E1139. Evaluation of the Modified Barium Swallow Study Conducted With the Presence or Absence of a Radiologist
  1. Luhe Yang; Royal University Hospital; University of Saskatchewan
  2. David Leswick; Royal University Hospital; University of Saskatchewan
  3. Michael Butler; Anishnawbe Health Toronto, Centre for Addictions and Mental Health
  4. Tasha Ellchuk; Royal University Hospital; University of Saskatchewan
The objective of this study is to assess the quality and safety of modified barium swallow studies (MBSS) performed before and after an institutional change from radiologist presence to absence during the procedure.

Materials and Methods:
This is a retrospective review of MBSS performed on adult inpatients at an academic tertiary care hospital 6-months prior to and 6-months after an institutional change to no longer requiring a radiologist to be present. Nuance mPower ™ Clinical Analytics was queried for a list of MBSS. Demographics, examination duration, number of image and cine loops, and report delay time were extracted from Picture Archiving and Communication Systems. Cerner Radiology Information System was queried for the fluoroscopic time. A 5-point collimation score was qualitatively used to assess the number of irradiated non-essential structures, which included the suprasellar brain, orbits, soft tissues posterior to the spine, anterior oral cavity, and shoulders. Differences in the demographics and outcomes were analyzed using Welch’s t-test if the data were continuous and a test of proportions for count data under the normal approximation. Count data are described as count and proportions. All analyses were performed in the R-statistical software package (R 4.0.0, “Arbor Day”) with the R-Studio GUI (1.2.5042).

106 MBSS were included from the 6-month radiologists present (RP) period and 119 studies were included from the 6-month radiologists absent (RA) period. There were 18.9% females in the RP group and 35.3% females in the RA group with the mean age of 69.7 years and 64.4 years, respectively. No statistically significant differences were found for the average fluoroscopic time (p = 0.161), study duration (p = 0.453), number of cine loops (p = 0.075), and number of images (p = 0.3495) for RP and RA groups respectively. A statistically significant difference between the RP and RA groups was found with: the average time to generate a report [126.6 minutes versus 942.0 minutes (p <0.001)]; the number of reports taking more than 24 hours to finalize [2 (1.9%) reports versus 19 (16.0%) reports (p = <0.0001)]; and the average number of non-diagnostic images taken per study [6.5 images versus 4.5 images (p = 0.001)]. The difference in collimation score for both groups was also statistically significant (p = 0.009), with higher scores tending to occur when the radiologist was present.

MBSS performed by technologists were not inferior to those performed by radiologists on multiple outcome measures. MBSS performed without the radiologist outperformed the radiologist present MBSS in taking less non-diagnostic images and decreasing the number of irradiated non-essential anatomical structures. However, not having the radiologist present during the study led to an increase in the time taken to finalize the reports. Findings of this study support a new practice standard of a technologist operated MBSS without the presence of a radiologist, while acknowledging a need to further address radiologist report time delay.