In a New Kind of Light: Patient Safety in Pediatric Radiology

[Ergonomically designed radiology workplace]

An ergonomically designed radiology workplace is a key factor for concentrated work during the whole day and is essential in preventing negative long-term effects due to inappropriate physical strain. To avoid such negative effects it is of paramount importance to know the factors that might cause strain on the radiologist, the appropriate application for workplace design to address these factors and how work-related disorders emerge. To minimize physical strain due to long-lasting and repetitive movements, the workspace must be adapted to the physical needs of the radiologist. Adjustable settings for the work desk and seat, together with correct screen positioning and distance from the screen, are examples of such important factors in an ergonomic workplace design. In addition, adjustable ambient light, an adjustable conditioned climate, an appropriate color design for the environment and a reduction of unnecessary noise are also crucial factors for an ergonomic workplace. This review gives an overview about the factors that influence the radiology workspace and summarizes the current literature on this topic.

Decreasing the effective radiation dose in pediatric craniofacial CT by changing head position

BACKGROUND

Children are exposed to ionizing radiation during pre- and post-operative evaluation for craniofacial surgery.

OBJECTIVE

The primary purpose of the study was to decrease effective radiation dose while preserving the diagnostic quality of the study.

MATERIALS AND METHODS

In this prospective study 49 children were positioned during craniofacial CT (CFCT) imaging with their neck fully extended into an exaggerated sniff position, parallel to the CT gantry, to eliminate the majority of the cervical spine and the thyroid gland from radiation exposure. Image-quality and effective radiation dose comparisons were made retrospectively in age-matched controls (n = 49).

RESULTS

When compared to CT scans reviewed retrospectively, the prospective examinations showed a statistically significant decrease in z-axis length by 16% (P < 0.0001) and delivered a reduced effective radiation dose by 18% (P < 0.0001). The subjective diagnostic quality of the exams performed in the prospective arm was maintained despite a slight decrease in the quality of the brain windows. There was statistically significant improvement in the quality of the bone windows and three-dimensional reconstructed images.

CONCLUSION

Altering the position of the head by extending the neck during pediatric craniofacial CT imaging statistically reduces the effective radiation dose while maintaining the diagnostic quality of the images.

Pediatric dose reduction in computed tomography

An appropriate balance between risk (radiation dose) and benefit (based on image quality) for computed tomography (CT) in children is essential. This balance comes through an understanding of CT dose, why we do pediatric CT, and how we do pediatric CT. The following material, then, will approach radiation dose in the context of a larger safety program, and address the challenges with determining radiation dose in contemporary CT technology. Unique considerations with respect to study quality, those factors which influence CT use, and strategies for dose reduction (that is, optimization) will also be reviewed.

'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.

The art of communication: strategies to improve efficiency, quality of care and patient safety in the emergency department

The practice of pediatric emergency medicine (PEM) has been supported by wonderful advancements in diagnostic testing, particularly in medical imaging. One of the most remarkable has been CT, which has arguably become our most valuable diagnostic tool in the emergency department (ED). PEM specialists have grown increasingly aware of quality and safety concerns in the care of children in emergency medical settings, spurred in part by a rapid growth in ED utilization and significant overcrowding. In the midst of this comes the revelation that one of our most valued diagnostic tools might place our youngest patients at a significant risk for the development of fatal cancer. This article reinforces the fundamental importance of communication and teamwork as a means to promote patient care quality and safety in the ED, and it offers partnership strategies for PEM and pediatric radiology specialists to consider as they address these important concerns.

Design, implementation, and assessment of a radiology workflow management system

OBJECTIVE

The objective of this article is to describe the development, launch, and outcomes studies of a paperless workflow management system (WMS) that improves radiology workflow in a filmless and speech-recognition environment.

MATERIALS AND METHODS

The WMS prioritizes cases automatically on the basis of medical and operational acuity factors, automatically facilitates communication of critical radiology results, and provides permanent documentation of these results and communications. It runs in parallel with an integrated radiology information system (RIS)-PACS and speech-recognition system. Its effects on operations, staff stress and satisfaction, and patient satisfaction were studied.

RESULTS

Despite an increase in caseload volume after the launch of the WMS, case turnaround times, defined as the time between case availability on PACS and signing of the final radiology staff interpretation, decreased for all case types. Median case turnaround time decreased by 33 minutes (22%) for emergency department, 47 minutes (37%) for inpatient, and 22 minutes (38%) for outpatient radiology cases. All reductions were significant at a p value of < 0.05. Interruptions were reduced, consuming an estimated 28% less radiology staff time, after implementation. Patient perceptions of radiology service timeliness showed modest improvement after the WMS was implemented. Staff satisfaction showed no significant change.

CONCLUSION

There is room for improvement in radiology workflow even in departments with integrated RIS-PACS and speech-recognition systems. This study has shown that software tools that coordinate decentralized workflow and dynamically balance workloads can increase the efficiency and efficacy of radiologists. Operational benefits, such as reduced reading times, improvements in the timeliness of care (both actual and as perceived by patients), and reduced interruptions to radiologists, further reinforce the benefits of such a system. Secondary benefits, such as documenting communication about a case and facilitating review of results, can also promote more timely and effective care. Although use of the system did not result in a substantial improvement in staff perceptions, neither did it reduce their satisfaction, suggesting that these operational improvements were not achieved as a trade-off against the quality of the work environment.