Radiology Commons^™

Application Of Lean Six Sigma Strategies To Improve Diagnostic Imaging Departmental Performance Metrics: A Literature Review, Obinna Newman Osuji

Radiologic Sciences

Purpose To systematically evaluate the effectiveness of Lean and Six Sigma quality improvement approaches in enhancing diagnostic imaging workflows and departmental financial performance.

Method Literature for this review was retrieved from Scopus, CINAHIL Plus, PubMed, and Healthcare Administration Database in February and March 2026. Empirical studies and literature reviews were included if they addressed the utilization of Lean Six Sigma, Lean, or Six Sigma as a method of quality improvement within a diagnostic imaging departmental setting.

Results Database searches generated 1,624 articles, and 17 were deemed suitable for inclusion in the study. There were four studies that directly measured patient …

Differences In Emergency Department Imaging Modalities For Femur Fractures Based On Insurance And Demographics, Patrick De La Torre Schutz, Bryce M. Bellon, Daniel Salinas, Kelsey Baker, Hamaad Gohar

Research Colloquium

Insurance status and race have been significant predictors of delayed care and reduced imaging utilization in emergency settings, particularly among minority and Medicaid-insured populations (Moser, Shan). The reasoning for the disparities in treatment for these underserved populations is still not well understood. To further analyze these claims, this study examined whether demographic factors such as ethnicity, sex, age, insurance type, and fracture classification were associated with differences in imaging modality among patients with femur fractures. Data from the Texas Department of State Health Services Trauma Registry (2018–2022) was analyzed using logistic regression to determine the odds ratios of receiving CT, …

Diagnostic Performance Of Contrast-Enhanced Ultrasound In Traumatic Solid Organ Injuries In Children: A Systematic Review And Meta-Analysis, Payam Jannatdoust, Parya Valizadeh, Amir Hassankhani, Melika Amoukhteh, Delaram J Ghadimi, Mahsa Heidari-Foroozan, Paniz Sabeghi, Paniz Adli, Jennifer H Johnston, Pauravi S Vasavada, Ali Gholamrezanezhad

Faculty, Staff and Student Publications

Background: Blunt abdominal trauma (BAT) is a significant contributor to pediatric mortality, often causing liver and spleen injuries. Contrast-enhanced computed tomography (CT), the gold standard for diagnosing solid organ injury, poses radiation risks to children. Contrast-enhanced ultrasound (CEUS) may be a promising alternative imaging modality.

Objectives: To evaluate the diagnostic utility of CEUS for detecting solid organ injuries following BAT in the pediatric population.

Methods: A systematic review and meta-analysis were conducted through a thorough literature search in PubMed, Scopus, Web of Science, and Embase databases up to October 1, 2023. Diagnostic accuracy metrics were aggregated using a bivariate model, …

A Guideline For Open-Source Tools To Make Medical Imaging Data Ready For Artificial Intelligence Applications: A Society Of Imaging Informatics In Medicine (Siim) Survey, Sanaz Vahdati, Bardia Khosravi, Elham Mahmoudi, Kuan Zhang, Pouria Rouzrokh, Shahriar Faghani, Mana Moassefi, Aylin Tahmasebi, Katherine Andriole, Peter Chang, Keyvan Farahani, Mona Flores, Les Folio, Sina Houshmand, Maryellen Giger, Judy Gichoya, Bradley Erickson

Department of Radiology Faculty Papers

In recent years, the role of Artificial Intelligence (AI) in medical imaging has become increasingly prominent, with the majority of AI applications approved by the FDA being in imaging and radiology in 2023. The surge in AI model development to tackle clinical challenges underscores the necessity for preparing high-quality medical imaging data. Proper data preparation is crucial as it fosters the creation of standardized and reproducible AI models while minimizing biases. Data curation transforms raw data into a valuable, organized, and dependable resource and is a fundamental process to the success of machine learning and analytical projects. Considering the plethora …

Checklist For Reproducibility Of Deep Learning In Medical Imaging, Mana Moassefi, Yashbir Singh, Gian Marco Conte, Bardia Khosravi, Pouria Rouzrokh, Sanaz Vahdati, Nabile Safdar, Linda Moy, Felipe Kitamura, Amilcare Gentili, Paras Lakhani, Nina Kottler, Safwan Halabi, Joseph Yacoub, Yuankai Hou, Khaled Younis, Bradley Erickson, Elizabeth Krupinski, Shahriar Faghani

Department of Radiology Faculty Papers

The application of deep learning (DL) in medicine introduces transformative tools with the potential to enhance prognosis, diagnosis, and treatment planning. However, ensuring transparent documentation is essential for researchers to enhance reproducibility and refine techniques. Our study addresses the unique challenges presented by DL in medical imaging by developing a comprehensive checklist using the Delphi method to enhance reproducibility and reliability in this dynamic field. We compiled a preliminary checklist based on a comprehensive review of existing checklists and relevant literature. A panel of 11 experts in medical imaging and DL assessed these items using Likert scales, with two survey …

Machine-Learning-Enabled Diagnostics With Improved Visualization Of Disease Lesions In Chest X-Ray Images, Md. Fashiar Rahman, Tzu-Liang (Bill) Tseng, Michael Pokojovy, Peter Mccaffrey, Eric Walser, Scott Moen, Alex Vo, Johnny C. Ho

Mathematics & Statistics Faculty Publications

The class activation map (CAM) represents the neural-network-derived region of interest, which can help clarify the mechanism of the convolutional neural network’s determination of any class of interest. In medical imaging, it can help medical practitioners diagnose diseases like COVID-19 or pneumonia by highlighting the suspicious regions in Computational Tomography (CT) or chest X-ray (CXR) film. Many contemporary deep learning techniques only focus on COVID-19 classification tasks using CXRs, while few attempt to make it explainable with a saliency map. To fill this research gap, we first propose a VGG-16-architecture-based deep learning approach in combination with image enhancement, segmentation-based region …

Ratio Of Vascular Pedicle Width And Thoracic Diameter To Differentiate Cardiogenic And Non-Cardiogenic Pulmonary Edema, Rahmi Afifi, Achmad Fachri, Amir Sjarifuddin Madjid, Joedo Prihartono, Marcel Prasetyo, Andreas Christian

Makara Journal of Health Research

Background: Excess intravascular volume evaluation is essential in the intensive care unit (ICU); however, clinical information to differentiate cardiogenic and non-cardiogenic pulmonary edema has been proven ineffective. Thus, this study aimed to distinguish cardiogenic from non-cardiogenic pulmonary edema using the ratio of vascular pedicle width (VPW) to thoracic diameter (VPTR).

Methods: This cross-sectional study was conducted based on secondary data from chest radiographs of 100 patients with clinical symptoms of pulmonary edema in the ICU from January 2013 to December 2015. Cardiogenic and non-cardiogenic pulmonary edema were distinguished using VPW and cardiothoracic ratio measurements (CTR). VPTR was measured …

Phase And Dark Field Radiography And Ct With Mesh-Based Structured Illumination And Polycapillary Optics, Uttam Pyakurel

Legacy Theses & Dissertations (2009 - 2024)

Imaging can be performed with a variety of techniques. For example, gamma radiation is used in nuclear medicine and radiation therapy A challenge in using gamma rays is the risk of high radiation exposure, which requires extensive custom shielding. The transmission of gamma rays through 3D printed shielding was measured to evaluate the required thickness of the shielding.Conventional radiography depends on x-ray attenuation. Another imaging technique, X-ray phase imaging, is known to improve the contrast of images relative to conventional imaging for low density materials. Phase differences imparted by soft tissue are roughly 1000 times larger than attenuation differences. Further, …

Diagnostic Accuracy Of Ultrasonography For Rotator Cuff Tears: A Systematic Review And Meta-Analysis, Ali S Farooqi, Alexander Lee, David Novikov, Ann Marie Kelly, Xinning Li, John D Kelly, Robert L Parisien

Department of Medicine Faculty Papers

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears.

Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds.

Study Design: Systematic review; Level of evidence, 3.

Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published …

Hepatocellular Carcinoma With Extrahepatic Blood Supply From Right Renal Artery, Amir Humza Sohail, Ahmad Musa, Muhammad Salman Khan, Hassan Raza Hashmi, Basit Salam, Collin E M. Brathwaite

Department of Radiology

Extrahepatic blood supply is seen in around 17-27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70-83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any …

Medical Imaging Stewardship And Healthcare Savings: Utilization Of Age Adjusted D-Dimer To Rule Out Acute Pulmonary Embolism, Phillip Bloodworth, Casey Morris, Kenneth Cail, Brian L. Pando, Brian Helmly

HCA Healthcare Journal of Medicine

Introduction

Acute pulmonary embolism (PE) is a common diagnosis that can lead to death if left untreated. Computerized tomography pulmonary angiogram scan (CTPA) is the gold standard for diagnosis of PE. Utilization of CTPA is increasing in the emergency setting even when suspicion for PE is very low. While CTPA is helpful, radiation exposure, contrast reactions, and cost must be considered. D-dimer is a well-established, high sensitivity and low specificity laboratory test that can effectively rule out PE in low-risk patients when negative. The ADJUST-PE trial showed that there is a natural rise of D-dimer levels with age. This age …

The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki

Rowan-Virtua Research Day

Intubation is an essential procedure performed on a routine basis in the emergency room. Unsuccessful intubations are associated with deleterious outcomes. A systematic review was performed to investigate the accuracy of point of care ultrasound (POCUS) in successful Endotracheal Tube (ET) tube confirmation, utilizing ultrasonography, identification of the cricothyroid membrane utilizing ultrasound, and dynamically during use of ultrasonography in the process of intubation. This review demonstrated high sensitivity and specificity for ultrasound confirmation of ET tube placement, high success rate in ultrasound-guided intubation, and lower than expected accuracy in identifying the cricothyroid membrane. Ultrasonography should be considered for ET tube …

Therapy And Medical Imaging Applications Of Focusing Polycapillary X-Ray Optics, Weiyuan Sun

Legacy Theses & Dissertations (2009 - 2024)

Focusing polycapillary optics yield high gains in intensity and increased spatial resolution for a variety of clinical, lab-based, synchrotron, or in situ analysis applications. In this dissertation we investigate the extension of two applications of focusing polycapillary optics. The first is the application of polycapillary optics in radiation therapy. This discussion includes measurements and calculation of dose for focused beam orthovoltage therapy. A system has been designed to investigate whether the polycapillary optics can produce an X-ray beam which can give more accurate dose painting due to the higher dose concentration at the focal spot. X-ray exposures were measured with …

What Is Scannable? An Mri Safety Guide, Michael Burcescu, Ravi Patel, Robert Hessemer, Peter Lore, Sriharsha Kota, Guarav Kumar

West Florida Division GME Research Day 2020

Supernumerary MRI protocols and recommendations exist to guide physicians at the forefront of patient care. While urgent imaging may be necessary for critical patients, inadvertent imaging of implantable devices can incur serious morbidity and mortality[11]. The American College of Radiology published a 30-page manual in 2013[1] on MRI safe practices and releases yearly updates with critical information separately[2]. There is increased utilization of advanced imaging modalities, especially among academic institutions[3]. Physicians are hard pressed to maximize efficiency; uncertainty delays imaging. Moreover, inappropriate orders delay appropriate management. We present pertinent and often questioned considerations in a comprehensible format along with devices …

Standardized Reporting In Pancreatic Protocol Ct: Implementation Across 3 Community Hospitals, Jacob L. Miller, Kevin Carr, James Banks, Nisha Mani

Radiology

No abstract provided.

Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, Ba, Arthur Hong, Md, Mph

Phase 1

Introduction: Defensive medicine, is defined as “order[ing] tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.” Nearly all physician who fear malpractice litigation have admitted to practicing some degree of defensive medicine. In response, many states have enacted policy reforms to lighten the threat of malpractice on physicians.

Objective: The most common defensive medicine behavior is ordering diagnostic imaging tests when it is potentially unwarranted. Many states have enacted non-economic damage caps from 2000-2010. We explored if these laws had an impact on the rates of diagnostic imaging …

Phase Imaging Using Focusing Polycapillary Optics, Sajid Bashir

Legacy Theses & Dissertations (2009 - 2024)

The interaction of X rays in diagnostic energy range with soft tissues can be described by Compton scattering and by the complex refractive index, which together characterize the attenuation properties of the tissue and the phase imparted to X rays passing through it. Many soft tissues exhibit extremely similar attenuation, so that their discrimination using conventional radiography, which generates contrast in an image through differential attenuation, is challenging. However, these tissues will impart phase differences significantly greater than attenuation differences to the X rays passing through them, so that phase-contrast imaging techniques can enable their discrimination.

Shape/Image Registration For Medical Imaging : Novel Algorithms And Applications., Ahmed Magdy Shalaby 1982-

Electronic Theses and Dissertations

This dissertation looks at two different categories of the registration approaches: Shape registration, and Image registration. It also considers the applications of these approaches into the medical imaging field. Shape registration is an important problem in computer vision, computer graphics and medical imaging. It has been handled in different manners in many applications like shapebased segmentation, shape recognition, and tracking. Image registration is the process of overlaying two or more images of the same scene taken at different times, from different viewpoints, and/or by different sensors. Many image processing applications like remote sensing, fusion of medical images, and computer-aided surgery …

Impact Of Varied Low Resolution Phantoms On Intensity Modulated Proton Therapy Dose Distributions, Aarohi Shyam Padhye

Theses Digitization Project

The primary purpose of this thesis is to discuss the usefulness of image segmentation techniques in creating accurate proton dose distribution plans. The calculation of the proton dose distribution has to take into account the material (tissue, bone, brain) in the treatment area of the patients body.

Stereotactic Localization And Targeting Accuracy For Experimental Proton Radiosurgery, Yin Chen

Theses Digitization Project

The purpose of this study was to improve an existing experimental proton radiosurgery system at Loma Linda University Medical Center to reach sub-millimeter accuracy before proton radiosurgery with narrow beams can be used in a clinical trial. Protons, different from photons (i.e., x-rays or gamma rays), are charged with particles that slow down in matter and release a burst of energy near the end of their range (maximum depth of penetration), which is called the Bragg peak, named after the physicist William Henry Bragg who discovered it in 1903. Photon beams deliver most doses over a large area near the …

Alternative Hull Detection Techniques For Preprocessing In Proton Computed Tomography Reconstruction, Blake Edward Schultze

Theses Digitization Project

The purpose of this study was to develop computationally efficient hull detection techniques appropriate for image reconstruction using sparse matrices. The hull detection techniques investigated were space carving (SC), modified space carving (MSC), and space modeling (SM) and these were compared to the cone-beam version of filtered back projection (FBP) algorithm in terms of their computation time and the quality of the object hull they produced.

Application Of X-Ray Diffraction To Material Analysis And Medical Imaging, Wei Zhou

Legacy Theses & Dissertations (2009 - 2024)

Powder diffraction is commonly used to determine the structures of both inorganic and organic materials. The angle and intensity of the diffraction (also called coherent scatter) peak depends on the nanostructure of the material. When no x-ray optic is used, the peak width broadens, and hence the resolution worsens, as the sample area is increased. However, a small sample area gives low diffracted signal intensity, particularly for thin films and for organic materials, which have low diffraction cross sections. X-ray optics can be used in x-ray powder diffraction to increase the diffraction intensity, thus decreasing exposure times. For a small …

Turf Wars In Radiology: What Must Academic Radiology Do?, Vijay M. Rao, David C. Levin

Department of Radiology Faculty Papers

In a previous article in this series, we called upon private practice radiology groups to better support radiology research financially, but also pointed out that academic radiology must make some changes as well. In this article, we discuss those changes in detail. They include revising the structure of the radiology residency, changing the timing of the American Board of Radiology oral examinations, requiring that all residents receive research training, and emphasizing the value of clinical and translational research. The Society of Chairmen of Academic Radiology Departments (SCARD) needs to assume a leadership role in implementing these changes.