关于额外的头部和部成像检查的建议:放射间变异和相关因素
Jeffrey P Guenette1, Elyse Lynch1, Nooshin Abbasi1
1Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
AJR. American journal of roentgenology
|January 31, 2024
概括
放射科医生的行为,而不是患者或检查因素,显著推动了额外成像 (RAI) 头部和部扫描的建议的变化. 质量改进工作应针对放射科医生特定的行为,以减少护理差异.
科学领域:
- 放射学 放射学是一门学科.
- 医学成像分析 医学成像分析
- 医疗保健服务研究 医疗服务研究
背景情况:
- 缺乏标准化的指导方针导致放射科医生在推额外成像 (RAI) 进行头部和部检查时存在显著的差异.
- 这种变化可能会影响诊断成像中的患者护理和资源利用.
研究的目的:
- 在头部和部成像中调查与RAI相关的因素,包括检查类型,患者人口统计和放射科医生特征.
- 量化个人放射科医生的行为对RAI的发行产生影响的程度.
主要方法:
- 在一年内,61名放射科医生解释了39,200次头部和部CT或MRI检查的回顾性分析.
- 使用自然语言处理 (NLP) 工具,通过手动审查验证,在放射学报告中识别RAI.
- 采用一个通用的混合效应模型来评估RAI与各种因素之间的关联.
主要成果:
- 在7.5%的报告中存在RAI,个别放射科医生的发射率在0.8%至22.0%之间差异很大.
- 与较高的RAI概率相关的因素包括CTA检查,学员的参与以及黑人或非裔美国人的种族.
- 在男性患者中,RAI的可能性较低,随着患者年龄的增加而下降,并且与放射科医生的经验相反相关.
- 个人放射科医生的行为占RAI的可解释可能性的74.3%.
结论:
- 在头部和部成像的RAI率中存在显著的放射间变化.
- RAI发行主要是由个体放射科医生的特定行为驱动的,而不是可测量的系统性或患者相关因素.
- 建议针对性质量改进举措,重点关注偶然发现的最佳实践,以减少偏好敏感的决策和相关的护理变化.
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