Frank J Hooper

University of Maryland Medical Center, Baltimore, Maryland, United States

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Publications (25)53.86 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess whether it is feasible to measure and compare work-flow times across institutional variations, and to apply such a comparison to technologist productivity in the performance of general radiographic examinations with computed radiography (CR) and direct radiography (DR). The study received internal review board exemption. Participants were informed about the study and willingly participated. Observational time-motion analyses were performed at four sites at which CR and DR are used concurrently. The time taken by the technologist for patient preparation, positioning, exposure, and postacquisition processing, and for the examination as a whole, was recorded. Data collected reflect unique elements at each clinical center, and no standardized work flow was imposed. Work-flow performance times were correlated with each site profile. Preliminary statistical analyses included examination of distributions of original and combined variables. Descriptive statistics were presented as means or frequencies, depending on whether the data were continuous or categorical. Continuous variables were compared by using the Student t test. Timing differences between CR and DR for each clinical center were compared, and all data were analyzed by using commercially available statistical software. For all four study sites, statistically significant total examination time differences were observed when comparing CR and DR (P < .001). The single step in the examination that was found to be the largest contributor to time difference was postacquisition processing, which accounted for 30%-100% of the total time difference between the two technologies. The most time-efficient sites were those that had in-room postacquisition processing capability and fully functional integration with the radiology information system. Investigators at two study sites compared times for two-view chest radiography only, and those at the other two study sites compared times for multiview general radiographic examinations. Only the results of two-view comparisons were reported for each site. Overall technologist time was significantly shorter when performing tasks associated with DR than when performing comparable tasks associated with CR, a difference that appears to result largely from technology configuration, staffing, and patient management.
    Radiology 09/2005; 236(2):413-9. · 6.34 Impact Factor
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    ABSTRACT: To compare economic aspects of equipment configurations, productivity levels, and patient waiting times in the performance of computed radiography (CR) and direct radiography (DR). The study received internal review board exemption status, without the need for informed patient consent. Data from four study sites were used to calculate the CR-DR crossover point (defined as the point at which the cost-effectiveness of DR equals that of CR) and CR-DR annual cost differentials. Analyzed variables included equipment and operating costs, examination volumes, and productivity. A program was developed to simulate patient arrival times, number of patient examinations, and patient waiting times on the basis of average annualized parameters for each of the four clinics. Sensitivity analyses were conducted to assess utilization rates and determine cost optimization. Utilization rates were compared with the number of excess long-stay CR patients (ie, patients who spent more than 30 minutes waiting in the radiology department prior to CR examination) and with the cost (per excess long-stay CR patient who waited more than 60 minutes) averted by using DR. Excess annual costs for DR over CR at the four sites ranged from $50,757 to $75,303. At extrapolated levels of economic penalties for long waiting times, the crossover point at which the DR cost became justifiable was when CR capacity utilization rates approached or exceeded 80%. In the current practice environment, with capacity utilization rates well below 80%, CR is likely to be a more cost-effective technology for the majority of general radiography providers.
    Radiology 09/2005; 236(2):420-6. · 6.34 Impact Factor
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    ABSTRACT: The relatively low (20%-25%) sensitivity of conventional radiography for lung nodules is an impetus for investigations into computer-assisted diagnostic (CAD) algorithms and into alternative acquisition techniques (such as dual-energy subtraction [DES]), both of which have been shown to increase diagnostic sensitivity for lung nodule detection. This pilot study combined these synergistic techniques in the diagnosis of digital clinical chest radiographs in 26 individuals. A total of 59 marks were identified by the CAD algorithm as suspicious for a nodule using a "conventional" chest direct radiography posterior/anterior image (an average of 2.3 marks per radiograph). Only 39 marks were identified on the soft tissue image of the corresponding DES radiographs (an average of 1.5 marks per radiograph). The sensitivity for nodules considered subtle but "actionable" in the 10-15-mm range was 0% (correctly identifying 0 of 4 nodules), whereas the sensitivity for the same radiographs with DES was 75% (correctly identifying 3 of 4 nodules). These pilot data suggest that the algorithms for at least one commercial CAD system may not be fully able to differentiate overlying bones and other calcifications from pulmonary lesions (which is also a difficult task for radiologists) and that the combination of CAD and DES acquisition may result in a substantial improvement in both sensitivity and specificity in the detection of relatively subtle lung nodules. This study has been expanded to evaluate a much larger set of images to further investigate the potential for the routine use of CAD with DES.
    01/2005;
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    ABSTRACT: PURPOSE To compare radiologist performance in the interpretation of musculoskeletal CR images using conventional 8-bit liquid crystal display (LCD) which show only 256 shades of gray and newly available 11-bit LCD devices. METHOD AND MATERIALS We evaluated a prototype 11 bit 3 mega-pixel monochrome LCD and 11 bit DICOM viewer specially designed for this task in order to assess differences in image presentation and quality when compared to an 8 bit 3 mega-pixel monochrome LCD. A customized 11 bit DICOM viewer was created by the vendor to enable image review at an 11 bit gray scale. Three radiologists experienced in soft-copy CR interpretation were asked to interpret 100 individual musculoskeletal CR exams to identify subtle fractures. Radiologist interpretation times, diagnostic accuracy and confidence in diagnosis were subsequently compared for these two types of display systems. RESULTS The 11 bit LCD display device was able to display 1531 shades of grey as compared to only 256 shades of grey displayed by the 8 bit monitor. The contrast ratio and maximum luminance were 600:1 and 190 fL (650 cd/m2) respectively for the 11 bit monitor. A decreased use of the window/level tool was associated with the use of the 11 bit display without a concomitant decrease in confidence levels (p = 0.29). These quantitative differences correlated with decreased image interpretation time for 11 bit monitor (120 sec) vs. 8 bit monitor (201 sec) (p=0.42). We were unable to document any significant difference in diagnostic accuracy between both display devices. CONCLUSIONS Higher bit LCD monitors offer the potential to improve reading times, and potentially improved diagnostic accuracy for a number of types of digital imaging studies. We were unable to show significant increase in diagnostic accuracy in our study possibly because the 11 bit displays performed best in the uniform grey areas of the images rather than the bones. As display technologies advance, the inherent bit depth of the imaging study may more closely match that of the display device, resulting in improved objective and subjective measures of radiologist performance.
    Radiological Society of North America 2004 Scientific Assembly and Annual Meeting; 11/2004
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    ABSTRACT: DISCLOSURE S.A.W.: Dr. Wood is an employee of R2 Technologies, Inc. ABSTRACT Purpose: The selection of the optimal CT reconstruction convolution kernel such as �soft tissue� or �bone� has been traditionally associated with a tradeoff between image sharpness and pixel noise. Although there are vendor recommendations for this convolution kernel for human observers, we are not aware of any previous studies that have evaluated these for a CAD algorithm. This study was performed to evaluate the effect of MDCT reconstruction slice thickness on CAD accuracy, in the detection of pulmonary nodules.Methods and Materials: A CAD algorithm (Image Checker CT LN-1000, R2 Technology Inc., Sunnyvale, CA) for CT detection of lung nodules was employed on a dataset of 11 MDCT chest examinations, obtained on a Siemens Sensation 16-detector CT scanner (Siemens Medical Solutions, Erlangen, Germany), using conventional exposure parameters of 120 kvP and 120 mAs and 0.75 mm collimation. The inclusion criteria for the CT dataset consisted of patients with suspected pulmonary nodules, based on previous chest radiograph or CT examinations. Following acquisition, images were reconstructed at 0.75mm slice thickness at the scanner console using either the �B40f� (soft tissue) or the �B60f� (bone) kernel. The CAD algorithm was then used to identify the presence of actionable pulmonary nodules, which were defined as non-calcified with a size greater or equal to 4mm. Truth was established by a consensus panel of subspecialty trained thoracic radiologists. Results: A total of 12 actionable lung nodules was identified in the 11 MDCT datasets. Overall sensitivity of the CAD program was highest (10/12 cases or 83%) at the B60f (bone) kernel in comparison to the soft tissue kernel reconstruction (9/12 cases or 75%). The bone kernel was also associated with fewer false positives (39 or a false positive rate of 3.5 per exam) in comparison to the soft tissue kernel (44 false positives, a false positive rate of 4 per CT). Conclusion: The superior performance of the bone kernel suggests that the optimal reconstruction technique for a CAD program may be different from the optimal one for human observers. Several strategies will be recommended to optimize both. LEARNING OBJECTIVES 1.Understand the impact of selection of a bone or soft tissue reconstruction kernal on the accuracy of CAD2. Be able to describe the implications of a different reconstruction algorithm for radiologist interpretation than for CAD performance3.Be able to suggest strategies to maximize both radiologist and CAD performance
    Radiological Society of North America 2004 Scientific Assembly and Annual Meeting; 11/2004
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    ABSTRACT: PURPOSE The transition from film-based to filmless operation has been shown to improve technologist productivity, through the elimination of time intensive tasks associated with film handling and processing. Once this conversion is complete, minimal attention is typically paid to workflow optimization, which offers the potential to further improve technologist productivity. This study was performed to assess the impact of workflow optimization on technologist productivity, in the performance of general radiographic exams, using digital radiography METHOD AND MATERIALS A prospective time-motion analysis was performed during two one-week time periods (separated by a six month time interval), pre and post workflow optimization, in the performance of two-view chest radiographic exams using digital radiography. An independent time keeper performed this time-motion analysis using a split function stopwatch, measuring the individual steps of patient preparation, positioning, exposure, post-acquisition processing, and total exam times. RESULTS Statistically significant time differences were observed for total exam times, pre and post workflow optimization (p<0.0001). Prior to workflow optimization, the mean total exam time was 213.4 seconds, which was reduced to 136.1 seconds after workflow optimization. The entire total exam time difference of 77.3 seconds was accounted for by differences in post-acquisition processing time alone, with all other steps combined accounting for a time difference of only 2.1 seconds. Post-acquisition entails the process of image display and manipulation and went from a mean time of 89.9 seconds to 10.5 seconds (p<0.0001), after workflow optimization. This change in workflow was largely the result of shifting post-acquisition processing from an �out of room� process to an �in room� process, through the introduction of an in-room QA workstation CONCLUSIONS In the performance of chest radiographic exams using digital radiography, significant time savings can be achieved through workflow optimization. The single most important step contributing to these potential time savings is post-acquisition processing, which is a primary contributor to quality assurance
    Radiological Society of North America 2004 Scientific Assembly and Annual Meeting; 11/2004
  • Bruce I Reiner, Eliot L Siegel, Frank J Hooper
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    ABSTRACT: The purpose of this study was to determine the relative diagnostic accuracy of radiologists in the interpretation of CT scans using a computer workstation in comparison with using film. Four board-certified radiologists with extensive soft-copy experience interpreted 117 CT scans in four anatomic regions using films displayed on an alternator and images displayed on a four-monitor workstation. The radiologists were asked to interpret the scans in their usual fashion and were aware that both the time required to review the study and the accuracy of the reports were being assessed. The radiologists' diagnostic impressions were compared with those of a consensus panel and scored for accuracy. Soft-copy interpretation using computer workstations was found to produce statistically significant improvement in combined measurements of sensitivity, specificity, and overall accuracy for chest, brain, and chest-abdominal CT scans compared with film interpretation. PACS (picture archiving and communication system) offers radiologists the potential for improved accuracy in CT interpretation compared with traditional film-based interpretation.
    American Journal of Roentgenology 01/2003; 179(6):1407-10. · 2.90 Impact Factor
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    ABSTRACT: A small group of Gulf War veterans have retained fragments of depleted uranium (DU) shrapnel, the long-term health consequences of which are undetermined. We evaluated the clinical health effects of DU exposure in Gulf War veterans compared with nonexposed Gulf War veterans. History and follow-up medical examinations were performed on 29 exposed veterans and 38 nonexposed veterans. Outcome measures used were urinary uranium determinations, clinical laboratory values, and psychiatric and neurocognitive assessment. Gulf War veterans with retained DU metal shrapnel fragments were found to be still excreting elevated levels of urinary uranium 7 years after first exposure to DU (range for exposed individuals is 0.01-30.7 micrograms/g creatinine vs. 0.01-0.05 microgram/g creatinine in the nonexposed). The persistence of the elevated urine uranium suggests ongoing mobilization of uranium from a storage depot, resulting in chronic systemic exposure. Adverse effects in the kidney, a presumed target organ, were not seen at the time of the study; however, other subtle effects were observed in the reproductive and central nervous systems of the DU-exposed veterans.
    Military medicine 03/2002; 167(2 Suppl):123-4. · 0.77 Impact Factor
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    ABSTRACT: Four radiologists independently reviewed eighty individual thoracic computed radiography images. These consisted of 41 normal radiographs and 39 abnormal radiographs. Images were reviewed using 2,048 by 1,536 pixel monitors which varied widely in image quality as documented using a SMPTE pattern. Overall sensitivity for pathology ranged from .94 to .97 for the radiologists and varied minimally (0.95 to 1.0) for the four monitor quality levels tested while specificity varied to a much greater extent for the radiologists (0.68 to 0.93) and for the various monitors (0.76 to 0.93). The control (good quality) monitor demonstrated substantially higher specificity than the other three monitors (which varied from very poor to fair) but there were no significant differences among the non-control monitors despite their wide variance with regard to image quality. There was no significant difference in sensitivity for the monitors (including the control). Additionally no significant differences were found in the level of diagnostic confidence by the radiologists for the four monitors. These findings suggest that the actual effect of monitor quality degradation on clinical accuracy and confidence is complex and correlates poorly with traditional quality assurance metrics performed for these systems. Additional investigation into the monitor characteristics which most affect clinical confidence and performance is warranted.
    Proc SPIE 08/2001;
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    ABSTRACT: We compared radiologists' times in the interpretation of CT using hardcopy films with the interpretation using a soft-copy picture archiving and communication system (PACS) computer workstation. One hundred CT examinations were selected at random and reviewed by four board-certified radiologists experienced in soft-copy interpretation. We performed time-motion analysis to determine the total time required to display, interpret, and dictate the individual findings of CT using conventional hard-copy interpretation on a viewbox and soft-copy interpretation, using a four-monitor high-resolution (2048 x 1536 pixel) workstation. Time-motion analysis showed a reduction of 16.2% in the overall time required for soft-copy interpretation of CT compared with that of film. Time savings with soft-copy interpretation were observed for all four participating radiologists. The benefit of soft-copy interpretation was increased for examinations in which there were comparison studies. We found that soft-copy interpretation of CT using a PACS workstation requires less time than interpretation using conventional film hung on a viewbox. The transition to filmless imaging has the potential to improve radiologists' productivity and report-turnaround time.
    American Journal of Roentgenology 05/2001; 176(4):861-4. · 2.90 Impact Factor
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    ABSTRACT: To determine the effect of a large-scale picture archiving and communication system (PACS) on in- and outpatient utilization of radiologic services. Data were collected at the Baltimore Veterans Affairs (VA) Medical Center (BVAMC) before and after implementation of an enterprise-wide PACS; the numbers and types of imaging examinations performed for fiscal years 1993 and 1996 were evaluated. These data were compared with those from a similar academic medical center, the Philadelphia VA Medical Center (PVAMC), and with aggregate data obtained nationally for all VA hospitals over comparable periods. Inpatient utilization, defined as the number of examinations per inpatient day, increased by 82% (from 0.265 to 0.483 examinations per patient day) after a transition to filmless operation at BVAMC. This is substantially greater than the increases of 38% (from 0.263 to 0.362 examinations per patient day) and 11% (from 0.190 to 0.211 examinations per patient day) at the film-based PVAMC and nationally, respectively. Outpatient utilization, defined as the number of examinations per visit, increased by 21% (from 0.108 to 0.131 examinations per visit) at BVAMC, compared with a 1% increase (from 0.087 to 0.088 examinations per visit) at PVAMC and a net decrease of 19% (from 0. 148 to 0.120 examinations per visit) nationally. The transition to filmless operation was associated with increases in inpatient and outpatient utilization of radiologic services, which substantially exceeded changes at PVAMC and nationally over the same interval.
    Radiology 05/2000; 215(1):163-7. · 6.34 Impact Factor
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    ABSTRACT: We evaluated whether the use of multiple window and level settings on a soft-copy workstation improves diagnostic accuracy on chest and abdominal CT. We hypothesized that routinely using window and level settings during soft-copy interpretation would beneficially affect the final diagnosis without compromising efficiency. Two hundred three randomly selected abdominal and chest CT scans were interpreted by three radiologists using a four-monitor soft-copy workstation (images per screen, nine; resolution, 2K). After the initial interpretations, all scans were reevaluated by the same radiologists using additional liver and bone window and level settings. Differences in conspicuity and characterization of abnormalities were graded on a three-point scale. Conspicuity and characterization of abnormalities were improved in 67% of abnormal findings (81/121; p = 0.01). Improvement (a finding that substantially affected the final diagnosis) was present in 18% of abnormal findings (22/121; p = 0.04). On average, the evaluation of images at multiple window and level settings required an additional 40 sec per case. The use of multiple window and level settings during soft-copy interpretation resulted in improved lesion detectability and characterization with greater diagnostic efficacy. Using soft-copy workstations, radiologists can evaluate images using multiple settings without compromising efficiency.
    American Journal of Roentgenology 03/2000; 174(2):311-4. · 2.90 Impact Factor
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    ABSTRACT: A small group of Gulf War veterans possess retained fragments of depleted uranium (DU) shrapnel, the long-term health consequences of which are undetermined. We evaluated the clinical health effects of DU exposure in Gulf War veterans compared with nonexposed Gulf War veterans. History and follow-up medical examination were performed on 29 exposed veterans and 38 nonexposed veterans. Outcome measures employed were urinary uranium determinations, clinical laboratory values, and psychiatric and neurocognitive assessment. DU-exposed Gulf War veterans with retained metal shrapnel fragments are excreting elevated levels of urinary uranium 7 years after first exposure (range 0.01-30.7 microg/g creatinine vs 0.01- 0.05 microg/g creatinine in the nonexposed). The persistence of the elevated urine uranium suggests on-going mobilization from a storage depot which results in a chronic systemic exposure. Adverse effects in the kidney, a presumed target organ, are not present at this time, though other effects are observed. Neurocognitive examinations demonstrated a statistical relationship between urine uranium levels and lowered performance on computerized tests assessing performance efficiency. Elevated urinary uranium was statistically related to a high prolactin level (>1.6 ng/ml; P=0.04). More than 7 years after first exposure, DU-exposed Gulf War veterans with retained metal fragments continue to excrete elevated concentrations of urinary uranium. Effects related to this are subtle perturbations in the reproductive and central nervous systems.
    Environmental Research 02/2000; 82(2):168-80. · 3.24 Impact Factor
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    ABSTRACT: The use of depleted uranium in munitions has given rise to a new exposure route for this chemically and radioactively hazardous metal. A cohort of U.S. soldiers wounded while on or in vehicles struck by depleted uranium penetrators during the Persian Gulf War was identified. Thirty-three members of this cohort were clinically evaluated, with particular attention to renal abnormalities, approximately 3 y after their injury. The presence of retained shrapnel was identified by x ray, and urine uranium concentrations were measured on two occasions. The absorption of uranium from embedded shrapnel was strongly suggested by measurements of urine uranium excretion at two time intervals: one in 1993/1994 and one in 1995. Mean urine uranium excretion was significantly higher in soldiers with retained shrapnel compared to those without shrapnel at both time points (4.47 vs. 0.03 microg g(-1) creatinine in 1993/1994 and 6.40 vs. 0.01 microg g(-1) creatinine in 1995, respectively). Urine uranium concentrations measured in 1995 were consistent with those measured in 1994/1993, with a correlation coefficient of 0.9. Spot urine measurements of uranium excretion were also well correlated with 24-h urine collections (r = 0.95), indicating that spot urine samples can be reliably used to monitor depleted uranium excretion in the surveillance program for this cohort of soldiers. The presence of uranium in the urine can be used to determine the rate at which embedded depleted uranium fragments are releasing biologically active uranium ions. No evidence of a relationship between urine uranium excretion and renal function could be demonstrated. Evaluation of this cohort continues.
    Health Physics 12/1999; 77(5):512-9. · 1.02 Impact Factor
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    ABSTRACT: OBJECTIVE: The purpose of the study was to determine the impact of filmless operation on the relative frequency of in-person consultations in the radiology department between radiologists and clinicians. CONCLUSION: The transition to filmless operation at the Baltimore Veterans Affairs Medical Center was associated with an 82% reduction in the in-person consultation rate for general radiography and a 44% reduction for cross-sectional imaging despite an increase in the volume of studies. The major reason for this decrease was the convenient access to current and prior images provided by the PACS (picture archiving and communication system). Radiology departments contemplating a transition to filmless operation should prepare for communication with clinicians to shift from being mostly in person to being conducted more and more through electronic forms of communication.
    American Journal of Roentgenology 12/1999; 173(5):1169-72. · 2.90 Impact Factor
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    ABSTRACT: The utility of spot urine collections for uranium bioassay determinations was examined in a small cohort of depleted uranium exposed Gulf War veterans. Some members of the group are excreting elevated concentrations of urinary uranium resulting from the metabolism of retained metal fragments, the residua of several friendly fire incidents. Uranium determinations were performed on both 24-h timed collections and spot urine samples using kinetic phosphorescence analyzer (KPA) methodology. Results ranged from non-detectable to 30.7 mcg g(-1) creatinine in a 24-h collection. A creatinine-standardized spot sample and a 24-h uncorrected sample both correlated highly (R2=0.99) with a creatinine corrected 24-h collection, presumed to be the best estimate of the urinary uranium measure. This relationship was upheld when the population was stratified by uranium concentration into a high uranium group (> or = 0.05 mcg U/g creatinine) but for the lower uranium group (< 0.05 mcg U/g creatinine) more variability and a lower correlation was seen. The uncorrected spot sample, unadjusted for volume, concentration or creatinine had the lowest correlation with the 24-h creatinine adjusted result, especially at lower urinary uranium concentrations. This raises questions regarding the representativeness of such a sample in bioassay programs.
    Health Physics 09/1999; 77(3):261-4. · 1.02 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the impact of filmless imaging on the frequency with which physicians access radiology images and to assess clinician perception of image accessibility using a hospital-wide Picture Archival and Communication System (PACS). Quantitative data were collected at the Baltimore VA Medical Center (BVAMC), prior to and after conversion to filmless imaging, to determine the frequency with which clinicians access radiology images. Survey data were also collected to assess physician preferences of image accessibility, time management, and overall patient care when comparing filmless and film-based modes of operation. In general, there was a significant increase in the average number of radiology images reviewed by clinicians throughout the hospital. However, the one area in the hospital where this trend was not observed was in the intensive care unit (ICU), where the frequency of image access was similar between film and filmless operations. Ninety-eight percent of clinicians surveyed reported improved accessibility of images in a filmless environment resulting in improved time management. The mean clinician estimate of time saved due to the use of PACS was 44 minutes. The study documented a combination of clinician perception of improved accessibility and substantial time savings with the use of a hospital-wide PACS, which was supported by objective measurements. The increased frequency of image review by clinicians and rapid image access should provide a further impetus to radiologists to decrease report turnaround time to provide “added value” for patient care.
    Journal of Digital Imaging 08/1998; 11:149-150. · 1.10 Impact Factor
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    ABSTRACT: To determine the relative time required for a technologist to perform a computed tomographic (CT) examination in a "filmless" versus a film-based environment. Time-motion studies were performed in 204 consecutive CT examinations. Images from 96 examinations were electronically transferred to a picture archiving and communication system (PACS) without being printed to film, and 108 were printed to film. The time required to obtain and electronically transfer the images or print the images to film and make the current and previous studies available to the radiologists for interpretation was recorded. The time required for a technologist to complete a CT examination was reduced by 45% with direct image transfer to the PACS compared with the time required in the film-based mode. This reduction was due to the elimination of a number of steps in the filming process, such as the printing at multiple window or level settings. The use of a PACS can result in the elimination of multiple time-intensive tasks for the CT technologist, resulting in a marked reduction in examination time. This reduction can result in increased productivity, and, hence greater cost-effectiveness with filmless operation.
    Radiology 06/1998; 207(2):481-5. · 6.34 Impact Factor
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    ABSTRACT: The purpose of the study was to ascertain how often additional malignant neoplasms are detected on CT scans of the thorax in patients with newly diagnosed squamous cell carcinoma of the head and neck and to determine how often these findings are evident on conventional radiographs of the chest. One hundred eighty-nine patients with newly diagnosed squamous cell carcinoma of the head and neck were prospectively examined in a 5-year period. At the time of the initial diagnosis, each patient underwent both chest radiography (posteroanterior and lateral radiographs in 95%, anteroposterior in 5%) and thoracic CT to assess the prevalence of additional primary or metastatic malignant neoplasms of the thorax and upper abdomen. Of the 189 patients studied, 66 showed a total of 73 significant abnormalities on thoracic CT scans of which only 17 abnormalities (23%) were detected on chest radiographs alone. Of these 66 patients, 36 (55%) were found to have one or more primary or metastatic neoplasms. These 36 patients manifested a total of 41 additional primary or secondary malignant neoplasms including 24 cases in which one or more pulmonary nodules were detected, six cases of lymphadenopathy, three hepatic lesions, three bone lesions, two pleural masses, two esophageal masses and one adrenal mass. Of these 41 malignant tumors, 13 (32%) were synchronous primary tumors and 28 were metastases. Only 12 (29%) of the 41 malignant tumors detected by thoracic CT were seen on the chest radiographs. In all patients in which an additional malignant tumor was diagnosed, clinical management was significantly affected, resulting in a modification of the planned surgery or the addition of chemotherapy, radiation therapy, or both. A relatively large percentage of patients (19%) with newly diagnosed squamous cell cancer of the head and neck was found to have additional malignant tumors, 32% of which were synchronous primary tumors. The discovery of these additional neoplasms had a major effect on both the therapy and the prognosis of these patients. The combination of a relatively poor detection rate for conventional chest radiography, with only 29% of the malignant tumors detected on CT scans of the chest being seen on chest radiographs, and the high prevalence of disease in this population support the routine inclusion of thoracic CT in these patients.
    American Journal of Roentgenology 10/1997; 169(3):667-71. · 2.90 Impact Factor
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    Journal of Digital Imaging 09/1997; 10(3 Suppl 1):176. · 1.10 Impact Factor

Publication Stats

514 Citations
53.86 Total Impact Points

Institutions

  • 1997
    • University of Maryland Medical Center
      Baltimore, Maryland, United States
  • 1996
    • Greater Baltimore Medical Center
      Baltimore, Maryland, United States
    • Loyola University Maryland
      Baltimore, Maryland, United States