Matthew E. Zygmont

Clinical Applications of 3D Printing: Primer for Radiologists

Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.

Opportunities for Patient-centered Outcomes Research in Radiology

Recently created in 2010, the Patient-Centered Outcomes Research Institute (PCORI) supports patient-centered comparative effectiveness research with a focus on prioritizing high-impact studies and improving trial design methodology. The Association of University Radiologists Radiology Research Alliance Task Force on patient-centered outcomes research in Radiology aims to review recently funded imaging-centric projects that adhere to the methodologies established by PCORI. We provide an overview of the successful application of PCORI standards to radiology topics, highlight how these methodologies differ from other forms of radiology research, and identify opportunities for new projects as well as potential barriers for involvement. Our hope is that review of specific case examples in radiology will clarify the use and value of PCORI methods mandated and supported nationally by the Affordable Care Act.

Logistics of Three-dimensional Printing: Primer for Radiologists

The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.

Radiology Research in Quality and Safety: Current Trends and Future Needs

Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research. Establishing and maintaining a culture of safety is paramount to organizations wishing to improve patient care. The correct culture must be in place to support quality initiatives and create accountability for patient care. Focused educational curricula are necessary to teach quality and safety-related skills and behaviors to trainees, staff members, and physicians. The increasingly complex healthcare landscape requires that organizations build effective data infrastructures to support quality and safety research. Incident reporting systems designed specifically for medical imaging will benefit quality improvement initiatives by identifying and learning from system errors, enhancing knowledge about safety, and creating safer systems through the implementation of standardized practices and standards. Finally, validated performance measures must be developed to accurately reflect the value of the care we provide for our patients and referring providers. Common metrics used in radiology are reviewed with focus on current and future opportunities for investigation.

Do Radiologists and Surgeons Speak the Same Language? A Retrospective Review of Facial Trauma

OBJECTIVE The objective of the present study is to examine the concordance of facial fracture classifications in patients with trauma who underwent surgery and to assess the epidemiologic findings associated with facial trauma. MATERIALS AND METHODS Patients with trauma who underwent facial CT examination and inpatient operative intervention during a 1-year period were retrospectively analyzed. Patient demographic characteristics, the mechanism of injury, the radiology report, the surgical diagnosis, and clinical indications were reviewed. Fractures were documented according to bone type and were classified into the following subtypes: LeFort 1, LeFort 2, LeFort 3, naso-orbital-ethmoidal, zygomaticomaxillary complex (ZMC), orbital, and mandibular. Concordance between the radiology and surgery reports was assessed. RESULTS A total of 115,000 visits to the emergency department resulted in 9000 trauma activations and 3326 facial CT examinations. One hundred fifty-six patients (4.7%) underwent facial surgical intervention, and 133 cases met criteria for inclusion in the study. The mean injury severity score was 10.2 (range, 1-75). The three most frequently noted injury mechanisms were as follows: assault (77 cases [57.9%]), a traffic accident (21 cases [15.8%]), and a fall (20 cases [15%]). The three most frequently noted facial bone fractures were as follows: mandible (100 cases [75.2%]), maxilla (53 cases [39.8%]), and orbit (53 cases [39.8%]). The five descriptors most frequently found in the radiology and surgery reports were the mandibular angle (25 cases), the orbital floor (25 cases), the mandibular parasymphysis (22 cases), the mandibular body (21 cases), and ZMC fractures (19 cases). A classification was not specified in 31 of the radiologic impressions (22.5%), with 28 of 31 radiologists expecting the surgeon to read the full report. The descriptors used in the radiology and surgery reports matched in 73 cases (54.9%) and differed in 51 cases (38.3%). No classifications were used by one or both specialties in nine cases (6.8%). CONCLUSION For 38.3% of patients needing facial surgery, descriptors used in the radiologic and surgery reports differed. Speaking a common language can potentially improve communication between the radiology and surgery services and can help expedite management of cases requiring surgery.

Association of lumbar fractures, abdominal aortic calcification, and osteopenia☆

PURPOSE The purpose was to assess if abdominal aortic calcification (AAC) and low bone mineral density (BMD) are associated with fractures on lumbar spine radiographs in trauma patients. METHODS Retrospectively, 303 consecutive lumbar radiographs were independently reviewed by two radiologists for AAC, low BMD, and traumatic findings. RESULTS Thirty-one percent of patients had low BMD, 34% had AAC, and 24% had both. Eleven percent of radiographs showed traumatic findings. Seventy-six percent of positive cases had low BMD (P<.001), and 64% had AAC (P<.001). CONCLUSION A higher index of suspicion for fractures is warranted when AAC and low BMD are present.

Trust But Verify: Online Management Tool Improves Compliance and Documentation of CT Quality Control Activities

DESCRIPTION OF THE PROBLEM CTquality control (QC) requirements have becomemore stringent, driven by increasing equipment complexity and awareness about medical radiation. To meet Joint Commission compliance regulations and maintain ACR accreditation [1,2], daily, monthly, and annual QC checks must be performed and documented for CT scanners. However, documenting compliance in an easily accessible way for regulatory audits is challenging. Also, quarterly review by our physicist could lead to a delay of as much as 3 months in recognizing subtle aberrant results if they were missed by the technologist. Many institutions, including ours, use paper-based QC logs, which are reviewed and acknowledged by a physicist. Large health systems face the challenge of physicists covering multiple scanners or modalities at different locations. Smaller hospital systems may not have a full-time physicist and contract with a medical physics service. These geographic and personnel constraints also increase the likelihood of an unrecognized defect, depending on the interval of review. Finally, compiling the daily, monthly, and annual QC reports as well as service reports of corrective action can be a daunting

The Science of Quality Improvement

Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs. Randomized controlled trials and cluster randomized trials are typically reserved for large-scale research projects evaluating the effectiveness of QI interventions that may be implemented broadly, have more than a minimal impact on patients, or are costly. Systematic reviews of QI studies will play an important role in providing overviews of evidence supporting particular QI interventions or methods of achieving change. We also review the general requirements for developing quality measures for reimbursement, public reporting, and pay-for-performance initiatives. A critical part of the testing process for quality measures includes assessment of feasibility, reliability, validity, and unintended consequences. Finally, publication and critical appraisal of QI work is discussed as an essential component to generating evidence supporting QI initiatives in radiology.

Point-of-Care Reference Materials Increase Practice Compliance With Societal Guidelines for Incidental Findings in Emergency Imaging

PURPOSE The aim of this study was to assess the efficacy of an educational framework encouraging the systematic application of national societal recommendations regarding the imaging evaluation and follow-up of incidental findings (IFs) in the emergency department. METHODS After institutional review board approval was received, consecutive CT and ultrasonographic examinations from the emergency department over a 2-month period were collected. Examination reports were categorized by study type and evaluated individually for the presence of IFs that fit into the following core categories: solid or subsolid pulmonary nodules, liver lesions, splenic lesions, gallbladder polyps, pancreatic cystic lesions, adrenal nodules, adnexal cysts on CT or ultrasonography, thyroid nodules (CT), and abnormal lymph nodes. Subsequently, after an educational intervention consisting of printed and electronic references, e-mail, and verbal communication detailing societal guidelines and the introduction of voice recognition macros, data were recollected in the same fashion for an additional 2-month period. RESULTS A total of 3,131 imaging events occurred in the 2-month preintervention period, yielding 514 total incidental findings. Of these 514 findings, 67.5% were correctly managed and 32.5% were incorrectly managed according to societal recommendations. In the postintervention period, 3,793 imaging events yielded 499 total incidental findings. Of these 499 findings, 80.2% were correctly managed and 19.8% were incorrectly managed. The increased rate of reporting incidental findings in concordance with societal guidelines was statistically significant (P < .0001). CONCLUSIONS Point-of-care decision support reference materials increase radiologist compliance with societal guidelines for incidental findings. Compliance with societal guidelines improves patient care and has cost-saving implications.