Christopher Toland, Presenter: Nothing to Disclose

Nabile M. Safdar MD, Abstract Co-Author: Co-founder, iVirtuoso, Inc, Baltimore, MD

Khan Mohammad Siddiqui MD, Abstract Co-Author: Speaker, TeraRecon, Inc, San Mateo, CA Co-founder, iVirtuoso, Inc, Baltimore, MD Advisory Board, General Electric Company, Barrington, IL

Steve Severance, Abstract Co-Author: Co-founder, iVirtuoso, Inc, Baltimore, MD

Paul G. Nagy PhD, Abstract Co-Author: Medical Advisory Board, Agfa-Gevaert Group

Eliot Lawrence Siegel MD, Abstract Co-Author: Research funded, General Electric Company

To determine the relevance of emergency radiology interpretations by (a) “clocking” the imaging workflow of emergency department (ED) physicians; and (b) measuring radiologists’ ability to provide interpretations before ED physician first viewing of imaging studies.

PACS audit logs of 9,384 radiology procedures on patients in the ED for a 3-mo period were queried as to when studies were accessed, preliminary reports were offered, reports were dictated, and on the patient care roles of those accessing studies. Analysis was performed to determine who was first to view each imaging study and in what percentage of cases radiology interpretations were available at the time of initial ED physician review.

Of all cases viewed by ED physicians, 53.5% had been previously viewed by a radiologist and only 47.1% had reports available. The mean time from a study’s arrival to first viewing by an ED physician was 21.7 min (1 SD = 15.1 min), compared with 21.8 min for radiologists (1 SD = 15.8 min). Distributions for study viewing times for radiologists and ED physicians were nearly identical. ED physicians were first to view studies in 32.9% of cases. They were more likely to view radiography before a radiologist (39.1 % of cases) than CT (27.7%) or MR (11.5%). In 29.3% of cases, ED physicians did not review completed imaging studies. Even had radiologists reviewed every case within 5 min of study arrival to PACS, ED physicians would still have been first to view in 14.6% of cases

ED physicians review imaging studies so soon after arrival in PACS that even radiologists’ interpretations provided in a 5-min turnaround would not be ready for review in a significant number of cases. ED physicians have leveraged PACS technology so that they are likely to view imaging studies concurrently with or even before radiologists. This poses a considerable challenge for radiology practices wishing to maintain clinical relevance in a fast-paced emergent environment.

The speed of emergency physicians in viewing imaging poses a considerable challenge for radiology practices wishing to maintain clinical relevance in a fast-paced emergent environment.

Toland, C, Safdar, N, Siddiqui, K, Severance, S, Nagy, P, Siegel, E, Challenges to Radiology Relevance: Emergency Physician Reviews of Imaging Studies.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4442456.html