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PubMed1999

Technology assessment of multileaf collimation: a North American users survey.

PURPOSE: The American Association of Physicists in Medicine (AAPM) initiated an Assessment of Technology Subcommittee (ATS) to help the radiotherapy community evaluate emerging technologies. The ATS decided to first address multileaf collimation (MLC) by means of a North American users survey. The survey attempted to address issues such as MLC utility, efficacy, cost-effectiveness, and customer satisfaction. METHODS AND MATERIALS: The survey was designed with 38 questions, with cross-tabulation set up to decipher a particular clinic's perception of MLC. The surveys were coded according to MLC types, which were narrowed to four: Elekta, Siemens, Varian 52-leaf, and Varian 80-leaf. A 40% return rate was desired. RESULTS: A 44% (108 of 250) return was achieved. On an MLC machine, 76.5% of photon patients are being treated with MLC. The main reasons for not using MLC were stair stepping, field size limitation, and physician objection. The most common sites in which MLC is being used are lung, pelvis, and prostate. The least used sites are head & neck and mantle fields. Of the facilities, 31% claimed an increase in number of patients being treated since MLC was installed, and 44% claimed an increase in the number of fields. Though the staffing for block cutting has decreased, therapist staffing has not. However, 91% of the facilities claimed a decreased workload for the therapists, despite the increase in daily treated patients and fields. Of the facilities that justified MLC purchase for more daily patients, 63% are actually treating more patients. Only 26% of the facilities that justified an MLC purchase for intensity-modulated radiotherapy (IMRT) are currently using it for that purpose. The satisfaction rating (1 = low to 5 = high) for department groups averaged 4.0. Therapists ranked MLC as 4.6. CONCLUSIONS: Our survey shows that most users have successfully introduced MLC into the clinic as a block replacement. Most have found MLC to be cost-effective and efficient. The use of MLC for IMRT has progressed slower, but users anticipate escalated use.

Consumer Behavior↗
PubMed1995

The NIH consensus development program.

The NIH CDCs are a highly visible, public forum to evaluate controversial medical technologies by synthesizing current medical science data. The consensus statements, although not intended as medical practice guidelines, may form part of the database preceding guideline formulation. It is difficult to assess the effect of the conferences on physician practice, in part reflecting the interference of the many other influences, medical and nonmedical, on physician behavior. Yet the program has had some success in influencing reimbursement policy for some technologies here and abroad and in influencing specialty organization policy, thereby indirectly affecting physician behavior. On the other hand, OMAR's dissemination activities have apparently been so successful that demand for CDC statements has more than doubled over the past five years, prompting OMAR to establish an information service (including fax and the Internet). And finally, the program has spawned consensus conferences throughout the world, including Canada, Western Europe, and Israel (Goodman & Baratz 1990).

Consensus Development Conferences, NIH as Topic↗
PubMed1999

Intermediate outcomes: diagnostic and therapeutic impact.

The conceptual basis for intermediate outcomes has been established, and scientifically sound methods are available for assessment of these short-term outcomes. While modest intermediate outcomes research experience assessing imaging technology has accumulated in the literature, much more remains to be done, for the benefit of both patients and physicians. I would recommend that intermediate outcomes research become more focused on assessment earlier in the diffusion phase of imaging technology development. These studies should be based on traditional diagnostic accuracy studies, but these should be extended to include well-designed, high scientific quality treatment impact studies. Furthermore, such studies need to be multidisciplinary and multiinstitutional/multisite and include patient utility assessment components.

Attitude to Health↗
PubMed1999

Health profiles in quality of life: evaluation of diagnostic technologies.

The use of instruments to measure health-related quality of life has become commonplace in medical research, although their use is still unusual in the evaluation of diagnostic technologies. Dr Greenfield has pointed out the potential to abuse as well as use these methods. The cautions that Dr Greenfield has outlined apply to any such research, whether one is evaluating a new drug or a new imaging device. Even though the chain of events from diagnostic technology to patient outcome is longer than for therapeutic interventions, we maintain that quality-of-life instruments are potentially valuable tools for evaluating any of the links in this chain.

Back Pain↗