Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need

Lambert, Lukáš; Foltan, Ondrej; Bríza, J; Lambertová, Alena; Harsa, Pavel; Banerjee, Rohan; Daneš, Jan

doi:10.1007/s00508-016-1025-6

Cited by 10 publications

(4 citation statements)

References 23 publications

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“…The number of acquired CT examinations requiring radiologist interpretation is growing at a rate that outpaces the growth of the radiologist population, which introduces concerns surrounding the presence of errors in imaging-based diagnoses, particularly for pathologies where misdiagnoses may lead to delays in time-sensitive treatment [3,[19][20][21]. Several studies have evaluated retrospective records of board-certified radiologists and estimated error rates and discrepancies of 3-5% [18,22].…”

Section: Discussionmentioning

confidence: 99%

Deep Learning System Boosts Radiologist Detection of Intracranial Hemorrhage

Warman¹,

Warman²,

Warman³

et al. 2022

Cureus

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Background: Intracranial hemorrhage (ICH) requires emergent medical treatment for positive outcomes. While previous artificial intelligence (AI) solutions achieved rapid diagnostics, none were shown to improve the performance of radiologists in detecting ICHs. Here, we show that the Caire ICH artificial intelligence system enhances a radiologist's ICH diagnosis performance.Methods: A dataset of non-contrast-enhanced axial cranial computed tomography (CT) scans (n=532) were labeled for the presence or absence of an ICH. If an ICH was detected, its ICH subtype was identified. After a washout period, the three radiologists reviewed the same dataset with the assistance of the Caire ICH system. Performance was measured with respect to reader agreement, accuracy, sensitivity, and specificity when compared to the ground truth, defined as reader consensus.Results: Caire ICH improved the inter-reader agreement on average by 5.76% in a dataset with an ICH prevalence of 74.3%. Further, radiologists using Caire ICH detected an average of 18 more ICHs and significantly increased their accuracy by 6.15%, their sensitivity by 4.6%, and their specificity by 10.62%. The Caire ICH system also improved the radiologist's ability to accurately identify the ICH subtypes present. Conclusion:The Caire ICH device significantly improves the performance of a cohort of radiologists. Such a device has the potential to be a tool that can improve patient outcomes and reduce misdiagnosis of ICH.

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Section: Discussionmentioning

confidence: 99%

Deep Learning System Boosts Radiologist Detection of Intracranial Hemorrhage

Warman¹,

Warman²,

Warman³

et al. 2022

Cureus

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“…They conclude that this cannot be entirely justified by clinical need as they observed that the highest increase occurred when the number of beds in this hospital was reduced by 21 % [1]. The cost reduction from the smaller number of beds outweighed the higher costs for CT, but the radiation exposure to patients increased.…”

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confidence: 93%

Defensive medicine and overutilization of imaging—an issue of radiation protection

Kainberger

2016

Wien Klin Wochenschr

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Defensive medicine is a serious and prevalent challenge in modern medicine and is a major cause of overutilization of imaging, i. e., its application with a low probability to improve patient outcome. The problems are concerns of missing unexpected or rare findings and fear from litigation; other reasons are avoidance of an inaccurate diagnosis or keeping costs low. Defensive ordering of diagnostic tests may additionally lead to overdiagnosis, which is the detection of new findings not associated with a substantial impact on health which in turn may cause further unnecessary actions.In this issue of the Wiener klinische Wochenschrift Lambert L et al. describe a significant increase of emergency cranial CTs in a trauma setting compared to CTs of other body regions. They conclude that this cannot be entirely justified by clinical need as they observed that the highest increase occurred when the number of beds in this hospital was reduced by 21 % [1]. The cost reduction from the smaller number of beds outweighed the higher costs for CT, but the radiation exposure to patients increased. In a similar study, Chen J et al. report that at a level I trauma center 38 % of CT scans were ordered out of defensive purposes [2]. Remarkably, in that study the rate of significant findings among CT scans obtained defensively was 6 %. Tong GE et al. calculated a doubling of CT scans from 3.51 % in 2005 to 7.17 % in 2013, observed in over 8.5 million Californian patients with minor trauma [3]. Based on a survey among orthopaedic surgeons, trauma surgeons and radiologists in Austria, Osti and Steyrer found that hospital admission with F. Kainberger ( ) Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro-and Muskuloskeletal Radiology, Medical University of Vienna, AKH, Waehringer Guertel 18-20, 1090 Vienna, Austria franz.kainberger@meduniwien.ac.at 65 % and CT examinations with 32 % were the most important consequences of defensive medicine, thus causing an enormous workload in hospital settings [4]. Taking these studies into consideration, aspects of dose reduction play an increasing role in defensive medicine and the question comes up what we can learn from the recent developments in radiation protection to optimize the process of ordering diagnostic tests.In Europe, referral guidelines for imaging are part of the continuously improving quality and safety framework of the EURATOM Basic Safety Standards (BSS) Directive [5]. These new standards reflect a holistic safety concept with the potential to change the "culture" of our clinical work substantially in the sense of predictive, personalized, preventive, and participatory (P4) medicine. Many measures developed to reduce patient dose may be applied for reducing the negative effects of defensive medicine. One is that the motivation for ordering a diagnostic test is differentiated into direct clinical need or a forensic, scientific, or other purpose. Labeling the imaging request in such a form might have the potential for gaining more transparency and optimiz...

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“…The number of computed tomography (CT) examinations is continuously increasing globally although a recent downward trend has been recorded in some countries [1][2][3]. In the emergency department (ED) setting, steadily increasing CT utilization has been observed [2,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%