Search

Artificial intelligence has become a ubiquitous term in radiology over the past several years, and much attention has been given to applications that aid radiologists in the detection of abnormalities and diagnosis of diseases. However, there are many potential applications related to radiologic image quality, safety, and workflow improvements that present equal, if not greater, value propositions to radiology practices, insurance companies, and hospital systems. This review focuses on six major categories for artificial intelligence applications: study selection and protocoling, image acquisition, worklist prioritization, study reporting, business applications, and resident education. All of these categories can substantially affect different aspects of radiology practices and workflows. Each of these categories has different value propositions in terms of whether they could be used to increase efficiency, improve patient safety, increase revenue, or save costs. Each application is covered in depth in the context of both current and future areas of work. Keywords: Use of AI in Education, Application Domain, Supervised Learning, Safety © RSNA, 2022

The existing fellowship imaging informatics curriculum, established in 2004, has not undergone formal revision since its inception and inaccurately reflects present-day radiology infrastructure. It insufficiently equips trainees for today's informatics challenges as current practices require an understanding of advanced informatics processes and more complex system integration. We sought to address this issue by surveying imaging informatics fellowship program directors across the country to determine the components and cutline for essential topics in a standardized imaging informatics curriculum, the consensus on essential versus supplementary knowledge, and the factors individual programs may use to determine if a newly developed topic is an essential topic. We further identified typical program structural elements and sought fellowship director consensus on offering official graduate trainee certification to imaging informatics fellows. Here, we aim to provide an imaging informatics fellowship director consensus on topics considered essential while still providing a framework for informatics fellowship programs to customize their individual curricula.

Objective We describe our experience in implementing enterprise-wide standardized structured reporting for chest radiographs (CXRs) via change management strategies and assess the economic impact of structured template adoption. Methods Enterprise-wide standardized structured CXR reporting was implemented in a large urban health care enterprise in two phases from September 2016 to March 2019: initial implementation of division-specific structured templates followed by introduction of auto launching cross-divisional consensus structured templates. Usage was tracked over time, and potential radiologist time savings were estimated. Correct-to-bill (CTB) rates were collected between January 2018 and May 2019 for radiography. Results CXR structured template adoption increased from 46% to 92% in phase 1 and to 96.2% in phase 2, resulting in an estimated 8.5 hours per month of radiologist time saved. CTB rates for both radiographs and all radiology reports showed a linearly increasing trend postintervention with radiography CTB rate showing greater absolute values with an average difference of 20% throughout the sampling period. The CTB rate for all modalities increased by 12%, and the rate for radiography increased by 8%. Discussion Change management strategies prompted adoption of division-specific structured templates, and exposure via auto launching enforced widespread adoption of consensus templates. Standardized structured reporting resulted in both economic gains and projected radiologist time saved.

OBJECTIVE. Nonphysician providers (NPPs) increasingly perform imaging-guided procedures, but their roles interpreting imaging have received little attention. We characterize diagnostic imaging services rendered by NPPs (i.e., nurse practitioners and physician assistants) in the Medicare population. MATERIALS AND METHODS. Using 1994-2015 Medicare Physician/Supplier Procedure Summary Master Files, we identified all diagnostic imaging services, including those billed by NPPs, and categorized these by modality and body region. Using 2004-2015 Medicare Part B 5% Research Identifiable File Carrier Files, we separately assessed state-level variation in imaging services rendered by NPPs. Total and relative utilization rates were calculated annually. RESULTS. Between 1994 and 2015 nationally, diagnostic imaging services increased from 339,168 to 420,172 per 100,000 Medicare beneficiaries (an increase of 24%). During this same period, diagnostic imaging services rendered by NPPs increased 14,711% (from 36 to 5332 per 100,000 beneficiaries) but still represented only 0.01% and 1.27% of all imaging in 1994 and 2015, respectively. Across all years, radiography and fluoroscopy constituted most of the NPP-billed imaging services and remained constant over time (e.g., 94% of all services billed in 1994 and 2015), representing only 0.01% and 2.1% of all Medicare radiography and fluoroscopy services. However, absolute annual service counts for NPP-billed radiography and fluoroscopy services increased from 10,899 to 1,665,929 services between 1994 and 2015. NPP-billed imaging was most common in South Dakota (7987 services per 100,000 beneficiaries) and Alaska (6842 services per 100,000 beneficiaries) and was least common in Hawaii (231 services per 100,000 beneficiaries) and Pennsylvania (478 services per 100,000 beneficiaries). CONCLUSION. Despite increasing roles of NPPs in health care across the United States, NPPs still rarely interpret diagnostic imaging studies. When they do, it is overwhelmingly radiography and fluoroscopy. Considerable state-to-state variation exists and may relate to local care patterns and scope-of-practice laws.

New consumer technologies and interoperability standards have dated the first standardized curriculum for imaging informatics fellowships suggested by the Society for Computer Applications in Radiology (SCAR) in 2004 (Journal of digital imaging 17(4):244-248, 2004). Last year, analysis from this institution characterized current state fellowship graduation requirements and broad curriculum topics for the first time in over a decade (SIIM Strategic Plan 2017–2020). However, an updated “core” curriculum has not yet been developed. Using the recent current state analysis as a baseline, we aimed to perform a focused assessment and propose that this would work towards an updated consensus “core” curriculum as outlined by the Society for Imaging Informatics in Medicine (SIIM, previously SCAR) strategic plan. A secondary aim was to identify individual program strengths and weaknesses to foster inter-program collaboration. Using sub-topics from the National Imaging Informatics Curriculum (NIIC), a week-long introductory course for residents, we expanded the original 29 broad curriculum categories identified in last year’s current state analysis into 114 sub-topics. We surveyed imaging informatics fellowship directors to identify sub-topic prioritization on a 5-item Likert scale, teaching methods for each sub-topic, cross-departmental partnerships, and individual program strengths and weaknesses. Only 8% of sub-topics (10/114) received a “definitely” rating with 100% agreement while the majority of sub-topics 77% (88/114) had mixed grading defined by two or fewer “definitely” ratings. These sub-topics mapped to only 4 of the original 29 broad fellowship curriculum categories including Standards, Programming/Development/Software, Infrastructure, and PACS/RIS/Reporting. Our plan is to use consensus topics to build a “core” informatics fellowship curriculum and initiate discussion surrounding mixed grading topics. Knowledge of individual program strengths and weaknesses can be used to foster inter-program collaboration.

Cost limitations of commercial-grade ultrasound phantoms often prevent ultrasound education from being incorporated into medical curricula (Bahner et al., Acad Med. 89:1681–6, 2014). While production of homemade agar gelatin phantoms to offset costs has been well documented, use of ballistic gelatin has only recently been described (Domenico et al., J Ultrasound. 11 (4):135-42, 2008; Zerth et al., J Emerg Med. 43:1066-9, 2012; Chao et al., J Emerg Med. 45:240-3, 2013; Shobeiri et al., J Ultrasound Med. 32:1393-6, 2013; Woywodt et al., Clin Nephrol. 79:241-5, 2013; Zeiler et al., Can J Neurol Sci. 40:225-9, 2013; Hunt et al., Eur J Radiol. 82:594-600, 2013; Lo et al., Emerg Med J. 29:738-41, 2012; Li et al., J Ultrasound Med. 30:263-72, 2011; Morrow and Broder, J Emerg Med. 49 (3):313-7, 2015). There exists a critical need for learner evaluation of homemade ballistic gelatin phantoms (BGPs) and their comparison to commercial-grade phantoms to better inform BGP introduction into medical education. The primary aim of this study is to describe survey-based evaluation of homemade BGPs and commercial-grade Blue PhantomsTM by medical students. The secondary aim is to compare image quality of BGPs and Blue PhantomsTM. Described are construction of BGPs and introduction in voluntary ultrasound training sessions offered to 61 first through fourth-year medical students. The evaluation and success of this model are reported. Students reported that versatility of homemade BGPs surpassed that of commercially available phantoms (4.52 ± 0.71) and that they felt more confident in their ultrasound skills after the session (4.82 ± 0.37). Side-by-side evaluation of images generated using BGPs and Blue PhantomsTM had comparable simulated vessel shape and echogenicity, adding objective assessment to subjective survey-based results. Training sessions were enabled by low-cost homemade BGPs at $4 vs $400+ cost of commercial-grade phantoms, a 100-fold reduction in cost. As students found BGPs and Blue PhantomsTM comparable, the results of this study can equip other institutions struggling with costs of incorporating ultrasound into their medical curricula with not only a cost-effective solution but also a learner-validated one.

Cutaneous lupus erythematosus (CLE), defined as isolated cutaneous lesions without significant systemic involvement, has a reported incidence and prevalence of 4.3 and 73.2 per 100,000, respectively.1 It occurs more commonly among women with a reported age of onset between the second and fourth decades of life.1 The 3 more common subtypes of lupus are systemic lupus erythematosus (SLE), subacute cutaneous lupus, and discoid lupus erythematosus. A subset of patients shows atypical clinical manifestations of CLE, which are more rare subtypes and pose a diagnostic and therapeutic challenge. Antimalarial drugs are considered the mainstay of systemic therapy. Because it may take 2 to 3 months to note some improvement,2 oral or topical steroids are used in conjunction to facilitate response. We report a patient with an atypical presentation of CLE who also responded to hydroxychloroquine and review similar cases in the literature.

The study of human anatomy has long been one of the cornerstones of medical training and practice. However, the need to teach other preclinical subjects in more depth within modern medical curricula has led to increasingly fewer hours being dedicated to anatomy. With limited time and few qualified instructors, the ability to convey fundamental anatomical knowledge and understanding to medical students poses a major challenge for anatomy educators. In the present study, we describe the design and initial implementation of a near-peer Anatomy Teaching Assistant Program (AT-AP) and evaluate the students’ perceptions of its success. We demonstrate how, in addition to improving the anatomy education for undergraduate medical students, the teaching assistants (TAs; advanced medical and MD/Ph.D. students) were able to gain much needed experience for upcoming teaching responsibilities in their respective residencies. At the University Of Alabama School Of Medicine (UASOM), gross anatomy is not taught as one consecutive block but is interspersed within organ modules of the first 2 years of undergraduate medical education (UME). There has been a consistently low faculty-to-student ratio in the anatomy lab despite increasing student numbers. This shorthandedness has led to challenges in the gross anatomy laboratory setting. Addressing the issue by recruiting advanced medical students as teaching assistants (TAs) has been unsuccessful due to their rigid clinical scheduling. The goal of this study was to describe the design, successful implementation, and evaluation of a flexible co-enrolled elective Gross Anatomy Teaching Assistant Program within the context of an integrated system-based curriculum.

PURPOSE Changes in medical education have prevented students from conducting full cadaveric dissections in gross anatomy. The efficacy of alternative educational methods is being explored to augment traditional dissection. METHODS Team-based learning was integrated into the 2014 gross anatomy laboratory for physician assistants (PA) and nurse anesthetists. Deidentified data from the 2013 and 2014 courses were used to assess with t-tests the effect of this addition on student academic performance. RESULTS Students in the 2014 course who experienced team-based learning performed significantly better on 75% of written and laboratory practical examinations (P < .05). Those mean examination increases correlated with a positive shift in final grades. A greater benefit was noted for PA students than for nurse anesthetist students. CONCLUSIONS Team-based learning is an effective supplement to cadaveric dissection. Student short-term knowledge outcomes improve with the combination of dissection and team-based learning in the gross anatomy laboratory.

Introduction The module utilizes the team-based learning (TBL) approach to teach the gross anatomy of the posterior abdominal wall, kidneys, and diaphragm. The application exercises include two different case studies: pyelonephritis and the pain management of cholangiocarcinoma. Methods This TBL module was originally delivered to an interprofessional class of first-year surgical physician assistant (PA) and nurse anesthetist (NA) students at the University of Alabama at Birmingham in the fall of 2014 in the NA/PA Gross Anatomy course, and designed to supplement cadaveric dissection activities following a traditional regional anatomy-based lecture. Following the standard TBL format, each TBL session included a preclass assignment in which students were given learning objectives and assigned readings to prepare for the session. Students were then administered individual readiness assurance tests, group readiness assurance tests, and a series of group application exercises centered on the clinical gross anatomy of the posterior abdominal wall and diaphragm. Results Following completion of the NA/PA Gross Anatomy course, student outcomes data was evaluated to determine the effectiveness of incorporating this TBL. Students of the 2014 course who participated in TBL outscored students of the 2013 course on all written and practical examinations. On average, students who participated in TBL in conjunction with lecture and dissection scored 4.9 percentage points higher on written examinations and 5.0 points higher on practical examinations than those who only participated in lectures and dissections. Discussion This TBL module successfully solidifies students' knowledge of the clinical gross anatomy of the posterior abdominal wall and diaphragm. While the content included in this module was written for first-year NA and PA students, the module is suited for a variety of health science disciplines including medicine, dentistry, optometry, and physical therapy.