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Objectives: There is a lack of clear and consistent cost reporting for cost-effectiveness analysis in radiology. Estimates are often obtained using costing derived from hospital charge records. This study aims to evaluate the accuracy of hospital charge records compared to a Singapore hospital's true diagnostic imaging costs. Methods: A seven-step process involving a bottom-up micro-costing approach was devised and followed to calculate the cost of imaging using actual data from a clinical setting. We retrieved electronic data from a random sample of 96 emergency department patients who had CT brain, CT and X-ray cervical spine, and X-ray lumbar spine performed to calculate the parameters required for cost estimation. We adjusted imaging duration and number of performing personnel to account for variations. Results: Our approach determined the average cost for the following imaging procedures: CT brain (€154.00), CT and X-ray cervical spine (€177.14 and €68.22), and X-ray lumbar spine (€79.85). We found that the true cost of both conventional radiography procedures was marginally higher than the subsidized patient charge, and all costs were slightly lower than the private patient charge except for X-ray lumbar spine (€73.49 vs.€79.85). We identified larger differences in cost for both CT procedures and smaller differences in cost for conventional radiography procedures, depending on the patient's private or subsidized status. For private status, the differences were: CT brain (Min: €194.20; Max: €264.40), CT cervical spine (Min: €219.54; Max: €399.05), X-ray cervical spine (Min: €5.27; Max: €61.94), and X-ray lumbar spine (Min: €6.36; Max: €108.04), while for subsidized status, the differences were: CT brain (Min: €7.56; Max: €62.64), CT cervical spine (Min: €47.02; Max: €132.49), X-ray cervical spine (Min: €15.88; Max: €103.44), and X-ray lumbar spine (Min: €13.66; Max: €149.44). Considering examination duration and the number of personnel engaged in a procedure, there were significant variations in the minimum, average, and maximum imaging costs. Conclusion: There is a modest gap between hospital charges and actual costs, and we must therefore exercise caution and recognize the limitations of utilizing hospital charge records as absolute metrics for cost-effectiveness analysis. Our detailed approach can potentially enable more accurate imaging cost determination for future studies.

Abstract Background With a significant increase in utilisation of computed tomography (CT), inappropriate imaging is a significant concern. Manual justification audits of radiology referrals are time-consuming and require financial resources. We aimed to retrospectively audit justification of brain CT referrals by applying natural language processing and traditional machine learning (ML) techniques to predict their justification based on the audit outcomes. Methods Two human experts retrospectively analysed justification of 375 adult brain CT referrals performed in a tertiary referral hospital during the 2019 calendar year, using a cloud-based platform for structured referring. Cohen’s kappa was computed to measure inter-rater reliability. Referrals were represented as bag-of-words (BOW) and term frequency-inverse document frequency models. Text preprocessing techniques, including custom stop words (CSW) and spell correction (SC), were applied to the referral text. Logistic regression, random forest, and support vector machines (SVM) were used to predict the justification of referrals. A test set (300/75) was used to compute weighted accuracy, sensitivity, specificity, and the area under the curve (AUC). Results In total, 253 (67.5%) examinations were deemed justified, 75 (20.0%) as unjustified, and 47 (12.5%) as maybe justified. The agreement between the annotators was strong (κ = 0.835). The BOW + CSW + SC + SVM outperformed other binary models with a weighted accuracy of 92%, a sensitivity of 91%, a specificity of 93%, and an AUC of 0.948. Conclusions Traditional ML models can accurately predict justification of unstructured brain CT referrals. This offers potential for automated justification analysis of CT referrals in clinical departments.

Open traumatic brachial plexus injuries are rare, yet can be life threatening and require rapid clinic assessment. Early interdisciplinary collaboration is critical to achieve superior patient outcomes. This case of a 24-year-old female of a traumatic neck injury with contralateral brachial plexus injury demonstrates the limitations of early clinical assessment due to the potential for haemodynamic instability and highlights the priority of patient stabilisation. Early and active interdisciplinary collaboration in this case demonstrates its importance in accurate diagnosis and timely intervention to achieve better patient outcomes. As published in recent guidelines, this report shows the importance of early interdisciplinary involvement following stabilisation and resuscitation of the patient.

Eagles syndrome, which is due to calcified stylohyoid ligaments or an elongated styloid process, may manifest as chronic throat pain. It is not usually implicated in trauma. This case report is unique in that we describe firstly a complete bony ring extending from bilateral styloids, and secondly, this abnormality being implicated in serious soft tissue injury. Our patient suffered a blow to the neck during a sports game. While initially asymptomatic, he developed severe neck pain, neck stiffness and odynophagia. Clinical examination of the larynx revealed pharyngeal wall oedema and there was evidence of free air in the retro-pharynx on plain film x-rays. Treatment was initiated in the intensive care unit. He made a complete recovery after 5 days and was discharged with no negative sequelae on follow up. This is a rare finding of bilateral styloid elongation and stylohoid complex ossification forming a complete bony ring around the larynx. Upon retropulsion of this tissue ring, puncture and disruption of the retropharyngeal soft tissues lead to the formation of free air. Prompt airway management is essential in cases such as this that have the potential to compromise the airway if not treated. This case represents a rare finding and an even rarer mechanism of injury.