No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The Effects of Including a Patient's Photograph to the Radiographic Examination
Abstract
PURPOSE
To evaluate the effects of adding the patient's photograph on the radiographic workup.
METHOD AND MATERIALS
A total of 1,137 CT examinations where performed at a single tertiary-care hospital in January, 2008. Two hundres and sixty-seven patients referred for CT agreed to being photographed prior to the examination. Mean patient age was 62.9 years (range 20-95). These patients comprised the study group, and their pictures were added to their file in the PACS. The photographs appeared automatically when opening the file. Fifteen radiologists who interpreted the examinations were asked to complete a questionnaire composed for the purpose of this study addressing their attitude toward the examinations after seeing the patients’ pictures. In order to assess the effect on the interpretation, 30 examinations from the study group containing incidental findings were shown again in a blinded fashion to the same radiologists after 3 months without the patients' photographs.
RESULTS
All radiologists felt more empathy to the patients after seeing the photograph. The photographs revealed medical information such as suffering or physical signs of disease. Out of the 30 cases which were presented twice, in 80% the incidental findings were not reported when the photograph was omitted from the file. All radiologists involved reported that the addition of the photograph did not lengthen the duration of the examination, however did render the interpretation more meticulous. All recommended adopting this idea to routine practice.
CONCLUSION
The addition of a patient's photograph to the radiographic images may be beneficial in interpreting examinations when the radiologist is not in physical contact with the patient. Further research with larger sample sizes is required, in order to verify the significance of this study.
CLINICAL RELEVANCE/APPLICATION
Radiologists often review CT images at a later time or from remote locations and lack physician patient contact. Addition of a photograph enables a more personal approach.
... Other small studies (sample size of less than 50) assessing the impact of having patients' photographs available at the time of radiologists' interpretation of imaging showed no significant difference in the presence and number of clinically significant findings, when compared to studies without attached patient's photographs [15]. However, the impact on reporting of incidental findings and recommendations were controversial with another study showing longer reports including more incidental findings and more recommendations after addition of patients' photographs to imaging [16]. However, both of these studies reported increased Bpersonalization^of the reporting process and feeling of empathy and responsibility in radiologists [15,16]. ...
... However, the impact on reporting of incidental findings and recommendations were controversial with another study showing longer reports including more incidental findings and more recommendations after addition of patients' photographs to imaging [16]. However, both of these studies reported increased Bpersonalization^of the reporting process and feeling of empathy and responsibility in radiologists [15,16]. ...
... Concerns have been raised that addition of photographic IDs may impact radiologists' workflow and diminish report productivity by nearly half the radiologist respondents in our study. However, prior observer studies on integrating photographic IDs with imaging had demonstrated minimal potential impact on interpretation times [7,8,16]. Additionally, 33 % of radiologists in the current study believed that photographic IDs might be distracting. ...
Integrating digital facial photographs of pediatric patients as identifiers (ID) with medical imaging (integrated photographic IDs) may increase the detection of mislabeled studies. The purpose of this study was to determine how different stakeholders would receive this novel technology. Parents or guardians of patients in a children's hospital outpatient radiology department, radiology faculty and residents, and radiology technologists and nurses were asked to complete a survey. The perception about the anticipated use of integrated photographic ID in different clinical scenarios was investigated, and its predictors were determined using logistic regression analysis. Four hundred ninety-eight parents responded (response rate 83 %); 96 and 97 % supported the use of integrated photographic ID, if it improves the radiologist's imaging interpretation or decreases the rate of mislabeled errors, respectively. Thirty-eight percent were worried that photographic IDs would impact patients' privacy. Ninety-four percent believed that they should be asked for their consent prior to obtaining their child's photograph. Seventy-eight radiologists responded (response rate 39 %); 63 and 59 % believed that the use of integrated photographic ID would result in improvement in accurate interpretation of images and identification of mislabeled patient errors, respectively. Forty-nine percent of radiologists had concern that integrated photographic ID would increase interpretation time. Fifty technologists and nurses responded (response rate 59 %); 71 and 73 % supported the technology if it resulted in more acute interpretation of images and identification of mislabeled patients, respectively. A majority of stakeholders support integrated photographic ID in order to improve safety. A majority of parents believe that consent should be obtained.
... However , the effect of patient photographs on the content of radiology reports has been investigated (to our knowledge) in only one prior study. In an unpublished analysis of 30 selected CT studies with incidental findings, Turner and Hadas-Halpern [7] demonstrated that radiologists provided longer reports, included more incidental findings, and made more recommendations when reporting images with attached patient photographs . In a separate questionnaire study of 267 cases with patient photographs , they found that radiologists felt more empathy for patients, were subjectively more meticulous in reading scans, and subjectively gained additional medically important information. ...
... We aimed to investigate the reproducibility of these findings in a North American health care setting, to classify abnormalities in terms of clinical relevance, and to evaluate the effect of patient photographs on reporting clinically important findings. Our study did not reproduce the findings of Turner and Hadas- Halpern [7] . No significant difference was observed in the presence and number of findings reported on studies with or without attached patient photographs, for any category of clinical significance. ...
... This could not be attributed to use of template reporting or fellows or residents coreporting the first read. We speculate that this finding could represent increased " personalization " of the reporting process, as suggested by Turner and Hadas-Halpern [7]. Viewing patients' photographs may promote feelings of empathy and responsibility in radiologists and remind them that they are dealing with people, not just scans. ...
... Interventions leveraging salience have been effective in modifying physicians' behavior in other healthcare contexts. For example, radiologists provided longer, more detailed reports when patient photographs were attached to the X-rays (11). In the example of N-acetylcysteine shortages, when physicians electronically enter a prescription, this could trigger a prompt that informs them about the shortage of N-acetylcysteine, displays a picture of the face of a jaundiced patient with liver failure from acetaminophen toxicity, and lists treatment alternative strategies for the prevention of contrast-induced nephropathy. ...
... However, in the absence of IL-12, IL-18 induces the release of Th2 and Th17 cytokines from activated Th1 cells and other leukocytes (9). Prior studies have linked IL-18 to COPD pathogenesis because IL-18 levels are increased in blood and lung samples from patients with COPD and correlate negatively with lung function (10)(11)(12), and IL-18R-a 2/2 mice are protected from cigarette smoke-induced airspace enlargement (10). However, until now, it has not been clear whether IL-18 contributes to other COPD lung pathologies. ...
... For this task, we augment inputs with algorithmic advice in the form of an 'avatar' framed as conveying through its facial expression information that is relevant to the conditional outcome of giving a loan. Facial expressions have been used successfully to represent and augment multivariate data [57,63,10], but by manually mapping features to facial components (whereas we learn this mapping). We use realistic-looking faces, with the goal of harnessing innate human cognitive capabilities-immediate, effortless, and fairly consistent processing of facial signals [26,33,62,23] -to successfully convey complex high-dimensional information (see Fig. 5 and Appendix for details). ...
We propose a new, complementary approach to interpretability, in which machines are not considered as experts whose role it is to suggest what should be done and why, but rather as advisers. The objective of these models is to communicate to a human decision-maker not what to decide but how to decide. In this way, we propose that machine learning pipelines will be more readily adopted, since they allow a decision-maker to retain agency. Specifically, we develop a framework for learning representations by humans, for humans, in which we learn representations of inputs ("advice") that are effective for human decision-making. Representation-generating models are trained with humans-in-the-loop, implicitly incorporating the human decision-making model. We show that optimizing for human decision-making rather than accuracy is effective in promoting good decisions in various classification tasks while inherently maintaining a sense of interpretability.
... In a study where radiologists had to examine CT scans with and without an accompanying photograph of the patient, it was shown that the radiologists felt more empathy towards the patients when they had seen their photographs (Turner and Hadas-Halpern 2008). Obviously, there were no photographic counterparts to the visualisations in Ancient lives. ...
The British Museum’s exhibition Ancient lives, new discoveries (2014–2015) is analysed from the point of view of how medical imaging was used to convey new knowledge about mummies and ancient history to the general public. Real mummies were on display together with interactive visualisations. The dramaturgy was based on eight mummies’ life stories and the audience was encouraged to identify with the mummies as individuals. However, the article argues that the visualisations are not neutral tools, but are based on a certain way of seeing, what Michel Foucault called the ‘medical gaze’ – a distancing gaze applied by doctors that separates the body of the patient from the individual. The prestige and credibility claims of the visualisations are also discussed, as well as the performative and interactive aspects of the exhibition. The article concludes by suggesting that visitors could oscillate between two positions, peers and doctors, and that a third position, as a new kind of discoverer, is a latent possibility.
... Even small interactive behaviors (e.g., nodding to participants) can increase anthropomorphic perceptions of robots. Participants' increased respect and sympathy for Interactive robots falls in line with results suggesting that humanization increases empathy toward a target [23]. Interactive robots may be more useful in situations where empathy can be used to enhance collaboration. ...
Human-robot interaction is increasingly likely in workplaces in the near future. In “co-working” relationships, humans may appreciate socially interactive robots for their anthropomorphic likeability, or functional robots for their strict task orientation. The current study examines the comparative perceived advantages of robots that behave interactively or functionally towards humans during a task with a superordinate goal. Survey results from 33 participants assessed perceptions of, and perceived cooperation with, robots during the task. Results indicated that participants stood physically closer to and rated Interactive robots as more anthropomorphic, sympathetic, and respected than Functional robots, but they did not rate the two types of robots differently in terms of cooperation. The more participants anthropomorphized, sympathized with, and respected the robots, the more willingness they reported to working with robots in the future.
... An unpublished study has shown that the inclusion of photographs with medical imaging studies resulted in longer reports with more incidental findings noted in these reports (24). ...
Rationale and objectives:
To increase detection of mislabeled medical imaging studies, evidence shows it may be useful to include patient photographs during interpretation. This study examined how inclusion of photographs impacts visual search.
Materials and methods:
Ten radiologists participated. Average age was 43.00 years and average years Board-certified was 9.70, with 2 residents, 1 general, 2 abdominal, 4 cardiothoracic, and 1 pediatric radiologist. They viewed 21 portable chest radiographs with and without a simultaneously acquired photograph of the patient while visual search was recorded. Their task was to note placement of lines and tubes.
Results:
Presence of the photograph reduced the number of fixations (chest radiograph only mean 98.68; chest with photograph present 80.81; photograph 10.59; p < 0.0001) and total dwell (chest radiograph only mean 30.84 seconds; chest radiograph with photograph present 25.68; photograph 3.93; p < 0.0001) on the chest radiograph as a result of periodically looking at the photograph. Overall viewing time did not increase with addition of the photograph because time not spent on the radiograph was spent on the photograph. On average, readers scanned from the radiograph to the photographs about four times during search. Men and non-cardiothoracic radiologists spent significantly more time scanning all the images, including the photographs. Average preference for having photographs was 6.10 on a 0-10 scale, and neck and chest were preferred as areas to include in the photograph.
Conclusion:
Photographs may help with certain image interpretation tasks and may help personalize the reading experience for radiologists without increasing interpretation time.
... An unpublished study has shown that the inclusion of photographs with medical imaging studies resulted in longer reports with more incidental findings noted in these reports (24). However, such results of longer reports and inclusion of more incidental findings after the introduction of photographs could not be replicated in a recent North American study (25). ...
To increase detection of mislabeled medical imaging studies evidence shows it may be useful to include patient photographs during interpretation. This study examined how inclusion of photos impacts visual search. Ten radiologists viewed 21 chest radiographs with and without a photo of the patient while search was recorded. Their task was to note tube/line placement. Eye-tracking data revealed that presence of the photo reduced the number of fixations and total dwell on the chest image as a result of periodically looking at the photo. Average preference for having photos was 6.10 on 0-10 scale and neck and chest were preferred areas.
... The experimental food allergy alert card included a photograph of a patron with food allergies. The image was intended to increase food service workers' engagement and motivation by amplifying the salience of food allergy and invoking concern for a specific customer (Blumenthal-Barby & Burroughs, 2012), just as patient photographs embedded in medical charts have been shown to increase radiologists' engagement in their work and to improve the accuracy and detail of their reports (Turner & Hadas-Halpern, 2008). Additionally, research on philanthropic giving has documented that people feel more empathy and give more to a cause when they see an associated photograph of an adversely affected individualdfor example, a single hungry child (Small & Verrochi, 2009). ...
... The idea of including photographs with medical imaging examinations was explored earlier by Turner and Hadas-Halpern (16), where they showed that the addition of photographs to computed tomography scans increased both the word length of radiologists' interpretation and the number of incidental findings that were reported. Unlike our study, their study did not assess the added value of photographs as an aid in detection of wrong-patient errors. ...
Rationale and objectives:
To evaluate whether the presence of facial photographs obtained at the point-of-care of portable radiography leads to increased detection of wrong-patient errors.
Materials and methods:
In this institutional review board-approved study, 166 radiograph-photograph combinations were obtained from 30 patients. Consecutive radiographs from the same patients resulted in 83 unique pairs (ie, a new radiograph and prior, comparison radiograph) for interpretation. To simulate wrong-patient errors, mismatched pairs were generated by pairing radiographs from different patients chosen randomly from the sample. Ninety radiologists each interpreted a unique randomly chosen set of 10 radiographic pairs, containing up to 10% mismatches (ie, error pairs). Radiologists were randomly assigned to interpret radiographs with or without photographs. The number of mismatches was identified, and interpretation times were recorded.
Results:
Ninety radiologists with 21 ± 10 (mean ± standard deviation) years of experience were recruited to participate in this observer study. With the introduction of photographs, the proportion of errors detected increased from 31% (9 of 29) to 77% (23 of 30; P = .006). The odds ratio for detection of error with photographs to detection without photographs was 7.3 (95% confidence interval: 2.29-23.18). Observer qualifications, training, or practice in cardiothoracic radiology did not influence sensitivity for error detection. There is no significant difference in interpretation time for studies without photographs and those with photographs (60 ± 22 vs. 61 ± 25 seconds; P = .77).
Conclusions:
In this observer study, facial photographs obtained simultaneously with portable chest radiographs increased the identification of any wrong-patient errors, without substantial increase in interpretation time. This technique offers a potential means to increase patient safety through correct patient identification.
... For instance, one study that examined the effects of adding a photograph of the patient's face onto radiological CT scans by randomly assigning some radiologists to examine the scans accompanied by the patient's face and some radiologists to examine the scans without a face attached. The radiologists who assessed the scans with patient faces gave more accurate diagnoses and fostered improved patient outcomes (Turner & Hadas-Halpern, 2008). With this intervention, radiologists wrote longer reports, reported more details, considered each CT scan in a more unique fashion, and expressed more empathy to patients. ...
Dehumanization is endemic in medical practice. This article discusses the psychology of dehumanization resulting from inherent features of medical settings, the doctor-patient relationship, and the deployment of routine clinical practices. First, we identify six major causes of dehumanization in medical settings (deindividuating practices, impaired patient agency, dissimilarity, mechanization, empathy reduction, and moral disengagement). Next, we propose six fixes for these problems (individuation, agency reorientation, promoting similarity, personification and humanizing procedures, empathic balance and physician selection, and moral engagement). Finally, we discuss when dehumanization in medical practice is potentially functional and when it is not. Appreciating the multiple psychological causes of dehumanization in hospitals allows for a deeper understanding of how to diminish detrimental instances of dehumanization in the medical environment.
© The Author(s) 2012.
... By similar logic, a recent study showed that subtle humanization of medical patients appears to improve care Social Cognition Unbound, 11 for these patients. Radiologists evaluating X-rays reported more details to patients and expressed more empathy when a photo of the patient's face accompanied the X-rays (Turner & Hadas-Halpern, 2008). One doctor praised the study's importance because advances in technology have dehumanized the patient and this simple addition of a photograph appears to counteract that dehumanization. ...
People conceive of wrathful gods, fickle computers, and selfish genes, attributing human characteristics to a variety of supernatural, technological, and biological agents. This tendency to anthropomorphize nonhuman agents figures prominently in domains ranging from religion to marketing to computer science. Perceiving an agent to be humanlike has important implications for whether the agent is capable of social influence, accountable for its actions, and worthy of moral care and consideration. Three primary factors—elicited agent knowledge, sociality motivation, and effectance motivation—appear to account for a significant amount of variability in anthropomorphism. Identifying these factors that lead people to see nonhuman agents as humanlike also sheds light on the inverse process of dehumanization, whereby people treat human agents as animals or objects. Understanding anthropomorphism can contribute to a more expansive view of social cognition that applies social psychological theory to a wide variety of both human and nonhuman agents.
... While these photographs may help with identifying wrong patients, they may lead to unintended consequences: (1) photographs may distract the reader and impair reader efficiency; (2) photographs may provide conflicting information relative to the medical images and confuse the interpreter; and (3) the interpretations may become more subjective. Indeed, preliminary work by Turner and Hadas-Halpern [23] suggested that subjectively radiologists felt more empathy towards patients when their photographs were shown along with CT examinations, but it was also noted that the reports become objectively longer and a greater number of incidental findings were reported. A survey reported in an abstract by Weiss and Safdar [24] revealed that 67 % of surveyed radiologists were not in favor of including photographs with medical images. ...
We introduce the concept, benefits, and general architecture for acquiring, storing, and displaying digital photographs along with medical imaging examinations. We also discuss a specific implementation built around an Android-based system for simultaneously acquiring digital photographs along with portable radiographs. By an innovative application of radiofrequency identification technology to radiographic cassettes, the system is able to maintain a tight relationship between these photographs and the radiographs within the picture archiving and communications system (PACS) environment. We provide a cost analysis demonstrating the economic feasibility of this technology. Since our architecture naturally integrates with patient identification methods, we also address patient privacy issues.
... Salience has also been used to nudge physicians toward better health outcomes. Attachment of patient photographs to x-rays resulted in radiologists providing longer, more detailed reports and feeling more connected to their patients (Turner and Hadas-Halpern 2008). Key to the effectiveness of salience is that the things that are made salient motivate people emotionally (e.g., fear of death or disability) or are things that the person cares about (e.g., money, avoiding losses generally). ...
Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for the utilization of each principle.
Technological advances, originating in the time of the industrial revolution and accelerating today, have alienated workers from consumers, and vice versa. We argue that this alienation and accompanying feelings of being objectified as a mere interchangeable source of profit are aversive to workers and consumers. These feelings reduce the meaningfulness and satisfaction workers find in their work and make products less attractive and consumption less meaningful to consumers. We propose simple and inexpensive interventions that can be used to make business more personal, with powerful effects on workers’ job satisfaction, product quality, and product attractiveness to consumers. Paradoxically, these interventions often rely on the same technological advances that otherwise facilitate the alienation. We specifically highlight how disclosing personal information (e.g., name, personal background) about workers and consumers can impact the motivation and performance of workers. We also highlight how disclosing personal information about workers and consumers can impact consumers’ satisfaction, preferences, and willingness-to-pay. We argue that providing personal information about workers to consumers and vice versa will often yield a win-win-win effect. As more satisfied customers buy more at higher prices, more satisfied workers do a better job, and personal information can be disclosed cheaply using information technology, companies benefit from increased sales at higher prices and at very little extra cost.
In the contemporary environment of patient- and value-centered care, it is no longer sufficient to limit the definition of an "excellent radiologist" to someone who is skilled at image interpretation. Since diagnostic radiologists are physicians, they are held to a certain character standard expected of a physician, whose primary objective is to serve the best interest of patients. An "excellent radiologist," then, is better defined as one who is both skilled at interpreting medical imaging and embodies the attributes of physician character. The concept of physician character can be understood as the interplay between the practice of the care-related virtues, such as empathy, compassion, and kindness, and cooperative efforts with nonradiologist health care team members, termed collaborative professionalism. The very nature of the work of diagnostic radiology, aided by advances in technology, increasingly isolates the radiologist from both patients and other care providers, making it difficult to find opportunities for virtuous care and collaborative professionalism. Using the moral intuitionist model of character development as a conceptual framework, we first delineate the challenges that diagnostic radiologists face in demonstrating virtuous caring and collaborative professionalism. Then, we explore strategies that diagnostic radiologists can employ to overcome these barriers, thereby cultivating their own physician character and setting an example for other radiologists, medical students, and trainees. Finally, we will examine some of the limitations of applying this theoretical model to the real world.
Purpose: A pilot study was undertaken to develop an integrated telemedicine platform for radiation oncology at Memorial Sloan-Kettering Cancer Center (MSKCC) and its regional sites. The platform consisted of a computer system with simultaneous display of multiple live data portals including 1) video-conferencing between physicians, 2) radiology, and 3) radiation treatment-planning system (RTPS). Methods and Materials: Two MSKCC regional centers were set up with a widescreen monitor, a dedicated computer, and a web camera with microphone. Each computer ran a Microsoft operating system, utilized video-conferencing software, and connected to the MSKCC Ethernet. This allowed for access to the health information system, radiology (web-based picture archiving and communication systems), RTPS, shared network drives and the internet. Results: After 3 months, physicians at two MSKCC sites were successfully able to implement the proposed telemedicine platform. A small sample of cases (prostate, breast, head and neck, and anal cases) were tested. Radiology images, radiation treatment volumes and plans, and portal images were reviewed. Side-by-side comparison of contouring techniques was performed. The platform allowed physicians to remotely review details of cases efficiently. The interactions of the telemedicine platform improved clinical understanding of each case and often resulted in contouring changes. Conclusion: From this experience, we feel that telemedicine could have a significant clinical impact on patient care, especially at centers with satellite clinics. The future goal of the system will be the development of a virtual tumor board for radiation oncologists. We envision the simultaneous display of multiple clinical components, including face photo, pathology, tumor images/videos of procedures, radiology, RTPS, and anatomy/contouring databases, on one screen surface.
If you were about to undergo a radiologic procedure, what 5 things would you want? The authors propose a construct for patient-centered radiology. Five wishes of a prospective radiology patient are described: 1) the information to choose, 2) the right examination, 3) a safe examination, 4) effective communication of correctly interpreted results, and 5) a fair price. The authors posit that the American practice of radiology would be considerably different if our profession practiced patient-centered radiology.
ResearchGate has not been able to resolve any references for this publication.