-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: This article will briefly describe the driving forces of radiology's changing landscape because of health care reform and outline opportunities for radiologists in training to use health services and policy research skills to help show the value of radiologists in patient care, define the future business model of radiology, and shape wide-reaching public policy. CONCLUSION: The ability of our specialty to continue to thrive will require the presentation of sound evidence showing our added value to patients' overall health and well-being.
American Journal of Roentgenology 12/2011; 197(6):W978-9. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: In the era of health care reform, our value-added to patient care, its corresponding level of reimbursement, and the stature of radiology as a specialty will likely be grounded in the scientific evaluation methods of health services research. CONCLUSION: We need to create more opportunities for training, provide resources and incentives for the brightest candidates to enter this field, and cultivate enriching environments for health services research in all academic radiology departments.
American Journal of Roentgenology 05/2011; 196(5):1111-4. · 2.78 Impact Factor
-
Radiology 11/2010; 257(2):313-4. · 5.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate the prevalence of incidental extracardiac findings on coronary CT, to determine the associated downstream resource utilization, and to estimate additional costs per patient related to the associated diagnostic workup.
This retrospective study examined incidental extracardiac findings in 151 consecutive adults (69.5% men and 30.5% women; mean age, 54 years) undergoing coronary CT during a 7-year period. Incidental findings were recorded, and medical records were reviewed for downstream diagnostic examinations for a follow-up period of 1 year (minimum) to 7 years (maximum). Costs of further workup were estimated using 2009 Medicare average reimbursement figures.
There were 102 incidental extracardiac findings in 43% (65/151) of patients. Fifty-two percent (53/102) of findings were potentially clinically significant, and 81% (43/53) of these findings were newly discovered. The radiology reports made specific follow-up recommendations for 36% (19/53) of new significant findings. Only 4% (6/151) of patients actually underwent follow-up imaging or intervention for incidental findings. One patient was found to have a malignancy that was subsequently treated. The average direct costs of additional diagnostic workup were $17.42 per patient screened (95% CI, $2.84-$32.00) and $438.39 per patient with imaging follow-up (95% CI, $301.47-$575.31).
Coronary CT frequently reveals potentially significant incidental extracardiac abnormalities, yet radiologists recommend further evaluation in only one-third of cases. An even smaller fraction of cases receive further workup. The failure to follow-up abnormal incidental findings may result in missed opportunities to detect early disease, but also limits the short-term attributable costs.
American Journal of Roentgenology 06/2010; 194(6):1531-8. · 2.78 Impact Factor
-
Journal of the American College of Radiology: JACR 03/2008; 5(2):78-9.
-
American Journal of Roentgenology 03/2007; 188(2):297-8. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this article is to characterize current informed consent practices for diagnostic CT scans at U.S. academic medical centers.
We surveyed 113 radiology chairpersons associated with U.S. academic medical centers using a survey approved by our institutional review board. The need for informed consent for this study was waived. Chairpersons were asked if their institutions have guidelines for nonemergent CT scans (by whom; oral and/or written), if patients are informed of the purpose of their scans (by whom), what specific risks are outlined (allergic reaction, radiation risk and dose, others; by whom), and if patients are informed of alternatives to CT.
The study response rate was 81% (91/113). Of the respondents, two thirds (60/90) currently have guidelines for informed consent regarding CT scans. Radiology technologists were most likely to inform patients about CT (38/60, 63%) and possible risks (52/91, 57%), whereas ordering physicians were most likely to inform patients about CT's purpose (37/66, 56%). Fifty-two percent (30/58) of sites provided verbal information and 5% (3/58) provided information in written form. Possible allergic reaction to dye was explained at 84% (76/91) of sites, and possible radiation risk was explained at 15% (14/91) of sites. Nine percent (8/88) of sites informed patients of alternatives to CT.
Radiology technologists are more likely to inform patients about CT and associated risks than their physician counterparts. Although most academic medical centers currently have guidelines for informed consent regarding CT, only a minority of institutions inform patients about possible radiation risks and alternatives to CT.
American Journal of Roentgenology 09/2006; 187(2):282-7. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the awareness level concerning radiation dose and possible risks associated with computed tomographic (CT) scans among patients, emergency department (ED) physicians, and radiologists.
Adult patients seen in the ED of a U.S. academic medical center during a 2-week period with mild to moderate abdominopelvic or flank pain and who underwent CT were surveyed after acquisition of the CT scan. Patients were asked whether or not they were informed about the risks, benefits, and radiation dose of the CT scan and if they believed that the scan increased their lifetime cancer risk. Patients were also asked to estimate the radiation dose for the CT scan compared with that for one chest radiograph. ED physicians who requested CT scans and radiologists who reviewed the CT scans were surveyed with similar questions and an additional question regarding the number of years in practice. The chi(2) test of independence was used to compare the three respondent groups regarding perceived increased cancer risk from one abdominopelvic CT scan.
Seven percent (five of 76) of patients reported that they were told about risks and benefits of their CT scan, while 22% (10 of 45) of ED physicians reported that they had provided such information. Forty-seven percent (18 of 38) of radiologists believed that there was increased cancer risk, whereas only 9% (four of 45) of ED physicians and 3% (two of 76) of patients believed that there was increased risk (chi(2)(2) = 41.45, P <.001). All patients and most ED physicians and radiologists were unable to accurately estimate the dose for one CT scan compared with that for one chest radiograph.
Patients are not given information about the risks, benefits, and radiation dose for a CT scan. Patients, ED physicians, and radiologists alike are unable to provide accurate estimates of CT doses regardless of their experience level.
Radiology 05/2004; 231(2):393-8. · 5.73 Impact Factor
