Survey of Current Status and Physician Opinion Regarding Ancillary Staffing for the IR Suite

PurposeTo survey the status quo of ancillary staffing in predominantly hospital-based interventional radiology (IR) suites and to assess interventional radiologist attitudes toward current IR procedure room staffing availability and appropriateness.Materials and MethodsInvitations to an online survey composed of 26 questions focused on levels of IR suite ancillary staffing as well as operators’ opinions of current IR procedure room staffing were sent via email to 2,284 active Society of Interventional Radiology members.ResultsThere were 777 survey responses. Nurse staffing count per IR room was at least one in 90% (n = 699) during regular hours and 93.6% (n = 730) during off-hours, respectively. A second technologist was frequently used during regular hours and, to a lesser extent, during on-call hours (n = 341 [43.9%] and n = 122 [15.7%]), respectively. Ten and 15% of IR respondents believe staffing support is inadequate for most interventional procedures requiring moderate sedation during normal business hours and off-hours/weekends, respectively, and 69% and 56% of IR respondents believe anesthesia support is inadequate during normal business hours and during off-hours, respectively.ConclusionsThe number of technologists used per IR suite varies across practices and frequently exceeds that of earlier American College of Radiology recommendations, whereas use of IR suite nurse staffing is consistent with approximately one per suite and constant. However, there is dissatisfaction among surveyed interventional radiologists with availability and appropriateness of staffing of the IR procedure room, particularly during on-call hours and weekends, as well as with anesthesia support for emergent cases. No evidence-based guidelines for staffing the IR suite currently exist. This underscores the need for further investigation with the ultimate goal of creating such guidelines.     

血清胱抑素C和尿微量白蛋白/肌酐比值在原发性高血压肾损害早期诊断的临床意义*

目的探讨检测血清胱抑素C(CysC)和尿微量白蛋白/肌酐比值(m Alb/Cr,ACR)对诊断高血压早期肾损害的临床价值。方法选取原发性高血压血肌酐(Cr)正常患者290例,检测血清CysC及尿ACR,将CysC、尿ACR与CysC与尿ACR组合比较检测阳性率。结果血清CysC对高血压早期肾损害诊断高于尿ACR,血清CysC联合尿ACR组合诊断高血压早期肾损害显著高于单一检测。结论血清CysC对诊断高血压早期轻度肾损害具有较高诊断价值,联合尿ACR能进一步提高对高血压早期肾功能损害的诊断。     

Making Sense of MACRA: A Guide for Diagnostic Radiologists

The Medicare Access and CHIP Reauthorization Act of 2015 was signed into law on April 16, 2015, fundamentally altering the way clinicians are reimbursed for the treatment of Medicare patients starting in 2017. Under this new pay-for-performance model, reimbursement will be tied to multiple metrics related to quality and cost of care. A scaled scoring system will require providers to compete for positive reimbursement adjustments, while also penalizing poor performers with negative adjustments. A firm understanding of this new system will be essential for all physicians looking to maximize their reimbursement, particularly diagnostic radiologists and members of other highly focused fields where special considerations lead to alterations in the scoring system.     

甲状腺乳头状癌ACR TI-RADS分类及其转移和伴发疾病分析

目的综合分析甲状腺乳头状癌ACR TI-RADS分类及其伴发疾病、转移情况特征,以提高超声诊断人员利用ACR TI-RADS分类对甲状腺乳头状癌与其他疾病的认识,能更好地鉴别及检出甲状腺乳头状癌。方法基于ACR TI-RADS分类回顾分析首次手术并证实甲状腺乳头状癌163例,综合分析瘤体超声特征、伴发疾病、转移情况。结果甲状腺乳头状癌发病率男:女=1:3.79;淋巴结转移男性64.70%(22/34)高于女性48.06%(62/129);癌体以实性结节占96.9%(158/163);癌体回声以低和极低回声占69.9%;直立性生长的占比73.0%;边缘光滑/模糊及不能确定的占比19.0%。出现点状强回声的癌灶占比47.2%,局灶性强回声≥3分的结节占70.6%;≥7分(TI-RADS5类)癌灶占比86.5%,发生淋巴结转移患者的TI-RADS评分12.00(10.00,14.00)高于未发生转移的患者[11.00(8.00,13.00)(P=0.003)]。病灶单发占73.6%(120/163),病灶数≥2个的占26.4%(43/163);单侧癌灶占81.6%(133/163),双侧癌灶占18.4%(30/163)。甲状腺乳头状癌伴随结节性甲状腺肿或淋巴性甲状腺炎的发生机率占74.85%(122/163),甲状腺乳头状癌伴随疾病与否与转移无统计学意义(P0.05)。结论超声诊断应用ACR TI-RADS分类结合其伴发疾病、转移情况综合分析对甲状腺乳头状癌具有较好的检出率。     

White matter integrity affected by depressive symptoms in migraine without aura: a tract‐based spatial statistics study

Previous studies have proven that migraine and depression are bidirectionally linked. However, few studies have investigated white matter (WM) integrity affected by depressive symptoms in patients suffering from migraine without aura (MWoA). Forty patients with MWoA were divided into two groups according to their self‐rating depression scale (SDS) score in the present study, including 20 in the SDS (+) (SDS > 49) group and 20 in the SDS (?) (SDS ≤ 49) group. Forty healthy participants were also recruited as the control group. Tract‐based spatial statistics analyses with multiple diffusion tensor imaging‐derived indices [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)] were employed collectively to investigate WM integrity between all patients with MWoA and all healthy controls, between each subgroup (SDS (?) group and SDS (+) group) and healthy controls, and between the SDS (?) and SDS (+) groups. Compared with healthy controls, decreased AD was shown in several WM tracts of the whole MWoA group, SDS (?) group and SDS (+) group. In addition, compared with the SDS (?) group, the SDS (+) group showed decreased FA and increased MD and RD, with conserved AD, including the genu, body and splenium of the corpus callosum, bilateral superior longitudinal fasciculi, the right anterior corona radiata and some other WM tracts, similar to previous findings in depression disorder. Furthermore, mean FA and RD in some of the above‐mentioned WM tracts in the SDS (+) group were correlated significantly with SDS scores, including the genu and splenium of the corpus callosum, the right anterior corona radiata and the superior longitudinal fasciculi. Our results suggest that WM integrity may be affected by both depression symptoms (more sensitive as RD) and migraine (more sensitive as AD). The findings may serve as a sensitive biomarker of depression severity in MWoA. Copyright © 2013 John Wiley & Sons, Ltd.     

2020 ACR Presidential Address: Quality,Ownership, and Our Role as Physicians

A story from long ago reminds us of the importance of quality in our practices, of taking ownership of our patients, and of our role as physicians. The coronavirus disease 2019 (COVID-19) pandemic has disrupted our practices. Before the pandemic, many practices were stretched thin by the amount of work that needed to be done. The work stoppage in many locations brought an unwelcome pause but gives us time to reflect on our practices. How can we maintain quality when high volumes return? The role of artificial intelligence, and our role in its development, needs to be considered. At the same time, we need to take more ownership of the patient and be more help to our referring providers. Our own ACR staff are great examples of taking ownership. Finally, we must recognize that patients and their families are important for optimal patient care. Making that connection is significant. Let us start where we began—in the service of our patients as their physicians. This role is rewarding and, together with a focus on quality and taking ownership, can lead to successful practices that are good for everyone, including ourselves.