Journal of the American College of Radiology : JACR
-
Practice Guideline
Ways to improve radiologists' adherence to Fleischner Society guidelines for management of pulmonary nodules.
The aim of this study was to assess one institution's experience with radiologists' adherence to the Fleischner Society guidelines for managing pulmonary nodules incidentally detected on CT, which anecdotally was substantially higher than in a recent report. ⋯ Radiologists' recommendations for the management of pulmonary nodules incidentally detected on CT adhered to the Fleischner guidelines in 82.8% of cases, more than twice that in a recent report. This difference may reflect various practical departmental attempts to emphasize the importance of the Fleischner guidelines in reducing patient radiation and health care costs.
-
A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. ⋯ The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
-
The Physician Payments Sunshine Act (PPSA) was enacted in 2010 and requires applicable manufacturers of medical devices, drugs, biological material, or medical supplies to report payments or transfers of value that are provided to physicians or teaching hospitals. PPSA has value in creating greater transparency in the financial relationships between industry, physicians, and teaching hospitals, and in potentially reducing problematic conflicts of interest. PPSA requires that this data be published, in searchable form, on a public website. ⋯ It behooves all physicians and healthcare managers to carefully follow the CMS PPSA regulations. In advance of meeting or interacting with any PPSA-applicable manufacturer, obtain a clear and mutual understanding regarding what reportable value, if any, will be prepared for and provided by the applicable manufacturer. In this, as in all situations in which government regulations are at play, "knowledge is strength."