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what a radiologist needs to read from home

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  • Journal Listing
  • J Digit Imaging
  • five.34(2); 2021 Apr
  • PMC7901504

J Digit Imaging. 2021 Apr; 34(ii): 308–319.

The Radiology Virtual Reading Room: During and Beyond the COVID-19 Pandemic

Joseph H. Yacoub

Medstar Georgetown University Infirmary, 3800 Reservoir Rd NW Washington, 20007 Georgetown, DC USA

Carl E. Swanson

Medstar Georgetown University Infirmary, 3800 Reservoir Rd NW Washington, 20007 Georgetown, DC United states of america

Ann K. Jay

Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007 Georgetown, DC The states

Cirrelda Cooper

Medstar Georgetown University Infirmary, 3800 Reservoir Rd NW Washington, 20007 Georgetown, DC USA

James Spies

Medstar Georgetown Academy Hospital, 3800 Reservoir Rd NW Washington, 20007 Georgetown, DC USA

Pranay Krishnan

Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007 Georgetown, DC U.s.a.

Received 2020 Jun 22; Revised 2021 Jan viii; Accepted 2021 Jan xviii.

Abstract

The COVID-19 pandemic has disrupted the radiology reading room with a potentially lasting impact. This disruption could introduce the risk of obviating the demand for the reading room, which would be detrimental to many of the roles of radiology that occur in and around the reading room. This disruption could besides create the opportunity for accelerated evolution of the reading room to run into the strategic needs of radiology and wellness intendance through thoughtful re-pattern of the virtual reading room. In this article, we overview the impact of the COVID-19 pandemic on radiology in our institution and across the state, specifically on the dynamics of the radiology reading room. Nosotros introduce the concept of the virtual reading room, which is a redesigned alternative to the concrete reading room that can serve the diverse needs of radiology and healthcare during and beyond the pandemic.

Keywords: COVID-19, Reading room, Virtual consults, Teleradiology, Imaging 3.0

Introduction

The COVID-nineteen pandemic has been a major and rapid disruptor to life and work around the world. The concept of social distancing, equally a way of containing the spread of the disease, has altered many aspects of life, and particularly in healthcare. In radiology, the unexpected sudden need for social distancing has disrupted the workflow of the traditional reading room. The duration of the interruption to the routine workflow in radiology reading rooms remains uncertain, just it is unlikely that after a prolonged disruption, it will ever render to its previous land. The radiology field could be continuing at a bifurcation in the road, choosing between abandoning the reading room or evolving it. Through the thoughtful application of informatics, the concept of the radiology reading room can evolve to meet the time to come needs of radiology and the healthcare system during and beyond the pandemic. In this article, we will discuss how social distancing can force an accelerated evolution of the concept of the reading room, into a new concept of the virtual reading room.

The Traditional Reading Room

The radiology reading room is a cardinal concept in radiology that has evolved with the evolution of the field. It can be loosely defined as the physical space in which radiologists perform their duties, typically providing coverage as a group, and where they are accessible to other healthcare providers in-person and via phone. The design and layout of the reading room evolved in the film-based era and persisted with limited modification in the PACS era in many institutions [i]. The transition to PACS around the turn of the century was a major disruptor to the dynamics of the reading room [two]. With radiology images being widely accessible from outside of the radiology section, in that location was less need for referring physicians to visit the reading room [ii]. Despite the disruption, the radiology reading room continues to get frequent telephone calls and visits from various health intendance providers in many institutions, with telephone calls as frequently as every four min in i written report [3]. In the modern PACS era of radiology, many infirmary-based radiology departments, particularly academic departments, continue to emphasize the accessibility of the reading room [4].

The introduction of PACS has likewise enabled teleradiology, which has since become widely used and has been shown to be effective [five]. A survey in 2007 estimated that 40% of radiology practices have performed outside reading which accounted for 11% of their workload and almost 4% of the workload of all radiologists [six]. Afterward reviewing the literature in the decade from 2005 to 2015, Bashshur et al. ended that the practice of teleradiology is well established, widely accepted and constructive [5]. While the benefits of teleradiology are widely best-selling, the on-site reading room remains the epicenter of radiology activeness in most academic institutions and many community institutions. The ACR chore force on teleradiology is clear that "on-site coverage is preferred," with teleradiology service ideally used every bit supplemental to a comprehensive on-site radiology practise [7].

The importance of the reading room and its survival despite the alternative of teleradiology stems from the fact that the reading room hosts several activities beyond the interpretation of examinations. A thoughtful redesign of the reading room needs to consider all these activities, namely:

  • • Interpretation of examinations

  • • Collaboration among radiologists (eastward.chiliad., 2d opinion, interesting case sharing, feedback and follow up)

  • • Communication with radiology squad: radiology technologist and sonographers (e.k., protocoling and checking studies)

  • • Resident didactics (e.g., resident readouts, interesting cases)

  • • Multidisciplinary conferences (while they exercise not typically happen in the reading room, they are a natural extension of the reading room and therefore discussed in this article)

  • • Consultation for referring physicians

  • • Patient consultation (currently limited to breast imaging and interventional radiology, only with an increasing interest in the broader radiology community)

In the PACS era of radiology, the telephone has get a natural extension of the radiology reading room, whereby many of the above activities happen through the radiology reading room phone.

Radiology Value Propositions

The design and function of the radiology reading room is not only a question of technology and technical feasibility, but it should exist primarily about serving the strategic goals of radiology. While currently, volume and metrics based on Relative Value Unit of measurement (RVU) remain the primary measures of productivity, at that place is an expected shift towards value-based metrics. Reforms in physician reimbursement and newer models such as accountable intendance organizations and bundled payments might further drive the shift towards measuring value and shifting away from a focus on the book of studies performed [8, 9]. Radiology departments will have to give more than consideration to their value propositions, where "value" would include things such as quality, service, resource management, and professional person evolution [ten] (Tabular array ​ 1). Many value-added activities performed by radiologists in and around the radiology reading room are investments that practise non directly translate into billing revenue, at least not at the current time; however, they are critical for the survival and progress of the field. To disregard such value-added activities would turn the radiologist'due south work into a commodity, differentiated only by cost. Furthermore, over the past decade, radiology organizations and societies take emphasized the need for increasing the visibility and accessibility of radiology to combat the commoditization of radiology. With competing pressures for productivity and value, it will exist increasingly important to non only encourage value-added activities but to also measure, track, and promote them. This increasing focus on value is at the core of the ACR Imaging 3.0™ initiative, which includes a broad set of initiatives addressing the visibility of radiologists and emphasizing the role of radiologists in managing all aspects of imaging care to improve patient safety and outcomes and to deliver high-value care [eleven–13]. From another perspective, radiology has long led the rest of medicine in the digital age, and the field must continue to lead in applying ongoing innovation in information technology and communication systems in supporting new approaches to knowledge management and advice [14]. At the eye of the Imaging 3.0 initiative is empowering radiologists to leverage technology to evangelize value [xi–13].

Tabular array ane

Examples of value-added activities occurring in and around the reading room categorized based on value-added matrix developed and described by Patel South[ten]

Value-added category Definition Examples of value-added activities in the reading room
Quality Activities related to quality assurance, quality control (QC), and patient safety Reporting quality, peer review/peer learning, second opinions, multidisciplinary conferences, protocol management, technologist staff feedback, QC of imaging studies
Service Activities performed to satisfy a demand or fulfill a need often in the context of interaction with patients or referring physicians Disquisitional results direction, referring provider communication/consultations, improving turnaround fourth dimension, subspecialty accessibility, patient supervision, patient consultations and overall contributing to positive patient experience
Resources management Efficient utilization of resources including equipment, supplies and personnel Evaluation of appropriateness and medical need for studies, efficient utilization of radiologist schedules
Professional development Activities relating to acquiring skills and knowledge and career advancement Didactics

The Virtual Reading Room During and Beyond COVID-nineteen

Social distancing during the COVID-nineteen pandemic had an immediate impact on the radiology reading room. This was accompanied by a rapid reject in book of studies that occurred in the initial few months of the pandemic and normalized slowly overtime. At our institution and many around the land, alternatives were rapidly devised to avoid having radiologists crowded in a limited space. In this department, we draw the alternatives that were adult in response to social distancing. Our practice represents the academic division of a larger radiology group serving ane of the largest healthcare providers in the region. Our organisation includes one academic hospital, nine community hospitals, and many outpatient facilities including multiple imaging centers. The unabridged radiology practice is supported by a unified PACS network beyond all hospital and outpatient facilities. Our discussion will be more focused on the academic do of the enterprise which is equanimous of 43 radiologists, 24 residents, and vi fellows who, earlier COVID, provided onsite coverage to the academic hospital, an affiliated community infirmary, and two imaging centers. We will refer to the broader radiology practise where applicable.

Interpretation of Examinations

During the Pandemic—Estimation of Examinations

Interpretation of examinations and rendering reports is the quintessential activeness occurring in the reading room. Information technology is too the activity that has been proven to be done effectively remotely [5]. Decades of success with teleradiology made the rapid transition to remote estimation feasible, though not without challenges. Our larger radiology group had long supported home and cross-site reads given the wide geographic spread of our enterprise and the use of remote radiology for overnight reads in the non-academic practice of our enterprise. Most all radiologists in the not-academic practice were already equipped with home workstations. In our academic do, however, very few radiologists had home workstations. This deviation between the bookish and non-bookish practice was due to the difference in the culture of the practices and the decisions of the radiology group leadership and not due to technical factors since the informatics infrastructure was unified. Before the written report of the first COVID-19 case in our area, the leadership of our academic radiology practice recognized the awaiting demand for equipping the academic radiologists with home workstations. Communication with other institutions around the state was disquisitional at this phase due to the novelty of the state of affairs in Northward America. Limited knowledge of the experience of some Asian countries with the severe acute respiratory syndrome (SARS) outbreak in 2003 was all the feel available in responding to pandemics of such magnitude [15]. Still, despite the early recognition of the potential needs of the academic practice, it took several weeks to complete the deployment of additional home workstations. During this gap, we had to resort to several temporizing strategies to mitigate the risks which are described briefly here. One strategy was team segregation in which radiologists from one subspecialty were divided among separate concrete reading rooms so that if an exposure happens in ane of the concrete reading room requiring quarantine, the touch would not all autumn on a single subspecialty that would stall the clinical operations. Another strategy was reducing the on-site staffing of attending and resident radiologists to the minimum required. The rapid decline in the book of imaging studies allowed for connected operation with reduced staff. Approximately 2 weeks after WHO'southward characterization of COVID-19 as a pandemic, workstations were issued for all the radiologists in the academic practice except for chest imagers and interventional radiologists. Reducing the staff and enabling remote reads immune united states of america to decompress the reading rooms, thereby reducing the occupancy to less than half pre-pandemic capacity. In general, a team of 1 attending radiologist and one resident with or without one swain provided on-site coverage for each of our iii primary reading rooms and 1 attending provided onsite coverage for our customs hospital. This translated into each radiologist providing on-site coverage on average about in one case a week, with some subspecialty sections preferring to alternate coverage daily and other alternating coverage weekly. After the pinnacle of COVID-xix cases had been passed and with the gradual return of imaging volumes closer to pre-pandemic volumes, we increased the onsite coverage by adding ane more than attending and one resident for busier reading rooms. By that time, more than rooms and offices had been repurposed as reading rooms farther decompressing the reading room and providing ample social distancing betwixt the onsite staff.

We faced two primary supply chain issues in acquiring boosted workstations and monitors: unplanned/unbudgeted expense at a time where declining volume called for vigilant fiscal responsibleness, in addition to massive shipment delays. The diagnostic quality monitors our institution generally sources are manufactured and shipped from northern Italy, which was one of the initial hotspots of the COVID-nineteen pandemic. To respond to these supply concatenation challenges, we partnered with our enterprise Information technology colleagues to create a new home workstation build that balanced a standardized hardware deployment with hardware available from a supply chain perspective. The workstations we deployed included medical grade diagnostic monitors that conformed to the ACR standards in resolution, luminance, and scale. An alternative to medical class monitors is commercially available, non-medical grade monitors, with at least 4 megapixel resolution (pixel pitch ≤ 0.2 mm) and luminance of at least 350 cd/one thousand [2] that meets the resolution and luminance requirement ACR technical standards [16, 17]. Still, these practice not conform to the grayscale calibration requirements of the ACR and additional steps of generating and installing DICOM grayscale look up tables as well quality control check of the calibrated monitors would have to be performed. Open source software packages are available to perform these steps [18].

Recognizing that the response to COVID-19 acquired additional clinical and administrative roles beyond radiology to move outside of the hospital and the internal network, we again partnered with our It colleagues to clarify the readiness of the network and PACS system. They determined that the VPN (Virtual Individual Network) would go quickly saturated equally local workflows were transitioned remotely and took two actions: increased the available bandwidth of the existing VPN by a factor of v and created a dedicated Imaging VPN. We analyzed the compression strategy on the PACS and determined that only lossless compression was utilized and ensured this was enabled for all remote interpretation.

Similar efforts of remote reading and decompressing the reading room have been reported across the land [nineteen, twenty]. Quraishi et al. surveyed 72 academic practices and 102 community practices across the country that were affiliated with a radiology residency plan. They reported that almost iii-quarters of practices switched normal daytime shifts to internal teleradiology, with a similar percentage for academic and customs hospitals. Near a third of the surveyed institutions had to increase the provision of home workstations to support this shift in practice, with more than of the academic practices having to do that [21]. In this survey, 45% of the customs practices and 25% of the academic practices, left their reading rooms unstaffed [21]. This shift to remote reading has been reported and encouraged by multiple reports during the pandemic [4, nineteen, twenty, 22]. Every bit for on-site coverage, models of decompressing the reading room and creating single-radiologist and single-workstation reading rooms have been reported and encouraged [nineteen, 22].

Beyond the Pandemic—Interpretation of Examinations

The implication of this widespread and rapid shift to home estimation at our institution and across the country is worth conscientious examination. Continuation of the policies and strategies of social distancing that evolved during the pandemic is likely to go along for at to the lowest degree the medium term, including decompressed reading rooms or if possible unmarried workstation reading rooms and dwelling interpretation [23]. Furthermore, over half of the respondents of the above-mentioned survey reported that they perceived enough do good from their experience with "internal teleradiology" that they program to continue a similar workflow afterward the pandemic subsides (64% of community radiologists and 46% of academic radiologist) [21]. These reports coupled with the prolonged elapsing for the social distancing, strongly indicate that the disruption to the traditional reading room with remote reading and fragmented reading rooms will persist for a long while and volition outlive the pandemic. Some take suggested that remote reading may also allow practices to expand radiologist hours providing increased flexibility in scheduling [24]. In summary, providing remote interpretation is mayhap the ane part of the reading room that nearly radiologists would agree can be performed equally well on-site or off-site when considered in isolation. It is the other functions of the reading room that need more than careful consideration.

Collaboration Among Radiologists

During the Pandemic—Collaboration Amid Radiologists

The radiology reading room has traditionally provided a natural surroundings for collaboration amongst radiologists. At our institution, the practice of seeking second opinions or sharing interesting and instructive cases is an integral part of our group dynamics. Continuing communication among the radiologist is critical to preserve, particularly given the novelty of the state of affairs that required frequent communication. The natural alternatives to in-person advice were mobile telephone messaging (SMS) and more than reliance on email communications; however, SMS was non designed for professional team communication and was not suitable for word of cases that include protected health information (PHI). At about 5 weeks into the pandemic, nosotros transitioned to an online collaboration software chosen Microsoft Teams (MS Teams®, Microsoft, Redmond, Washington, The states), which was fortunately already available beyond our enterprise and was preinstalled and configured on all new dwelling house workstations and several of our existing on-site workstations. MS Teams was configured in our enterprise to be HIPAA compliant which allowed for discussions that include PHI [25]. While it represented a shift in the method of team communications that needed some adjusting and education, within a few weeks it gained acceptance in the trunk imaging section that piloted its use. The Teams feature of the software allowed united states of america to recreate our morning huddle virtually and provided a venue to share cases and carry on discussions. Preliminary data of our initial pilot in the intestinal imaging section, which is equanimous of 10 radiologists, demonstrated that there were 44 posts, 78 replies, and 58 mentions in the terminal 30 days (including weekends) to our "morning huddle" channel. The conversation feature immune for ane-on-i communication such every bit seeking second opinions and giving feedback. The usage date for the chat feature too as voice communication and screen sharing are depicted in Fig.1 and will be discussed farther as nosotros describe its use in resident teaching. Meanwhile, our bi-weekly section meeting continued via Webex® (Cisco, San Jose, California, USA).

An external file that holds a picture, illustration, etc. Object name is 10278_2021_427_Fig1_HTML.jpg

Usage data amongst the radiology attendings (a) and radiology residents (b). Period 1 is the period from the characterization of COVID-19 as a pandemic until the start of the use of MS Teams in the section (March 11 through April nine). MS Teams was available but was not in use during this period. Menses two is the following iv weeks representing the early adoption of MS Teams (April 10 through May nine). Period iii is the subsequent four weeks representing increasing adoption past attendings are residents (May 10 through June 8)

Like online collaboration tools for squad communication have been described, with multiple modern PACS systems providing built-in messaging tools, which provide similar chat functions. These features are popular among radiologists. Another alternative to MS Teams that has widespread use in the it world is Slack® (Slack Technologies, San Francisco, CA, USA) which tin also be configured to be HIPAA compliant [26]. There is no published literature on the use of MS Teams or Slack in radiology to our noesis; still, through informal communication, we are aware of other radiology societies or departments that started the utilize of these tools, which may represent the early stages of adopting group conversation tools amid radiologists. Several additional group chat solutions exist some of which offer HIPPA compliance but there are no reports of their usage in radiology to our knowledge. The use of these electronic communications tools is generally encouraged during the epidemic and in the absenteeism of these tools, direct telephone advice is certainly preferred over in-person communication [19].

Beyond the Pandemic—Collaboration Amidst Radiologists

Before the pandemic, many collaborative efforts in the reading room occurred informally and spontaneously, while some were somewhat more structured in the form of "the case of the 24-hour interval" or "a morning huddle." With dwelling house interpretation predominating during the epidemic and likely persisting for a long time, recreating the team dynamic via advice technology should be a priority. Losing this team dynamic may have a long-term impact on professional satisfaction and development that volition be hard to mensurate and quantify. Empirical studies on this topic are express in the radiology literature. Perhaps we can illustrate by extrapolating from one well-studied aspect of radiology collaboration, namely peer learning. The nigh common form of peer review is the RADPEER organization developed by the ACR in 2002 which reflects a traditional quality assurance approach, derived from manufacturing in the mid-1900s [27, 28]. Despite its wide adoption, multiple contempo articles have highlighted the express-value of the organisation [27–30] with recent calls for a different arroyo, namely peer learning [27, 28]. Peer learning emphasizes collaborative learning environments and interpersonal professional relationships [28, 31, 32]. This transition from peer review that focused on impersonal quality assurance to peer learning, which is deeply collaborative, stresses the need for maintaining collaboration in the reading room. Modern engineering science companies have taken the concept of collaboration to new levels, by designing physical function spaces and collaboration software solutions, that promote collaboration and open up communication [33, 34]. This collaboration is inherent in the radiology reading room.

The advantages of collaboration tools like MS Teams and Slack are that, in addition to their direct messaging feature, they recreate a team dynamic. Our experience during the pandemic has been promising in this regard. Our airplane pilot of using MS Teams to maintain a virtual squad dynamic amongst radiologists has been successful and we are now in the procedure of expanding it by including residents and expanding to other sections. This practice of virtual collaboration using electronic media is expected to continue to thrive post the pandemic even with increasing on-site coverage. The fragmentation of the physical reading room that happened during the epidemic will probable enshrine the reliance on electronic advice. One do good that these tools have over face up to face or phone communication is that they enable asynchronous communication with the ability to escalate to synchronous communication when needed. Using information technology in such a way tin assistance reduce interruption to concentration. It also gives the radiologist more control over availability to respond to requests when engaged in attention intensive tasks. The ease of use of these asynchronous modes of communication may encourage increased collaboration. These tools would eliminate barriers betwixt subspecialty reading rooms, perhaps encouraging more collaboration beyond subspecialties of radiology.

Advice with the Radiology Team: Radiology Technologists and Sonographers

During the Pandemic—Communication with the Radiology Team

Radiology technologists and sonographers (collectively referred to as RTs in the rest of the commodity) are an integral part of the radiology squad. According to the ACR task force on teleradiology, RTs must function under the supervision of a qualified licensed physician [7]. Therefore, maintaining advice between radiologists and RTs is critical. This communication pertains to protocoling of examinations, reviewing studies, and handling patients' inquiries and medical needs. In our institution, an electronic protocoling tool was already in use for several years which streamlined a significant portion of advice with technologists and which immune for a smoothen transition when we implemented social distancing. Most of the remaining communication needs and support were provided by at least one on-site radiologist for each subspecialty. On-site trainees also helped to provide RT support under the guidance from the on-site radiologist. Even before the pandemic, the large size of the hospital meant that the phone served as an extension of the reading room with many RTs communicating with radiologists via phone. The exception to that was sonographers who reviewed their cases in person. During the pandemic, nosotros shifted most of these communications to the phone. We tried to decrease the demand on the limited on-site staff by directing some of these calls to dwelling house readers, but for all practical purposes, the on-site staff fronted near of the calls. A similar approach predominates in many departments beyond the land [nineteen]. It is important to note the absenteeism of radiologists who were working remotely at a fourth dimension marked by increasing stress levels among healthcare workers, created an unanticipated tension betwixt the RTs and the radiologists.

Across the Pandemic—Communication with the Radiology Team

Beyond the epidemic, we anticipate a office for asynchronous tools for advice between RTs and radiologists, which could exist more efficient and less disruptive to the workflow of both groups. These tools will be benign irrespective of the physical location of the radiologists. As we discuss in the department on consultations below, replacing the radiology reading room phone with an asynchronous tool that allows radiologists to function as a team despite their geographic dispersion will be at the middle of recreating a virtual version of the radiology reading room. The on-site presence will still be important to provide back up to the RTs and handle occasional patient condom considerations (e.g. dissimilarity complications); however, this on-site presence can be handled by a smaller staff, once the necessary supportive culture has been built and communicated.

Resident Education

During the Pandemic—Resident Education

The radiology reading room is where resident education primarily happens. One of the biggest concerns and challenges of social distancing during the pandemic is resident education, specially in the reading room. The requirements for social distancing and government-issued sheltering-in place mandates caused significant disruptions to the education of our residents. Eighty percentage of our residents were required to shelter at habitation with instructions to immerse themselves in "independent learning." While independent learning was more feasible for the more senior residents, this was much more than difficult for the inferior residents. The first-year residents were the near vulnerable grouping affected past the pandemic. The second half of the academic year is when they first their 2nd rotations in the dissimilar subspecialties, with the goal of honing their skills to set up for taking independent call starting July i. Furthermore, with the majority of attendings reading from home on whatsoever given 24-hour interval, even the on-site residents were at a disadvantage. To alleviate the latter problem, we initiated the use of MS Teams to exercise virtual readouts. The chat feature allowed for rapid advice and feedback and the screen-share function proved to be valuable in creating a virtual readout experience comparable to the side-to-side readout. The integration of the software in the workstation reduced the overhead of adoption. Our usage data of MS Teams for radiology attending and radiology residents are shown in Fig.1.

Like efforts in scheduling resident and remote readouts were reported effectually the country. Some programs scheduled residents on a one-calendar week-on, 1-week-off bike [35]. Some described the use of PACS integrated messaging tools to communicate with residents [4]. Multiple reports described the use of teleconferencing to perform remote readout with screen sharing [iv, 22, 35, 36].

The other aspect of resident didactics was didactic education that typically occurred outside of the reading room. This was especially important as a large percentage of residents were sheltering at home and as the volume of cases plummeted. We, therefore, increased the amount of didactic education and case conferences. All resident conferences were virtual via Webex, which proved to be effective, with first-class resident participation. Attendings reading from dwelling house were to continue and intensify their didactic instruction efforts during the pandemic. Additionally, there was a tremendous national and international endeavor to quickly create and offer free educational content for all residents sheltering at dwelling house. World-class educators offered free lectures and multiple radiology societies, such as the Association of Program Directors in Radiology (APDR), created curricula on a scheduled basis. Given that all lectures were virtual, there were numerous cross-institutional collaborations to provide additional educational content that was provided to residents in improver to our usual lecture curriculum provided by our faculty. To accost the specific result of the start-year residents, many faculty held additional case conferences for this grade alone, to target must-know call cases. While the response of the academic radiology community was remarkable, the residents and faculty alike came to sympathize the meaning of "Zoom burnout." Despite existence a specialty that sits in front of a computer all day, participating in hours of lectures online proved to exist draining. Similar furnishings were reported beyond the country [4, 36].

Beyond the Pandemic—Resident Educational activity

No studies have yet evaluated the relative educational value of alive virtual readout with screen sharing to the traditional side-past-side readout; yet, our early on feel suggests that it is well received by residents and attendings. Beyond the pandemic, virtual readouts are likely to proceed. With many academic institutions having a wider geographic spread with multiple hospitals and imaging centers, virtual readout may serve an increasing part and provide more than scheduling flexibility. This may also be the case equally physical reading rooms become more fragmented to allow for continued social distancing. However, department collegiality and opportunities for mentorship will have to be prioritized if remote readout continues beyond the pandemic [24]. As previously mentioned, we are in the process of including residents and fellows in the teams we created in MS Teams to recreate some of the dynamics of the reading room that residents traditionally participated in such as huddles too as planned and spontaneous sharing of cases. Studies evaluating the relative educational value of virtual readout and the perceptions of attendings and residents are encouraged.

Multidisciplinary Briefing

During the Pandemic—Multidisciplinary Briefing

Multidisciplinary conferences are a formalized form of radiology consultation and are a requirement for cancer centers and a valuable tool for providing the highest quality of intendance. Enabling radiologists' participation in multidisciplinary conferences is critical. Earlier the pandemic, many conferences were already providing an option for teleconferencing for remote participants from satellite clinics, just, our radiologists always presented in person. During the pandemic, multidisciplinary conferences accept transitioned very smoothly to nearly exclusively virtual forms. The new virtual format has underscored the central office of the radiologist in the multidisciplinary management patients. This virtual format likewise enabled trainees to nourish, which, is strongly encouraged peculiarly during the period of low imaging volumes.

Beyond the Pandemic—Multidisciplinary Briefing

Multidisciplinary conferences accept major implications on patient management [37], and specifically with refining the imaging findings and recommendations across the initial reports [38]. Fortunately, virtual multidisciplinary conferences have worked very effectively during the pandemic and could go on at least in part nearly. A common challenge when in-person multidisciplinary conferences were held outside of the radiology department was that the reckoner systems used were not optimized for PACS viewers, which frequently created an uncomfortable working environment for the presenting radiologist. With teleconferencing, the radiologist may have more control over the IT environment and the tools used. Advanced radiology software tools can hands be incorporated in the conference, such as 3D visualization tools, etc.… Teleconferencing also allows other radiologists who are not presenting to attend these conferences with more ease and tin can certainly give trainees more opportunities for omnipresence. On the other mitt, the consequences of the loss of face-to-face interaction will exist difficult to measure and quantify. Radiology may take to learn from other industries that have already gone downward this road.

Radiology Consultation

During the Pandemic—Radiology Consults

The radiology reading room is the access indicate to radiology expertise, and it is this kind of access to expertise that is disquisitional to preserve. In our institution, during COVID-19, in-person radiology consults have been replaced by phone consultation. Signs were placed on the reading room with phone numbers to call to access the radiologist. The on-site radiologist and trainee keep to field all calls to the reading room. Remote radiologists are bachelor through their personal phones. A tool integrated into our worklist application provided a list of all actively reading radiologists and their phone numbers thereby making the redirection of incoming calls simpler. The list is only viewable to radiology users of the worklist application and is inaccessible to ordering physicians, thus maintaining the role of the reading room as a router for all incoming calls. Despite the signage, in-person consultation continued in the reading room. We take besides attempted to provide virtual consults to ordering physicians via MS Teams with screen sharing. Nonetheless, these efforts are nonetheless in their infancy and have not been systematically piloted yet. On the other hand, in the not-bookish sectionalization of our practice, a radiology operator service has been in place for several years, termed Radiology Operation Center (ROC). During the pandemic, the ROC connected the routine part of fielding calls for radiologists beyond a broad geographic spread as well as aiding the radiologists in reaching the referring providers with disquisitional results. Access to the ROC is integrated into our worklist application.

Around the country phone and telecommunication have been encouraged for virtual consults [19]. Bookish departments that take encouraged in-person consultation had to requite conscientious thought to consultation with respect to the pandemic [four]. Some have placed signage on reading rooms and data for the providers well-nigh ways to admission radiology via phone or messaging platforms [4, 39]. One IR division had an e-consultations (asynchronous provider-to-provider communications) tool in place, which was being considered for increased utilization [4, 9]. Another institution started hosting radiology virtual rounds with clinicians on the floor including radiology residents [36]. However, policies and procedures using the technology for greater clinician-clinician interaction over remote sessions are defective in virtually institutions.

Across the Pandemic—Radiology Consults

The transition to PACS effectually the turn of the century has shifted the communication with referrers to electronic forms of communication [ii]. Paradigm accessibility outside of the radiology department resulted in many consults coming in the class of phone calls. Rapid turnaround times of reports also mean that an increasing portion of consults to radiology are seeking the radiologist expertise and insight as opposed to simply asking for preliminary interpretations, though the later exercise all the same prevails in the emergency departments [twoscore]. The radiology societies are emphasizing the need for radiologists to maintain meaningful relationships with ordering physicians. These relationships non merely protect radiologists from being replaceable [8, 41] but, the absence of these relationships may undermine the radiologist's sense of professional dedication and fulfillment [8]. Referring physicians highly value these relationships and consider them important in developing interprofessional trust [42]. Furthermore, radiology consultations have direction implications. I written report found that 33.9% of consultations resulted in a new finding, a alter in the severity of a previously detected finding, or a change in management recommendation [43]. It is therefore a matter of placing patient intendance first and has been strongly stressed past the ACR chore forcefulness on teleradiology [vii]. While one survey reported that only a minority of radiologists perceived less rapport with other physicians during the pandemic [21], radiology consultation is likely to exist the area that suffers the most from remote reading if no solution is developed to make radiology more accessible. This should be at the heart of the re-design of the virtual radiology reading room.

Early models of systems and procedures to allow physician-to-dr. subspecialty consultation in other branches of medicine have shown to be constructive in providing intendance with high provider satisfaction [9]. In one case e-consults were introduced in the context of accountable care organizations with the physician-to-physician e-consults replacing some of the straight patient subspeciality patients consults at a reduced fee [nine]. In diagnostic radiology, Rosenkrantz et al. accept described a system to allow referring physicians and radiologists to efficiently conduct instant-messaging based virtual consults that allowed for screen sharing [xl]. In their study, referring physicians had a highly favorable response to the virtual consult system, indicating that information technology "tended to improve their understanding of the radiology study and to touch on patient management, being particularly valuable in situations in which traditional consultation was difficult because of time or location restraints" [40]. On the other mitt, while radiologists recognized the perceived value of the system for the referring md, they constitute information technology disruptive to their workflow [40].

Dissimilar other subspecialties, diagnostic radiology imaging consultations are not billable events, yet they contribute value to patient care which is of import to capture and measure. Creating a radiology virtual consult solution could make radiology even more than easily accessible for referring physicians particular given the increasing sizes and geographic spread of many institutions. A radiology virtual consult system would also permit tracking and quantifying volume of consults provided past radiologists which would aid approximate the value provided past radiology beyond the volume-based metrics of RVU and written report turnaround time. This would align with the new era of radiology value propositions that emphasizes patient care and quality over book.

For a radiology consult solution to be effective it needs to address the following 8 considerations:

  1. Information technology needs to be easily accessible to the referring providers

The ACR task force on teleradiology emphasizes that the methods of advice should be the option of the referring provider [7]. If the system is not easily accessible and user friendly, it will simply non be used. Various access points to the arrangement must be designed including apps for handheld devices and links from the infirmary portals and the medical record system. The interface must exist intuitive and easy to use. Consideration has to been given to the accessibility of this system by referrers within and outside the enterprise. The latter may innovate more than challenges to the design of the arrangement.

  • ii-

    It needs to be well integrated into the radiologist workflow

The system needs to exist congenital into the radiology workstation. Ideally, one interface would meet all the radiologist advice needs, whether with radiology colleagues, trainees, RTs, and referring providers. While, this may be hard to achieve, at a minimum one interface should handle all alerts for incoming communications, fifty-fifty if the radiologist had to resort to other systems to respond to the communication (eastward.one thousand. recollect via phone).

  • three-

    It needs to allow the radiologist to function as a team

Inherent to the design of the virtual reading room is that radiologists can continue to function every bit a squad despite of their physical separation. This provides continuity of care and accessibility around the clock. The ACR job force on teleradiology emphasizes that the radiologist should ever exist available for consultation with referring physicians [7]. This could only be accomplished if the radiologists work as team, providing coverage for each other. The burden of tracking a specific radiologist who may or may non be on duty should non be laid on the referring physician. The physical reading room provided such continuous access to the radiologist by acting as a stock-still admission bespeak to the radiology team. The virtual reading room should likewise allow referrers to direct their inquiries to a team of radiologists that is accessible around the clock.

  • 4-

    Information technology needs to be asynchronous but timely

Despite the importance of radiology consults, they can be a source of recurrent interruption to the radiologist'due south workflow [44]. As previously mentioned, telephone interruptions occur as oftentimes every bit every 4 min in one study of on-call radiologists. The on-call radiologist can expect to be interrupted two to 3 times during the interpretation of a routine CT belly and pelvis [iii]. Another study found a correlation between telephone interruption and error rates for on-call residents' preliminary reports [45]. Another study looking at the intermission in knowledge-intensive environments mitigated the result of interruption past an operational policy of "sequestering," where some service resources are protected from interruption [46]. A organisation that allows for asynchronous, yet timely communication, reduces the negative outcome of constant interruptions. Consultation requests can be handled between cases as opposed to in the heart of cases, particularly when approached as a team, which volition likely better efficiency and reduce mistake. The system needs to be timely to maintain the trust of the ordering physicians. A turnaround of fourth dimension 10 min or so for routine requests and shorter turnaround time for emergent inquiries can serve both purposes of timely responses and reduced intermission during examinations. These target turnaround times can be set based on surveys of referrers' expectations and needs.

  • 5-

    It needs to allow the radiologist to respond to the consults effectively and efficiently

The ability to accost simple requests via messaging integrated into the workstation tin can raise the efficiency of the radiologist. More involved consults requiring image review can benefit from avant-garde features such every bit screen-sharing which can enhance the effectiveness of the consults. These avant-garde consult features could heighten the function and perception of radiology in regards to patient care. In the study by Rosenkrantz et al. screen sharing was used in 15% of virtual consults and was establish helpful by 70% of referring physicians [40].

  • vi-

    It needs to track the consults

Virtual consults can enable quantification of the noninterpretative work performed by radiologists. While consults are not RVU generating, they are disquisitional in many respects and therefore demand to be at least quantified and tracked. The ability to track the volume and nature of radiology consults will let for quantification of the value-added past radiology beyond volume metrics.

  • 7-

    It needs to provide the power for express rapid documentation

Unlike other subspecialty consults, radiology consults are oftentimes breezy with just a minority of them existence documented past the radiologist. A larger portion of these informal consults is documented by the consulting provider without the knowledge of the radiologist with room for misrepresentation and advice errors [43]. Authors of one study recommended that "Radiology practices should consider developing policies requiring radiologists to certificate breezy consultations potentially affecting patient direction, while developing solutions to facilitate such documentation when it is not readily accomplished through written report addenda (e.chiliad., through direct documentation past the radiologist in the EMR)" [43]. A radiology consultation system could provide limited documentation capabilities for most routine uncomplicated consults. Consults that may have implications on patient direction would however have to exist documented in the radiology report or the electronic medical tape. Won and Rosenkrantz country that "the importance of such documentation is highlighted past the observation that doctor-to-physician communication errors are amid the acme reasons for medical malpractice claims in radiology" [43].

  • eight-

    It needs to allow for intelligent automation

In the era of big data, natural language processing, and machine learning, digitizing consultation requests can allow for more than intelligent routing of the requests and maybe automation of some routine requests that do not need the radiologist expertise. A big number of telephone calls to radiology practise not require radiology expertise [44] and can exist handled either by intelligent automation, other staff, or notification to the radiologist that can be chop-chop acknowledged for the satisfaction of both requester and the radiologist.

Patient-Centered Radiology

During the Pandemic—Patient-Centered Radiology

At our institution patient consultations are express to breast imaging and IR. For the residue of diagnostic radiology, the question of direct patient consultation has not been an consequence either before or during the pandemic. Effectually the country, efforts of providing direct patient consultation outside of breast imaging and IR are still in their infancy stages and but be as pilot programs or investigational studies. It is therefore hard to appraise the result of the pandemic on these efforts.

Beyond the Pandemic—Patient-Centered Radiology

There is emerging literature nearly radiologists provided consultation and patient access to radiologists. Early on studies of direct radiologist-patient communication, have shown favorable and even enthusiastic feedback from patients and improved understanding of the radiologist's role in their intendance [viii, 47]. Meanwhile, patients are growing accustomed to virtual visits during the pandemic. Subspecialties similar chest imaging and IR can benefit from virtual visit workflows and can continue offer these after the pandemic without geographical constraints. For the rest of radiology, the incorporation of virtual patients visits in workflow could become more feasible with less overhead (concrete space and staff). Reimbursement for virtual visits, in full general, was already condign an choice earlier the pandemic, but, with the onset of a pandemic, insurers are being required to reimburse for these visits in some states [4]. The implication of that for diagnostic radiology is not yet clear, only, could represent an opportunity to bring radiology closer to patients.

Closing Remarks on the Virtual Reading Room

While the evolution of PACS and later teleradiology had the undesired side event of isolating the radiologist from patient care, the virtual radiology reading room offers the potential to brand the radiologist more attainable and hence more involved in patient care. It is a mod rethinking of the radiology reading room with the radiology strategic goals and value propositions in mind. The virtual reading room need not imply off-site or on-site coverage; it is rather centered around the idea of creating attainable radiology teams non limited by geographical constraints and operating more than efficiently. Existing advice tools are already enabling certain aspects of this vision. The COVID-19 pandemic is forcing many of the elements of the virtual reading room to be adult and adopted. The initial steps were ad hoc in nature due to the rapid onset of the problem. However, now we have the opportunity for a more thoughtful redesign of the reading room that tin serve radiology during and beyond the pandemic that would align with its new value propositions. Well-designed computer science solutions are needed to provide a complete integrated organization that does not ignore whatsoever of the important roles that radiologists play. As is always the case, informatics solutions cannot bring civilisation changes without a vision and a plan. Procedures and policies will as well need to be established to enable the tools to achieve their desired results.

Footnotes

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References

i. Nagy P, Siegel Due east, Hanson T, et al. PACS reading room pattern. SeminRoentgenol. 2003;38(3):244–255. doi: x.1016/S0037-198X(03)00049-Ten. [PubMed] [CrossRef] [Google Scholar]

2. Reiner B, Siegel Eastward, Protopapas Z, et al. Impact of filmless radiology on frequency of clinician consultations with radiologists. Am J Roentgenol. 1999;173(5):1169–1172. doi: 10.2214/ajr.173.5.10541082. [PubMed] [CrossRef] [Google Scholar]

three. Yu J-PJ, Kansagra AP, Mongan J. The radiologist's workflow environment: Evaluation of disruptors and potential implications. J Am CollRadiol. 2014;eleven:589–593. doi: 10.1016/j.jacr.2013.12.026. [PubMed] [CrossRef] [Google Scholar]

4. Prabhakar AM, Glover M, Schaefer PW, et al. Academic radiology departmental operational strategy related to the coronavirus affliction 2019 (COVID-nineteen) Pandemic. J Am CollRadiol. 2020;17(6):730–733. doi: 10.1016/j.jacr.2020.04.004. [PMC gratuitous commodity] [PubMed] [CrossRef] [Google Scholar]

5. Bashshur RL, Krupinski EA, Thrall JH, et al. The empirical foundations of teleradiology and related applications: a review of the evidence. Telemed e-Wellness. 2016;22(eleven):868–898. doi: ten.1089/tmj.2016.0149. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

6. Huffman RI, Lewis RS, Forman HP, et al. The performance of exterior readings past radiology practices. Am J Roentgenol. 2010;195(5):1159–1163. doi: x.2214/AJR.10.4359. [PubMed] [CrossRef] [Google Scholar]

7. Silva E, Breslau J, Barr RM, et al. ACR white paper on teleradiology practice: a report from the job force on teleradiology practice. J Am CollRadiol. 2013;ten(viii):575–585. doi: x.1016/j.jacr.2013.03.018. [PubMed] [CrossRef] [Google Scholar]

8. Gunderman RB, Chou HY. The futurity of radiology consultation. Radiology. 2016;281(1):six–9. doi: ten.1148/radiol.2016152781. [PubMed] [CrossRef] [Google Scholar]

9. Chittle MD, Rao SK, Jaff MR, et al. Asynchronous vascular consultation via electronic methods: a feasibility pilot. Vasc Med. 2015;20(6):551–556. doi: 10.1177/1358863X15601734. [PubMed] [CrossRef] [Google Scholar]

ten. Patel Southward. Value direction program: performance, quantification, and presentation of imaging value-added actions. J Am CollRadiol. 2015;12:239–248. doi: x.1016/j.jacr.2014.07.036. [PubMed] [CrossRef] [Google Scholar]

xi. McGinty GB, Allen B, Geis JR, et al. It Infrastructure in the Era of Imaging 3.0. J Am CollRadiol. 2014;xi(12):1197–1204. doi: 10.1016/j.jacr.2014.09.005. [PubMed] [CrossRef] [Google Scholar]

12. Norbash A, Bluth E, Lee CI, et al. Radiologist Manpower considerations and Imaging 3.0: effort planning for value-based imaging. J Am CollRadiol. 2014;eleven(ten):953–958. doi: 10.1016/j.jacr.2014.05.022. [PubMed] [CrossRef] [Google Scholar]

thirteen. Kohli M, Dreyer KJ, Geis JR. The Imaging 3.0 Informatics Scorecard. J Am CollRadiol. 2015;12(4):396–402. doi: 10.1016/j.jacr.2014.11.017. [PubMed] [CrossRef] [Google Scholar]

fourteen. Thrall JH. Trends and developments shaping the future of diagnostic medical imaging: 2015 annual oration in diagnostic radiology. Radiology. 2016;279(3):660–666. doi: x.1148/radiol.2016160293. [PubMed] [CrossRef] [Google Scholar]

xv. Goh Y., Chua W., Lee JKT., et al. Operational strategies to preclude coronavirus illness 2019 (COVID-nineteen) spread in radiology: experience from a Singapore radiology section after severe astute respiratory syndrome. J Am Coll Radiol 2020. x.1016/j.jacr.2020.03.027 [PMC free article] [PubMed]

sixteen. ACR-AAPM-SIIM technical standard for electronic practice of medical imaging. 2017. [PMC free article] [PubMed]

17. Norweck JT, Seibert JA, Andriole KP, et al. ACR–AAPM–SIIM technical standard for electronic practice of medical imaging. J Digit Imaging. 2013;26(1):38–52. doi: ten.1007/s10278-012-9522-2. [PMC gratis commodity] [PubMed] [CrossRef] [Google Scholar]

19. Mossa-Basha Thousand., Azadi J., Ko J., et al. RSNA COVID-19 task force: best practices for radiology departments during COVID-19. 2020.

20. Lee CI., Raoof Due south., Patel SB., et al. Coronavirus disease 2019 (COVID-19) and your radiology practice: example triage, staffing strategies, and addressing revenue concerns. J Am Coll Radiol 2020. 10.1016/j.jacr.2020.04.025. [PMC free article] [PubMed]

21. Quraishi MI., Rizvi AA., Heidel RE. Off-site radiology workflow changes due to the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Radiol 2020. ten.1016/j.jacr.2020.05.008. [PMC free commodity] [PubMed]

22. Mossa-Basha M., Medverd J., Linnau M., et al. Policies and guidelines for COVID-19 preparedness: experiences from the University of Washington. Radiology 2020:201326. ten.1148/radiol.2020201326.

23. Mossa-Basha M, Linnau KF, Sahani DV. Radiology department preparedness in the COVID-19 post-shutdown environment. J Am CollRadiol. 2020 doi: 10.1016/j.jacr.2020.05.017. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

24. Cavallo JJ., Forman HP. The economical touch of the COVID-19 pandemic on radiology practices. Radiology 2020:201495. ten.1148/radiol.2020201495. [PMC free article] [PubMed]

25. Marco Southward., Seegmiller B., Lazo J., et al. HIPAA Compliance Microsoft Part 365 and Microsoft teams. 2019.

27. Moriarity AK, Hawkins CM, Geis JR, et al. Meaningful peer review in radiology: a review of current practices and potential future directions. J Am CollRadiol. 2016;xiii(12 Pt A):1519–1524. doi: 10.1016/j.jacr.2016.08.005. [PubMed] [CrossRef] [Google Scholar]

28. Larson DB, Donnelly LF, Podberesky DJ, et al. Peer feedback, learning, and comeback: answering the call of the Institute of Medicine report on diagnostic error. Radiology. 2017;283(1):231–241. doi: ten.1148/radiol.2016161254. [PubMed] [CrossRef] [Google Scholar]

29. Itri JN, Donithan A, Patel SH. Random versus nonrandom peer review: a case for more meaningful peer review. J Am CollRadiol. 2018;15:1045–1052. doi: ten.1016/j.jacr.2018.03.054. [PubMed] [CrossRef] [Google Scholar]

30. Yacoub JH, Obara P, Bova D. Integration of peer review in PACS results in a marked increment in the discrepancies reported. Am J Roentgenol. 2020;214(3):613–617. doi: 10.2214/AJR.nineteen.21952. [PubMed] [CrossRef] [Google Scholar]

31. Donnelly LF, Dorfman SR, Jones J, et al. Transition from peer review to peer learning: feel in a radiology department. J Am CollRadiol. 2018;xv(8):1143–1149. doi: ten.1016/j.jacr.2017.08.023. [PubMed] [CrossRef] [Google Scholar]

32. Chetlen AL, Petscavage-Thomas J, Cherian RA, et al. Collaborative learning in radiology: from peer review to peer learning and peer coaching. AcadRadiol. 2019 doi: 10.1016/j.acra.2019.09.021. [PubMed] [CrossRef] [Google Scholar]

33. Patel H, Pettitt M, Wilson JR. Factors of collaborative working: a framework for a collaboration model. Appl Ergon. 2012;43(ane):ane–26. doi: x.1016/j.apergo.2011.04.009. [PubMed] [CrossRef] [Google Scholar]

35. Alvin MD., George E., Deng F., et al. The bear on of COVID-19 on radiology trainees. Radiology 2020:201222. x.1148/radiol.2020201222. [PMC complimentary commodity] [PubMed]

36. Slanetz PJ., Parikh U., Chapman T., et al. Coronavirus illness 2019 (COVID-19) and radiology teaching—strategies for survival. J Am Coll Radiol 2020. 10.1016/j.jacr.2020.03.034. [PMC costless article] [PubMed]

37. Basta YL., Bolle S., Fockens P., et al. The value of multidisciplinary team meetings for patients with gastrointestinal malignancies: a systematic review. Ann Surg Oncol 2017:2669–78. 10.1245/s10434-017-5833-3. [PMC free article] [PubMed]

38. Pillay B, Wootten Ac, Crowe H, et al. The touch of multidisciplinary squad meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treat Rev. 2016;42:56–72. doi: 10.1016/j.ctrv.2015.11.007. [PubMed] [CrossRef] [Google Scholar]

39. Chen RC., Cheng LT-Due east., Liang Lim JL., et al. Impact Me Not: Physical Distancing in Radiology During Coronavirus Disease 2019 (COVID-xix). J Am Coll Radiol 2020. 10.1016/j.jacr.2020.04.019. [PMC costless article] [PubMed]

40. Rosenkrantz AB, Sherwin J, Prithiani CP, et al. Technology-assisted virtual consultation for medical imaging. J Am CollRadiol. 2016;13(eight):995–1002. doi: 10.1016/j.jacr.2016.02.029. [PubMed] [CrossRef] [Google Scholar]

41. Glazer GM., Ruiz-Wibbelsmann JA. The invisible radiologist one. Radiology 2011;258(1). ten.1148/radiol.10101447.

42. Fatahi N, Krupic F, Hellström M. Difficulties and possibilities in advice between referring clinicians and radiologists: perspective of clinicians. J MultidiscipHealthc. 2019;12:555–564. doi: ten.2147/JMDH.S207649. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]

43. Won E, Rosenkrantz AB. JOURNAL CLUB: breezy consultations between radiologists and referring physicians, every bit identified through an electronic medical tape search. Am J Roentgenol. 2017;209(5):965–969. doi: 10.2214/AJR.17.18050. [PubMed] [CrossRef] [Google Scholar]

44. Watura C, Blunt D, Amiras D. Band RingRing! Characterising phone interruptions during radiology reporting and how to reduce these. CurrProblDiagnRadiol. 2019;48(3):207–209. doi: x.1067/j.cpradiol.2018.01.004. [PubMed] [CrossRef] [Google Scholar]

45. Balint BJ, Steenburg SD, Lin H, et al. Practise telephone call interruptions have an touch on radiology resident diagnostic accurateness? AcadRadiol. 2014;21(12):1623–1628. doi: 10.1016/j.acra.2014.08.001. [PubMed] [CrossRef] [Google Scholar]

46. Froehle CM, White DL. Interruption and forgetting in knowledge-intensive service environments. Prod OperManag. 2014;23(iv):704–722. doi: ten.1111/poms.12089. [CrossRef] [Google Scholar]

47. Mangano MD, Bennett SE, Gunn AJ, et al. Creating a patient-centered radiology exercise through the establishment of a diagnostic radiology consultation clinic. Am J Roentgenol. 2015;205(1):95–99. doi: ten.2214/AJR.14.14165. [PubMed] [CrossRef] [Google Scholar]

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