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Magnetic Resonance Imaging (MRI) is an important diagnostic scanning tool for the detection and monitoring of specific diseases and conditions. However, the equipment cost, maintenance and specialty training of the technologists make the examination expensive. Consequently, unnecessary scanner time caused by poor scheduling, repeated sequences, aborted sequences, scanner idleness, or capture of non-diagnostic or low-value sequences is an opportunity to reduce costs and increase efficiency. This paper analyzes data collected from log files on 29 scanners over several years. 'Wasted' time is defined and key performance indicators (KPIs) are identified. A decrease in exam duration results when actively modifying and monitoring the number of sequences that comprise the exam card for a protocol., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023. Published by Elsevier Inc.)

Objective: The Liver Imaging Reporting and Data System (LI-RADS) has been widely applied to CT and MR liver observations in patients at high-risk for hepatocellular carcinoma (HCC). We investigated the impact of CT vs MR in upgrading LI-RADS 3 to LI-RADS 5 observations using a large cohort of high-risk patients., Methods: We performed a retrospective, longitudinal study of CT and MR radiographic reports (June 2013 - February 2017) with an assigned LI-RADS category. A final population of 757 individual scans and 212 high-risk patients had at least one LI-RADS 3 observation. Differences in observation time to progression between modalities were determined using uni- and multivariable analysis., Results: Of the 212 patients with a LI-RADS 3 observation, 52 (25%) had progression to LI-RADS 5. Tp ranged from 64 - 818 days (median: 196 days). One hundred and three patients (49%) had MR and 109 patients (51%) had CT as their index study. Twenty-four patients with an MR index exam progressed to LI-RADS 5 during the follow-up interval, with progression rates of 22% (CI:13%-30%) at 1 year and 29% (CI:17%-40%) at 2 years. Twenty-eight patients with a CT index exam progressed to LI-RADS 5 during follow-up, with progression rates of 26% (CI:16%-35%) at 1 year and 31% (CI:19%-41%) at 2 years. Progression rates were not significantly different between patients whose LI-RADS 3 observation was initially diagnosed on MR vs CT (HR: 0.81, P = 0.44)., Discussion: MR and CT modalities are comparable for demonstrating progression from LI-RADS 3 to 5 for high risk patients., (Copyright © 2021. Published by Elsevier Inc.)

Study Objective: We describe the characteristics of and predictors for apnea and clinical interventions during emergency department (ED) procedural sedation., Methods: High-resolution data were collected prospectively, using a convenience sample of ED patients undergoing propofol or ketofol sedation. End tidal CO 2 (etco 2 ), respiratory rate, pulse rate, and SpO 2 were electronically recorded in 1-second intervals. Procedure times, drug delivery, and interventions were electronically annotated. Kaplan-Meier curves were used to describe the onset of clinical interventions as a function of sedation time. The onset of apnea (15 consecutive seconds with carbon dioxide ≤10 mm Hg) and clinical interventions were estimated with a series of Cox proportional hazards survival models, with time to first apnea or clinical intervention as the dependent variable. Finally, we tested the association between apnea and clinical intervention., Results: Three hundred twelve patients were analyzed (53% male patients). Apnea was preceded by etco 2 less than 30 mm Hg or greater than 50 mm Hg at 30, 60, and 90 seconds before its onset. Clinical interventions were predicted by apnea, SpO 2 , and propofol use. Increasing age predicted both apnea and interventions. Apnea was not predicted by respiratory rate or SpO 2 . Apnea occurred in half of the patients and clinical interventions in a quarter of them. Clinical intervention was not predicted by abnormal respiratory rate or abnormal etco 2 level. The majority of clinical interventions (85%) were minor, with no cases of assisted ventilation, intubation, or complications., Conclusion: Alterations in etco 2 predicted apnea along a specific time course. Alterations in SpO 2 , apnea, and propofol use predicted clinical interventions. Increasing age predicted both apnea and clinical intervention., (Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)