Managed care's impact on radiology.
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Almost 400 years ago, the English writer and clergyman Robert Burton observed that "humor purges the blood, making the body young and lively, and fit for any manner of employment." Centuries later, Charles Darwin and Sigmund Freud interpreted laughter as a means of releasing surplus tension or mental anxiety. For radiology administrators, an understanding of humor and laughter from the historical, biological and psychological perspectives provides the basis for developing successful management strategies. Successful radiology administrators can incorporate humor into the workplace in a way that enhances the work environment for all. An enjoyable workplace and happy workforce ultimately enhance the radiology department's primary goal--providing quality patient care.
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The Wangensteen's proposal of the SLL is far from us, not only chronologically but, what is more meaningful, technologically. Radiology, with its digestive tract barium meal or enema, was at his time the only mean entrusted for the instrumental study of the patient, and the medical oncology was at its very dawn. The Wangensteen's purpose was to discover with a SLL the recurrence (metastasis or relapse) of the neoplastic disease after a first demolitive surgical approach, not waiting its late clinical evidence. And this on the conviction that also the recurrent neoplastic disease can be again successfully treated by surgery when early detected. Many facts have happened since the 50's, and if it is by now demonstrated true that also the neoplastic recurrence can be successfully treated by surgery--naturally for particular neoplasms and in particular localization--it is equally true that diagnostic possibilities have widely evolved permitting the non invasive detection and localization of neoplastic recurrences with remarkable accuracy. Thence the renewed possibility of a reinterventional surgery.
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The image of radiology is changing rapidly. Hospitals are chucking the old light boxes and plugging in high-performance, filmless clinical image networks that not only enhance the accuracy of diagnoses but also cut long-term costs and improve service to referring physicians.
This overview examines the principles underlying modern diagnostic imaging techniques already in use and those expected in the near future. As new techniques have become accepted, older ones such as air studies have been dispensed with. Although many of the new modes appear expensive, they give the doctor an opportunity to effect large cost savings to the community if he employs them wisely.
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During the first century since the discovery of X-rays by Roentgen in 1885, imaging technology has contributed significantly to the progress of diagnostic radiology, mainly by providing various methods and techniques for production of diagnostic images. In the next century, it is expected that imaging science and technology will contribute to the most important process of diagnostic decision makings by radiologists and physicians by providing quantitative analyses of medical images using high-speed computers. The computer output may be used as a "second opinion" to assist radiologists' interpretation of images. This concept has been investigated as computer-aided diagnosis (CAD) during the last ten years in chest radiography and mammography for detection of lesions and characterization of normal and abnormal patterns. The aim of CAD is to improve the accuracy and the consistency of radiologic diagnoses. In this article, recent results are presented on the detection of lung nodules and pneumothoraces as well as quantitative analyses of interstitial infiltrates and cardiomegaly in chest radiographs. In mammography, CAD schemes are being developed for detection of clustered microcalcifications and masses. Recently, the prototype mammography intelligent workstation has been implemented in the clinical section of our department and initial clinical results from screening cases appear promising.
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