Chris Sistrom - Academia.edu (original) (raw)

Papers by Chris Sistrom

Research paper thumbnail of Increasing the Appropriateness of Outpatient Imaging: Effects of a Barrier to Ordering Low-Yield Examinations 1

Radiology, Jun 1, 2010

To determine the effect of a computerized radiology order entry system rule that prevented noncli... more To determine the effect of a computerized radiology order entry system rule that prevented nonclinician support staff from completing orders for outpatient computed tomographic, magnetic resonance imaging, and nuclear medicine examinations that received initial low-yield decision support scores in the order entry system. This retrospective HIPAA-compliant study was approved by the institutional review board; the requirement for informed consent was waived. The control group consisted of 42737 consecutive orders for examinations in which decision support was provided that were placed from April to December 2006. The study group consisted of 76238 consecutive orders that were placed from April to December 2007. During the latter time period, a new rule in the order entry system was implemented: Examinations that had low-yield decision support scores could not be scheduled when the orders were placed by nonclinician support staff. To schedule the blocked examinations, the responsible clinician was required to personally log in to complete the process. System event logs and records of outpatient imaging procedures were extracted, counted, and analyzed to determine which ordering sessions resulted in examinations being scheduled and performed and which sessions resulted in modified or cancelled examinations. Results were correlated with user status and decision support scores. The Cochran-Mantel-Haenszel technique was used to control for the status of the order initiator and to allow testing for significance of the effect of the intervention on the "fate" of ordering events. After the intervention, the proportion of total examination requests initiated by clinicians directly logging in almost doubled: from 11,243 (26.31%) of 4,737 to 41,450 (54.37%) of 76238 examinations (P < .001). The fraction of low-yield (decision support score, 1-3) examinations requested through the order entry system that were later scheduled and performed decreased from 2106 (5.43%) of 38,801 to 1261 (1.92%) of 65,765 (P < .001). This is in contrast to requests for examinations with higher initial decision support scores that were not affected by the policy change and were scheduled at the same rate (relative risk, 0.988) before and after the change. A simple change in the business logic of the order entry system resulted in a substantially decreased rate of low-yield imaging examinations and a markedly increased percentage of tests personally ordered by clinicians.

Research paper thumbnail of Free Text Versus Structured Format: Information Transfer Efficiency of Radiology Reports

We discuss the effect of radiology report format on the accuracy and speed with which reviewers c... more We discuss the effect of radiology report format on the accuracy and speed with which reviewers can extract case-specific information. A Web-based testing mechanism was used to present radiology reports to each of 16 senior medical students and record their answers to 10 multiple choice questions about specific medical content for each of 12 cases. Subjects were randomly assigned to view the reports in either free text or structured format. In addition to number of answers correct for each case, we recorded the time taken for each case and an efficiency score (correctly answered questions per minute). These three outcomes were tested for differences on report format using multifactorial analysis of variance. A postexperimental questionnaire and a mediated focus group elicited subject preference as to radiology report format. There were no significant differences in the three outcomes (score, time, and efficiency) between the free text and structured format conditions. The power of the experiment was sufficient to detect small differences in these outcomes by format. Subjects strongly and consistently expressed a preference for the structured version. We assert that free text and itemized (structured) forms of radiology reports are equally efficient and accurate for transmitting case-specific interpretative content to reviewers of the document.

Research paper thumbnail of Computerized Physician Order Entry: Advances and Challenges

Research paper thumbnail of Conscious sedation: A safe, cost-effective alternative to general anesthesia in the endovascular treatment of unruptured intracranial aneurysms

Research paper thumbnail of Breath-holding capability of adults. Implications for spiral computed tomography, fast-acquisition magnetic resonance imaging, and angiography

Investigative Radiology

The breath-holding capabilities of various groups of individuals were evaluated to develop protoc... more The breath-holding capabilities of various groups of individuals were evaluated to develop protocols so that patients undergoing spiral computed tomography (CT), digital angiography, and breath-hold magnetic resonance imaging (MRI) can be studied successfully. Twenty-five outpatients and 25 inpatients (all adults) were studied before undergoing body CT. Each subject was asked to hold his or her breath for as long as possible. Then each patient was asked to perform as many repetitive 12-second breath holds as possible. These data were correlated with demographic and historical information. The maximum breath-hold time for inpatients and those outpatients who were heavy smokers or had chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) was 18 to 32 seconds (95% confidence interval) with a mean of 25 seconds. For all other outpatients, breath-hold time was 38 to 56 seconds (mean = 45 seconds). The 95% confidence interval for the number of 12-second breath hol...

Research paper thumbnail of Face time versus test ordering: is there a trade-off?

The American journal of managed care, 2013

As clinician-patient face time comes under pressure, clinicians might consider substituting testi... more As clinician-patient face time comes under pressure, clinicians might consider substituting testing for time spent in diagnostic reasoning, history, and physical exam. To explore the relationship between clinician-patient time and medical resource utilization. In the Massachusetts General Hospital/Massachusetts General Physician Organization outpatient radio frequency identification project, clinicians and patients wore real-time location system (RTLS) tags. "Face time" was defined as the duration patients and clinicians were colocated. Radiology testing was used as a proxy for medical resource use. A radiology test was determined to be associated with a clinical encounter if it involved the same patient and clinician and occurred less than 3 months after the index encounter. Radiologic data were derived from the electronic health record and test appropriateness proxy score from the radiology order entry system. Data were synthesized and analyzed using standard structured ...

Research paper thumbnail of Determinants of diagnostic imaging utilization in primary care

The American journal of managed care, 2012

To examine patient and physician factors affecting utilization of diagnostic imaging in primary c... more To examine patient and physician factors affecting utilization of diagnostic imaging in primary care. Patient-level data from a large academic group practice over the period July 1, 2007, through June 30, 2009. This is a retrospective cohort study of 85,277 patients cared for by 148 primary care physicians (PCPs). The dependent variable is the number of outpatient imaging exams ordered by each patient's PCP over the study period. Independent variables include 17 patient factors describing both clinical need and demographic characteristics and 7 physician factors. Data were collected from the electronic medical record and associated administrative databases. Patient factors having a statistically significant effect on both the probability race, more than 10 medications, congestive heart failure, diabetes, hypertension, other problems, visits to the PCP, visits to specialists, and imaging exams ordered by specialists. For physician factors, experience, gender, and having another d...

Research paper thumbnail of The Lancet. London: Saturday, July 23, 1870

Research paper thumbnail of Use of Imaging Appropriateness Criteria for Decision Support During Radiology Order Entry: The MGH Experience

Radiological Safety and Quality, 2013

Research paper thumbnail of Provider Feedback about Imaging Appropriateness by Using Scores from Order Entry Decision Support: Raw Rates Misclassify Outliers

Radiology, 2014

Purpose To determine the relevant physician- and practice-related factors that jointly affect the... more Purpose To determine the relevant physician- and practice-related factors that jointly affect the rate of low-utility imaging examinations (score of 1-3 out of 9) ordered by means of an order entry system that provides normative appropriateness feedback. Materials and Methods This HIPAA-compliant study was approved by the institutional review board under an expedited protocol for analyzing anonymous aggregated administrative data. This is a retrospective study of approximately 250 000 consecutive scheduled outpatient advanced imaging examinations (computed tomography, magnetic resonance imaging, nuclear medicine) ordered by 164 primary care and 379 medical specialty physicians from 2008 to 2012. A hierarchical logistic regression model was used to identify multiple predictors of the probability that an examination received a low utility score. Physician- and practice-specific random effects were estimated to articulate (odds ratio) and quantify (intraclass correlation) interphysician variation. Results Fixed effects found to be statistically significant predictors of low-utility imaging included examination type, whether the examination was cancelled, status of the person entering the order, and the total number of examinations ordered by the clinician. Neither patient age nor sex had any effect, and there were no secular trends (year of study). The remaining amount of interphysician variation was moderate (intraclass correlation, 22%), whereas the variation between medical specialties and primary care practices was low (intraclass correlation, 5%). The estimated physician-specific effects had reliability of 70%, which makes them just suitable for identifying outliers. Conclusion The authors found that 22% of the variation in the rate of low-utility examinations is attributable to ordering providers and 5% to their specialty or clinic. © RSNA, 2014.

Research paper thumbnail of Thoracic sonography for diagnosis and intervention

Current Problems in Diagnostic Radiology, 1997

Research paper thumbnail of Optic neuropathy secondary to cat scratch disease: distinguishing MR imaging features from other types of optic neuropathies

AJNR. American journal of neuroradiology

MR imaging characteristics of optic neuropathy caused by cat scratch disease have not yet been de... more MR imaging characteristics of optic neuropathy caused by cat scratch disease have not yet been described; this lack of information may result in incorrect diagnosis and may contribute to initiation of inappropriate therapy. Our study was based on the hypothesis that cat scratch disease-related optic neuropathy has distinct MR imaging features compared with those of other types of optic neuropathies. Eighty-two patients with various causes of optic neuropathy and available MR imaging examinations were included in this study. Two readers blinded to the diagnosis reviewed the MR images independently in regard to presence, location, and extent of optic nerve enhancement. The MR imaging findings were correlated with the final diagnosis. Eleven percent (9/82) of the patients received a final diagnosis of cat scratch disease. Optic nerve enhancement in patients with cat scratch disease (5/37) was localized to a 3- to 4-mm segment at the optic nerve-globe junction. All other patients with o...

Research paper thumbnail of Use of Imaging in the Emergency Department: Physicians Have Limited Effect on Variation

Radiology, 2013

To quantify interphysician variation in imaging use during emergency department (ED) visits and e... more To quantify interphysician variation in imaging use during emergency department (ED) visits and examine the contribution of factors to this variation at the patient, visit, and physician level. This study was HIPAA compliant and approved by the institutional review board of Partners Healthcare System (Boston, Mass), with waiver of informed consent. In this retrospective study of 88 851 consecutive ED visits during 2011 at a large urban teaching hospital, a hierarchical logistic regression model was used to identify multiple predictors for the probability that low- or high-cost imaging would be ordered during a given visit. Physician-specific random effects were estimated to articulate (by odds ratio) and quantify (by intraclass correlation coefficient [ICC]) interphysician variation. Patient- and visit-level factors found to be statistically significant predictors of imaging use included measures of ED busyness, prior ED visit, referral source to the ED, and ED arrival mode. Physician-level factors (eg, sex, years since graduation, annual workload, and residency training) did not correlate with imaging use. The remaining amount of interphysician variation was very low (ICC, 0.97% for low-cost imaging; ICC, 1.07% for high-cost imaging). These physician-specific odds ratios of imaging estimates were moderately reliable at 0.78 (95% confidence interval [CI]: 0.77, 0.79) for low-cost imaging and 0.76 (95% CI: 0.74, 0.78) for high-cost imaging. After careful and comprehensive case-mix adjustment by using hierarchical logistic regression, only about 1% of the variability in ED imaging utilization was attributable to physicians.

Research paper thumbnail of A framework for improving radiology reporting

Journal of the American College of Radiology, 2005

The interpretative reports rendered by radiologists are the only tangible manifestation of their ... more The interpretative reports rendered by radiologists are the only tangible manifestation of their expertise, training, and experience. These documents are very often the primary means by which radiologists provide patient care. Radiology reports are extremely variable in form, content, and quality. The authors propose a framework for conceptualizing the reporting process and how it might be improved. This consists of standard language, a structured format, and consistent content. These attributes will be realized by modifying the clinical reporting process, including the creation, storage, transmission, and review of interpretative documents. The authors also point out that changes in training and evaluation must be a part of the process, because they are complementary to purely technical solutions.

Research paper thumbnail of Costs, Charges, and Revenues for Hospital Diagnostic Imaging Procedures: Differences by Modality and Hospital Characteristics

Journal of the American College of Radiology, 2005

Purpose: This study examined financial data reported by Florida hospitals concerning costs, charg... more Purpose: This study examined financial data reported by Florida hospitals concerning costs, charges, and revenues related to imaging services.

Research paper thumbnail of Managing predefined templates and macros for a departmental speech recognition system using common software

Journal of Digital Imaging, 2001

Research paper thumbnail of Ultrasound guidance for biopsy of omental abnormalities

Journal of Clinical Ultrasound, 1992

We review our two-year experience with ultrasound-guided fine needle aspiration biopsy of omental... more We review our two-year experience with ultrasound-guided fine needle aspiration biopsy of omental pathology. Eleven patients were referred for biopsy of omental abnormalities. Biopsy was performed without complication in all cases and the asprates were positive for malignancy in 9. The discharge diagnosis was ovarian carcinoma in 6 patients, adenocarcinoma of unknown origin in 1, lymphoma in 1, and carcinoma of the colon in 1. The technique requires the use of a linear array transducer for biopsy guidance, and is safe, rapid, and easy to perform.

Research paper thumbnail of Supraclavicular Mass in a Woman with Hyperparathyroidisrn

Investigative Radiology, 1994

... Supraclavicular Mass in a Woman with Hyperparathyroidism. SISTROM, CHRIS L. MD; HANKS, JOHN B... more ... Supraclavicular Mass in a Woman with Hyperparathyroidism. SISTROM, CHRIS L. MD; HANKS, JOHN B. MD; FELDMAN, PHILLIP S. MD. Collapse Box Abstract. An abstract is unavailable. This article is available as a PDF only. Close Window. ...

Research paper thumbnail of Breath-Holding Capability of Adults

Investigative Radiology, 1994

ABSTRACT PURPOSE. The breath-holding capabilities of various groups of individuals were evaluated... more ABSTRACT PURPOSE. The breath-holding capabilities of various groups of individuals were evaluated to develop protocols so that patients undergoing spiral computed tomography (CT), digital angiography, and breath-hold magnetic resonance imaging (MRI) can be studied successfully. METHODS. Twenty-five outpatients and 25 inpatients (all adults) were studied before undergoing body CT. Each subject was asked to hold his or her breath for as long as possible. Then each patient was asked to perform as many repetitive 12-second breath holds as possible. These data were correlated with demographic and historical information. RESULTS. The maximum breath-hold time for inpatients and those outpatients who were heavy smokers or had chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) was 18 to 32 seconds (95% confidence interval) with a mean of 25 seconds. For all other outpatients, breath-hold time was 38 to 56 seconds (mean=45 seconds). The 95% confidence interval for the number of 12-second breath holds for these two groups was 4 to 6 breath holds (mean=4.9) and 6 to 7 breath holds (mean=6.6), respectively. One inpatient could not hold his breath at all and three others were only able to hold their breath once for short periods. The sex and age of the patient had no significant effect on breath-holding performance. CONCLUSIONS. Breath-holding protocols must account for the diminished capabilities of most inpatients, and outpatients who are heavy smokers or have COPD or CHF. Most outpatients who are not heavy smokers or without COPD or CHF can achieve a single breath hold of 38 seconds, or up to six 12- second breath holds.

Research paper thumbnail of Methods Used for Liver Computed Tomography Scanning in Community Radiology Practice

INVESTIGATIVE RADIOLOGY, 1993

A survey conducted in 1987 of mostly academic radiologists revealed that 8 of 22 (36%) respondent... more A survey conducted in 1987 of mostly academic radiologists revealed that 8 of 22 (36%) respondents used bolus enhanced dynamic technique when performing computed tomography (CT) of the liver. In the current study, the authors performed a new survey of private practice radiologists that was over four times larger and had more comprehensive questions. An 18-item questionnaire was sent to 260 members of the American College of Radiology. The answers from 98 usable responses were tallied and analyzed. Forty-six percent of the radiologists polled use bolus enhanced dynamic CT. Thirty-three percent still use ionic contrast, and a significantly lower iodine dose was used when nonionic contrast was chosen. There is general agreement in the imaging literature that dynamic enhanced scanning is the method of choice for detecting liver masses with CT. The authors speculate that cost and convenience considerations strongly influence such decisions, because less than 50% of radiologists we polled use this somewhat more expensive and time-consuming technique.

Research paper thumbnail of Increasing the Appropriateness of Outpatient Imaging: Effects of a Barrier to Ordering Low-Yield Examinations 1

Radiology, Jun 1, 2010

To determine the effect of a computerized radiology order entry system rule that prevented noncli... more To determine the effect of a computerized radiology order entry system rule that prevented nonclinician support staff from completing orders for outpatient computed tomographic, magnetic resonance imaging, and nuclear medicine examinations that received initial low-yield decision support scores in the order entry system. This retrospective HIPAA-compliant study was approved by the institutional review board; the requirement for informed consent was waived. The control group consisted of 42737 consecutive orders for examinations in which decision support was provided that were placed from April to December 2006. The study group consisted of 76238 consecutive orders that were placed from April to December 2007. During the latter time period, a new rule in the order entry system was implemented: Examinations that had low-yield decision support scores could not be scheduled when the orders were placed by nonclinician support staff. To schedule the blocked examinations, the responsible clinician was required to personally log in to complete the process. System event logs and records of outpatient imaging procedures were extracted, counted, and analyzed to determine which ordering sessions resulted in examinations being scheduled and performed and which sessions resulted in modified or cancelled examinations. Results were correlated with user status and decision support scores. The Cochran-Mantel-Haenszel technique was used to control for the status of the order initiator and to allow testing for significance of the effect of the intervention on the "fate" of ordering events. After the intervention, the proportion of total examination requests initiated by clinicians directly logging in almost doubled: from 11,243 (26.31%) of 4,737 to 41,450 (54.37%) of 76238 examinations (P < .001). The fraction of low-yield (decision support score, 1-3) examinations requested through the order entry system that were later scheduled and performed decreased from 2106 (5.43%) of 38,801 to 1261 (1.92%) of 65,765 (P < .001). This is in contrast to requests for examinations with higher initial decision support scores that were not affected by the policy change and were scheduled at the same rate (relative risk, 0.988) before and after the change. A simple change in the business logic of the order entry system resulted in a substantially decreased rate of low-yield imaging examinations and a markedly increased percentage of tests personally ordered by clinicians.

Research paper thumbnail of Free Text Versus Structured Format: Information Transfer Efficiency of Radiology Reports

We discuss the effect of radiology report format on the accuracy and speed with which reviewers c... more We discuss the effect of radiology report format on the accuracy and speed with which reviewers can extract case-specific information. A Web-based testing mechanism was used to present radiology reports to each of 16 senior medical students and record their answers to 10 multiple choice questions about specific medical content for each of 12 cases. Subjects were randomly assigned to view the reports in either free text or structured format. In addition to number of answers correct for each case, we recorded the time taken for each case and an efficiency score (correctly answered questions per minute). These three outcomes were tested for differences on report format using multifactorial analysis of variance. A postexperimental questionnaire and a mediated focus group elicited subject preference as to radiology report format. There were no significant differences in the three outcomes (score, time, and efficiency) between the free text and structured format conditions. The power of the experiment was sufficient to detect small differences in these outcomes by format. Subjects strongly and consistently expressed a preference for the structured version. We assert that free text and itemized (structured) forms of radiology reports are equally efficient and accurate for transmitting case-specific interpretative content to reviewers of the document.

Research paper thumbnail of Computerized Physician Order Entry: Advances and Challenges

Research paper thumbnail of Conscious sedation: A safe, cost-effective alternative to general anesthesia in the endovascular treatment of unruptured intracranial aneurysms

Research paper thumbnail of Breath-holding capability of adults. Implications for spiral computed tomography, fast-acquisition magnetic resonance imaging, and angiography

Investigative Radiology

The breath-holding capabilities of various groups of individuals were evaluated to develop protoc... more The breath-holding capabilities of various groups of individuals were evaluated to develop protocols so that patients undergoing spiral computed tomography (CT), digital angiography, and breath-hold magnetic resonance imaging (MRI) can be studied successfully. Twenty-five outpatients and 25 inpatients (all adults) were studied before undergoing body CT. Each subject was asked to hold his or her breath for as long as possible. Then each patient was asked to perform as many repetitive 12-second breath holds as possible. These data were correlated with demographic and historical information. The maximum breath-hold time for inpatients and those outpatients who were heavy smokers or had chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) was 18 to 32 seconds (95% confidence interval) with a mean of 25 seconds. For all other outpatients, breath-hold time was 38 to 56 seconds (mean = 45 seconds). The 95% confidence interval for the number of 12-second breath hol...

Research paper thumbnail of Face time versus test ordering: is there a trade-off?

The American journal of managed care, 2013

As clinician-patient face time comes under pressure, clinicians might consider substituting testi... more As clinician-patient face time comes under pressure, clinicians might consider substituting testing for time spent in diagnostic reasoning, history, and physical exam. To explore the relationship between clinician-patient time and medical resource utilization. In the Massachusetts General Hospital/Massachusetts General Physician Organization outpatient radio frequency identification project, clinicians and patients wore real-time location system (RTLS) tags. "Face time" was defined as the duration patients and clinicians were colocated. Radiology testing was used as a proxy for medical resource use. A radiology test was determined to be associated with a clinical encounter if it involved the same patient and clinician and occurred less than 3 months after the index encounter. Radiologic data were derived from the electronic health record and test appropriateness proxy score from the radiology order entry system. Data were synthesized and analyzed using standard structured ...

Research paper thumbnail of Determinants of diagnostic imaging utilization in primary care

The American journal of managed care, 2012

To examine patient and physician factors affecting utilization of diagnostic imaging in primary c... more To examine patient and physician factors affecting utilization of diagnostic imaging in primary care. Patient-level data from a large academic group practice over the period July 1, 2007, through June 30, 2009. This is a retrospective cohort study of 85,277 patients cared for by 148 primary care physicians (PCPs). The dependent variable is the number of outpatient imaging exams ordered by each patient's PCP over the study period. Independent variables include 17 patient factors describing both clinical need and demographic characteristics and 7 physician factors. Data were collected from the electronic medical record and associated administrative databases. Patient factors having a statistically significant effect on both the probability race, more than 10 medications, congestive heart failure, diabetes, hypertension, other problems, visits to the PCP, visits to specialists, and imaging exams ordered by specialists. For physician factors, experience, gender, and having another d...

Research paper thumbnail of The Lancet. London: Saturday, July 23, 1870

Research paper thumbnail of Use of Imaging Appropriateness Criteria for Decision Support During Radiology Order Entry: The MGH Experience

Radiological Safety and Quality, 2013

Research paper thumbnail of Provider Feedback about Imaging Appropriateness by Using Scores from Order Entry Decision Support: Raw Rates Misclassify Outliers

Radiology, 2014

Purpose To determine the relevant physician- and practice-related factors that jointly affect the... more Purpose To determine the relevant physician- and practice-related factors that jointly affect the rate of low-utility imaging examinations (score of 1-3 out of 9) ordered by means of an order entry system that provides normative appropriateness feedback. Materials and Methods This HIPAA-compliant study was approved by the institutional review board under an expedited protocol for analyzing anonymous aggregated administrative data. This is a retrospective study of approximately 250 000 consecutive scheduled outpatient advanced imaging examinations (computed tomography, magnetic resonance imaging, nuclear medicine) ordered by 164 primary care and 379 medical specialty physicians from 2008 to 2012. A hierarchical logistic regression model was used to identify multiple predictors of the probability that an examination received a low utility score. Physician- and practice-specific random effects were estimated to articulate (odds ratio) and quantify (intraclass correlation) interphysician variation. Results Fixed effects found to be statistically significant predictors of low-utility imaging included examination type, whether the examination was cancelled, status of the person entering the order, and the total number of examinations ordered by the clinician. Neither patient age nor sex had any effect, and there were no secular trends (year of study). The remaining amount of interphysician variation was moderate (intraclass correlation, 22%), whereas the variation between medical specialties and primary care practices was low (intraclass correlation, 5%). The estimated physician-specific effects had reliability of 70%, which makes them just suitable for identifying outliers. Conclusion The authors found that 22% of the variation in the rate of low-utility examinations is attributable to ordering providers and 5% to their specialty or clinic. © RSNA, 2014.

Research paper thumbnail of Thoracic sonography for diagnosis and intervention

Current Problems in Diagnostic Radiology, 1997

Research paper thumbnail of Optic neuropathy secondary to cat scratch disease: distinguishing MR imaging features from other types of optic neuropathies

AJNR. American journal of neuroradiology

MR imaging characteristics of optic neuropathy caused by cat scratch disease have not yet been de... more MR imaging characteristics of optic neuropathy caused by cat scratch disease have not yet been described; this lack of information may result in incorrect diagnosis and may contribute to initiation of inappropriate therapy. Our study was based on the hypothesis that cat scratch disease-related optic neuropathy has distinct MR imaging features compared with those of other types of optic neuropathies. Eighty-two patients with various causes of optic neuropathy and available MR imaging examinations were included in this study. Two readers blinded to the diagnosis reviewed the MR images independently in regard to presence, location, and extent of optic nerve enhancement. The MR imaging findings were correlated with the final diagnosis. Eleven percent (9/82) of the patients received a final diagnosis of cat scratch disease. Optic nerve enhancement in patients with cat scratch disease (5/37) was localized to a 3- to 4-mm segment at the optic nerve-globe junction. All other patients with o...

Research paper thumbnail of Use of Imaging in the Emergency Department: Physicians Have Limited Effect on Variation

Radiology, 2013

To quantify interphysician variation in imaging use during emergency department (ED) visits and e... more To quantify interphysician variation in imaging use during emergency department (ED) visits and examine the contribution of factors to this variation at the patient, visit, and physician level. This study was HIPAA compliant and approved by the institutional review board of Partners Healthcare System (Boston, Mass), with waiver of informed consent. In this retrospective study of 88 851 consecutive ED visits during 2011 at a large urban teaching hospital, a hierarchical logistic regression model was used to identify multiple predictors for the probability that low- or high-cost imaging would be ordered during a given visit. Physician-specific random effects were estimated to articulate (by odds ratio) and quantify (by intraclass correlation coefficient [ICC]) interphysician variation. Patient- and visit-level factors found to be statistically significant predictors of imaging use included measures of ED busyness, prior ED visit, referral source to the ED, and ED arrival mode. Physician-level factors (eg, sex, years since graduation, annual workload, and residency training) did not correlate with imaging use. The remaining amount of interphysician variation was very low (ICC, 0.97% for low-cost imaging; ICC, 1.07% for high-cost imaging). These physician-specific odds ratios of imaging estimates were moderately reliable at 0.78 (95% confidence interval [CI]: 0.77, 0.79) for low-cost imaging and 0.76 (95% CI: 0.74, 0.78) for high-cost imaging. After careful and comprehensive case-mix adjustment by using hierarchical logistic regression, only about 1% of the variability in ED imaging utilization was attributable to physicians.

Research paper thumbnail of A framework for improving radiology reporting

Journal of the American College of Radiology, 2005

The interpretative reports rendered by radiologists are the only tangible manifestation of their ... more The interpretative reports rendered by radiologists are the only tangible manifestation of their expertise, training, and experience. These documents are very often the primary means by which radiologists provide patient care. Radiology reports are extremely variable in form, content, and quality. The authors propose a framework for conceptualizing the reporting process and how it might be improved. This consists of standard language, a structured format, and consistent content. These attributes will be realized by modifying the clinical reporting process, including the creation, storage, transmission, and review of interpretative documents. The authors also point out that changes in training and evaluation must be a part of the process, because they are complementary to purely technical solutions.

Research paper thumbnail of Costs, Charges, and Revenues for Hospital Diagnostic Imaging Procedures: Differences by Modality and Hospital Characteristics

Journal of the American College of Radiology, 2005

Purpose: This study examined financial data reported by Florida hospitals concerning costs, charg... more Purpose: This study examined financial data reported by Florida hospitals concerning costs, charges, and revenues related to imaging services.

Research paper thumbnail of Managing predefined templates and macros for a departmental speech recognition system using common software

Journal of Digital Imaging, 2001

Research paper thumbnail of Ultrasound guidance for biopsy of omental abnormalities

Journal of Clinical Ultrasound, 1992

We review our two-year experience with ultrasound-guided fine needle aspiration biopsy of omental... more We review our two-year experience with ultrasound-guided fine needle aspiration biopsy of omental pathology. Eleven patients were referred for biopsy of omental abnormalities. Biopsy was performed without complication in all cases and the asprates were positive for malignancy in 9. The discharge diagnosis was ovarian carcinoma in 6 patients, adenocarcinoma of unknown origin in 1, lymphoma in 1, and carcinoma of the colon in 1. The technique requires the use of a linear array transducer for biopsy guidance, and is safe, rapid, and easy to perform.

Research paper thumbnail of Supraclavicular Mass in a Woman with Hyperparathyroidisrn

Investigative Radiology, 1994

... Supraclavicular Mass in a Woman with Hyperparathyroidism. SISTROM, CHRIS L. MD; HANKS, JOHN B... more ... Supraclavicular Mass in a Woman with Hyperparathyroidism. SISTROM, CHRIS L. MD; HANKS, JOHN B. MD; FELDMAN, PHILLIP S. MD. Collapse Box Abstract. An abstract is unavailable. This article is available as a PDF only. Close Window. ...

Research paper thumbnail of Breath-Holding Capability of Adults

Investigative Radiology, 1994

ABSTRACT PURPOSE. The breath-holding capabilities of various groups of individuals were evaluated... more ABSTRACT PURPOSE. The breath-holding capabilities of various groups of individuals were evaluated to develop protocols so that patients undergoing spiral computed tomography (CT), digital angiography, and breath-hold magnetic resonance imaging (MRI) can be studied successfully. METHODS. Twenty-five outpatients and 25 inpatients (all adults) were studied before undergoing body CT. Each subject was asked to hold his or her breath for as long as possible. Then each patient was asked to perform as many repetitive 12-second breath holds as possible. These data were correlated with demographic and historical information. RESULTS. The maximum breath-hold time for inpatients and those outpatients who were heavy smokers or had chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) was 18 to 32 seconds (95% confidence interval) with a mean of 25 seconds. For all other outpatients, breath-hold time was 38 to 56 seconds (mean=45 seconds). The 95% confidence interval for the number of 12-second breath holds for these two groups was 4 to 6 breath holds (mean=4.9) and 6 to 7 breath holds (mean=6.6), respectively. One inpatient could not hold his breath at all and three others were only able to hold their breath once for short periods. The sex and age of the patient had no significant effect on breath-holding performance. CONCLUSIONS. Breath-holding protocols must account for the diminished capabilities of most inpatients, and outpatients who are heavy smokers or have COPD or CHF. Most outpatients who are not heavy smokers or without COPD or CHF can achieve a single breath hold of 38 seconds, or up to six 12- second breath holds.

Research paper thumbnail of Methods Used for Liver Computed Tomography Scanning in Community Radiology Practice

INVESTIGATIVE RADIOLOGY, 1993

A survey conducted in 1987 of mostly academic radiologists revealed that 8 of 22 (36%) respondent... more A survey conducted in 1987 of mostly academic radiologists revealed that 8 of 22 (36%) respondents used bolus enhanced dynamic technique when performing computed tomography (CT) of the liver. In the current study, the authors performed a new survey of private practice radiologists that was over four times larger and had more comprehensive questions. An 18-item questionnaire was sent to 260 members of the American College of Radiology. The answers from 98 usable responses were tallied and analyzed. Forty-six percent of the radiologists polled use bolus enhanced dynamic CT. Thirty-three percent still use ionic contrast, and a significantly lower iodine dose was used when nonionic contrast was chosen. There is general agreement in the imaging literature that dynamic enhanced scanning is the method of choice for detecting liver masses with CT. The authors speculate that cost and convenience considerations strongly influence such decisions, because less than 50% of radiologists we polled use this somewhat more expensive and time-consuming technique.