Credentialing for radiology

Patients expect to receive safe, predictable and high-quality care delivered by competent professionals. Thus, it has become important to provide specific training in existing and new modalities and prove on-going clinical expertise. Hospital credentialing is the process by which the competence of a doctor is determined by the hospital management. In Australia, radiologists participate in a mandatory program of continuing professional development and are also required to maintain a logbook of procedures. The Conjoint Committee for the Recognition of Training in Peripheral Endovascular Therapy has been established to advise the respective subspecialty groups on the requirements for accreditation. This article examines some of the issues the committee has considered in preparing the criteria to assist institutions for the purposes of credentialing and gives an Australian perspective on future trends.

The introduction of an undergraduate interventional radiology (IR) curriculum: impact on medical student knowledge and interest in IR

INTRODUCTION: Interventional radiology (IR) plays a vital role in modern medicine, with increasing demand for services, but with a shortage of experienced interventionalists. The aim of this study was to determine the impact of a recently introduced IR curriculum on perception, knowledge, and interest of medical students regarding various aspects of IR. METHODS: In 2014, an anonymous web-based questionnaire was sent to 309 4th year medical students in a single institution within an EU country, both before and after delivery of a 10-h IR teaching curriculum. RESULTS: Seventy-six percent (236/309) of the respondents participated in the pre-IR module survey, while 50 % (157/309) responded to the post-IR module survey. While 62 % (147/236) of the respondents reported poor or no knowledge of IR compared to other medical disciplines in the pre-IR module survey, this decreased to 17 % (27/157) in the post-IR module survey. The correct responses regarding knowledge of selected IR procedures improved from 70 to 94 % for venous access, 78 to 99 % for uterine fibroid embolization, 75 to 97 % for GI bleeding embolization, 60 to 92 % for trauma embolization, 71 to 92 % for tumor ablation, and 81 to 94 % for angioplasty and stenting in peripheral arterial disease. With regard to knowledge of IR clinical roles, responses improved from 42 to 59 % for outpatient clinic review of patients and having inpatient beds, 63-76 % for direct patient consultation, and 43-60 % for having regular ward rounds. The number of students who would consider a career in IR increased from 60 to 73 %. CONCLUSION: Delivering an undergraduate IR curriculum increased the knowledge and understanding of various aspects of IR and also the general enthusiasm for pursuing this specialty as a future career choice.

Outsourcing and downsizing: Processes of workplace change in public health

Throughout the 1990s, public hospitals embarked on a range of benchmarking exercises for support services, often accompanied by downsizing and, in some cases, outsourcing. These support services included clinical areas such as, radiology, pharmacy and pathology, and nonclinical areas of catering and cleaning, engineering and environmental services. The impetus for this trend was the introduction of the Federal Governments National Competition Policy with its rationale that private sector pressures and competition would make the public sector more efficient.
Through a case study approach, this paper discusses this process at two public hospitals, the aim being to investigate the reasons for outsourcing, outsourcings interconnectedness with downsizing, and the implications at the workforce level. Workplace issues discussed include consultation between management, unions and employees, changes to employee numbers and work practices, maintenance of workplace conditions, implications for staff recruitment and retention, and the relative power of management and unions. It concludes that benchmarking, outsourcing and downsizing have all been used to bring about workplace change. Whilst the choice between processes may be dependent on management perception of the workplace environment, implications for the workplace from each process have been similar.

Outsourcing and benchmarking in a rural public hospital : does economic theory provide the complete answer?

INTRODUCTION: The ideology and pronouncements of the Australian Government in introducing 'competitive neutrality' to the public sector has improved efficiency and resource usage. In the health sector, the Human Services Department directed that non-clinical and clinical areas be market tested through benchmarking services against the private sector, with the possibility of outsourcing. These services included car parking, computing, laundry, engineering, cleaning, catering, medical imaging (radiology), pathology, pharmacy, allied health and general practice. Managers, when they choose between outsourcing, and internal servicing and production, would thus ideally base their decision on economic principles. Williamson's transaction cost theory studies the governance mechanisms that can be used to achieve economic efficiency and proposes that the optimal organisation structure is that which minimises transaction costs or the costs of exchange. Williamson proposes that four variables will affect such costs, namely: (i) frequency of exchange; (ii) asset specificity; (iii) environmental uncertainty; and (iv) threat of opportunism. This paper provides evidence from a rural public hospital and examines whether Williamson's transaction cost theory is applicable. d into an analysis that relies solely on transaction

Medical image classification using an efficient data mining technique

Data mining refers to extracting or "mining" knowledge from large amounts of data. It is an increasingly popular field that uses statistical, visualization, machine learning, and other data manipulation and knowledge extraction techniques aimed at gaining an insight into the relationships and patterns hidden in the data. Availability of digital data within picture archiving and communication systems raises a possibility of health care and research enhancement associated with manipulation, processing and handling of data by computers.That is the basis for computer-assisted radiology development. Further development of computer-assisted radiology is associated with the use of new intelligent capabilities such as multimedia support and data mining in order to discover the relevant knowledge for diagnosis. It is very useful if results of data mining can be communicated to humans in an understandable way. In this paper, we present our work on data mining in medical image archiving systems. We investigate the use of a very efficient data mining technique, a decision tree, in order to learn the knowledge for computer-assisted image analysis. We apply our method to the classification of x-ray images for lung cancer diagnosis. The proposed technique is based on an inductive decision tree learning algorithm that has low complexity with high transparency and accuracy. The results show that the proposed algorithm is robust, accurate, fast, and it produces a comprehensible structure, summarizing the knowledge it induces.

Central venous dialysis : an Australian survey

Aim: To explore the current central venous dialysis catheter (CVDC) nursing care practices in Australia. Method: A survey of dialysis units in Australia. Results: 66% return rate (48/73) Internal jugular is the main insertion site (75%) and the majority are tunneled (85%). Insertion was performed most commonly by radiologists (34%) followed by intensivists (24%) with one center reporting insertion by nursing staff. CVDCs were most commonly inserted in radiology (54%), followed by theatre (33%). Dressings were attended weekly (55%) or on dialysis days (45%). Chlorhexidine was the antiseptic solution of choice (54%) followed by povidine-iodine (37%). In 21% of centres Mupirocin was routinely applied in addition to the antiseptic solution. Transparent dressings were overwhelmingly favoured however most centres recommended alternatives related to patient need. 21% of units reported enrolled nurses undertaking dressings. All units reported the use of sterile gloves and sterile dressing packs. 10% reported different routine care for tunneled and non-tunneled. 40% of the units collected data on infection rates per catheter days. General opinion (39%) was identified as the reason to base CVDC protocols while descriptive studies (25%), RCTs (23%) and guidelines (18%) were also reported. Conclusion: There are significant variations in the Australian nursing practice related to the care of CVDCs. Although there is still practice based on general opinion there is evidence that changes in practice in the past 8 years may be associated with knowledge derived from research.

Patterns of treatment in Australian men following fracture

Summary This study aimed to describe treatment initiation rates for men who had recently sustained a fracture. Most (75.9%) men potentially eligible for subsidised treatment at the time of fracture remained untreated even after a subsequent fracture.

Introduction This study aimed to describe treatment initiation rates for men who had recently sustained a fracture.

Methods The study was conducted as part of the Geelong Osteoporosis Study in south-eastern Australia. Men in the study area who had sustained an incident fracture in the period July 2006 to December 2007 were identified from hospital radiology reports. A self-report questionnaire was sent to eligible participants approximately 12 months after fracture. Respondents were asked for details of medications prescribed for ‘osteoporosis/fracture/low bone mass’ before and after fracture, and where applicable, reasons for cessation of treatment.We analysed the results for 109 men aged 50 years and older who had sustained fracture in the study period.

Results Most (75.9%) men potentially eligible for subsidised treatment at the time of fracture remained untreated. Of the 87 men who were untreated, nine had osteoporosis at the hip and/or spine and 29 (26.6%) reported having sustained a low trauma prior fracture.

Conclusions Our findings are consistent with previously published data showing low rates of treatment initiation in men eligible for osteoporosis treatment. There appear to be barriers involving participants’ and medical practitioners’ knowledge, beliefs and attitudes regarding osteoporosis and treatment, as well as in the doctor–patient partnership in osteoporosis management. Establishment of clinical pathways for fracture management beyond orthopaedic care may be one of a range of appropriate responses.

Identification of incident fractures : the Geelong Osteoporosis Study

Background: Complete fracture ascertainment is critical for fracture cost estimates and planning for future health care facilities. Virtually complete ascertainment is possible for hip fractures because they nearly always require hospitalisation.

Aims: To validate the use of radiological reports as a resource for ascertaining fracture cases, using hip fracture as a model.

Methods: Hip fracture rates obtained from radiological reports were compared with rates obtained from hospital discharge summaries of medical records using International Classification of Diseases-9 (ICD-9) codes 820.0–820.9 and 733.1 over a three-year period.

Results: Hip fracture cases numbered 589 using radiological reports and 585 using medical records. Discharge summaries failed to identify 15 cases ascertained through radiology reports whereas 11 cases ascertained through medical records were not identified from X-ray reports. The age-specific incidence rates for radiological ascertainment were within the 95% confidence limits of the rates derived from medical records.

Conclusions: Among a population of patients generally admitted to hospital for treatment of their fracture, we were able to identify more cases from radiological reports than from medical records. Incidence rates for hip fracture were comparable using the two methods. Radiological reports provide a valuable resource for identifying incident fractures. This method of case ascertainment would be suitable for identifying both major and minor fractures in regions with self-contained health services where access to all radiological reports is possible.

Web health portal to enhance patient safety in Australian healthcare systems

The use of a web Health Portal can be employed not only for reducing health costs but also to view patient's latest medical information (e.g. clinical tests, pathology and radiology results, discharge summaries, prescription renewals, referrals, appointments) in real-time and carry out physician messaging to enhance the information exchanged, managed and shared in the Australian healthcare sector. The Health Portal connects all stakeholders (such as patients and their families, health professionals, care providers, and health regulators) to establish coordination, collaboration and a shared care approach between them to improve overall patient care safety. The paper outlines a Health Portal model for designing a real-time health prevention system. An application of the architecture is described in the area of web Health Portal.

Personal and psychosocial impacts of clinical fracture in men

Background : Little is known about the personal burden of fracture across the age spectrum, particularly in men. This study aimed to document the impact of clinical fracture on men's participation in employment, sports and outdoor recreation, mobility, handiwork, activities of daily living, home modification, and utilisation of community and health services.

Methods : This prospective study followed 196 men with incident fracture identified from radiology reports at the Geelong Hospital during the period July 2006 to December 2007 and examined personal and psychosocial impacts 12 months post-fracture, using a self-report questionnaire.

Results : Of all men identified with fracture, 40% took time off work. All fractures, except those to the upper limbs, had considerable impact on mobility. Inability to drive was associated with all fractures, but was most common with ankle fractures and most prolonged with hip fractures. Loss of confidence was reported by over one-third of all fracture cases, even 12 months after the fracture event. All fractures affected activities of daily living, and this was generally most prolonged for fractures of the hip. Similarly, all men with fracture utilised community and health services, even for the relatively minor fractures of the finger/thumb.

Conclusions : This study supports previous reports of the personal impact of hip fracture, and presents data about the consequences of upper and lower limb fractures and the generally poorly described sequelae of fractures of the finger/thumb and foot/toe. These observations have important implications for post-fracture care and rehabilitation in men.

Age- and sex-related patterns of first fracture and fracture prevalence

There are few data documenting the pattern of prevalent fracture across the entire adult age range, so we aimed to address this gap by investigating the prevalence of fractures in an Australian cohort. All-cause (ever) fractures were identified for males and females enrolled in the Geelong Osteoporosis Study (Australia) using a combination of radiology-confirmed and self-reported data. First fractures were used to generate age-related frequencies of individuals who had ever sustained a fracture. Of 1,538 males and 1,731 females, 927 males and 856 females had sustained at least one fracture since birth. The proportion of all prevalent fractures in the 0-10 year age group was similar for both sexes (~10 %). In males, the proportion with prevalent fracture increased to 34.1 % for age 11-20 year. Smaller increases were observed into mid-life, reaching a plateau at ~50 % from mid to late life. The age-related prevalence of fracture for females showed a more gradual increase until mid-life. For adulthood prevalent fractures, approximately 20 % of males had sustained a first adulthood fracture in the 20-30 year age group, with a gradual increase up to the oldest age group (49.1 %), while females showed an exponential pattern of increase from the 20-30 year age group (6.8 %) to the oldest age group (60.4 %). In both sexes, those who had not sustained a fracture in childhood or early adulthood generally appeared to remain fracture-free until at least the sixth decade. When considering the prevalence of adulthood fractures across the age groups, males showed a gradual increase while females showed an exponential increase.

Localization and degmentation of 3D intervertebral discs in MR Images by data driven estimation

This paper addresses the problem of fully-automatic localization and segmentation of 3D intervertebral discs (IVDs) from MR images. Our method contains two steps, where we first localize the center of each IVD, and then segment IVDs by classifying image pixels around each disc center as foreground (disc) or background. The disc localization is done by estimating the image displacements from a set of randomly sampled 3D image patches to the disc center. The image displacements are estimated by jointly optimizing the training and test displacement values in a data-driven way, where we take into consideration both the training data and the geometric constraint on the test image. After the disc centers are localized, we segment the discs by classifying image pixels around disc centers as background or foreground. The classification is done in a similar data-driven approach as we used for localization, but in this segmentation case we are aiming to estimate the foreground/background probability of each pixel instead of the image displacements. In addition, an extra neighborhood smooth constraint is introduced to enforce the local smoothness of the label field. Our method is validated on 3D T2-weighted turbo spin echo MR images of 35 patients from two different studies. Experiments show that compared to state of the art, our method achieves better or comparable results. Specifically, we achieve for localization a mean error of 1.6-2.0 mm, and for segmentation a mean Dice metric of 85%-88% and a mean surface distance of 1.3-1.4 mm.

The epidemiology of incident fracture from cradle to senescence

To reduce the burden of fracture, not only does bone fragility need to be addressed, but also injury prevention. Thus, fracture epidemiology irrespective of degree of trauma is informative. We aimed to determine age-and-sex-specific fracture incidence rates for the Barwon Statistical Division, Australia, 2006-2007. Using radiology reports, incident fractures were identified for 5342 males and 4512 females, with incidence of 210.4 (95 % CI 204.8, 216.2) and 160.0 (155.3, 164.7)/10,000/year, respectively. In females, spine (clinical vertebral), hip (proximal femoral) and distal forearm fractures demonstrated a pattern of stable incidence through early adult life, with an exponential increase beginning in postmenopausal years for fractures of the forearm followed by spine and hip. A similar pattern was observed for the pelvis, humerus, femur and patella. Distal forearm, humerus, other forearm and ankle fractures showed incidence peaks during childhood and adolescence. For males, age-related changes mimicked the female pattern for fractures of the spine, hip, ribs, pelvis and humerus. Incidence at these sites was generally lower for males, particularly among the elderly. A similar childhood-adolescent peak was seen for the distal forearm and humerus. For ankle fractures, there was an increase during childhood and adolescence but this extended into early adult life; in contrast to females, there were no further age-related increases. An adolescent-young adult peak incidence was observed for fractures of the face, clavicle, carpal bones, hand, fingers, foot and toe, without further age-related increases. Examining patterns of fracture provides the evidence base for monitoring temporal changes in fracture burden, and for identifying high-incidence groups to which fracture prevention strategies could be directed.