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PubMed1997

Basic radiological system: a case study in 'appropriate technology for better health'.

Radiology continues to play an important role in diagnosis and management of disease. The provision of radiology services to rural areas has represented a challenge to rural communities all over the world, particularly in developing countries. In 1980, the World Health Organization (WHO) introduced the Basic Radiological System (BRS) project to provide the specifications for a safe, inexpensive diagnostic imaging system for rural areas, together with radiological manuals. Several manufacturers now produce imaging equipment to the WHO-BRS standard and are meeting the WHO goal for providing 'appropriate technology for better health' in rural areas of developing countries. With the improvement in access to radiological systems, the WHO is now turning to improving the provision of ultrasound manuals and equipment.

Health Services Needs and Demand↗
PubMed1979

Comparative evaluation of the effect of a high yield criteria list upon skull radiography.

Based on results of studies using high yield criteria to determine the need for skull radiography, the Utilization Review Committee of the University Hospital (UH), University of Washington, Seattle implemented a policy encouraging use of the criteria in ordering skull radiology. The Bureau of Radiologic Health of the FDA supported a project comparing skull radiology use patterns at UH, with the high yield criteria policy, and Harborview Medical Center (HMC), without a policy. Results showed an increase of around 60% at HMC since the 1972--73 academic year. At UH, there was a decrease of 40% since the 1972--73 academic year. At HMC a medical record review showed only 51 positive reports that significantly contributed to patient care, about the same rate observed in 1967. At the UH, only nine positive reports significantly contributed to patient care, with 62% compliance with the high yield criteria. A current demonstration project under the auspices of the Washington State Professional Standards Review Organization and Bureau of Radiologic Health involves implementing the high yield criteria list at both HMC and UH. After three months, out of 6,003 patient visits, skull radiography was deemed necessary in 518 cases. Of this total 181 had high yield criteria checked. There were 37 positive reports out of these and 23 examinations that made a documented significant contribution to patient care. In the group without high yield criteria, 434 cases, there were 22 positive reports but no significant contribution to patient care documented after four weeks.

Craniocerebral Trauma↗
PubMed1992

A health survey of radiologic technologists.

A health survey of more than 143,000 radiologic technologists is described. The population was identified from the 1982 computerized files of the American Registry of Radiologic Technologists, which was established in 1926. Inactive members were traced to obtain current addresses or death notifications. More than 6000 technologists were reported to have died. For all registrants who were alive when located, a detailed 16-page questionnaire was sent, covering occupational histories, medical conditions, and other personal and lifestyle characteristics. Nonrespondents were contacted by telephone to complete an abbreviated questionnaire. More than 104,000 responses were obtained. The overall response rate was 79%. Most technologists were female (76%), white (93%), and employed for an average of 12 years; 37% attended college, and approximately 50% never smoked cigarettes. Radiation exposure information was sought from employer records and commercial dosimetry companies. Technologists employed for the longest times had the highest estimated cumulative exposures, with approximately 9% with exposures greater than 5 cGy. There was a high correlation between cumulative occupational exposure and personal exposure to medical radiographs, related, in part, to the association of both factors with attained age. It is interesting that 10% of all technologists allowed others to practice taking radiographs on them during their training. Nearly 4% of the respondents reported having some type of cancer, mainly of the skin (1517), breast (665), and cervix (726). Prospective surveys will monitor cancer mortality rates through use of the National Death Index and cancer incidence through periodic mailings of questionnaires. This is the only occupational study of radiation employees who are primarily women and should provide new information on the possible risks associated with relatively low levels of exposure.

Adult↗
PubMed1986

Patient exposure trends in medical and dental radiography.

Patient exposure to medical and dental x rays has long been of interest to the radiological health community. With the cooperation of state and local agencies and professional groups, the Center for Devices and Radiological Health has conducted three major surveys of patient exposure to x rays. The latest of these surveys, the Nationwide Evaluation of X-ray Trends (NEXT), collected x-ray exposure data for each year starting in 1972. Two earlier studies, the 1964 and 1970 X-ray Exposure Studies collected x-ray data during the years these surveys were conducted. Exposure trends presented are based on results of all three studies. Major improvements in beam limitation are seen for medical and dental radiography. Since 1964, when the first nationwide survey was conducted, dental exposures have decreased about 75%. Decreases of up to one-third occurred in exposures for medical examinations. The current exposure data presented continue to show a wide variation in medical exposures. Also presented are organ doses for four organs (ovaries, testes, thyroid and active bone marrow).

Female↗
PubMedDate not supplied

[Telecommunications, health and radiology: potential synergies for the new millennium].

Healthcare telematics, or telemedicine, is a new methodology that applies the potentialities of telecommunications technologies to the needs of medicine, thereby greatly contributing to improving the management of clinical data and medical information for the benefit of the individual patient and the community at large. The fields of application of Telemedicine are becoming increasingly vast, and this gives rise to technical problems (interconnections) as well as professional, ethical, medico-legal and legal problems. The dissemination of Telemedicine will require changes to be made to the organisation and delivery of the medical/administrative services connected to the management of patient data, the remote provision of care, and the impact of Telemedicine itself (e.g. need to standardise the nomenclature for telemedicine services). In addition, it will also call for a careful analysis of costs and benefits for both healthcare providers and patients. One of the most interesting experiences in terms of impact is Teleradiology. This is neither a new discipline nor a (sub)specialty: the practice of Teleradiology must comply with the rules regulating any radiological medical act, the primary aim of which is to contribute to establishing - rapidly and accurately - a diagnosis that will affect treatment strategies. It may be anticipated that in some situations Teleradiology will significantly change the working practices of Radiology Specialists and Radiology Technicians. Because it is better to anticipate problems rather than wait for them to arise, our Scientific Society, which is always sensitive to emerging issues, intends to propose the following recommendations/guidelines for the use of Teleradiology in the common interest of the community and healthcare workers. The invitation to take part in the initiative proposed by the Italian Society of Medical Radiology (SIRM), the Italian Association of Nuclear Medicine (AIMN) and the Italian Association of Neuroradiology (AINR) was received with great satisfaction and is proof that we are working towards common goals. As on other occasions, this was reflected in the excellent collaboration between the National Radiologists' Union (SNR), the Italian Association of Medical Physics (AIFM) and the National Federation of Radiology Technicians (F.N.C.TSRM) in drafting the document. The document aims to highlight the potentialities and limitations in the use of Teleradiology and to provide a set of recommendations/guidelines, which are not, however, to be intended as strict, absolute rules. Because this field is continually evolving both in structural and regulatory terms, and because it is very difficult to establish universal criteria to rigidly define behavioural models for implementing and managing Teleradiology-related activities (which in any case fall into the category of radiological medical acts), the recommendations/guidelines proposed necessarily have an informative rather than prescriptive nature. The document starts by defining the meaning of the following currently used terms: Teleconsultation; Telediagnosis; Teledidactics. It then goes on to analyse the following aspects of Teleradiology: Technological requirements; Qualifications and training of Medical Personnel; Qualifications, training and competences of Radiology Technicians. Based on the regulations in force in Italy, these recommendations are structured in terms of rationale and possible professional issues arising from the use of Teleradiology. A section is devoted to data security and confidentiality, including legal implications, an area which is currently evolving and being studied in Italy and abroad. Finally, the professional liabilities of all the healthcare providers involved in Teleradiology (imprudence, incompetence, negligence) are outlined, as well as the responsibilities related to the necessary maintenance of equipment. The aim of the document is to propose recommendations/guidelines for the correct use and validation of Teleradiology. The Scientific Societies SIRM-AIMN-AINR and the Academic Institutions, together with the SNR, AIFM and the F.N.C.TSRM, the Regional Bodies and the Italian National Health Trusts are required to make a positive and constructive commitment to this new field, which has become the object of considerable attention and interests. While confirming that, if used correctly, this methodology will no doubt increase the overall efficiency of Diagnostic Imaging - in the primary interest of the patient's right to health - it is felt that attention should also be paid to the working practices of the Radiology Specialists and Radiology Technicians and to the training of both. It is necessary to standardise training and practice, and to make an integrated and coherent use of resources with respect to the healthcare goals we wish to attain. Many have described the undisputed advantages of Teleradiology, but there have been relatively few reports on the related risks and recommendations for its use. It is certain that an improper use of the method (forced& interpretation of the bill on complementary diagnostic activities, operational misunderstandings between Radiology Specialists and Radiology Technicians, rarefaction of the relationship between Radiologist and Patient, obligation to use teleconsultation in all situations) will lead to considerable disadvantages for all those working in the field of Radiology, specialists and radiology technicians alike. Therefore, by adopting this document, which is by no means against Teleradiology but for a rational use of the method and full awareness of what it actually implies, the Scientific Society intends on the one hand to participate actively and concretely in the process of regulating all those aspects of Teleradiology for which it is competent - rather than waiting for regulations to be imposed from above - and, on the other, to provide, through its highly qualified Study Group (Specialists in Radiology, Nuclear Medicine, Legal Medicine, Medical Physics, and Radiology Technicians), Radiologists, Specialists in Nuclear Medicine, Neuroradiologists and Radiology Technicians with practical recommendations for use/guidelines for the correct and rational performance of their (tele)radiological acts. These indications and recommendations are also being submitted to the Italian Government. Teleradiology has attracted so much attention that, even as a result of pressure from Industry, an international consensus conference is needed to regulate the rational and informed use of this new methodology.

Delivery of Health Care↗
PubMed1993

Establishment of a public docket for medical device/radiological health policy statements and operating procedure guides--FDA. Notice.

The Food and Drug Administration (FDA) is announcing that it is establishing a public docket for policy speeches, policy statements, and standard operating procedure guides pertaining to product evaluation and regulatory enforcement for its medical device and radiological health programs. The docket will operate on a 1-year trial basis and will serve both as a repository for critical policy documents generated by the Center for Devices and Radiological Health (CDRH) and as a public display mechanism for access by representatives of the industry and other interested persons. This action is one element of an overall communications initiative to ensure uniform and timely access to important information.

Equipment and Supplies↗
PubMed2003

Cancer incidence in the US radiologic technologists health study, 1983-1998.

BACKGROUND: Workers exposed to low doses of radiation can provide information regarding cancer risks that are of public concern. However, characterizing risk at low doses requires large populations and ideally should include a large proportion of women, both of which rarely are available. METHODS: Among 90305 radiologic technologists in the U.S. (77% women) who were followed during 1983-1998, data concerning incident cancer occurrence was obtained from mailed questionnaires and from death records. Standardized incidence ratios (SIRs) were computed using age-specific, gender-specific, race-specific, and calendar year-specific cancer rates from the Surveillance, Epidemiology, and End Results Program. RESULTS: The SIR for all cancers in both genders combined was 1.04 (95% confidence interval [95% CI], 1.00-1.07; n = 3292 technologists). Female technologists had an elevated risk for all solid tumors combined (SIR = 1.06; 95% CI, 1.02-1.10; n = 2168 women) and for breast cancers (SIR = 1.16; 95% CI, 1.09-1.23; n = 970 women), melanoma (SIR = 1.66; 95% CI, 1.43-1.89; n = 181 women), and thyroid cancers (SIR = 1.54; 95% CI, 1.24-1.83; n = 107 women). Male technologists experienced a decreased risk for solid tumors (SIR = 0.92; 95% CI, 0.85-0.98; n = 755 men); however, melanoma (SIR = 1.39; 95% CI, 1.00-1.79; n = 56 men) and thyroid cancers (SIR = 2.23; 95% CI, 1.29-3.59; n = 17 men) were increased. Among both genders, the risks were decreased for buccal cavity/pharyngeal cancers (SIR = 0.73; 95% CI, 0.55-0.90; n = 54 technologists), rectal cancers (SIR = 0.62; 95% CI 0.48-0.76; n = 53 technologists), and lung cancers (SIR = 0.77, 95% CI, 0.70-0.85; n = 307 technologists). CONCLUSIONS: The elevated risk for breast cancer may have been related to occupational radiation exposure. The observed excesses of melanoma and thyroid cancers may reflect, at least in part, earlier detection among medical workers with easy access to health care.

Adult↗