Law,ethics and research ethics committees

This paper examines the view of the operational management of the UK Research Ethics Committee (REC) system that RECs may not reject applications on purely legal grounds. Two arguments are offered for this view: the first rests on the contention that being lawful and being ethical are not the same thing; the second is that RECs lack expertise and authority to base their decisions on legal considerations. However, whatever the philosophical standing of the first argument, it is contrary to published guidance, the basis of RECs' official authority, unethical, and politically imprudent to permit RECs not to consider conformity with the law to be at least a necessary condition for REC approval. In any event, RECs can obtain competent and authoritative advice on the law (though the Department of Health has been remiss in this regard), and they do not exceed their authority by applying the law, because this is within their ethical remit. When current guidance to RECs about advising researchers on whether or not breaches of confidence are permissible in the public interest is linked to the view of the REC management that the role of RECs is to facilitate research (albeit ethical research), this raises serious doubts about the integrity of the system of ethical review currently in place, which is illustrated by a recent "agreement" of the Chairmen of the MRECs not to consider the Data Protection Act 1998 in their ethical review.     

Diagnostic radiologists' subspecialization and fields of practice

OBJECTIVE: The purpose of this study was to explore the diagnostic radiology profession from the perspective of subspecialization and fields of practice. MATERIALS AND METHODS: Data for 1244 practicing diagnostic radiologists were gathered from the American College of Radiology's 1995 Survey of Radiologists. Radiation oncologists, the retired, and residents and fellows were excluded. Responses were weighted to represent all practicing diagnostic radiologists in the United States and were compared with a similar previous survey. RESULTS: More than one quarter (28%) of diagnostic radiologists are subspecialists. Diagnostic radiology subspecialists were more likely than generalists to have fellowship training, work in center cities, work in large groups, and be employed by an academic institution. They were also generally younger and provided a narrower range of imaging services than generalists. CONCLUSION: Although most diagnostic radiologists are generalists, subspecialization will likely continue to grow.     

The reliability of radiologists' quality assessment of MR pelvic scans.

The purpose of this study was to test the reliability of radiologists' subjective assessment of the quality of MR scans of the pelvis. A four-grade ordinal subjective scale, based on the degree of artifact and contrast between pelvic organs, was developed in a pilot study by two MR radiologists. Forty pelvic scans were graded "blindly" in random order by the same two "practiced" MR radiologists, and an objective measurement of scan artifact was obtained for each scan. Twenty-eight pelvic scans were also graded by two "unpracticed" radiologists not involved in the development of the scale. For the practiced radiologists, the interobserver percentage agreement was 80% (weighted kappa of 0.78) and the intraobserver percentage agreement was 75% (weighted kappa of 0.73). For the unpracticed radiologists the percentage agreement was 61% and the weighted kappa was 0.55. The correlation between the subjective and objective measurement was only 0.27. In conclusion, the objective measurement of scan artifact showed poor correlation with the radiologists' subjective assessment of scan quality. The subjective assessment demonstrated satisfactory reliability and, therefore, could be considered as an additional outcome measurement for scan quality in clinical trials or as a relevant measure of quality assurance.     

Survey of gynecologists' and interventional radiologists' opinions of uterine fibroid embolization.

PURPOSE: To evaluate the opinions of gynecologists and interventional radiologists regarding uterine fibroid embolization (UFE). METHODS: We mailed surveys to all gynecologists and interventional radiologists practising in Toronto, Ontario. Study criteria excluded those physicians who did not assess or treat patients with uterine fibroids. We evaluated whether they educated patients regarding UFE, together with their opinion of current and future effectiveness of UFE, self-rated knowledge of fibroid treatment options, and recommendations for treatment in several clinical scenarios. RESULTS: A total of 102 gynecologists (46.4% response rate) and 28 interventional radiologists (51.9% response rate) completed the survey. After applying the exclusion criteria, the final study population was 82 gynecologists and 17 interventional radiologists. Both groups reported high rates of patient education regarding UFE (gynecologists 100% and interventional radiologist 88.2%, P > 0.05). Interventional radiologists had higher self-rated knowledge of UFE (P = 0.05), and gynecologists had higher self-rated knowledge of all other treatment options (P = 0.00). Interventional radiologists had a more favourable opinion of the current effectiveness (P < 0.05) and future use (P > 0.05) of UFE. In 5 of the 7 clinical scenarios, interventional radiologists chose UFE, whereas gynecologists chose other treatment options (P < 0.05). CONCLUSIONS: Although most gynecologists and intterventional radiologists educate their patients regarding UFE as a treatment option for uterine fibroids, interventional radiologists have greater self-rated knowledge and a higher opinion of current effectiveness and future use and recommend UFE more often for uterine fibroid scenarios.     

U.S. radiologists' workload in 1995-1996 and trends since 1991-1992

The authors describe a simple method for placing a non-end-hole nasojejunal feeding tube with fluoroscopic guidance by using a multipurpose catheter and guide wire. The method was used successfully in 12 patients with no side effects or complications.