A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The purpose of this survey was to expand the limited knowledge regarding non-radiologist physician preferences in radiology report styles and content.

Revisión por pares

No description available.

O câncer de mama é uma triste realidade no contexto mundial, sendo o segundo tipo mais frequente entre as mulheres, representando um grave problema de saúde pública. Para diagnosticá-lo, realiza-se a mamografia, interpretada por médicos radiologistas devidamente treinados. Porém, diferentes fatores dificultam a interpretação da imagem mamográfica, como a fadiga visual, stress e distração do profissional, podendo ocasionar falhas ou atraso no diagnóstico. É possível minimizar a taxa de erros se a análise for realizada por meio da dupla leitura, realizada por dois radiologistas ou auxiliada por esquemas computacionais (CAD), no intuito de funcionar como uma segunda opinião. O objetivo do presente estudo foi avaliar a influência do CAD na interpretação de imagens mamográficas de radiologistas experientes, tanto como ferramenta auxiliar na detecção de nódulos e de agrupamentos de calcificações (CADe) quanto como classificador de nódulos (CADx). Os resultados obtidos mostraram que o CAD influenciou positivamente na precisão diagnóstica quando utilizado como classificador, aumentando a sensibilidade e a especificidade dos radiologistas, com a vantagem de não aumentar significativamente a taxa de falsos positivos. Tal fato demonstra que o CAD auxiliou no diagnóstico, sendo ferramenta plausível de ser utilizada na análise mamográfica. Mais estudos devem ser realizados seguindo esta metodologia a fim de realizar novos testes com maior número das amostras e de analisadores. Futuros estudos poderiam explorar especificamente a atuação dos esquemas CADx quando aplicados exclusivamente na análise de mamas densas, em que os sinais radiológicos não são tão evidentes, o que é um grande entrave para diagnósticos corretos. / Breast cancer is a sad reality all over the world, the second most frequent type among women, therefore a serious public health concern. For it diagnosis, mammography is performed and interpreted by qualified medical radiologists. However, several factors have limited the correct interpretation of mammographic images, as visual fatigue, stress and professional distraction, which may result in failed or delayed diagnosis. Its possible to minimize the error rate performing the analysis by means of double reading or by the support of computational schemes (CAD) in order to act as a second opinion. The aim of this study was evaluate the impact of CAD on the interpretation of mammographic images performed by experienced radiologists, aiming to detect nodules and clusters of calcifications (CADe) and as classifier nodules tool (CADx). The results showed that CAD has positively influenced the diagnostic accuracy when used as a classifier, increasing the sensitivity and specificity of radiologists with the advantage of not significantly increasing the rate of false positives. This shows that the CAD really improved the diagnosis, being a useful tool in the analysis of mammographic images.. Additional tests including more samples and analyzers should be performed according to this approach. Future studies could specifically explore the performance of CADx schemes when applied exclusively to the analysis of dense breasts, where the radiological signs are not so obvious, which is a serious difficulty for the medical examination.

O câncer de mama é uma triste realidade no contexto mundial, sendo o segundo tipo mais frequente entre as mulheres, representando um grave problema de saúde pública. Para diagnosticá-lo, realiza-se a mamografia, interpretada por médicos radiologistas devidamente treinados. Porém, diferentes fatores dificultam a interpretação da imagem mamográfica, como a fadiga visual, stress e distração do profissional, podendo ocasionar falhas ou atraso no diagnóstico. É possível minimizar a taxa de erros se a análise for realizada por meio da dupla leitura, realizada por dois radiologistas ou auxiliada por esquemas computacionais (CAD), no intuito de funcionar como uma segunda opinião. O objetivo do presente estudo foi avaliar a influência do CAD na interpretação de imagens mamográficas de radiologistas experientes, tanto como ferramenta auxiliar na detecção de nódulos e de agrupamentos de calcificações (CADe) quanto como classificador de nódulos (CADx). Os resultados obtidos mostraram que o CAD influenciou positivamente na precisão diagnóstica quando utilizado como classificador, aumentando a sensibilidade e a especificidade dos radiologistas, com a vantagem de não aumentar significativamente a taxa de falsos positivos. Tal fato demonstra que o CAD auxiliou no diagnóstico, sendo ferramenta plausível de ser utilizada na análise mamográfica. Mais estudos devem ser realizados seguindo esta metodologia a fim de realizar novos testes com maior número das amostras e de analisadores. Futuros estudos poderiam explorar especificamente a atuação dos esquemas CADx quando aplicados exclusivamente na análise de mamas densas, em que os sinais radiológicos não são tão evidentes, o que é um grande entrave para diagnósticos corretos. / Breast cancer is a sad reality all over the world, the second most frequent type among women, therefore a serious public health concern. For it diagnosis, mammography is performed and interpreted by qualified medical radiologists. However, several factors have limited the correct interpretation of mammographic images, as visual fatigue, stress and professional distraction, which may result in failed or delayed diagnosis. Its possible to minimize the error rate performing the analysis by means of double reading or by the support of computational schemes (CAD) in order to act as a second opinion. The aim of this study was evaluate the impact of CAD on the interpretation of mammographic images performed by experienced radiologists, aiming to detect nodules and clusters of calcifications (CADe) and as classifier nodules tool (CADx). The results showed that CAD has positively influenced the diagnostic accuracy when used as a classifier, increasing the sensitivity and specificity of radiologists with the advantage of not significantly increasing the rate of false positives. This shows that the CAD really improved the diagnosis, being a useful tool in the analysis of mammographic images.. Additional tests including more samples and analyzers should be performed according to this approach. Future studies could specifically explore the performance of CADx schemes when applied exclusively to the analysis of dense breasts, where the radiological signs are not so obvious, which is a serious difficulty for the medical examination.

Objetivo: Verificar graus de concordância diagnóstica pela Angio-TC entre médicos da emergência, residentes de radiologia e radiologistas torácicos em casos suspeitos de tromboembolismo pulmonar (TEP). Material e Métodos: Foram retrospectivamente estudados 123 pacientes consecutivos com suspeita de TEP, de maço/2012 a fevereiro/2013, os quais realizaram Angio-TC pulmonar, obtida com colimação por multidetector 64x0,5. As imagens foram inicialmente interpretadas isoladamente por dois médicos da Emergência e por dois médicos residentes da Radiologia, e subsequentemente por dois Radiologistas Torácicos em consenso, verificando-se o grau de concordância interobservador entre eles quanto à presença de TEP. Resultados: O grau de concordância entre os Residentes da radiologia e os Radiologistas torácicos foi muito bom (Índice Kappa de 0,82 e 0,81); entre os Médicos da Emergência e os Radiologistas torácicos foi baixo ou moderado (Kappa de 0,37 e 0,42.), com um índice de 40,0% de relatos falso-positivos, aproximadamente. Aproximadamente 40,0% das interpretações falso-positivas correlacionaram-se principalmente com casos de TEP lobar e segmentar, enquanto que as falso-negativas ocorreram mais vezes com casos de TEP segmentar e subsegmentar. O grau de concordância geral entre todos os observadores mostrou-sei também moderado (Kappa de 0,50). Conclusão: Usando a Angio-TC no diagnóstico do TEP, o grau de concordância entre os radiologistas torácicos e os residentes da radiologia foi muito bom; entretanto, a concordância entre os médicos da emergência com os radiologistas torácicos foi baixa, com tendência a superestimar o diagnóstico da condição. / Purpose: To assess interobserver agreement rates between the Radiology resident, the thoracic radiologist and the Emergency physician for diagnosing pulmonary embolism (PE) in Computed Tomography Pulmonary Angiography (CTPA) examinations. Methods: Two Emergency physicians and two Radiology residents retrospectively evaluated 123 CTPA scans at our institution, and reported the presence of PE or not, individually. Two thoracic radiologists then reviewed the images, and a consensus was reached. Statistical analysis was performed, in order to provide the interobserver agreement. Results were expressed in kappa values for subsequent comparison. Results: Very good agreement in CTPA reading was observed between Radiology residents and thoracic radiologists (kappa index of 0.82 and 0.81). Fair and moderate agreement (kappa index of 0.39 and 0.42) was demonstrated between Emergency physicians and thoracic radiologists, with a rate of 40% false-positive reports, approximately, mainly in cases of both lobar and segmental involvement, whereas false-negative occurred more times in cases of segmental and subsegmental PE. The overall agreement was also moderate (kappa index of 0.50). Conclusion: The inter-observer agreement in CTPA examinations between radiology residents and thoracic radiologists in PE diagnoses was good, but it was low between the emergency physicians and the radiologists, with a tendency of overestimating that diagnoses.

Objetivo: Verificar graus de concordância diagnóstica pela Angio-TC entre médicos da emergência, residentes de radiologia e radiologistas torácicos em casos suspeitos de tromboembolismo pulmonar (TEP). Material e Métodos: Foram retrospectivamente estudados 123 pacientes consecutivos com suspeita de TEP, de maço/2012 a fevereiro/2013, os quais realizaram Angio-TC pulmonar, obtida com colimação por multidetector 64x0,5. As imagens foram inicialmente interpretadas isoladamente por dois médicos da Emergência e por dois médicos residentes da Radiologia, e subsequentemente por dois Radiologistas Torácicos em consenso, verificando-se o grau de concordância interobservador entre eles quanto à presença de TEP. Resultados: O grau de concordância entre os Residentes da radiologia e os Radiologistas torácicos foi muito bom (Índice Kappa de 0,82 e 0,81); entre os Médicos da Emergência e os Radiologistas torácicos foi baixo ou moderado (Kappa de 0,37 e 0,42.), com um índice de 40,0% de relatos falso-positivos, aproximadamente. Aproximadamente 40,0% das interpretações falso-positivas correlacionaram-se principalmente com casos de TEP lobar e segmentar, enquanto que as falso-negativas ocorreram mais vezes com casos de TEP segmentar e subsegmentar. O grau de concordância geral entre todos os observadores mostrou-sei também moderado (Kappa de 0,50). Conclusão: Usando a Angio-TC no diagnóstico do TEP, o grau de concordância entre os radiologistas torácicos e os residentes da radiologia foi muito bom; entretanto, a concordância entre os médicos da emergência com os radiologistas torácicos foi baixa, com tendência a superestimar o diagnóstico da condição. / Purpose: To assess interobserver agreement rates between the Radiology resident, the thoracic radiologist and the Emergency physician for diagnosing pulmonary embolism (PE) in Computed Tomography Pulmonary Angiography (CTPA) examinations. Methods: Two Emergency physicians and two Radiology residents retrospectively evaluated 123 CTPA scans at our institution, and reported the presence of PE or not, individually. Two thoracic radiologists then reviewed the images, and a consensus was reached. Statistical analysis was performed, in order to provide the interobserver agreement. Results were expressed in kappa values for subsequent comparison. Results: Very good agreement in CTPA reading was observed between Radiology residents and thoracic radiologists (kappa index of 0.82 and 0.81). Fair and moderate agreement (kappa index of 0.39 and 0.42) was demonstrated between Emergency physicians and thoracic radiologists, with a rate of 40% false-positive reports, approximately, mainly in cases of both lobar and segmental involvement, whereas false-negative occurred more times in cases of segmental and subsegmental PE. The overall agreement was also moderate (kappa index of 0.50). Conclusion: The inter-observer agreement in CTPA examinations between radiology residents and thoracic radiologists in PE diagnoses was good, but it was low between the emergency physicians and the radiologists, with a tendency of overestimating that diagnoses.

Objetivo: Verificar graus de concordância diagnóstica pela Angio-TC entre médicos da emergência, residentes de radiologia e radiologistas torácicos em casos suspeitos de tromboembolismo pulmonar (TEP). Material e Métodos: Foram retrospectivamente estudados 123 pacientes consecutivos com suspeita de TEP, de maço/2012 a fevereiro/2013, os quais realizaram Angio-TC pulmonar, obtida com colimação por multidetector 64x0,5. As imagens foram inicialmente interpretadas isoladamente por dois médicos da Emergência e por dois médicos residentes da Radiologia, e subsequentemente por dois Radiologistas Torácicos em consenso, verificando-se o grau de concordância interobservador entre eles quanto à presença de TEP. Resultados: O grau de concordância entre os Residentes da radiologia e os Radiologistas torácicos foi muito bom (Índice Kappa de 0,82 e 0,81); entre os Médicos da Emergência e os Radiologistas torácicos foi baixo ou moderado (Kappa de 0,37 e 0,42.), com um índice de 40,0% de relatos falso-positivos, aproximadamente. Aproximadamente 40,0% das interpretações falso-positivas correlacionaram-se principalmente com casos de TEP lobar e segmentar, enquanto que as falso-negativas ocorreram mais vezes com casos de TEP segmentar e subsegmentar. O grau de concordância geral entre todos os observadores mostrou-sei também moderado (Kappa de 0,50). Conclusão: Usando a Angio-TC no diagnóstico do TEP, o grau de concordância entre os radiologistas torácicos e os residentes da radiologia foi muito bom; entretanto, a concordância entre os médicos da emergência com os radiologistas torácicos foi baixa, com tendência a superestimar o diagnóstico da condição. / Purpose: To assess interobserver agreement rates between the Radiology resident, the thoracic radiologist and the Emergency physician for diagnosing pulmonary embolism (PE) in Computed Tomography Pulmonary Angiography (CTPA) examinations. Methods: Two Emergency physicians and two Radiology residents retrospectively evaluated 123 CTPA scans at our institution, and reported the presence of PE or not, individually. Two thoracic radiologists then reviewed the images, and a consensus was reached. Statistical analysis was performed, in order to provide the interobserver agreement. Results were expressed in kappa values for subsequent comparison. Results: Very good agreement in CTPA reading was observed between Radiology residents and thoracic radiologists (kappa index of 0.82 and 0.81). Fair and moderate agreement (kappa index of 0.39 and 0.42) was demonstrated between Emergency physicians and thoracic radiologists, with a rate of 40% false-positive reports, approximately, mainly in cases of both lobar and segmental involvement, whereas false-negative occurred more times in cases of segmental and subsegmental PE. The overall agreement was also moderate (kappa index of 0.50). Conclusion: The inter-observer agreement in CTPA examinations between radiology residents and thoracic radiologists in PE diagnoses was good, but it was low between the emergency physicians and the radiologists, with a tendency of overestimating that diagnoses.

Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2019 / Introduction: After-hours diagnostic imaging is essential in the majority of large public hospitals, as it plays a vital role in the treatment and management of patients. Radiologists are not always available after hours to provide reports on radiographic images since, nationally and globally, there is a shortage of these professionals. Radiographic images are frequently interpreted by emergency physicians after hours. Thus, while diagnostic imaging represents an essential component in patient care (including management and treatment), according to the literature, a significant cause of clinical error occurs through the misinterpretation of radiographic images by emergency physicians. The aim of this study was to determine emergency physicians’ views on whether there was a need for an after-hours diagnostic radiology reporting service in emergency departments at some public hospitals, in the Durban Metropole. It is important to note that in addition to the above, this study calculated the number of radiographic examinations performed after-hours, and the number that was reported by the radiologist during office hours, since there was no radiology cover after hours. Methods: A descriptive cross-sectional quantitative survey design was employed using a self-administered questionnaire as a data collection instrument completed by emergency physicians at four public hospitals. In addition, additional data was collected to determine the number of radiographic examinations that had been performed after hours, at the selected four public hospitals over a period of three months, as well as the number of radiographic examinations that was reported on. This enabled the authors to determine the number of radiographic examinations that went unreported during this study period. Results: A total of 39 emergency physicians participated in the survey, with a mean and median age of 39.46 and 38 years, respectively (SD = 9.11 years). The results of this study showed that between 0.1% and 0.6% of radiographic examinations performed after hours were reported on by radiologists during office hours, for this study period. This implies that less than 1% of all examinations produced after hours at the four public hospitals, received a radiology report. Emergency physicians felt that the interpretation of images took up valuable time. The survey found that there was near total consensus amongst respondents on whether they prefer after-hours reporting to be performed by a radiologist as 46.2% (n = 18) of the respondents strongly agreed and 41.0% agreed (n = 16). Furthermore, a total of 35.9% (n=14) of respondents agreed and 43.6% (n=17) strongly agreed, that having a reporting radiographer reporting on radiographic images after-hours, would benefit patient flow. The survey also found that 92% of the sampled emergency physicians agreed (59.0% strongly agreed and 33.3% agreed, respectively) that there was a need for further training in the interpretation of radiographic images. Discussion: From the above results, it is evident that since the majority of radiographic examinations went unreported after hours, the task to interpret the radiographic images is left to the emergency physicians as part of their patient management. Conceivably, this added image interpretation results in a further increase in the workload of emergency physicians. It is therefore not surprising that emergency physicians preferred that after-hours reporting of radiographic images be done by radiologists. According to the literature, reporting radiographers also play a role in alleviating the workload of emergency physicians and improving patient flow, by providing a report for the radiographic images during after-hours. Thus, reporting radiographers afford emergency physicians additional time to concentrate on patient treatment, resulting in faster patient throughput. Reporting on radiographic images is not yet included in the scope of the South African radiographer. The findings of this study, though, suggested that there was a need for emergency physicians to undergo training in the interpretation of radiographic images. Conclusion: The study recommends that an after-hours reporting service be considered for the four public hospitals concerned. It is recommended that the heads of the emergency and radiology departments further consider offering courses on radiographic image interpretation for emergency physicians.

Titel: Röntgensjuksköterskans upplevelse av att arbeta med externa granskare under jourtid Syfte: Att undersöka hur röntgensjuksköterskan upplever arbetet med externa granskare under jourtid. Material och metod: Sex stycken röntgensjuksköterskor från två olika sjukhus i mellansverige intervjuades under perioden januari till mars 2017. Inklusionskriterierna för studien var minst två års erfarenhet av yrket samt minst ett års erfarenhet av att arbeta med externa granskare under jourtid. Tillstånd från verksamhetschefer och samtycke från informanterna erhölls innan studien startade. Data samlades in genom en kvalitativ metod med semistrukturerade intervjuer bestående av öppna frågor. Den insamlade datan analyserades med kvalitativ innehållsanalys enligt Graneheim & Lundman. Intervjuerna transkriberades och lästes igenom flera gånger. Därefter identifierades meningsbärande enheter och dessa kondenserades till koder. Genom koderna kunde kategorier och subkategorier identifieras. Resultat: I resultatet framkom fyra kategorier; Teleradiologi – tekniska aspekter, externa granskare jämfört med radiolog på plats, kommunikation och röntgensjuksköterskans kompetenser och egenskaper med tillhörande subkategorier. Konklusion: Informanterna upplever att det tar längre tid att kommunicera med externa granskare (EG) i jämförelse med att ha en radiolog på plats som kan ge svar direkt när röntgensjuksköterskan (RSS) är i behov av vägledning och snabba svar. I kommunikationen upplevs det också finnas språkbarriärer samt bristande kunskap, speciellt hos de sekreterare som tar emot samtal hos EG. Detta leder till frustration och blir ofta ett hinder i akuta situationer då RSS vill prata med en radiolog direkt. Under jourtid upplever RSS att denne får ta ett ökat ansvar samtidigt som förmågan att ta egna initiativ och beslut måste finnas. RSS upplever ingen förändring av bildkvalitén på de bilder som skickas i arbetet med EG. Informanterna upplevde i helhet att arbetet med EG fungerar bra och tillfredsställande under förutsättningarna att tekniken fungerar som den ska samtidigt som arbetsflödet inte ökar för mycket.