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Error Management and Reduction

Introduction It is indeed human to err, yet unrealistic expectations for perfection persist throughout the practice of medicine. For radiology, the challenge has increased substantially in recent years due to rapidly advancing imaging technologies, increasing volumes of studies, each with massively increased volumes of images per study, as well as poor overall communication of needed clinical information from referring physicians, all of which contribute to an…

Error in Radiology

Introduction Errors are innate in every field of medicine and persist despite the best efforts of medical professionals to be (or become) flawless. In fact, the prevalence of errors by radiologists (i.e., the radiology error rate) has been remarkably constant in repeated studies dating to the 1930s. For radiologists, there are multiple contributing factors for this, including knowledge gaps and perceptual errors; flaws inherent in emerging…

Communication

Introduction Radiology reports are instrumental in decisions about patient management in most medical specialties. Clear communication requires written reports to be accurate, concise, and unambiguous. Constructing a quality report constitutes a critical, although often neglected, component of radiologists’ training and practice. Four key areas of communications in radiology are reviewed in this chapter. The first section discusses communications between radiologists and both referring providers and patients.…

Professionalism and Ethics

Principles of Medical Professionalism and the Physician Charter As societal norms have transformed and continued to evolve, physicians and other clinicians have faced significant legal, moral, and ethical quandaries that have influenced the practice of medicine. Although the development of professionalism stems from the core tenets of ethics and medicine, coined by Aristotle and Hippocrates respectively, it has been codified most famously by the Institute of…

Patient-Centered Radiology

Introduction The Institute of Medicine highlighted the essential role of patient-centered care by including it as one of the committee’s six specific aims for improving healthcare in Crossing the Quality Chasm (2001). In this report, patient-centered healthcare is defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” and “encompasses…

Evidence-Based Imaging

Introduction Over the past 2 decades, evidence-based medicine has become a dominant paradigm for understanding best practices in medicine. Simply put, evidence-based medicine is the explicit incorporation of the best research evidence into the care decision-making process. More formally, evidence-based medicine has been defined by Sackett and others as the incorporation of the best available evidence with physician judgment and experience and patient values and preferences.…

Future of Quality Assurance

Introduction Quality assurance, quality improvement, and total quality Management initiatives and programs have been used, to different degrees, in business, management, and healthcare settings for decades now. However, despite the obvious positive impact on all healthcare outcomes, diffusion and integration of these methodologies have been inconsistent across health systems, subspecialty disciplines, and programs. There are many causes and contributing factors to this lack of penetration, which…

Highly Reliable Organizations/Systems in Healthcare and Radiology

Introduction The Institute of Medicine’s reports, Crossing the Quality Chasm and To Err Is Human , created an awareness within the American healthcare system that change and redesign are necessary to improve patient safety and quality of care. This is exemplified by studies performed by RAND Health that found Americans with common health problems receive only 50% of recommended care. These needed changes clearly include healthcare…

Radiology-Related Quality Programs and Organizations

In recent years there have been several initiatives dedicated to improving radiologic standards of practice. Many of these programs, such as “Image Gently,” “Image Wisely,” “Step Lightly,” and the Dose Index Registry, address growing concerns over patient exposure to high levels of ionizing radiation from radiologic exams and raise awareness in both the medical community and public to these trends while taking steps to curtail radiation…

Quality Improvement in Radiology

Introduction In 2012, the American Board of Radiology (ABR) implemented a new Maintenance of Certification (MOC) process, known as Continuous Certification, for all participating diplomates. Every year on March 15, the ABR looks back at the previous 3 years for each diplomate to consider if he or she is meeting the MOC requirements. All diplomates who hold continuous certificates issued in 2012 or after or time-limited…

Patient Safety

Safety in radiology is expected by our patients, colleagues, administrators, providers, national organizations, oversight organizations, and the government. It is no longer enough to provide accurate reports of findings on imaging studies. Radiologists and their coworkers in the radiology department are also expected to provide patient-centered care and safe experiences prior to, during, and after imaging and procedures in radiology. To meet this need, considerable educational…

Quality Improvement Tools

Introduction The challenge of a changing economy and increasing pressure in healthcare for optimal performance while dealing with limited resources and maintaining the high quality levels of medicine is becoming increasingly difficult. There is increasing demand for quality improvement to drive improved outcomes and reduce costs. The primary methodology used to deliver improved quality with lower costs is a process improvement methodology known as Lean Six…

Quality Improvement : Definition and Limitations

Current and Traditional Definitions of Quality in Healthcare How do we best define quality in healthcare? The quality literature includes several definitions. The Institute of Medicine (IOM) defines quality of care as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. How care is administered should demonstrate appropriate use of the…

Key Concepts in Quality Improvement

Concepts for Quality Improvement Quality improvement (QI) methods are not new; they are just relatively new to the healthcare industry and the field of radiology. As a result, there is currently a gap between the high desire and need to apply QI methods in daily practice and a lack of radiologists who are sufficiently trained in the proper use of these methods. In response to this…

History and Current Status of Quality Improvement in Radiology

To Err is Human When the Institute of Medicine (IOM, now the Academy of Medicine) first released its report, To Err Is Human , in 1999, headlines were made throughout the world. The notion that our healthcare delivery system was not only not achieving the positive exceptionalism that one might expect from the most expensive system in the world, but also guilty of contributing to the…

Single Voxel MR Spectroscopy in the Spinal Cord: Technical Challenges and Clinical Applications

5.1.1 Magnetic Resonance Spectroscopy 5.1.1.1 Introduction In the large majority of applications MRI focuses on detecting proton signal, in particular the signal from water protons. It therefore provides information about anatomical structure and the biophysical state of tissue water. Magnetic resonance spectroscopy (MRS) can be seen as an alternative or complementary technique to MRI as it provides chemical and biophysical information that can be extracted from…

Mapping the Vasculature of the Spinal Cord

4.3.1 Rationale Spinal cord blood vessels are millimeter- to submillimeter-sized blood vessels that are hard to visualize in the human body. In vivo imaging of spinal cord arteries and veins was until recently only possible using invasive catheter-based angiography, which involves a radiation burden and needs to be performed by experienced specialists. Noninvasive imaging of spinal cord blood vessels had only recently become available in a…

Physiological Noise Modeling and Analysis for Spinal Cord fMRI

4.2.1 What is Physiological Noise? Physiological noise can be defined as any signal change occurring in an image that is due to the subject and that is of no interest. Equally, movement of the subject (e.g., bulk movement of the cord) and indirect movement of structures of interest (e.g., caused by arterial pulsation or cerebrospinal fluid (CSF) flow) could also be included in this heading. For the…

Spinal Cord fMRI

4.1.1 Blood Oxygenation Level Dependent 4.1.1.1 Basic Principles Functional magnetic resonance imaging (fMRI) allows noninvasive detection of neuronal activity. fMRI based on the blood oxygenation level dependent (BOLD) contrast mechanism was first introduced in 1990. The basic principle behind the BOLD effect is that following neuronal activation, metabolic demand for oxygen induces a local increase in blood flow and blood volume. However, this blood supply far…