• +91 9544652090
  • support@cloudexrad.com
  • Working Hours - Mon - Sun: 12.00 am - 11.59 pm
What are you looking for?

Category Archives: Radiology

4 STRATEGIES TO REDUCE REPORTING ERRORS IN RADIOLOGY

Reporting errors happen in radiology. Certainly they are not intentional, and many have little or no consequence to patients; others are significant. In an effort to be helpful, I would like to share four strategies to help reduce reporting errors in radiology. They are not intended to be in any way comprehensive, but they are actions that might help to increase accuracy.

It’s important to emphasize that I prefer the term “discrepancy” rather than error for much of what we’re considering. The term error implies a mistake, and that a clear-cut diagnosis and correct report are possible. However, as radiologists we know that there is not always a single definitive outcome from an imaging study. Imaging is rarely binary – “normal” or “abnormal”. We render an interpretation that is based on our understanding of the patient’s condition at the time of the exam. Often an “error” is determined later in the light of additional information and a developing clinical picture. The concept of necessary fallibility must be accepted. However, I will use the term “error” for the purpose of this blog, as it is the label most frequently used in literature and discussion.

How prevalent are errors? It seems that 3-5 % is the best minimum error rate achievable even when working in the best of circumstances (1). Knowing that one billion radiologic imaging exams are read annually worldwide, and assuming an average error rate of 4 percent, that equals approximately 40 million radiologist errors annually (2).

Strategy: address cognitive biases in radiology

We all have cognitive biases. They are the result of our brains’ attempts to simplify information processing. We cannot rid ourselves of these biases, but we need to be aware of them and take corrective actions to minimize their influence on our reporting (3). The following are only a selection of the many recognized biases to which radiologists are prone, with some suggested corrective measures of varying practical applicability. Admittedly, some of the suggested correction strategies are not feasible in usual radiology practice.

Strategy: address cognitive biases in radiology

We all have cognitive biases. They are the result of our brains’ attempts to simplify information processing. We cannot rid ourselves of these biases, but we need to be aware of them and take corrective actions to minimize their influence on our reporting (3). The following are only a selection of the many recognized biases to which radiologists are prone, with some suggested corrective measures of varying practical applicability. Admittedly, some of the suggested correction strategies are not feasible in usual radiology practice.

  • Anchoring bias – this is the tendency to rely on our initial impression and fail to adjust it in the light of subsequent information. Correction: avoid early guesses, and seek to disprove your initial diagnosis rather than confirm it. In some cases, you might want to get a second opinion.
  • Framing bias – this is the result of being influenced by the way a problem is framed. For example, if a referrer states, “the patient may have leprosy,” then your interpretation will be influenced by that statement, even though the likelihood of imaging findings being due to leprosy may be remote. Correction: initially review the study blindly before reading the clinical information.
  • Availability bias – this is the tendency to consider a diagnosis more likely if it readily comes to mind. For example, you are more likely to consider a pathology that you saw on a study the previous day, even if its likelihood is very small. Correction: try to use objective information to estimate the true base rate of that diagnosis, rather than relying on a quick initial impression.
  • Satisfaction of search – this is the tendency to stop searching for abnormalities once a likely diagnosis or first abnormality is found. Correction: use a systematic interpretation strategy, perhaps relying on a checklist or algorithmic approach, to help ensure a thorough review. Additionally, do a secondary search after initial abnormality detection, and also consider known combinations (e.g associated multiple injuries that commonly occur together in the knee).
  • Premature closure – this is the tendency to accept a diagnosis before full verification. Correction: always give a differential diagnosis. Never make a working diagnosis absolute without pathological confirmation. It’s important to make clear that I DON’T advocate this suggested corrective strategy; it would diminish the value created by radiology in patient care).

Strategy: probe for more patient information

I realize that it can be difficult to find time for clinical consultations with our referring colleagues, and for direct interaction with our patients. But I strongly believe that these activities are essential to improving our clinical practice. Also, their value is supported by several studies that show a higher percentage of errors occur when reporting is done by off-site reporters who had no opportunity to interact with the referrers or patients, and were presented with only a limited amount of clinical information (4). It is part of the job of radiologists to probe for more information when our instincts tell us the picture we have been given is incomplete.

A few helpful actions are:

• Discussing the appropriateness and justification of scans

• Tailoring studies to the specific clinical question

• Asking for appropriate missing snippets of history, rather than just proceeding because of time pressures

• Having direct discussions with referrers (including within multidisciplinary team meetings) about the significance of the scan results

Strategy: improve report writing

Sometimes we may interpret imaging studies accurately but be unclear in how we convey our meaning in the written report. From the patient’s perspective, the outcome can be the same whether we miss a potential diagnosis or we identify the relevant abnormalities but fail to effectively communicate the key findings and/or their meaning in a poorly-written report. If our reports are incoherent, rambling, and verbose – and if it’s impossible for the referrer to clearly understand what is most important in them – then we have failed to communicate, and are as guilty of “error” as if we missed the relevant findings entirely.

In fact, communication failure in general is the fourth most common reason for radiologists in the U.S. being sued, and 60% of these cases were due to a failure to highlight an urgent or unexpected abnormal finding and to emphasize it appropriately in reports.

I recommend you take a look at your own past reports with a fresh set of eyes, or perhaps ask a trusted colleague to read them. Look closely at your report structure, its organization, and your vocabulary choices. Are there mistakes in grammar or punctuation? Have you failed to correct errors in voice-recognition transcription, leading to confusion about your meaning?

I personally am not a huge fan of structured reporting, but I acknowledge that using them, especially for complex imaging studies, increases thoroughness and accuracy.

My recommendation: make your reports simple and clear, correct typographical errors, include what matters, do not include the irrelevant.

Strategy: ease mental and visual fatigue

Visual fatigue results from prolonged focusing on a workstation, and can be  alleviated (in part) by accommodative relaxation, shifting your visual focal point from near to far (e.g. looking at a distant object for 15-30 seconds) every 15 minutes.

Prolonged focus on a workstation causes visual and mental fatigue.

Mental fatigue is the consequence of continuous and prolonged decision making. We need to be aware that our cognitive processes respond to this mental strain by taking short cuts that might result in poor judgement and diagnostic errors. Here are a few suggestions that that might help you ease your mental fatigue (5):

  • Read the most difficult cases at the beginning of your shift when you are fresh.
  • Switch periodically between modalities.
  • Take structured breaks.
  • Reduce unnecessary interruptions and distractions

It is impossible to expect 100 percent accuracy 100 percent of the time, even under the best of circumstances. Our working environments in this current era of expected hyper-efficient radiology are far from ideal. Radiologist “error” may arise from personal issues, such as the visual and mental fatigue mentioned above, but systemic issues beyond our control (staff shortages, excessive workload, inadequate equipment, poor lighting conditions, lack of availability of previous studies etc.) are also frequent contributors, and they are unlikely to ever be completely eliminated.

Shifting to a system-centered view of errors

In addition to taking steps to minimize the occurrence of errors, we should also consider our reaction when they do happen. The traditional approach within medicine has been  person-centered, with errors viewed as indicative of a personal or professional failure. This culture of “naming, shaming and blaming” can result in suppression of error reporting as well as missed opportunities to learn from each other’s mistakes, and to make process improvements. We need understanding and support from each other and from others in healthcare when mistakes happen.

I believe we should shift our focus to the system, rather than the individual. A system-centered approach facilitates exploration of why an error happened and what can be done to prevent it from happening again. The National Radiology Quality Improvement Programme of the Faculty of Radiologists of the Royal College of Surgeons in Ireland is an example of an effort to embed in practice this more-enlighted and more-beneficial approach to errors. (6)

I also believe that we as a profession need to educate our patients about error rates. As leaders in radiology like Giles Maskell have emphasized, there is a yawning gap between what we know to be our error rate and what our patients believe it to be. The discovery in hindsight of an error in interpretation of a radiological image is often perceived by the patient as something shocking and exceptional, calling into question the competence of the radiologist and the overall care they are receiving. It would benefit radiologists if patients, referrers, and others in healthcare better understood the pervasive nature of radiological “error”, the inherent uncertainty in much of what we do,  and the measures we take to avoid it, while also emphasizing the enormous benefit that radiology – despite its inherent flaws – continues to bring to patient care.

In closing, I will share this quote from Sir William Osler, English/Canadian physician, who said, “Errors in judgement must occur in the practice of an art which consists largely in balancing probabilities.”

What are your thoughts and strategies for reducing errors in radiology? Please comment below.

This content was originally presented by Dr. Brady at ECR 2023.

Conclusion

Esr president Adrian Brady recently sat down with Carestream to discuss the 4 best  Strategies for reducing reporting errors in radiology.

We would like to thank https://www.myesr.org/ for providing valuable information and resources for this article.

Teleradiology Kannur

The Whistle That Never Blew: Real-Time Communication Between Teleradiologists & Referring Physician Aids Diagnosis and Quick Clinical Decision

40-year-old Rani (name changed) in Kerala (Southern state of India) had a Barking cough along with episodes of breathing problems. Many times, had consulted many physicians to get relief from her racking cough which used to get aggravated during the winter season. This year Rani consulted a pulmonologist who listened to her medical history patiently and advised her for a chest CT. The Radiologist who was seeing the CT image had doubts of history and finding mismatch and discussed it with a pulmonologist then reported the presence of a metallic foreign body, and she got referred to a tertiary center with a Bronchoscope facility. The lodged metal (whistle) got removed, and it shocked Rani. She remembered her childhood whistle incident and got relieved to breathe with ease. Whistle… a fun toy brings in many tangy fun-filled childhood memories. And seeing the metal whistle, remembered that she had swallowed one in her childhood while playing with her friends. Scared of getting a scolding from her parents, she drank loads of water to dislodge it and remained silent about the whole incident with her parents. And with progressing time, this incident faded away from her memory. But the lodged whistle did not remain silent. It kept causing.

Many hidden subtle factors have played a crucial role in restoring the easeful breathing of Rani.

  • The multiple one-to-one communication between pulmonologist and teleradiologist benefited both caregivers. 
  • Teleradiologists‘ experience and the back-and-forth interaction with pulmonologists helped in the identification of the abnormality as a foreign body and encouraged the pulmonologist to refer the patient to a tertiary center for removal of the foreign body. 
  • The communication between the pulmonologist and endoscopy surgeon at the tertiary center resulted in the successful removal of the impacted whistle and smooth recovery of the patient. 

The information related to medical history, current illness, physical examination findings, and other diagnostic investigational reports helps the teleradiologists in providing the referring physician with accurate diagnosis and thus helps decide on an appropriate treatment plan with their interpretation. They make deliberate attempts at avoiding any underrating or overlooking of certain possibilities. 

Today, programmers, system designers, and developers have incorporated multiple modes of communication (voice/video conferencing like face to face, text or voice messages/chatbox, emails, etc.) into PACS. The different verbal and written communications have enabled the possibility of instant and face-to-face interaction breaking the anonymous barrier aiding the collaboration and understanding between the referring physician and teleradiologists; eliminating the assumption of nameless/faceless association between the distanced healthcare providers. 

Good, effective communication is an integral part of good patient care. The contemporary gadgets, programs & systems have enabled a faster, reliable communication platform adding value to the caregiver and patient relationship resulting in higher scores of patient satisfaction. Effective communication of referring physicians with his patients ensures a better understanding of the clinical situation facilitating better decision-making by patient / supporting family members and their involvement in treatment management. 

Cloudex Radiology Solutions communicates with Referring Clients aiding diagnosis and clinical decision …

“I want to express my gratitude to Cloudex and Drs. because of whom all this was possible …” 

Whatsapp messages received to express thanks by Rani’s Pulmonologist says it all.

Our team of experienced, qualified & expert Teleradiologists and PACS administrators understand the significance of communication and work closely with referring client’s team.

Various initiatives incorporated for communication are as follows:

  • The protocols are customized based on the type of imaging modality, involved body parts, and the patient’s critical condition. 
  • Ensuring receipt of various information along with image transfer for a better understanding of situation/interpretation and saving on TAT.
  • The administrators managing the advanced PACS are quick in attending to the queries raised by reporting radiologists and coordinate with the referring client’s team, especially in cases of emergency.  
  • The Teleradiologists raise the red flag to get either the additional information from the referring caterer for a better understanding of the situation from the referring Physician.
  • If needed, textual/verbal communication is facilitated between the reporting radiologists and referring physicians for the achievement of the desired goal – delivery of appropriate patient care. 

The whistle removal story whistles loudly that communication is the key to the success of a team. Here everyone- patient, tertiary center, pulmonologist, and teleradiologist succeeded. The communication between the pulmonologist and teleradiologist improved the working relationship between these care providers and helped the referring physician inaccurate diagnosis and planning of further care, thus gaining the confidence and satisfaction score of patients as winning edge among his peers. 

At Cloudex, we support you to have that winning edge. 

Teleradiology Services

PACS: Diminishing the Distance and Enabling the Real-Time Services in Teleradiology

The pandemic time has unveiled a plethora of opportunities and brought in a paradigm shift in work culture – Remote Working, driven by technology. This has enabled the continuation of services irrespective of location and time without compromising the quality-of-service delivery. But this remote working is not a new concept in Radiology. Many radiologists have been supporting the clinicians irrespective of their location and time through teleradiology and delivering quality patient care without delay. 

Teleradiology, identified with remote working is actually vibrant, spontaneous, and into real-time work. All this is possible because of PACS.

PACS – Picture Archiving and Communication System; a system involved in acquiring the medical images, transmission, viewing, storage, and retrieval of same images. Basically, PACS is an electronic version of the file room and reading room for radiologists. PACS works as a host that integrates the radiological images acquired from different radiological imaging modalities (X-Ray, Ultrasound, CT, MRI, PET Scan, Nuclear Medicine, etc…) with a network of information system (RIS and or HIS), EMR, different work stations and image storage/archival system.

Since 1980, PACS has undergone many transformations in multiple ways. All these have been worked out to improve – the transmission of images without any compromise on its quality, archiving and retrieving of data (images and other information) for reference without any delay, communication between the referring Physician, and reporting radiologist. The fundamental parts of PACS are – imaging acquisition, display workstations, archive servers. The workflow is customized based on the modality of images and criticality of the cases marked in the raised work orders

Today, the Web-based PACS offers many additional features like AI-Assisted Decision Support systems, Multi-Media Enhanced Reporting (MMER), an intuitive user interface, intelligent work aids (personalized tools and layout), mobile extensions, multimedia communication tools, etc that boost reading/reporting, making it a smart PACS. It is a coordinator between multiple processes (software & hardware) and applications enabling the image reporting as a real-time service supporting referring physicians.

The benefit of all these features has resulted in reduced TAT, improved productivity of department, better management of emergency / critical cases, and maintenance of data security. It also enables the viewing of images for reporting from anywhere – inside the department or at the nursing station or on mobile gadgets (mobile/notepads/laptops) or remote reporting sites (Teleradiology). 

PACS infrastructure is evolving with advancements in medical imaging technologies and it is highly scalable to keep up the pace with the increasing number of imaging and reporting. This scalability can involve – the addition of more no. of imaging modalities, storage space, no. of work stations, integration of artificial intelligence and machine learning or any other features.

PACS in Hospitals / Tele-reporting service providers with different modalities and multiple work stations use Vendor Neutral Archive (VNA) which brings about compatibility between the different software of imaging machines and PACS’ networking. VNA ensures seamless functioning of data receiving, transmission, integration, and archival and saves time by providing one viewing experience/interface irrespective of the origin of data acquisition.  

Cloudex Solutions: extending teleradiology with cloud-based PACS

Cloudex has set its tele-reporting infrastructure with the advanced smart PACS that provides a convenient workflow and easy-to-use interfaces/dashboard. These advanced online PACS is capable of handling multiple modalities and multiple workstations providing the browser as the main viewing tool enhancing the faster TAT.

The teleradiologists login into the browser and start with the flexibility of time ensuring the tele-reporting services for 24x 7 x 365. Now hospitals / diagnostic centers have the advantage of need-based tele-reporting depending on the imaging modality/subspecialty/timing (full time or night hawk services) instead of traditional reporting apart without a huge investment in digitalized workflow and storage. The experience of the PACS administrator adds a lot of value especially in critically marked/emergency cases apart from their regular maintaining or managing or troubleshooting roles. 

Cloudex with its flexibility in working and range of tele-reporting services aims to support its clients (healthcare service providers) in overcoming obstacles faced while delivering patient care and have a winning edge towards patient satisfaction.

At Cloudex, we support you to have that winning edge. 

Teleradiology Reporting Company

Panademic Crisis Boon Teleradiology

A medical system by which patient’s radiological images from a variety of health care facilities are transmitted electronically for review and reporting by experienced, offsite radiologists and that’s teleradiology. The resulting reports are then transmitted back to the original facility, providing key insights about the images and helping to determine the course of further patient care. The true fact is that this system is grown within the medical field over the last number of decades, only a few are familiar with the particulars of teleradiology.

Now in the present scenario use of teleradiology is highly recommended as the covid 19 crisis threatens the entire world. Moreover, it ensures the safety of professionals and patients simultaneously. However, optimization of IT solutions and implementation of the right change process is a significant milestone for a successful transition.

Radiology plays an important role during the pandemic as it is essential to maintain the continuity of the health service to the patients. Using such technology based on the transmission of radiological patient images from one location to another and allows radiologists to provide services without having to be in contact with the patient is peculiarly important to minimize the expansion of the covid 19 virus.

In some countries, radiology departments in public and private experienced this solution of remote working, showing a positive impact during the outbreak.

The physical distance between the technologist radiologist, the referring physicians, and the patient is of great advantage now as concerns the present situation. If the concerned patient is in self-quarantine due to exposure to a covid patient, in such situation teleradiology helps much with doctors as being able to read, albeit from far x-rays or CT scan of coronavirus patients.

In China at an early stage of a pandemic outbreak, before swab testing was really available, CT scan was used by doctors to assess the probability of covid 19 infections, same time used to track and monitor the progression of the disease as described by some researchers from China.

Teleradiology allows radiologists to work and be productive when isolated from the rest of their community, while the necessity for social distancing is inevitable in the current pandemic, definitely help to restrict the virus transmission. This practice of receiving images to interpret from a facility and that too is out of radiologists’ geographical vicinity is a truly valuable contribution at this time of unprecedented crisis. By supporting areas of the physician shortage and backing up they are in hospital counterparts, teleradiology serves in a significant way to relieve some of the stresses that global health care systems are currently experiencing.

Medical Science has proven time and again that when the resources are provided, great progress in the treatment, cure, and prevention of diseases can occur.

When there is a crisis we can use two brush strokes to write the word ‘crisis’. One brush stroke stands for danger and the other for opportunity. In a crisis, be aware of the danger but on the other hand recognize the opportunity. It’s really an unpredictable situation for the medical field globally, the danger is on the way we move on. But on the other side of the coin, we are forced to find innovative solutions to problems we may never face before.
When we approach the crisis from a hopeful perspective rather than with a stance of resistance, we can navigate this difficult situation by making it beneficial for the modern medical system knows to be teleradiology.

Teleradiology Services India

Teleradiology Enhancing The Patient Satisfaction and Quicker TAT for Referring Physician

Once upon a time, teleradiology was considered as a fragmented and interrupted experience where the images, texts, and speeches were getting delivered on a different medium. And the poor communication between the referring physician and teleradiologist might have resulted in confusion in the patient’s mind or the high cost or undesirable clinical outcomes.

Currently, technological advances have revolutionized the way teleradiology is conducted and are contributing to quality healthcare service delivery. Today, teleradiology represents the integration of the many advanced multimedia technologies which supports the upload/download of reports along with other necessary support documents (other than radiological images), display of images (multiple viewing/screening options), tools for image annotation, image/report archival and retrieval, communication between the group/team, audio reporting and its conversion into text report are some of the important features facilitating the remote reporting equivalent to real-time reporting.

At present, Teleradiology addresses the key concern of the referring physician – accurate report at the earliest with the provision of communicating with teleradiologists in real-time.

These concerns get addressed and benefit him in multiple ways.

  1. Benefit of Support from the extended team during the deciding moments becomes crucial for those who are based in healthcare centers where the radiology department works in stipulated working hours or patients are referred to other centers for radiology services. In such a scenario, the treating physician is benefitted by receiving accurate reports within the decided TAT and can interact with the teleradiologist for further clarification. Overall, the referring physician has an extended team outside his team (employed/assigned team) to support him in providing quality patient care and on whom he can rely during his crucial deciding moments.
  2. Benefit of 24 x 7 Reporting services empowers the referring physician in providing quality patient care round the clock without any delay. This benefits the physician as well as the patient in saving the time and cost, the shift of patient to emergency service and unexpected situation.
  3. Benefit of Expert Opinion when an ambiguous situation. A qualified and expert panel of subspecialists can support the referring physician in more than one way – correct diagnosis, prognosis, and working out the appropriate treatment plan or in understanding/monitoring the treatment outcome. This works wonders for the multispecialty hospitals who need the subspecialty reporting and expert opinions for critical cases additional to their regular radiologist’s reporting; especially in cases of Orthopaedic, Neurology, Oncology, Paediatric or Emergency to name a few.
  4. Benefit of Remote Reporting has brought about a paradigm shift in the quality of patient care extended in primary or secondary care centers located in tier 2 / 3 towns or geographically challenging locations. Teleradiology has built a connection where referring physicians can interact with the reporting teleradiologist in real-time. As a result, Referring Physician can inform the patient about the criticality of the patient in emergency cases and guide the patient in taking appropriate action or referring a patient to comprehensive healthcare centers at right time.
  5. Benefit of Selective Reporting services is an option where the referring physician can choose from different types of teleporting services based on the need; like during the absence of regular radiologists due to holiday/weekend / off-duty / night-time. The different services available to opt for are night call reporting, weekend reporting, overload reporting, vacation reporting. All these selective options are available to ensure patient care without any delay.
  6. Benefit of Answers to the queries of Patient which helps in building trust. Many times, the internet-savvy patient from the metro and tier 1 town throws a series of queries for a better understanding of the situation and for taking appropriate action (shift to a specialty center for surgery/treatment). The patient’s interaction with the reporting teleradiologist who has given the detailed imaging report helps in briefing those critical characteristics playing a crucial role in prognosis. The building of trust depends on many aspects and this can prove to be one of the ways.

Cloudex Radiology Solutions empowers the Referring Physician with a winning edge…

Cloudex teleradiology services empowered with its qualified & experienced experts and subspecialty teleradiologist extends the benefits of technologically advanced infrastructure (RIS-PACS) supported with interactive multimedia components, advanced visualization, and communications (voice message/text/messenger app-based communication, etc.). All these features help in low TAT, quality reporting, and increase the Physician’s satisfaction and confidence with service resulting in the effective clinical outcome – patient care. In today’s competitive world where the patient is ready to go extra mile for better information, better patient care, better treatment option; Teleradiology empowers the referring physician with that winning edge.

At Cloudex, we support you to have that winning edge.