Developments and outcomes in Australian diagnostic imaging services.
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Australia↗
Biomedical subjects
D M Hailey
Publications and source records attributed to D M Hailey.
Initial qualitative evaluation of computed radiography in an intensive care unit.
The first computed radiography (CR) unit in Australia was installed at St Vincent's Hospital, Melbourne, in February 1994. An initial qualitative evaluation of the attitude of the intensive care unit (ICU) physicians to the CR unit was conducted in June 1994 by use of a survey. The results of the survey of ICU physicians indicated that images were available faster than under the previous system and that the use of the CR system was preferred to evaluate chest tubes and line placements. While it is recognized that a further detailed radiological evaluation of the CR system is required to establish the diagnostic performance of CR compared with conventional film, some comments on the implementation of the system and ICU physician attitudes to the CR system are put forward for consideration by other hospitals examining the possible use of CR systems.
Attitude of Health Personnel↗
Teleradiology at a children's hospital: a pilot study.
A pilot teleradiology project was conducted between the Royal Alexandra Hospital for Children in Camperdown, central Sydney, and Nepean Hospital in Penrith, about 48 km away. Over three months 575 paediatric radiographs were transmitted at full resolution. The results demonstrated that it was possible to transmit paediatric chest images of diagnostic quality in a reliable and secure manner. Mean transmission time per image was 3.26 min using ISDN, which was considered to be acceptable. Costs were calculated in terms of transmission, equipment, maintenance and staff components. The cost per image transmitted would vary from A$80 for 2500 images per year to A$34 for 10,000 images per year. The experience of the pilot study suggested that more widespread introduction of high-quality paediatric telemedicine in Australia would be feasible. Adoption of the technique would have major implications for paediatric health care, including potential improvements in patient management due to quicker diagnosis and earlier intervention, and potential savings through avoiding transfer of some emergency cases.
Confidentiality↗
Health technology assessment in Australia: a need to re-focus.
Health technology assessment in Australia has been undertaken for a number of years. While there have been many useful achievements, problems remain with the coverage and timeliness of assessments and with access to information on healthcare technologies. Further desirable developments might include greater involvement of State agencies, professional bodies and industry, and the identification of a single focus for provision of information.
Australia↗
Orthoses and prostheses.
Orthoses and prostheses include a wide range of devices and strategies for correcting and alleviating dysfunction and disability. Features in these areas of technology include continuing evolution of new devices, further development of well-established approaches, a need for critical assessment, requirements for support from technical and health care workers, and the need to identify funding to achieve efficient programs.
Persons with Disabilities↗
The cochlear implant. A technology for the profoundly deaf.
The cochlear implant is a device that enables the profoundly deaf to hear. This article considers the nature of the technology, the need for rehabilitation programs for those who are implanted and the evidence of benefits from this approach. A preliminary economic assessment suggests that costs per QALY for this technology would be of the order of $ 14,000 for children and $ 22,000 for adults. Cochlear implantation appears to be superior to vibrotactile devices, and is an effective technology for appropriately selected persons.
Adult↗
Prospects for newer technologies in cervical cancer screening programmes.
Because of the limitations of the Pap smear test, much attention has been given to development of technologies to increase the reliability of routine cervical cytology. Newer technologies in this field include automated slide preparation devices, automated slide readers, direct visualization methods and application of flow cytometry and nuclear magnetic resonance. These technologies show promise, but data on their costs, efficacy and effectiveness remain limited. Their introduction in Australia should be linked to local trials, and consideration of their impact on mortality and morbidity and on health care budgets.
Australia↗
The influence of technology assessments by advisory bodies on health policy and practice.
Assessments of 45 health technologies undertaken by Australian advisory bodies are considered in terms of the effect they have had on health care policy. The conduct and impact of the assessments was influenced by selection of topics, timing, other inputs to policy formulation and changes to policy areas and assessment agencies. Seventeen of 26 detailed assessments appear to have influenced policy, with greatest impact occurring when the technology was being introduced and there was collection of local primary data. Continued requests for the assessment reports suggests a possible longer term educational effect. All nine appraisals of proposals for nationally funded centres were influential, but the influence of guidelines for superspecialty services is less clear. Factors decreasing the influence of assessments included limitations of available policy instruments, lack of consensus between governments and professional groups and pressure of more urgent matters on the policy process.
Australia↗
The influence of health technology assessment on the diffusion of MRI in Australia.
A major assessment of magnetic resonance imaging (MRI) in Australia influenced the early use of this technology and informed policy decisions on future MRI services. However, the impact of the assessment, and of government policy, on the subsequent diffusion of MRI has been more modest, reflecting the limitations of the evaluation process in a complex health care system.
Australia↗
The effect of magnetic resonance imaging in a teaching hospital on patient management.
An observational study was undertaken to obtain measures of the impact of magnetic resonance imaging (MRI) on diagnosis, patient management and patient outcome. A minimum data set at the time of examination was used for 1119 consecutive patients referred by specialists for MRI of the brain or spine. Three month follow up of 707 brain examinations and 235 spinal examinations was undertaken using a questionnaire on diagnosis and patient management. Magnetic resonance imaging made a dominant contribution to final diagnoses of neoplasia and vascular disorders, but was less significant for white matter disease. In a high proportion of cases other types of examination also influenced the final diagnosis. Magnetic resonance imaging affected patient management in a high proportion of spinal examinations and in cases of cerebral neoplasm, with lesser contributions to cases of cerebrovascular disorder and white matter disease. While MRI was considered superior to other imaging methods, which it could often replace, in practice it will form only one input to the diagnostic decision.
Brain Diseases↗
Influences on the introduction and use of minimally invasive therapies in Australia.
Minimally invasive therapies (MIT), developed as alternatives to open surgery, offer the promise of reduction in morbidity and mortality, quicker return of patients to their normal activities and lower overall costs to society. However, minimally invasive therapies cause concern in that their comparative advantage over older methods may not always be well defined, their introduction may result in additional costs and reorganization for the institutions where they are used, and achieving adequate training of all who use them may not be easy. In this paper, the Australian experience in the introduction and assessment of some MIT is considered to illustrate a number of the issues facing those who use and fund such methods. Examples include both high capital cost technologies, such as shock wave lithotripsy and stereotactic radiosurgery, and less expensive techniques such as laparoscopic surgery.
Ambulatory Surgical Procedures↗
Laparoscopic surgery: some unresolved issues.
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Cholecystectomy, Laparoscopic↗
Assessment of costs and benefits in the introduction of digital radiology systems.
A discussion is presented of cost and benefit considerations in establishing digital radiology systems and an approach to assessment of such factors. Costs of digital radiology systems need to be defined and compared appropriately. Assessments should consider capital and replacement costs, but also less tangible items such as effects on staff and training requirements, hospital infrastructure, productivity, file integrity and diagnostic accuracy. Benefits of digital radiology systems could be assessed using cost-benefit and social audit analysis techniques, yielding a matrix of monetary items and also summaries of non-monetary benefits. Such analysis would define the major participants in the digital radiology process and the nature of their interests and assess the costs and benefits impacting on each of them. Economic evaluation of digital radiology to date has focused on the cost side of the appraisal. Analyses of benefits of digital radiology systems have been limited and have given inconclusive results. There is a need for better definition of comparative costs and benefits to inform interested parties, including hospital staff and health policy makers. Such economic analysis is an important way of asking the right questions about resource usage and could usually be carried out in a pilot setting before there is wider diffusion of digital radiology systems.
Cost-Benefit Analysis↗
Evaluation and policy considerations in the introduction of extracorporeal membrane oxygenation.
The introduction of extracorporeal membrane oxygenation (ECMO) in Australia was associated with establishment of the technology at two teaching hospitals followed by appraisal through a consensus conference and a subsequent synthesis report and cost analysis. The assessments and associated policy processes have helped to define the place of the technology, but many uncertainties remain due to limited relevance of results from other countries, the preliminary nature of local data and absence of controlled trials. This experience raises questions concerning approaches by professional groups, funding authorities and assessment agencies in dealing with specialised new techniques which are associated with a small national caseload.
Australia↗
CT and MRI scanning. Specialised imaging techniques.
Advanced diagnostic imaging methods, while offering many benefits to patients, have caused concern because of the additive nature of the technologies and their costs. The authors outline the indications for the use of computed tomography and magnetic resonance imaging, discuss costs, availability and major indications for use, and recommend increased use of imaging algorithms in the selection of diagnostic tests.
Costs and Cost Analysis↗
MRI assessment programme: a clearer picture?
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Costs and Cost Analysis↗
The introduction and evaluation of magnetic resonance imaging in Australia.
The introduction of magnetic resonance imaging (MRI) into Australia was linked to a formal assessment of the technology in public hospitals associated with restrictions on government funding. The assessment produced comprehensive data on the usage, cost and efficacy of MRI in the hospital setting. This paper summarises the major results of the assessment and considers issues related to the methodology used and the impact on the policy process.
Australia↗
Cost considerations in the provision of magnetic resonance imaging services.
Data from the Australian MRI Assessment Program, which involved five public hospitals, are presented covering the second year of operation at each MRI unit when stable conditions of service provision had become established. The data relate to two 1.5T superconductive units, one 1.0T superconductive unit and two 0.3T resistive magnetic resonance imaging units. A review of the cost data suggests the need for the operation of expensive facilities for extended periods with careful patient selection in order to reduce the average cost per scan and to maximise the clinical benefit to patients. There were variations in the conditions of use of the equipment between the differing centres and there will be a need for a consensus on optimum levels of matters such as operating times and staffing levels. As the results from the MRI Assessment Program were obtained in a teaching hospital environment with a particular referral pattern, the benefits of the technology in other situations will need further consideration.
Australia↗