Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes最新文献

{"title":"Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 2: Technical Issues and Interpretation Pitfalls.","authors":"Elsie T Nguyen,&nbsp;Cameron Hague,&nbsp;Daria Manos,&nbsp;Brett Memauri,&nbsp;Carolina Souza,&nbsp;Jana Taylor,&nbsp;Carole Dennie","doi":"10.1177/08465371211000739","DOIUrl":"https://doi.org/10.1177/08465371211000739","url":null,"abstract":"<p><p>The investigation of acute pulmonary embolism is a common task for radiologists in Canada. Technical image quality and reporting quality must be excellent; pulmonary embolism is a life-threatening disease that should not be missed but overdiagnosis and unnecessary treatment should be avoided. The most frequently performed imaging investigation, computed tomography pulmonary angiogram (CTPA), can be limited by poor pulmonary arterial opacification, technical artifacts and interpretative errors. Image quality can be affected by patient factors (such as body habitus, motion artifact and cardiac output), intravenous (IV) contrast protocols (including the timing, rate and volume of IV contrast administration) and common physics artifacts (including beam hardening). Mimics of acute pulmonary embolism can be seen in normal anatomic structures, disease in non-vascular structures and pulmonary artery filling defects not related to acute pulmonary emboli. Understanding these pitfalls can help mitigate error, improve diagnostic quality and optimize patient outcomes. Dual energy computed tomography holds promise to improve imaging diagnosis, particularly in clinical scenarios where routine CTPA may be problematic, including patients with impaired renal function and patients with altered cardiac anatomy.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"214-227"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211000739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25528901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Parameter, the Smallest Oblique Sagittal Area of the Neural Foramen, as an Index to Diagnose Cervical Neural Foramen Stenosis.","authors":"Yukun Jia,&nbsp;Zhan Peng,&nbsp;Jin Li,&nbsp;Guangye Wang","doi":"10.1177/08465371211005540","DOIUrl":"https://doi.org/10.1177/08465371211005540","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to reconstruct the cervical neural foramen and accurately measure the minimum oblique sagittal area of the neural foramen. Then, a quantitative diagnostic standard for cervical neural foramen stenosis was proposed and its value as an indication for surgery was evaluated.</p><p><strong>Methods: </strong>(1) CT data were used to reconstruct the neural foramen using Mimics software, and the minimum area was measured. (2) The optimal cut-off value was determined using a receiver operating characteristic (ROC) curve. (3) Patients who underwent single-segment surgery were divided into 2 groups according to the cut-off value. Then the postoperative neurological function improvement rate was analyzed to identify any significant difference between the 2 groups.</p><p><strong>Results: </strong>A total of 1056 neural foramens were measured in 132 patients, of which 495 (46.88%) were diagnosed as radiculopathy by clinical neurological examination. The optimal cut-off value determined by the ROC curve was 25.95 mm² (sensitivity 74.1%, specificity 80.9%) and the area under the curve (AUC) was 0.827 (95%CI: 0.803-0.849). There was a significant difference in the neurological function improvement rate between the 2 groups after surgery (<i>P</i> < 0.05). The intraclass correlation coefficient (ICC) was 0.969.</p><p><strong>Conclusion: </strong>Three-dimensional digital simulation reconstruction of CT data is a good measurement method. The optimal cut-off value determined here not only has a certain reference value for the diagnosis of cervical neural foramen bony stenosis, but also helps to select patients suitable for neural foramen decompression and can be used as a reference for surgical indication.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"170-178"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211005540","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38887952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Call Karma Real? Resident After-Hours On-Call Imaging at the University of Saskatchewan: An Assessment of Call Volumes Including Inter-Resident Variability.","authors":"James Huynh,&nbsp;David Horne,&nbsp;Rhonda Bryce,&nbsp;David A Leswick","doi":"10.1177/08465371211026310","DOIUrl":"https://doi.org/10.1177/08465371211026310","url":null,"abstract":"<p><strong>Purpose: </strong>Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups.</p><p><strong>Methods: </strong>Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call.</p><p><strong>Results: </strong>During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected.</p><p><strong>Conclusions: </strong>Annual increases in scan volumes were modest. Although residents' experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"38-48"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211026310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39155096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Cholangiopancreatography (MRCP) in the Setting of Acute Pancreaticobiliary Disease: Can Certain Clinical Factors Guide Appropriate Utilization?","authors":"Stuart Breakey,&nbsp;Alison C Harris","doi":"10.1177/08465371211025527","DOIUrl":"https://doi.org/10.1177/08465371211025527","url":null,"abstract":"Magnetic resonance cholangiopancreatography (MRCP) is a widely available imaging technique that enables rapid and non-invasive assessment of the biliary tree and localization of pathology. T2-weighted imaging is useful for assessing the fluid components of lesions or collections, and provides detailed evaluation of the pancreaticobiliary ductal system. In the emergency setting, MRCP may be applied as an adjunct to US, CT or nuclear medicine (HIDA) imaging to detect cholelithiasis, biliary obstruction, acute cholecystitis, acute biliary (gallstone) pancreatitis (ABP) or provide clinically relevant information in patients with trauma. When compared with MDCT, MRCP has the distinct advantage of avoiding ionizing radiation. Unlike Endoscopic Retrograde Cholangiopancreatography (ERCP), which requires contrast opacification of bile ducts, MRCP utilizes intrinsic high T2 signal of bile to image the biliary tree in the physiologic non-distended state. At present, the utilization of MRCP in the acute setting varies between institutions and is dependent upon the clinical scenario and MRI availability. In a single center retrospective review, Yahya et al evaluated inpatient and emergency department patients with suspected acute pancreaticobiliary disease over a two year period that underwent urgent MRCP following initial US examination to identify factors that might improve MRCP diagnostic yield. Of 155 patients included, the majority (N 1⁄4 125, 81%) had an abnormal initial US and 68 (54%) had concordant MRCP findings. An abnormal preceding ultrasound was a significant predictor of subsequent abnormal MRCP (p &lt; 0.001). A sizeable number of patients (N1⁄4 50, 40%) with abnormal initial US had additional findings identified at MRCP; the majority (N 1⁄4 33, 66%) with clinically significant findings such as choledocholithiasis, pancreaticobiliary neoplasm, complicated pancreatitis and biliary stricture. 17 patients (33%) had non-clinically significant findings such as uncomplicated pancreatitis while 7 (6%) patients with positive US result had a normal subsequent MRCP. Conversely, of 30 (19%) patients with normal preceding US, 21 (70%) had a concordant negative MRCP. Importantly, 9, (30%) had a discordant MRCP with findings of CBD stones, pancreatitis and cholelithiasis. Overall, concordant results were demonstrated in the majority (N1⁄4 89, 57%) with discordant results in remainder (N1⁄4 66, 43%). However, this latter group included patients with a prior normal US and subsequent abnormal MRCP (N 1⁄4 9, 14%), abnormal US and abnormal MRCP with additional significant findings such as CBD stones or pancreatic neoplasm (N 1⁄4 50, 76%) or abnormal US with subsequent normal MRCP (N 1⁄4 7, 10%). Predictive factors for abnormal MRCP included preceding abnormal US, hyperlipasemia and increased age. Age was the sole predictor of significant US/MRCP discrepancy providing new information impacting subsequent management. MRCP proved useful in confirming the suspected clin","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"27-29"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211025527","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39225726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I Wouldn't Start From Here.","authors":"Adrian P Brady","doi":"10.1177/08465371211006063","DOIUrl":"https://doi.org/10.1177/08465371211006063","url":null,"abstract":"An oft-told Irish joke concerns a lost tourist who asks a passing local for directions to some destination. After considering the matter for a moment, the local answers: ‘‘Well, if I were trying to get there, I wouldn’t start from here.’’ The joke’s not very good, but the punchline can be adapted to contradict the notion that the human body (or any other biological entity) is perfectly designed for its functional life. If a deliberate designer wanted to make the perfect dominant mammal to occupy, preside over and manage our planet, she could do better than the human bodies we inhabit. Of course, human beings are not ‘‘designed.’’ We are, instead, the accidental residue of aeons of evolution, mutation and adaptation. Natural selection has certainly favored some of those mutations, but many have been random, causing changes which have no meaningful impact on whether an individual survives and reproduces or not. And some of the phenotypic outcomes of these mutations are, frankly, mind-bogglingly inefficient. Many aspects of human anatomy & physiology are not exactly how one might design an organism to fulfill certain functions. For example, the retinal photocells in human (and all vertebrate) eyes are positioned ‘‘behind’’ the nerves that connect them to the brain, with the nerves emerging anteriorly (toward the light), before converging and passing backward through the retinal ‘‘blind spot’’ to the brain. This is not an ideal physical arrangement; having the nerves pass directly from the back of the photocells to the brain would make more sense, if our eyes were deliberately designed. But by the time this arrangement became disadvantageous, the vertebrate eye had evolved sufficiently far that reversing and re-engineering the process could not have happened by natural selection. ‘‘The vertebrate retina faces the way it does because of the way it develops in the embryo, and this certainly goes back to its ancient ancestors.’’ It’s only by understanding embryology, how some of our bodily features are molded by inherited past forms from which we have evolved, that we can understand many bodily functions, disease processes and anomalies. The weird becomes explicable when we know our embryology, which in part relates to our evolutionary development. The semicircular canals of our inner ears share an evolutionary origin with the neuromasts of fish, sensory organs on their surfaces which allow them hold their position in flowing water by sensing the currents flowing past. Both are gel-filled structures containing hair-like projections. When we drink too much alcohol, the alcohol diffuses into the gel of our semicircular canals, reducing its density. This stimulates movement of the hair cells within the canals, making our brains believe we’re moving. The next time the room starts to spin when you drink too much, blame our evolutionary connection with a trout. Gut rotation in the embryo and crossed-fused renal ectopic are two common anomalies that become eas","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"21-22"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211006063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25528216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow.","authors":"Francesco Macri,&nbsp;Bonnie T Niu,&nbsp;Shannon Erdelyi,&nbsp;John R Mayo,&nbsp;Faisal Khosa,&nbsp;Savvas Nicolaou,&nbsp;Jeffrey R Brubacher","doi":"10.1177/08465371211023861","DOIUrl":"https://doi.org/10.1177/08465371211023861","url":null,"abstract":"<p><strong>Purpose: </strong>Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital.</p><p><strong>Methods: </strong>Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint.</p><p><strong>Results: </strong>During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern.</p><p><strong>Conclusions: </strong>At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"249-258"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211023861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39154424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Density and Risk of Interval Cancers.","authors":"Paula B Gordon","doi":"10.1177/08465371211030573","DOIUrl":"https://doi.org/10.1177/08465371211030573","url":null,"abstract":"Breast cancer screening in Canada varies by province. The Canadian Task Force on Preventive Health Care recommends against routine screening for women aged 40-49 at average risk, in spite of evidence that the most lives are saved by annual screening starting at age 40. Each province chooses what age women can attend screening mammography and at what interval: eight provinces/territories start screening at age 50, but some of those allow women to attend starting at 40 if they have a requisition. Four allow women to self-refer (without a physician’s requisition) starting at age 40. Most provinces screen biennially, but some allow all women to attend annually from 40-49. Not included in the analysis: all women in BC could self-refer to screening annually during the period of the study. Yukon is currently the only jurisdiction where all women may self-refer annually from 40-74. Density reporting is also variable: some provinces use the ACR BIRADS 5th edition 4-category density scoring system; some use a binary system, usually less than or greater than 75% (based on BIRADS 4th edition categories). Thanks to patient advocacy, there is increasing notification of women of their breast density, but not yet all across Canada. Some provinces designate only women with ACR BIRADS category D as having dense breasts. Supplemental screening ultrasound for women with dense breasts is theoretically covered by public health insurance in all jurisdictions. BC is the only jurisdiction that explicitly covers screening ultrasound for all women with categories C and D. In this paper, Seely et al focus on the critical relationship of breast density to interval cancers. They point out that in 5 jurisdictions, women are screened annually if they have category D density breasts. Mammography doesn’t detect all cancers. The undetected cancers can grow and are frequently found by women as a lump in the interval between planned screening visits, and these are called interval cancers. Some interval cancers that are easily seen mammographically at the time they are clinically detected, can be shown to have not been present on the prior screen, even in non-dense tissue. This scenario suggests a rapidly-growing tumour that arose de novo after the prior examination. Cancers may be undetected if they are masked in normal dense tissue. Mammography sensitivity decreases, as mammographic breast density increases, and mammograms miss up to 50% of cancers in women with the densest breasts. So, women with dense breasts are more likely to have interval cancers. In addition to the masking of cancer, dense breast tissue is an independent risk factor for developing cancer. Interval cancers are, on average, larger and more often nodepositive at the time of diagnosis, and frequently higher grade. They have a poorer prognosis than screen-detected cancers. Hence, one of the goals of screening is to reduce interval cancers, and this can be achieved by more effective screening: by screening more fre","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"19-20"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39384225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?","authors":"Adrian Marcuzzi,&nbsp;Bruce B Forster","doi":"10.1177/08465371211023889","DOIUrl":"https://doi.org/10.1177/08465371211023889","url":null,"abstract":"We have read with interest the manuscript entitled ‘‘Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?’’ by Muylaert et al. which is one of few articles assessing measures to reduce iatrogenic extravasation from theglenohumeral joint following arthrography prior to MR. The authors should be commended for contributing to this currently sparse area of research, particularly in their efforts to test for a correlation between extravasation and image quality. However, one could legitimately consider whether the potential impact of extravasation on image interpretability is substantial enough to warrant investigation and procedural changes. Multiple systematic reviews and meta-analyses have demonstrated that MR arthrography has a high baseline sensitivity and specificity in the diagnosis of several lesion types, most recently labral lesions, regardless of the presence of extravasation. Furthermore, the risk of iatrogenic extravasation resulting in the misdiagnosis of lesions is reduced by current knowledge of imaging features that distinguish between clinically significant (e.g. the J sign associated with HAGL lesions) and insignificant leakage. This prospective study by Muylaert et al. has several design strengths. The subjects came directly from a relevant patient population and were randomized to either the intervention or control group, and the design controlled for age and gender. The 3 T MRI platform used is state of the art. The authors minimized confounding by assessing for the J sign and immediate post-fluoroscopy extravasation prior to MRA imaging. All participants received the intervention they were assigned to and no dropouts occurred during the study. During initial fluoroscopy, contrast was injected into participants’ anteroinferior glenohumeral quadrant. The article referenced evidence in support of rotator interval and posterior injection approaches but argued that these methods also had high rates of leakage, in their clinical experience. Current evidence does indeed suggest a high frequency of extravasation with these approaches, though there is some disagreement in the literature on which is comparatively greater. In the absence of a gold standard for grading the extent of extravasation, the authors created an ordinal five-point scale (1: none, 2: less than 2 cm, 3: 2-5 cm, 4: 5-10 cm, 5: more than 10 cm) based on their clinical observations. The validity of this scale was not quantified, but it demonstrated a strong interrater reliability (0.81). Image quality was also graded on an ordinal five-point scale (1: very poor, 5: very good) and demonstrated only a moderate interrater reliability (0.49). Although not mentioned, it is assumed that the assessors were blinded when grading images, so the presence of observation bias is unlikely. Muylaert et al. discovered no significant difference in extravasation or image quality between the interventional and control groups, though this may ","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"25-26"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211023889","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39003783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Modified Barium Swallow Study Conducted With and Without Radiologist Supervision: A Pre- and Post-Observational Study.","authors":"Luhe Yang,&nbsp;David Leswick,&nbsp;Michael Butler,&nbsp;Tasha Ellchuk","doi":"10.1177/08465371211020630","DOIUrl":"https://doi.org/10.1177/08465371211020630","url":null,"abstract":"<p><strong>Purpose: </strong>Assess quality metrics of modified barium swallow studies (MBSS) with and without a radiologist present during the procedure.</p><p><strong>Methods: </strong>Retrospective review of MBSS performed on adult inpatients at a tertiary care hospital 6-months pre- and post-institutional change from having to not having a radiologist present during the examination.</p><p><strong>Factors assessed included: </strong>fluoroscopy time; study duration; number of cine loops; number of images; efficiency of collimation (using a 5-point scoring system); time to final report; radiologist-speech language pathologist report disagreement; and recalls for inadequate studies. Statistical analysis was via Welch's t-test and a test of proportions for continuous and count data under the normal approximation.</p><p><strong>Results: </strong>106 and 119 MBSS were analyzed from the radiologist present and radiologist absent periods, respectively. No statistically significant differences were found for: average fluoroscopy time (116.1 s vs. 126.9 s; <i>P</i> = 0.161); study duration (400.4 s vs. 417.3 s; <i>P</i> = 0.453); number of cine loops (9.3 vs. 10.2; <i>P</i> = 0.075); number of images (620.5 vs. 581.1; <i>P</i> = 0.350); or report disagreement. There was improved performance without the radiologist present for collimation (1.92 vs. 1.43; <i>P</i> = 0.003) and fewer non-diagnostic images (6.5 vs. 4.5; <i>P</i> = 0.001). Time to final report was longer with the radiologist absent due to more reports with significant delays. There were no repeated studies because of inadequate technique in either group.</p><p><strong>Conclusion: </strong>MBSS performed by technologists without radiologist supervision is not inferior to those performed with radiologist supervision on multiple performance measures. This supports technologist operated MBSS without radiologist supervision, while acknowledging a need to further address radiologist report time delay.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"84-89"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211020630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39098841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging, Paternalism and the Worried Patient: Rethinking Our Approach.","authors":"Shushiela Appavoo","doi":"10.1177/08465371211021996","DOIUrl":"https://doi.org/10.1177/08465371211021996","url":null,"abstract":"<p><p>The Covid pandemic has taught many lessons, including the importance of mental health. The value of the radiologist in holistic patient care may be underestimated and underresearched. Barriers to the acceptance of imaging as an important component in reassurance may be rooted in old ideas minimizing the importance of mental health.</p>","PeriodicalId":444006,"journal":{"name":"Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes","volume":" ","pages":"121-124"},"PeriodicalIF":3.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08465371211021996","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39155097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}