CT technology overview

I hope that you will find the product matrix to be a useful tool for making comparisons between vendors and scanners. Please keep in mind that the vendors have directly provided the specific answers to the questions within the matrix. Neither the author nor Radiology Management shall be held responsible for any misrepresented or erroneous data.     

Effective management starts with self management

Each manager is his or her own best resource. As with any resource, managers should put effort into the development and improvement of that resource. A conscious effort to continuously improve personal resources will increase a manager's ability to effectively manage the efforts of others. These personal resources include initiative, integrity, organization of time and resources, and coping strategies. An individual's ability to practice initiative in their profession is only limited by their attitude. How do you answer the following questions: How much do I like my job? Do I have the desire to improve the skills and the abilities that will allow me to perform my duties more efficiently? How can I best achieve the goals expected of my department and me? In short, you will never improve your ability to manage unless you get moving! Don't wait for occasional pushes from above. Become an active and enthusiastic contributor to the development of plans and goals. Integrity is essential in establishing trust and loyalty between managers and their staff. Integrity is displayed to the department through honesty, consistency and fairness when dealing with operational problems. Most managers have an honest desire to learn how to manage their time, but don't have the time for it. In other words, we are so busy working inefficiently that we don't have time to become efficient. By organizing your space, you begin to organize the effective use of the time you spend in that space. Remember that your office is space, and space is a resource; demonstrate that you as a manager are concerned with the effective utilization of all organizational resources. Management is not for everybody. Some individuals may be better off realizing this early in the process. If an individual feels that management is their field, they should establish as much control over themselves and over the work place as they can if they hope to perform effectively for the long run. Some stress can be a positive motivator, but if the stress is unrelenting, if managers finds that they are chronically on the verge of anxiety, depression or panic, stress can also lead to personal ineffectiveness or eventually even physical or emotional illness.     

When time matters

The most important organizational resource is energy. The most important resource in time management is energy. Managing energy, not time, can help create encouraging time management skills and appropriate work life balance. Once a leader understands that time should be spent on things that are important instead of everything that is urgent, you can begin to develop a balance that will support your values, your family, and your organization. When leaders find meaningful ways to add a sense of purpose to their work they can personally improve themselves and their organizations. If your personal values do not align with the values of your organization you will never work with a true sense of purpose. Make the time to manage your energy. You will be surprised how much free time you find.     

'Lessons learnt from America'--Reflections from a fellowship examining the prevention, recognition and treatment of operational stress injuries in U.S. Army serving personnel

These are my personal views and reflections from a hugely rewarding experience. They are not opinions or recommendations of the MOD or any other institution I am associated with. I realise that there may be various logistical reasons why my recommendations cannot be carried out; however I do hope that some will be able to be put into place. If nothing else I gained a massive amount from my travelling fellowship and it has already had a positive impact on my own clinical work. I hope to continue to pass on what I have learnt from the fellowship for many years to come. A special thank you goes to the Winston Churchill Memorial Trust for providing me with this fantastic opportunity and everyone who helped me before and during my visit.     

Patellar subluxation. A recent history

For 15 years (1955 to 1970), I was plowing "new ground" pretty much by myself. When you plow behind an old mule and hit a stump hole full of cottonmouth moccasins, you have to get on the move in a hurry and figure out some solution to the predicament or you won't get your corn planted. So, I was not treating the overweight, knock-kneed, loose-jointed, teenaged girl, but the young boy or girl who thought that he or she was an athlete and had dreams of being a star. If rehabilitation did not work, then I thought a lateral release, an Elmslie, and nothing short of a full reconstruction would solve the problem. One had to develop as much vastus medialis obliquus power as this dysplastic muscle could generate, had to transfer the strong vastus lateralis to a more central pull, and, with the distal reconstruction, correct any patella alta and Q-angle abnormality. One had to give the knee every possible advantage in order to serve an athlete. As Hippocrates so wisely noted, one needed to study the athlete to know, with appropriate modifications, what is best for every patient, young or old. In the late 1960s and early 1970s, many fine young orthopedists were stimulated by the information of the AAOS postgraduate courses in sports medicine. They, after having gained further through their own experiences, have become the major contributors to our increasing knowledge of the patellofemoral joint, especially in athletes, and many of these fine "young" (now a little older) orthopedists are now the contributors to this issue. They are giving you their experiences, knowledge, and lessons. A close and repeated study of their information must be combined with compassion for your patient. Then, only experience will develop the desired fine tuning.     

A new era of competitiveness

Many of my family, friends, and colleagues would describe me as competitive and that at times I overuse this skill with a win-at-all-costs attitude. I would tend to agree. I love to win. Yet for me winning is not about me, it is as our coaches suggest, about others. I was recently asked by a new clinical leader if I missed taking care of patients. Without thinking, my response was that I take part in the care (add value) of every patient as a leader. Every decision we make as leaders (coaches) impacts many others regardless of the magnitude of our decision and, at times, our direct involvement. Operational excellence, in any field, is about winning. We all have different definitions of winning, defined by the strategic vision for our organizations. An organization's managers, supervisors, and employees all play an important role in the team to achieve the vision of the organization. As some elite coaches have suggested, winning starts with each of us being our best. Today's environment requires consistent change. Yet many in the radiology field change the wrong things for the wrong reasons. Many organizations and individuals look for instant gratification, specifically in this new era of competitiveness. Many evaluate what their competitors are doing in the market, what cars their neighbors are buying, or become jealous over a friend's success. Focusing on others and not improving yourself takes your focus away from what is important-you and the team you lead. Keeping your focus on your operations and what you can control may very well help you coach a winning team.     

CTAs revisited

It is important that you ensure you are billing correctly for CT/CTA studies based on what is documented. From a facility perspective, you may know that a CTA study is being performed, but if it is not adequately documented you may have a refund obligation in the event of a payor audit. This is a key issue that I recommend all organizations, regardless of which side you are billing, review to ensure compliance.     

Everybody's doing a brand new dance now...CT/CTA coronary

Before you purchase new equipment to perform this service make sure you have all the facts regarding reimbursement for your payor population to ensure correct financial calculations. There is not much argument that CTA of the coronary arteries holds the future and will replace many traditional diagnostic cardiac catheterization procedures. It is important to remember that this is another instance where technology is once again ahead of reimbursement.     

Segmental cement extraction system (SEG-CES) and the Ilizarov method in limb salvage procedure after total knee cemented prosthesis removal in a former osteosarcoma patient

Survival of osteosarcoma has greatly improved in the past few decades. Knee prosthesis is a well-recognized limb salvage procedure for osteosarcoma of the distal end of the femur. One drawback is that prostheses have a limited life and prosthetic failure with the inherent high rate of reoperations remains a serious long-term problem for former osteosarcoma patients. The segmental cement extraction system (SEG-CES) is a technique to remove cement in arthroplasty revision, based on a cement–bone interface with a lower strength compared to the old cement–new cement interface. We report the case of a 32-year-old former osteosarcoma patient in whom the SEG-CES was applied to remove a long-stemmed total knee cemented prosthesis. The prosthesis was placed 17 years before for a recurrent telangiectatic osteosarcoma of the left femur. Thirteen years after the prosthesis implantation, the patient complained of knee instability, pain, and complete failure of the extensor apparatus. The extraction of the prosthesis was performed using cylindrical batters of diameter corresponding to the diameter of the axle, two hammer extractors clamping the prosthesis components between two jaws. Extraction of the periprosthetic cement in the femoral and tibial components was done using the SEG-CES technique. The successful prosthesis removal performed in this patient allowed us to perform an external fixation with bone lengthening and reconstruction by the Ilizarov method.I will build you up again and you will be rebuilt [Jeremiah 31:4]An erratum to this article can be found at     

Mammography technology overview.

As you can see, there are many options in mammography units. This article is not meant to recommend one unit or manufacturer over another, but rather to inform consumers that all units have assets to help technologists acquire the perfect mammogram. This article is meant to make you think about the pros and cons as you consider purchasing new mammography equipment. Though it may seem wise and certainly easier to equip your multiple-unit site(s) with one manufacturer's equipment or even one model, it might truly be wise to have a little variety; this addresses shortcomings of a particular unit. If you provide technologists with a mammography system with which they are comfortable and feel they can address any issues-accommodating disabled patients, patients with breast implants or patients with dense breast tissue-you will see the perfect mammograms you desire.     

Prepare for an SpR interview

By the time you attend an interview for a military SpR number you should have no real problems but it pays to be prepared. Begin preparations early, reading widely and talk to as many people as possible. Your consultants will have a useful viewpoint on the proceedings and may be able to help you refine your answers to the common questions. Arrive at your interview in a smart and timely fashion and answer questions with confidence and common sense. Avoid confrontation and bluff and be courteous at all times, whatever you may be feeling inside and thank the interview panel as you leave.     

Mobile contract services: what you need to know

With sufficient planning and ongoing attention to detail, the performance of a mobile imaging service provider can exceed expectations and requirements. The relationship can prove to be mutually agreeable and profitable for many years. But, when contracting mobile services, you cannot spend too much time on initial research and detail. Several scenarios present outsourcing or mobile services as an acceptable alternative to purchase or lease: outdated equipment, novel or under-utilized technologies, the need for incrementally added or temporary service. To find suitable providers, check with peer sources in your area for recommendations; look specifically for facilities that are comparable in size and volume to your facility. Expect that larger volume facilities will rate more favorable schedules or pricing. Obtain and check references. Require mobile service providers to adhere to the same state and federal laws, rules and regulations that govern your facility; receive the assurance of compliance in writing if it is not specifically addressed in the contract. JCAHO requires that any contract service provider be governed by the same requirements as the accredited facility. Several other rules or licensing requirements may also pertain to mobile services. A prevailing reason for outsourcing imaging services is high equipment costs that cannot be justified with current volume projections. However, equipment quality should not be compromised; it must meet your needs and be in good repair. The mobile service provider you choose should be an extension of your department; quality standards must exist unilaterally. The set rule for assessing mobile service fees is that there is no set rule. There are many ways to negotiate the fee schedule so that it meets the needs of both parties. An effective marketing campaign lets physicians and patients know what you have available. Work with the mobile service provider to plan an initial announcement or open house. The mobile provider should also have patient education materials for referring physicians and your hospital. Having the mobile technologist meet with the radiologists to discuss written protocols will eliminate misunderstandings concerning expectations of both parties; ongoing communication is vital.     

Right to die--a corollary to the right to live and the right to leave

I am going to talk to you on a sinister subject: the question as to whether there is--or should be--a human right to die, which can be regarded as the corollary of the most essential human right: the right to life. Pain and suffering are most useful faculties. They help us to avoid dangers and to treat injuries. But you could get too much of it. There can be pain without cure and suffering without limit. If for good reasons people are finding life unbearable, are they not entitled to put an end to it? I am thinking here of individuals and their personal problems. I will not deal with suicidal missions in warfare or terror raids. The prime goal for society is--as I see it--the benefit of the individual. In other words, the fundamental aim of public affairs is the wellbeing of each individual person. There must of course be a balancing of conflicting interests, but we must never lose sight of the prime goal.     

QARNNS at sea--HMS Roebuck

Despite an initial problem of seasickness I thoroughly enjoyed my five weeks at sea on board HMS Roebuck. Having to make medical decisions can be somewhat daunting. However, you always have back up radio support if required. Although only at sea for a short time, my experience has given me a good insight into life at sea especially with both men and women serving on the same ship. With no experience of serving on board larger ships I can recommend that, if possible further QARNNS ratings are given the opportunity to sample life on board HMS Roebuck and that their presence on board would be appreciated by the ship's company, especially with their forthcoming East Coast Surveys. All that remains to say is to thank the Captain and the rest of the ship's company for making me feel so welcome and that the terms 'For Exercise, for exercise, for exercise and Machinery Breakdown' will be sorely missed.....not! ('fair one!' as the Buffer would say).     

Making PACS the present, not the future

Why haven't you moved forward with PACS? Have you just procrastinated or does your facility have legitimate reasons? Some say the technology is too confusing or too new, while others say the cost of PACS is too high. Many facilities say they haven't found a satisfactory way to deal with the conflicting opinions of their radiologists, IS department, administration, referring physicians and staff. Take time to compare the technology you do understand with something familiar such as your own PC or perhaps the current networks inside your facility. You'll soon begin to see that PACS is not a new technology, but rather a new methodology. To handle the perceived high cost of PACS, remember that every facility has different needs. Look at your work flow and then the many byproducts of PACS, such as marketing. If you are the first in your area to implement this new technology, you'll gain a marketing advantage in competing for referring physicians and managed care referral business. Follow the process you use to purchase other products, such as CT or MRI, as you investigate the vendors. Finally, make a plan! Determine departmental goals and gather information from vendors. Create a timeline, a financial plan and your marketing strategy. Together, these steps will help move PACS into the present for you.     

Establishing an endovascular carotid stent program

FDA approval of carotid stent and distal protection devices has transformed carotid artery stenting (CAS) from an investigational procedure to a practical application. Recent approval by the Center for Medicare Services (CMS) has ensured that CAS will be a part of everyday practice throughout the country. To establish a competitive endovascular carotid stent program, one needs to develop an effective strategy. The key to success is substance and service. A high-quality clinical program with excellent communication between the patient and referring physician is essential. You must first get access to the patient by establishing a clinical practice. As a radiologist, you have the advantage of gaining access by identifying appropriate patients through noninvasive vascular labs, CTA, and MRA. An algorithm-driven evaluation and treatment protocol with good pre- and postoperative care, along with a quality assurance program, will ensure that your carotid stent program has substance and delivers optimal service. With good planning, you will have a firm clinical foundation for treatment of carotid artery stenosis in your community. Putting all of the ingredients together will ensure a successful carotid endovascular program.