La Radiologia medica
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La Radiologia medica · May 2000
Review[Necrotizing fasciitis of soft tissues: role of diagnostic imaging and review of the literature].
We retrospectively reviewed the diagnostic imaging findings (radiography, CT and US) of our cases of necrotizing fascitis of soft tissues looking for signs that could be useful for early and accurate diagnosis. ⋯ Early diagnosis and proper treatment are the key issues affecting the chances of recovery for patients with necrotizing fascitis. The clinical suspicion of this condition calls for prompt intervention with effective diagnostic protocols. B-mode, and sometimes color Doppler, US and contrast enhanced CT, together with appropriate laboratory tests, can provide useful information for precise diagnosis and proper treatment.
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La Radiologia medica · May 2000
Can benchmarking be applied to radiation protection? And is it useful?
Any program of protection from the ionizing radiations used for health care must ultimately lead to the total prevention of graduated effects and to the limitation of probabilistic effects to acceptable levels. The latter are the more dangerous because they may occur even at very low doses and involve the whole population including unexposed subjects; these effects may appear in the generations to come. The specific protection of the health of operators, patients, and the general population, depends on a series of physical-technical and bureaucratic-administrative factors. These must be known and applied based on precise reference standards, recommended or stated by law, as well as on appropriately regulated and controlled procedures. We chose to apply the benchmarking method to radiation protection in order to standardize and increase the efficacy of prevention and to plan, according to Deming's cycle, the continuous improvement of radiation protection performance. ⋯ Solving the operators' doubts and consequently decreasing the statistical errors and/or the cases of incorrect performance has resulted in improved rendered quality, which will be further increased after the planned replacement of substandard or unsafe equipment. Meanwhile, the early application of equipment quality controls has helped rationalize and markedly decrease maintenance costs, which results in possible technologic investment to improve emergency imaging. Greater attention to their protection has made patients feel an improvement in received quality and has increased empathy in general. Total quality, as compared with the best practice, has increased thanks to the positive stimulus from standardization, emulation and sharing, and not only to the controls performed. It is difficult to evaluate the management indices, especially the performance efficacy, that is the relationship between radiation protection and results, because the work is in progress and we still lack the actual data on the decrease in accidents at work or occupational diseases of the operators. Moreover, the epidemiological data on radiation-induced conditions will be difficult to collect and interpret, which will make the dynamics of lawsuits for unwarranted or excessive exposure a useful and more readily available piece of information. Finally, relative to economic results, we would like to stress that no additional costs have been necessary to implement safety and quality in a setting involving, directly or indirectly, thousands of people. (ABSTRACT TRUNCATED)