Teleradiology for consultation between practitioners and radiologists.
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Computer Communication Networks↗
Biomedical subjects
E A Franken
Publications and source records attributed to E A Franken.
Contrast enema diagnosis of necrotizing enterocolitis.
Contrast enema was performed in a select group of 126 neonates with ambiguous diagnosis of necrotizing enterocolitis (NEC). Enema findings were compared with that on plain abdominal radiographs (AXR) and the clinical outcome. Thirty-one of the 34 patients with a discharge diagnosis of NEC were interpreted to have a positive contrast enema, and 91 of the 92 patients without a discharge diagnosis of NEC were interpreted to have a negative contrast enema. The AXR was interpreted as positive in 57 patients and as negative or indeterminate in 69. Not a single case of perforation was produced. Judicious use of contrast enema can improve specificity of diagnosis in cases with discordant clinical and plain radiographic findings.
Barium Sulfate↗
The predictive utility of behavior-based interviewing compared with traditional interviewing in the selection of radiology residents.
RATIONALE AND OBJECTIVES: This study compares the predictive use of measures based on traditional faculty and resident interviews of residency applicants with measures obtained through behavior-based interviewing. A special emphasis was placed on predicting residents' noncognitive abilities. METHODS: One hundred fifty-one resident applicants, over a 3-year period, were interviewed using standard interviews by faculty and residents. These residents also were interviewed with an experimental behavior-based accomplishment interview. Four years later, during their diagnostic radiology residency, evaluations of performance were gathered on these applicants from their residency director. RESULTS: Results indicated that scores based on responses given during the accomplishment interviews added considerable predictive utility to the low prediction demonstrated by traditional interviews. CONCLUSIONS: These findings imply that improving unstructured faculty and resident interviews to obtain, in a more rigorous manner, desired information about noncognitive abilities may be a key to successful resident selection.
Behavior↗
Evaluation of a digital workstation for interpreting neonatal examinations. A receiver operating characteristic study.
RATIONALE AND OBJECTIVES: The purpose of this study is to compare the diagnostic accuracy of interpreting clinical neonatal radiographs using a commercially available digital workstation versus conventional radiographic images. METHODS: The case sample consists of 100 chest or abdominal radiographs from the neonatal intensive care unit in which diagnosis was confirmed. Four radiologists served as observers. During two initial reading sessions, half of the studies were viewed on digital radiography monitors and the other half by plain film. Observers indicated whether each patient had normal or abnormal findings and their degree of confidence in this judgment. Six weeks later, observers viewed cases on the alternate presentation system. Two statistical analyses were performed: the data from each observer were treated as a separate experiment in the first analysis; the data from all observers were combined using a new method in the second analysis. RESULTS: No differences between areas under receiver operating characteristic (ROC) curves for viewing on the picture archiving and communication system (PACS) console and plain film were found for any observer (0.86 versus 0.86, 0.89 versus 0.86, 0.88 versus 0.85, 0.83 versus 0.82). CONCLUSIONS: The study suggests that for pediatric plain film images, video images offer diagnostic information comparable with that of conventional radiographs for neonatal examinations.
Evaluation Studies as Topic↗
Error in radiology: classification and lessons in 182 cases presented at a problem case conference.
The authors review and classify errors in 182 cases that were presented at problem case conferences between August 1986 and October 1990. Errors were classified by means of a system developed 20 years ago and by means of a system developed within the past several years. The authors found that sources of error have changed very little. Errors usually involved failure to consult old radiologic studies or reports, limitations in imaging technique, acquisition of inaccurate or incomplete clinical history, location of a lesion outside the area of interest on an image, lack of knowledge, failure to continue to search for abnormalities after the first abnormality was found, and failure to recognize a normal biologic variant. Errors included 126 perceptual errors (64 false-negative, 15 false-positive, and 47 misclassification errors) and 56 mishaps, including 38 complications and 18 communication errors. In seven cases nonperception errors occurred because established departmental routines were not followed, and in nine cases a new departmental routine was established after a complication occurred. Departmental policy exerts less effect on perception and interpretation errors.
Diagnostic Errors↗
Critical performance behaviors of radiology residents: evaluation of two category systems.
OBJECTIVE: Previous research has suggested that certain behavioral aspects of job performance are critical for successful performance in a diagnostic radiology residency. We report two studies conducted to determine the long-term stability of critical performance behaviors for radiology residents and refine their definitions. SUBJECTS AND METHODS: A trained psychology graduate student conducted critical incident interviews with 20 senior faculty in diagnostic radiology. From these interviews, the faculty generated 120 descriptions of exemplary or poor resident performance. These descriptors were then independently sorted by two radiologists into the previously defined categories of behaviors to evaluate consistency of the behaviors. As a second study, the 120 descriptors were sorted into an expanded behavioral definition system and the reproducibility, using the expanded system, was compared with the original results. RESULTS: The interrater reliability for placing the current incidents in the originally described behavioral categories was good (Cohen's kappa 0.70). The overall distribution of incidents showed strong similarity to the original data. Sorting into the expanded categories improved the Cohen's kappa from 0.70 to 0.92, indicating that the expanded behavioral definitions improved reliability for categorizing a behavioral incident. CONCLUSION: The critical behaviors necessary for successful performance in diagnostic radiology residency are stable over time. The expanded and refined system of definitions of these behaviors is more efficacious than the original system was.
Attitude of Health Personnel↗
Comparison of a PACS workstation with conventional film for interpretation of neonatal examinations: a paired comparison study.
The diagnostic value of neonatal examinations using picture archiving and communication systems (PACS) was compared with that of conventional radiographs. A total of 202 consecutive chest or abdominal radiographs from the newborn intensive care unit were digitized for display on a commercially available PACS console. Experimental design was a paired comparison study. Plain films and PACS images were reviewed alternately in unbiased fashion. After the examination was evaluated using the second modality, any change in diagnosis or confidence in diagnosis was noted. Overall evaluation showed slight preference for the PACS modality. Change of diagnosis or in confidence of diagnosis was more than twice as likely to occur with evaluation of PACS (35%) after hardcopy than with evaluation of conventional radiographs (14%) after PACS. Of the variety of image processing features available on PACS, only window and leveling were judged to be of significant value. These results indicate that PACS and conventional radiographs of the neonatal chest and abdomen are of similar diagnostic value.
Humans↗
Pathways to improved radiologic research. An NIH workshop.
In summary, the workshop recommended two years of research training as being essential for radiologists to acquire the skills and knowledge necessary to begin a successful research career in today's funding and academic environment. Many pathways can combine two years of research training and provide fulfillment of existing requirements to achieve specialty certification and subspecialty credentialing. Departments of radiology supporting the beginning qualified investigator should allow him or her approximately 75% research time for the first three years of the academic appointment. Departmental research time accorded faculty members may best be concentrated on a few individuals, providing them sufficient time to be competitive for peer-reviewed grants and enabling research advances to provide a solid foundation for the future of radiologic imaging.
Humans↗
The effect of clinical history on chest radiograph interpretations in a PACS environment.
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Humans↗
Time course of satisfaction of search.
"Satisfaction of search" (SOS) refers to the effect in which a second lesion remains undetected after detection of another lesion on the same radiograph. The objective of this study was to clarify our understanding of SOS by relating it to total time of inspection and time intervals before, between, and after discovery of lesions. Detection accuracy of native lesions in chest radiographs, before and after the addition of a simulated nodular lesion, was measured for ten observers. Analysis of data from this and a previous experiment showed that average perceptual accuracy of individual receiver operating characteristic curves was significantly reduced with the addition of the nodules. Plots and analyses of search time revealed that, on average, during a typical 46-second inspection of a case, simulated nodules were found at 18 seconds, native abnormalities at 25 seconds, and false positives occurred at 33 seconds. Time needed to find nodules did not depend on whether native lesions were present; time to find native lesions did not change with addition of nodules; and total search time was the same for images with one, two, or no lesions. The detection results show that the SOS effect was obtained, but that interrupting search in order to measure it also diminishes accuracy. Analysis of the time course data relates SOS to perceptual capture and strategic halting of search.
Diagnostic Errors↗
Analysis of the cost-effectiveness of PACS.
Picture archiving and communications systems (PACS) have emerged as an important part of digital imaging technology. However, the future of PACS is uncertain because its economic viability is in doubt. Cost-effectiveness analysis is an accepted technique for evaluating the economics of new technologies. This paper addresses the cost-effectiveness of PACS and identifies factors that are important in determining the cost of PACS relative to film-based radiology. These include the impact of PACS on physician productivity, maintenance costs, discount rates, and the time period for amortization of capital goods. The effectiveness of PACS is also explored in terms of improvements in diagnostic accuracy and timely diagnosis. Financial and clinical impacts should be integrated to provide information about how PACS expenditures will affect radiology departments, hospitals, and national research and development objectives.
Cost-Benefit Analysis↗
Aortosternopexy for tracheomalacia following repair of esophageal atresia: evaluation by cine-CT and technical refinement.
During the period of 1 year (1988 to 1989), five infants, aged 3 weeks to 10 months, presented with recurrent respiratory distress following repair of esophageal atresia with tracheoesphageal fistula (EA/TEF). These patients had associated congenital anomalies, including right aortic arch (1), biliary atresia (1), and a long gap that required esophageal elongation by spiral myotomy (1). The patients were evaluated for tracheomalacia using cinecomputed tomography (cine-CT; C-100 Scanner, Imatron, San Francisco, CA), which provides images of eight levels (8-mm interval) simultaneously with 0.7 second time intervals of cine-CT. Dynamic studies of the trachea by cine-CT showed tracheal collapse that was most significant during expiration in the segment immediately above and at the aortic arch. These patients underwent aortosternopexy. Via a right second intercostal approach, the ascending aorta and aortic arch were lifted anteriorly using two to four sutures of 5-0 Tevdek on pledgets placed between the tunica media and adventitia of the side walls of the aorta and the adjacent sternum. Respiratory distress was significantly improved postoperatively. Preliminary experience with these patients allows us to conclude that (1) cine-CT is a useful technique for diagnosing tracheomalacia; (2) it provides objective indication for its correction by aortosternopexy; and (3) the refined technique in placing sutures on the aorta may reduce the surgical risks of aortosternopexy.
Anastomosis, Surgical↗
Satisfaction of search in diagnostic radiology.
A subset of underreading errors (false-negative responses) in radiology has been attributed to "satisfaction of search," which occurs when lesions remain undetected after detection of an initial lesion. This phenomenon has not been studied in the experimental laboratory. A primary goal of this study was to develop a procedure or paradigm to study satisfaction of search. The authors measured detection accuracy for native lesions in images before and after the addition of a simulated nodular lesion. Simulated and native lesions were not spatially superimposed and the native abnormalities were physically identical with and without the nodules. Only responses related to the native lesion were analyzed. Accuracy parameters of receiver operating characteristic (ROC) curves were estimated by the method of maximum likelihood and jackknife. The average perceptual accuracy of the individual ROC curves as measured by Az and de' was significantly reduced with addition of the nodules (t = 2.364, p = 0.025, t = 2.648, p = 0.017, respectively). Az and de' parameters of the pooled ROC curve showed a similar effect (t = 1.573, p = 0.080; t = 1.934, p = 0.047, respectively). The results indicated a substantial satisfaction-of-search effect, with diminished accuracy in perception of native lesions.
Adolescent↗
Factors influencing choice of academic or practice careers in radiology.
Factors, both personal and job-related in nature, that influence career choice among radiology residents are identified. Twenty-six third and fourth year radiology residents at two separate locations, and 17 age-matched and sex-matched internal medicine residents completed a 30-minutes interview and rated themselves on a series of job-related competencies. Data were collected on five groups of variables: demographic data, residency-related variables, factors that influence career choice, self-descriptions, and personal competencies. The results indicate that residents who choose academic careers and those who plan to have private practice careers differ substantially in their reasons for career choice. An academic career is chosen because of its atmosphere, emphasis on research and specialized techniques, and opportunity for teaching. In contrast, private practice careers are selected because of the autonomy they allow, the accompanying lifestyle, and financial reimbursement.
Career Choice↗
A prospective study of cognitive and noncognitive selection criteria as predictors of resident performance.
The primary purpose of this study was to compare objective measures of diagnostic radiology resident applicant performance, such as National Board (NBME) scores, with nonobjective measures, such as conscientiousness and interpersonal skills, in their prediction of resident performance. A second purpose of the study was to examine the predictive usefulness of the Accomplishment Interview (AI), a behavioral selection interview. Thirty resident applicants were interviewed using standard interviews, the AI, and objective data on the applicants were gathered. Four years later, during their diagnostic radiology residency, evaluations were gathered on these applicants, allowing for comparison of current resident performance with past predictive data. Results indicated that noncognitive factors were as important as cognitive factors in the prediction of resident behavior. Further, objective measures, such as NBME scores, failed to adequately predict residents' performance. The implications of these findings for resident selection are discussed.
Cognition↗
Clinical and radiologic features of malignant neoplasms in organ transplant recipients: cyclosporine-treated vs untreated patients.
The radiologic and clinical features of 37 posttransplantation malignant tumors occurring in 33 organ transplant recipients were reviewed to determine the characteristics of the tumors, particularly in relation to previous treatment (or nontreatment) with cyclosporine. The 37 malignant tumors included lymphomas (eight in patients receiving cyclosporine and four in patients not given cyclosporine) and carcinomas of the skin and lips (11), head and neck (five), colon and rectum (three), uterus (two), vulva (two), lung (one), and urinary bladder (one). The neoplasms of the internal viscera and head and neck were relatively advanced when detected. The neoplasms of the skin, vulva, uterine cervix, and urinary bladder were low-grade malignant tumors. Most of the cyclosporine-induced malignant lesions were lymphomas. The lymphomas in cyclosporine-treated recipients were characterized by early appearance after transplantation; more extensive organ involvement; multiple, homogeneous solid lesions without central low density on CT and sonography; and regression after reduction of cyclosporine dose. We conclude that malignant tumors occurring after transplantation are often advanced and that lymphoma induced by cyclosporine has characteristic features.
Adult↗
Ultrafast CT of laryngeal and tracheobronchial obstruction in symptomatic postoperative infants with esophageal atresia and tracheoesophageal fistula.
We evaluated the role of ultrafast CT in the diagnosis and follow-up of nine consecutive, symptomatic infants with suspected laryngeal and tracheobronchial obstruction after surgery for esophageal atresia. With 80% or more area collapse as a criterion for the diagnosis of laryngomalacia and 50% or more for tracheomalacia, six patients had tracheomalacia, one had laryngomalacia, and two had both. Tracheomalacia was focal in four patients and diffuse, involving the thoracic trachea, in the other four. Associated bronchomalacia was present in two patients. The site and degree of abnormality were verified by endoscopy in five of nine patients. The degree of tracheal collapse did not always correlate with the size of the esophageal pouch or with the site of the tracheo-esophageal fistula. These findings support the concept that the larynx and/or tracheal walls are often abnormal in symptomatic infants with esophageal atresia, tracheoesophageal fistula, and airway obstruction. Ultrafast CT was a reliable technique for detecting and assessing the site, extent, severity, and dynamics of airway collapse in five of seven symptomatic infants with congenital tracheoesophageal anomalies when the imaging findings were compared with endoscopic findings and previously published normal standards.
Airway Obstruction↗
Teleradiology for a family practice center.
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Family Practice↗