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PubMedDate not supplied

The impact of a physician assistant in diagnostic radiology [PA-DR] on the delivery of diagnostic radiologic clincial services.

A program to train highly selected, experienced radiologic technologists to become Physician Assistants in Diagnostic Radiology [PA-DRs] was initiated at the University of Kentucky Medical Center in 1970. The initial postgraduate year of employment in several different radiologic environments for the first twelve trainees has been evaluated. Their work activities, including examinations that otherwise would have been performed by a radiologist and the number of radiographs screened for evidence of diseases, were analyzed. Studies during their training show they perform these activities accurately. Lastly, the economic impact of PA-DRs and their acceptability to patients and other professionals were evaluated. The PA-DRs spent a majority of their time in activities for which they were trained. Calculated yearly "earnings" of the PA-DRs averaged +31,164. Their salaries ranged +18-25,000. Each PA-DR averaged saving 34% of the employing radiologist's time. They were well accepted by professional colleagues and patients.

Costs and Cost Analysis↗
PubMed1985

Integration of the Diagnostic Radiological Health Sciences Learning Laboratory films into a radiology elective for medical students.

The basic Diagnostic Radiological Health Sciences Learning Laboratory (ACR Teaching File) consists of 5000 films (1400 cases). This educational system was developed under contract with the Bureau of Radiological Health, Food and Drug Administration and made available by the American College of Radiology. We report our experience with our own course and the ACR Teaching File for medical student teaching. For 24 of 75 students, the ACR Teaching File provided the basic core film material during a fourth-year elective clerkship. We compared the ACR Teaching File films with our own film material when used in similar teaching circumstances. ACR Teaching File films, when combined with established teaching methods, proved to be satisfactory for medical student teaching.

Audiovisual Aids↗
PubMed1991

In-house testing in emergency radiology. A method for teaching and credentialling radiology residents.

Residents frequently learn emergency radiology simply by on-the-job experience. As an educational tool and as a credentialling vehicle, the authors developed an examination consisting of imaging unknowns as well as written questions. The authors have administered the test each of the last three years. After initial apprehension, the residents became comfortable with the annual examination. They now regard the follow-up conferences as the best-organized instruction in emergency radiology in the training program. The authors' experiences suggest that in-house examinations can serve as an important means for teaching and credentialling in emergency radiology.

Credentialing↗
PubMed1993

The General Electric-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF). An industry-academic collaboration to improve clinical research in radiology.

The association of GE Medical Systems and the AUR represents a unique collaboration between academic radiology and industry that bears important potential for elevating the quality of clinical research in radiology and developing a cadre of high-quality radiologist researchers for the future. The establishment of the GERRAF is especially timely given the new imperatives of the rapidly changing health care environment, with its emphasis on expenditure reduction. The ultimate goals of GERRAF are to develop research leaders for radiology that will provide guidance for appropriate clinical practice, better train future researchers, and secure the role of radiologists in caring for patients.

Fellowships and Scholarships↗
PubMed2001

2000 RSNA annual oration in diagnostic radiology: The future of interventional radiology.

Origins in imaging, procedural emphasis, and dependence on innovation characterize interventional radiology, which will continue as the field of image-guided minimally invasive therapies. A steady supply of innovators will be needed. Current workforce shortages demand that this problem be addressed and in an ongoing fashion. Interventional radiology's major identity problem will require multiple corrective measures, including a name change. Diagnostic radiologists must fully embrace the concept of the dedicated interventionalist. Interspecialty turf battles will continue, especially with cardiologists and vascular surgeons. To advance the discipline, interventional radiologists must remain involved in cutting-edge therapies such as endograft repair of aortic aneurysms and carotid stent placement. As the population ages, interventionalists will experience a shift toward a greater emphasis on cancer treatment. Political agendas and public pressure will improve access to care and result in managed health care reforms. Academic centers will continue to witness a decline in time and resources available to pursue academic missions. The public outcry for accountability will result in systems changes aimed at reducing errors and process changes in the way physicians are trained, certified, and monitored. Evidence-based medicine will be the watchword of this century. Interventional radiology will maintain its role through development of methods for delivery of genes, gene products, and drugs to specific target sites; control of angiogenesis and other biologic processes; and noninvasive image-guided delivery of various forms of energy for ablation.

Certification↗
PubMedDate not supplied

Informatics in radiology (infoRAD): benefits of content-based visual data access in radiology.

The field of medicine is often cited as an area for which content-based visual retrieval holds considerable promise. To date, very few visual image retrieval systems have been used in clinical practice; the first applications of image retrieval systems in medicine are currently being developed to complement conventional text-based searches. An image retrieval system was developed and integrated into a radiology teaching file system, and the performance of the retrieval system was evaluated, with use of query topics that represent the teaching database well, against a standard of reference generated by a radiologist. The results of this evaluation indicate that content-based image retrieval has the potential to become an important technology for the field of radiology, not only in research, but in teaching and diagnostics as well. However, acceptance of this technology in the clinical domain will require identification and implementation of clinical applications that use content-based access mechanisms, necessitating close cooperation between medical practitioners and medical computer scientists. Nevertheless, content-based image retrieval has the potential to become an important technology for radiology practice.

Humans↗
PubMed1979

Radiology in Nicaragua: Lessons from a radiologic paramedic training effort.

The authors, during repeated visits and a sabbatical period, participated in the initiation of a program to train radiologic technologists in Nicaragua. The training program, its objectives, and the level of development of Nicaraguan radiology in 1977-1978 are described. The results achieved and problems encountered are discussed. Although the training was effective, all of the goals could not be accomplished because of political unrest. Nevertheless, lessions were learned and conclusions reached concerning future efforts to improve radiologic services in countries such as Nicaragua. These relate to economics, language barriers, governmental control, and the attitudes of native physicians and radiologists.

Allied Health Personnel↗
PubMed2000

Evaluation of SNOMED3.5 in representing concepts in chest radiology reports: integration of a SNOMED mapper with a radiology reporting workstation.

Standardized medical terminologies are gaining importance in the representation of medical data. In this paper, we present the evaluation of the SNOMED3.5 medical terminology to code concepts routinely used in chest radiology reports. Integration of this terminology mapper into a radiology reporting workstation that incorporates a speech recognition system and a natural language processor is also discussed. A total of 700 anatomical location terms (including synonyms) were tested and 72% of the terms had corresponding SNOMED terms. Of the 28% that did not result in a match, 16% were either morphological variants of SNOMED terms or could be found from a combination of terms from two or more SNOMED axes. Only 12% of the terms (primarily specialized radiology terms) were concepts not actually included in the SNOMED terminology.

Humans↗
PubMed2000

HIPAA security: compliance in radiology--an academic radiology department's plan contrasted with a small private practice.

In complying with the HIPAA security regulations, the large, multi-site academic radiology department is quite different from the small, private radiology practice. This article compares and contrasts the methods each of these two model organizations use to achieve compliance. In common between the two organizations is that complete documentation of the procedures and processes involved in data management must be prepared and reviewed. Although not required in the regulations, having the documentation conform to the regulation allows for easy monitoring, auditing, and certification of compliance by future independent bodies. The level to which each organization must secure their data, perform threat assessments, and implement security procedures and intrusion detection systems are very different. The regulations do not specify what level of due diligence is required. This must be determined by each organization using their own common-sense dictum. Although the solutions used by these two types of organizations may not be the same as those adopted by other radiology departments and practices, the approaches may still serve as useful templates to guide compliance efforts by others.

Academic Medical Centers↗
PubMed2003

Optimized delivery radiological reports: applying Six Sigma methodology to a radiology department.

PURPOSE: To optimise the process of reporting and delivering radiological examinations with a view to achieving 100% service delivery within 72 hours to outpatients and 36 hours to inpatients. To this end, we used the Six Sigma method which adopts a systematic approach and rigorous statistical analysis to analyse and improve processes, by reducing variability and minimising errors. More specifically, our study focused on the process of radiological report creation, from the end of the examination to the time when the report is made available to the patient, to examine the bottlenecks and identify the measures to be taken to improve the process. MATERIALS AND METHODS: Six Sigma uses a five-step problem-solving process called DMAIC, an acronym for Define, Measure, Analyze, Improve and Control. The first step is to define the problem and the elements crucial to quality, in terms of Total Quality Control. Next, the situation is analysed to identify the root causes of the problem and determine which of these is most influential. The situation is then improved by implementing change. Finally, to make sure that the change is long-lasting, measures are taken to sustain the improvements and obtain long-term control. In our case we analysed all of the phases the report passes through before reaching the user, and studied the impact of voice-recognition reporting on the speed of the report creation process. RESULTS: Analysis of the information collected showed that the tools available for report creation (dictaphone, voice-recognition system) and the transport of films and reports were the two critical elements on which to focus our efforts. Of all the phases making up the process, reporting (from end of examination to end of reporting) and distribution (from the report available to administrative staff to report available to the patient) account for 90% of process variability (73% and 17%, respectively). We further found that the reports dictated into a voice-recognition reporting system are delivered in 45 hours (median), whereas those dictated using a dictaphone take 96 hours: voice-recognition reporting systems therefore improve performance by 50 hours. Unfortunately, 38% of our reports are delivered within longer timeframes than the 72h for outpatients and 36h for inpatients agreed with the service users. Reports for inpatients have much faster delivery times and lower variability, as 95% of these examinations are reported using voice-recognition reporting (as a result of the greater sensitivity of physicians to the problem of inpatient waiting times). For conventional radiology examinations, numerically greater than CT or MRI, there is a stronger tendency to use the dictaphone which allows for faster dictation as it is unburdened by administrative tasks such as entering examination codes, correcting errors, etc. Freelance status has no impact on report delivery times, service delivery being the same as in the institutional setting. The subprocess of reporting is strongly affected by the choice of reporting method (voice-recognition system or dictaphone), whereas report delivery is affected by the individual's behaviour patterns and ultimately by habits generated by the lack of a clearly charted process (lack of synchronisation among the various phases), and therefore potentially avoidable. DISCUSSION: The analytical study of the various phases of examination reporting, from writing to delivery, allowed us to identify the process bottlenecks and take corrective measures. Regardless of imaging modality and individual physician, examination reporting consistently takes longer when a dictaphone is used instead of a voice-recognition reporting system, as this makes the process more complex. To improve the two critical subprocesses whilst maintaining constant resources, a first step is to abandon the dictaphone in favour of the voice-recognition system. In addition, we are experimenting other measures to improve the collection and sorting of examinations and the delivery of reports: the technical staff take the films from the examination rooms to the reporting rooms three times a day; the radiologists collect their examinations and prepare the reports, possibly on the same day; the radiologists leave their signed reports on the table in the central reporting room; the administrative staff collect the signed reports three times a day in the morning and afternoon to be able to deliver them on the same day. CONCLUSIONS: This project has allowed us to become familiar with the principles of total quality, to better understand our internal processes and to take effective measures to optimise them. This has resulted in enhanced satisfaction of all the department staff and has laid the grounds for further measures in the future.

Humans↗
PubMed1987

The effect of an on-site radiology facility on radiologic utilization in family practice.

Family physicians around the world are increasing their use of diagnostic x-ray examinations at a time of controversy about radiologic overutilization. To explore the role of accessibility in utilization, a study was undertaken testing the hypothesis that on-site radiology facilities are an important determinant of usage. Using a historical cohort design with chart review, rates in selected groups of patients were compared between two teaching family medicine centers, one with an on-site radiology service and one without. After controlling for confounding variables, patients with chest-related diagnoses were 2.4 times more likely (P less than .05) to have a chest film in the presence of on-site facilities. Rates for the off-site examination, upper gastrointestinal series, in patients with abdominal-related diagnoses were similar (relative risk 1.34, P greater than .5) at both centers. Higher usage brought no short-term clinical benefit. It was also observed that residents overinterpreted one quarter of chest films when compared with radiologists' reports.

Community Health Centers↗
PubMed2006

Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact.

BACKGROUND: A new radiologic classification for small adenocarcinoma is necessary for discussions of limited surgical resection for peripheral lung cancer. METHODS: Between 1999 and 2003, 1,697 consecutive patients underwent pulmonary resection for lung cancer. Three hundred forty-nine of these patients with clinical stage IA lung cancer who had lung peripheral adenocarcinoma, 2 cm or less in size, were investigated retrospectively. Radiologic classification was based on the findings of thin-section computed tomographic scan such as the presence of solid and ground-glass opacity (GGO). Type 1 (n = 22), type 2 (n = 26), type 3 (n = 25), and type 4 (n = 43) show a simple GGO, an intermediate homogeneous increase in density, a halo, and a mixed area of GGO and a solid, respectively. Type 5 (n = 54) shows a solid tumor with GGO, and type 6 (n = 179) shows a solid tumor. RESULTS: There was no difference in the maximum tumor dimension among the six groups. All but 1 patient had no lymph node metastases among type 1 to 4 tumors, whereas these were found in 5% and 24% of the patients with type 5 and 6 tumors, respectively. Lymphatic invasions were rarely found in patients with type 1 to 4 tumors (p < 0.001). CONCLUSIONS: Types 1, 2, 3, and 4 are considered to be radiologic early adenocarcinoma of the lung, and their pathologic features were minimally invasive. On the other hand, type 5 and 6 tumors could have lymph node metastases and are considered to be invasive adenocarcinoma. Although limited surgical resection may be enough for type 1 to 4 tumors, anatomic pulmonary resection should be recommended for type 5 or 6 tumor.

Adenocarcinoma↗
PubMed1979

[The neuro-radiological anatomy of the normal and abnormal rat brain. I. Radiological techniques for normal anatomy (author's transl)].

In vivo and post mortem techniques for the radiological examination of normal brains have been developed, using 66 white adult rats. Aortic arch injections for survey angiograms (10 animals), selective catheterisation of the internal carotid artery (16 animals) and ventriculography by percutaneous needle puncture (20 animals) were performed in vivo; the animals survived and the examinations could be repeated. The techniques proved useful and accurate methods for the radiological demonstration of the topography and morphology of cerebral vessels and chambers; they also provided information on the function of the cerebral circulation and C.S.F. dynamics. The findings were checked and correlated by post mortem studies (20 animals) using contact radiography, micro-angiography and casts of the ventricles. As a result, extensive topographic and anatomic information concerning the cerebral vessels in the rat was obtained, including some microscopic-radiological findings. The combined use of these methods provided a basis for studying the growth of experimentally induced brain tumours and the effect of various types of treatment.

Angiography↗
PubMed1999

Diagnostic radiology of pet and wild birds: a review II. Indications of radiological examination and radiographs of pathological lesions.

The second part of the review dealing with the diagnostic radiology of pet and wild birds discusses the indications of radiological examination, the interpretation of radiographs taken of pathological lesions, and the differential diagnosis of such lesions. Radiology has paramount importance in the diagnosis of diseases affecting the skeletal, digestive, respiratory, urogenital and cardiovascular systems. Certain diseases (shortage of grits, ovarian cysts) cannot be recognized without radiography. Other conditions (e.g. Macaw Wasting Disease, renal tumours, egg retention) require this complementary diagnostic method for confirmation of a suspicion based upon the clinical signs. Radiographic examination is also indicated for follow-up of the surgical management of bone fractures and for facilitating the implantation of transponders aimed at individual identification of the birds.

Animals↗
PubMed1999

[Quality assessment of radiological diagnostic examinations from the perspective of radiological protection].

The paper presents current recommendations on radiological protection concerning medical exposure, especially during X-ray diagnostic examinations. Major factors responsible for the level of radiological risk for patients undergoing X-ray examinations are also discussed. (In Poland about 28 million X-ray examinations are performed annually.) A thorough evaluation of 18 X-ray units used in diagnostic laboratories in the Lódź district is presented. It was found that only 6 of 18 X-ray units controlled, satisfy best the evaluation criteria laid down according to the recommendations of the International Atomic Energy Agency (IAEA). The significance of satisfying individual criteria for the achievement of high quality radiological examinations was highlighted.

Health Services↗
PubMed2001

The current status of interventional radiology in Canada: results of a survey by the Canadian Interventional Radiology Association.

OBJECTIVE: To evaluate the current status of interventional radiology in Canada. METHODS: A questionnaire was sent to 28 Canadian interventional radiologists (defined as a physician who performs any type of interventional procedure, including biopsies, but excluding interventional neuroradiology) practising in both tertiary and community hospitals in the major centres in all provinces except Prince Edward Island. RESULTS: Twenty-two (79%) of 28 surveys were completed and returned, providing data about 86 interventional radiologists (IRs). IRs were performing almost all of the following procedures at their institutions: inferior vena cava filter placement, venous angioplasty, dialysis fistula angioplasty, diagnostic and therapeutic pulmonary and bronchial artery procedures, diagnostic and therapeutic procedures of the lower extremity and renal arteries, percutaneous abscess and biliary drainage procedures, percutaneous nephrostomy, and fibroid embolization. A second group of procedures, performed by both IRs and non-radiologists in most institutions, included: all types of central venous catheter placements, pleural drainage, and gastrostomy tube placement. Procedures not being performed by anyone in a number of institutions included: dialysis graft thrombolysis, varicocele embolization, transjugular intrahepatic portosystemic shunts, palliative stenting of the gastrointestinal tract, fallopian tube recannalization, and liver and prostate tumour treatments. The factors most often limiting the respondents' ability to provide a comprehensive interventional service were the interventional radiology inventory budget and the availability of interventional radiology rooms; 50% of respondents indicated the number of available nurses, technologists and IRs was also an important limiting factor. CONCLUSION: IRs in Canada still play a major role in many of the most commonly performed procedures. However, limited availability of resources and personnel in many institutions may be hampering the ability of IRs to develop new procedures.

Canada↗
PubMed1996

[Radiologic medical desktop conferences--clinical evaluation of the KAMEDIN teleradiology system in routine practice of a radiologic institute].

KAMEDIN is a teleradiology project of "Deutsche Telekom". ISDN based image transfer, visualisation and online-presentation of digital radiological images is performed. In this study the suitability of the KAMEDIN-system has been tested in a clinical environment. The software has been adapted to the requirements of radiological image visualisation. During 6 months over 50 conferences took place with an average of 36 CT-slices per patient. The amount of time was approximately 10 min for conference preparation, 20 min for image transfer and 8 min for conferencing. Software problems occurred and were solved. Image quality on the monitor as well as online presentation including "simultaneous cursors" showed high performance and achieved high acceptance by the clinicians. Thus KAMEDIN is a useful teleradiology system, especially if the system is adapted to the requirements of radiology departments.

Computer Systems↗
PubMed1998

[First experiences with the trauma radiologic PACS project at the University of Innsbruck Department of Radiology].

Radiography in an emergency setting is a demanding task, in technical as well as in logistical terms. Rapid acquisition of high quality radiographs under difficult conditions, for example severely injured patients with multi-organ trauma is important. All image data and radiological reports must be transmitted to the trauma surgeon as soon as possible. To meet these needs with the promising means of modern X-ray technology, we decided to implement a completely digital X-ray division inside the new outpatient trauma department. In the setting of an outpatient emergency department digital radiography and PACS cannot be realised without problems. We present our first experience with the installation and 10 month filmless routine in the X-ray division for traumatology outpatients at the university of Innsbruck department of radiology.

Emergencies↗