Biomedical subjects

J T Rhea

Publications and source records attributed to J T Rhea.

80 records · Page 5Linked to original sources

PubMed1980

The disappearing ellipse: a new sign of a linear skull fracture.

A linear nondepressed skull fracture may be seen as two connecting lines because slight angulation of the beam of radiation results in separate visualization of the fracture as it crosses the outer table and then the inner table. These two lucent lines form an elliptical shape. A second projection can result in superimposition of the inner and outer table fractures, and the elliptical configuration is no longer seen. This disappearing ellipse is offered as an additional sign of a linear skull fracture which can help differentiate such fractures from vascular grooves.

Diagnosis, Differential↗

PubMed1979

The relationship of patient waiting time to capacity and utilization in emergency room radiology.

The relationship between patient waiting time and capacity and utilization is quantified. By deciding upon the average acceptable and maximum allowable waiting times, the required capacity and resulting utilization rate are fixed. The data needed for analysis include waiting time, patient volume, time required for specific types of examinations, and technologist and equipment capacity. Cost reduction is achieved without adversely affecting waiting time if volume variability can be reduced. Steps to increase productivity should also be considered as a means of reducing cost per examination, given the cost structure in emergency room radiology and the personnel costs.

Appointments and Schedules↗

PubMed1979

Errors of interpretation as elicited by a quality audit of an emergency radiology facility.

A process-oriented quality care audit was performed in a large metropolitan hospital emergency radiology facility with an annual volume of over 50,000 examinations. One aspect of the audit dealt with errors found among interpretations by radiology residents, the initial interpreters of x-ray studies. Misinterpretations were identified by staff radiologists, who checked all examinations and countersigned the reports. Error rates were correlated with duration of training and were separated as to significance and whether the errors were false-negative (omission) or false-positive (commission). The false-positive to false-negative ratio was 27:73% which is in agreement with previous studies. For all cases of errors, the significance of change in interpretation was high in 20%, moderate in 29% and low in 51%. The effect of inadequate clinical history on the rate and significance of interpretation errors was also determined. When clinical information was inadequate, the significance was high in 27%, moderate in 40% and low in 33%.

Diagnostic Errors↗

PubMed1979

Basilar pneumothorax in the supine adult.

A pneumothorax in a supine patient may outline the anterior costophrenic sulcus, resulting in an abrupt curvilinear change in density projected over the right or left upper quadrant, which is normally convex inferiorly. The upper quadrant will also appear relatively lucent. In a small pneumothorax these may be the only radiographic findings when the patient is supine. This can be easily identified on mobile-unit radiographs of limited technical quality. Either finding should lead to a prompt cross-table lateral or decubitus study to confirm the diagnosis and allow estimation of the size of the pneumothorax.

Adult↗

PubMed1978

Quality assessment and assurance in diagnostic imaging. Theoretical and practical considerations and a quality audit of the excretory urogram.

Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals.

Costs and Cost Analysis↗

PubMedDate not supplied

Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations.

PURPOSE: Our goal was to determine the sensitivity, specificity, and diagnostic value of individual signs at helical appendiceal CT. METHOD: Two hundred helical appendiceal CT scans (100 appendicitis and 100 normal appendix cases) were interpreted for individual signs of appendicitis. Scan findings were correlated with appendectomy or clinical follow-up results. RESULTS: Individual CT signs identified and their sensitivity and specificity, respectively, included fat stranding (100%, 80%), enlarged (> 6 mm) unopacified appendix (93%, 100%), focal cecal apical thickening (69%, 100%), adenopathy (62%, 66%), appendolith(s) (44%, 100%), arrowhead sign (23%, 100%), paracolic gutter fluid (18%, 86%), abscess (11%, 100%), cecal bar (10%, 100%), extraluminal air (8%, 97%), phlegmon (7%, 99%), ileal (3%, 86%) or sigmoid (3%, 95%) wall thickening, and diffuse cecal wall thickening (0%, 91%). CONCLUSION: Individual appendiceal CT signs of appendicitis vary in sensitivity, specificity, and thus diagnostic value. An enlarged appendix with periappendiceal fat stranding occurs in 93% of appendicitis CT cases. Less common but specific signs [cecal apical changes, appendolith(s) are usually present in the remaining appendicitis cases. Some signs seen with appendicitis (adenopathy, fat stranding, adjacent bowel wall thickening, fluid) can also be noted with alternative conditions, and in these cases normal appendix identification is the key to excluding appendicitis.

Abscess↗

PubMedDate not supplied

Long-term improvement in cost and quality within hospitals.

Today's hospitals face a difficult management task: they must change so that the goal of providing quality care to patients is combined with the demand of payors that care be provided at a lower cost. To successfully accomplish this, hospitals must understand the healthcare process, identifying the strengths of that process and focusing those strengths to simultaneously attain both goals. The healthcare process is characterized by a large amount of variability in the resources used for patients, even those patients with a common diagnosis. It is also characterized by customizing the care for an individual patient. As such, the provision of healthcare is difficult to standardize. A major strength of healthcare has been the ability to develop and to adopt new procedures and techniques which improve the quality of care; healthcare is flexible to change. The challenge is to use that strength--the flexibility of healthcare--to improve our performance relative to cost as well as quality.

Cost Control↗

PubMedDate not supplied

Hearing loss in skull fractures.

One hundred three cases of skull fractures in or around the temporal bone were reviewed for hearing loss. Of these, 100 patients had skull series, 66 had computed tomographic head scans, and 44 had polytomographic studies of the temporal bone. Hearing loss in head trauma can be grouped into four categories: conductive hearing loss, peripheral sensorineural hearing loss, central sensorineural hearing loss, and combinations of these hearing losses. The cause of conductive hearing loss and peripheral sensorineural hearing loss was usually identified by the type of temporal bone fracture. However, the cause of the central sensorineural hearing loss was more difficult to correlate with the brain lesions shown in the computed tomographic scans.

Adolescent↗