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Introduction: Radiologist reporting times are a key component of radiology department workload assessment, but reliable measurement remains challenging. Currently, there are three contenders for this task: median reporting times (MRTs), extracted directly from a department's radiology information system (RIS); study‐ascribed times (SATs), using published tables of individual descriptors derived from a combination of measurement and consensus; and radiology reporting figures (RRFs), using published tables of measured times based on modality and numbers of anatomical areas. Methods: We review these techniques, their possible uses and some potential pitfalls. We discuss the level of precision that can realistically be attained in measuring reporting times, and list the strengths and weaknesses of each technique, comparing them in relation to each of eight potential applications. Results: We believe that SATs are challenging for practical use due to their static nature, absent common descriptors and large number. RRFs are more user‐friendly but are also static and require ongoing updates; currently, they do not include ultrasound. MRTs cannot currently be extracted from every RIS, but where available they are easy to use and their dynamic nature provides the most objective data. They underestimate the unmeasurable components of a radiologist's work and therefore the total time spent in a reporting session. Conclusion: MRTs are superior to the other methods in flexibility, precision and ease of use. All institutions should have access to this data and we call on vendors of Radiology Information Systems which are currently not capable of providing it to make the necessary modifications. [ABSTRACT FROM AUTHOR]

Introduction: Pectus excavatum (PX) denotes a concavity of the sternum and is the most common chest wall deformity. Many characteristic signs have been described on frontal chest radiographs including increased density of the inferomedial right lung, blurring of the right heart border, steeply angled anterior ribs, horizontal posterior ribs, straight or convex left heart border and loss of silhouette of the descending thoracic aorta. These signs are often subtle and rarely all present in any individual. We describe a further sign in women with PX, the medial breast margin sign. This sign consists of more sharply defined and more vertically oriented medial breast borders on frontal chest radiographs than in those of women with normal chest wall morphology. This study aims to document the sensitivity, specificity and inter-observer reliability of the new sign, and compare with that of the previously described signs in patients with varying degrees of PX.Methods: The frontal chest radiographs of 185 women with PX and 50 women with normal chest wall morphology were assessed by two reviewers for the presence of the new sign and previously described signs. All the signs had their sensitivity, specificity and inter-observer reliability calculated.Results: The new sign had a sensitivity of 0.48, a specificity of 0.96 and inter-observer reliability of κ = 0.79, ranking third, second and first among all other signs, respectively.Conclusion: The medial breast margin sign is useful in diagnosing PX and is comparable to the previously described classic signs. [ABSTRACT FROM AUTHOR]

Introduction: The need to measure reporting workload in teaching departments remains a current pertinent need. In Australia, the Pitman-Jones reporting RVUs have been in the public domain since 2003 (revised in 2009). These are expressed in arbitrary units. In New Zealand, single-site Christchurch Hospital reporting times have been validated and placed in the public domain. Concurrently, the RANZCR has been developing a formulaic descriptor lexicon for imaging studies (the Body System Framework). There is a need to bring these three strands of work together into a common public resource. In 2015, under the auspices of the Chief Accreditation Officer, RANZCR convened the Radiologist Workload Working Group. The goal of the group was to develop a robust method of measuring radiologist workload in teaching departments in Australia and New Zealand for the RANZCR accreditation processes of teaching departments as training sites. This paper concerns itself with one aspect of the group's work, namely reaching a consensus on radiologist study ascribable times for common imaging studies.Method: The BSF examination descriptors were reduced to a smaller, generic dataset of descriptors at the expense of loss of specificity. BSF study ascribable times had been previously obtained by stopwatch observation. The dataset was harmonized with the Christchurch descriptors to ensure commonality of case mix. The two lead authors reached an approximate consensus study ascribable time for each descriptor in agreement with the BSF and Christchurch data. Specifically, the Christchurch reporting times were relied on extensively to validate the new dataset's study ascribable times. The first draft of descriptors and times was tabled at the meetings of the RANZCR Radiologist Workload Working Group, and was progressively refined by iterative consensus.Results: The output of the Radiologist Workload Working Group comprises a simplified modality-based table of robust descriptors and 'best estimate' corresponding study ascribable times. These can be used with the extant Pitman-Jones methodology in order to estimate the reporting workload of a medical imaging teaching department in units of time. As a first for Australia and New Zealand, nuclear medicine and PET study ascribable times have been incorporated and balanced against radiology study ascribable times.Conclusion: The RANZCR 2016 study ascribable times are ready for use by the Australian and New Zealand radiologist and nuclear medicine specialist community. We hope these times will also stimulate further data collection in our two countries towards a robust, bi-national study ascribable times database. [ABSTRACT FROM AUTHOR]

Introduction We describe how techniques traditionally used in the manufacturing industry (lean management, the theory of constraints and production planning) can be applied to planning radiology services to reduce the impact of constraints such as limited radiologist hours, and to subsequently reduce delays in accessing imaging and in report turnaround. Methods Targets for imaging and reporting were set aligned with clinical needs. Capacity was quantified for each modality and for radiologists and recorded in activity lists. Demand was quantified and forecasting commenced based on historical referral rates. To try and mitigate the impact of radiologists as a constraint, lean management processes were applied to radiologist workflows. A production planning process was implemented. Results Outpatient waiting times to access imaging steadily decreased. Report turnaround times improved with the percentage of overnight/on-call reports completed by a 1030 target time increased from approximately 30% to 80 to 90%. The percentage of emergency and inpatient reports completed within one hour increased from approximately 15% to approximately 50% with 80 to 90% available within 4 hours. The number of unreported cases on the radiologist work-list at the end of the working day reduced. The average weekly accuracy for demand forecasts for emergency and inpatient CT, MRI and plain film imaging was 91%, 83% and 92% respectively. For outpatient CT, MRI and plain film imaging the accuracy was 60%, 55% and 77% respectively. Reliable routine weekly and medium to longer term service planning is now possible. Conclusions Tools from industry can be successfully applied to diagnostic imaging services to improve performance. They allow an accurate understanding of the demands on a service, capacity, and can reliably predict the impact of changes in demand or capacity on service delivery. [ABSTRACT FROM AUTHOR]

Introduction Historically, there has been no objective method of measuring the time required for radiologists to produce reports during normal work. We have created a technique for semi-automated measurement of radiologist reporting time, and through it produced a robust set of absolute time requirements and relative value units for consultant reporting of diagnostic examinations in our hospital. Methods A large sample of reporting times, recorded automatically by the Radiology Information System ( COMRAD, Software Innovations, Christchurch, New Zealand) along with the description of each examination being reported, was placed in a database. Analysis was confined to diagnostic reporting by consultant radiologists. A spreadsheet was produced, listing the total number and the frequency of reporting times of each distinct examination. Outliers with exceptionally long report times (more than 10 min for plain radiography, 30 min for ultrasound, or 60 min for CT or MRI with some exceptions) were culled; this removed 9.5% of the total. Complex CTs requiring separate workstation time were assigned times by consensus. The median time for the remainder of each sample was the assigned absolute reporting time in minutes and seconds. Relative value units were calculated using the reporting time for a single view department chest X-ray of 1 min 38 s including verifying a report made using speech recognition software. Results A schedule of absolute and relative values, based on over 179 000 reports, forms Table 2 of this paper. Conclusions The technique provides a schedule of reporting times with reduced subjective input, which is more robust than existing systems for measuring reporting time. [ABSTRACT FROM AUTHOR]

Introduction Accurate and transparent measurement and monitoring of radiologist workload is highly desirable for management of daily workflow in a radiology department, and for informing decisions on department staffing needs. It offers the potential for benchmarking between departments and assessing future national workforce and training requirements. We describe a technique for quantifying, with minimum subjectivity, all the work carried out by radiologists in a tertiary department. Methods Six broad categories of clinical activities contributing to radiologist workload were identified: reporting, procedures, trainee supervision, clinical conferences and teaching, informal case discussions, and administration related to referral forms. Time required for reporting was measured using data from the radiology information system. Other activities were measured by observation and timing by observers, and based on these results and extensive consultation, the time requirements and frequency of each activity was agreed on. An activity list was created to record this information and to calculate the total clinical hours required to meet the demand for radiologist services. Results Diagnostic reporting accounted for approximately 35% of radiologist clinical time; procedures, 23%; trainee supervision, 15%; conferences and tutorials, 14%; informal case discussions, 10%; and referral-related administration, 3%. The derived data have been proven reliable for workload planning over the past 3 years. Conclusions A transparent and robust method of measuring radiologists' workload has been developed, with subjective assessments kept to a minimum. The technique has value for daily workload and longer term planning. It could be adapted for widespread use. [ABSTRACT FROM AUTHOR]

Describes the physical and numerical simulations of the flow of atmospheric boundary layers around a number of building configurations. Discussion on the use of computational fluid dynamics for wind engineering; Experimental arrangements; General computation details; Conclusion.

Very uncommonly, Eustachian tube dysfunction can lead to symptomatic chronic elevation of middle ear pressure with aeration of bone and adjacent structures in the skull base and upper cervical spine, and an increased risk of fracture. We present a case demonstrating the natural history of this condition over 11 years before treatment and 10 months after treatment. [ABSTRACT FROM AUTHOR]

An audit was performed of contrast use in 400 CT brain scans performed with and without contrast enhancement; all 400 scans were re-read by a second reader who did not know the result of the original reading. From this initial series 184 scans were identified in which the unenhanced series had been read as normal by both observers. Of these 184 studies, only one enhanced scan showed an abnormality, and this lesion is thought to be benign. In conjunction with published literature it is concluded that it is reasonable not to give contrast if there is a low expectation of a lesion being present, and if the unenhanced scan is normal. Protocols are presented for the use of intravenous contrast in CT brain scans. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with research which compared selective versus mandatory whole-body computed tomography scanning in multiply injured patients.

Presents a case study of splenic rupture following colonoscopy. Report that the most common complication of colonoscopy is bowel perforation; Details of the treatment of a woman with severe abdominal pain following colonoscopy; Diagnosis of splenic rupture after several tests and examinations failed to diagnose bowel perforation; Discussion of the signs and symptoms of splenic rupture; Incidence of splenic rupture following colonoscopy; Recommendation for diagnosing splenic rupture using computed tomography; Details of conditions which predispose patients to splenic rupture, including previous abdominal surgery, and pancreatitis.

Paediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children. [ABSTRACT FROM AUTHOR]

The immune phenotype of the infiltrating cells in 13 positive patch tests from 8 cases of contact dermatitis and 1 case of poison ivy was studied. An indirect immunoperoxidase technique was used in conjunction with monoclonal antibodies directed against mature T cells (Leu-1, T11), helper T cells (Leu-3A), suppressor/cytotoxic T cells (Leu-2A), killer and natural killer cells (HNK 1), B cells (B1), Langerhans cells (HLA-DR), and the common acute lymphoblastic leukemia antigen (CALLA), (J5). The majority of infiltrating mononuclear cells were Leu-1+, T11+ Leu-3A+, HLA-DR+,T9-, T10-, HNK-, B1-, J5, -. Ocassional T6+ cells were observed in the epidermis (including spongiotic micro- vesicles) and also isolated in the dermis and within the dermal mononuclear infiltrates. The phenotype was compared with cutaneous T-cell lymphoma, a disease in which contact allergy and antigenic persistence may play a role. [ABSTRACT FROM AUTHOR]