Teamwork Training for Interdisciplinary Applications

Safe healthcare delivery in the emergency department is a team sport. Medical educators seek efficient and effective methods to teach and practice teamwork skills to all levels of interdisciplinary learners with the goal of enhancing communication, insuring smooth clinical operations, and improving patient safety. We present a new interdisciplinary, health professions teamwork curriculum, modified from TeamSTEPPS, that is efficient, effective, and can be delivered using multiple teaching modalities. This flexible curriculum structure begins with a brief didactic core designed to orient the learners to team concepts and invest them in the rationale for focusing on teamwork skills. This is followed by one of four additional instructional modalities: traditional didactic, interactive audience response didactic, low-fidelity simulation (role play), and high-fidelity patient simulation. Each of these additional modalities can be utilized singly or in combination to enhance the learners' attitudes, knowledge, and skills in team-based behaviors. Interdisciplinary cases have been defined, piloted, modified, and deployed at two major universities across more than 400 learners. Interdisciplinary simulation scenarios range from team-based role play to high-fidelity human patient simulation. Assessment cases using standardized patients are designed for interdisciplinary applications and focus on observable team-based behaviors rather than clinical knowledge. All of these cases have accompanying assessment instruments for attitudes, knowledge, and skills. These instruments may be used for formative assessment to provide feedback to the learners and standardize the faculty's information delivery. If used in a summative manner they provide data for course completion criteria, remediation, or competency assessment.     

Managing radiation use in medical imaging: a multifaceted challenge

This special report aims to inform the medical community about the many challenges involved in managing radiation exposure in a way that maximizes the benefit-risk ratio. The report discusses the state of current knowledge and key questions in regard to sources of medical imaging radiation exposure, radiation risk estimation, dose reduction strategies, and regulatory options.     

Pediatric hematopoietic stem cell transplantation and the role of imaging

The use of hematopoietic stem cell transplantation (HSCT) in the treatment of children afflicted with many potentially fatal malignant and nonmalignant diseases is well recognized. Although outcomes continue to improve and the utility of HSCT is increasing, HSCT remains a complicated process necessitating support from many medical disciplines, including radiology. Importantly, children who undergo HSCT are at risk for the development of specific complications that are linked to the timeline of transplantation, as well as to the relationship between the underlying diagnoses, severe immune deficiency, cytoreductive regimen, and graft-versus-host reactions. An understanding of the complex interplay of the immune status, therapeutic regimen, and disease allows increased diagnostic accuracy. Successful treatment of these high-risk children requires that radiologists who are involved with their care be familiar with broad concepts, as well as with specific problems that frequently occur following HSCT. In this article, the clinical aspects of pediatric HSCT are summarized, including common complications, and imaging features of these complications are described.     

MOSFET dosimetry for radiation dose assessment of bismuth shielding of the eye in children

OBJECTIVE: The purpose of our study was to measure radiation dose to the orbit during pediatric cranial CT with and without bismuth shielding using a novel dosimetry system. Cranial CT was performed on a pediatric anthropomorphic phantom, with and without bismuth eye shields. A solid-state metal oxide semiconductor field effect transistor (MOSFET) dosimeter was used to obtain real-time dose measurements. CONCLUSION: Bismuth shielding reduced radiation dose to the eye by up to 42%; shield artifact fell outside the diagnostic area of interest.     

Effective dose determination using an anthropomorphic phantom and metal oxide semiconductor field effect transistor technology for clinical adult body multidetector array computed tomography protocols

PURPOSE: To determine the organ doses and total body effective dose (ED) delivered to an anthropomorphic phantom by multidetector array computed tomography (MDCT) when using standard clinical adult body imaging protocols. MATERIALS AND METHODS: Metal oxide semiconductor field effect transistor (MOSFET) technology was applied during the scanning of a female anthropomorphic phantom to determine 20 organ doses delivered during clinical body computed tomography (CT) imaging protocols. A 16-row MDCT scanner (LightSpeed, General Electric Healthcare, Milwaukee, Wis) was used. Effective dose was calculated as the sum of organ doses multiplied by a weighting factor determinant found in the International Commission on Radiological Protection Publication 60. Volume CT dose index and dose length product (DLP) values were recorded at the same time for the same scan. RESULTS: Effective dose (mSv) for body MDCT imaging protocols were as follows: standard chest CT, 6.80 +/- 0.6; pulmonary embolus CT, 13.7 +/- 0.4; gated coronary CT angiography, 20.6 +/- 0.4; standard abdomen and pelvic CT, 13.3 + 1.0; renal stone CT, 4.51 + 0.45. Effective dose calculated by direct organ measurements in the phantom was 14% to 37% greater than those determined by the DLP method. CONCLUSIONS: Effective dose calculated by the DLP method underestimates ED as compared with direct organ measurements for the same CT examination. Organ doses and total body ED are higher than previously reported for MDCT clinical body imaging protocols.     

Fundamentals of a patient safety program

Thousands of people are injured or die from medical errors and adverse events each year, despite being cared for by hard-working, intelligent and well-intended health care professionals, working in the highly complex and high-risk environment of the American health care system. Patient safety leaders have described a need for health care organizations to make error prevention a major strategic objective while at the same time recognizing the importance of transforming the traditional health care culture. In response, comprehensive patient safety programs have been developed with the aim of reducing medical errors and adverse events and acting as a catalyst in the development of a culture of safety. Components of these programs are described, with an emphasis on strategies to improve pediatric patient safety. Physicians, as leaders of the health care team, have a unique opportunity to foster the culture and commitment required to address the underlying systems causes of medical error and harm.     

'Sleeping with the enemy?' Expectations and reality in imaging children in the emergency setting

As an introduction to the ALARA conference titled "Building Bridges between Radiology and Emergency Medicine: Consensus Conference on Imaging Safety and Quality for Children in the Emergency Setting," it is important for us to understand the landscapes of both the pediatric radiology and emergency medicine subspecialties. Recognizing potentially different practice patterns, including perspectives on pediatric care, as well as shared and sometimes unique professional pressures, can help us identify common concerns and problems and facilitate the development of strategies aimed at correcting these issues.