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Clinical workflow

L Barinov, A Jairaj, M Becker, S Seymour, E Lee, A Schram, E Lane, A Goldszal, D Quigley, L Paster
Ultrasound (US) is a valuable imaging modality used to detect primary breast malignancy. However, radiologists have a limited ability to distinguish between benign and malignant lesions on US, leading to false-positive and false-negative results, which limit the positive predictive value of lesions sent for biopsy (PPV3) and specificity. A recent study demonstrated that incorporating an AI-based decision support (DS) system into US image analysis could help improve US diagnostic performance. While the DS system is promising, its efficacy in terms of its impact also needs to be measured when integrated into existing clinical workflows...
October 15, 2018: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
Riku Katainen, Iikki Donner, Tatiana Cajuso, Eevi Kaasinen, Kimmo Palin, Veli Mäkinen, Lauri A Aaltonen, Esa Pitkänen
Next-generation sequencing (NGS) is routinely applied in life sciences and clinical practice, but interpretation of the massive quantities of genomic data produced has become a critical challenge. The genome-wide mutation analyses enabled by NGS have had a revolutionary impact in revealing the predisposing and driving DNA alterations behind a multitude of disorders. The workflow to identify causative mutations from NGS data, for example in cancer and rare diseases, commonly involves phases such as quality filtering, case-control comparison, genome annotation, and visual validation, which require multiple processing steps and usage of various tools and scripts...
October 15, 2018: Nature Protocols
V A Andrianarison, M Laouiti, O Fargier-Bochaton, G Dipasquale, X Wang, N P Nguyen, R Miralbell, V Vinh-Hung
PURPOSE: To measure the impact of contouring on worktime in the adjuvant radiation treatment of breast cancer, and to identify factors that might affect the measurements. MATERIAL AND METHODS: The dates and times of contouring clinical target volumes and organs at risk were recorded by a senior and by two junior radiation oncologists. Outcome measurements were contour times and the time from start to approval. The factors evaluated were patient age, type of surgery, radiation targets and setup, operator, planning station, part of the day and day of the week on which the contouring started...
October 12, 2018: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
Molly Finnerty, Elizabeth Austin, Qingxian Chen, Deborah Layman, Edith Kealey, Daisy Ng-Mak, Krithika Rajagopalan, Kimberly Hoagwood
Electronic shared-decision making programs may provide an assistive technology to support physician-patient communication. This mixed methods study examined use of a web-based shared decision-making program (MyCHOIS-CommonGround) by individuals receiving specialty mental health services, and identified qualitative factors influencing adoption during the first 18 months of implementation in two Medicaid mental health clinics. T-tests and χ2 analyses were conducted to assess differences in patient use between sites...
October 13, 2018: Community Mental Health Journal
Xia Zhong, Norbert Strobel, Annette Birkhold, Markus Kowarschik, Rebecca Fahrig, Andreas Maier
PURPOSE: With the recent introduction of fully assisting scanner technologies by Siemens Healthineers (Erlangen, Germany), a patient surface model was introduced to the diagnostic imaging device market. Such a patient representation can be used to automate and accelerate the clinical imaging workflow, manage patient dose, and provide navigation assistance for computed tomography diagnostic imaging. In addition to diagnostic imaging, a patient surface model has also tremendous potential to simplify interventional imaging...
October 13, 2018: International Journal of Computer Assisted Radiology and Surgery
Jingzhi Li, Laurence Needleman, Ji-Bin Liu, Andrej Lyshchik, Flemming Forsberg, Maria Stanczak, James McAlister, John Eisenbrey
RATIONALE AND OBJECTIVES: To explore the influence of data parsing (either selection of frames at set time intervals or by an experienced sonographer) of contrast-enhanced ultrasound (CEUS) exams on physician diagnoses and confidence levels. MATERIALS AND METHODS: Forty consecutive CEUS exams consisting of 10 cases each of indeterminate liver lesions, indeterminate renal lesions, renal cell carcinoma postablation follow-up, and hepatocellular carcinoma postchemoembolization follow-up were selected for analysis...
October 10, 2018: Academic Radiology
Mauro Scimia, Jinwei Du, Francesco Pepe, Maria Antonia Bianco, Silvana Russo Spena, Farah Patell-Socha, Qing Sun, Michael J Powell, Umberto Malapelle, Giancarlo Troncone
Circulating cell free tumour derived nucleic acids are becoming recognised as clinically significant and extremely useful biomarkers for detection of cancer and for monitoring the progression of targeted drug therapy and immunotherapy. Screening programmes for colorectal cancer in Europe use the Fetal Immunochemical Test (FIT) test as a primary screener. FIT+ patients are referred to immediate colonoscopy and the positive predictive value (PPV) is usually 25%. In this article, we report a study employing the ColoScape assay panel to detect mutations in the APC, KRAS, BRAF and CTNNB1 genes, in order to collect preliminary performance indicators and plan a future, larger population study...
October 12, 2018: Journal of Clinical Pathology
Michelle R Hribar, Abigail E Huang, Isaac H Goldstein, Leah G Reznick, Annie Kuo, Allison R Loh, Daniel J Karr, Lorri Wilson, Michael F Chiang
OBJECTIVE: To improve clinic efficiency through development of an ophthalmology scheduling template developed using simulation models and electronic health record (EHR) data. DESIGN: We created a computer simulation model of one pediatric ophthalmologist's clinic utilizing EHR timestamp data, which was used to develop a scheduling template based on appointment length ("short", "medium", or "long"). We assessed its impact on clinic efficiency after implementation in the practices of five different pediatric ophthalmologists...
October 9, 2018: Ophthalmology
David F Steiner, Robert MacDonald, Yun Liu, Peter Truszkowski, Jason D Hipp, Christopher Gammage, Florence Thng, Lily Peng, Martin C Stumpe
Advances in the quality of whole-slide images have set the stage for the clinical use of digital images in anatomic pathology. Along with advances in computer image analysis, this raises the possibility for computer-assisted diagnostics in pathology to improve histopathologic interpretation and clinical care. To evaluate the potential impact of digital assistance on interpretation of digitized slides, we conducted a multireader multicase study utilizing our deep learning algorithm for the detection of breast cancer metastasis in lymph nodes...
October 12, 2018: American Journal of Surgical Pathology
Arpad M Danos, Deborah I Ritter, Alex H Wagner, Kilannin Krysiak, Dmitriy Sonkin, Christine Micheel, Matthew McCoy, Shruti Rao, Gordana Raca, Simina M Boca, Angshumoy Roy, Erica K Barnell, Joshua F McMichael, Susanna Kiwala, Adam C Coffman, Lynzey Kujan, Shashikant Kulkarni, Malachi Griffith, Subha Madhavan, Obi L Griffith
Harmonization of cancer variant representation, efficient communication, and free distribution of clinical variant-associated knowledge are central problems that arise with increased usage of clinical next-generation sequencing. The Clinical Genome Resource (ClinGen) Somatic Working Group (WG) developed a minimal variant level data (MVLD) representation of cancer variants, and has an ongoing collaboration with Clinical Interpretations of Variants in Cancer (CIViC), an open-source platform supporting crowdsourced and expert-moderated cancer variant curation...
November 2018: Human Mutation
P Schick, H Gottschlag, O Fielitz, W Budach, I Simiantonakis
The University Hospital of Düsseldorf, Germany (UKD) recently installed the Respiratory Gating for Scanners module (RGSC) (Varian Medical Systems, Palo Alto, USA). The aim of this article is to report on the commissioning and clinical implementation of the RGSC system. The steps encompassed the validation of the manufacturer's specifications including functionality tests using a commercial and in-house developed breathing phantom, to establish calibration procedures, and clinical workflow analysis involving breath acquisition and patient data evaluation...
October 8, 2018: Zeitschrift Für Medizinische Physik
Zohaib Iqbal, Da Luo, Peter Henry, Samaneh Kazemifar, Timothy Rozario, Yulong Yan, Kenneth Westover, Weiguo Lu, Dan Nguyen, Troy Long, Jing Wang, Hak Choy, Steve Jiang
Deep learning has started to revolutionize several different industries, and the applications of these methods in medicine are now becoming more commonplace. This study focuses on investigating the feasibility of tracking patients and clinical staff wearing Bluetooth Low Energy (BLE) tags in a radiation oncology clinic using artificial neural networks (ANNs) and convolutional neural networks (CNNs). The performance of these networks was compared to relative received signal strength indicator (RSSI) thresholding and triangulation...
2018: PloS One
Ingo Paetsch, Philipp Sommer, Cosima Jahnke, Sebastian Hilbert, Susanne Loebe, Katharina Schoene, Sabrina Oebel, Sascha Krueger, Steffen Weiss, Jouke Smink, Tom Lloyd, Gerhard Hindricks
Aims: To determine safety and efficacy of electrophysiological cardiovascular magnetic resonance (EP-CMR)-guided radiofrequency (RF) ablation in patients with typical right atrial flutter in a routine clinical setting. Methods and results: Thirty patients with typical right atrial flutter underwent clinically indicated EP-CMR-guided cavotricuspid isthmus ablation. EP-CMR protocols included pre- and post-ablation CMR imaging (whole heart, T2-weighted, and early-/late-gadolinium enhancement) together with electroanatomic mapping of the right atrium...
October 10, 2018: European Heart Journal Cardiovascular Imaging
Olakotan Olufisayo, Maryati Mohd Yusof, Sharifa Ezat Wan Puteh
Despite the widespread use of clinical decision support systems with its alert function, there has been an increase in medical errors, adverse events as well as issues regarding patient safety, quality and efficiency. The appropriateness of CDSS must be properly evaluated by ensuring that CDSS provides clinicians with useful information at the point of care. Inefficient clinical workflow affects clinical processes; hence, it is necessary to identify processes in the healthcare system that affect provider's workflow...
2018: Studies in Health Technology and Informatics
Irena Sailer, Sven Mühlemann, Ralf J Kohal, Benedikt C Spies, Bjarni E Pjetursson, Niklaus P Lang, Klaus L Gotfredsen, Jan E Ellingsen, Helena Francisco, Mutlu Özcan, Bassam Hassan, Guillem E Pardo, Javier A Bardaji, Riccardo D Kraus, Ann Wennerberg
OBJECTIVES: The tasks of this working group were to evaluate the existing evidence on the efficiency and efficacy of the digital and conventional workflows for the fabrication of fixed implant reconstructions, to assess the performance of all-ceramic fixed implant reconstructions and, finally, to evaluate the outcomes of internally and externally connected implant abutments and reconstructions. METHODS: Four reviews were available analyzing the current literature on the respective topics...
October 2018: Clinical Oral Implants Research
Sven Mühlemann, Riccardo D Kraus, Christoph H F Hämmerle, Daniel S Thoma
OBJECTIVE: To identify clinical studies evaluating efficiency and/or effectiveness of digital technologies as compared to conventional manufacturing procedures for the fabrication of implant-supported reconstructions. MATERIALS AND METHODS: A systematic search from 1990 through July 2017 was performed using the online databases Medline, Embase, and Cochrane-Central-Register-of-Controlled-Trials. Literature on efficiency and/or effectiveness during the impression session, the manufacturing process, and the delivery session were included...
October 2018: Clinical Oral Implants Research
Kwok-Chuen Wong, Xiaohui Niu, Hairong Xu, Yuan Li, Shekhar Kumta
In orthopaedic bone tumour surgery, surgeons perform malignant bone tumour resections with tumour-free margin. The bone defects following the resections have to be reconstructed to restore limb function. An inaccurate resection with positive surgical margin increased the risk of local recurrence and compromised patients' survival. Conventionally, orthopaedic tumour surgeons analyse two-dimensional (2D) imaging information and mentally integrate to formulate a three-dimensional (3D) surgical plan. It is difficult to translate the surgical plan to the operating room in complex cases...
2018: Advances in Experimental Medicine and Biology
Chidozie H Ewurum, Yingying Guo, Seang Pagnha, Zhao Feng, Xiongbiao Luo
Orthopedic surgery is a widely performed clinical procedure that deals with problems in relation to the bones, joints, and ligaments of the human body, such as musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. Surgical navigation is generally recognized as the next generation technology of orthopedic surgery. The development of orthopedic navigation systems aims to analyze pre-, intra- and/or postoperative data in multiple modalities and provide an augmented reality 3-D visualization environment to improve clinical outcomes of surgical orthopedic procedures...
2018: Advances in Experimental Medicine and Biology
Akhil Narang, Victor Mor-Avi, Aldo Prado, Valentina Volpato, David Prater, Gloria Tamborini, Laura Fusini, Mauro Pepi, Neha Goyal, Karima Addetia, Alexandra Gonçalves, Amit R Patel, Roberto M Lang
Aims: Studies have demonstrated the ability of a new automated algorithm for volumetric analysis of 3D echocardiographic (3DE) datasets to provide accurate and reproducible measurements of left ventricular and left atrial (LV, LA) volumes at end-systole and end-diastole. Recently, this methodology was expanded using a machine learning (ML) approach to automatically measure chamber volumes throughout the cardiac cycle, resulting in LV and LA volume-time curves. We aimed to validate ejection and filling parameters obtained from these curves by comparing them to independent well-validated reference techniques...
October 9, 2018: European Heart Journal Cardiovascular Imaging
Mark S DeFrancesco, Richard N Waldman, Melissa M Pearlstone, Dana Karanik, Ryan Bernhisel, Jennifer Logan, Lindsey Alico, Royce T Adkins
OBJECTIVE: To evaluate the feasibility and results of incorporating routine hereditary cancer risk assessment, counseling, and follow-up genetic testing in the community obstetrics and gynecology practice setting without referral to a genetic counselor. METHODS: This prospective process intervention study was conducted with two obstetrics and gynecology practice groups (five sites). The intervention included baseline process assessment, refinement of clinic-specific patient screening workflows and tools, and training in hereditary cancer risk screening and follow-up...
October 5, 2018: Obstetrics and Gynecology
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