2 results
1 - Introduction to principles of the radiological investigation of the neonate
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- By Sara B. DeMauro, University of Pennsylvania, John Richard Mernagh, McMaster University Medical Centre, Monica Epelman, University of Pennsylvania, Haresh Kirpalani, University of Pennsylvania
- Edited by Haresh Kirpalani, Monica Epelman, John Richard Mernagh, McMaster University, Ontario
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- Book:
- Imaging of the Newborn
- Published online:
- 05 March 2012
- Print publication:
- 24 November 2011, pp 1-6
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- Chapter
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Summary
The team approach to neonatal imaging
The clinical and radiological examinations are the foundation of medical investigation of the acutely ill neonate. The proper use and interpretation of radiological studies requires teamwork and clear communication between the clinicians (including the obstetricians and surgeons, as appropriate) and the radiologists. Some literature confirms that a radiologist's interpretation oft en differs from the clinician's interpretation. In a prospective study, five pediatric intensivists interpreted 460 chest x-rays (CXRs) and were matched against a “gold-standard” opinion of a pediatric radiologist. This resulted in “important” discordance in 7% of CXRs, but most of these did not lead to management changes [1]. These data can be used to support an argument that clinicians do not need interpretative assistance. Alternatively, one could say that clinicians have an unacceptable rate of incorrect interpretation. The CXR is the most frequent radiological test in intensive care units. Differences between clinician and radiologist interpretations are greater when less common forms of radiology are evaluated. We suggest that the different perspectives of the clinician and the radiologist can be viewed as symbiotic.
With the advent of digital radiology, direct face-to-face communication with the radiologist has become less common. To facilitate a coordinated approach, regular rounds between the radiologists responsible for reporting the neonatal films and the clinical team are advised.
2 - Evidence-based use of diagnostic imaging: reliability and validity
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- By Sara B. DeMauro, University of Pennsylvania, Haresh Kirpalani, University of Pennsylvania
- Edited by Haresh Kirpalani, Monica Epelman, John Richard Mernagh, McMaster University, Ontario
-
- Book:
- Imaging of the Newborn
- Published online:
- 05 March 2012
- Print publication:
- 24 November 2011, pp 7-10
-
- Chapter
- Export citation
-
Summary
Recent commentaries describe the dearth of evidence upon which to base most imaging decisions [1]. The lack of instructive literature is arguably an even larger deficiency in newborn medicine than in adult medicine. Unfortunately, very few imaging modalities have been subject to randomized trial evaluation to assess the value of imaging as a supplement to sound clinical assessment. The irrational drivers of increased imaging and increased use of more sophisticated modalities include fears of liability and clinicians' or patients'/parents' wishes to have the “best” and “latest” imaging technology. In adult practice in Massachusetts, a survey indicated that more than 28% of diagnostic tests were performed for fear of litigation [2]. To use modern imaging technology efficiently and effectively, the clinician is advised to apply some fundamentals of clinical epidemiology. Below we provide a simple critical approach to assessing the potential value of imaging technology in patient diagnosis and management.
Reliability: how reproducible are the results?
“Reliability” refers to the reproducibility or repeatability of results. There are two important types of reliability: intra-rater reliability and inter-rater reliability. Intra-rater reliability is the reproducibility of interpretation of a diagnostic study by one individual. In other words, it asks: “On a different day, would the radiologist/film reader give the same report?” Interrater reliability refers to the repeatability of interpretations between individuals.
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