Canadian Initiative Reduces Inappropriate Lumbar MRI, Increases Use of Clinical Decision Tools
Newswise — Reston, Va. (July 30, 2014) — The August issue of the Journal of the American College of Radiology (JACR®) focuses on a variety of issues relating to clinical practice, practice management, health services and policy, and radiology education and training.
Articles include: Effect of Governmental Intervention on Appropriateness of Lumbar MRI Referrals: A Canadian ExperienceSean A. Kennedy, William Fung, BSc, Atiqa Malik, BSc, MSc, Forough Farrokhyar, MPhil, PhD, Mehran Midia, MDIn the past two decades, the utilization MRI for spinal imaging in Canada has increased by 600 percent. In an effort to curb inappropriate utilization, the government of Ontario Ministry of Health implemented a campaign to reduce the overutilization of lumbar MRI examinations and reduce health care costs in May 2012. Before the policy change, 50.4 percent of lumbar MRI referrals were appropriate, and 47.9 percent were not appropriate. After the policy change, appropriateness increased, with 62.6 percent of referrals being appropriate and 37.1 percent not appropriate.
The Maryland Self-Referral Law: History and ImplicationsRehan Quadri, MD, Satinder S. Rekhi, MD, Robert K. Zeman, MD, Albert Blumberg, MD, Raymond K. Tu, MDStudies have shown that nonradiologist physicians who refer advanced MRI and CT examinations to themselves or within their practices use these modalities at a much higher rate than those who refer their examinations to unaffiliated radiology facilities. The authors discuss the politics and economics of self-referral and provide a comprehensive review of the creation, progression, and impact of the self-referral law passed in Maryland in 1993.
Radiology Trainees’ Comfort With Difficult Conversations and Attitudes About Error Disclosure: Effect of a Communication Skills WorkshopStephen D. Brown, MD, Michael J. Callahan, MD, David M. Browning, MSW, Robert L. Lebowitz, MD, Sigall K. Bell, MD, Jisun Jang, MA, Elaine C. Meyer, RN, PhDMany radiology trainees desire programs to aid them in communicating with patients and family members about sensitive medical matters. However, few educational programs actually exist. This article examines the effectiveness of a program that improved trainees’ comfort levels in communicating bad news, medical errors and radiation risks. The authors emphasize the importance of such programs in order for radiology trainees to meet new standards required by the ACGME and ABR.
Communication of Unexpected and Significant Findings on Chest Radiographs With an Automated PACS Alert SystemSara A. Hayes, MD, Michael Breen, MB, Patrick D. McLaughlin, MB, Kevin P. Murphy, MB, Michael T. Henry, MB, Michael M. Maher, MD, Max F. Ryan, MBThis study demonstrates that the development of electronic systems plugged into PACS can aid greatly in communicating unexpected or acute significant findings on radiologic reports to referring physicians. A study was conducted over a 14-month period analyzing the number, source, and outcome of chest radiographic unexpected findings. The most common referral source was the emergency department, and more than half of clinicians notified acknowledged the result with 24 hours.