Factors Associated With Imaging of Nontraumatic Headaches in Virginia Emergency Departments.

PURPOSE: To explore whether patient-reported demographics and hospital classifications were significant factors in the likelihood that a computed tomography (CT) scan of the head would be ordered for nontraumatic headaches. METHODS: Nonexperimental, cross-sectional analysis was performed on a database that included 18 279 patients presenting to emergency departments (EDs) in the Commonwealth of Virginia. Information included in the analysis was diagnosis of a generalized, nontraumatic headache; patient age and sex; the treating hospital's profit status (ie, for-profit vs nonprofit); status of the hospital as a teaching institution; hospital location (ie, rural vs suburban and urban); diagnostic procedures ordered; and patient's insurance coverage (commercial insurance, Medicare, or Medicaid). Descriptive statistics, chi-square, and binary logistic regression analyses were performed. RESULTS: Approximately 10% of patients who presented to EDs with a chief complaint of headache received a diagnostic head CT scan. Patient age proved to be the only significant variable in the analysis (P ≤ .001). Hospital's teaching status, classification as rural or suburban and urban, and profit status were not significant factors in determining the likelihood of a head CT being performed, nor were any other demographic variables studied. DISCUSSION: Radiologic procedure expenditures have increased more than any other physician service in the past 2 decades. The increase in CT use warrants further research. Although the analysis did not demonstrate that hospital characteristics were a significant factor in the ordering of head CT scans for nontraumatic headaches, continued analysis should be performed because resource use in EDs is not static. CONCLUSION: The overall rate of CT usage in EDs in the United States has increased significantly. Understanding CT use rates is important to radiographers and policymakers when considering resource use in dynamic EDs.

Effect of Cardiac Catheterization Personnel On Time to Treatment for Myocardial Infarction.

PURPOSE: To evaluate the effect of physician and nonphysician cardiac catherization laboratory personnel on the treatment of myocardial infarction. METHODS: Admissions data from 4 Las Vegas, Nevada hospitals were analyzed via multivariate regression analysis to determine predictors of reperfusion times. The goal for reperfusion is a door-to-balloon time of less than 90 minutes. RESULTS: Prehospital ST-segment elevation myocardial infarction (STEMI) activation, cardiologist arrival time, lifesaving measures, door-to-electrocardiogram (ECG) time, time and day, critical diagnostic examinations, and door-to-first-medical-doctor time all significantly affected door-to-balloon time. However, cardiac catheterization laboratory (CCL) staff arrival time did not affect door-to-balloon time. DISCUSSION: This study confirms the well-established importance of prehospital ECG and STEMI protocol activation. The results also indicate the importance of cardiologist arrival time on reperfusion times as this explained a significant amount of the explained variance in door-to-balloon time. CCL team arrival time did not affect door-to-balloon time, dispelling a long-held belief that reducing the response time of the CCL team significantly reduced reperfusion times. CONCLUSION: Although cardiologist arrival time influenced door-to-balloon time, CCL staff arrival time did not. Programs to provide greater laboratory coverage might help improve reperfusion times as well as assist STEMI program coordinators in developing more efficient protocols.

Process Factors Affecting Reperfusion Time in Patients With ST-Segment Elevation Myocardial Infarction.

OBJECTIVE: To determine process factors impacting myocardial infarction reperfusion time. BACKGROUND: An ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that necessitates emergent medical treatment; longer reperfusion times are associated with negative patient outcomes. Therefore, time is critical in the treatment of a STEMI. METHODS: Admissions data from Las Vegas hospitals were analyzed via multivariate regression analysis to determine predictors of reperfusion times. The analysis was based on 618 patients presenting with a diagnosis of STEMI at participating facilities from 1 January 2015 to 31 December 2017. The dependent variable was door to balloon time; independent variables included the mode of arrival, regular vs off hours, pre-hospital electrocardiogram (ECG), the use of pre-hospital activation of the STEMI protocol, door to triage time, door to ECG time, door to first physician contact time, cardiologist arrival time, cardiac catheterization lab team arrival time, lifesaving measures prior to percutaneous coronary intervention (PCI), critical diagnostic exams prior to PCI, and anatomical variances causing PCI delay. RESULTS: Prehospital STEMI activation, cardiologist arrival time, lifesaving measures, door to ECG time, time/day, critical diagnostics exams, and door to first MD time all had a statistically significant impact on door-to-balloon time (p < 0.05). CONCLUSIONS: Timely identification of STEMI patients via ECG and activation of the STEMI protocol is paramount to shorten time to heart vessel reperfusion. However, this study indicates that some process factors indicated previously to impact reperfusion times did not have significantly effects in this study sample.

X-ray field size and patient dosimetry.

PURPOSE: Limiting the size of the x-ray field during radiography is an important radiation safety practice and the sole responsibility of the radiologic technologist. Collimation reduces the volume of tissue irradiated and therefore reduces patient exposure and improves image quality. The purpose of the research experiment was to investigate the effect of decreasing the x-ray field size on patient dosimetry during lumbar spine imaging. METHODS: The x-ray field size was decreased from 14 × 17 in (35 × 43 cm) to 8 × 17 in (20 × 43 cm) with an increase in mAs to maintain exposure to the image receptor. Patient dosimetry was investigated by measuring the thermoluminescent dosimeter (TLD) exposure to the abdominal region of an anthropomorphic adult male phantom. Seven TLD chips were placed in the abdominal region, exposed, and replaced for each of 10 exposures, totaling 70 exposed TLDs. A 2-way factorial analysis of variance for independent samples was calculated to determine whether x-ray field size and the TLD locations altered the milliroentgen (mR) reading. RESULTS: The TLDs located closest to the lumbar spine yielded no significant change in patient dose for the 8 × 17 in (20 × 43 cm) x-ray field size following the increase in mAs. However, the TLDs located closest to the lateral edge of the 8 × 17 in (20 × 43 cm) collimated x-ray beam received a significantly (P < .001) lower mR exposure (> 60%). CONCLUSION: Radiologic technologists should make considerable effort to limit the x-ray field size to the region of interest to reduce patient exposure.

Patient safety perceptions among vascular interventional technologists.

OBJECTIVE: To describe perceptions of patient safety culture (PSC) among US vascular interventional technologists (VIR). METHODS: A letter to complete The Hospital Survey on Patient Safety Culture online was distributed in the US to all full-time American Registry of Radiologic Technologists (ARRT)-registered technologists with a primary discipline of cardiac-interventional or vascular interventional (n=3,184). Mean scores on each PSC dimension and overall outcome measures were calculated. RESULTS: The response rate was 13.7% (n=437) for the entire universe of ARRT-registered VIR technologists working full-time. Overall, respondents ranked the following dimensions as supporting patient safety within their respective institution: supervisor/manager promotion of patient safety, staffing, hospital handoffs/transitions, and teamwork within units. Neutral perceptions focused on teamwork across hospital units, hospital management's support for patient safety, and nonpunitive response to errors. CONCLUSION: For this population, teamwork across hospital units and administrative support for a culture of safety should be addressed. With almost 20' of respondents rating their institutions with an overall safety grade of C or below, there is clearly a need for further investigation of patient safety issues within VIR departments to confirm these findings and to expand the scope of inquiry to other radiologic science professionals.

Safety considerations for IMRT: executive summary.

This report on intensity-modulated radiation therapy (IMRT) is part of a series of white papers addressing patient safety commissioned by the American Society for Radiation Oncology's (ASTRO) Target Safely Campaign. The document has been approved by the ASTRO Board of Directors, endorsed by the American Association of Physicists in Medicine (AAPM) and American Association of Medical Dosimetrists (AAMD), and reviewed and accepted by the American College of Radiology's Commission on Radiation Oncology. This report is related to other reports of the ASTRO white paper series on patient safety which are still in preparation, and when appropriate it defers to guidance that will be published by those groups in future white papers. This document takes advantage of the large body of work on quality assurance and quality control principles within radiation oncology whenever possible. IMRT provides increased capability to conform isodose distributions to the shape of the target(s), thereby reducing dose to some adjacent critical structures. This promise of IMRT is one of the reasons for its widespread use. However, the promise of IMRT is counterbalanced by the complexity of the IMRT planning and delivery processes, and the associated risks, some of which have been demonstrated by the New York Times reports on serious accidents involving both IMRT and other radiation treatment modalities. This report provides an opportunity to broadly address safe delivery of IMRT, with a primary focus on recommendations for human error prevention and methods to reduce the occurrence of errors or machine malfunctions that can lead to catastrophic failures or errors.

High kilovoltage digital exposure techniques and patient dosimetry.

PURPOSE: To explore digital exposure techniques during pelvic imaging on patient dosimetry, exposure indicator (EXI) values and image quality. METHODS: An experimental design was used to study the effect of varying kilovoltage peak (kVp) and milliampere-seconds (mAs) on a male phantom pelvis when using a direct digital radiography (DR) flat panel detector. The radiation intensity was varied by increasing the kVp and reducing mAs. Image quality was evaluated by assessing density, density differences, quantum noise and overall diagnostic quality. RESULTS: When the kVp was increased in 15% increments and mAs divided by half, the radiation dose to the gonads significantly decreased. The lowest and highest kVp exposure groups produced the lowest EXI values. There was no correlation between the thermoluminescent dosimeter milliroentgen (mR) measurements and the EXI values. CONCLUSION: The results indicate that a pelvic DR image produced at 93 kVp and 12.5 mAs will reduce the gonadal dose while maintaining an image of diagnostic quality.