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RATIONALE AND OBJECTIVES: The purpose of this study was to define the current use of information technology in radiology tutorials for medical students. MATERIALS AND METHODS: The authors conducted a Web-based survey of directors of medical school courses in radiology. The survey dealt with the details of the courses and the use of computers and the Web during the courses. RESULTS: There were 48 responses. Most radiology courses were elective (73%) and were offered monthly. Most institutions (79%) had picture archiving and communication systems (PACS) available or were completely filmless. The teaching case presentations, however, often included film images displayed on a view box or by an overhead projector. Computers dedicated to student use were uncommon (28%). The Web was used infrequently as a teaching resource, and a Web site was not available in most courses. Computer technical support was variable and usually provided by the course director. Course directors at institutions with PACS were more likely to use digital technology for case presentations and more likely to use the Web for teaching purposes. CONCLUSION: Despite the widespread use of digital technology and PACS in the field of radiology, digital technology is underused in radiology courses. However, departments with PACS tend to use digital technology more frequently in education than do departments without PACS.
In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project--creating a virtual radiology environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the Meta-Manager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture (CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master Meta-Manager function to float to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the Meta-Manager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments.
AIM: To assess medical emergency radiology referral practice compared with a set of French guidelines and to measure the efficiency of computer-based guidelines on unnecessary medical imaging. MATERIALS AND METHODS: All radiological requests were computerized in the medical emergency departments of two French teaching hospitals. During control periods, radiological requests were recorded but no action was taken. During intervention periods, reminder displays on screen indicated the appropriate recommendations. Three control and three intervention periods of 1 month each were conducted. The percentage of requests that did not conform to the guidelines and variation related to periods of control and intervention were measured. RESULTS: The proportion of requests that did not conform to the guidelines was 33.2% when the guidelines were inactive and decreased to 26.9% when the recommendations were active (P < 0.0001). The three imaging examinations (chest radiographs, abdominal plain radiographs and CT of the brain) accounted for more than 80% of all requests; more than 50% of abdominal plain radiographs requests did not conform with recommendations while this percentage was respectively 24.9% and 15.8% for chest radiographs and computed tomography (CT) of the brain. Seven situations accounted for 70% of non-conforming radiological referrals; in these situations, junior practitioners' knowledge was inadequate. CONCLUSION: While the computer provided advice that was tailored to the needs of individual patients, concurrent with care, the effect of our intervention was weak. However, our study identified the few situations that were responsible for the majority of unnecessary radiological requests; we expect that this result could help clinicians and radiologists to develop more specific actions for these situations.
Maintenance of Certification (MOC) recognizes that in addition to medical knowledge, several essential elements involved in delivering quality care must be developed and maintained throughout one's career. The MOC process is designed to facilitate and document the professional development of each diplomate of The American Board of Radiology (ABR) through its focus on the essential elements of quality care in Diagnostic Radiology and its subspecialties, and in the specialties of Radiation Oncology and Radiologic Physics. The initial elements of the ABR-MOC have been developed in accord with guidelines of The American Board of Medical Specialties. All diplomates with a ten-year, time-limited primary certificate in Diagnostic Radiologic Physics, Therapeutic Radiologic Physics, or Medical Nuclear Physics who wish to maintain certification must successfully complete the requirements of the appropriate ABR-MOC program for their specialty. Holders of multiple certificates must meet ABR-MOC requirements specific to the certificates held. Diplomates with lifelong certificates are not required to participate in the MOC, but are strongly encouraged to do so. MOC is based on documentation of individual participation in the four components of MOC: (1) professional standing, (2) lifelong learning and self-assessment, (3) cognitive expertise, and (4) performance in practice. Within these components, MOC addresses six competencies: medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
There has been widespread adoption of personal digital assistants (PDAs) within medicine in recent years. However, information on the prevalence and usage of these devices among radiologists is limited. A survey was designed and mailed to randomly selected members of the Radiological Society of North America to determine the percentage of PDA users, their use patterns, and the types of applications that they would like to see in the future. The use patterns of attending radiologists were compared with those of trainees (residents and fellows). Overall usage was also compared with the relevant findings in two surveys of internal medicine users. It was found that slightly less than one-half of respondents used PDAs on a daily basis, a finding that was comparable to that in the internal medicine surveys. However, less than one-quarter of PDA users had radiology-specific applications installed on their devices, whereas a greater percentage of internal medicine users had software such as drug databases and clinical references on their PDAs. Radiology trainees had a higher rate of both PDA ownership and radiology application usage than did attending radiologists. It is likely that, as PDA hardware becomes more powerful, with higher display resolution, better wireless networking capabilities, and greater memory capacity, PDA ownership as well as radiology application usage will increase.
OBJECTIVE: This study was done to determine how often the original research published in AJR and Radiology is formally funded by external sources of explicit intramural institutional research grants and to explore the association of financial support with the subspecialty field; type of research (clinical vs basic); number of coauthors; number of departments, nonradiology departments, and institutions participating per paper; country of origin; and citation impact of investigations. MATERIALS AND METHODS: All 736 original articles published in AJR and Radiology in 1990 were surveyed. The following information was abstracted: the presence or absence of specific funding, as determined from the footnote acknowledgments given by the authors (for the 560 papers from the United States, financial support was further classified according to the funding agency listed first); the subspecialty field of research, as determined from the indexing of the paper in the table of contents; the type of research (clinical, basic, combined clinical and basic); the number of coauthors; the number of departments, nonradiology departments, and institutions participating; the first author's department (radiology, medicine, surgery, medical physics); the first author's institution (university-affiliated medical institution, medical institution not affiliated with a university, National Institutes of Health center); and the country of the first author's institution. Research impact was assessed by using citation counts. RESULTS: Only 17% of the surveyed studies were formally funded. The 95 funded studies from the United States were federally sponsored (63%), funded by private industry (11%), supported by nonprofit foundations (16%), or funded from explicit intramural institutional monies (11%). Funding was significantly related to the subspecialty field (p = .00007), the type of research (p < .000001), and the category of the first author's department (p < .000001). When papers on contrast media research were excluded from the analysis, the association of funding to the field of research became statistically insignificant (p = .21). Financial support was not significantly related to the category of the first author's institution (p = .71) or to whether the research was done in the United States (p = .71). A statistically significant positive association was found between funding and the number of coauthors (p = .013), the number of departments (p = .049), nonradiology departments (p = .004), and institutions participating per paper (p = .018). Funded papers were cited more extensively than nonfunded papers (p = .015). CONCLUSION: Only a small percentage of radiology research attracts formal, especially extramural, financial support. This should be a cause for concern. As the informal funding of investigations from redirected clinical revenues is diminishing, action will be required to procure funds to support the radiology research necessary for the vitality of the specialty.
OBJECTIVE: This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared. MATERIALS AND METHODS: In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses. RESULTS: Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs. CONCLUSION: Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.
After a retrospective history of radiology since the discovery of x-rays the development of medical radiology and the Society for Medical Radiology of the DRG are described. Cornerstones of these development are the foundation of the Society for Medical Radiology in 1954, the continuous increase of the numbers of examinations until 1974, the significantly increased availability of modern imaging methods since 1985 and the introduction of special training courses for physicians in the fields of diagnostic radiology, radiation therapy and nuclear medicine in 1988. A bibliography was compiled, containing data on the numbers of available devices, costs in medical care and the impact on life expectancy.
Two radiologists individually gave 'blind' diagnoses of benignancy or malignancy to 145 radiographic representations of gastric ulcers, all with gastrectomy histological proof of benignancy or malignancy. A radiological diagnosis of malignancy was shown to be 98-6% reliable. A diagnosis of benignancy was less reliable (85-4% true positives) but this was a surgical series containing thereby an abnormally high proportion (over a third) of malignant ulcers. A correct diagnosis was mde in 99-5% of the proven benign ulcers, but in only 68-6% of the proven malignant ulcers. Analysis of the pathology reports on the malignant ulcers has shown that it was mainly those arising on the basis of pre-existing benign ulcers (i.e. secondarily malignant ulcers) that were wrongly diagnosed radiologically, thus suggesting that they have fundamentally different radiographic appearance from that of primarily malignant ulcers. It was then found that the ulcers could be divided into three simplified radiological types based on their in-profile appearances: type 1 (projecting), type 2 (intraluminal) and type 3 (so shallow as to be neither projecting nor intraluminal). Statistical association with the histological types led to the following conclusions: (a) radiological type 2 or 3 ulcers should be diagnosed as almost certainly malignant (usually primarily malignant) and (b) radiological type 1 ulcers are almost always benign but should be followed up until healed because the rare secondarily malignant ulcers are also usually of this type.
This document is a revision of a previously published cardiothoracic curriculum for diagnostic radiology residency, and reflects interval changes in the clinical practice of cardiothoracic radiology and changes in the Accreditation Council for Graduate Medical Education (ACGME) requirements for diagnostic radiology training programs. The revised ACGME Program Requirements for Residency Education in Diagnostic Radiology went into effect December 2003.
RATIONALE AND OBJECTIVES: We surveyed program directors to determine current radiology program practices in evaluating their residents, faculty, and program. MATERIALS AND METHODS: In January 2003, a 52-item Web-based survey was made available to program directors of accredited core radiology programs. Responses to the items were tabulated to determine relative frequency distribution. Two-tailed Pearson chi-square tests were used to compare proportions and assess the association between variables. RESULTS: A total of 99 (52%) of 192 program directors responded. Programs were largely in compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements. Noncompliance was related to the requirements to evaluate residents at least four times per year in at least 22 (22.2%) of 99 programs and annually evaluate the program in 20 (20.2%) of 99 programs. New program directors (<1-year tenure) were less likely than those with >/=1-year tenure to be using the Association of Program Directors in Radiology Education Committee global rating form (41.2% versus 68.8%, P =.03). Programs that used this form, compared with those that didn't, were more likely to evaluate resident competence in systems-based practice (88.5% versus 44.0%, P =.001). Being a program director for 1 or more years versus less than 1 year was associated with using a computerized evaluation system (35.8% versus 11.8%, P =.05). CONCLUSION: In general, there is a high degree of compliance among radiology programs in meeting ACGME evaluation requirements. However, some programs do not comply with requirements for frequency of resident evaluation or annual program evaluation. The percentage of new program directors is high and related to not using or knowing about useful evaluation resources. Use of computerized evaluation systems, which have the potential to decrease the work associated with evaluations and provide more dependable and reliable data, is minimal.
Digital techniques have the potential to improve the practice of radiology but they also risk the overuse of radiation. The main advantages of digital imaging, i.e. wide dynamic range, post processing, multiple viewing options, and electronic transfer and archiving possibilities, are clear but overexposures can occur without an adverse impact on image quality. In conventional radiography, excessive exposure produces a 'black' film. In digital systems, good images are obtained for a large range of doses. It is very easy to obtain (and delete) images with digital fluoroscopy systems, and there may be a tendency to obtain more images than necessary. In digital radiology, higher patient dose usually means improved image quality, so a tendency to use higher patient doses than necessary could occur. Different medical imaging tasks require different levels of image quality, and doses that have no additional benefit for the clinical purpose should be avoided. Image quality can be compromised by inappropriate levels of data compression and/or postprocessing techniques. All these new challenges should be part of the optimisation process and should be included in clinical and technical protocols. Local diagnostic reference levels should be re-evaluated for digital imaging, and patient dose parameters should be displayed at the operator console. Frequent patient dose audits should occur when digital techniques are introduced. Training in the management of image quality and patient dose in digital radiology is necessary. Digital radiology will involve new regulations and invoke new challenges for practitioners. As digital images are easier to obtain and transmit, the justification criteria should be reinforced. Commissioning of digital systems should involve clinical specialists, medical physicists, and radiographers to ensure that imaging capability and radiation dose management are integrated. Quality control requires new procedures and protocols (visualisation, transmission, and archiving of the images).
Oral and maxillofacial radiology is a dynamic and multifaceted discipline that plays a critical role in patient care, the education of general dentists and dental specialists, and the academic health of the dental school. Diagnostic and treatment advances in temporomandibular joint disorders (TMD), implants trauma and orthognathic surgery, and craniofacial abnormalities depend heavily on conventional and advanced imaging techniques. Oral and maxillofacial radiology contributes to the education of pre- and post-doctoral dental students with respect to biomedical and clinical knowledge, cognitive and psychomotor skills, and the professional and ethical values necessary to properly prescribe, obtain, and interpret radiographs. The development of an active and successful oral and maxillofacial radiology department, division, or section requires the committment of institutional resources. This document may serve as a guide to dental schools committed to excellence in oral and maxillofacial radiology.
Over the last several years, the concept and methodology of Evidence-Based Medicine (EBM) have received significant attention in the scientific community. However, compared to therapeutic medical disciplines, EBM-based radiological publications are still underrepresented. This article summarizes the principles of EBM and discusses the possibilities of their application in radiology. The presented topics include the critical appraisal of studies on the basis on EBM principles, the explanation of EBM-relevant statistical outcome parameters (e. g., "likelihood ratio" for diagnostic and "number needed to treat" for interventional procedures), as well as the problems facing evidence-based radiology. Evidence-based evaluation of radiological procedures does not only address aspects of cost-effectiveness, but is also particularly helpful in identifying patient-specific usefulness. Therefore it should become an integral part of radiologist training.
A basic course in emergency radiology has been developed and taught jointly to first- and second-year radiology residents and emergency medicine residents at the Medical College of Georgia. The course, comprising thirty-five lectures, was presented in a 5-month block. Both written and practical examinations were administered at the end of the course, and the course was evaluated by the participating residents. There was little overlap in examination scores between emergency medicine and radiology residents, with radiology residents scoring higher than emergency medicine residents. There was a wider gap in scores between the two groups on the practical than on the written examination. All participants considered the course useful and the material presented to be immediately applicable.
The year 1934, just over a third of the way into the first century of the x ray and of the NMA, reflected both successes and difficulties for the minority radiologist. African-Americans constituted disproportionately small numbers within the radiologic community (Fig 9), and few of them were on the AMA's approved list. Membership in major radiologic societies was lacking; many were excluded from applying for the new American Board of Radiology examination. On the other hand, the major radiology journals began to publish articles by African-American authors, a select few radiologists were on the AMA specialist list, and the first steps to board certification were appearing.
These regulations define "radiological services" for which the Medicare program provides for payment at 100 percent of reasonable charges. Section 1833(2)(1)(B) of the Act provides for the 100 percent reimbursement for "radiological services" when furnished to hospital inpatients by physicians in the field of radiology. CUrrent administrative guidelines restrict the 100 percent reimbursement to services in which X-rays or rays from radioactive substances are used. Proposed regulations published on January 25, 1979 (44 FR 5162) would have extended the 100 percent reimbursement to other diagnostic imaging services such as ultrasound. On the basis of information acquired through public comments on the proposed regulations, we have concluded that there is not sufficient reason at this time to extend the 100 percent reimbursement to services not already so reimbursed. Accordingly, these regulations follow current operating instructions and define "radiological services" as those in which ionizing radiation is used for diagnostic or therapeutic purposes.