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PubMed2003

[Gastric phantom for training beginners in gastric segment (Stomap) recognition].

It is usually difficult for a beginner to understand precisely and quickly the three-dimensional (3D) construction of gastric lesions in a gastric X-ray examination with barium meal. In this study, a training-use stomach phantom was developed using the stomach segment to provide beginners with an understanding of 3D stomach construction. The hook-shaped phantom (the shape of the stomach when a patient is in the supine position) was formed by using styrene, wire, and clay. It was then coated with dental stiffening agent, and wires were attached along the stomach segment. After drying, the stomach phantom was cut off and the oil clay was removed. The phantom then was immersed in water and the oil clay was dried. After that, the phantom again was glued together with a dental stiffening agent. The usefulness of the phantom was determined by an evaluation experiment. Ten students, as observers, were selected randomly for evaluation from 40 students of the Department of Radiological Technology, College of Medical Technology, Hokkaido University. Eight films were shown to the observers, 4 films with segment and 4 films without segment. The observers checked 5 markers in different positions of the phantom and recorded the results on an answer sheet with segment picture. The significance of position recognition was identified by Wilcoxon's sign rank sum test (p=0.021) between the segment film and non-segment film.

Humans↗
PubMedDate not supplied

Cooperative ventures in a competitive environment: the influence of regulation on management decisions.

Two generalized game theory models are developed to explain observed management decisions between two large hospitals in Shelby County Tennessee within the regulatory context of competition for an advanced radiological technology pursued through the certificate-of-need process. The first model rationalizes each hospital's decision to submit competing certificate-of-need applications. The second model rationalizes the eventual joint venture agreement between the two hospitals and offers an explanation as to why the technology has yet to be acquired. The models are tested through interviews with the hospital administrators responsible for negotiating the joint venture agreement. The interviews confirm a preemptive motive behind each hospital's decision to compete and that the certificate-of-need requirement contributed to the eventual joint venture agreement.

Certificate of Need↗
PubMed1995

[The first 25 years of digestive radiology].

The first medical radiological attempts used the natural contrasts of the human body: bones of the limbs, intra-alveolar air of the lung; but as regards the abdomen, one could only observe gases or eventually calcified calculi. Whence the idea of a product opaque to the X-rays, not toxic, in order to obtain an internal cast of the various segments of the digestive tractus, making them thus visible by radiology. After little demonstrative trials of opaque sounds and capsules containing opacifying substances, there was an orientation towards the bismuth salts: sub-nitrate and carbonate generally used as therapeutical agents. In all the countries, engineers and physicians thrived to fit the equipment and experiment techniques of serial radiographies. Rieder, a radiologist from Munich perfected in 1905 the "meal" wearing his name (gruel of food and bismuth salts) adapted nearly everywhere. The radiological technology developed itself accordingly, creating progressively performant material. Finally, Paul Krause from Bonn and his team preconized in 1910 the use of insoluble baryum sulfate in watery suspension of which the purification was from now on assured. This product will be universaly used as a "gruel" or a "baryted milk" for the aesophago-gastro-duodenal transit and as a baryted enema for the examination of the colon.

Digestive System↗
PubMed2004

Intraoperative ultrasonography in patients who undergo liver resection or transplantation for hepatocellular carcinoma.

Careful staging of hepatic tumors forms the basis of appropriate selection of, and is a precondition for, customized treatment. Advances in radiodiagnostic technology have increased the sensitivity of noninvasive liver staging by means of magnetic resonance imaging (MRI), computed tomography (CT), and helical CT (HCT). Nevertheless, surgical exploration and intraoperative ultrasonography (IOUS) are considered the "gold standard." The value of HCT and IOUS was investigated in patients who underwent orthotopic liver transplantation (OLT) (group A; n=23) or hepatic resection for hepatocellular carcinoma (HCC) (group B; n=52). In group A, the results of liver imaging (HCT performed immediately before OLT, IOUS) were compared with histopathological results after 3-mm slicing of the explanted liver. In group B, patients were evaluated by CT (n=8), HCT (n=43), MRI (n=18), or both, as indicated by the respective surgeon. The results were compared with those of surgical exploration and IOUS (n=52), as well as with the pathological examination of the resected liver specimen. In group A, 52 malignant lesions were detected by histopathology. By each of the preoperative examinations (IOUS, HCT), 54 lesions were suspected of being malignant. Thirteen HCCs were missed by HCT (for IOUS: n=4) and 15 lesions were false-positive (for IOUS: n=6). Thirty-nine of 52 lesions were verified to be true-positive by HCT in contrast to 48/52 by IOUS, which resulted in sensitivities of 75% (HCT) and 92% (IOUS, P=0.017), respectively. In group B, the sensitivity of CT was 77%, HCT 90%, MR 93%, and IOUS 99% (P<0.01). In 10%, the strategy of surgical treatment was changed because of IOUS findings. IOUS offered relevant additional information in 6%. Even after sufficient preoperative evaluation, IOUS can provide additional information that frequently has a remarkable impact on surgical decision-making. Identification of HCC is commonly hampered by coexistent cirrhosis. Identification of lesions and orientation of borders to non-tumorous tissue are assessed reliably by IOUS. Thus, IOUS remains a mandatory tool in patients treated by locoregional surgical modalities such as resection, cryotherapy, and intraoperative ethanol instillation for HCC even after refinement of radiological technologies.

Carcinoma, Hepatocellular↗
PubMed1993

Mammography quality assurance. Current issues.

Some of the issues being addressed in mammography quality assurance are 1) that image quality is the most important technical aspect of mammography; 2) that image quality has improved steadily over the past two decades and will continue to improve at most mammography sites in the United States; 3) that the American College of Radiology's Mammography Accreditation Program is the best way to ensure high quality mammogram; 4) that access to high quality mammography is not geographically restricted, with over half the mammography sites in the United States now ACR accredited and another 30% participating in the accreditation process; 5) that regular and effective quality assurance, as described in the ACR Mammography Quality Control Manuals and as required of ACR accredited sites, is the only way to ensure that superior mammography image quality is maintained; and 6) that sites with higher mammography volume have better quality assurance practices and lower failure rates than others within the ACR Mammography Accreditation Program. Two bills passed by the United States Congress, the Medicare Coverage of Screening Mammography (1990) and the Mammography Quality Standards Act (1992), contain mammography quality assurance provisions. As a result of the 1990 Medicare bill, on-site inspections of Medicare screening sites began in the fall of 1992. The Mammography Quality Standards Act is scheduled to go into effect on October 1, 1994. The current challenges to mammography are to improve and maintain high image quality at every mammography site, to improve imaging of the dense breast, to implement patient-tracking and follow-up mechanisms to improve compliance and assess the efficacy of screening, and to ensure that federal mammography quality standards are effectively and appropriately implemented.

Accreditation↗
PubMed1983

Productivity-based relative value units for radiology procedures. A Delphi approach.

This paper presents a methodology to develop relative value units (RVUs) for radiology procedures. The RVUs were developed to measure and to monitor the productivity of radiologists and technologists in a large HMO. In all, 13 radiologists and 33 technologists participated in a Delphi process to develop relative weights for 595 procedures in eight different radiology modalities, including CAT scanner and ultrasound. The RVUs generated were readily accepted by the users and are currently being implemented in the computerized information system at the HMO.

Delphi Technique↗
PubMed2005

The influence of liquid crystal display (LCD) monitors on observer performance for the detection of nodular lesions on chest radiographs.

PURPOSE: To access the influence of liquid crystal display (LCD) monitors on the detectability of nodular lesions depicted on chest radiographs by comparing them with a high-resolution cathode ray tube (CRT) monitor. MATERIAL AND METHODS: Ten radiologists interpreted 247 soft-copy images on LCD monitors with pixel arrays of 1,024x1,280, 1,200x1,600, 1,536x2,048 and 2,048x2,560, and a CRT monitor with a pixel array of 2,048x2,560, and were asked to indicate their individual confidence levels regarding the presence of a nodule. These images were chest radiographs with and without a lung nodule from the "Standard Digital Image Database" created by the Japanese Society of Radiological Technology. The luminance distributions of all monitors were adjusted to the same, and the ambient illumination was 200 lux. Observer performance was analyzed in terms of the receiver-operating characteristics. RESULTS: No significant statistical differences in nodule detection performance were found among the four LCD monitors and the CRT monitor. CONCLUSION: The nodule detection performance on the LCD monitors with a spatial resolution higher than a matrix size of 1,024x1,280 was found to be equivalent to that on the high-resolution CRT monitor.

Analysis of Variance↗
PubMed2005

The radiology assistant: a contrarian's view.

Recent and rapid increases in the utilization of diagnostic imaging have not been matched by concomitant additions to the supply of radiologists and radiology technologists. One proposal to alleviate an expected worsening of this emerging workforce crisis is to create a new job category, the radiology assistant (RA), encompassing a roster of enhanced capabilities that would allow the radiologists to divest themselves of some of their non-interpretative duties with respect to the performance of imaging tests. Through the collaborative efforts of the American College of Radiology and the American Society of Radiology Technologists a nationally recognized, baccalaureate-level curriculum has been designed for the training of RAs. A centerpiece of the curriculum is instruction in fluoroscopy. However, examinations of the GI tract by fluoroscopy are rapidly declining in frequency, raising doubt about the enhanced value an RA would bring to a radiology practice in the near future and worries about encroachment on the range of radiologists' responsibilities over the long term.

Diagnostic Imaging↗
PubMed2006

Systematic approach to human error in radiology.

We propose a systematic approach to human errors in radiology. We consider perceptual, cognitive and system errors. Practical aspects with psychological and clinical involvement are discussed with tree diagrams.

Clinical Competence↗
PubMed1988

Congenital arteriovenous malformation of the female pelvis: a gynecologic perspective.

Nine female patients with the rare congenital arteriovenous malformation of the pelvis were treated at New York University Medical Center in the past 8 years. The patients varied significantly in the anatomic location of the arteriovenous malformation, clinical presentation, and natural course of disease. A gynecologic perspective on the management of this condition is presented, which ranges from a conservative approach with preservation of childbearing potential to extensive pelvic surgery. The important role of modern interventional radiology technology and the multidisciplinary approach are stressed. The unpredictable course of disease after any intervention should be emphasized in planning the management of pelvic arteriovenous malformation.

Adult↗
PubMedDate not supplied

Severe head injury: should expected outcome influence resuscitation and first-day decisions?

An early 'prognosis' based on initial findings can influence clinical decisions. To evaluate the quality of first-day outcome prediction based on either clinical or neuroradiological information, we prospectively examined 100 consecutive severely head-injured patients from the surgical intensive care unit. The prognoses were always made by the same experienced neurosurgeon and neuroradiologist according to a contracted Glasgow Outcome Scale (GOS). Every patient's outcome was predicted according to a three-class GOS within 24 h after injury. Correct 'first-day' prognoses were made in 59 and 56% of the cases by the neuroradiologist and neurosurgeon, respectively. In those instances where the prognoses made by the clinician and the radiologist coincided, the prognoses were correct for 73% of the patients. Based on accepted criteria, the neuroradiologist tended to overpredict favorable outcomes and missed many of the unfavorable outcomes (dead or vegetative) whereas the clinician overestimated unfavorable outcomes. Our study showed that outcome prognosis of patients with severe head injury has limited accuracy when made within 24 h after the injury, although an improvement in accuracy occurred when there was agreement between clinical and radiological predictions. Even with sophisticated clinical and radiological technologies, it is not possible to predict outcome on the first day after the accident with sufficient accuracy to guide early management.

Adult↗