Various Reading Options

The option was added to require “Dual Read” for certain exam types by the radiologist. For example; require dual read on screening and symptomatic mammograms, MRIs, and stereotactic exams, whereas all other exams only require a single reader. Radiologists without “required dual read” option set, can approve an exam without a second reader. For example; senior breast imager does not require overread for report approval.

The dual read feature is similar to the resident feature, where the resident cannot approve a report exclusively and the exam retains a “hold for second read” status pending approval for non resident radiologist. This feature also is applicable for the opposite workflow, where resident over reads secondarily.

The resident or “hold for second read” system allows collective agreement prior to approve with an “agree” signification. Both agreeing radiologists appear on the report. If agreement is not applicable, then it signified by a disagree status by second reader, and further collaboration between readers can take place for approval.

A non-resident can take exclusive ownership of the study and alter the report as necessary for report approval, contingent on the exam type not requiring a dual read or if the radiologist is not participating in the required dual read option. Also an option exists by radiologist to be excluded from participating as an second reader.

Another option can be applied to resolve an exam in disagreement status based on specified exam types. This incorporates the second reader comments for the reason for disagreement, and the resolution is advanced to a third reader. When disagreement is indicated by second reader, the exam status is advanced to “Reviewer” status versus “Disagree”.

When the exam with the Reviewer status is selected for approval, if reader three concurs with reader one, then reader one and three are incorporated (attached) into the report during approval. If reader three concurs with reader two, then reader three incorporates the changes indicated by reader two, and reader two and three are attached. If reader three does not concur with either reader one or two, then the process is repeated where the exam enters the queue requiring second read, unless reader three does not require the dual read option and is not a resident, and has the option of final approval.

Some facilities apply a reading workflow that requires the exam to be reviewed by more than two radiologists, for example; a resident, breast radiologist, and then the body imager for MRI studies. PenRad can facilitate a “move to next” up to six moves and all radiologists are associated to the exam. During the holding of exam for second read or move to next, the “hold for” radiologist can specified. Holding “for” works in conjunction with the “assign” system that allows the logged in radiologist to select from the reading schedule the “my assigned exams” filter to only display on worklist their assigned exams to streamline workflow.

Another benefit of assignment system, allows the resident that participated in the procedure and is preparing the initial documentation and/or is paired with a staff radiologist for the day, to indicate whom should review the exam when suspending for approval. Assignment as well can be used or applied if review of the initial interpretation is desired. Example; facility protocol requires two readers for approval for biopsy. Assignment can also be used for workload distribution, exam type, continuation of a workup, or a patient request.

For facilities that practice group teaching versus the individual resident preparing or documenting the exam in advance for review, the teaching radiologist can select multiple radiologists simultaneously and retain them during the teaching session, to include them as observers into the exam for accumulation of reading qualities.

The hold for second read feature can also be used for lower volume facilities to help maintain annual minimums, and/or a second look at dense breast exams for example.

Another component in the PenRad system during current exam interpretation provides the ability to peer review using the comparison images with the narrative report to accumulate annual interpretation quantities and classify concurrence, provided the interpreting radiologist was not originally attached to the exam being PeerReviewed.

For facilities deploying quality initiatives, the PeerReview system allows the radiologist to independently set annual review goals, and to be reminded if the opportunity exists with comparison images if their moving average is behind their annual goal.

PenRad offers a gamut of administrative reports to extract various statistics by radiologist, by level of concurrence from the PeerReview system. The PeerReview system also provides the radiologist the ability to exact applicable exams (was not attached to the exam or has not been previously reviewed within 365 days) and fetch these exam images to the interpretation workstation (requires PenFetch module) for review by various combinations by density, by birads, and patient risk percentages derived from the risk models.

Other options by radiologist to customize and automate workflow:

Resident option – Typically the “first” reader does first read and/or documents procedure, holds the exam for second read, requires non-resident for approval. Resident can over read non-resident exam and agree with. Both radiologists are attached to the exam, enabling the accumulation of annual exam counts for both.

Auto Negatives option – Advances the exam to negative mammogram directly for screening mammograms,
by-passing the Pre-Exam screen if no indicated problems and comparison studies selected (N/A if first ever mammo). Also this option clones the last known tissue density, pre-selects no-change, and any previously indicated generic findings, for example benign scattered densities, cysts or calcs, this is the one-click exam.

The Left/right option – Flips left mammographic images and findings to left side on screens (left on left).

CC on top option – Displays the CC images on mammography detail screen above MLO/ML views instead.

No second read assignment option – Inhibits second reads or display of these exams on the interpretation list.

Requires second read option – Inhibits full approval of exam until second read. First reader initially approves for second read. The requirements for require second read can be suppressed by each exam type for example; required for screening, not for diagnostic studies.

Master user – Provides access to user profiles, protected admin reports, and exams requiring intervention.

Ignore warnings – Suppress low level warning messages, however recall inconsistency warning still applicable.

Annual Peer Review target – Set annual goal for Peer Review and be warned if it falls below moving average.

Use alternate viewer – Allows the radiologist to use PenView for viewing breast studies versus PACS.

Hide items on screen – Allows each radiologist the ability to customize screens by suppressing display of items. For example; use only BIRADS approved verbiage, hide items seldom used or not applicable. Access to items hidden are visible by tapping unhide button located on each screen. Can be applied globally for non-residents and/or by residents for interpretation screens. Hide items can be applied on other screens as well. An individual user hide profile overrides global settings.

Default items – Allows each radiologist to have items preselected or incorporated into the exam for example; preselect consent phrase, preselect hide clock and/or depth, preselect bx devices and needle size, etc.

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