Internetkommunikation in der Radiologie

E-mail is an Internet service that can be used for sending messages and binary files between individuals as well as for participating in discussion groups. For sending and receiving these types of messages, the users must use either a dedicated e-mail client or one of the several mailing facilities of the World Wide Web. The news-groups enable like-minded people to discuss subjects on a group-wide basis, but access is generally not limited, and the participants cannot be selected. CONCLUSION: The objective of this paper is to give radiologists an introduction to using e-mail, mailing lists and news-groups, the three most important communication services of the Internet. The function of these services is explained, and the advantages of implementing them in a radiology practice are discussed. Potential problems and concerns including security matters are highlighted, and ways in which they can be resolved are suggested.     

Radiology uses of the Internet

The Internet promises to be an essential resource for radiology administrators. In addition to offering remarkable access to colleagues all over the world, the Internet offers specialized information resources for radiology, many of which are described in this article. The Internet is many networks that communicate with each other and whose general purpose is to share information. Although there are several consortium organizations that support and regulate it, no single body or organization "owns" the Internet. Many employees and students at large teaching centers already have access to the Internet through their institution's connection. Individuals and small institutions can contract with independent service providers for Internet access. Internet functions covered in this article include: e-mail, listservs, newsgroups, file transfer protocols, Gopher, and the World Wide Web. The rapid pace of information exchange is making the world of radiology smaller and more intimate. Communication and knowledge are becoming so accessible that individuals are privy to the most minute happenings in the industry. Sharing information on the Internet will benefit not only individual users and the industry, but also patients.     

Use of nutritional supplements by Danish elite athletes and fitness customers

The nutritional supplement (NS) industry is one of the fastest growing in the world, and NS use in Denmark is among the highest in Europe. However, the exact use in elite athletes and fitness customers targeted for doping control is unknown. Information from 634 doping control forms obtained in 2014 was evaluated (elite athletes: n = 361; fitness customers: n = 273). The majority of female (92.6%) and male (85.0%) elite athletes and female (100.0%) and male (94.0%) fitness customers declared using one or more NS. The use of non‐ergogenic NS was more prevalent in women than in men and in younger (15–34 years) compared with older (35–49 years) subjects, but it was less prevalent in intermittent compared with endurance and power/strength sports. Additionally, fitness customers who tested positive for doping also reported using more NS than subjects testing negative, indicating an association between NS and doping abuse. The present results demonstrate a very high prevalence of NS usage in both elite athletes and fitness customers. This highlights the importance of a strong national regulation of NS to avoid contamination of NS with doping substances.     

Military tobacco policies: the good, the bad, and the ugly

The United States military has the legacy of a pro-tobacco culture and still has prevalence rates of tobacco use that are higher than their civilian counterparts. One tactic for decreasing use and the subsequent health problems is through effective tobacco control policies. We collected available tobacco control policies from all four branches of the military and, through qualitative analysis, identified policies that were unique either as providing more or less detail and restriction than peer group policies. Best and worst practice policies in the areas of enforcement, smoking cessation, smokeless tobacco use, environmental tobacco smoke, framing tobacco as non-normative, designated tobacco use areas, and monitoring of tobacco use are presented. Because policy making can be an effective tool for improving the health of military members, understanding what policy components are comparatively positive or negative is an important tool for health advocates both in the military and civilian settings.     

Science to practice: how will myocardial inflammation be imaged with MR imaging?

The elegant study by Naresh and colleagues (1) synthesizes many of the best aspects of molecular magnetic resonance(MR) imaging: Quantitative serial imaging of a well-defined molecular process is performed in vivo, and its results are correlated with sensitive measures of left ventricular function. The technique described adds a valuable tool to the molecular imaging armamentarium. How, then, will myocardial inflammation be imaged with MR imaging?The only clinical experience to date has been with iron oxide nanoparticles (2,3). Their excellent sensitivity, dynamic range, and safety record make them a highly appealing choice. It will be critical, however, for any iron oxide nanoparticle that is used clinically to be well studied and validated in animal models of the disease before it is used in humans. A “group effect” cannot be assumed, even in the case of fairly similar iron oxide nanoparticles. The use of MR imaging–detectable liposomes appears promising,and initial clinical studies with fluorine-containing liposomes are likely to begin shortly. The clinical use of gadolinium-labeled liposomes appears further away, and the approach described by Naresh and colleagues is thus likely to remain confined to preclinical investigation for the foreseeable future. The development of novel anti-inflammatory therapies, however, will require robust imaging tools to shepherd these agents through preclinical studies and into the clinical arena. The approach described by Naresh et al adds a valuable tool to the preclinical molecular imaging armamentarium.     

Customer service: developing a new mindset for today's instant gratification society.

Today's society expects and demands immediate service, results and access to information. Can those of us in leadership positions say that the service we provide is equal to or exceeds what our customers expect? How can we redesign our services so they are better than those we currently provide? Some people look to advances in technology as one means to improve services and access to information, but this should not be the only means. If we are to develop a philosophy of exceptional service, we must develop a vision of those services. We must gain an understanding of our customers, plus a knowledge of products, the availability of resources and any industry constraints. In healthcare, we must look to leadership to achieve our goals. A goal of exceptional customer service must be communicated to all levels of service providers from management. Top-down action by management--leadership by example--is critical. Leadership must gain the trust of both customers and employees by actively listening to both verbal and nonverbal comments at all points of service. Without an understanding of our customers' needs, it won't be possible to deliver services at or above their expectations.     

Tomosynthesis as a screening tool for breast cancer: A systematic review

BackgroundMammography is an important screening tool for reducing breast cancer mortality. Digital breast tomosynthesis (DBT) can potentially be integrated with mammography to aid in cancer detection.MethodUsing the PRISMA guidelines, a systematic review of current literature was conducted to identify issues relating to the use of tomosynthesis as a screening tool together with mammography.FindingsUsing tomosynthesis with digital mammography (DM) increases breast cancer detection, reduces recall rates and increases the positive predictive value of those cases recalled. Invasive cancer detection is significantly improved in tomosynthesis compared to mammography, and has improved success for women with heterogeneous or extremely dense breasts.ConclusionTomosynthesis reduces some limitations of mammography at the time of screening that until recently were most often addressed by ultrasound at later work-up. Tomosynthesis can potentially be adopted alongside mammography as a screening tool.     

Radiation Protection in Interventional Radiology: Survey Results of Attitudes and Use

PurposeTo assess attitudes of interventional radiologists toward personal radiation protection and the use of radiation protection devices.Materials and MethodsInvitations to an anonymous online survey that comprised eight questions focused on operator attitudes toward radiation protection devices were sent via e-mail to the active membership of the Society of Interventional Radiology (SIR): a total of 3,158 e-mail invitations. A single reminder e-mail was sent.ResultsThere were 504 survey responders (16% response rate). Reported radiation safety device use included lead apron (99%), thyroid shield (94%), leaded eyeglasses (54%), ceiling-suspended leaded shield (44%), rolling leaded shields (12%), ceiling-suspended/rolling lead-equivalent apron (4%), radiation-attenuating sterile surgical gloves (1%), and sterile lead-equivalent patient-mounted drape (4%). Reasons commonly cited for not using certain devices were comfort (eyewear), ease of use (mounted shields), and lack of availability (rolling/hanging shields and patient-mounted shields).ConclusionsInterventionalists have an array of tools from which to choose for personal radiation protection; however, for a variety of reasons related to lack of availability or choice, these tools are not universally employed. Further study may be of value to clarify why comfort was cited most often as the primary barrier to the use of protective eyewear and difficulty of use was cited as the primary barrier to use of mounted shields (despite reporting that concern for radiation-induced injury to the eye is paramount). It may also be of interest to further study why certain devices with demonstrable protection effects are not readily available, such as rolling/hanging and patient-mounted shields.     

Test report on the system components for film processing by the middle-format technology

Industrially developed accessories for use with medium-format equipment, which have been tested in a-clinical settery, were evaluated separately. The automatic mounting system (Delcadro) with the plastic mount (Cadrix) was accepted by all of our colleagues, and was rated as an advantage, with hardly any reservations. A slight modification is needed in the design of the mounts. This equipment would be a desirable addition to our own equipment for routine work. The daylight system (camera magazine and feeder) is, in principle, certainly a step in the right direction. Handling of the magazine proved to be too complicated and it was prone to malfunctions. Simplification, especially of the loading mechanism, would be desirable. The film feeder is designed for use with conventional roll processing machines. In our opinion, a feeder will always be put to full use if the films processed in this machine are mainly or exclusively of middle format; the darkroom is not permanently staffed and/or adaptation to an existing daylight system (large formats) has already been effected and/or depending on availability, both large and medium size-formats can be processed fully automatically as quickly as possible. However, if films of various formats are processed by an assistant in a darkroom, it is possible to deal with the total quantity of films faster than with a feeder by inserting 3 or 4 medium-format films (or 2 or 3 large-format films) simultaneously. The Heliomat film viewer offers impressive reproductions of 100 mm film on a glare-free glass screen.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluating the emotions of patients with chronic low back pain. A preliminary examination

The Emotions Scale (EMS) was developed to assess responses of patients with CLBP to pain in terms of positive and negative emotions. Such an evaluation may be able to provide an insight into the effectiveness of a rehabilitation programme in patients with CLBP. To determine the final number of factors, an initial principal component analysis without rotation was conducted. The EMS developed and validated in the present study for patients with CLBP is a tool that can be applied by all specialists and in all medical or rehabilitation settings because it is short and concise. At the same time it includes most of the main emotions affected by CLBP, so that with one tool, many assessments can be performed. The EMS may be used in controlled trials, or in observational and survey studies. The results revealed that two factors explained 56.31% of the total variance. Cronbach α coefficients were: 0.92 for factor “negative emotions” (12 items, e.g. “weak”) and 0.90 for factor “positive emotions” (8 items, e.g. “cheer”). Importantly, the component correlation matrix of the specific analysis showed a negative correlation between these two factors.     

Chemistry of radioiodine

The properties of radioiodine are reviewed in relation to its use in labeled compounds. Iodine is characterized by a varied spectrum of oxidation states and can form a variety of complex ions and multivalent compounds. The picture of exchange reaction mechanisms is complex, but can be rationalized in terms of stabilization of intermediate complexes formed with negative, neutral, or positive iodine species. The replacement of organometallic groups by electrophilic iodine is discussed as a synthetic tool.     

Developing a 360-degree, value-based performance review model

In healthcare, competency assessment continues to be a concern. Even the JCAHO stresses its importance, along with ongoing education for employees. Many healthcare facilities have developed specific technical-competency requirements to ensure quality of service. The leadership at the University of Kansas Hospital (UKMC) wanted to develop a value-driven performance review process that focused on values and interpersonal skills for its employees. The current set of values lacked focus on key quality, behavior and service values, and it was felt employees had not committed to these values. A task force, made up of representatives from key hospital groups, was formed to create a process that would emphasize and assess key leadership skills and values. This team discussed various review mechanisms, including Micheli's 360-degree review process, which uses various sources (supervisors, colleagues and peers, for example) to give input that will be broader and more comprehensive of employee performance. The team incorporated such key leadership expectations as visioning, empowering, modeling, communication, stewardship and self-development into the tool. Called Leadership Enhancement And Development (LEAD), the tool could be completed by a peer, supervisor, direct report or even used for self-review. Results were kept confidential through the use of numbers and letters yet could be incorporated into a spreadsheet for analysis. Starting with managers and supervisors, the process has been piloted in a few larger departments at UKMC where it has been well received. Over time, the process will be used for all employees where it will continue to stress the importance of hospital values and commitment to patients and other employees.     

Employee retention: a customer service approach

Employee retention is a huge problem. There are staff shortages in radiology because not enough people are entering the profession; too many people are leaving the profession for retirement, higher-paying jobs or jobs with less stress; and there are not enough opportunities for career advancement. Staff shortages are exacerbated by difficulty in retaining people who enter the profession. While much work has been focused on recruitment and getting more people "in the front door," I suggest that the bulk of future efforts be focused on employee retention and "closing the back door." Employee retention must be an ongoing process, not a program. Approaches to employee retention that focus on external things, i.e., things that the company can do to or for the employee, generally are not successful. The truth is that employee retention processes must focus on what the employee gets out of the job. The process must be a benefits-based approach that helps employees answer the question, "What's in it for me?" The retention processes must be ongoing and integrated into the daily culture of the company. The best way to keep your employees is to treat them like customers. Customer service works for external customers. We treat them nicely. We work to satisfy them. We help them achieve their goals. Why not do the same for our employees? If positive customer service policies and practices can satisfy and keep external customers, why not adapt these policies and practices for employees? And, there is a service/satisfaction link between employee retention and higher levels of customer satisfaction. Customers prefer dealing with the same employees over and over again. Employee turnover destroys a customer's confidence in the company. Just like a customer does not want to have to "train and educate" a new provider, they do not want to do the same for your "revolving door" employees. So, the key is to keep employees so they in turn will help you keep your customers. Because the techniques of this process mirror the activities of customer service and customer relationship management, I call the combined process C/ERM for customer/employee relationship management. Both activities must be going on simultaneously to create a loyalty link that ensures customer satisfaction and retention through employee service, satisfaction and retention.     

Computers in radiology departments

Although the computer is now becoming more common in radiology departments, where its application is generally in the field of assisting in the operational effectiveness of the department at a clerical and secretarial level, the implementation of the White Paper "Working for Patients" will make it increasingly important for the radiologist in charge of a department and the superintendent radiographer to have the facts and figures of the operation of the department at their fingertips. This will be to the benefit of our patients, as it can only lead to an improvement in the effectiveness of our activities. Such information will also give us greater confidence in discussion with clinical colleagues, by providing specific facts relating to unrealistic use of the services we provide.     

A case study in developing a radiology information technology (RIT) specialist position for supporting digital imaging

Support services in providing PACS to healthcare facilities are becoming more complex. Imaginative staffing models are imperative to provide a successful PACS program to customers. Choosing the right staffing grid of support staff can be assisted by locations with like volumes or geographic areas. The RIT (radiology information technology) specialist is an excellent asset in a growing PACS environment. RITs can be the crucial liaison between the radiology department and the customer. RITs with different backgrounds can be recruited based on what type of support services your customers need. RITs are a great resource for one-on-one training from physicians to nursing staff. This mobile PACS spokesperson can take the concerns of the customers to the PACS administrator to open dialogue and communication that will win customer loyalty in this ever changing world of technology.     

Interventional Cardiology: Percutaneous Noncoronary Interventions,Howard C. Hermann (Ed.), The Humana Press (2005), 433 pp., price: Euro 99.50, ISBN 1-588-29-367-X

Becherer and colleagues’ report in the European Journal of Radiology of their interesting data on the use of FDG PET in the evaluation of residual masses in seminoma patients is extremely similar to the data that the same authors published in 2004 in the Journal of Clinical Oncology. It would be very helpful to know whether these are the same patients being presented again or a new multicenter study of the same size asking the same question. Oddly, the authors do not acknowledge their prior report even though it was published the same month that the report to the European Journal of Radiology was submitted for review. It would be helpful if the authors explained what the 2005 report adds to the 2004 report for those of us trying to assess the role of FDG PET in this patient population. At this point in time, it appears that there are two studies that have been completed, including a negative trial from the United States and a positive trial (now published three times) from Europe.     

Sicherheitsaspekte im Internet

Aim of the study: Is it possible to use the Internet as a secure media for transport of telemedicine? Which risks exist for routine use? In this article state of the art methods of security were analysed. Telemedicine in the Internet has severe risks, because patient data and hospital data of a secure Intranet can be manipulated by connecting it to the Web. Conclusions: Establishing of a firewall and the introduction of HPC (Health Professional Card) are minimizing the risk of un-authorized access to the hospital server. HPC allows good safety with digital signature and authentication of host and client of medical data. For secure e-mail PGP (Pretty Good Privacy) is easy to use as a standard protocol. Planning all activities exactly as well as following legal regulations are important requisites for reduction of safety risks in Internet.     

Feasibility determination for use of polymerase chain reaction in the U.S. Air Force air-transportable hospital field environment: lessons learned

At present, the use of molecular probes and polymerase chain reaction (PCR) for the identification of microorganisms in body fluids or tissues is becoming more commonplace. There is an added advantage when serological or culture methods are difficult, expensive, or unavailable. Slow-growing or fastidious microorganisms, including Mycobacterium tuberculosis, spirochetes, viruses, and the dimorphic fungi, can be detected rapidly using these techniques. The presence of different chromosomal or plasmid-mediated antibiotic-resistant markers can also be determined. PCR is an extremely powerful tool that has been applied to research, and more recently it has been used to augment standard clinical applications. It is a very simple process that can amplify nucleic acid sequences, both DNA and RNA, a million times over. The sensitivity, rapidity, broad applicability, and compactness of this technology make it an ideal candidate for use in the military arena. We recently established a molecular biology laboratory at a Deployable Medical System at the Camp Parks Army Reserve Training Facility in Dublin, California. This article will briefly summarize the use of PCR and its applicability in the air-transportable hospital field environment. Proper handling, processing, and testing as well as the requirements for setting up a molecular biology laboratory will be discussed. Finally, the benefits and disadvantages of using PCR-based techniques in the deployed field environment will be considered.     

A sequential chart for the audit-based evaluation of screening mammogram interpretation

RATIONALE AND OBJECTIVES: Auditing has received much attention recently as a method for radiologists to use to evaluate their interpretation of screening mammograms. U.S. Food and Drug Administration regulations require that some sort of audit be in place before a mammography screening facility can receive accreditation. Auditing presents a unique opportunity to monitor accuracy continually and identify problems early. Audit data present unique challenges, however, and appropriate methods must be used to control the risk of errors. MATERIALS AND METHODS: This article introduces a simple method for the task of deciding if a radiologist yields an acceptable positive predictive value based on audit. The method is based on "sequential" decision-making techniques that have found wide application in quality control problems. These techniques are developed for diagnostic radiology and embodied in an easy-to-use decision-making chart. RESULTS: Several examples, based on audit data from actual mammography facilities, provide insights into the use of these charts and the influence of (a) the selection of standards, (b) the selection of error risks, and (c) radiologist variability. The examples also serve to demonstrate another important property of this method--that is, it specifies the minimum amount of data that has to be collected before any decision can reliably be made. CONCLUSION: The chart presented in this article provides a method by which audit data can be used objectively to evaluate the accuracy of screening mammogram interpretation. The method controls the risk of either falsely accepting an unqualified radiologist or falsely rejecting a qualified radiologist. It should be a useful tool to radiologists who must evaluate their own practices.     

Ultrasonography in the evaluation of the acute abdomen: intestinal pathology

Ultrasonography (US) has become an essential tool in the initial evaluation of patients presenting with an acute abdomen, being quick and easy to use. When a patient is referred with acute abdomen of presumed intestinal origin, US can be employed in the diagnosis of acute appendicitis, acute diverticulitis, obstruction, intussusception, Crohn's disease, infectious enteritis, ischemic bowel disease, and even tumors. US does not show findings specific for these disease processes, and frequently only shows nonspecific wall thickening, some infiltration of the adjacent fat, and a small amount of fluid, but nevertheless it is quite sensitive when performed by an experienced examiner, and can therefore be used as a rapid screening tool in patients with an acute abdomen. This paper describes the use of US in the evaluation of the acute abdomen of intestinal origin.