Computer-Aided Reporting of Chest Radiographs: Efficient and Effective Screening in the Value-Based Imaging Era

Abstract

In the post-PACS era, mammography is unique in adopting specialized ergonomic interfaces to improve efficiency in a high volume setting. Chest radiography is also a high volume area of radiology. The authors hypothesize that applying a novel interface for chest radiography interpretation and reporting could create high productivity while maintaining quality. A custom version of the ClearCanvas open source software, EzRad, was created with a workflow re-designed specifically for tuberculosis screening chest radiographs, which utilized standardized computer generated reports. The preliminary reports from 881,792 studies evaluated by radiology residents over a nine-year period were analyzed for productivity as RVU/FTE and compared to the finalized reports from a subspecialty attending chest radiologist for accuracy. Radiology residents were able to produce 7480 RVU/FTE per year in screening chest radiography productivity when using a custom interface at a large academic medical center with a miss rate of 0.1%. Sensitivity was 77% and specificity was 99.9%. An ergonomic user interface allowed high productivity in interpretation of chest radiography for tuberculosis screening while maintaining quality.

Keywords: Big data; Computer aided reporting; Productivity; Screening chest radiograph; Tuberculosis; Value based care.

Fig. 1

Flow chart demonstrating the customized workflow created and implemented for high volume screening TB radiography interpretation 24 h a day 7 days a week

Fig. 2

Two screen shots of the EzRAD software interface. a Close up of the interface when a positive study is identified with an associated free text comment provided by the radiologist. b Close up of the interface when a negative study is selected. c PA radiograph given preliminary read of positive due to findings of bilateral upper lobe opacities that are suspicious for TB. d PA radiograph with no concerning findings for TB

Fig. 3

Bar graph demonstrating a miss rate of 0.1% with the majority of screening cases (881,792) interpreted preliminarily by residents matching the attending radiologist interpretation

Fig. 4

Chart demonstrating the sensitivity, specificity, positive predictive value, and negative predictive value of resident performance using EZrad when compared with finalized attending interpretations