Elsevier

Academic Radiology

Volume 22, Issue 9, September 2015, Pages 1191-1198
Academic Radiology

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

https://doi.org/10.1016/j.acra.2015.05.007Get rights and content

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.

Section snippets

Study Design

This retrospective study performed at a single academic medical center met Health Insurance Portability and Accountability Act privacy guidelines and was subject to institutional review board (IRB) approval. The need for continued IRB oversight was waived as this study qualified as a quality improvement project. All diagnostic, angiographic, and interventional CT and MRI examinations performed from 1999 to 2010 were extracted from our institutional Radiology Information Management System using

Trends in Number of Examinations Over Time

From 1999 to 2010, a total of 1,517,149 examinations (994,471 CT, 522,678 MRI) were performed at our institution. Trends in institutional CT and MRI examination utilization from 1999 to 2010 are shown in Figure 1a; Sen's slope estimates are summarized in Table 1. Over this span of time, CT examination utilization increased from 55,372 exams/year to 93,491 exams/year (Q = +4499 exams/year, Z = 3.77, P < .0001); representing a 68% increase in CT utilization over the study period. Similarly, MRI

Discussion

The results from our large single-center radiology practice revealed that, despite efforts to normalize staffing workload for increases in cross-sectional imaging utilization, radiologist workloads are dramatically increasing. Although there has been a steady rise in the number of examinations performed per year, much of this increase in workload burden is a result of increases in the number of images that must be interpreted in each examination. Increases in examination content alone have

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