Published on the July 27, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
Last October, the U.S. Food and Drug Administration (FDA) held a meeting to examine the biggest MRI safety concerns and outline best practices to reduce injuries associated with the scans. So far, however, the industry has received no national guidance on how to accomplish this goal.
But the lack of official instruction at the federal level doesn’t mean the push toward greater MRI safety — being recognized this week during MRI Safety Week — has stalled. Advancements are underway at the state level and in the accreditation process to prevent another tragedy, such as the 2001 Colombini case when a 6-year-old boy died when an oxygen tank flew across the room and struck him during the imaging process.
“Any protection that is implemented will benefit the 30 million Americans who get MRIs on an annual basis,” said Tobias Gilk, president and MRI safety director at Mednovus and senior vice president at the design and architecture firm Rad-Planning. “People are beginning to look harder at MRI risk factors as the power of our magnets continue to increase.”
Many states and the Joint Commission have implemented new regulations that strictly govern the design and construction of new MRI suites. These requirements do not mandate retrofitting existing installations.
“There are a growing number of states that are adopting this building code,” Gilk said. “Anyone who does MRI suite work — renovation, upgrade, equipment replacements, anything with a building permit — in virtually every jurisdiction must follow these state standards.”
To conform to the building regulations, health care engineers must meet eight standards, Gilk said. They must follow the American College of Radiology’s (ACR) 4-Zone Principles that addresse integrated access controls and screening practices. There must also be a clear line-of-sight between the operator’s console and patient inside the MRI machine, and designers must include demarcation lines to keep individuals with implantable medical devices far enough away. The presence of ferromagnetic-only detectors is required, and new MRI suites must also have exhaust fans and other protective measures to eliminate any cryogen that escapes into the imaging area.They must include an always-illuminated sign to remind staff that the MRI magnetic field is always active even without a patient.
These new design codes also require a clearly marked safe zone in which staff can use MR conditional equipment. Most importantly, Gilk said, designers and engineers must remember there is no cookie-cutter model for MRI suites. Each site is different and requires individual planning.
In a switch from years past, Gilk said, the Joint Commission is requiring far more documentation to prove you are making your MRI suite as safe as possible for patients. As part of the ACR’s 4-Zone Principles, the Commission now requires proof that you have established access control and provide proper staff supervision. You must also produce documentation that you have adequately trained your MRI personnel in safety procedures and protocols, he said.
“The Joint Commission wants to see evidence of screening protocols for implants and devices, clinical contraindications, and physical screenings,” Gilk said. “They want to see what you’re doing to make sure visitors aren’t carrying objects that will become dangers in the magnet room and what processes or tools are in place that accidents don’t occur.”
Requiring these measures — from an accreditation standpoint — is a giant step forward, he said.
To read the remainder of the story at its original location:
Published on the Jan. 24, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
Over the past decade, the field of mammography has become a paradox. Leading medical organizations disagree about the benefits of the study and the best age for a baseline exam, but the number of scans is rising. At the same time, the number of facilities and radiologists willing to read these studies is falling.
As of January 1, according to the American College of Radiology, there were 8,125 accredited mammography facilities nationwide, down from 9,400 in 2000. Many in the industry have turned to telemammography as the best way ensure patients still have access to screening and diagnostic scans. The number of companies offering telemammography is still small, but the group is growing.
“The potential for telemammography is huge — women over 40 will need to have their mammograms,” said Timothy Myers, MD, a reading radiologist with teleradiology company vRad. “The issue, however, is there just aren’t a lot of players. Teleradiology is just now coming to an age where it’s easy to transfer images.”
As part of its teleradiology services, vRad also offers telemammography.
The premise behind telemammography is the same as general teleradiology — a radiologist reads the studies at a location other than the clinical setting of service. Today, most telemammographers are compliant with the Mammography Quality Standards Act and are licensed in both their states of residence and practice. This strategy does have specific hardware requirements unique to mammography, however, including mega-pixel computers that provide a high degree of image clarity for both sending and receiving providers.
Although there is some disagreement between industry experts and practitioners about whether telemammography is equally as useful for screening and diagnostic mammograms, overall the strategy has received a warm — if slow — reception.
To read the remainder of the article:
Published on the Oct. 4, 2011, DiagnosticImaging.com website
By Whitney L.J. Howell
Aching hands and a sore back are familiar ailments for many of those working in a digital imaging department. However, there is a trend among radiology practices and hospitals to provide workstations that are far more comfortable.
Over the past few years, industry vendors have taken great pains to produce ergonomically designed imaging tables and chairs and workstations. The goal is easing the physical stress of repetitive motions associated with
performing and reviewing imaging tests, as well as chronic conditions such as carpal tunnel syndrome and tendonitis.
“There are some sonographers who suffer career-ending injuries because they don’t have comfortable workstations,” said Richard Schubert, product manager of imaging tables at design company Biodex.
In a 2008 study published in the Journal of the American College of Radiology, Phillip Boiselle, MD, reported 58 percent of radiologists at Beth Israel Deaconess Medical Center experienced repetitive stress injury symptoms associated with their work. The study also determined 70 percent saw symptom improvements after using an ergonomic chair, and 80 percent had the same experience after switching to an ergonomic workstation.
“Repetitive stress symptoms are highly prevalent among radiologists working in a PACS-based environment but are responsive to ergonomic interventions,” Boiselle and his colleagues wrote. “Radiology departments should implement ergonomic initiatives to reduce the risk for repetitive stress injuries.”
To read the remainder of the article: http://www.diagnosticimaging.com/practice-management/content/article/113619/1962878
Published in the March 2011 AAMC Reporter
By Whitney L.J. Howell, special to the Reporter
The scene is shocking. Sixteen gravely injured trauma victims lie on the floor. Some have lost limbs; others are disfigured. Teams of doctors scramble to care for critical patients—and time is running out.
Seconds stretch into minutes. Not every patient is going to make it.
Lucky for everyone, then, that the patients are made of plastic, and don’t exactly have the most complicated of comorbidities.
The patients are, in fact, Mr. Potato Head dolls, and the “doctors” are third-year students at the University of Massachusetts Medical School (UMMS). Working in teams, the students race to reassemble each dismembered spud while honing their critical thinking, decision-making, and process-improvement skills.
“Every school has lectures that talk about this type of work,” said Eric Dickson, M.D., UMMS emergency medicine professor and co-director of the Medical Error and Patient Safety Interclerkship, which runs the Mr. Potato Head simulation. “But you can’t learn to ride a bike by sitting in a classroom, and you can’t learn teamwork or rapid response without actually doing it.”
UMMS fashioned the simulation after car manufacturer Toyota’s production model, Dickson said. The goal is to
remove wasteful actions from health care and create a better environment for giving and receiving treatment, with everything done to add maximum value for the patient.
To conduct the simulation, Dickson divides 100 students into 10 teams and tasks them with reassembling 16 dolls —hats and glasses included—to match 16 photographs.
Teams select a leader, two members to deliver parts, and two others to assemble the potatoes, with the remaining students organizing the pieces. The goal is to reconfigure the spuds in about eight minutes, after which point incomplete dolls are considered casualties.
A July 2009 Mount Sinai Journal of Medicine article reported that simulation exercises in medical education can improve “clinical knowledge, procedural skills, teamwork, and communication.” Third-year UMMS medical student Jacob Klein, who completed the Mr. Potato Head simulation in September, said he felt the activity enhanced the learning process. Working quickly pushed students to identify and avoid errors that could harm a patient’s health, Klein said. The task is advantageous, he added, because it not only captures the stress of high-risk scenarios but gives students insights they do not receive elsewhere.
“In medical school, we study the basic science behind disease and what treatments are used,” Klein said. “But medicine is a business—a large organization—and, as physicians, we will be team leaders and managers. We don’t get formal training on that aspect of medicine. That’s often lacking in medical education.”
The experience also keeps the new medical student generation engaged in learning. Many of today’s students grew up in a more fast-paced environment where they moved quickly between activities, and hour-long lectures can strain their attention spans, Dickson said.
Cynthia Morris, R.N., associate professor of simulation education and coordinator of the University of New England Clinical Simulation Program, echoed the need to capture students’ focus.
“Students respond to things that are creative and that spark their interest,” she said. “Simulation doesn’t have to be high-tech, and using Mr. Potato Head is interesting.”
The activity could also enhance how students perform as physicians, said Miriam Bar-on, M.D., associate dean for graduate medical education and advisory panel member of the Clinical Simulation Center of Las Vegas at the University of Nevada School of Medicine.
“It gives groups an opportunity to assess situations, form plans together, and have them work toward a common goal,” she said. “It teaches them to take their steps as a team. They can execute their plan and see that learning can be fun.”
This simulation could also be an icebreaker for interprofessional teams, Bar-on said, because it levels the playing field between provider types. All health professionals can complete this activity, allowing everyone to perform equally and giving each individual an opportunity to contribute to finishing the task.
Students have reacted positively to the simulation, said Eric Alper, M.D., UMMS associate professor of medicine, who discussed the simulation at the June AAMC Integrating Quality Meeting in Chicago. Graduating students who are armed with the skills to provide better, more patient-centered care is the true success, he said.
“This is a nice model of real-life experience,” Alper said. “It’s a fun way to communicate, it keeps students engaged, and they can apply what they learn to actual patient care.”
To read the story online: