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Emergency Radiology: Increasingly stress- inducing for humans and computers?

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BACKGROUND

‘The RCR Clinical Radiology Workload: guidance on radiologists reporting figures’ of 2012 highlights the ‘workload of clinical radiology continues to increase year on year. This puts pressure on radiology services to increase their efficiency while maintaining and improving the quality’ [1].

 The Clinical Radiology Workforce census  2015 report highlights several further points:

Between 2012 and 2015 the number of Computer Tomography (CT) scans undertaken has increased by 29% and Magnetic Resonance Imaging (MRI) scans by 26% with an average increase in the radiology consultant workforce of only 3% per annum [2].

LEARNING OBJECTIVES

Our learning objectives were as follows:

 1.To retrospectively quantify the number and type of on call scans carried out of hours, provisionally reported by the registrar on call over a 6 year period (2010 to 2016).

2.To quantify the average number of images saved to  the Picture Archive and Communications System (PACS) for a randomly chosen CT head and to consider the average total number of images saved to PACS out of hours. 

METHODS

The emergency CT scans undertaken over a 16 hour period (5pm to 9am) were assessed over a 6 year period (August 2010 to October 2016) at Heart of England NHS Trust; (which includes three sites: Heartlands Hospital (HH), Good Hope (GH) Hospital and SolihullHospital (SH)).

The data was compiled from CRIS (Computerised Radiology Information System) and PACS by looking at the first day of the month (a non bank holiday or non weekend day) and recording the following parameters:

1. Average number of CT scans undertaken out of hours

2. Type of CT study

3. Number of images saved to PACS of  a randomly chosen  trauma CT head study.

4. Average total number of images saved to PACS in one evening/night shift.

RESULTS

•The number of CT scans undertaken out of hours  on a typical weekday at HEFT increased: from an average of 8 scans in 2010 to 31 scans in 2016.
 
•The average total number of images saved to PACS from a routine on call  evening and night shift ranged from: 912 images in 2010 to 16,810 images in 2016.
 
•CT head image numbers ranged from 42 images in 2010 to 1,085 images in 2016.
 
•The range and complexity of the scans also increased with further  thoracic  and abdominal scanning undertaken out of hours.

DISCUSSION

At Heart of England NHS Trust (HEFT) we are scanning more patients, scanning more of the body with more complex requests and saving more images to PACS. This is beginning to put additional pressure on the radiologist on call and the PACS system.

Reasons for this may include: over-reliance and increasing expectation from our medical colleagues, greater CT reconstructions undertaken in order to be safer and more efficient. This does have consequences for our trust, department and specialty as a whole.

 

References and Acknowledgement

1.RCR Clinical Radiology Workload: Guidance on radiologists reporting figures. Board of the Faculty of Clinical Radiology. The Royal College of Radiologists. 2012.
2.Clinical Radiology Workforce Census 2015Report. Faculty of Clinical Radiology. The Royal College of Radiologists. Sept 2016.

We acknowledge the support of the Radiology Department at Heart of England NHS Trust


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