A Web-Based Flexible Communication System in Radiology

A web-based system for rapid multidirectional communication has been created in the Radiology department at San Francisco General Hospital. The system allows messaging among radiology attendings, residents, and technologists, as well as other members of the hospital community, such as Emergency Department physicians and nurses. Instead of being tied to a particular workflow, this system provides a flexible communication infrastructure which can be easily adapted for different functions and user roles. The system has so far been configured to successfully support the standard “wet reading” workflow, to support marking and tracking of critical results, as well as multiple educational and quality improvement workflows. In the 19 months of operation, the system has gained over 1,800 users (virtually all providers at our institution), it has been accessed by radiologists over 39,000 times and by non-radiologists over 34,000 times. It has become an integral part of the radiology department operations and non-radiology clinical workflows. Unlike most existing softwares, our system is not a task-specific application, but a multipurpose communication system. It is able to effectively accommodate multiple workflows and user roles through configuration (without additional programming). This flexibility has helped this system to be rapidly and widely adopted within our enterprise. The extended reach of the system enables improved monitoring and documentation of workflows, helping with management decision making, and quality assurance. We report a successful radiology communication system based on the principles of flexibility and inclusiveness of users inside and outside the radiology department

Effects of Increased Image Noise on Image Quality and Quantitative Interpretation in Brain CT Perfusion

Background and purposeThere is a desire within many institutions to reduce the radiation dose in CTP examinations. The purpose of this study was to simulate dose reduction through the addition of noise in brain CT perfusion examinations and to determine the subsequent effects on quality and quantitative interpretation.Materials and methodsA total of 22 consecutive reference CTP scans were identified from an institutional review board-approved prospective clinical trial, all performed at 80 keV and 190 mAs. Lower-dose scans at 188, 177, 167, 127, and 44 mAs were generated through the addition of spatially correlated noise to the reference scans. A standard software package was used to generate CBF, CBV, and MTT maps. Six blinded radiologists determined quality scores of simulated scans on a Likert scale. Quantitative differences were calculated.ResultsFor qualitative analysis, the correlation coefficients for CBF (-0.34; P < .0001), CBV (-0.35; P < .0001), and MTT (-0.44; P < .0001) were statistically significant. Interobserver agreements in quality for the simulated 188-, 177-, 167-, 127-, and 44-mAs scans for CBF were 0.95, 0.98, 0.98, 0.95, and 0.52, respectively. Interobserver agreements in quality for the simulated CBV were 1, 1, 1, 1, and 0.83, respectively. For MTT, the interobserver agreements were 0.83, 0.86, 0.88, 0.74, and 0.05, respectively. For quantitative analysis, only the lowest simulated dose of 44 mAs showed statistically significant differences from the reference scan values for CBF (-1.8; P = .04), CBV (0.07; P < .0001), and MTT (0.46; P < .0001).ConclusionsFrom a reference CTP study performed at 80 keV and 190 mAs, this simulation study demonstrates the potential of a 33% reduction in tube current and dose while maintaining image quality and quantitative interpretations. This work can be used to inform future studies by using true, nonsimulated scans