05). Average review times were longer for discrepant ratings with a score of 2 or 3 (p < 0.05). The total time requirement calculated for reviewing all 5 types of examination for one year would be more than 1200 working hours. CONCLUSION  A retrospective peer review of reports of radiological examinations using the RADPEER system requires considerable human resources. However, to improve quality, it seems feasible to peer review at least a portion of the total yearly reporting volume. KEY POINTS   · A systematic retrospective assessment of the content of radiological reports using the RADPEER system involves high personnel costs.. · The retrospective assessment of all reports of a clinic or practice seems unrealistic due to the lack of highly specialized personnel.. · At least part of all reports should be reviewed with the aim of improving the quality of reports.. CITATION FORMAT · Maurer MH, Brönnimann M, Schroeder C et al. Time Requirement and Feasibility of a Systematic Quality Peer Review of Reporting in Radiology. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1178-1113

Development of Report Turnaround Times in a University Department of Radiology during Implementation of a Reformed Curriculum for Undergraduate Medical Education.

Purpose The implementation of a reformed curriculum for undergraduate medical education with a problem-oriented focus and more bedside teaching in small groups increases the academic teaching workload. The aim of this study was to investigate whether this increase in teaching duties is associated with an increase in report turnaround times of radiologists or increased unplanned absence during term times compared with term breaks (lecture-free periods) and over the whole period under investigation. Materials and Methods The database of all radiological examinations performed at a large German university hospital was retrospectively analyzed for a two-year period from the winter term 2011/12 to the summer term 2013. A total of 192 984 radiological examinations performed during this period were included in an analysis of reporting times (i. e., time from end of examination to completion of report) during term times versus term breaks. Reporting times were analyzed for all radiological examinations and for intensive care unit (ICU) patients. In addition, radiologists' schedules were analyzed in terms of teaching duties, unplanned absence, vacation days, and days away from work for education and training. Results During the period under investigation, the teaching load increased from overall 1.75 hours/day in the winter term 2011/12 to 6.49 hours/day in the summer term 2013 and in the term break from overall 0.10 hours/day in the winter term 2011/12 to 0.71 hours/day in the summer term 2013. Reporting time increased during this period (p < 0.05) but remained shorter during term times than during term breaks. The difference between term and term break for ICU patients was not significant. There was no increase in unplanned absences during term times. Conclusion Overall, radiologists' reporting times increased during the period when the reformed curriculum for undergraduate medical education was implemented. As this was observed both during term and during term breaks, increased teaching duties alone cannot serve as a sole causal explanation. Key Points: · Digital high-quantitative parameters can be used to evaluate workflow in radiology.. · Reporting time can be a criterion for efficient staffing.. · The acquisition and evaluation of parameters such as reporting times could lead to a more efficient resource allocation by providing hints of changed framework conditions and changing working intensities and/or capicity reserves - which may not be immediately apparent.. · During the period under investigation with the implementation of a teaching-intensive reformed curriculum for undergraduate medical education there was an increase in reporting time, which was not significant in intense care units.. · Since during the period under investigation the increase in reporting times can be stated both during term time and in the lecture free period, the implementation of the reformed curriculum for undergraduate medical education alone cannot serve as a sole causal explanation.. Citation Format · Albrecht L, Maurer MH, Seithe T et al. Development of the Report Turnaround Times in a University Department of Radiology during Implementation of a Reformed Curriculum for Undergraduate Medical Education. Fortschr Röntgenstr 2017; DOI: 10.1055/s-0043-118482