Process modification and emergency department radiology service.

Our purpose was to demonstrate the impact of changes in technology, staffing, and departmental processes on service levels in emergency department (ED) radiology. We also attempted to determine if report turnaround time affects ED patient throughput. Radiology performance was evaluated before and after the modifications of processes integral to the interpretation of ED imaging. Picture archiving and communication system, voice recognition (VR), staffing, physical site, work flow, and administrative modifications were undertaken over approximately 2 years. The average time interval from the exam completion to report signature was 5,184 min (standard deviation (SD) of 1,858 min before the implementation of VR and other modifications of ED radiology processes). In post initial modifications, it was 150 min (SD, 169 min) and 157 min (SD, 215 min) in post additional modifications. The percentage of the signed written reports available in less than or equal to 60 min was 0%, 27%, and 40%, respectively. Ongoing improvements are needed to increase the service levels for ED radiology. Further improvement will require collaboration and adjustment with the ongoing assessment of metrics.

Techniques that decrease or eliminate ionizing radiation for evaluation of ventricular shunts in children with hydrocephalus.

Shunted hydrocephalus in children is a commonly seen diagnosis in hospitals throughout the world and is one of the most common chronic pediatric neurosurgical conditions. These children undergo numerous studies for routine surveillance as well as for evaluation of shunt malfunction, many of which are associated with significant radiation exposure over the child׳s lifetime. It is in the child׳s best interest to minimize the overall exposure to ionizing radiation so as to decrease the chance of the deleterious effects from occurring. The article outlines the epidemiology of ventricular shunt catheters, the typical indications and methods for shunt evaluation, and the preferred alternative imaging methods that eliminate or reduce radiation exposure.

Imaging of nontraumatic acute hip pain in children: multimodality approach with attention to the reduction of medical radiation exposure.

Nontraumatic acute hip pain in children is common. However, the presentation and etiology is variable, including difficulty with weight bearing and abnormal gait. Barriers in communication, multiple possible etiologies, and age-specific anatomical variations of the pediatric hip make the evaluation of hip pain in children a difficult clinical diagnosis. Multimodality radiologic approach plays an important role for the evaluation of these children. However, owing to the complexity of pediatric hip disease, children sometimes undergo multiple radiologic examinations, resulting in delay in diagnosis and increased radiation dose. This article focuses on the illustration and discussion of common causes of acute hip pain or limp in children. Current recommendations for the imaging of these patients with specific attention to the ALARA (as low radiation as reasonably achievable) principle of radiation exposure are considered. Examples of the entities discussed are provided.

Pectus excavatum: current imaging techniques and opportunities for dose reduction.

Pectus excavatum (PE) is the most common congenital chest wall deformity in children. It affects 1 in every 300-1000 live births with a male to female ratio of 5:1. Most of the patients present in their first year of life. During the teenage years, patients may have exercise intolerance and psychological strain because of their chest wall deformity. The Nuss and Ravitch procedures are established methods of surgical correction of PE. An index of severity known best as the Haller index, typically evaluated with computed tomography scan, when measuring greater than 3.2 is considered to indicate moderate or severe PE and is a prerequisite for third-party insurance reimbursement for these corrective procedures. This article reviews the clinical features of PE, the role of imaging, and the opportunities for radiation dose reduction.