Radiology Performed Fluoroscopy-Guided Lumbar Punctures Decrease Volume of Diagnostic Study Interpretation – Impact on Resident Training and Potential Solutions

Abstract

Objectives: Lumbar punctures performed in radiology departments have significantly increased over the last few decades and are typically performed in academic centers by radiology trainees using fluoroscopy guidance. Performing fluoroscopy-guided lumbar punctures (FGLPs) can often constitute a large portion of a trainee’s workday and the impact of performing FGLPs on the trainee’s clinical productivity (i.e. dictating reports on neuroradiology cross-sectional imaging) has not been studied. The purpose of the study was to evaluate the relationship between the number of FGLPs performed and cross-sectional neuroimaging studies dictated by residents during their neuroradiology rotation (NR). Material and Methods: The number of FGLPs and myelograms performed and neuroimaging studies dictated by radiology residents on our neuroradiology service from July 2008 to December 2017 were retrospectively reviewed. The relationship between the number of FGLPs performed and neuroimaging studies (CT and MRI) dictated per day by residents was examined. Results: Radiology residents (n = 84) performed 3437 FGLPs and myelograms and interpreted 33402 cross-sectional studies. Poisson regression demonstrated an exponential decrease in number of studies dictated daily with a rising number of FGLPs performed (P = 0.0001) and the following formula was derived: Number of expected studies dictated per day assuming no FGLPs × e-0.25 x number of FGLPs = adjusted expected studies dictated for the day. Conclusion: We quantified the impact performing FGLPs can have on the number of neuroimaging reports residents dictate on the NR. We described solutions to potentially decrease unnecessary FGLP referrals including establishing departmental guidelines for FGLP referrals and encouraging bedside lumbar punctures attempts before referral. We also emphasized equally distributing the FGLPs among trainees to mitigate procedural burden.

How Are We Handling Fluoroscopy-Guided Lumbar Puncture Requests? A Nationwide Survey of Practice Trends

“…Furthermore, FGLPs can be disruptive to both trainees in academic practices and radiologists. 7,8 Performing FGLPs on outpatients without a bedside attempt also appears to be common practice, with only 10.6% of respondent indicating that they always require a bedside attempt before performing an FGLP on outpatients. FGLPs have a high success rate, and we suspect that FGLPs are requested by outpatient clinicians to potentially decrease the inconvenience of a longer procedure and possibly requiring a return for a second attempt if the bedside LP is unsuccessful.…”

“…While radiology trainees need to learn to perform FGLPs as part of their clinical training and they provide no added cost to the radiology department for performing this service, it is important to not overburden trainees with performing a superfluous number of FGLPs to avoid impacting their diagnostic neuroradiology training. Richards et al 8 reported that for each FGLP performed by a radiology resident, there was a predictable and significant decrease in the number of diagnostic cross-sectional neuroradiology studies that they read in a day. Increased use of physician extenders in academic centers may help relieve some of the burden on trainees of performing increasing number of FGLPs.…”