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Interventional Radiology

Safety Culture and Teamwork in Interventional Radiology The practice of interventional radiology (IR) is distinct from that of diagnostic radiology (DR) in that IR is able to treat patients with a wide variety of vascular and nonvascular disorders. Inherent in these abilities is the responsibility to provide safe, evidence-based, and patient-centered care. One method of working toward this goal is creating a safety culture within the…

Optimizing Radiation Dose for Computed Tomography

Evolution of Computed Tomography Technology Computed tomography (CT) plays a major role in the practice of medicine. CT was invented by the British scientist Sir Godfrey Hounsfield in 1972 at Electric and Musical Industries research laboratories. Since its invention, CT has evolved rapidly and transformed the field of medicine. The first CT scanners were dedicated to acquiring head images. With development of subsequent scanners, it became…

Noninterpretive Skills in Magnetic Resonance Imaging

Introduction Magnetic resonance imaging (MRI) is used in the diagnosis of patients with many conditions, and while the interpretive skills necessary to appropriately interpret the MRI images are complex, so too are the noninterpretive skills. Many of these issues come to the radiologist’s attention on a daily basis—for example, issues concerning magnetic resonance (MR) safety, whether a patient will be safe in the MRI environment, and…

Noninterpretive Skills in Ultrasound

Bioeffects of Ultrasound The benefit of diagnostic ultrasound as an imaging modality in clinical practice cannot be overstated. Avoiding the radiation of radiography and computed tomography and the restrictive nature of magnetic resonance imaging coupled with the portability of ultrasound machines make ultrasound an attractive diagnostic tool. Although there are no known deleterious effects in humans when used within normal ranges, knowledge of potential bioeffects of…

Safe Use of Contrast Media

Introduction Widespread use of medical imaging has led to a significant increase in the use of radiologic contrast media (CM). Half of the estimated 78 million computed tomography (CT) examinations and 37 million magnetic resonance imaging (MRI) examinations performed annually in the United States include the use of CM. Radiographic CM are used in imaging examinations to aid in the characterization, detection, and staging of disease.…

Imaging of Pregnant and Lactating Women

Introduction Radiation risks are of concern in pregnant patients due to the potential of harmful effects on the fetus. However, due to referring physician concerns about maternal health, some exams using ionizing radiation have to be performed in pregnant patients. A balance between appropriateness and overutilization of imaging techniques needs to be maintained to provide the best care to the patient. Any imaging technique performed should…

Statistical Tools and Quantitative Reasoning

Introduction The practice of medicine frequently requires that physicians make critical diagnostic and treatment decisions with incomplete information, working in a background of high uncertainty. The specialty of diagnostic radiology is not exempt from this reality. Although people in other walks of life might view such a high-uncertainty/high-stakes situation to be paralyzing, inaction is rarely an option in the practice of medicine. Many doctors consider this…

Radiology Informatics

Informatics is the science and practice of computer information systems. Imaging informatics encompasses the use of information technology to deliver efficient, accurate, and reliable medical imaging services within a healthcare network. Its imprint is felt in every step of the process of patient imaging, from order entry to results communication. Radiologists have key roles as leaders in imaging informatics and are the liaisons between the clinical…

Accounting in Radiology

Dominant Payers in American Healthcare Most healthcare costs, roughly 72% by current estimates, are paid by third-party payers. Insured patients still have out-of-pocket expenses, for example, to meet copayments and deductibles, depending on the actuarial value of their plan. Approximately 12% of the US population is uninsured, or self-pay ( Fig. 16.1 ). Third-party payers include private insurance, Medicare, and Medicaid. The majority of the funds,…

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…