Biomedical subjects
Publications and source records attributed to R G Jost.
Several different computer methods have been developed to assist in the production of radiology reports. Some systems require the radiologist to interact directly with the computer; in other departments, it is the transcriptionist who types the report into a computer terminal. Automated reporting systems, if they are well designed, offer a significant benefit to most departments, providing an efficient method to produce, store, and distribute radiology reports.
Effective radiology management requires accurate, timely data about the ongoing operation of a department. Computers provide a method to assemble detailed information, and well-designed management reports can then provide the department administrator with summarized information that can be useful in identifying problems and initiating changes to reduce costs and improve the quality of patient care.
We developed an interactive computer system to support various educational uses. The system allowed numerous instructors to create lessons or tests in a flexible, personalized fashion. As a pilot project, the system was used to develop and administer a computer-driven final examination in a didactic radiology course for second-year medical students. It was our objective to change the examination into an enjoyable experience that would also bring about long-term learning gains. The computer added immediate feedback to the testing situation.
Of the 72 clinical magnetic resonance imaging (MRI) installations operating in the United States in 1985, operations data were obtained from 47. The average annual technical operating cost of each unit is estimated at $841,500 when performing 2000 clinical procedures. Most costs are fixed and the annual cost varies slightly, between $800,000 and $882,000, with procedure volumes of 1000-3000 annually. The "typical" clinical MRI unit currently is examining 1500 patients and billing 1260 patients annually with a mean technical charge of $500. Of the procedures, 77% are neuroradiologic (head and spine). Radiologists are responsible for 93% of MRI procedures. The partial-pay/bad-debt revenue deduction is high (40%). With annual technical costs of about $820,000 and net technical revenues of $378,000, the typical unit is operating at an annual economic loss of about $440,000. An economic break-even point would be met with a charge of $1100 at the current procedure volume or a volume of 2700 procedures/year at the current charge. MRI units in outpatient locations study more patients, perform considerably more spinal examinations, and have higher charges. Compared with computed tomography at a comparable stage of development, MRI has less clinical demand, more outpatient locations, three to five times higher costs, and two-and-one-half times higher charges. To achieve economic viability with a technical charge of $500 or less, increased patient volume and third-party payer acceptance to reduce the partial-pay/bad-debt revenue factor will be required.
Plain radiographic examinations were performed on 388 patients (adult and pediatric) using either a calcium tungstate or rare-earth screen. Radiographs were compared for overall image quality, mottle, contrast, density, and detail. The rare-earth screen produced radiographs with significantly more mottle than did the standard screen. However, this was almost never of diagnostic importance. A small but significant decrease in overall image quality also was found with the rare-earth screen. This was the result of minor differences between the grading of optimal and good. A major advantage of rare-earth screens is a 50% or more reduction in radiation exposure. The results here show that rare-earth screens may be used in plain radiographic examinations without a clinically important decrease in image quality.
A microcomputer system has been developed and installed at the Mallinckrodt Institute of Radiology to monitor the moment-to-moment activity in a radiology department. Data about department performances are collected, summarized, and displayed in graphs and tables on terminals at stations throughout the department. The system is currently used to monitor a wide variety of functions including patient waiting time, report production time, film-library operations, equipment maintenance, and room use. Since the displays are updated in real-time, it is possible to identify and address problems as they occur, thereby providing a method of evaluation that leads to improved performance as related to patient care.
Data are reported from 94 medical computed tomography (CT) installations that operated 153 CT units in 1981. All CT installations began operation before 1977 and are the most experienced CT facilities in the United States. Sixty-five per cent of studies are head CT, and 68% of body CT procedures are in the abdomen and pelvis. Intravenous contrast material is used in almost 70% of body and 80% of head examinations. On average, each CT unit performs 62 patient procedures in a 56 hour week and is estimated to be operating at 90% capacity. The total typical charge is $324 for head CT and $362 for body CT. CT equipment with scanning times of less than 10 seconds per image is more efficient and examines more patients per hour. CT installations are continuing to increase in overall patient volume and in the percentage of body examinations, even in the most experienced CT installations.
A minicomputer system has been developed to assist in the transcription, distribution, and long-term storage of radiology reports. Reports are dictated in the traditional manner by a radiologist and then entered into specially programmed computer terminals by a transcriptionist. Completed reports are electronically distributed throughout the department and the hospital. Inactive reports are stored by the computer on microfiche. At one institution, the system is used to produce all of the reports in the radiology department, a total of approximately 200,000 reports per year.
Of 164 excretory urograms obtained from women with a history of recurrent urinary tract infections 88 per cent were perfectly normal. Eleven (6.7 per cent) had minor, normal, anatomic variations. Nine (5.5 per cent) were considered to have positive findings but in no case a significant finding present that required surgical intervention or altered the therapeutic approach. The total cost of the studies to the patients involved was $17,930. Thus, an extremely negative cost-benefit ratio emerged. The routine use of excretory urograms as part of the evaluation of a woman with a urinary tract infection is expensive, unrewarding and has little justification.
Utilization and economic data from head computed tomography (HCT) units providing more than 2 1/2 years' experience are compared with data from installations in 1976. The average unit operates 60 hr/wk, examining 63 patients. Nearly half the examinations are "double" studies, requiring about 53 minutes. The annual total technical cost is approximately $383,000. Charges have been reduced since 1976. While technical charges are lower in high-volume institutions, professional charges are higher. Usual charges and expected net revenues are above Medicare maximum allowable charges. Most units meet the national guidelines. There is considerable variation in data from individual facilities; a "typical" HCT unit cannot be defined.
Utilization and economic data from body computed tomography (BCT) units with more than 1 1/2 years' experience are compared to data in 1977. The average unit operates 52 hr./wk., examining 34 patients. Head studies constitute 55% of examinations, abdominal and pelvic 38%. The total technical cost of examining 35 patients/wk. is approximately $384,000. Charges have been reduced since 1977 by approximately 5%; the average annual loss is about $77,000. Technical and professional charges are lower in high-volume institutions. Current Medicare maximum allowable charges are below BCT costs and charges. Only 17% of installations meet the National Guidelines of 2,500 patient examinations per year.
Three cases of oat cell carcinoma appearing as a bronchocele on the chest radiograph are described. A bronchocele as the major radiologic manifestation of oat cell carcinoma has not been emphasized previously. Such a bronchocele may be filled with neoplastic cells rather than only inspissated mucus. Needle aspiration biopsy was definitive in two of the cases when conventional diagnostic methods failed.
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Computed tomography (CT) provides a valuable new perspective in assessing abnormalities of the thorax. In the patient with a mediastinal mass or widening detected by plain chest radiography, a definitive diagnosis is sometimes possible which would not be obtainable by conventional noninvasive radiological techniques. In certain clinical situations, CT is a highly sensitive modality for examining the lungs. The proved and potential clinical uses of CT in solving diagnostic problems of the thorax are discussed.
113 cases of pancreatic and renal disease studied by both ultrasound and computed tomography (CT) were analyzed retrospectively. CT provided a diagnosis when pancreatic ultrasound was unsuccessful due to overlying bowel gas or obesity and when renal ultrasound was unsuccessful due to obesity, reverberations from ribs, small lesions, or multiple lesions. Conversely, ultrasound provided a diagnosis when CT was unsuccessful due to lack of fat planes or respiratory motion. CT usualy distinguished carcinoma from pancreatitis when ultrasound showed a focal echogenic mass. CT resolved renal cyst from neoplasm when ultrasound showed a mixed echo pattern mass.
All operating body computed tomography installations in the United States were surveyed in May 1977; data were obtained from 74 of 118 installations. Utilization and economic data from this survey are compared to similar data from January 1976. Scheduling delay data indicate that computed tomography availability is closer to meeting the clinical demand for CT studies than in January 1976; however, CT demand (as indicated by scheduling delay) is rising at installations with greater than 5 months BCT experience. The estimated annual technical cost of BCT is $359,000--$392,000 with a patient volume of 25--50 patients per week and is higher than the current net technical revenue.
Cranial computed tomography (CCT) has already been demonstrated to provide significant diagnostic information in patients with neurologic disease and to reduce the need for special neuroradiologic procedures. The important question remaining is: Should CCT replace the radionuclide brain scan (RBS) as the first diagnostic study in most patients with suspected intracranial pathology? Data are now available to define the costs and benefits of this substitution. The technical costs of CCT have been determined by a national survey and have shown to be $130 per patient at a volume of 50 patients per week. The costs of RBS at the Mallinckrodt Institute have been estimated at $51 per patient. Data from the literature indicate that CCT is slightly more sensitive and considerably more accurate than RBS. Eighteen to twenty-eight percent of patients studied by CCT and RBS have abnormalities (e.g. cerebral atrophy and ventricular dilatation) that are only detected by CCT, and the overall accuracy of CCT is 95%, while the accuracy of RBS is approximately 70%. Substituting CCT for RBS is cost-beneficial. Although CCT is more costly, it increases overall accuracy by approximately 25%. The cost benefit is further increased by the reduction of complicated diagnostic procedures (and associated hospitalization and morbidity) and improvement in diagnostic information for the individual patient. Substituting CCT for RBS may not be more costly because a positive RBS will be followed by CCT (because of increased diagnostic information), and a negative RBS may be followed by CCT (because of increased accuracy), whereas a positive or negative CCT is unlikely to be followed by RBS.