Radiology Extenders Outperform Radiology Residents with Chest X-ray Interpretations

October 15, 2020

Cases drafted by radiology extenders saved attending radiologists nearly one hour a day.

Radiology extenders who read chest X-rays save attending radiologists more time during the day than radiology residents do, potentially streamlining workflow and alleviating provider burnout.

At least that has been the experience for researchers at the University of Pennsylvania. Radiologists in their department read more cases per hour when the drafts came from radiology extenders than from residents, resulting in nearly an hour – 51 minutes – of provider time saved each day. The authors shared their experience on Oct. 13 in the Journal of the American College of Radiology.

“Interpreting these radiographs entails a disproportionate amount of work (eg., retrieving patient history, completing standard dictation templates, and ensuring proper communication of important findings before finalization of reports). Given low reimbursement rates for these studies, economic necessities push radiologists to provide faster interpretations, contributing to burnout,” said the team led by Arijitt Borthakur, MBA, Ph.D., senior research investigator in the Perelman School of Medicine radiology department. “Deployment of [radiology extenders] in the thoracic imaging section of our academic radiology practice improved efficiency of chest radiography.”

Taking these more routine exams off of the radiologist’s plate can also help improve his or her sense of job satisfaction, the team pointed out.

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To determine the kind of impact radiology extenders would have on daily workflow, Borthakur’s team recruited two radiologic technologists to be radiology extenders and trained them over two months to interpret one- or two-view chest radiographs and to dictate using standardized templates. The extenders subsequently drafted an average of between 130 and 160 cases each day for six months. These cases were compared with those created by radiology residents.

Attending radiologists used the RADPEER scoring system to judge the quality of the drafted cases, assigning each case a score of 1, 2, or 3. A 1 score indicated agreement with the interpretation; a 2 score referred to a discrepancy with an understandable miss; and a 3 score indicated a discrepancy with a miss that should not have occurred. The RADPEER scores between the two groups were largely similar, and the team said any variability was likely due to case mix more than whether the scan was read by an extender or a resident.

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But, according to their analysis, radiology extender-drafted cases were finalized faster than those drafted by residents. On average, four attending radiologists were able to finalize 93.6 cases per hour when reviewing cases from radiology extenders, but only 72.6 cases when reviewing resident-drafted cases. When they worked independently, they read just 62.4 cases per hour, +/ 10.2 cases.

As a result, the team said, radiology extender-drafted cases improved the flow rate by 52 percent compared to just 17 percent by resident-drafted cases. In addition, attending radiologists were also able to finalize radiology extender cases 36 percent faster than they were resident cases. This difference, they said, suggests that resident cases needed more edits.

The increased productivity can also have a direct impact on how departments organize their workflow and schedules. The team recommended strategically scheduling radiology extenders to work during times when study volumes are higher, potentially leading to more efficiency gains.

“We are confident that the [radiology extender] job function makes more business sense if radiology extenders are deployed in a strategic and meaningful manner,” they said.

Alongside accelerating study interpretations, the team pointed out that radiology extenders can also streamline workflow by stepping in to field reading room phone calls and communicate previous reporting findings to referring physicians. And, as artificial intelligence continues to assume a larger role in patient care, such as identifying lung nodules on CT or distinguishing COVID-19 pneumonia from other types, the radiology extender role has the ability to grow and morph with that expansion.

“We foresee the [radiology extender] role evolving in conjunction to serve as a data curator,” they said, “leveraging their technical expertise to assess image quality and guide reacquisition and performing hyperparameter tuning during model training to accelerate the adoption of machine learning algorithms in radiology workflow.”