The evolving practice of nuclear cardiology: Results from the 2011 ASNC member survey

Background

Today??s imaging laboratories face challenges including reimbursement, prior authorization, and accreditation standards. The impact on the practice of nuclear cardiology in the United States is unknown. We conducted a survey of ASNC members to provide a snapshot of nuclear cardiology imaging laboratories in 2011.

Methods and Results

The survey identified practice patterns including personnel, volumes, protocols used, and laboratory characteristics. We employed random sampling methodology stratified geographically. The response rate was 19.5% (73/374 laboratories). A non-random survey conducted in 2001 of 25 laboratories served as a comparator. A total of 73 laboratories, representing 202 physicians and 177 technologists responded. The reported median procedural volume was 1,225 studies annually; 88.9% of laboratories were accredited. Compared with 2001, dual isotope imaging protocol use dropped from 72% to 15.6%. Five markers of quality were surveyed. Half of laboratories use the American College of Cardiology??s Appropriate Use Criteria, 61% used segmental scoring, and 32% provided guidance on post-test therapeutic management. 89% perform catheterization correlations while only 33% implemented radiation dose tracking.

Conclusions

This survey of ASNC members provides critical information on nuclear cardiology practice to better target and service our members?? needs. These data can prove invaluable to target educational needs and inform healthcare policy of contemporary nuclear cardiology practice.     

Gallbladder damage control: compromised procedure for compromised patients

Background

The objective of this study was to analyze a population-based database for (1) recent 9-year trends in utilization of partial cholecystectomy (PC), laparoscopic PC, and trocar cholecystostomy (TC), (2) demographics, associated diagnoses, and hospital characteristics, and (3) relevant inpatient outcomes.

Methods

Retrospective cohort analysis of the Nationwide Inpatient Sample (NIS) files from 2000 to 2008 was performed. For the purposes of the study, gallbladder damage control was defined as PC, laparoscopic PC, and TC.

Results

A national estimate of 10,872 gallbladder damage control cases was obtained. Procedures performed included PC (47.8?%), laparoscopic PC (27.2?%), TC (25.3?%), and intraoperative cholangiogram (IOC) (19.7?%). A total of 1,479 (13.6?%) postoperative complications were identified, including pulmonary complications (4.3?%), hemorrhage/hematoma/seroma (3.4?%), and accidental puncture or laceration during procedure (3.3?%). Common bile duct injury occurred in 3.3?% overall. Hospital types included nonteaching (82.1?%) and urban (67.8?%), with regional variations of 42.1?% from the South and 45.2?% from the West. Inpatient outcomes included mean length of stay of 11.4 (0.16 SEM) days, mean total hospital charge of $71,296.69 ($1,106.03 SEM), 7.4?% mortality, and 16.8?% discharge to skilled nursing facility. Multivariate logistic regression analysis identified independent risk variables for common bile duct injury: teaching hospitals (OR?=?1.517, CI?=?1.155–1.991, P?=?0.003). IOC (OR?=?2.030, CI?=?1.590–2.591, P?Conclusion Various circumstances may require gallbladder damage control with PC and TC. Postoperative complications and common bile duct injury remain significantly high despite limited resection, and the teaching status of the hospital is associated with CBD injury. High morbidity and mortality of gallbladder damage control may reflect both the compromised nature of the procedures and multiple comorbidities.     

Does ultra-pulse CO2 laser reduce the risk of enamel damage during debonding of ceramic brackets?

This study seeks to evaluate the enamel surface characteristics of teeth after debonding of ceramic brackets with or without laser light. Eighty premolars were bonded with either of the chemically retained or the mechanically retained ceramic brackets and later debonded conventionally or through a CO₂ laser (188 W, 400 Hz). The laser was applied for 5 s with scanning movement. After debonding, the adhesive remnant index (ARI), the incidence of bracket and enamel fracture, and the lengths, frequency, and directions of enamel cracks were compared among the groups. The increase in intrapulpal temperature was measured in ten extra specimens. The data were analyzed with SPSS software. There was one case of enamel fracture in the chemical retention/conventional debonding group. When brackets were removed with pliers, incidences of bracket fracture were 45% for the chemical retention, and 15% for the mechanical retention brackets. No case of enamel or bracket fracture was seen in the laser-debonded teeth. A significant difference was observed in ARI scores among the groups. Laser debonding caused a significant decrease in the frequency of enamel cracks, compared to conventional debonding. The increase in intrapulpal temperatures was below the benchmark of 5.5 °C for all the specimens. Laser-assisted debonding of ceramic brackets could reduce the risk of enamel damage and bracket fracture, and produce the more desirable ARI scores without causing thermal damage to the pulp. However, some augmentations in the length and frequency of enamel cracks should be expected with all debonding methods.