Browsing by Author "Pitcher, Richard"
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- ItemThe accuracy of radiology speech recognition reports in a multilingual South African teaching hospital(BioMed Central, 2015-03) Du Toit, Jacqueline; Hattingh, Retha; Pitcher, RichardBackground: Speech recognition (SR) technology, the process whereby spoken words are converted to digital text, has been used in radiology reporting since 1981. It was initially anticipated that SR would dominate radiology reporting, with claims of up to 99% accuracy, reduced turnaround times and significant cost savings. However, expectations have not yet been realised. The limited data available suggest SR reports have significantly higher levels of inaccuracy than traditional dictation transcription (DT) reports, as well as incurring greater aggregate costs. There has been little work on the clinical significance of such errors, however, and little is known of the impact of reporter seniority on the generation of errors, or the influence of system familiarity on reducing error rates. Furthermore, there have been conflicting findings on the accuracy of SR amongst users with English as first- and second-language respectively. Methods: The aim of the study was to compare the accuracy of SR and DT reports in a resource-limited setting. The first 300 SR and the first 300 DT reports generated during March 2010 were retrieved from the hospital’s PACS, and reviewed by a single observer. Text errors were identified, and then classified as either clinically significant or insignificant based on their potential impact on patient management. In addition, a follow-up analysis was conducted exactly 4 years later. Results: Of the original 300 SR reports analysed, 25.6% contained errors, with 9.6% being clinically significant. Only 9.3% of the DT reports contained errors, 2.3% having potential clinical impact. Both the overall difference in SR and DT error rates, and the difference in ‘clinically significant’ error rates (9.6% vs. 2.3%) were statistically significant. In the follow-up study, the overall SR error rate was strikingly similar at 24.3%, 6% being clinically significant. Radiologists with second-language English were more likely to generate reports containing errors, but level of seniority had no bearing. Conclusion: SR technology consistently increased inaccuracies in Tygerberg Hospital (TBH) radiology reports, thereby potentially compromising patient care. Awareness of increased error rates in SR reports, particularly amongst those transcribing in a second-language, is important for effective implementation of SR in a multilingual healthcare environment.
- ItemAdrenal rest tumours in congenital adrenal hyperplasia(Journal of Endocrinology, Metabolism and Diabetes of South Africa (JEMDSA), 2008-07) Zollner, Ekkehard W.; Pitcher, RichardClassic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is rare, occurring approximately once in every 15 000 live births.1 At birth it is often suspected in girls because of ambiguous genitalia, whereas boys have normal genitalia. The salt-losing type of CAH presents with adrenal crisis a few weeks after birth, while the simple type manifests virilisation and rapid growth years later. The diagnosis is confirmed by an elevated plasma 17-hydroxyprogesterone (17- OHP) level. Additional features in the salt-losing variety are hyponatraemia, hyperkalaemia, metabolic acidosis and an elevated plasma renin level. The gluco- and mineralocorticoid insufficiency is corrected by providing hydrocortisone and fludrocortisone, respectively. It may be necessary to add sodium chloride to infant feeds. Treatment is lifelong. If compliance is poor, excess androgen production, accelerated growth, secondary central precocious puberty and, in boys, adrenal rest tumours can occur, as in the following case.
- ItemDiagnostic reference levels for paediatric computed tomography(AOSIS Publishing, 2015-11-30) Vawda, Zakariya; Pitcher, Richard; Akudugu, John; Groenewald, WillemObjectives: To establish local diagnostic reference levels (LDRLs) for emergency paediatric head computed tomography (CT) scans performed at a South African (SA) tertiary-level hospital and to compare these with published data. Materials and methods: A retrospective analysis was conducted of volume-based CT dose index (CTDIvol) and dose length product (DLP) data from uncontrasted paediatric head CT scans performed in the Trauma and Emergency Unit of a tertiary-level SA hospital from January to June 2013. A random sample of 30 patients in each of 3 age groups (0–2, >2–5 and >5–10 years) was used. LDRL values were compared with several national DRLs from Europe and Australia. Results: Mean CTDIvol and DLP values were: 30 mGy and 488 mGy.cm for the 0–2 years age group; 31 mGy and 508 mGy.cm for the >2–5 years group, and 32 mGy and 563 mGy.cm for the >5–10 years group, respectively. The mean DLP for 0–2 year-olds was the only parameter outside the range of corresponding published reference data. Stratification into narrower age groupings showed an increase in DLP values with age. Conclusion: An institutional review of the head CT scanning technique for emergency studies performed on children less than 2 years of age is recommended. The current study highlights the role of LDRLs in establishing institutional dosimetry baselines, in refining local imaging practice, and in enhancing patient safety. Standard age stratification for DRL and LDRL reporting is recommended.
- ItemThe FC Rad Diag(SA) : stretched, but still in step – report on a Royal College observership(AOSIS Publishing, 2017) Pitcher, Richard; De Vries, Coert; Lockhat, ZarinaA delegation of the College of Radiologists of the overarching Colleges of Medicine of South Africa observed the spring sitting of the Part 2B Examination of the Fellowship of the Royal College of Radiologists (FRCR) in London, in April 2016. Although the principal focus of the Observership was the Part 2B examination, the delegates also assessed broader aspects of the FRCR. This report presents an overview of current FRCR practices, including the findings of an independent review of the FRCR, and reflects on the implications for the South African Fellowship examination. The report is based on discussions with key Royal College role players, direct observation of the Part 2B examination and web-based documentation. It allows appreciation of the continued close alignment of the FC Rad Diag(SA) (Fellowship of the College of Radiologists of the Colleges of Medicine of South Africa) with the FRCR and highlights expected trends in the FC Rad Diag(SA). It also documents the increasing human resources required for successful conduct of examinations. It is hoped that the report will be of interest and relevance to the broad South African radiological community and to those contemplating specialist training in the discipline. It is trusted that it will encourage wider involvement of radiological and medical physics colleagues in the various FC Rad Diag(SA) examination processes.
- ItemMammography reporting at Tygerberg Hospital, Cape Town, South Africa(Health & Medical Publishing Group, 2014-07) Pitcher, Richard; Lotz, Jan; Ackermann, Christelle; Bagadia, Asif; Davis, Razaan; Du Plessis, Anne-Marie; Griffith-Richards, Stephanie; Hattingh, Retha; Wagener, Georg; Apffelstaedt, Justus; Dalmayer, Lisa; Baatjes, KarinIn their recent article, Apffelstaedt et al.[1] analysed 16 105 mammograms performed at Tygerberg Hospital (TBH), Cape Town, South Africa (SA), between 2003 and 2012. The summary reported that ‘mammograms were read by experienced breast surgeons’, while the discussion stated: ‘A further noteworthy fact is that this TBH series was based exclusively on mammography interpretation by surgeons with a special interest in breast health.’ The suggestion that mammograms were exclusively interpreted by breast surgeons does not reflect the mammography workflow at our institution.
- ItemRadiological response and histological findings in nephroblastoma: Is the any correlation?(Wolters Kluwer - Medknow, 2020-12) Middleton, Pamela; Banieghbal, Berhouz; Pitcher, RichardIntroduction: The Sociétè Internationale d'Oncologie Pédiatrique advocates for neoadjuvant chemotherapy in the management of nephroblastoma. Postoperatively, histological findings are used to assign risk classification to resected tumours. The aim of this study is to compare the response demonstrated by pre-operative imaging to the amount of necrosis seen on histology postoperatively. Patients and methods: About 33 patients with nephroblastoma over a 10 year period had adequate imaging and histology records for this study. Three methods were used to assess tumour change following neoadjuvant therapy and were compared with histological records. 1. An estimation of necrosis, 2. Surface areas of apparent necrosis within the tumour measured on static imaging, 3. The change in volume of the mass. Pearson coefficient was calculated to measure the correlation between histologically observed necrosis and radiological changes. Results were considered significant if P< 0.05. Results: There was no correlation between radiological changes on pre-operative imaging and the percentage of necrosis seen on histology. Change in tumour size on radiological studies showed a moderate correlation to percentage tumour necrosis on histology but was unable to predict tumour risk classification. Conclusions: In nephroblastoma, there is a moderate correlation between the decrease in size of a mass noted on imaging following chemotherapy and the degree of necrosis found postoperatively on histology. Change in tumour size cannot be used to predict histological risk classification. It is not possible to predict the histological risk classification of a nephroblastoma based on the changes demonstrated on non-contrasted magnetic resonance imaging or computed tomography preoperatively.