Appropriateness of Computed Tomography and Ultrasound for Abdominal Complaints in the Emergency Department

Francisco, Martina Zaguini; Altmayer, Stephan; Verma, Nupur; Watte, Guilherme; Brandao, Marina de Campos; Barros, Marcelo Cardoso; Mohammed, Tan-Lucien H.; Hochhegger, Bruno

doi:10.1067/j.cpradiol.2020.11.004

Cited by 10 publications

(3 citation statements)

References 15 publications

(21 reference statements)

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“…insert Table 4 below):DiscussionThis study has shown that over a third 34.5% of the commonly performed CT procedures were inappropriate and could have been avoided or replaced by imaging modalities that use less or no ionizing radiation. The ndings are almost similar to that found by Fransico et al among adults in Emergency Departments of a non-trauma tertiary care urban hospital, where they found that the rate of inappropriate orders was 36.3% for CT[19]. Additionally, a study done Eng et al to assess for Utility, Appropriateness of Request and Report of Computed Tomography Scan for the Diagnosis of paranasal sinuses pPathologies in a Sub-Saharan Africa Urban Setting also found the level of appropriateness to be 37.4%[20].On the other hand, there are as well contradictory ndings.…”

supporting

confidence: 89%

Computed tomography requisitions among children and young adults in sub-Saharan Africa: are we doing it right?

Kisembo

Malumba

Nsereko

et al. 2023

Preprint

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Background The advances in diagnostic technology such as the Helical Multi-Detector Computed Tomography (MDCT) have improved the outcome of several diseases, especially in emergencies and children. However, the upsurge in utilization is associated with global unjustified CT procedures, 10-30% of which are performed among children. MDCT imparts relatively high radiation doses with increased risk of radiation induced cancers and wastage of imaging resources. This is a radiation and public health concern in low resource setting especially sub-Saharan Africa, which has a youthful population. Quality improvement in medical imaging requires measuring compliance of imaging-referrers’ ordering practice behavior against an evidence-based tool such as clinical imaging guidelines. To the best of our knowledge, there is paucity of such studies in the sub-Saharan Africa. This study therefore aimed at determining the frequency and proportion of inappropriate requisitions for commonly performed CT examinations among children and young adults. Methods This was a retrospective review for CT requisition forms (CTRFs) for patients aged 35 years and below from 6 hospital-based CT units performed from 1st July 2018 to 31st December 2018. The level of appropriateness for each request was determined using the online Appropriate Use Criteria (AUC)” ESR iGuide Results A total of 931 CTRFs were assessed, 80% of which were head CT scans. Overall, 34.5% CTRFS were inappropriate. Inappropriate Ct requisition was significant associated with the category of hospital, age, non-trauma indication, the anatomical scan region, and the non- use of contrast media agent. A total of 40(4.3%) CTRFs were not categorized because of insufficient clinical information Conclusions The findings show significant levels of performed CT procedures, especially for head region, non-traumatic and non-contrasted among adult patients could be avoided or replaced by procedures that use less or non-ionizing radiation. What is now needed is a pilot study (ies) to investigate causes of inappropriate use of diagnostic imaging and evaluate the effects of some strategies such as education, training and the use of CIGs on such clinical practices in low resource setting

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supporting

confidence: 89%

Computed tomography requisitions among children and young adults in sub-Saharan Africa: are we doing it right?

Kisembo

Malumba

Nsereko

et al. 2023

Preprint

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“…The topic of our study is of great relevance as the insufficient usage of guidelines results in a large amount of inappropriate imaging 3,6,7 . Inappropriate imaging is associated with increased costs for the healthcare systems, prolonged waiting lists, incorrect or delayed diagnoses, and potentially unnecessary exposure to ionizing radiation 9 .…”

Section: Discussionmentioning

confidence: 99%

“…This allows for optimized patient care, improved diagnostic accuracy and lower radiation exposure, and reduces healthcare costs (https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria). However, variability in clinical routine still persists regarding requirement of imaging itself, modality and need for contrast agent leading to a substantial amount of inappropriate imaging procedures [2][3][4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

A context-based chatbot surpasses trained radiologists and generic ChatGPT in following the ACR appropriateness guidelines

Rau

Fink

et al. 2023

Preprint

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Background Radiological imaging guidelines are crucial for accurate diagnosis and optimal patient care as they result in standardized procedures and thus reduce inappropriate imaging studies. In the present study, we investigated the potential to support clinical decision-making using an interactive chatbot designed to provide personalized imaging recommendations based on indexed and vectorized American College of Radiology (ACR) appropriateness criteria documents. Methods We utilized 209 ACR appropriateness criteria documents as specialized knowledge base and employed LlamaIndex and the ChatGPT 3.5-Turbo to create an appropriateness criteria contexted chatbot (accGPT). Fifty clinical case files were used to compare the accGPT`s performance against radiologists at varying experience levels and to generic ChatGPT 3.5 and 4.0. Results All chatbots reached at least human performance level. For the 50 case files, the accGPT provided a median of 83% (95% CI 82-84) `usually appropriate` recommendations, while radiologists provided a median of 66% (95% CI 62-70). GPT 3.5-Turbo 70% (95% CI 67-73) and GPT 4 79% (95% CI 76-81) correct answers. Consistency was highest for the accGPT with almost perfect Fleiss` Kappa of 0.82. Further, the chatbots provided substantial time and cost savings, with an average decision time of 5 minutes and a cost of 0.19 Euro for all cases, compared to 50 minutes and 29.99 Euro for radiologists (both p < 0.01). Conclusion ChatGPT-based algorithms have the potential to substantially improve the decision-making for clinical imaging studies in accordance with ACR guidelines. Specifically, a context-based algorithm performed superior to its generic counterpart, demonstrating the value of tailoring AI solutions to specific healthcare applications.

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Inappropriate CT examinations: how much, who and where? Insights from a clinical decision support system (CDSS) analysis

Rosen,

Singer,

Vaknin

et al. 2023

Eur Radiol

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Appropriateness of Computed Tomography and Ultrasound for Abdominal Complaints in the Emergency Department

Cited by 10 publications

References 15 publications

Computed tomography requisitions among children and young adults in sub-Saharan Africa: are we doing it right?

Computed tomography requisitions among children and young adults in sub-Saharan Africa: are we doing it right?

A context-based chatbot surpasses trained radiologists and generic ChatGPT in following the ACR appropriateness guidelines

Inappropriate CT examinations: how much, who and where? Insights from a clinical decision support system (CDSS) analysis

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