Advanced imaging programs: maximizing a multislice CT investment

Advanced image processing has moved from a luxury to a necessity in the practice of medicine. A hospital's adoption of sophisticated 3D imaging entails several important steps with many factors to consider in order to be successful. Like any new hospital program, 3D post-processing should be introduced through a strategic planning process that includes administrators, physicians, and technologists to design, implement, and market a program that is scalable-one that minimizes up front costs while providing top level service. This article outlines the steps for planning, implementation, and growth of an advanced imaging program.     

Wellness Program Implementation in an Academic Radiology Department: Determination of Need,Organizational Buy-in,and Outcomes

ObjectiveTo implement a multifaceted wellness program in an academic radiology department to prevent burnout and to assess initial outcomes with special focus on the challenges related to the coronavirus disease 2019 (COVID-19) pandemic.MethodsA wellness program was established to address institutional and personal factors of burnout. The program focused on interventions to improve efficiency of practice, provide personal and career support, and create a culture of wellness. The components of the program were designed with input from radiology faculty, and the program was financially supported by the hospital’s physician organization. A survey was performed 6 months after the initiation of the program to determine radiologist engagement and satisfaction. With the onset of the COVID-19 pandemic, a new survey was administered to identify needs of faculty and adjust initiatives. This study was exempt from institutional review board approval.ResultsThe majority of radiologists (79%) agreed or strongly agreed that the wellness program provided opportunities to connect with coworkers. All radiologists agreed that the program was helpful and should be continued. During the COVID-19 pandemic, 49% of physicians requested initiatives focused on well-being, emotional health, and mindfulness to support them during the crisis.ConclusionsThe implementation of a faculty wellness program in an academic radiology department addressed institutional and personal factors of burnout, allowed faculty to connect with coworkers, and was found to be helpful by all radiologists. The COVID-19 pandemic shifted needs to well-being and emotional health initiatives. Follow-up data are necessary to assess its effect on burnout reduction.     

Walking for Fitness: Slow but Sure

A walking program may be the best option for out-of-shape adults just starting a fitness program. It's safe, convenient, and it definitely exerts a training effect.     

Differences in psychosocial determinants of physical activity in older adults participating in organised versus non-organised activities

BACKGROUND: With the introduction of the new consensus on 30 minutes of moderate physical activity preferably on all days of the week, exercise implemented into daily activities is promoted whereas structured activity programs lose importance. Activity levels of most older people don't come up with current recommendations. Therefore strategies to enhance attendance of older adults in physical activities should be developed. Group programs may be more effective in changing exercise behaviour of older adults than non-supervised physical activity. The purpose of this study was to investigate the differences in level of activity and psychosocial determinants of physical activity between seniors involved in an exercise class and seniors not engaged in any organised physical activity. METHODS: Seventy-five elderly who were currently involved in structured exercise classes and 75 elderly who did not participate in any organised physical activity during the previous year were recruited in senior citizens' centres and were asked to fill out a questionnaire. RESULTS: Subjects involved in an exercise program had higher levels of activity and reported more social influences and higher self-efficacy compared to the respondents practising on an individual basis. No differences were found in perceived barriers or benefits. CONCLUSIONS: Exercising in a group program gives the opportunity to accumulate some extra physical activity and positively affects the level of activity outside the program. Stimulating older adults to join a structured activity program in the company of family or friends in order to enhance supporting social influences and perceived competence could be an important intervention strategy.     

Application of the ACTA-scanner to visualization of the spine.

The development of a new computer program called VISUAL, designed to be applied to a series of cross-sectional ACTA scans of the body, makes possible the three-dimensional visulaization of spinal structure without the necessity of surgical exploration. With VISUAL, a molded three-dimensional image of the spine can be displayed on a CT scanner monitor from any of several angles, or from several angles successively, with the direction of illumination determined by the operator.     

Documentation of a new contrast medium for the subarachnoid space. Demands, design and results from the first multicentre trial with iohexol

The first clinical trial with the non-ionic contrast medium iohexol (Omnipaque) in lumbar myelography was performed as a multicentre investigation of a total of 88 included patients. The design of the comprehensive clinical trial program is presented and the necessity of using such an extensive clinical trial program in the early stage of the investigation is discussed. This comprehensive monitoring did not reveal any serious or persistent side effects. The documentation on the safety of the drug encourages further clinical trials.     

A unified computer program for assessment of attenuation correction and data acquisition methods in single photon emission computed tomography (SPECT)

A computer based simulation program was developed to assess the usefulness of various attenuation correction algorithms and data acquisition methods in single photon emission computed tomography (SPECT) in a unified approach. The program analytically calculated projection ray sums from a mathematical model with various distributions of activities and either uniform or non uniform attenuation coefficients by using the line integrals including the effect of attenuation. Data acquisition starting at arbitrary angles, various acquisition angles, including a 180° scan and a non circular orbit of a gamma camera, including an elliptical orbit can readily be taken into consideration in our simulation program. To simulate non circular orbit data acquisition, the resolution dependence on the object distance from the collimator surface was incorporated into the simulation. This computer based simulation program allows various combinations of attenuation correction algorithms such as hybrid methods, and data acquisition methods can be evaluated under a large number of study conditions. The usefulness of this computer based simulation program is shown with several representative examples.     

Evolution of nuclear medicine training: past, present, and future.

Since the official inception of nuclear medicine in 1971, the practice of nuclear medicine and its training programs have undergone major revisions. Numerous procedures that were common in the 1970s are no longer available, and many new radiotracers and procedures have since been developed. Training programs have evolved from an unstructured experience before 1971 to 2 y of nuclear medicine training after 2 clinical years, to 2 y of nuclear medicine training after 1 clinical year and, most recently, to 3 y of nuclear medicine training after 1 clinical year. The most substantial content changes in the new 2007 training program requirements are an increased emphasis on 6 clinical competencies, an increased emphasis on Nuclear Regulatory Commission requirements, and a new CT training requirement that was spawned by the advent of PET/CT. In addition to the new training program requirements, residents will need to become familiar with the concept of maintenance of certification, which will continue to be an important component of their professional careers. Nuclear medicine is gradually evolving into molecular imaging. Hence, it is inevitable that in the near future, training programs will be required to place greater emphasis on molecular imaging in both clinical and research applications. The incorporation of molecular imaging will represent a significant paradigm shift for the specialty but will ensure that nuclear medicine will be a major part of medical practice for the foreseeable future.     

Communicating in organizations, part II: Tips for leaders when starting a team

Team projects are an important part of the innovative work done in large organizations. Individuals from various portions of the department or organization are chosen who have different areas of expertise, backgrounds, and personalities. In a properly functioning team, the group decisions made will be superior to those made by any individual on the team. There are many different conversations that are necessary during a team project to make sure that all goes optimally, and this article will focus on communication tips for leaders when starting a team.     

Primary Care Physicians: First Stop for Exercise Advice?

Patients are urged to consult a physician before starting an exercise program, but how many do and what advice do they receive?     

Managing Diabetes in Older Adults

In brief Exercising regularly can have important benefits for older adults with diabetes, including improving insulin sensitivity and cardiovascular fitness. When embarking on a new exercise program, all older diabetic patients should seek the help of health professionals who can determine an appropriate and safe regimen. Special precautions should be taken to lower the risk of developing exercise-induced hypoglycemia or injury due to neuropathy or retinopathy. However, the psychological and physiologic benefits of a regular exercise routine far outweigh any risk to the older person who has diabetes.     

Modern Perspectives on Radiation Oncology Residency Expansion,Fellowship Evolution,and Employment Satisfaction

PurposeIn an effort to better characterize the extent and impact of residency expansion and job placement, the authors conducted a multilevel survey of radiation oncologists exploring the current state of the radiation oncology employment market.MethodsA multilevel survey was conducted using the Qualtrics platform in the spring of 2017. Survey participants were categorized into five groups within radiation oncology: (1) chairpersons, (2) program directors, (3) new practitioners (at least 1 year out of residency), (4) new residency graduates (radiation oncology postgraduate year 5 graduates with new jobs), and (5) medical students. The Wilcoxon-Mann-Whitney test was used to compare Likert scale scores.ResultsA total of 752 participants were surveyed, with an overall response rate among all five groups of 31% and 92% of those completing the entire survey. Chairpersons were more likely to consider expanding their residency programs compared with program directors. Fellowship remained low on the job search, with less than 10% of new graduates and new practitioners interested in fellowship positions. Job satisfaction was high with 85% of new graduates, and 78% of new practitioners moderately to very satisfied with their future or current employment. The vast majority of both new practitioners (85%) and new graduates (81%) was moderately to very satisfied with their location of practice.ConclusionsResident job satisfaction remains high, whereas interest in radiation oncology fellowships remains low. Conflicting perception regarding the job market and residency expansion could have downstream impacts, such as deterring potential applicants.     

MR angiography with two-dimensional acquisition and three-dimensional display. Work in progress

Magnetic resonance arteriograms of healthy volunteers and selected patients were produced with a new spoiled gradient-echo pulse sequence based on time-of-flight phenomena. The procedure involves sequential acquisition of many contiguous, thin (1.5-mm) axial two-dimensional sections. These volume data are then submitted to a raytracing projection program, which retrospectively yields multiple arbitrary projection angles rotating through any plane. Venous structures are suppressed with a presaturation slab superior to the current section. The slab location is advanced in concert with advancement of each new section location. The acquisition time varies from 6 to 13 minutes, depending on the number of sections acquired for three-dimensional display. This method obviates the subtraction of image data sets to suppress signals from stationary spins, is more sensitive to slow blood flow than three-dimensional methods of acquisition, and shows special promise for the study of extracranial vascular disease.     

Current practices in evaluating radiology residents, faculty, and programs: results of a survey of radiology residency program directors

RATIONALE AND OBJECTIVES: We surveyed program directors to determine current radiology program practices in evaluating their residents, faculty, and program. MATERIALS AND METHODS: In January 2003, a 52-item Web-based survey was made available to program directors of accredited core radiology programs. Responses to the items were tabulated to determine relative frequency distribution. Two-tailed Pearson chi-square tests were used to compare proportions and assess the association between variables. RESULTS: A total of 99 (52%) of 192 program directors responded. Programs were largely in compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements. Noncompliance was related to the requirements to evaluate residents at least four times per year in at least 22 (22.2%) of 99 programs and annually evaluate the program in 20 (20.2%) of 99 programs. New program directors (<1-year tenure) were less likely than those with >/=1-year tenure to be using the Association of Program Directors in Radiology Education Committee global rating form (41.2% versus 68.8%, P =.03). Programs that used this form, compared with those that didn't, were more likely to evaluate resident competence in systems-based practice (88.5% versus 44.0%, P =.001). Being a program director for 1 or more years versus less than 1 year was associated with using a computerized evaluation system (35.8% versus 11.8%, P =.05). CONCLUSION: In general, there is a high degree of compliance among radiology programs in meeting ACGME evaluation requirements. However, some programs do not comply with requirements for frequency of resident evaluation or annual program evaluation. The percentage of new program directors is high and related to not using or knowing about useful evaluation resources. Use of computerized evaluation systems, which have the potential to decrease the work associated with evaluations and provide more dependable and reliable data, is minimal.     

Effect of Health Care Financing Administration regulation on radiology fellowship training

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the effect of Health Care Financing Administration (HCFA) regulations on radiology fellowship training. MATERIALS AND METHODS: Surveys were sent to 157 fellowship program directors in body imaging and vascular/ interventional radiology. Questions addressed program accreditation status, faculty supervision of fellows, and any change in faculty supervision of fellows in response to HCFA's revised plan for Medicare Part B reimbursement. RESULTS: Eighty of 157 (51%) surveys were returned. Thirty (37%) respondents indicated supervision of fellows had changed after institution of the new HCFA rules in July 1996. Vascular/interventional program directors (n = 25, 49%) were more likely to have changed their practice than body imaging program directors (n = 5, 17%). Nearly all respondents (29 of 30, 97%) indicating a change stated supervision had increased. Twenty-seven (33%) respondents also indicated faculty supervision was beyond that necessary for patient care and house staff education; most of these respondents (21 of 27, 78%) stated the new HCFA regulations were responsible. Many program directors also expressed concern the HCFA regulations might prevent fellows from obtaining sufficient experience to effectively learn independent clinical decision-making. CONCLUSION: HCFA regulations intended to address attending physician billing practices at teaching institutions may have had the unintended effect of substantively altering the training of radiology fellows.     

CQI: using the Hoshin planning system to design an orientation process

The Hoshin planning system, developed in Japan after World War II, includes management tools intended specifically for planning new processes. There are seven tools, which can be used individually or in any combination: affinity diagrams, interrelationship digraphs, systematic diagrams, matrix diagrams, process decision program charts, arrow diagrams and prioritization matrices. The radiology department at Carson-Tahoe Hospital formed a CQI team to improve the training of front office clerks. The team quickly discovered that a new orientation program was needed and decided to use Hoshin tools to create one. Using the tools, the team identified and prioritized all relevant factors, described specific tasks needed to complete the planning process and how long each would take, anticipated problems, and assigned areas of responsibility to members of the team. Each time the team grew weary or discouraged, the clarity and organization afforded by the tools helped them feel productive and in control of the process. The team was amazed at the creative ideas they generated through this 3-month-long process. Not only did they develop and implement a new orientation program, they also cultivated a stronger sense of pride and confidence in their work and each other.     

Equipment, technique, quality assurance, and accreditation for imaging-guided breast biopsy procedures

Needle biopsy diagnosis of breast lesions can be performed using fine needle aspiration or large core needle biopsy techniques. Imaging guidance using mammographic stereotactic devices or sonography can accurately guide biopsy probes into suspicious lesions. Choice of the biopsy probe in any individual patient will depend upon equipment availability, lesion characteristics, breast configuration, and cost considerations. Quality control and quality assurance programs should be instituted to maintain a high level of patient care. Facilities performing these biopsies can obtain accreditation to attest to the quality of their biopsy program.     

"March fractures" on a female military recruit

Stress fractures are caused by repetitive low-impact activities. It is important to have a high index of suspicion in diagnosing and treating stress fractures early for remodeling to occur. This is a case report of a 19-year-old female military recruit with stress fractures of the right foot. The patient had an extended non-weight-bearing treatment that eventually had a successful outcome after allowing the fracture to heal by starting the patient on weight-bearing activities and a "walk-to-run" program. Treatment points in managing stress fractures including female-specific issues are also discussed.     

Anabolic Steroids and Athletes

In brief: This article introduces terms and concepts associated with resistance training in order to reduce the existing confusion in this area. The authors describe the sports associated with resistance training—weight lifting, power lifting, and bodybuilding—and discuss the benefits of exercising with free weights vs resistance training machines. They also make recommendations for individuals who are starting a resistance training program.     

肽序列从头测序算法

从头测序为蛋白质组研究提供了一种不用借助于任何蛋白质序列数据库信息，直接解读串联质谱数据的方法。其基本算法主要由4个部分组成：质谱图的构建，离子类型的确定，测序算法以及打分算法。质谱图的构建和离子类型的确定是从头测序算法的基础。测序算法是从头测序算法的关键，比较常用的是动态规划算法。打分算法是整个从头测序算法的核心部分，各种从头测序算法对基本算法的改进通常都是围绕着打分算法进行的。