Journal of the American College of Radiology : JACR
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Review Comparative Study
ACR Appropriateness Criteria® right lower quadrant pain--suspected appendicitis.
The diagnostic imaging of patients presenting with right lower quadrant pain and suspected appendicitis may be organized according to age and gender and to the presence or absence of "classic" signs and symptoms of acute appendicitis. Among adult patients presenting with clinical signs of acute appendicitis, the sensitivity and specificity of CT are greater than those of ultrasound, with improved performance when CT is performed with intravenous contrast. The use of rectal contrast has been associated with decreased time in the emergency department. ⋯ 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 in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Comparative Study
Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure.
CT radiation exposure has come under increasing scrutiny because of dramatically increased utilization. Multiphase CT studies (repeated scanning before and after contrast injection) are a potentially important, overlooked source of medically unnecessary radiation because of the dose-multiplier effect of extra phases. The purpose of this study was to determine the frequency of unindicated multiphase scanning and resultant excess radiation exposure in a sample referral population. ⋯ The results of this study suggest that a large proportion of patients undergoing abdominal and pelvic CT scanning receive unindicated additional phases that add substantial excess radiation dose with no associated clinical benefit.
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Diagnostic physicians generally acknowledge their responsibility to notify referring clinicians whenever examinations demonstrate urgent or unexpected findings. During the past decade, clinicians have ordered dramatically greater numbers of diagnostic examinations. One study demonstrated that between 1996 and 2003, malpractice payments related to diagnosis increased by approximately 40%. Communication failures are a prominent cause of action in medical malpractice litigation. The aims of this study were to (1) define the magnitude of malpractice costs related to communication failures in test result notification and (2) determine if these costs are increasing significantly. ⋯ There is increased risk for malpractice litigation resulting from diagnostic test result notification. The advent of semiautomated critical test result management systems may improve notification reliability, improve workflow and patient safety, and, when necessary, provide legal documentation.
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Review Comparative Study
Safety in radiation oncology: the role of international initiatives by the International Atomic Energy Agency.
The International Atomic Energy Agency (IAEA) has a wide range of initiatives that address the issue of safety. Quality assurance initiatives and comprehensive audits of radiotherapy services, such as the Quality Assurance Team for Radiation Oncology, are available through the IAEA. Furthermore, the experience of the IAEA in thermoluminescence dosimetric audits has been transferred to the national level in various countries and has contributed to improvements in the quality and safety of radiotherapy. ⋯ The agency is also active in developing staffing guidelines and encourages advanced planning at a national level, aided by information collection systems such as the Directory of Radiotherapy Centers and technical cooperation project personnel planning, to prevent shortages of staff. The IAEA also promotes the safe procurement of equipment for radiation therapy centers within a comprehensive technical cooperation program that includes clinical, medical physics, and radiation safety aspects and review of local infrastructure (room layout, shielding, utilities, and radiation safety), the availability of qualified staff members (radiation oncologists, medical physicists, and radiation technologists and therapists), as well as relevant imaging, treatment planning, dosimetry, and quality control items. The IAEA has taken the lead in developing a comprehensive program that addresses all of these areas of concern and is actively contributing to the national and international efforts to make radiation therapy safer in all settings, including resource-limited settings.
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Comparative Study
Addenda to the radiology report: what are we trying to convey?
The aims of this paper are to describe addenda to radiology reports and to discuss the communication gaps in radiology addenda reaching referring physicians. The authors examine impediments to compliance with an addendum policy and suggest possible solutions. ⋯ Poor compliance with an addendum policy was found. The reasons for noncompliance and possible remedies are discussed, with the hope of beginning a dialogue in the radiology literature on the risks of poor communication processes and the benefits of full implementation of well thought-out addendum policies.