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The Effects of Changes in Utilization and Technological Advancements of Cross-Sectional Imaging on Radiologist Workload

      Rationale and Objectives

      To examine the effect of changes in utilization and advances in cross-sectional imaging on radiologists' workload.

      Materials and Methods

      All computed tomography (CT) and magnetic resonance imaging (MRI) examinations performed at a single institution between 1999 and 2010 were identified and associated with the total number of images for each examination. Annual trends in institutional numbers of interpreted examinations and images were translated to changes in daily workload for the individual radiologist by normalizing to the number of dedicated daily CT and MRI work assignments, assuming a 255-day/8-hour work day schedule. Temporal changes in institutional and individual workload were assessed by Sen's slope analysis (Q = median slope) and Mann–Kendall test (Z = Z statistic).

      Results

      From 1999 to 2010, a total of 1,517,149 cross-sectional imaging studies (CT = 994,471; MRI = 522,678) comprising 539,210,581 images (CT = 339,830,947; MRI = 199,379,634) were evaluated at our institution. Total annual cross-sectional studies steadily increased from 84,409 in 1999 to 147,336 in 2010, representing a twofold increase in workload (Q = 6465/year, Z = 4.2, P < .0001). Concomitantly, the number of annual departmental cross-sectional images interpreted increased from 9,294,140 in 1990 to 94,271,551 in 2010, representing a 10-fold increase (Q = 8707876/year, Z = 4.5, P < .0001). Adjusting for staffing changes, the number of images requiring interpretation per minute of every workday per staff radiologist increased from 2.9 in 1999 to 16.1 in 2010 (Q = 1.7/year, Z = 4.3, P < .0001).

      Conclusions

      Imaging volumes have grown at a disproportionate rate to imaging utilization increases at our institution. The average radiologist interpreting CT or MRI examinations must now interpret one image every 3–4 seconds in an 8-hour workday to meet workload demands.

      Key Words

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      References

        • Brenner D.J.
        • Hall E.J.
        Computed tomography–an increasing source of radiation exposure.
        N Engl J Med. 2007; 357: 2277-2284
        • Boland G.W.
        • Houghton M.P.
        • Marchione D.G.
        • et al.
        Maximizing outpatient computed tomography productivity using multiple technologists.
        J Am Coll Radiol. 2008; 5: 119-125
        • Boland G.W.
        • Guimaraes A.S.
        • Mueller P.R.
        The radiologist's conundrum: benefits and costs of increasing CT capacity and utilization.
        Eur Radiol. 2009; 19 (discussion 2): 9-11
        • Korley F.K.
        • Pham J.C.
        • Kirsch T.D.
        Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007.
        Jama. 2010; 304: 1465-1471
        • Limkakeng A.T.
        • Halpern E.
        • Takakuwa K.M.
        Sixty-four-slice multidetector computed tomography: the future of ED cardiac care.
        Am J Emerg Med. 2007; 25: 450-458
        • Robb R.A.
        X-ray computed tomography: an engineering synthesis of multiscientific principles.
        Crit Rev Biomed Eng. 1982; 7: 265-333
        • Siegel M.J.
        • Evens R.G.
        Advances in the use of computed tomography.
        Jama. 1999; 281: 1252-1254
        • Villafana T.
        Technologic advances in computed tomography.
        Curr Opin Radiol. 1991; 3: 275-283
        • Alvarez-Linera J.
        3T MRI: advances in brain imaging.
        Eur J Radiol. 2008; 67: 415-426
        • Blackwell C.D.
        • Gorelick M.
        • Holmes J.F.
        • et al.
        Pediatric head trauma: changes in use of computed tomography in emergency departments in the United States over time.
        Ann Emerg Med. 2007; 49: 320-324
        • Doria A.S.
        • Moineddin R.
        • Kellenberger C.J.
        • et al.
        US or CT for diagnosis of appendicitis in children and adults? A meta-analysis.
        Radiology. 2006; 241: 83-94
        • Holmes J.F.
        • Akkinepalli R.
        Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis.
        J Trauma. 2005; 58: 902-905
        • Jones C.
        • Jazayeri F.
        Evolving standards of practice for cervical spine imaging in trauma: a retrospective review.
        Australas Radiol. 2007; 51: 420-425
        • Markel T.A.
        • Kumar R.
        • Koontz N.A.
        • et al.
        The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma.
        J Trauma. 2009; 67: 23-28
        • Pines J.M.
        Trends in the rates of radiography use and important diagnoses in emergency department patients with abdominal pain.
        Med Care. 2009; 47: 782-786
        • Raja A.S.
        • Andruchow J.
        • Zane R.
        • et al.
        Use of neuroimaging in US emergency departments.
        Arch Intern Med. 2011; 171: 260-262
        • Rosengren D.
        • Brown A.F.
        • Chu K.
        Radiological imaging to improve the emergency department diagnosis of acute appendicitis.
        Emerg Med Australas. 2004; 16: 410-416
        • Street M.
        • Brady Z.
        • Van Every B.
        • et al.
        Radiation exposure and the justification of computed tomography scanning in an Australian hospital emergency department.
        Intern Med J. 2009; 39: 713-719
        • Kochergaev O.V.
        • Shapovalov M.V.
        [Efficacy of spiral computed tomography in diagnosis of thorax injuries due to combined trauma].
        Khirurgiia (Mosk). 2006; 3: 38-42
        • Blamire A.M.
        The technology of MRI–the next 10 years?.
        Br J Radiol. 2008; 81: 601-617
        • Ortendahl D.A.
        • Crooks L.E.
        Directions in magnetic resonance imaging technology.
        Med Prog Technol. 1989; 15: 171-184
        • Runge V.M.
        Current technological advances in magnetic resonance with critical impact for clinical diagnosis and therapy.
        Invest Radiol. 2013; 48: 869-877
        • Bates D.W.
        • Gawande A.A.
        Improving safety with information technology.
        N Engl J Med. 2003; 348: 2526-2534
        • Erickson B.J.
        • Persons K.R.
        • Hangiandreou N.J.
        • et al.
        Requirements for an enterprise digital image archive.
        J Digit Imaging. 2001; 14: 72-82
        • Thrall J.H.
        Quality and safety revolution in health care.
        Radiology. 2004; 233: 3-6
        • Dhanoa D.
        • Dhesi T.S.
        • Burton K.R.
        • et al.
        The evolving role of the radiologist: the Vancouver workload utilization evaluation study.
        J Am Coll Radiol. 2013; 10: 764-769
        • Pitman A.G.
        • Jones D.N.
        Radiologist workloads in teaching hospital departments: measuring the workload.
        Australas Radiol. 2006; 50: 12-20
        • Lee C.S.
        • Nagy P.G.
        • Weaver S.J.
        • et al.
        Cognitive and system factors contributing to diagnostic errors in radiology.
        AJR Am J Roentgenol. 2013; 201: 611-617
        • Krupinski E.A.
        • Berbaum K.S.
        • Caldwell R.T.
        • et al.
        Long radiology workdays reduce detection and accommodation accuracy.
        J Am Coll Radiol. 2010; 7: 698-704
      1. Computing RFfS. R: A language and environment for statistical computing. Available at: http://www.R-project.org. Accessed February 1, 2014.

        • Sen P.K.
        Estimates of the regression coefficient based on Kendall's tau.
        Journal of the American Statistical Association. 1968; 63: 1379-1389
        • Mann H.B.
        Nonparametric tests against trend.
        Econometrica. 1945; 13: 245-259
        • Wickham H.
        ggplot2: elegant graphics for data analysis.
        Springer, New York, NY2009
        • Boone J.M.
        • Brunberg J.A.
        Computed tomography use in a tertiary care university hospital.
        J Am Coll Radiol. 2008; 5: 132-138
        • Broder J.
        • Fordham L.A.
        • Warshauer D.M.
        Increasing utilization of computed tomography in the pediatric emergency department, 2000-2006.
        Emerg Radiol. 2007; 14: 227-232
        • Broder J.
        • Warshauer D.M.
        Increasing utilization of computed tomography in the adult emergency department, 2000-2005.
        Emerg Radiol. 2006; 13: 25-30
        • Kocher K.E.
        • Meurer W.J.
        • Fazel R.
        • et al.
        National trends in use of computed tomography in the emergency department.
        Ann Emerg Med. 2011; 58: 452-462 e3
        • Lee J.
        • Kirschner J.
        • Pawa S.
        • et al.
        Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007.
        Ann Emerg Med. 2010; 56: 591-596
        • Tsze D.S.
        • Asnis L.M.
        • Merchant R.C.
        • et al.
        Increasing computed tomography use for patients with appendicitis and discrepancies in pain management between adults and children: an analysis of the NHAMCS.
        Ann Emerg Med. 2012; 59: 395-403
        • Weir I.D.
        • Drescher F.
        • Cousin D.
        • et al.
        Trends in use and yield of chest computed tomography with angiography for diagnosis of pulmonary embolism in a Connecticut hospital emergency department.
        Conn Med. 2010; 74: 5-9
        • Zhou J.C.
        • Zheng S.W.
        • Yu Y.X.
        • et al.
        Trends in computed tomography utilization and association with hospital outcomes in a Chinese emergency department.
        PLoS One. 2012; 7: e40403
        • Prakken N.H.
        • Velthuis B.K.
        • Cramer M.J.
        • et al.
        Advances in cardiac imaging: the role of magnetic resonance imaging and computed tomography in identifying athletes at risk.
        Br J Sports Med. 2009; 43: 677-684
        • Hendee W.R.
        • Becker G.J.
        • Borgstede J.P.
        • et al.
        Addressing overutilization in medical imaging.
        Radiology. 2010; 257: 240-245