Scientific Session 1 â Breast Imaging: Mammography

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Scientific Session 5—Informatics, Quality, Safety, and PolicyMondayof scan, time of return to outpatient unit, and time of discharge. Afterdata review, a new proposed workflow for scheduling and performing CThydration was developed.Results: Forty-nine patients received IV hydration. There were 24 vascularCT studies, 18 abdominal/pelvic CT scans, and seven head and neckCT scans. The average time from check-in to the outpatient unit to thestart of examination was 2 hours 55 minutes. The average length of examinationwas 28 minutes, and the time from completion of the examinationto return to the unit was 24 minutes. Average total time away fromthe outpatient unit was 54 minutes. The average duration of admissionwas 8 hours 5 minutes. As a result, proposed improvements include internalizingthe process of hydration into the department of radiology, leadingto streamlined scheduling, decreased time lost between admissiontime and time of CT scan, eliminating time lost to patient transportationdelays, and decreased patient turnaround.Conclusion: Internalizing the process of IV hydration prior to and followingiodinated contrast material into the radiology department can decreasepatient stay by 1 hour. It will also relieve demand on outpatientbeds and reliance on hospital transport. In addition, there would be moreefficient triage of cases requiring hydration and a streamlined schedulingprocess. These can lead to increased satisfaction for the referring physiciansand clinics, as well as the patient.040. Prospective Randomized Comparison of Standard DidacticLecture Versus High-Fidelity Simulation for Radiology ResidentContrast Reaction Management TrainingWang, C. 1 *; Schopp, J. 1 ; Petscavage, J. 1,2 ; Paladin, A. 1 ; Richardson,M. 1 ; Bush, W. 1 1. University of Washington, Seattle, WA; 2. Penn StateUniversity, Hershey, PAAddress correspondence to C. Wang (kaerolynlee@yahoo.com)Objective: Assess if high-fidelity simulation-based training is more effectivethan traditional didactic lecture to train radiology residents in themanagement of contrast reactions.Materials and Methods: Prospective study of 44 radiology residents randomizedinto a simulation versus lecture group based on questionnaireresponses. All residents attended a contrast reaction didactic lecture, andbaseline knowledge was assessed with a written pretest. Four monthslater, 21 residents in the lecture group had a repeat didactic lecture, and23 residents in the simulation group underwent high-fidelity simulationbasedtraining with five contrast reaction scenarios, followed by a writtenposttest. Two months later, both groups took a delay written posttest andunderwent performance testing with a high-fidelity severe contrast reactionscenario graded on predefined critical actions.Results: There was no statistical difference between the simulation andlecture group scores on the pretest, immediate posttest, or delay posttest.The simulation group performed statistically better than the lecture groupon the severe contrast reaction simulation scenario (p = 0.001). The simulationgroup reported statistically improved comfort in identifying andmanaging contrast reactions and administering medications followingthe simulation training (p = 0.04) and were statistically more comfortablethan the control group (p = 0.03), which reported no change in theircomfort level following the repeat didactic lecture.Conclusion: High-fidelity simulation-based training of contrast reactionmanagement demonstrates equal results on written test scores, but improvedperformance during a high-fidelity severe contrast reaction simulationscenario when compared with didactic lecture.041. Image Interpretation Discrepancy Rates Measured by ExternalPeer ReviewMerritt, C. 1 *; Baram-Clothier, E. 2 1. Thomas Jefferson University,Philadelphia, PA; 2. American Medical Foundation, Philadelphia, PAAddress correspondence to C. Merritt (crbmerritt@verizon.net)Objective: Determination of the interpretation error rates of practicingradiologists by external peer review of randomly selected examinations.Materials and Methods: Review of more than 12,270 interpretations of42 radiologists in five group practices in different geographic regions wasperformed by The American Medical Foundation for Peer Review andEducation between 1995 and 2008. For each radiologist, 200–300 randomlyselected cases were reviewed by a panel of experienced academicradiologists. Interpretation discrepancies were classified as follows: 0 =minor incidental finding; 1 = miss, diagnosis not expected by a generalradiologist; 2 = miss, subtle finding with no impact on care; 3 = miss ofapparent finding; 4 = gross error; 5 = overdiagnosis.Results: The overall significant (class 3 and 4) error rate for all radiologistswas 3.32%, with overall error rates for individual radiologists from lessthan 1% to greater than 8%. Lowest error rates were found for ultrasound(1.68%) and general radiographic examinations (2.56%). Discrepancieswere highest for body imaging (4.72%) and neuroradiology (5.85%) examinations.Overcalls were noted in 0.65% of reports. Among the departmentssurveyed, overall error rates ranged from 2.52% to 4.16%.Conclusion: Our results agree with previous studies of discrepancy ratesmeasured by external review with overall significant interpretation errorsin 3–4% of studies. Of interest is the finding that these values are upto 10 times higher than those reported by internal peer review using theAmerican College of Radiology Radpeer process, suggesting external reviewas a more objective process for assessment of physician performance.042. Do Racial or Socioeconomic Disparities Exist in Utilization ofPET/CT Scans?Agarwal, A.*; Kapoor, T.; Ozonoff, A.; Subramaniam, R. BostonUniversity School of Medicine, Boston, MAAddress correspondence to A. Agarwal (aagarwal@bu.edu)Objective: To determine the disparities in the utilization of PET/CTacross different ethnic and socioeconomic groups at an academic medicalcenter.Materials and Methods: This is an institutional review board–approved,HIPAA-compliant retrospective analysis. A list of patients who underwentPET/CT imaging and a list of patients diagnosed with cancer betweenAugust 2004 and September 2009 were obtained from our institutionaltumor registry. Patients were classified as black, white, or other(Hispanic, Asian, American Indian, Middle Eastern, and unknown) andtheir payment method was categorized as Medicare, Private, or Free care(Boston Medical Center HealthNet Plan, Massachusetts Free Care, andA16*Will present paper
MondayScientific Session 6—Breast Imaging: Interventional ProceduresMedicaid). Rates of utilization were calculated using the number of patientsreceiving PET/CT scans in each calendar year as numerator andtotal number of cancer patients in that year as denominator. Log-linear(Poisson) regression models were used to estimate trends over time whilecontrolling for race and payer status. Data were analyzed using SAS version9.2, with two-tailed hypothesis tests and a significance level of 0.05.Results: A total of 4567 eligible subjects with cancer were identified.Overall, 51% were male and 49% were female. The mean age for malesubjects was 60.68 years (SD = 13.00) and the mean age for female subjectswas 59.70 (SD = 15.36). The racial distribution of patients was 55%white, 26% black, and 19% other. Forty-seven percent of the study populationpaid by Medicare, compared with 22% using Free Care, and 31% payingwith private insurance. Of the sample, 2248 patients (49%) receivedPET/CT scans. Overall, 50.2% were men and 49.8% were women. Themean age for men was 59.48 years (SD = 12.97) and the mean age forwomen was 59.22 years (SD = 14.01). The distribution of patients by ethnicgroup was 51% white, 29% black, and 20% other. The distribution ofpatients by payment method was 56% Medicare, 19% Free Care, and 25%private insurance. Utilization of PET/CT scans increased at an adjusted annualrate of 17% over the course of the study period. Both black and othergroups had significantly higher rates of utilization compared with whites(18.7% [p = 0.0009] and 26.0% [p = 0.0001] higher, respectively). FreeCare and private insurance payers had similar rates of utilization (p = 0.70),but Medicare payers had 47% higher rates (p < 0.0001).Conclusion: Disparities exist in the utilization of PET/CT scans dependingon a patient’s race and insurance type. This suggests that ability topay for PET/CT scans may affect access to PET/CT scans.043. Impact of the Sentinel Effect in a Radiology BenefitManagement ProgramFriedman, D.; Smith, N. Jefferson Medical College/Thomas JeffersonUniversity Hospital, Wynnewood, PAObjective: The sentinel effect can be defined as a decrease in servicesgiven by providers as a result of a utilization management program. In thisproject, we evaluated the sentinel effect caused by a prior authorization(PA) process in a radiology benefit management (RBM) company.Materials and Methods: Using evidence-based guidelines, an RBM company(HealthHelp, LLC) provides real-time, peer-to-peer decision supportfor physicians ordering high-cost outpatient imaging studies on patients enrolledin national and local health plans. After initial consultation betweenRBM personnel (level I, customer service representative; level II, nurse) andthe provider’s staff, studies not meeting appropriateness criteria are referredto an academic radiologist (level III) for further review. The radiologist canapprove the study based upon the electronic chart evaluation or call the provider’soffice for further information; the determination of appropriatenessis then made. If a suitable individual is not available to take the radiologist’scall, and there is subsequently “no callback” from the provider’s office with48 hours, the study is administratively withdrawn. Studies are not denied bythe radiologist. We analyzed the rate of “procedure withdrawn by consensuswith the provider” and the rate of “no callback” for a three year interval(January 2007 – December 2009). We also assessed how often a study wasreordered after being withdrawn simply due to “no callback.”Results: A total of 28,120 studies were reviewed during the 3-year interval.There were 3906 procedures “withdrawn by consensus” (13.9%).There were “no callbacks” for 4216 (15.0%). Dividing each year intoquarters, the percentage of “no callbacks” did not significantly changeover the study period (mean, 14.9%; median, 15.1%, range, 11.5 – 18.3%).Of 4216 studies withdrawn due to “no callback,” 1557 (36.9%) were subsequentlyreordered within the next 30 days. Hence, 2659/28,120 (9.5%)of all studies were not performed simply due to “no callback.”Conclusion: The PA process acts as a “sentinel” by imposing a minorbarrier to ordering high-cost outpatient imaging studies. In our project,at Level III, almost one out of four studies was not performed due to thisbarrier. Moreover, this study does not address the sentinel effect at thepoint of entry into the PA process (Level I). Our data suggest that RBMscan slow the rapid growth in high-cost outpatient imaging.Scientific Session 6 — BreastImaging: InterventionalProceduresMonday, May 2, 2011Abstracts 044-051044. Impact of Radiologist-Patient Communication on Patient AnxietyLevels Before and During Imaging-Guided Core Breast BiopsySoo, M.; Miller, L.*; Shelby, R.; Hayes, M.; Yoon, S.; Baker, J. DukeUniversity Medical Center, Durham, NCAddress correspondence to M. Soo (soo00002@mc.duke.edu)Objective: Women undergoing core needle breast biopsy report high levelsof anxiety before and during biopsy and up to 3 years after benignresults. Anxiety related to breast biopsy was recently cited as a potentialcause of harm stemming from screening mammography and has influencedrecent changes in breast cancer screening guidelines. We evaluatedthe impact of radiologist-patient communication at the time of biopsyrecommendation and during biopsy on patient anxiety in women undergoingimage-guided breast biopsy.Materials and Methods: As part of an ongoing study, 28 women recommendedfor image-guided breast interventions (stereotactic and ultrasound-guidedcore biopsy, ultrasound-guided diagnostic cyst aspiration)completed questionnaires immediately before biopsy, measuring stateanxiety (STAI-S), communication with the radiologist recommendingbiopsy, sociodemographic characteristics, and comorbid medical disorders.Immediately following biopsy, participants completed assessmentsof postbiopsy anxiety (STAI-S) and communication with the radiologistperforming the biopsy. Experience levels (e.g., attending physician, fellow,or attending physician with fellow or resident) of the radiologistsrecommending the biopsy and performing the biopsy were recorded.Results: Participants averaged 51 years of age (SD = 17) and had 15 yearsof education (SD = 3); 68% of the sample were married, 61% were white.Average prebiopsy anxiety was 45.5 (SD = 12.9; range, 26–71) on a 20–80 point scale. Perceived communication with radiologists recommendingbiopsy averaged 59.5 (SD = 11.2; range, 28–70). Poorer communica-*Will present paperA17
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Scientific Session 1 â Breast Imaging: Mammography