Typical office lighting and current recommendations on ambient lighting can reduce diagnostic efficacy compared with lower levels of ambient lighting. If, however, no light other than that of the monitor is used, results are similar to those with excessive levels of lighting. Careful control of ambient lighting is therefore required to ensure that diagnostic accuracy is maximized, particularly for clinicians not expert in interpreting posteroanterior wrist images.

Overall, findings of this study showed no evidence that the accuracy of expert radiologists is altered due to changing prevalence expectation rates. However, the time spent interpreting each image and the number of fixations increased at higher prevalence rates. Maintenance of diagnostic efficacy has been shown even when circumstances challenge normal observer behavior.

ObjectiveTo review knowledge of computed tomography (CT) parameters and their influence on patient dose and image quality amongst a cohort of clinical specialist radiographers (CSRs) and examining radiologists.MethodsA questionnaire survey was devised and distributed to a cohort of 65 examining radiologists attending the American Board of Radiology exam in Kentucky in November 2011. The questionnaire was later distributed by post to a matching cohort of Irish CT CSRs. Each questionnaire contained 40 questions concerning CT parameters and their influence on both patient dose and image quality.ResultsA response rate of 22 % (radiologists) and 32 % (CSRs) was achieved. No difference in mean scores was detected between either group (27.8 ± 4 vs 28.1 ± 4, P = 0.87) although large ranges were noted (18–36). Considerable variations in understanding of CT parameters was identified, especially regarding operation of automatic exposure control and the influence of kilovoltage and tube current on patient dose and image quality. Radiologists were unaware of recommended diagnostic reference levels. Both cohorts were concerned regarding CT doses in their departments.ConclusionsCT parameters were well understood by both groups. However, a number of deficiencies were noted which may have a considerable impact on patient doses and limit the potential for optimisation in clinical practice.Key points• CT users must adapt parameters to optimise patient dose and image quality.• The influence of some parameters is not well understood.• A need for ongoing education in dose optimisation is identified.

Objective-Orthopedic injury and intracranial hemorrhage are commonly encountered in emergency radiology, and accurate and timely diagnosis is important. The purpose of this study was to determine whether the diagnostic accuracy of handheld computing devices is comparable to that of monitors that might be used in emergency teleconsultation.Materials and Methods-Two handheld devices, a Dell Axim personal digital assistant (PDA) and an Apple iPod Touch device, were studied. The diagnostic efficacy of each device was tested against that of secondary-class monitors (primary class being clinical workstation display) for each of two image types-posteroanterior wrist radiographs and slices from CT of the brain-yielding four separate observer performance studies. Participants read a bank of 30 wrist or brain images searching for a specific abnormality (distal radial fracture, fresh intracranial bleed) and rated their confidence in their decisions. A total of 168 readings by examining radiologists of the American Board of Radiology were gathered, and the results were subjected to receiver operating characteristics analysis.Results-In the PDA -CT brain study, the scores from PDA readings were significantly higher than those from the monitor readings for all observers (p≤0.01) and for radiologists who were not neuroradiology specialists (p≤0.05). No statistically significant differences were noted for the wrist images or in the iPod Touch studies, although some comparisons approached significance.Conclusion-Handheld devices show promise in the field of emergency teleconsultation for detection of basic orthopaedic injuries and intracranial haemorrhage, although further investigation is warranted.

Objectives To evaluate whether the presence of facial photographs obtained at the point-of-care of portable radiography leads to increased detection of wrong-patient errors. Materials and Methods In this IRB-approved study, 166 radiograph-photograph combinations were obtained from 30 patients. Consecutive radiographs from the same patients resulted in 83 unique pairs (i.e., a new radiograph and prior, comparison radiograph) for interpretation. To simulate wrong-patient errors, mismatched pairs were generated by pairing radiographs from different patients chosen randomly from the sample. Ninety radiologists each interpreted a unique randomly chosen set of 10 radiographic pairs, containing up to 10% mismatches (i.e., error pairs). Radiologists were randomly assigned to interpret radiographs with or without photographs. The number of mismatches identified and interpretation times were recorded. Results Ninety radiologists with 21 ± 10 (mean ± SD) years of experience were recruited to participate in this observer study. With the introduction of photographs, the proportion of errors detected increased from 31% (9/29) to 77% (23/30) (P = 0.006). The odds ratio for detection of error with photographs to detection without photographs was 7.3 (95% CI: 2.29, 23.18). Observer qualifications, training or practice in cardiothoracic radiology did not influence sensitivity for error detection. There is no significant difference in interpretation time for studies without photographs and those with photographs (60 ± 22 seconds vs 61 ± 25 seconds; P=0.77). Conclusion In this observer study, facial photographs obtained simultaneously with portable chest radiographs increased the identification of any wrong-patient errors, without substantial increase in interpretation time. This technique offers a potential means to increase patient safety through correct patient identification.