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PubMed2003

Percutaneous abscess drainage: use of related radiology services and associated economic impact on a radiology practice.

PURPOSE: To evaluate the impact of percutaneous abscess drainage on the usage and professional value of subsequent services provided by a radiology practice. MATERIALS AND METHODS: Percutaneous abscess drainage was selected as a marker interventional radiology procedure because of its pervasiveness and ease of identification of related services. Billing records were reviewed for 48 consecutive patients who underwent abscess drainage during a 9-month period. Current procedural terminology (CPT) codes for all radiology services during the subsequent 90 days were analyzed to identify those related to the initial drainage procedure. Professional relative value unit (RVU) impact was calculated. RESULTS: Initial abscess drainage services were identified by 2.6 +/- 1.2 CPT codes, but patients underwent 13.4 +/- 10.7 related radiology services during the subsequent 90 days. The professional RVU impact of subsequent services was 64% higher than that of initial procedures: initial drainage services accounted for 11.5 +/- 5.1 RVUs and all subsequent related radiology services accounted for 18.9 +/- 16.8 RVUs (P =.0042). Of those, additional interventional radiology procedures amounted to 10.7 +/- 12.8 RVUs, diagnostic radiology services 4.7 +/- 4.6 RVUs, and evaluation and management services 3.5 +/- 2.9 RVUs. CONCLUSION: Basic interventional radiology services may result in far more economic impact on radiology practices than initial direct procedure analyses suggest. For percutaneous abscess drainage, the professional RVU impact of subsequent services exceeds that of the initial procedure by 64%. Practices negotiating capitated contracts for interventional services need to consider the high value of such related services.

Abdominal Abscess↗
PubMed2003

Basic characteristics of radiology practices: results from the American College of Radiology's 1999 survey.

OBJECTIVE: The basic characteristics of radiology practices in the United States are described. We defined radiology practices as diagnostic-radiology-only practices, either solo or multiradiologist practices. Findings were compared with those from other data sources. MATERIALS AND METHODS: In May 1999, the American College of Radiology surveyed 970 practices by mail using a 65-item questionnaire. A final response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. RESULTS: Approximately 4400 radiology practices existed in the country; 39% were located in nonmetropolitan or rural areas. The greatest percentage of practices (85%) was private nonacademic radiology practices. The greatest percentage of practices (43%) served only hospitals. However, solo practices were particularly likely (p < or = 0.01) to serve only nonhospital sites. Of all multiradiologist practices, 87% were completely owned by their members, but approximately two thirds of academic multiradiologist practices had outside owners. Seventy percent of multiradiologist practices interpreted images from outside clinics or groups; these averaged 3.2 outside clinics or groups for which they interpreted images. CONCLUSION: The basic characteristics of radiology practices in 1999 are described. Good agreement was seen with findings obtained from other data sources.

Data Collection↗
PubMed2001

Screening panoramic radiology of adults in general dental practice: radiological findings.

AIM: To identify the radiological findings from routine screening panoramic radiographs taken of adult (> or = 18 years) patients in general dental practice. METHOD: Forty-one general dental practitioners (GDPs) who routinely took panoramic radiographs of all new adult patients were recruited. In total, they submitted 1,818 panoramic radiographs of consecutive patients along with basic patient information, radiological reports and treatment plans. The radiographs were also reported by 'experts' (consensus of two dental radiologists). Radiological findings were recorded from the GDP assessments (dentist RY), the experts (expert RY), after exclusion of findings that would have been seen on posterior bitewing radiographs (MRY) and after exclusion of findings of no relevance to treatment (MRYT). RESULTS: There was no significant difference in age profile between the study sample and Dental Practice Board population figures (P = 0.26). No radiographs other than the panoramic radiograph had been taken for 57.1% of patients. For the GDP assessments, only 4.6% of patients had radiographs with no radiological findings, while for the experts this proportion was 3.1%. With the exception of the assessment of periodontal bone loss, the experts diagnosed significantly greater proportions of cases as having positive radiological findings. Agreement between dentist and expert assessments varied greatly. When findings from bitewing radiographs were excluded, no radiological findings were recorded on the radiographs of 17.2% of patients. When proposed treatment plans were taken into account, the majority of patients' radiographs (56.3%) had no radiological findings of relevance to treatment. CONCLUSIONS: The choice of radiographic examination for the majority of patients in the study did not follow current guidelines. Dentists diagnosed fewer abnormalities than did experts. While many radiological findings are revealed by panoramic radiography, these may either duplicate information from bitewing radiographs or are often of no significance to treatment planning. This study did not provide evidence to support the practice of routine panoramic radiography of all new adult patients.

Adult↗
PubMed2006

Proposed program guidelines for pregnant radiology residents: a project supported by the American Association for Women Radiologists and the Association of Program Directors in Radiology.

RATIONALE AND OBJECTIVES: Written institutional policies governing radiation exposure and work responsibilities for pregnant radiology residents are not uniform and often are nonexistent. Standardized program guidelines would allow residents and program directors alike to prepare for a resident pregnancy with objectivity and consistency. MATERIALS AND METHODS: The American Association for Women Radiologists (AAWR) launched a task force to revisit guidelines for the protection of pregnant residents from radiation exposure during training. We conducted two surveys of the Association of Program Directors in Radiology (APDR) membership. Survey 1 was designed to learn about existing program and institutional policies and to assess the need for and interest in standardized guidelines that would address radiation exposure and work responsibilities for pregnant radiology residents. Based on those responses, we drafted a set of program guidelines incorporating policies contributed by responding program directors. Our follow-up APDR survey, survey 2, was conducted to determine opinions and acceptance of the drafted program guidelines. Each survey was analyzed by using a proportion of means test. RESULTS: Fifty-five of 156 program director APDR members (35%) responded to survey 1. Only half the respondents had formal written policies at their respective institutions. Review of submitted policies showed widely divergent opinions about appropriate policies for pregnant radiology residents. Most (34/52; 75%) supported the development of standardized guidelines. In survey 2, 38/73 responding APDR members (53%) offered their opinions and comments on our drafted guidelines. Approximately 90% agreement was catalogued on 13 of 18 items (72%); a majority (>60%) agreed on all points, even the most controversial points concerning fluoroscopy. CONCLUSION: A minority of radiology residency programs have written policies addressing pregnancy during training. With expressed support from a majority of responding program directors, we have developed and present here proposed program guidelines for pregnant radiology residents to serve as a framework for radiology residents and program directors alike.

Data Collection↗
PubMed2001

Evidence-based radiology: a new approach to the practice of radiology.

In this review, the principles of evidence-based health care and their application to radiology are discussed. Evidence-based health care involves the more formal integration of the best research evidence with clinical expertise and explicit acknowledgment of patient values in clinical decision making, as compared with conventional practice. Recently, many health care disciplines have adopted the principles and practice of evidence-based health care. In radiology, including its diagnostic and interventional aspects, these developments have received limited attention. This review of evidence-based health care could, therefore, be useful to radiologists at any stage of their training or career, to encourage the practice of evidence-based radiology. The development of evidence-based health care is described, and evidence-based health care and evidence-based radiology are defined. The importance of evidence-based health care as a new approach to the practice of medicine and its importance for transdisciplinary collaboration are discussed. The skills required to practice evidence-based radiology are identified, and the roles of evidence-based radiology in radiologic practice, education, and research are discussed.

Diagnostic Imaging↗
PubMed2003

COMPARE radiology: creating an interactive Web-based training program for radiology with multimedia authoring software.

RATIONALE AND OBJECTIVES: Computer-based training has two primary benefits: Content can be presented interactively, and students can choose the time, place, and pace of learning. As a subject of medical education, radiology lends itself particularly well to computer-based training because of its highly visual content. To improve the efficiency of radiology training at their institution, the authors decided to create an interactive Web-based training site. MATERIALS AND METHODS: Working with a group of medical students knowledgeable in multimedia authoring, the authors used authoring software to create "COMPARE Radiology," an interactive training program that follows the modality-based structure of the undergraduate curriculum for radiology at the University of Erlangen-Nuremberg, Erlangen, Germany, and at medical schools worldwide. RESULTS: The Web-based program offers cases and exercises in radiographic anatomy at different selectable levels of difficulty, allowing users to test and build their knowledge of radiology. Pathologic images are initially presented without any further information. Additional information (patient history, laboratory results, reports from other imaging studies, and normal images for comparison) can be retrieved selectively and successively. Further information regarding the diagnosis and pathologic findings can be found by following links to external Web sites. The COMPARE Radiology program content is extended and updated regularly. The program is subject to internal peer review and can be evaluated by the user online. CONCLUSION: The authors' experience shows that a highly interactive Web-based training program for radiology, tailored to the requirements of the target group, can be developed economically by a team of medical students using an advanced storing system, with the guidance of a radiologist and without the help of professionally trained computer experts.

Computer-Assisted Instruction↗
PubMed1989

Medical student perceptions of diagnostic radiology. Influence of a senior radiology elective.

To assess the impact of a four-week elective on medical student perceptions of diagnostic radiology, we gave questionnaires to 96 senior students on the first and last days of the rotation. Eighty-five anonymous entrance responses and 73 exit responses were obtained during a 13-month interval. Compared with other clinical specialties, the students viewed radiology as third, behind surgery and medicine, in terms of required breadth of knowledge, skill, training, and "glamour." Radiology was also perceived to have the lightest workload with the exception of psychiatry. Responses did not significantly change after completion of the elective. Perceived advantages and disadvantages of radiology were studied in detail in a subset of students. Exit responses indicated that the elective promoted favorable perceptions of radiology but did not change the relative rankings of the various specialties. It appears that at our institution basic attitudes concerning radiology are formed prior to the senior radiology elective and are affected only moderately during the elective.

Attitude of Health Personnel↗
PubMed1984

The Residency Review Committee for Radiology: its organization, function, and performance in diagnostic radiology.

The accreditation process for training in radiology is managed by the Residency Review Committee for Radiology under a prescribed system. That system and the actions taken by the Committee in recent years are described. Most applications for new or continuing programs in 1975-1981 were approved. An analysis of the adverse actions of the Committee indicates the most common deficiencies were inadequate clinical experience in subspecialty areas, inadequate formal teaching, and understaffing of the clinical program. Certain trends in radiology are apparent. The numbers of programs in diagnostic and therapeutic radiology have not changed significantly over the past 5 years, whereas opportunities for training in nuclear radiology have increased greatly. The number of trainees in diagnostic radiology has increased 13% during this period; the number in radiation therapy remains unchanged. The number of women trainees in diagnostic radiology has increased from 15% to 22%, and the number of foreign graduate trainees has decreased from 19% to 11%.

Accreditation↗
PubMed2003

[Virtual organization in the digital age of radiology - principle and solution for radiologic research?].

The research project "VICORA - Virtual Institute for Computer-Assisted Radiology", funded by the German Federal Ministry of Education and Research, was initiated in the year 2000. Its virtual organization brings together physical science, engineering, information technology, clinical radiology and the medical technology industry. In the German radiology research domain VICORA serves as a model for interdisciplinary collaboration for the changing radiology paradigm illustrated by a "radiologycube". The project does not only aim at scientific goals but also considers the infrastructure, components and human resource management within a virtual organization. The common rapid prototyping platform ILAB 4 ensures user-friendly and time-efficient software that assists with the routine radiology work-flow including full DICOM functionality. By offering a new work environment and collaborative culture based on telematics and knowledge exchange in radiology research, VICORA overcomes limitations of traditional research organization.

Diagnosis, Computer-Assisted↗
PubMed2000

Activity-based costing in radiology. Application in a pediatric radiological unit.

PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

Child↗
PubMed1997

[Server World-Wide Web on the Internet for the provision of clinical cases and digital radiologic images for training and continuing education in radiology].

The Internet, as a global computer network, provides opportunities to make available multimedia educational materials, such as teaching files and image databases, that can be accessed using "World-Wide Web" client browser to provide continuing medical education. Since August, 1995, at the Institute of Radiology-University of Palermo, we developed a World-Wide Web server on the Internet to provide a collection of interactive radiology educational resources such as teaching files and image database for continuing medical education in radiology. Our server is based on a UNIX workstation connected to the Internet via our campus Ethernet network and reachable at the uniform resource locator (URL) address: http:/(/)mbox.unipa.it/approximately radpa/ radpa.html. Digital CT and MR images for teaching files and image database are downloaded through an Ethernet local area network from a GE Advantage Windows workstation. US images will be acquired on-line through a video digitizing board. Radiographs will be digitized by means of a Charge Coupled Device (CCD) scanner. To set up teaching files, image database and all other documents, we use the standard "HyperText Markup Language" (HTML) to edit the documents, and the Graphics Interchange Format (GIF) or Joint Photographic Expert Group (JPEG) format to store the images. Nine teaching files are presently available on the server, together with 49 images in the database, a list of international radiological servers, a section devoted to the museum of radiology hosted by our Institute, the electronic version of the Journal Eido Electa. In the first 12 months of public access through the Internet, 12,280 users accessed the server worldwide: 45% of them to retrieve teaching files; 35% to retrieve images from the database; the remaining 20% to retrieve other documents. Placing teaching files and image database on a World-Wide Web server makes these cases more available to residents and radiologists to provide continuing medical education in radiology.

Computer Communication Networks↗