Ancillary Software

Question 1

What is the “build vs buy” question?

Answer 1

when an imaging practice
has to decide whether the software solution they need exists and can be purchased or will have to be developed in-house

Question 2

What are some examples of common purchased software in a radiology practice?

Answer 2

PACS, RIS, and EMR

Question 3

What are some advantages of home-built solutions?

Answer 3

Customization

Greater knowledge of necessary data streams and interfaces

Better integration to the clinical workflow

easier navigation of any governance approvals or security clearances

Question 4

What is an advantage of commercial solutions?

Answer 4

Service contracts that provide application maintenance and updates

Question 5

CTRM system

Answer 5

Critical test results management system

Question 6

What can a CTRM system be used for?

Answer 6

It can connect to
the various software applications
that the radiologist uses (PACS/
RIS, EMR, report generation system, paging system)

as well as alerting the referring physician/APP

Question 7

In what form does the CTRM alert the ordering provider?

Answer 7

It can take on many forms including phone calls, electronic pages, or text messages

Question 8

How does the CTRM system encourage closed-loop communication?

Answer 8

The system will continue trying to reach the ordering provider until they acknowledge receipt of the message

If they do not answer the message after a predetermined number of attempts, the system will launch an escalation protocol

Question 9

What happens when the CTRM launches an escalation protocol?

Answer 9

It will attempt to reach another designated individual

Question 10

What happens if no one answers the CTRM system’s alert?

Answer 10

Radiology will become notified and attempt a phone call or in-person message delivery

Question 11

What is the purpose of a recommendation-tracking system?

Answer 11

Ideally, the system would identify each finding of
interest, the recommended follow-up, and the timing, and notify the ordering physician/APP in a closed-loop fashion

Question 12

What have many radiology practices implemented as a hybrid solution for identification of noncritical actionable findings/

Answer 12

Structured Reporting

Question 13

REM

Answer 13

Radiation Exposure Monitoring

Question 14

What do REM tools do?

Answer 14

REM tools enable a radiology practice to monitor radiation dose indices for different modalities

Question 15

What are two way dose indices can be generated and stored?

Answer 15

1. A legacy dose sheer
2. a DICOM Radiation Dose Structured Report object

Question 16

DICOM RDSR

Answer 16

DICOM Radiation Dose Structured Report

Question 17

What is a Legacy Dose Sheet?

Answer 17

typically a DICOM Secondary Capture object, with the numeric data burned into the pixels of the image

Question 18

Who should be included on the multidisciplinary review committee for a radiation exposure monitoring program and why?

Answer 18

radiologists, physicists, and technologists

To periodically review reports from the REM tool and identify areas for improvement

Question 19

What person represents the REM software and where should they be sending dose information to?

Answer 19

1. Dose information reporter
2. Dose Index Registry

Question 20

DRLs

Answer 20

Dose Reference Levels

Question 21

What can DRLs do?

Answer 21

They can help imaging facilities
determine if the radiation exposure from a particular imaging examination or procedure is unusually high

Question 22

What would constitute as an unusually high dose?

Answer 22

At the 75th percentile

Question 23

PAMA

Answer 23

The Protecting Access to Medicare Act

Question 24

CDSM

Answer 24

Clinical Decision Support Mechanism

Question 25

What did PAMA require?

Answer 25

That ordering providers use a qualified clinical decision support mechanism (CDSM) when ordering certain types of advanced imaging examinations

Question 26

How are radiologists reimbursed for CMS patients?

Answer 26

CMS will only reimburse radiologists for the interpretation of advanced imaging that is ordered using a qualified CDSM

Question 27

What is a numeric appropriateness score?

Answer 27

A scored formulated by the CDSM (ranging from 0 for least appropriate to 9 for most appropriate) based on the ordered exam and the indication chosen from a picklist of options

Question 28

Why are numeric appropriateness scores important?

Answer 28

They can be used to better understand physician/APP ordering patterns and the number and nature of outliers among physicians/APPs ordering advanced imaging

Question 29

What factors affect the adoption of CDSMs?

Answer 29

1. Seamless integration into the EMR and clinical workfow 2. Suffcient education of end-user physicians/APPs 3. Customization of the CDSM to the clinical context 4. Level of experience of the CDS vendor

Question 30

What does a radiologist decision support system do?

Answer 30

Provides guidance around the interpretation process (help radiologists craft more consistent and evidence-based follow-up recommendations, provide differential diagnoses based on findings identified on the images, or standardize the language used to report particular findings)

Question 31

CAR/DS

Answer 31

computer-assisted reporting and decision support

Question 32

What does a CAR/DS do for radiologists?

Answer 32

It can be used to encode follow-up guidelines in a radiologist’s report generation system, to make clinical guidelines accessible at the point of care

Question 33

What is an example of how CAR/DS can be used by a radiologist?

Answer 33

It can prompt the radiologist for specific data elements (e.g., the size of a pulmonary nodule; whether the nodule is solid, subsolid, or ground glass; and whether or not the patient has a smoking history) It additionally can compute the appropriate time interval for follow-up chest CT and appropriate language generation

Question 34

What are some examples of ACR Assist modules that have been developed using the CAR/DS framework?

Answer 34

BI-RADS for breast imaging LI-RADS for liver mass reporting on MRI Lung-RADS for CT lung cancer screening

Question 35

What can Bayesian networks be used for?

Answer 35

They can be used to implement point-of-care decision support for radiologists who have identified the characteristics of an imaging abnormality but are unsure what it represents

Question 36

What do many PACS vendors include in their system to aid in education through real-studies?

Answer 36

integrated teaching file modules

Question 37

What is the main purpose of discrepancy tracking systems?

Answer 37

to give feedback to residents and allow them to review additions to their reports as well as identify major and minor discrepancies between the preliminary and final reports

Question 38

Which of these costs of home-built software applications is often overlooked during the build-versus-buy decision-making process? A. Up-front fnancial expenditure B. Maintenance and support cost C. Hardware infrastructure D. User training

Answer 38

B

Question 39

Which of the following features of a recommendation-tracking system is important for decreasing the likelihood of an adverse patient outcome? A. Asynchronous messaging B. Message logging C. Text paging D. Closed-loop communication

Answer 39

D

Question 40

What is the most salient difference between a critical imaging test result and a noncritical actionable fnding? A. Timeline during which patient harm may occur B. Size of the detected abnormality C. Modality on which the finding was identified D. Location where the patient was imaged

Answer 40

A

Question 41

Which actor in the IHE REM profle transaction diagram would be expected to collect dose indices from exams sent to PACS? A. Acquisition modality B. Image archive C. Dose information consumer D. Dose register

Answer 41

C

Question 42

What output does a CDS system generate in response to the selection of an imaging exam and associated indication for the study? A. Pre-authorization B. Appropriateness score C. Peer-to-peer authorization D. Explanation of benefits

Answer 42

B

Question 43

What is the major advantage of using radiologist decision support to generate follow-up recommendations? A. Standardization of recommendation language across a practice B. Increased revenue from follow-up imaging C. Increased need for structured reporting templates D. Decreased cost to the department or practice

Answer 43

A

Question 44

Which of the following is a potential pitfall of teaching fle systems that ingest DICOM image objects? A. Limited data storage due to larger fle sizes B. Compromise of PHI still in the DICOM header C. Slower loading times for individual teaching cases D. Less likelihood of backward compatibility

Answer 44

B

Question 45

Which of the following systems is least likely to need connections to PACS? A. Teaching fle B. Radiation exposure monitoring C. Discrepancy tracking D. Clinical decision support

Answer 45

C

Question 46

Which of the following systems requires the least integration with the PACS, RIS, or EMR? A. Critical test results management B. Radiologist decision support C. Recommendation tracking D. Incident reporting

Answer 46

D

Question 47

Which important feature do web conferencing applications generally lack? A. Interactivity via chat or question/answer box B. Simultaneous audio and video sharing C. Multi-monitor display to replicate PACS viewer functionality D. Collaboration features, e.g., sharing mouse control