Value-Based Radiology in Canada: Reducing Low-Value Care and Improving System Efficiency.

Journal Article Skin Dose to Patients from Interventional Radiology and Cardiology Procedures with Potentially Long Fluoroscopy Times Get access R.B. Mooney R.B. Mooney Search for other works by this author on: Oxford Academic PubMed Google Scholar Radiation Protection Dosimetry, Volume 90, Issue 1-2, 1 August 2000, Pages 123–126, https://doi.org/10.1093/oxfordjournals.rpd.a033100 Published: 01 August 2000

Objective To investigate radiation dose to the patients undergoing interventional radiology and make radiation risk assessment.Methods Data was collected on 198 instances of 10 interventional radiology procedures by using Philips Allura Xper FD20 DSA, which was equipped with the transparent ionization chamber system in compliance with IEC 60601-2.Patient peak skin dose and effective dose were estimated.Results Cumulative fluoroscopy time was 2.1 - 80.9 min, and number of images monitored for PSD were above 1 Gy and 79 cases monitored for E were above 20 mSv.Conclusions Substantial number of cases exceeded the dose threshold for erythema.Due attention should be paid to radiation protection of patients. Key words: Interventional radiology; Radiation dose; Radiation protection

Highlights In the analytical review, the main pathophysiological mechanisms of myocardial infarction development are presented, including complex molecular processes that lead to ischemia and necrosis of the heart muscle. Historically, understanding of this condition has come a long way from its first descriptions to modern diagnostic and treatment methods, which have significantly improved the prognosis for patients with MI. Understanding the history and pathophysiology of myocardial infarction is key to medical practice, research, and patient education. This knowledge contributes to improved diagnosis, treatment, and prevention, which ultimately leads to improved quality of life for patients and a reduced burden of cardiovascular disease at the societal level. Abstract Understanding the historical aspects and pathophysiology of myocardial infarction is important for both medical professionals and patients. Knowledge of the mechanisms of myocardial infarction development allows physicians to more accurately assess the patient’s condition and choose optimal treatment methods, including drug therapy and interventional procedures. An analysis of scientific literature and articles published over the past decade was conducted using the resources of the PubMed and eLibrary search engines using the following keywords: atherosclerosis, history of myocardial infarction, pathophysiology of myocardial infarction, ischemic heart disease, pathogenesis of atherothrombosis, endothelium, inflammation. In the selection, preference was given to systematic reviews and meta-analyses as sources with the highest level of evidence, as well as randomized controlled trials (RCTs), large cohort studies and authoritative clinical guidelines.

Medical waste management in Independent Midwifery Clinics: A discussion paper on the implications for planetary health and maternal and newborn health in Indonesia.

The increasing use of ionizing radiation for diagnostic aims increases the alert on radiation protection. Whereas high standard and awareness are typically possessed by workers on Diagnostic Radiology facilities, personnel of Interventional Radiology departments are of higher need of attention. The works in Interventional Radiology the procedures are done with a long time fluoroscopy and the personnel being inside the imaging room. Two studies were performed on occupational dose measurement in Cardiac Interventional Radiology. The first study was done by measuring exposure levels on working staffs during a single interventional procedure, with the efficacy of available shielding being evaluated also. Second study was carried on by measuring scattered dose levels in various positions during a range of varied cardiac interventional procedures. On the whole, resulting remarks served as an input for the workers on the feasibility of their equipment, and scattered radiation during Cardiac Interventional Radiology procedures.

Introduction: Analyses from early- and late-window thrombectomy trials for acute large vessel occlusion (LVO) stroke have consistently demonstrated a strong time-dependent treatment effect for best outcomes. The utilization of an artificial intelligence (AI)-based care coordination platform to support LVO diagnosis and treatment has the potential to assist in reducing door to puncture times and improve outcomes. Hypothesis: Utilization of an AI-based care platform in the management of LVO patients may significantly decrease door to Neurointerventionalist (NIR) notification time. Methods: Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 166 facilities (17 states) that utilized VIZ.AI software or did not have an AI software from December 1, 2021 through March 31, 2022 were extracted from the Telecare TM database. Facilities that neurology does not initiate contact with NIR were excluded. The encounters were analyzed by age, ethnicity, last known normal, arrival time, initial telemedicine stroke code activation time (TCA), candidacy for thrombolytics, door to needle time (DTN), advanced imaging, presence of LVO, time NIR accepted, premorbid modified Rankin Score, and NIHSS score. Patients were divided into two groups (utilization and non-utilization of the AI platform) and median door to NIR notification times were compared. There was a 4 minute shorter time to TCA at AI hospitals. Results: A total of 14,116 patients (8,557 AI and 5,559 non-AI) were included. The median door to NIR notification time for AI was 50 minutes (40, 82) and non-AI was 89.5 minutes (59.3, 122), p <0.001. There was a small but significantly shorter time (3 minutes) from door to TCA at AI hospitals. Median DTN times for thrombolytics was also lower with AI, 40 minutes (30, 52) vs 44 minutes (32, 57.5) for non-AI, p=0.018. The AI group had more advanced imaging performed, a higher percentage of LVOs identified, and a higher percentage accepted by NIR. Conclusion: Hospital utilization of an AI-based care coordination platform was associated with a significant decrease of 39.5 minutes in the time to NIR contact, increase in patients taken for intervention, and lower DTN times for thrombolytics.

Both cerebral arterial aneurysm and arteriovenous malformation are cerebrovascular disease, which required immediate diagnosis and urgent treatment. Since the introduction of multislice CT scanners, CT angiography (CTA) has become a powerful tool for imaging the vascular system. The goal of this study is to compare catheter based angiography and CTA in the evaluation of cerebral arterial aneurysm and arteriovenous malformation AVM. A retrospective analysis of 50 patients for exploring the record of patient who underwent both multislice CT angiography (MSCTA) and catheter based angiography before treatment is presented during last one year in the department of Radiology, King Fahd Hospital-Jeddah, Kingdom of Saudi Arabia. The sensitivity of CTA for picking up aneurysm is 86% and the sensitivity of catheter based angiography for picking up aneurysm is 97%. The specificity of CTA for picking up aneurysm is (76%), the false positive cases are (3%) and the false negative cases are 10%. The sensitivity of both CTA and catheter based angiography for picking up arteriovenous malformation is (90%). The specificity of CTA for picking up AVM is (76%), the false positive cases are (10%) and no false negative cases in CTA are found. The sensitivity and specificity of catheter based angiography is 100% in diagnosis and detection of cerebral arterial aneurysm and AVM. The present study concluded that CTA has high sensitivity and specificity in detecting aneurysm and AVM enough to be chosen as the first step. Catheter based angiography, still a gold standard for radiology examination, is the most accurate, sensitive and specific method in diagnosis and detection of cerebral arterial aneurysm and arteriovenous malformation, which can be done as the second step. In addition, catheter based angiography is done for treatment planning, treatment with interventional procedure and for prognosis after treatment.

The Appropriate Use Criteria for Coronary Revascularization (AUC) were created in 2009 [1,2] and updated in 2012 [3] through a rigorous process and then endorsed by major cardiovascular societies. The AUC were developed from a limited set of carefully defined clinical scenarios; they were not envisioned as covering every clinical situation, but rather, descriptive of common ones. The AUC have become widely accepted as one component of decision making, along with published clinical guidelines, physician experience, and patient preference. Regrettably, they have also come to be seen as an instrument for directing insurance coverage policy. While the original AUC document [1,2] noted “it is hoped that payors would use these criteria as the basis for the development of rational payment management strategies to ensure that their members receive necessary, beneficial, and costeffective cardiovascular care,” denial of coverage in individual cases based on the AUC category was not an intended purpose. In addition, the 2012 update [3] explicitly states that some inappropriate indications should be reimbursed and that the uncertain rating does not justify denial of payment. Policymakers and payors must be good stewards of the insurance system, and are increasingly challenged to find innovative ways to curb expenditures. Thus, it is tempting for them to view the AUC as a professionally mandated tool for “cost-cutting” [4]. SCAI and its members recognize the essential need for prudent cost management but are very concerned with this unanticipated and detrimental approach to coverage determinations. This SCAI position statement addresses our members’ apprehension that the application of AUC by many payors without consideration of other features of the patient’s medical condition is far beyond the intent of the AUC, and has the potential for significant unintended consequences for patients and hospitals. Accordingly, this position statement outlines SCAI’s recommendations regarding the use of AUC in making coverage determinations for percutaneous coronary intervention (PCI) procedures. SCAI and its members have several concerns. First, although the AUC may be useful in helping to guide insurance coverage, the AUC classification should not be the solitary reason used to deny coverage. Such unjustifiable application of AUC might be harmful to patients, and could be contrary to shared decision-

Ultrasound practice is a longstanding tradition for radiology departments, being part of the family of imaging techniques. Ultrasound is widely practiced by non-radiologists but becoming less popular within radiology. The position of ultrasound in radiology is reviewed, and a possible long-term solution to manage radiologist expectations is proposed. An international group of experts in the practice of ultrasound was invited to describe the current organisation of ultrasound within the radiology departments in their own countries and comment on the interaction with non-radiologists and training arrangements. Issues related to regulation, non-medical practitioners, and training principles are detailed. A consensus view was sought from the experts regarding the position of ultrasound within radiology, with the vision of the best scenario for the continuing dominance of radiologists practising ultrasound. Comments were collated from nine different countries. Variable levels of training, practice, and interaction with non-radiologist were reported, with some countries relying on non-physician input to manage the service. All experts recognised there was a diminished desire to practice ultrasound by radiologists. Models varied from practising solely ultrasound and no other imaging techniques to radiology departments being central to the practice of ultrasound by radiologists and non-radiologist, housed within radiology. The consensus view was that the model favoured in select hospitals in Germany would be the most likely setup for ultrasound radiologist to develop and maintain practice. The vision for 20 years hence is for a central ultrasound section within radiology, headed by a trained expert radiologist, with non-radiologist using the facilities.Critical relevance statement The future of ultrasound within the radiology department should encompass all ultrasound users, with radiologists expert in ultrasound, managing the ultrasound section within the radiology department. The current radiology trainees must learn of the importance of ultrasound as a component of the ‘holistic’ imaging of the patient.Key points: 1. Ultrasound imaging within radiology departments precedes the introduction of CT and MR imaging and was first used over 50 years ago.2. Non-radiology practitioners deploy ultrasound examinations to either ‘problem solve’ or perform a comprehensive ultrasound examination; radiologists provide comprehensive examinations or use ultrasound to direct interventional procedures.3. Radiology does not ‘own’ ultrasound, but radiologists are best placed to offer a comprehensive patient-focused imaging assessment.4. A vision of the future of ultrasound within the radiology department is encompassing all ultrasound users under radiologists who are experts in ultrasound, positioned within the radiology department.5. The current radiology trainee must be aware of the importance of ultrasound as a component of the ‘holistic’ imaging of the patient.

Impact of cancer symptom awareness campaigns on diagnostic testing and treatment

A flexible shield is described that reduces x-ray scatter to the radiologist's hands by as much as 73%. The shield can be made in the radiology department using readily available, flexible, lead-vinyl material.

Due to the rising costs and competitive pressures radiological clinics and practices are now facing, controlling instruments are gaining importance in the optimization of structures and processes of the various diagnostic examinations and interventional procedures. It will be shown how the use of selected controlling instruments can secure and improve the performance of radiological facilities. A definition of the concept of controlling will be provided. It will be shown which controlling instruments can be applied in radiological departments and practices. As an example, two of the controlling instruments, material cost analysis and benchmarking, will be illustrated.

Diagnostic Imaging Utilization in the Emergency Department: Recent Trends in Volume and Radiology Work Relative Value Units

Periostitis ossificans (PO) is a subtype of chronic osteomyelitis characterized by subperiosteal bone formation as a reaction to mild infection or irritation. In the veterinary medicine literature, it has been described in large breed dogs, aged 3 to 5 months, and was postulated to be caused by mild inflammation related to tooth eruption. This report describes 3 Belgian Malinois puppies from the same litter diagnosed with PO at 3 months of age. The puppies presented with non-painful distal mandibular swellings. Diagnostic procedures included intraoral dental radiographs, a computed tomography scan of the head, and bone biopsies submitted for histopathological examination. PO is typically a self-limiting condition and likely caused by inflammation due to tooth eruption. Therefore, treatment focuses on pain management and monitoring until the permanent teeth emerge. Long-term follow up until two and a half years of age showed a significant decrease to total resolution of the swelling, with minor bone changes evident on advanced imaging. Histopathologic findings are not pertinent for the diagnosis of PO and imaging shows pathognomonic features of the condition. Mandibular PO, craniomandibular osteopathy, and calvarial hyperostotic syndrome are all self-limiting proliferative bone diseases of the skull in juvenile dogs with an implied genetic component. The authors' findings support grouping them as a single disorder called "Idiopathic Canine Juvenile Cranial Hyperostosis" with predilection sites that vary between breeds.

Surgical care for CHD is increasingly available in low- and middle-income countries, and efforts to optimise outcomes are growing. This study characterises cardiac imaging and prenatal diagnosis infrastructure in this setting. An infrastructure survey was administered to sites participating in the International Quality Improvement Collaborative for CHD. Questions regarding transthoracic, transesophageal and epicardial echocardiography, cardiac CT, cardiac magnetic resonance, prenatal screening and fetal echocardiography were included. Associations with in-hospital and 30-day mortality were assessed. Thirty-seven sites in 17 countries responded. Programme size and geography varied considerably: < 250 cases (n = 13), 250-500 cases (n = 9), > 500 cases (n = 15); Americas (n = 13), Asia (n = 18), and Eastern Europe (n = 6). All had access to transthoracic echo. Most reported transesophageal and epicardial echocardiography availability (86 and 89%, respectively). Most (81%) had cardiac CT, but only 54% had cardiac magnetic resonance. A third reported impediments to imaging, including lack of portable machines, age/size-appropriate equipment and advanced cardiac imaging access and training. Only 19% of centres reported universal prenatal CHD screening in their catchment area, and only 46% always performed fetal echocardiography if screening raised concern for CHD. No statistically significant associations were identified between imaging modality availability and surgical outcomes. Although access to echocardiography is available in most middle-income countries; advanced imaging modalities (cardiac CT and magnetic resonance) are not always accessible. Prenatal screening for CHD is low, and availability of fetal echocardiography is limited. Imaging infrastructure in low- and middle-income countries and associations with outcomes merits additional study.