As new imaging practices emerge, computed tomography (CT) remains a vital tool in the evaluation of patients in the emergency department (ED) with symptoms of chest pain and those involved with trauma, according to an article in the July issue of the Journal of the American College of Radiology (JACR).
Recent data from the Centers for Disease Control and Prevention state that out of the 11 million ED visits per year in the United States, 44 per cent of patients undergo imaging studies. In 'Emergency Department Imaging: Current Practice', by John Thomas, M.D., et al., the demographics and current imaging practices of radiologists providing coverage for EDs were evaluated through the results of an online survey. CT scanners were the most common pieces of imaging equipment found in EDs (40 per cent) followed by ultrasound units (27 per cent).
All surveyed groups used multiple methods for communicating findings to ED physicians; however the most prevalent method was via telephone (49 per cent), followed by delivering the results in person (21 per cent). Twenty-one per cent of groups had dedicated emergency radiology divisions, the majority of them being in academic centers (73 per cent). Of the groups surveyed, 15 per cent obtained written consent before performing either noncontrast CT or MRI scans, as compared to 47 per cent that obtained written consent before performing contrast-enhanced CT or MRI scans.
'The Growing Size of Radiology Practices', by Mythreyi Bhargavan, Ph.D., and Jonathan Sunshine, Ph.D., reports on trends in the size of radiology practices as well as the causes of trends and how they compare with physician practices as a whole.
Radiology practices grew in size throughout the 1990 to 2007 period, with significant growth occurring in practices with 30 or more radiologists. The median radiologist was in a practice with seven radiologists in 1990, which increased to 11 in 2000 where it remained in 2007. The fraction of radiologists in small practices (one to four radiologists) decreased from 29 per cent in 1990 to 22 per cent in 2007, the fraction in medium-sized practices (five to 14 radiologists) decreased from 51 per cent in 1990 to 38 per cent in 2007, and the fraction of practices with 15 to 29 radiologists increased from 14 per cent in 1990 to 21 per cent in 1995 and has since remained constant.
In general, the authors state that the changes were more rapid in 1990 to 2000 than since. The authors also discuss the advantages of a larger practice, citing increased opportunity for diversity in subspecialization and more leniency in negotiating leverage with insurers and hospitals.
Quality and consistency are just some of the advantages of standardizing radiology reports, as described in the paper, 'Structured Reporting: Coronary CT Angiography' , by Arthur E. Stillman, M.D., Ph.D., et al. With the increased usage of electronic medical records, reporting trends in diagnostic imaging have shifted to an increasingly standardized format. Structured reporting allows for more streamlined communication with referring physicians, ensures all required elements are included for billing purposes, and helps facilitate data mining. The essential elements of a structured report are outlined in the paper for coronary artery computed tomographic angiograms (CCTA).
Techniques for negotiating nondepartmental conflicts and a discussion on mutual benefits achievable by maintaining open dialogue with cardiologists are outlined in 'Interdepartmental Conflict Management and Negotiation in Cardiovascular Imaging' by Hansel J. Otero, M.D., et al.
Innovation in health care has fostered the development of noninvasive radiological procedures, including cardiac computed tomography (CT), which presents challenges to radiologists and cardiologists who maintain that each respective specialty is better suited to provide the service. The authors encourage radiologists to entertain an ongoing communication with cardiology, because in many cases, both sides can benefit. The benefits of a negotiated outcome include minimizing internal competitors, incorporating cardiologists' expertise to cardiac imaging algorithms, and more effective training opportunities.
