The Use of Patient and Family Advisory Councils to Improve Patient Experience in Radiology. AJR. American journal of roentgenology 2016; 207 (5): 965-970
Rising costs and widespread inefficiencies in current practices have prompted a paradigm shift in American health care from volume- to value-based care with patients and families assuming a central role. Patient and family advisory councils (PFACs) are particularly compelling as a strategy for using patient and family engagement for process improvement. Although relatively new in the radiologic community, PFACs can be a powerful tool in improving patient experience.PFACs are a particularly powerful method of patient and family engagement that can be used in effecting meaningful change in practice. This valuable resource resides within most hospitals and is generally readily accessible. In the era of value-based care, it is essential that radiologists actively engage with patients to improve efficiency, reduce expenditures, and maximize patient satisfaction.
View details for PubMedID 27440525
Communicating Potential Radiation-Induced Cancer Risks From Medical Imaging Directly to Patients AMERICAN JOURNAL OF ROENTGENOLOGY 2015; 205 (5): 962-970
Over the past decade, efforts have increasingly been made to decrease radiation dose from medical imaging. However, there remain varied opinions about whether, for whom, by whom, and how these potential risks should be discussed with patients. We aimed to provide a review of the literature regarding awareness and communication of potential radiation-induced cancer risks from medical imaging procedures in hopes of providing guidance for communicating these potential risks with patients.We performed a systematic literature review on the topics of radiation dose and radiation-induced cancer risk awareness, informed consent regarding radiation dose, and communication of radiation-induced cancer risks with patients undergoing medical imaging. We included original research articles from North America and Europe published between 1995 and 2014.From more than 1200 identified references, a total of 22 original research articles met our inclusion criteria. Overall, we found that there is insufficient knowledge regarding radiation-induced cancer risks and the magnitude of radiation dose associated with CT examinations among patients and physicians. Moreover, there is minimal sharing of information before nonacute imaging studies between patients and physicians about potential long-term radiation risks.Despite growing concerns regarding medical radiation exposure, there is still limited awareness of radiation-induced cancer risks among patients and physicians. There is also no consensus regarding who should provide patients with relevant information, as well as in what specific situations and exactly what information should be communicated. Radiologists should prioritize development of consensus statements and novel educational initiatives with regard to radiation-induced cancer risk awareness and communication.
View details for DOI 10.2214/AJR.15.15057
View details for Web of Science ID 000363814900023
View details for PubMedID 26295534
Project Management for Quality Improvement in Radiology AMERICAN JOURNAL OF ROENTGENOLOGY 2015; 205 (5): W470-W477
This article outlines a structured approach for applying project management principles to quality improvement in radiology. We highlight the framework we use for managing improvement projects in our department and review basic project management principles.Project management involves techniques for executing projects effectively and efficiently. We recognize the following phases for managing improvement projects: idea, project evaluation and selection, role assignment, planning, improvement, and sustaining improvement.
View details for DOI 10.2214/AJR.15.14807
View details for Web of Science ID 000363814900002
View details for PubMedID 26496568
Added Value of Radiologist Consultation for Pediatric Ultrasound: Implementation and Survey Assessment AMERICAN JOURNAL OF ROENTGENOLOGY 2015; 205 (4): 822-826
The purpose of this study was to determine whether radiologist-parent (guardian) consultation sessions for pediatric ultrasound with immediate disclosure of examination results if desired increases visit satisfaction, decreases anxiety, and increases understanding of the radiologist's role.Parents chaperoning any outpatient pediatric ultrasound were eligible and completed surveys before and after ultrasound examinations. Before the second survey, parents met with a pediatric radiologist on a randomized basis but could opt out and request or decline the consultation. Differences in anxiety and understanding of the radiologist's role before and after the examination were compared, and overall visit satisfaction measures were tabulated.Seventy-seven subjects participated, 71 (92%) of whom spoke to a radiologist, mostly on request. In the consultation group, the mean score (1, lowest; 4, highest) for overall experience was 3.8 0.4 (SD), consultation benefit was 3.7 0.6, and radiologist interaction was 3.7 0.6. Demographics were not predictive of satisfaction with statistical significance in a multivariate model. Forty-six of 68 (68%) respondents correctly described the radiologist's role before consultation. The number increased to 60 (88%) after consultation, and the difference was statistically significant (p < 0.001). There was also a statistically significant decrease in mean anxiety score from 2.0 1.0 to 1.5 0.8 after consultation (p < 0.001). Sixty-four of 70 (91%) respondents indicated that they would prefer to speak with a radiologist during every visit.Radiologist consultation is well received among parents and associated with decreased anxiety and increased understanding of the radiologist's role. The results of this study support the value of routine radiologist-parent interaction for pediatric ultrasound.
View details for DOI 10.2214/AJR.15.14542
View details for Web of Science ID 000361847300033
View details for PubMedID 26397331
Key Concepts of Patient Safety in Radiology RADIOGRAPHICS 2015; 35 (6): 1677-1693
Harm from medical error is a difficult challenge in health care, including radiology. Modern approaches to patient safety have shifted from a focus on individual performance and reaction to errors to development of robust systems and processes that create safety in organizations. Organizations that operate safely in high-risk environments have been termed high-reliability organizations. Such organizations tend to see themselves as being constantly bombarded by errors. Thus, the goal is not to eliminate human error but to develop strategies to prevent, identify, and mitigate errors and their effects before they result in harm. High-level reliability strategies focus on systems and organizational culture; intermediate-level reliability strategies focus on establishment of effective processes; low-level reliability strategies focus on individual performance. Although several classification schemes for human error exist, modern safety researchers caution against overreliance on error investigations to improve safety. Blaming individuals involved in adverse events when they had no intent to cause harm has been shown to undermine organizational safety. Safety researchers have coined the term just culture for the successful balance of individual accountability with accommodation for human fallibility and system deficiencies. Safety is inextricably intertwined with an organization's quality efforts. A quality management system that focuses on standardization, making errors visible, building in quality, and constantly stopping to fix problems results in a safer environment and engages personnel in a way that contributes to a culture of safety. ()RSNA, 2015.
View details for DOI 10.1148/rg.2015140277
View details for Web of Science ID 000364361800007
View details for PubMedID 26334571
Root Cause Analysis: Learning from Adverse Safety Events RADIOGRAPHICS 2015; 35 (6): 1655-1667
Serious adverse events continue to occur in clinical practice, despite our best preventive efforts. It is essential that radiologists, both as individuals and as a part of organizations, learn from such events and make appropriate changes to decrease the likelihood that such events will recur. Root cause analysis (RCA) is a process to (a) identify factors that underlie variation in performance or that predispose an event toward undesired outcomes and (b) allow for development of effective strategies to decrease the likelihood of similar adverse events occurring in the future. An RCA process should be performed within the environment of a culture of safety, focusing on underlying system contributors and, in a confidential manner, taking into account the emotional effects on the staff involved. The Joint Commission now requires that a credible RCA be performed within 45 days for all sentinel or major adverse events, emphasizing the need for all radiologists to understand the processes with which an effective RCA can be performed. Several RCA-related tools that have been found to be useful in the radiology setting include the "five whys" approach to determine causation; cause-and-effect, or Ishikawa, diagrams; causal tree mapping; affinity diagrams; and Pareto charts. ()RSNA, 2015.
View details for DOI 10.1148/rg.2015150067
View details for Web of Science ID 000364361800005
View details for PubMedID 26466177
Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification RADIOGRAPHICS 2015; 35 (6): 1643-1651
Practice quality improvement (PQI) is a required component of the American Board of Radiology (ABR) Maintenance of Certification (MOC) cycle, with the goal to "improve the quality of health care through diplomate-initiated learning and quality improvement." The essential requirements of PQI projects include relevance to one's practice, achievability in one's clinical setting, results suited for repeat measurements during an ABR MOC cycle, and reasonable expectation to result in quality improvement (QI). PQI projects can be performed by a group or an individual or as part of a participating institution. Given the interdisciplinary nature of radiology, teamwork is critical to ensure patient safety and the success of PQI projects. Additionally, successful QI requires considerable investment of time and resources, coordination, organizational support, and individual engagement. Group PQI projects offer many advantages, especially in larger practices and for processes that cross organizational boundaries, whereas individual projects may be preferred in small practices or for focused projects. In addition to the three-phase "plan, do, study, act" model advocated by the ABR, there are several other improvement models, which are based on continuous data collection and rapid simultaneous testing of multiple interventions. When properly planned, supported, and executed, group PQI projects can improve the value and viability of a radiology practice. ()RSNA, 2015.
View details for DOI 10.1148/rg.2015150024
View details for Web of Science ID 000364361800003
View details for PubMedID 26334572
Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model EUROPEAN RADIOLOGY 2015; 25 (8): 2231-2238
To develop and assess the performance of a diameter-based logistic predictive model and a derived 3-category interpretive scheme for the sonographic diagnosis of paediatric appendicitis.Appendiceal diameters were extracted from reports of ultrasound examinations in children and young adults. Data were used to generate a logistic predictive model which was used to define negative, equivocal and positive interpretive categories. Diagnostic performance of the derived 3-category interpretive scheme was compared with simulated binary interpretive schemes.Six hundred forty-one appendix ultrasound reports were reviewed with appendicitis present in 181 (28.2%). Cut-off diameters based on the logistic predictive model were 6mm = normal, >6mm-8mm = equivocal and >8mm = positive with appendicitis present in 2.6% (11/428), 64.9% (72/111) and 96.1% (98/102) of cases in each group. These cut-offs conferred 97.2% accuracy with 17.3% (111/641) of cases considered equivocal. Of the binary cut-offs, a 6mm cut-off performed best with 91.6% accuracy. AIC analysis favoured the logistic model over the binary model for prediction of appendicitis.A 3-category interpretive scheme based on a logistic predictive model provides higher accuracy in the diagnosis of appendicitis than traditional binary diameter cut-offs. Inclusion of an equivocal interpretive category more accurately reflects the probability distribution of prediction of appendicitis by ultrasound. Three diameter categories outperform a 6-mm cut-off to diagnose appendicitis Three categories allow more confident exclusion of appendicitis Three categories allow more confident diagnosis of appendicitis Three categories more accurately reflect the probability of appendicitis by ultrasound.
View details for DOI 10.1007/s00330-015-3639-x
View details for Web of Science ID 000357660100005
View details for PubMedID 25916384
Tackling the problem of error in diagnostic radiology PEDIATRIC RADIOLOGY 2015; 45 (6): 790-792
Toward Large-Scale Process Control to Enable Consistent CT Radiation Dose Optimization AMERICAN JOURNAL OF ROENTGENOLOGY 2015; 204 (5): 959-966
This article reviews the concepts of CT radiation dose optimization and process control, discusses how to achieve optimization and how to verify that it is consistently accomplished, and proposes strategies to move toward large-scale application.CT dose optimization is achieved when the least amount of radiation necessary is used to achieve adequate image quality. The key to consistent optimization is minimization of unnecessary variation. This minimization is accomplished through local process control mechanisms.
View details for DOI 10.2214/AJR.14.13918
View details for Web of Science ID 000356776900028
View details for PubMedID 25730157
A Framework for Describing Health Care Delivery Organizations and Systems AMERICAN JOURNAL OF PUBLIC HEALTH 2015; 105 (4): 670-679
Describing, evaluating, and conducting research on the questions raised by comparative effectiveness research and characterizing care delivery organizations of all kinds, from independent individual provider units to large integrated health systems, has become imperative. Recognizing this challenge, the Delivery Systems Committee, a subgroup of the Agency for Healthcare Research and Quality's Effective Health Care Stakeholders Group, which represents a wide diversity of perspectives on health care, created a draft framework with domains and elements that may be useful in characterizing various sizes and types of care delivery organizations and may contribute to key outcomes of interest. The framework may serve as the door to further studies in areas in which clear definitions and descriptions are lacking.
View details for DOI 10.2105/AJPH.2014.301926
View details for Web of Science ID 000357387800034
View details for PubMedID 24922130
Radiologist Compliance With California CT Dose Reporting Requirements: A Single-Center Review of Pediatric Chest CT AMERICAN JOURNAL OF ROENTGENOLOGY 2015; 204 (4): 810-816
Effective July 1, 2012, CT dose reporting became mandatory in California. We sought to assess radiologist compliance with this legislation and to determine areas for improvement.We retrospectively reviewed reports from all chest CT examinations performed at our institution from July 1, 2012, through June 30, 2013, for errors in documentation of volume CT dose index (CTDIvol), dose-length product (DLP), and phantom size. Reports were considered as legally compliant if both CTDIvol and DLP were documented accurately and as institutionally compliant if phantom size was also documented accurately. Additionally, we tracked reports that did not document dose in our standard format (phantom size, CTDIvol for each series, and total DLP).Radiologists omitted CTDIvol, DLP, or both in nine of 664 examinations (1.4%) and inaccurately reported one or both of them in 56 of the remaining 655 examinations (8.5%). Radiologists omitted phantom size in 11 of 664 examinations (1.7%) and inaccurately documented it in 20 of the remaining 653 examinations (3.1%). Of 664 examinations, 599 (90.2%) met legal reporting requirements, and 583 (87.8%) met institutional requirements. In reporting dose, radiologists variably used less decimal precision than available, summed CTDIvol, included only series-level DLP, and specified dose information from the scout topogram or a nonchest series for combination examinations.Our institutional processes, which primarily rely on correct human performance, do not ensure accurate dose reporting and are prone to variation in dose reporting format. In view of this finding, we are exploring higher-reliability processes, including better-defined standards and automated dose reporting systems, to improve compliance.
View details for DOI 10.2214/AJR.14.13693
View details for Web of Science ID 000351614700037
Improvement in Diagnostic Accuracy of Ultrasound of the Pediatric Appendix Through the Use of Equivocal Interpretive Categories AMERICAN JOURNAL OF ROENTGENOLOGY 2015; 204 (4): 849-855
The purpose of this article is to evaluate the diagnostic performance of ultrasound of the pediatric appendix using standardized structured reports that incorporate equivocal interpretive categories.Standardized structured appendix ultrasound reports using a five-category interpretive scheme were reviewed. Interpretive categories were positive, intermediate likelihood, or negative when the appendix was visualized, and secondary signs or no secondary signs when the appendix was not visualized. Interpretations were compared with clinical and pathologic follow-up. Diagnostic accuracy was compared with the accuracy of a simulated binary interpretive scheme based on the same data.One thousand three hundred fifty-seven examinations were included, with appendicitis present in 16.9% (230/1357) of cases. The appendix was visualized in 47.2% (641/1357) of cases, with interpretations as follows: positive, 27.5% (176/641); intermediate likelihood, 9.7% (62/641); and normal, 62.9% (403/641). The appendicitis rate in each group was 92.6% (163/176), 25.8% (16/62), and 0.5% (2/403), respectively. The appendix was not visualized in 52.8% (716/1357) of cases, with secondary findings identified in 8.5% (61/716) and no secondary findings in 91.5% (655/716) of cases. The appendicitis rate was 39.3% (24/61) and 3.8% (25/655) in these groups, respectively. Appendicitis was present in 32.5% of equivocal (intermediate likelihood and not visualized, secondary findings) cases and 2.6% of negative (normal and not visualized, no secondary findings) cases. Diagnostic accuracy of a five-category scheme was 96.8% versus 94.1% for a binary scheme.Appendix ultrasound examinations interpreted according to a scheme that incorporates equivocal categories better convey diagnostic certainty and increase diagnostic accuracy compared with a binary interpretive scheme.
View details for DOI 10.2214/AJR.14.13026
View details for Web of Science ID 000351614700042
View details for PubMedID 25794076
Beginner's Guide to Practice Quality Improvement Using the Model for improvement JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY 2014; 11 (12): 1131-1136
Radiologists in the United States are required to complete the Practice Quality Improvement (PQI) program as part of their Maintenance of Certification by the ABR. The Institute for Healthcare Improvement's (IHI) Model for Improvement (MFI) offers an alternative to the 3-phase approach currently advocated by the ABR. The MFI implicitly assumes that many interventions will need to be tested and refined for any meaningful project, and provides a project management approach that enables rapid assessment and improvement of performance. By collecting data continuously, rather than simply before and after interventions, more interventions can be tested simultaneously and projects can progress more rapidly. In this article, we describe the ABR's 3-phase approach, and introduce the MFI and how it can be employed to affect positive changes. Using a radiology case study, we demonstrate how one can utilize the MFI to enable rapid quality improvement.
View details for DOI 10.1016/j.jacr.2014.08.033
View details for Web of Science ID 000345953400012
View details for PubMedID 25467725
Communication in diagnostic radiology: meeting the challenges of complexity. AJR. American journal of roentgenology 2014; 203 (5): 957-964
As patients and information flow through the imaging process, value is added step-by-step when information is acquired, interpreted, and communicated back to the referring clinician. However, radiology information systems are often plagued with communication errors and delays. This article presents theories and recommends strategies to continuously improve communication in the complex environment of modern radiology.Communication theories, methods, and systems that have proven their effectiveness in other environments can serve as models for radiology.
View details for DOI 10.2214/AJR.14.12949
View details for PubMedID 25341133
Pediatric CT quality management and improvement program PEDIATRIC RADIOLOGY 2014; 44: 519-524
Pediatric CT quality management and improvement program. Pediatric radiology 2014; 44: 519-524
Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve.
View details for DOI 10.1007/s00247-014-3039-4
View details for PubMedID 25304715
Optimizing CT radiation dose based on patient size and image quality: the size-specific dose estimate method PEDIATRIC RADIOLOGY 2014; 44: 501-505
Guide to Effective Quality Improvement Reporting in Radiology RADIOLOGY 2014; 271 (2): 561-573
Substantial societal investments in biomedical research are contributing to an explosion in knowledge that the health delivery system is struggling to effectively implement. Managing this complexity requires ingenuity, research and development, and dedicated resources. Many innovative solutions can be found in quality improvement (QI) activities, defined as the "systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of healthcare in particular settings." QI shares many similarities with biomedical research, but also differs in several important ways. Inclusion of QI in the peer-reviewed literature is needed to foster its advancement through the dissemination, testing, and refinement of theories, methods, and applications. QI methods and reporting standards are less mature in health care than those of biomedical research. A lack of widespread understanding and consensus regarding the purpose of publishing QI-related material also exists. In this document, guidance is provided in evaluating quality of QI-related material and in determining priority of submitted material for publication. RSNA, 2014.
View details for DOI 10.1148/radiol.14131930
View details for Web of Science ID 000335153000028
View details for PubMedID 24555635
Improving the Availability of Clinical History Accompanying Radiographic Examinations in a Large Pediatric Radiology Department AMERICAN JOURNAL OF ROENTGENOLOGY 2014; 202 (4): 790-796
The purpose of this quality improvement initiative was to improve the consistency with which radiologists are provided a complete clinical history when interpreting radiography examinations performed in the outpatient and emergency department settings.The clinical history was considered complete if it contained three elements: nature of the symptoms, description of injury, or cause for clinical concern; duration of symptoms or time of injury; and focal site of pain or abnormality, if applicable. This was reduced to three elements: "what-when-where." A goal was established that 95% of the clinical histories should contain all three elements. To achieve this goal, technologists supplemented referring clinicians' history. The project was divided into four phases: launch, support, transition to sustainability, and maintenance. During the support phase, results of automated weekly audits automatically populated group-level performance reports. During the transition to the sustainability phase, audit results populated individual-level performance reports. During the maintenance phase, quarterly audit results were incorporated into technologists' employee performance goals.Before initiation of the project, 38% (76/200) of radiography examinations were accompanied by a complete clinical history. This increased to 92% (928/1006) by the end of the 15-week improvement phase. Performance was sustained at 96% (1168/1213) 7 months later [corrected].By clearly defining expectations for an appropriate clinical history and establishing system and organizational mechanisms to facilitate verifiable compliance, we were able to successfully and sustainably improve the consistency with which radiography examinations were accompanied by a complete clinical history.
View details for DOI 10.2214/AJR.13.11273
View details for Web of Science ID 000333454300033
View details for PubMedID 24660708
Twiddler syndrome with a twist: a cause of vagal nerve stimulator lead fracture PEDIATRIC RADIOLOGY 2013; 43 (12): 1647-1651
Twiddler syndrome is uncommon in children and most commonly described as causing lead retraction with implanted cardiac pacemakers and defibrillators. We report an uncommon case of a child repeatedly "twiddling" a vagal nerve stimulator to the point of lead fracture. The findings of Twiddler syndrome illustrated here apply to all implanted devices and show the complication of lead fracture in addition to the more commonly reported complication of lead retraction. This case highlights the need to be aware of the radiographic findings of this phenomenon in children with implanted vagal nerve stimulators due to the perceived increased risk of "twiddling" in pediatric and developmentally delayed patients.
View details for DOI 10.1007/s00247-013-2736-8
View details for Web of Science ID 000327425400014
View details for PubMedID 23832019
Practice Policy and Quality Initiatives Quality Improvement and Confirmation Projects: Facilitating Rapid, Measurable Performance Improvement RADIOGRAPHICS 2013; 33 (7): E225-E235
As radiology departments continue to increase in size and complexity, the process of improving and maintaining excellent performance is becoming increasingly challenging. In response, a systematic process for efficiently implementing and sustaining measurable improvement in our radiology department has been developed, which targets focused aspects of individual performance that contribute to overall departmental quality. Projects designed to achieve such improvements have been called quality improvement and confirmation (QuIC) projects. The QuIC project process involves a project champion, medical expert, technical expert, quality improvement technologist specialist, and appropriate leaders, managers, and support personnel. The project champion conducts a preliminary investigation and organizes team members, who define the desired performance through consensus, establish data collection and analysis procedures, and prepare to launch the project. Once launched, the QuIC project process follows an execution period that is divided into four phases: (a) project launch phase, (b) support phase, (c) transition phase, and (d) maintenance phase. The first three phases focus on education, group-level feedback, and individual feedback, respectively. Weekly audits are performed to track performance improvement. Data collection, analysis, and dissemination processes are automated to the extent possible. To date, four such projects have been successfully conducted. The QuIC project concept is an attempt to apply the principles of process improvement to the process of process improvement by enabling any member of a radiology department to efficiently and reliably spearhead a quality improvement project. We consider this to be a work in progress and continue to refine the process with the goal of eventually being able to conduct many projects simultaneously.
View details for DOI 10.1148/rg.337135058
View details for Web of Science ID 000327759900003
View details for PubMedID 23988633
Emergency Department Computed Tomography Utilization in the United States and Canada ANNALS OF EMERGENCY MEDICINE 2013; 62 (5): 486-494
We compare secular trends in computed tomography (CT) utilization in emergency departments (EDs) in the United States and Ontario, Canada.Using a systematic survey in the US (The National Hospital Ambulatory Medical Care Survey) and administrative databases in Ontario, we performed a retrospective study of ED visits from 2003 to 2008. We calculated utilization overall, by visit characteristics, and for 5 clinical conditions in which CT is commonly indicated: abdominal pain, complex abdominal pain (abdominal pain, age 65 years, urgent to most urgent triage), admitted complex abdominal pain (abdominal pain, age 65 years, urgent to most urgent triage, and admitted to hospital), headache, and chest pain/shortness of breath. US data were weighted to produce national estimates.On-site CT was available for 97% (95% confidence interval [CI] 95% to 99%) of visits in the United States compared with 80% (95% CI 80% to 80%) in Ontario. Visits were more frequently triaged as higher acuity in the United States than in Ontario, with 15.1% (95% CI 13.9% to 16.4%) of US visits categorized as most urgent versus 11.8% (95% CI 11.8% to 11.8%) in Ontario. The proportion of all ED visits in which CT was performed was 11.4% (95% CI 10.8% to 12.0%) in the United States versus 5.9% (95% CI 5.9% to 5.9%) in Ontario. The proportion for children was 4.7% (95% CI 4.3% to 5.1%) in the United States versus 1.4% (95% CI 1.4% to 1.4%) in Ontario. The rate of visits involving CT per year increased faster from 2003 to 2008 in the United States (odds ratio 2.00; 95% CI 1.81 to 2.21) than Ontario (odds ratio 1.69; 95% CI 1.68 to 1.70). Over time, all subgroups experienced increases in CT rate except Ontario children younger than 10 years, who experienced a significant decrease. United States-Ontario differences in CT proportions were significant among patients presenting with headache, abdominal pain, chest pain/shortness of breath, and complex abdominal pain. Proportions for visits involving admitted complex abdominal pain in the two jurisdictions were indistinguishable: 45.8% in the United States (95% CI 39.9% to 51.7%) versus 44.7% (95% CI 44.4% to 45.0%) in Ontario.CT was more readily available in US EDs, and US clinicians used the technology more frequently than their colleagues in Ontario for nearly every category of patients, including children. CT utilization increased over time in both jurisdictions, but faster in the United States. Different demographic features between the two jurisdictions, including triage severity, frequency of hospitalization, and availability of CT scanners, likely account for at least some of the differences in CT utilization. Investigation of both clinical and nonclinical reasons for the differences in CT utilization between the United States and Canada would be a fruitful area for further research.
View details for DOI 10.1016/j.annemergmed.2013.02.018
View details for Web of Science ID 000326906200008
View details for PubMedID 23683773
System for Verifiable CT Radiation Dose Optimization Based on Image Quality. Part II. Process Control System RADIOLOGY 2013; 269 (1): 177-185
To evaluate the effect of an automated computed tomography (CT) radiation dose optimization and process control system on the consistency of estimated image noise and size-specific dose estimates (SSDEs) of radiation in CT examinations of the chest, abdomen, and pelvis.This quality improvement project was determined not to constitute human subject research. An automated system was developed to analyze each examination immediately after completion, and to report individual axial-image-level and study-level summary data for patient size, image noise, and SSDE. The system acquired data for 4 months beginning October 1, 2011. Protocol changes were made by using parameters recommended by the prediction application, and 3 months of additional data were acquired. Preimplementation and postimplementation mean image noise and SSDE were compared by using unpaired t tests and F tests. Common-cause variation was differentiated from special-cause variation by using a statistical process control individual chart.A total of 817 CT examinations, 490 acquired before and 327 acquired after the initial protocol changes, were included in the study. Mean patient age and water-equivalent diameter were 12.0 years and 23.0 cm, respectively. The difference between actual and target noise increased from -1.4 to 0.3 HU (P < .01) and the standard deviation decreased from 3.9 to 1.6 HU (P < .01). Mean SSDE decreased from 11.9 to 7.5 mGy, a 37% reduction (P < .01). The process control chart identified several special causes of variation.Implementation of an automated CT radiation dose optimization system led to verifiable simultaneous decrease in image noise variation and SSDE. The automated nature of the system provides the opportunity for consistent CT radiation dose optimization on a broad scale.
View details for DOI 10.1148/radiol.13122321
View details for Web of Science ID 000325000700020
View details for PubMedID 23784877
System for Verifiable CT Radiation Dose Optimization Based on Image Quality. Part I. Optimization Model RADIOLOGY 2013; 269 (1): 167-176
To develop and validate a mathematical radiation dose optimization model for computed tomography (CT) of the chest, abdomen, and pelvis.This quality improvement project was determined not to constitute human subject research. A model for measuring water-equivalent diameter (DW) based on the topogram was developed and validated on each axial section in eight CT examinations of the chest, abdomen, and pelvis (500 images). A model for estimating image noise and size-specific dose estimates (SSDEs) using image and metadata was developed and validated in 16 examinations of anthropomorphic phantoms. A model to quantify radiologist image quality preferences was developed and applied to evaluations of 32 CT examinations of the abdomen and pelvis by 10 radiologists. The scanners' dose modulation algorithms were modeled and incorporated into an application capable of prediction of image noise and SSDE over a range of patient sizes. With use of the application, protocol techniques were recommended to achieve specific image noise targets. Comparisons were evaluated by using two-tailed nonpaired and paired t tests. Results: The mean difference between topogram- and axial-based DW estimates was -3.5% 2.2 (standard deviation). The mean difference between estimated and measured image noise and volume CT dose index on the anthropomorphic phantoms was -6.9% 5.5 and 0.8% 1.8, respectively. A three-dimensional radiologist image quality preference model was developed. For the prediction model validation studies, mean differences between predicted and actual effective tube current-time product, SSDE, and estimated image noise were -0.9% 9.3, -1.8% 10.6, and -0.5% 4.4, respectively.CT image quality and radiation dose can be mathematically predicted and optimized on the basis of patient size and radiologist-specific image noise target curves.
View details for DOI 10.1148/radiol.13122320
View details for Web of Science ID 000325000700019
View details for PubMedID 23784878
Comparison of radiation dose estimates, image noise, and scan duration in pediatric body imaging for volumetric and helical modes on 320-detector CT and helical mode on 64-detector CT PEDIATRIC RADIOLOGY 2013; 43 (9): 1117-1127
Advanced multidetector CT systems facilitate volumetric image acquisition, which offers theoretic dose savings over helical acquisition with shorter scan times.Compare effective dose (ED), scan duration and image noise using 320- and 64-detector CT scanners in various acquisition modes for clinical chest, abdomen and pelvis protocols.ED and scan durations were determined for 64-detector helical, 160-detector helical and volume modes under chest, abdomen and pelvis protocols on 320-detector CT with adaptive collimation and 64-detector helical mode on 64-detector CT without adaptive collimation in a phantom representing a 5-year-old child. Noise was measured as standard deviation of Hounsfield units.Compared to 64-detector helical CT, all acquisition modes on 320-detector CT resulted in lower ED and scan durations. Dose savings were greater for chest (27-46%) than abdomen/pelvis (18-28%) and chest/abdomen/pelvis imaging (8-14%). Noise was similar across scanning modes, although some protocols on 320-detector CT produced slightly higher noise.Dose savings can be achieved for chest, abdomen/pelvis and chest/abdomen/pelvis examinations on 320-detector CT compared to helical acquisition on 64-detector CT, with shorter scan durations. Although noise differences between some modes reached statistical significance, this is of doubtful diagnostic significance and will be studied further in a clinical setting.
View details for DOI 10.1007/s00247-013-2690-5
View details for Web of Science ID 000323275700007
View details for PubMedID 23636537
Diagnostic Reference Ranges for Pediatric Abdominal CT RADIOLOGY 2013; 268 (1): 208-218
To develop diagnostic reference ranges (DRRs) and a method for an individual practice to calculate site-specific reference doses for computed tomographic (CT) scans of the abdomen or abdomen and pelvis in children on the basis of body width (BW).This HIPAA-compliant multicenter retrospective study was approved by institutional review boards of participating institutions; informed consent was waived. In 939 pediatric patients, CT doses were reviewed in 499 (53%) male and 440 (47%) female patients (mean age, 10 years). Doses were from 954 scans obtained from September 1 to December 1, 2009, through Quality Improvement Registry for CT Scans in Children within the National Radiology Data Registry, American College of Radiology. Size-specific dose estimate (SSDE), a dose estimate based on BW, CT dose index, dose-length product, and effective dose were analyzed. BW measurement was obtained with electronic calipers from the axial image at the splenic vein level after completion of the CT scan. An adult-sized patient was defined as a patient with BW of 34 cm. An appropriate dose range for each DRR was developed by reviewing image quality on a subset of CT scans through comparison with a five-point visual reference scale with increments of added simulated quantum mottle and by determining DRR to establish lower and upper bounds for each range.For 954 scans, DRRs (SSDEs) were 5.8-12.0, 7.3-12.2, 7.6-13.4, 9.8-16.4, and 13.1-19.0 mGy for BWs less than 15, 15-19, 20-24, 25-29, and 30 cm or greater, respectively. The fractions of adult doses, adult SSDEs, used within the consortium for patients with BWs of 10, 14, 18, 22, 26, and 30 cm were 0.4, 0.5, 0.6, 0.7, 0.8, and 0.9, respectively.The concept of DRRs addresses the balance between the patient's risk (radiation dose) and benefit (diagnostic image quality). Calculation of reference doses as a function of BW for an individual practice provides a tool to help develop site-specific CT protocols that help manage pediatric patient radiation doses.
View details for DOI 10.1148/radiol.13120730
View details for Web of Science ID 000320761400023
View details for PubMedID 23513245
Commentary: Masters of Radiology Panel Discussion-How Do We Maintain Control Over Imaging? AMERICAN JOURNAL OF ROENTGENOLOGY 2013; 201 (1): 128-132
Masters of Radiology Panel Discussion: Defining a Quality Dashboard for Radiology-What Are the Right Metrics? AMERICAN JOURNAL OF ROENTGENOLOGY 2013; 200 (4): 839-844
Improving Consistency in Radiology Reporting through the Use of Department-wide Standardized Structured Reporting RADIOLOGY 2013; 267 (1): 240-250
To successfully develop a department-wide standardized structured reporting program and achieve widespread adoption throughout the radiology department.A structured reporting work group was formed in February 2010 to oversee development of standardized structured reports for a radiology department of 36 radiologists at a tertiary care children's hospital. The committee reached consensus on report organization and provided written guidelines and checklists for division representatives to aid in creation of the structured reports. Report drafts were reviewed by a subcommittee and revised until agreement was reached with the report author. Each report was vetted by all radiologists who would be using the report, and further revisions were made, as appropriate. Reports were then entered into the speech recognition system so that each report was associated with a procedure code or a group of codes from the radiology information system. This enabled automatic report population within the speech recognition system. The initiative was completed by September 2011. Quarterly audits were performed to evaluate for adherence to the standard report format and use of the normal report in cases in which the radiologist believed the study was normal. In August 2012, radiologists were surveyed as to their impressions of the structured reporting program.A total of 228 standardized structured reports were created within 2 years after initiation of the project, corresponding to 199,000 (94%) of 212,000 departmental studies by volume. By the end of the implementation period in September 2011, all 223 (100%) audited reports adhered to the standard report format and 80 (99%) of 81 reports adhered to the normal report. Radiologist feedback was largely favorable.Standardized department-wide structured reporting can be implemented in a radiology department, with a high rate of adoption by the radiologists.
View details for DOI 10.1148/radiol.12121502
View details for Web of Science ID 000316565000025
View details for PubMedID 23329657
Practice Policy and Quality Initiatives Decreasing Variability in Turnaround Time for Radiographic Studies from the Emergency Department RADIOGRAPHICS 2013; 33 (2): 361-371
A study was performed to evaluate use of quality improvement techniques to decrease the variability in turnaround time (TAT) for radiology reports on emergency department (ED) radiographs. An interdepartmental improvement team applied multiple interventions. Statistical process control charts were used to evaluate for improvement in mean TAT for ED radiographs, percentage of ED radiographs read within 35 minutes, and standard deviation of the mean TAT. To determine if the changes in the radiology department had an effect on the ED, the average time from when an ED physician first met with the patient to the time when the final treatment decision was made was also measured. There was a significant improvement in mean TAT for ED radiographs (from 23.9 to 14.6 minutes), percentage of ED radiographs read within 35 minutes (from 82.2% to 92.9%), and standard deviation of the mean TAT (from 22.8 to 12.7). The mean time from when an ED physician first met with the patient to the time a final treatment decision was made decreased from 88.7 to 79.8 minutes. Quality improvement techniques were used to decrease mean TAT and the variability in TAT for ED radiographs. This change was associated with an improvement in ED throughput.
View details for DOI 10.1148/rg.332125738
View details for Web of Science ID 000315998700007
View details for PubMedID 23479701
Standardization of Quality Initiative Reporting RADIOGRAPHICS 2013; 33 (2): 373-374
Masters of Radiology Panel Discussion: Hyperefficient Radiology-Can We Maintain The Pace? AMERICAN JOURNAL OF ROENTGENOLOGY 2012; 199 (4): 838-843
Masters of Radiology Panel Discussion: The Future of the Radiology Job Market AMERICAN JOURNAL OF ROENTGENOLOGY 2012; 199 (1): 127-132
Masters of Radiology Panel Discussion: Maintaining Maintenance of Certification in the Field of Radiology AMERICAN JOURNAL OF ROENTGENOLOGY 2012; 198 (4): 854-857
Masters of Radiology Panel Discussion: Women in Radiology-How Can We Encourage More Women to Join the Field and Become Leaders? AMERICAN JOURNAL OF ROENTGENOLOGY 2012; 198 (1): 145-149
What Is the Role of the Radiologist in Holding Down Health Care Cost Growth? AMERICAN JOURNAL OF ROENTGENOLOGY 2011; 197 (4): 919-922
Changing Radiologists' Expectations: False Information versus Years of Experience RADIOLOGY 2011; 261 (1): 327-327
Masters of Radiology Panel Discussion: Encouraging and Fostering Mentorship-How We Can Ensure That No Faculty Member Is Left Behind and That Leaders Do Not Fail AMERICAN JOURNAL OF ROENTGENOLOGY 2011; 197 (1): 149-153
Rethinking Peer Review: What Aviation Can Teach Radiology about Performance Improvement RADIOLOGY 2011; 259 (3): 626-632
Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995-2008 RADIOLOGY 2011; 259 (3): 793-801
To describe nationwide trends and factors associated with the use of computed tomography (CT) in children visiting emergency departments (EDs) in the United States between 1995 and 2008.This study was exempt from institutional review board oversight. Data from the 1995-2008 National Hospital Ambulatory Medical Care Survey were used to evaluate the number and percentage of visits associated with CT for patients younger than 18 years. A mean of 7375 visits were sampled each year. Data were subcategorized according to multiple patient and hospital characteristics. The Rao-Scott (2) test was performed to determine whether CT use was similar across subpopulations.From 1995 to 2008, the number of pediatric ED visits that included CT examination increased from 0.33 to 1.65 million, a fivefold increase, with a compound annual growth rate of 13.2%. The percentage of visits associated with CT increased from 1.2% to 5.9%, a 4.8-fold increase, with a compound annual growth rate of 12.8%. The number of visits associated with CT at pediatric-focused and non-pediatric-focused EDs increased from 14,895 and 316,133, respectively, in 1995 to 212,716 and 1,438,413, respectively, in 2008. By the end of the study period, top chief complaints among those undergoing CT included head injury, abdominal pain, and headache.Use of CT in children who visit the ED has increased substantially and occurs primarily at non-pediatric-focused facilities. This underscores the need for special attention to this vulnerable population to ensure that imaging is appropriately ordered, performed, and interpreted.
View details for DOI 10.1148/radiol.11101939
View details for Web of Science ID 000290898100019
View details for PubMedID 21467249
Reliability of Renal Length Measurements Made With Ultrasound Compared With Measurements From Helical CT Multiplanar Reformat Images AMERICAN JOURNAL OF ROENTGENOLOGY 2011; 196 (5): W592-W597
The purpose of this article is to determine the reliability of sonographic renal length measurements compared with measurements obtained from helical CT multiplanar reformat images and compared with standard renal growth curves.A retrospective review was performed of 76 subjects who underwent both renal ultrasound and abdominal CT within 2 weeks of one another. Renal lengths were measured using oblique coronal reformat images of helically acquired CT data by two observers on two occasions. Intraobserver and interobserver error for these measurements were calculated. Ultrasound renal length measurements were compared with CT measurements. Measurement variation was compared with standard renal growth curves.The mean ( SD) of the absolute value of interobserver error of CT measurements was 0.9 0.8 mm. Compared with CT, individual ultrasound measurements underestimated renal length by 1.5 5.6 mm on average, with a 95% CI of -12.5 to 9.5 mm. When the maximum of three ultrasound renal length measurements was used, the SD was 4.7 mm, with a 95% CI of -8.2 to 10.1 mm of the reported renal length. This corresponds to greater or less than 3.3 years of normal renal growth.Lack of renal growth can be asserted only when renal length falls below the growth curve, taking into account the corresponding measurement error limits, which we found to be greater or less than 9.3 mm. If the follow-up measurement falls within these limits, one should not infer lack of appropriate renal growth, even if the renal length measurement decreases or remains unchanged for up to 3 years.
View details for DOI 10.2214/AJR.10.5486
View details for Web of Science ID 000289769000014
View details for PubMedID 21512050
Masters of Radiology Panel Discussion: The Commoditization of Radiology AMERICAN JOURNAL OF ROENTGENOLOGY 2011; 196 (4): 843-847
Masters of Radiology Panel Discussion: Models for Health Care Performance in Radiology-How Do We Measure Our Productivity and Ourselves? AMERICAN JOURNAL OF ROENTGENOLOGY 2011; 196 (1): 130-135
National Trends in CT Use in the Emergency Department: 1995-2007 RADIOLOGY 2011; 258 (1): 164-173
To identify nationwide trends and factors associated with the use of computed tomography (CT) in the emergency department (ED).This study was exempt from institutional review board approval. Data from the 1995-2007 National Hospital Ambulatory Medical Care Survey were used to evaluate the numbers and percentages of ED visits associated with CT. A mean of 30044 visits were sampled each year. Data were also subcategorized according to multiple patient and hospital characteristics. The Rao-Scott (2) test was performed to determine whether CT use was similar across subpopulations. Data were evaluated according to exponential and logistic growth models.From 1995 to 2007, the number of ED visits that included a CT examination increased from 2.7 million to 16.2 million, constituting a 5.9-fold increase and a compound annual growth rate of 16.0%. The percentage of visits associated with CT increased from 2.8% to 13.9%, constituting a 4.9-fold increase and a compound annual growth rate of 14.2%. The exponential growth model provided the best fit for the trend in CT use. CT use was greater in older patients, white patients, patients admitted to the hospital, and patients at facilities in metropolitan regions. By the end of the study period, the top chief complaints among those who underwent CT were abdominal pain, headache, and chest pain. The percentage of patient visits associated with CT for all evaluated chief complaints increased-most substantially among those who underwent CT for flank, abdominal, or chest pain.Use of CT has increased at a higher rate in the ED than in other settings. The overall use of CT had not begun to taper by 2007.
View details for DOI 10.1148/radiol.10100640
View details for Web of Science ID 000285574200019
View details for PubMedID 21115875
Masters of Radiology Panel Discussion: Who Is Accountable for the Appropriateness of Studies-The Radiologist, the Referring Physician, or Both? AMERICAN JOURNAL OF ROENTGENOLOGY 2010; 195 (4): 968-973
Masters of Radiology Panel Discussion: Radiology Extenders-Challenges and Opportunities to Balance the Demands of Our Changing Work Environment AMERICAN JOURNAL OF ROENTGENOLOGY 2010; 195 (1): 170-175
Masters of Radiology Panel Discussion: Role of Communication in Today's Radiologic Practices AMERICAN JOURNAL OF ROENTGENOLOGY 2010; 194 (4): 1014-1017
Masters of Radiology Panel Discussion: Responding to Health Care Reform and Other Market Pressures AMERICAN JOURNAL OF ROENTGENOLOGY 2010; 194 (1): 173-177
RADPEER scoring white paper. Journal of the American College of Radiology 2009; 6 (1): 21-25
The ACR's RADPEER program began in 2002; the electronic version, e-RADPEER, was offered in 2005. To date, more than 10,000 radiologists and more than 800 groups are participating in the program. Since the inception of RADPEER, there have been continuing discussions regarding a number of issues, including the scoring system, the subspecialty-specific subcategorization of data collected for each imaging modality, and the validation of interfacility scoring consistency. This white paper reviews the task force discussions, the literature review, and the new recommended scoring process and lexicon for RADPEER.
View details for DOI 10.1016/j.jacr.2008.06.011
View details for PubMedID 19111267
My old Kentucky home, goodnight: Potential impact of planned changes in the radiology board certification process AMERICAN JOURNAL OF ROENTGENOLOGY 2008; 190 (5): 1149-1151
Informing parents about CT radiation exposure in children: It's OK to tell them AMERICAN JOURNAL OF ROENTGENOLOGY 2007; 189 (2): 271-275
The purpose of our study was to determine how parents' understanding of and willingness to allow their children to undergo CT change after receiving information regarding radiation dose and risk.One hundred parents of children undergoing nonemergent CT studies at a tertiary-care children's hospital were surveyed before and after reading an informational handout describing radiation risk. Parental knowledge of whether CT uses radiation or increases lifetime risk of cancer was assessed, as was willingness to permit their child to undergo both a CT examination that their child's doctor recommended and one for which their doctor thought observation might be equally effective.Of the 100 parents who were surveyed, 66% believed CT uses radiation before reading the handout, versus 99% afterward (p < 0.01). Before reading the handout, 13% believed CT increases the lifetime risk of cancer, versus 86% afterward (p < 0.01). After reading the handout, parents became less willing to have their child undergo CT given a hypothetic situation in which their doctor believed that either CT or observation would be equally effective (p < 0.01), but their willingness to have their child undergo CT recommended by their doctor did not significantly change. After reading the handout, 62% of parents reported no change in level of concern. No parent refused or requested to defer CT after reading the handout.A brief informational handout can improve parental understanding of the potential increased risk of cancer related to pediatric CT without causing parents to refuse studies recommended by the referring physician.
View details for DOI 10.2214/AJR.07.2248
View details for Web of Science ID 000248624400006
View details for PubMedID 17646450
Major changes in radiology residency program requirements are coming AMERICAN JOURNAL OF ROENTGENOLOGY 2007; 188 (1): 3-4
The AFIP and the tragedy of the commons. Journal of the American College of Radiology 2007; 4 (1): 8-10
Non-enhancing pilocytic astrocytoma of the spinal cord PEDIATRIC RADIOLOGY 2006; 36 (12): 1312-1315
Pilocytic astrocytomas are among the most common intramedullary spinal cord tumors in the pediatric age group. The presence of contrast enhancement is a major factor used to distinguish these tumors from other spinal cord lesions. We present a case of histologically proved non-enhancing intramedullary spinal cord pilocytic astrocytoma in a 12-year-old girl. This case represents an exception to the conventional wisdom that pediatric spinal neoplasms enhance with administration of intravenous contrast material.
View details for DOI 10.1007/s00247-006-0301-4
View details for Web of Science ID 000242831000012
View details for PubMedID 17021719
A comprehensive portrait of teleradiology in radiology practices: Results from the American College of Radiology's 1999 survey AMERICAN JOURNAL OF ROENTGENOLOGY 2005; 185 (1): 24-35
This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared.In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses.Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs.Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.
View details for Web of Science ID 000229951900005
View details for PubMedID 15972394
Graduate medical education financing: its effect on radiologists at all career levels AMERICAN JOURNAL OF ROENTGENOLOGY 2004; 182 (4): A9-A10
MD/MBA programs in the United States: Evidence of a change in health care leadership ACADEMIC MEDICINE 2003; 78 (3): 335-341
Managerial sciences are playing an increasingly prominent role in the organization and delivery of health care. Despite popular media reports that a rising number of physicians are acquiring a background in this discipline through MD/MBA (medical and master of business administration) programs, no recent study has verified this. This study measured changes in the number and nature of the affiliations between management and medicine in the form of MD/MBA programs in the United States.Surveys of admission officers of 125 U.S. allopathic medical schools and of the overseers of each joint MD/MBA degree program were administered in May-October 2001. Main outcome measures included program growth, curriculum and degree requirements, application and admission requirements, and program leadership and organization.The number of MD/MBA programs grew from six to 33 between 1993 and 2001, and 17 more medical schools were considering establishing the joint-degree program. Ten, 15, and 20 programs produced 27, 42, and 61 graduates in 1999, 2000, and 2001, respectively, and over 100 students were expected to graduate per year when all 33 programs matured. Program structures and oversight indicate a spectrum of philosophies regarding the appropriate level of integration of the two degrees. MD/MBA programs apparently attempt to complement medical education with management education rather than the converse.The growth in the numbers of MD/MBA programs and participants indicates rising cooperation between medical and business schools and increasing interest in management education early in the careers of graduating physicians.
View details for Web of Science ID 000181465500017
View details for PubMedID 12634220
Technical skills for weight loss: Preliminary data from a randomized trial PREVENTIVE MEDICINE 2002; 34 (6): 608-615
Optimal behavioral interventions for sustainable weight loss are uncertain. We therefore conducted a study among overweight/obese women comparing conventional dietary counseling of individuals (counseling-based intervention) to a novel, group-based skill-building intervention.Eighty subjects were randomly assigned to either the counseling-based or to the skill-building intervention. Outcomes included weight loss, dietitian hours per group and per unit weight loss, and dollars spent per group and per unit weight lost.Weight loss at 6 months (follow-up rate 61.3%) in the counseling-based group was 8.8 lb (P = 0.0001), and in the skill-building group was 3.8 lb (P = 0.01). A total of 160 dietitian hours were required for the counseling-based group, and 131 for the skilled-building group. The counseling-based group cost an average of $21 per pound lost, while the skill-building cost an average of $48 per pound lost (P = 0.16).At 6 months, individualized office-based counseling produced more weight loss than a skill-building approach and cost less than half as much per pound of weight loss. Longer-term follow-up is required to determine if, as hypothesized, the skill-building intervention produces more sustainable weight loss.
View details for DOI 10.1006/pmed.2002.1025
View details for Web of Science ID 000176029600007
View details for PubMedID 12052021
Self-reported weight and height - Implications for obesity research AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2001; 20 (4): 294-298
Self-reported weight and height are under- and over-reported, respectively, in epidemiologic studies. This tendency, which may adversely affect study operations, has not been evaluated among subjects being enrolled into a weight-loss program.Self-reported weight, height, and body mass index (BMI) were compared to measured values in 97 overweight or obese (BMI>27.3) women being enrolled into a randomized, controlled trial of two behavioral interventions for weight loss. The effects of demographic factors, baseline weight, baseline height, and baseline BMI on weight and height reporting were assessed.There was a significant difference between measured and reported weight (mean difference=-3.75 lb, p=0.0001) and height (mean difference=+0.35 in., p=0.0007). The mean difference between measured and reported BMI was -1.14 kg/m(2) (p=0.0001). Unemployed, retired, or disabled women were more likely to under-report their BMI than employed women (p=0.001). Six percent of subjects who were initially considered eligible for the study on the basis of the self-report were eventually excluded from the study because they did not meet the inclusion criterion for BMI.Obese women who seek weight-loss assistance tend to under-report their weight and over-report their height, suggesting that self-reported data are likely to be inaccurate. Misreporting is apparently influenced by employment and disability and has the potential to complicate recruitment of subjects for research studies.
View details for Web of Science ID 000168351400010
View details for PubMedID 11331120