Posted on November 27, 2011
This entry was posted in Patient Care.
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Pre-procedural checklists for common fluoroscopic gastrointestinal and genitourinary imaging procedures reduce fluoroscopic times and may improve communication among a multidisciplinary team of radiologists, residents and technologists, according to a scientific poster presented Nov. 28 at the Radiological Society of North America (RSNA).
Radiation dose delivered during fluoroscopy exams is highly dependent on operator experience and familiarity with each procedure, which is especially important for first-year residents who can be “naïve to these multistep procedures,” according to the study authors.
Michael J. DeLeo, III, MD, and colleagues from radiology department at the Hospital of the University of Pennsylvania in Philadelphia, sought to reduce radiation dose and improve team performance during fluoroscopic exams performed by first-year residents by developing pre-procedural checklists for common gastrointestinal and genitourinary fluoroscopic exams.
“Previous work demonstrated that the use of checklists can improve communication and team performance, which is important for first-year residents since they learn these procedures from a multidisciplinary team of senior radiologists and technologists,” the researchers wrote. This team had previously demonstrated that the use of targeted educational and training interventions can significantly reduce fluoroscopy times.
Rather than use remediation to improve fluoroscopy times, in this study, they hypothesized that proactive use of pre-procedural checklists can reduce fluoroscopy times while also improving efficiency and communication.
“We measured the fluoroscopy times of the 11 first-year residents for all the procedures, and averaged those times. It seemed very high that on average double upper gastrointestinal exams were taking more than five minutes, and the retrograde and hysterosalpingography exams also were high,” DeLeo told Health Imaging.
Checklist items include goal fluoroscopy time, basic procedural steps and tips for difficult aspects of each procedure. DeLeo and colleagues compared fluoroscopy times for first-year residents before and after implementation of pre-procedural checklists using a resident database of fluoroscopy times. They identified one resident whose mean fluoroscopy times for genitourinary procedures was two standard deviations below that of his peers and used these mean times as a benchmark for resident performance.
“The concept beyond the checklist, somewhat inspired by Atul Gawande’s book The Checklist Manifesto, is the first-year resident and the technologist can quickly discuss and check off approximately four boxes to ensure that the proper steps have been and will be taken for the procedure to be performed appropriately and quickly,” DeLeo said. “It’s particularly important for residents who aren’t as familiar with the procedures, but the checklist also could be a helpful reminder for a seasoned radiologist.”
For hysterosalpingography, the mean fluoroscopy time decreased from 0.93 minutes before implementation of pre-procedure checklists to a mean of 0.2 minutes. Mean fluoroscopy times decreased for retrograde pyelopgraphy (from 6.71 minutes) before to 4.34 minutes after and voiding cystourethrography (from 2.41 minutes) before to 0.81 minutes after implementation of pre-procedure checklists.
The researchers continue to collect data for other genitourinary procedures, and data collection for gastrointestinal procedures is currently underway.
The study’s second author, Jason Neil Itri, MD, PhD, a diagnostic radiologist at the Hospital of the University of Pennsylvania, has created a fluoroscopy dashboard, called Orion, in which the residents can login and compare their fluoroscopy times to their peers. Therefore, the residents can immediately know whether they are an outlier one way or the other, DeLeo explained.
Fusion may be a good thing for restaurants and the Ford Motor Company, but it’s among the factors making life harder for radiologic technicians and nuclear-medicine experts.
That’s according to an expert panel at RSNA 2011, which tackled the topic of radiology scope of practice on Monday afternoon.
Donna Thaler Long, MSM, RT, Ball State University’s radiography program director and president-elect of the American Society of Radiologic Technologists (ASRT), described technological fusion of imaging modalities as among the main culprits complicating the rad-tech’s existence.
Two scanners acting as one – think PET/CT, MR/PET, MR/SPECT, Cardiac CT/SPECT, ultrasound/CT, and radiation therapy combined with CT – has far-reaching implications, particular in regulation to education, Long said.
On the regulatory side, some U.S. states aren’t keeping pace, she said, considering technicians through the lens of the machine he or she operates.
“PET/CT is a problem in a lot of states,” she said. “Some states are specific about who can do the nuclear medicine part and who can do the CT part. You can’t expect two people working every imager.”
Perhaps more pressing, though, is the impact on training, she said. There’s simply a lot more to learn to meet the ASRT standard of “individually prepared and competent,” and fusion shows no signs of slowing down, she added.
The rise of molecular imaging adds to the challenge, she said.
“We’ve got a little bit of it in our curriculum, but it’s going to explode,” she said. “Fusion imaging and molecular imaging are the future, and there’s going to be a huge gap [on the education front].”
Those gaps include the need to understand anatomy and physiology at a cellular level, imaging agents, and merging modalities, among others, she said. Given the constant growth of the scope of learning necessary to performing as a radiologic technician, Long foresees a four-year degree as a basic educational requirement in the future.
The same may soon be true for nuclear-medicine technologists, added Lynne Roy, MBA, MS, director of imaging at Cedars Sinai Medical Center in Los Angeles. The Society of Nuclear Technologists says that by 2015, nuclear medicine technologists should have a bachelor of science. The curriculum would involve the current requirements plus immunology, molecular biology, medical terminology, health economics, CT physics and radiation, cross-sectional anatomy, and magnetic resonance imaging fundamentals.
“You can’t teach all this in two years,” she said.
Changes are indeed afoot, Long added.
“It’s scary to think, ‘I’m going to have to learn a number of other things if I’m going to continue to practice. But it’s coming.”
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