Showing papers in "Radiologic technology in 2007"

Patient Dose From CT: A Literature Review

Abstract: CONTEXT: Computed tomography (CT) exams are increasingly common and account for a significant portion of individuals' mounting exposure to medical radiation. OBJECTIVE: To explore issues surrounding patient radiation dose, including techniques for minimizing dose and the feasibility of tracking lifetime exposure to medical radiation from CT and other imaging exams. METHODS: The authors conducted a review of the recent literature to assess current knowledge of dose levels, protocols for minimizing patient dose and possible systems for tracking cumulative dose. RESULTS: Currently, no regulations are in place to track cumulative patient radiation dose. However, the authors discuss possible means of recording, tracking and storing this data, such as standardizing its inclusion in DICOM headers and transmitting it to electronic personal health records. CONCLUSION: More research is needed to develop and implement uniform dose tracking procedures and protocols for minimizing patient dose.

Spinal curves and scoliosis.

Abstract: Scoliosis, an abnormal side-to-side curve of the spine with associated vertebral rotation, affects as many as 4% of all adolescents. Several different categories of scoliosis exist, and treatment can range from observation and follow-up to bracing and surgical correction. This article discusses special imaging series for scoliosis and emphasizes the need for proper radiation protection techniques for patients with scoliosis, most of whom are girls in their early to mid-teens.

Chest radiography for radiologic technologists.

Abstract: The chest exam is performed more frequently than any other exam in the imaging department. It is important for radiographers to understand the standards for imaging the chest because good chest radiographs are critical in managing patient care. This article provides an overview of chest radiography from the perspective of both the radiologist and the technologist. Readers will gain an understanding of several pathologic processes involving the chest and can use this information to perform optimal radiographic imaging.

18FDG uptake in brown fat: potential for false positives.

Abstract: CONTEXT (18)FDG is used widely to enhance PET and PET-CT images. However, this radiotracer tends to be taken up by brown fat, which can lead to false-positive diagnoses. Purpose To determine which patients, areas of the body and circumstances are more likely to be associated with false-positive diagnoses due to (18)FDG uptake in brown fat. METHOD A review of the literature was conducted on factors that contribute to false-positive diagnoses caused by (18)FDG uptake in brown fat. RESULTS Brown fat commonly is found in women and children and can be located in the supraclavicular, mediastinal, paravertebral and perirenal areas of the body. Research has shown that these areas can be sources of a false-positive diagnosis because of (18)FDG uptake. Studies also have indicated that cold climate affects the uptake of (18)FDG, contributing to false-positive results on PET-CT examinations. CONCLUSIONS This literature review should stimulate continued research into and awareness of the potential for false-positive PET findings in women and children during the winter months and in cold climates. This information is especially applicable to young female patients undergoing PET or PET-CT.

Patient satisfaction with obstetric ultrasonography.

Abstract: BACKGROUND Several investigators studying patient satisfaction have shown that the mode of medical care delivery appears to be more important to the patient than the care itself. OBJECTIVE This study investigated patient satisfaction ratings with obstetric ultrasonography based on variables that the operator of the ultrasound equipment can influence. METHOD A total of 100 self-completion questionnaires were delivered to 4 ultrasound centers in Ebonyi State, Nigeria (25 to each center). The questionnaire included questions on patient demographics as well as ordinal scales for patients to rate their satisfaction on various indices. Ninety-two questionnaires (92%) were returned. Both descriptive and inferential statistics were done. Tests were 2 tailed with P<.05 indicating statistical significance. RESULTS The results were encouraging. Average satisfaction ratings above 50% were noted for all the indices except for patients' perception of the time between arrival and departure, which was slightly below 50%. CONCLUSION Good staff-patient interaction and proper organizational behavior could improve satisfaction ratings.

Factors affecting radiographers' organizational commitment.

Abstract: Context A variety of factors influence employees' attitudes toward their workplace and commitment to the organization that employs them. However, these factors have not been well documented among radiologic technologists. Objective To determine the predictive ability of selected organizational, leadership, work-role and demographic variables on organizational commitment for a national sample of radiographers. Methods Three thousand radiographers registered by the American Registry of Radiologic Technologists working full time in clinical settings were surveyed by mail regarding their commitment to their employers, leadership within the organization that employs them, employer support and demographic information. Results Overall, radiographers were found to have only a moderate level of commitment to their employers. Among the factors that significantly affected commitment were the radiographer's educational level, perceived level of organizational support, role clarity and organizational leadership. Conclusion The results of this study could provide managers and supervisors with insights on how to empower and challenge radiographers and offer opportunities that will enhance radiographers' commitment to the organization, thus reducing costly turnover and improving employee performance.

Chest compressions: biomechanics and injury.

Abstract: Context Radiologic technologists are sometimes called on to resuscitate patients in cardiac emergencies. By understanding the dynamics of chest compressions during cardiopulmonary resuscitation (CPR) and the related risks for rib and sternal fractures, R.T.s will be better equipped to perform CPR. Objective To review the mechanics of CPR and its associated risks, as well as propose criteria for future studies of CPR-related injuries. Methods The author reviewed the literature to explain how CPR works, how often injuries occur during CPR and how these injuries have been studied in the past. Results Past investigations into CPR-related rib and sternal fractures are not consistent in research methodology and thus are not comparable. In addition, there is only 1 recent study that collected data on compression-induced injuries in survivors of cardiac arrest. Conclusion Consistent study protocols are needed to enhance interstudy comparability and improve resuscitative health care. Recently revised guidelines regarding chest compression during CPR invite new research on compression injuries. The author supports adoption of 5 criteria for future study protocols.

Improving communication for better patient care.

Abstract: Communication failures in radiology departments stem from a variety of sources and significantly influence the success of patient care. This article reviews the communication responsibilities of health care providers, identifies how errors are made and how they become medical mistakes and provides methods for improving communication within radiology departments.

The even-number guide and imaging ballistic injuries.

Abstract: Purpose It is important to account for all bullets or shrapnel in patients with multiple ballistic injuries, whether they have lodged in the patient's body or exited through a wound. Recent combat experience involving ballistic injuries and explosive fragments underscores this requirement. METHODS: The even-number guide described in this paper can be a useful tool to quickly account for all metallic foreign bodies that have entered a patient in a blast or multiple shootings. Cases are presented to illustrate the guide. Also, an evolving technology called total-body digital radiography (DR) is introduced that may help to quickly account for all ballistics in patients. Results and Conclusions Patients with injuries from multiple bullets or shrapnel should have an even number of entrance and exit wounds and retained metallic fragments. Deviation from this guide should prompt a radiographic hunt for embolized, migrated or ricocheted fragments. The authors conclude that the guide allows for effective communication among members of multispecialty trauma teams. Language: en

The increasing use of CT and its risks.

Abstract: Emergency Department Use The use of CT has increased at an even higher rate in many EDs. One ED reported a patient increase of 13% between 2000 and 2005, with a disproportionately higher increase in the use of CT over the same period (see Table 1). The increase in CT use is driven by ever-increasing detection capabilities, as well as by the increasing availability of CT scanners. Additionally, many departments consider CT the first test for many conditions. Physicians might be replacing clinical judgment and time-consuming physical examinations with a “let’s do a quick CT” approach to emergency medicine. A trauma patient in the Yale University Medical Center ED might have his or her entire body scanned.

A MnCl2-based MR signal intensity linear response phantom.

Abstract: PURPOSE This study aimed to develop a manganese chloride (MnCl2)-based phantom model that would allow progressive quantitative assessment of tissue hydration based on observed magnetic resonance (MR) imaging signal intensity (SI) linearity characteristics. MATERIALS AND METHODS The study was performed using a progressive signal refinement technique that allowed development of an imaging tool for semiquantitative sequential discrimination of MR signal responses. A series of 82 phantoms comprising a gelatin-set MnCl2 composite were imaged under basic T1- and T2-weighted conditions. MR SI measurements were taken using region-of-interest selection, and MnCl2 concentrations were adjusted to allow development of a pair of 8-tube phantoms. These phantoms permitted progressive incremental assessment of hydration based on fundamental MR SI response. RESULTS Statistical analysis showed that phantom MR signal response linearity can be achieved using the phantoms described under both T1 and T2 imaging conditions, yielding R2 values of 0.97 and 0.94, respectively. CONCLUSION This novel MnCl2-based phantom can be used as a noninvasive reference standard for quantitative classification of in vivo tissue hydration based on routine clinical MR imaging sequences. Progressive correlation testing using a human cartilage sample should be performed to further refine the model for clinical application.

Paget disease of bone.

Abstract: Paget disease of bone, also known as osteitis deformans, is a nonmalignant disease of bone that causes accelerated and abnormal bone remodeling. It is the second most common bone disorder, osteoporosis being first. It is a localized disorder, meaning it affects just 1 or several bones in the body. Paget disease of bone is characterized by enlarged and deformed bones and occurs mainly in the axial skeleton. The cause of the disease is still not known entirely, but genetics are certain to be involved, and viral factors also are suspected.

Students' views of cooperative learning and group testing.

Abstract: CONTEXT Today's radiologic technology students must learn to collaborate and communicate to function as part of the health care team. Innovative educational techniques such as cooperative learning (working collectively in small groups) and group testing (collaborating on tests) can foster these skills. OBJECTIVE Assess students' familiarity with and opinions about cooperative learning and group testing before and after participation in a semester-long course incorporating these methods. METHODS Twenty-eight students enrolled in a baccalaureate-level radiologic technology program in Louisiana were surveyed at the beginning and end of the semester. RESULTS Results showed that students were more knowledgeable about and more accepting of cooperative learning and group testing after participating in the course. However, some students continued to prefer independent learning. SUMMARY Students are open to new learning methods such as cooperative learning and group testing. These techniques can help them develop the skills they will need to function collaboratively in the workplace.

Job satisfaction among radiation therapy educators.

Abstract: Context Job satisfaction is one of the most consistent variables related to employee retention and is especially relevant considering the shortage of radiation therapists and radiation therapy educators in the United States. Objective To investigate job satisfaction levels among radiation therapy educators certified by the American Registry of Radiologic Technologists and employed in programs accredited by the Joint Review Committee on Education in Radiologic Technology. Methods The long form of the Minnesota Satisfaction Questionnaire (MSQ) was mailed to 158 radiation therapy educators to measure job satisfaction. Overall job satisfaction and subscales were calculated based on MSQ methodology. Results A total of 90 usable surveys were returned for a 56.9% response rate. With a "general satisfaction" score of 69.64, radiation therapy educators ranked in the lowest 25th percentile of the nondisabled norm scale for job satisfaction. Respondents reported higher degrees of job satisfaction on the moral values, social service and achievement subscales. Lower job satisfaction levels were associated with the company policies and practices, advancement and compensation subscales. Conclusion Radiation therapy educators report low job satisfaction. Educational institutions must tailor recruitment and retention efforts to better reflect the positive aspects of being a radiation therapy educator. Furthermore, improving retention and recruitment efforts might help offset the current shortages of radiation therapy educators and, ultimately, clinical radiation therapists.

The role of the GI radiographer: a United Kingdom perspective.

Abstract: Context Since the 1990s radiographers in the United Kingdom have expanded their role in gastrointestinal (GI) radiology, first by performing double-contrast barium enema (DCBE) examinations independently and later by interpreting and reporting the results of these exams. Objective This article will trace the evolution of GI radiographers in the United Kingdom, evaluate their success and explore how the U.K. experience could apply to American radiologist assistants. Methods The authors surveyed the professional literature to determine the historical context in which GI radiographers emerged and assess how their performance on DCBE exams compares with radiologists' performance. Results DCBE exams performed by GI radiographers have been shown to be efficient, cost effective and safe. In addition, GI radiographers have helped reduce waiting and turnaround times for DCBE exams. Summary The success of GI radiographers in the United Kingdom offers assurance that radiologist assistants can benefit American patients, radiologists and radiologic technologists.

Diagnosis and treatment of back pain.

Abstract: Back pain is one of the most prevalent medical problems seen by primary care physicians, and it costs the American public billions of dollars each year. Yet, accurate diagnosis and successful treatment remain elusive. Medical imaging plays an increasing role in helping to diagnose back pain causes, pinpoint treatments and study how back pain might be addressed more adequately.

Diagnosis and Management Of Uterine Fibroids

Abstract: Uterine fibroids are the most common gynecological tumors. Fibroids significantly affect fertility and lead to approximately 200,000 hysterectomies annually in the United States alone. Several effective treatments exist, with varying levels of invasiveness and potential complications for fertility. Although its effects on fertility are still uncertain, uterine artery embolization shows promise as a uterus-sparing treatment for fibroids.

Developmental dysplasia of the hip.

Abstract: Objective. To create a recommendation for pediatricians and other primary care providers about their role as screeners for detecting developmental dysplasia of the hip (DDH) in children. Patients. Theoretical cohorts of newborns. Method. Model-based approach using decision analysis as the foundation. Components of the approach include the following: Perspective: Primary care provider. Outcomes: DDH, avascular necrosis of the hip (AVN). Options: Newborn screening by pediatric examination; orthopaedic examination; ultrasonographic examination; orthopaedic or ultrasonographic examination by risk factors. Intercurrent health supervision-based screening. Preferences: 0 for bad outcomes, 1 for best outcomes. Model: Influence diagram assessed by the Subcommittee and by the methodology team, with critical feedback from the Subcommittee. Evidence Sources: Medline and EMBASE search of the research literature through June 1996. Hand search of sentinel journals from June 1996 through March 1997. Ancestor search of accepted articles. Evidence Quality: Assessed on a custom subjective scale, based primarily on the fit of the evidence to the decision model. Results. After discussion, explicit modeling, and critique, an influence diagram of 31 nodes was created. The computer-based and the hand literature searches found 534 articles, 101 of which were reviewed by 2 or more readers. Ancestor searches of these yielded a further 17 articles for evidence abstraction. Articles came from around the globe, although primarily Europe, British Isles, Scandinavia, and their descendants. There were 5 controlled trials, each with a sample size less than 40. The remainder were case series. Evidence was available for 17 of the desired 30 probabilities. Evidence quality ranged primarily between one third and two thirds of the maximum attainable score (median: 10–21; interquartile range: 8–14). Based on the raw evidence and Bayesian hierarchical meta-analyses, our estimate for the incidence of DDH revealed by physical examination performed by pediatricians is 8.6 per 1000; for orthopaedic screening, 11.5; for ultrasonography, 25. The odds ratio for DDH, given breech delivery, is 5.5; for female sex, 4.1; for positive family history, 1.7, although this last factor is not statistically significant. Postneonatal cases of DDH were divided into mid-term (younger than 6 months of age) and late-term (older than 6 months of age). Our estimates for the mid-term rate for screening by pediatricians is 0.34/ 1000 children screened; for orthopaedists, 0.1; and for ultrasonography, 0.28. Our estimates for late-term DDH rates are 0.21/1000 newborns screened by pediatricians; 0.08, by orthopaedists; and 0.2 for ultrasonography. The rates of AVN for children referred before 6 months of age is estimated at 2.5/1000 infants referred. For those referred after 6 months of age, our estimate is 109/1000 referred infants. The decision model (reduced, based on available evidence) suggests that orthopaedic screening is optimal, but because orthopaedists in the published studies and in practice would differ, the supply of orthopaedists is relatively limited, and the difference between orthopaedists and pediatricians is statistically insignificant, we conclude that pediatric screening is to be recommended. The place of ultrasonography in the screening process remains to be defined because there are too few data about postneonatal diagnosis by ultrasonographic screening to permit definitive recommendations. These data could be used by others to refine the conclusions based on costs, parental preferences, or physician style. Areas for research are well defined by our model-based approach. Pediatrics 2000;105(4). URL: http://www. pediatrics.org/cgi/content/full/105/4/e57; developmental dysplasia of the hip, avascular necrosis of the hip, newborn. ABBREVIATIONS. DDH, developmental dysplasia of the hip; PE, physical examination; AVN, avascular necrosis of the hip; SD, standard deviation. I. GUIDELINE METHODS

The Economics of Caring

Abstract: and they have less choice, autonomy and integrity on the job.Although caring is fundamental to health care, it does take time to care. And in the modern health care system, time is money. So the question arises, can caring be looked at from an economic perspec-tive? If imaging patients quickly brings in increased revenue through increased billing, is there still a role for caring in our health care system? Could there be a value-added economic advantage to caring? More specifically, could caring in the radiology department ultimately increase revenues? This article examines the economic value of caring as delivered by radiologic technologists. DiscussionThe economic impact of caring as demonstrated by radiologic technologists can be measured in 3 areas. First, caring can increase patient satisfaction, which helps generate revenue. If patients are satisfied with the service they receive, they will return for further service and share their positive experience with others. Second, caring can help avoid unneces-sary costs. This happens in several ways: by reducing patients’ stress, creating a positive relationship between the technol-ogist and patient and boosting patients’ self-esteem.

Breast MR imaging: applications and pitfalls.

Abstract: Context Contrast-enhanced magnetic resonance (MR) imaging provides better detail of the breast than either mammography or ultrasound imaging and can be a valuable adjunct to other imaging techniques, particularly for small lesions, in dense or augmented breasts and for treatment planning. Objective To illustrate some common technical problems encountered with MR imaging of the breast and present breast pathologies depicted with MR. Results Using a case-study approach, the authors discuss breast MR imaging difficulties related to hardware, software, technologist performance and patient cooperation. They also present examples of contralateral breast cancer, recurrent breast carcinoma and local staging of breast cancer with MR imaging. Summary MR imaging of the breast has important advantages over other techniques, despite occasional technical problems.

Diagnosis and Treatment Of Carotid Artery Disease

Abstract: Carotid artery disease (CAD) can cause strokes or even death. Fortunately, some of the risk factors for CAD can be controlled, and the disease can be prevented, slowed or reversed. This article reviews those risk factors, along with normal and abnormal carotid artery anatomy, techniques for imaging the carotid arteries, treatment options for CAD and the roles of specialists who diagnose and treat it. The article concludes with a look at promising new and alternative treatments.

Academic tenure in radiologic technology--revisited.

Abstract: CONTEXT Academic tenure is important to most educators, including those in the radiologic sciences; however, many factors can influence an educator's ability to attain tenure. OBJECTIVE This article empirically examines the concept of tenure among radiologic science educators using data from a national survey of registered radiologic technology educators. RESULTS Greater proportions of tenured and tenure-eligible faculty held higher academic rank, had higher levels of education and were employed by 2- and 4-year colleges or universities compared with nontenure-track faculty. Also, tenured R.T. educators tended to be older than tenure-eligible and nontenure-track faculty. SUMMARY R.T. educators are a diverse group, and attention should focus on the individual needs of educators in a variety of professional settings.