Quality & Safety

ACR 2017 Landing Page

Here's what you missed

DUCK

The Bulletin team has loved our time at ACR 2017. Radiologists engaged with patients, grew confident in the role with machine learning, advocated on the Hill, and learned about the most important topics facing the specialty, among countless other activities. We've rounded up some of the best news from the meeting in case you've missed it. See you next year at ACR 2018!

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Radiology Champions

The specialty’s first champion was selected based on his focus on reducing unnecessary imaging for ICU patients.Radiology champions

Jeffrey P. Kanne, MD, was recently named radiology’s first champion in the American Board of Internal Medicine Foundation’s Choosing Wisely Champions program.

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Building Momentum

MACRA and QPP are here. Are you ready to drive change, but don't know how or where to start?Building Momentum

With fast-approaching deadlines, the mandate for transformation to value-based radiology is more urgent than ever before. The trouble is many smaller and mid-sized practices are still struggling with implementing the principles and practices of Imaging 3.0®.

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Tailoring Access to Care

The business case for reducing missed care opportunities.tailoring access to care

Recently, a patient walked away from a meeting that included her primary care physician (PCP) and her radiologist and declared she had just received "a mini lesson in medical evaluation and reasoning."

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Putting Together the Pieces

Radiology's role in detecting, reporting, and diagnosing potential cases of child abuse.putting together the pieces

Every 10 seconds, child abuse is reported in the U.S. More than 3.6 million cases are referred to child protection agencies every year, involving more than 6.6 million children.

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Bringing Interaction Back

New York University Langone Medical Center's department of radiology leverages technology to give radiologists a more active role in patient care.

nyu langone rounds

Before PACS technology, doctors had to visit the radiology reading room to see x-rays. When PACS made scans more accessible to clinicians, their interaction with radiologists waned.

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The Road Less Traveled

Find a path to patient-centered radiology by following in the footsteps of Imaging 3.0® leaders.

Untitled 2

Robert Frost, one of America's most-celebrated poets, once said, "Two roads diverged in a wood and I – I took the one less traveled by, and that has made all the difference."

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Great Expectations

Unprecedented practice transformation is underway, and radiologists need to get involved.great expectations

Now more than ever, patients expect the right care, at the right time, and at a reasonable cost. To reach that goal, health providers must achieve practice transformation on an unprecedented scale.

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A Look Inside

Boosting value in your practice can be as simple as examining what you're already doing.A Look Inside

Value-based change is coming. It's a phrase you've heard for a while now, along with a host of acronyms and advice on how to make changes to your practice.

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Transforming Practices

More than 140,000 clinicians will be transforming their practices over the next four years. The ACR Commission on Economics wants radiology engaged.transforming practice

"Better care, smarting spending, and healthier people." CMS has committed $685 million to support these important goals through the Transforming Clinical Practice Initiative (TCPi). It is imperative that we are engaged in this effort. In this column, I describe ways in which radiology can participate.

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What’s a PTN and Why Should I Get Involved?66258397 thumbnail

You may have heard (read: you’ve definitely heard unless you live under a rock) about value-based care lately. “Value” is a hard term to nail down, but it’s not just a buzzword.

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MACRA: How We Got Here

Learn the ins-and-outs of value-based care.iStock 57127560 SMALL

Take home points:
1. Even agreed-upon legislative reforms take time and political pressure to bring about.
2. The SGR created incentives to “patch” the ill-conceived legislation rather than pay for its repeal.
3. MACRA represents a shift from an old mechanism of payment adjustments to a new value-based paradigm.

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Understanding Episodes of Care

The Commission on Economics is working to define radiology’s place in episode groups.july bulletin episodes of care

What role does radiology play in clincal care? This is a wide-open question with multiple potential answers.

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A Radiologist’s Boundaries

Who is responsible for determining medical necessity: radiologists or referring providers?

RADLAWJune

Medicare and many other payers require that services rendered to beneficiaries must be “reasonable and necessary”1 in order for a physician to be paid for them. Thus, despite what many radiologists believe, medical necessity must be a key part of their professional judgment. Will an imaging study or the procedure that a patient undergoes help the physician diagnose or treat illness or injury?

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How (and Why) to Get Your Colleagues on Board with CDS

Practical Steps to Leverage Clinical Decision Support Tools and Enhance Collaboration Between Ordering Physicians and RadiologistsCDS pic

In the drive to reduce inappropriate imaging and deliver better care at lower costs, it is imperative for physicians who order imaging and for radiologists to forge a strong, collaborative partnership. Avoiding unnecessary care begins by following evidence-based recommendations for which tests and procedures are most appropriate for each patient’s clinical situation.

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Rounding Up ACR 2016

Here's what you missed

DUCK

The Bulletin team has loved our time at ACR 2016. Radiologists engaged with patients, partnered with programmers at a hackathon, advocated on the Hill, and learned about the most important topics facing the specialty, among countless other activities. We've rounded up some of the best news from the meeting in case you've missed it. See you next year at ACR 2017!

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The Lung Cancer Screening Team

Putting together a cohort to develop a screening program requires a mix of skills and a shared purpose.

Lungs2

No specialty can singlehandedly take on the task of screening patients for lung cancer. With that in mind, an ACR 2016 session brought together a multidisciplinary panel to focus on the ins and outs of setting up a lung cancer screening program from a variety of perspectives.

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3 Things to Read Today

Intriguing links from around the web

Links

This week we’re reading about how to stop a nuclear meltdown (and how that relates to radiology) and finding time to connect with patients.

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March Case of the Month

1

Access Case

Authors: Jay Karajgikar, MD, PGY-4, Radiology Resident, Diagnostic Radiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, N.Y., John O'Donnell, MD, Assistant Professor of Radiology, Department of Musculoskeletal Radiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, N.Y., Ralph Milillo, MD, Assistant Professor of Radiology, Department of Musculoskeletal Radiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, N.Y. 

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April Case of the Month

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Authors: Amanda Jeanne Beer, MD,PGY-5, Resident, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, and Luke Lancaster, MD, Associate Professor, Nuclear Medicine and Pediatric Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA

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May Case of the Month

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Authors: John Daniel Bisges, MD, PGY-5, Radiology Resident, Department of Radiology, University of Mississippi Medical Center, Jackson, MS, Melanie Christine Dahse, MD, PGY-5, Radiology Resident, Department of Radiology, University of Mississippi Medical Center, Jackson, MS, and Anson Thaggard, MD,Associate Professor of Radiology, Nuclear Radiology,Department of Radiology, University of Mississippi Medical Center, Jackson, MS

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June Case of the Month

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Authors: Tony Alias, BS, Medical Student, Texas A&M School of Medicine, College Station, TX, Jessica A. Page, MD, PGY2, Radiology Resident, Department of Diagnostic Radiology, Texas A&M Health Sciences Center/Baylor Scott & White Health, Dallas, TX, and Richard E. Seggerman, MD, Body Imaging Division, Texas A&M Health Sciences Center/Baylor Scott & White Health, Dallas, TX

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July Case of the Month

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Authors: Scott Sosin, DO, Radiology Resident, Department of Radiology, Atlantic Health System-Overlook Medical Center, Summit, NJ; Marci Handler, MD, PGY3, Radiology Resident, Department of Radiology, Atlantic Health System- Overlook Medical Center, Summit, NJ; Rita Yeretsian, MD, Attending Physician, Neuroradiology, Department of Radiology, Atlantic Health System-Overlook Medical Center, Summit, NJ

Why did you select this case for submission?

I have a particular interest in anatomic variants and their relative benignity and/or pathologic correlates. This case is one of many such examples that I have had the privilege of seeing at my institution.

What should readers learn from this case?

Vascular anatomic variants have significant implications with regard to physiology and flow dynamics, which can lead to aneurysm formation.

What did you learn from working on the case?

Recognizing a typically “benign” anatomic entity often is not enough. Rather, its identification should prompt closer inspection for any well-documented associated pathology.

How did guidance from senior staff at your institution impact your learning and case development?

I am fortunate to have terrific mentors at my institution (Atlantic Health System), who are always willing to teach and explain the details of our most interesting cases. Their enthusiasm is contagious!

Why did you choose Case in Point for submission of your case?

Case in Point is the most respected radiology case repository on the Internet. I felt this case deserved the kind of exposure within our profession that only Case in Point could provide.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

Online learning is just so accessible, and so easy to squeeze into an otherwise busy day of clinical or administrative duties. Print materials could never provide the level of casual convenience that electronic CME offers.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, I try to keep up with Case in Point on a weekly basis, at the very least. I find it is an excellent resource for keeping skills sharp, and reinforcing what I have learned from textbook readings. There is nothing quite like seeing a “real world” example.

Is there anything else you'd like readers to know about your case?

You never know what you might find in your stack of studies! I am learning to always keep my eyes peeled. Expect the unexpected.

August Case of the Month

Access case here.

Authors: Allison M. Aripoli, MD,PGY-4, Radiology Resident, Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kans.; Lucas Meek, MDPGY-5, Assistant Professor of Radiology, Cardiothoracic Imaging, Department of Diagnostic Radiology, University of Kansas Medical Center,Kansas City, Kans.; Steven Lemons, MD Associate Professor of Radiology,Assistant Professor of Radiology, Vascular and Interventional Radiology, Department of Interventional Radiology University of Kansas Medical Center, Kansas City, Kans.

Why did you select this case for submission?

Mycotic pulmonary artery pseudoaneurysms are uncommon, but an important entity to recognize because of the associated morbidity and mortality. This case was unique not only for its rarity, but also because we were able to follow the case from presentation through treatment.

What should readers learn from this case?

The clinical context for image interpretation of cavitary lung lesions is valuable. While cavitary pulmonary metastases, granulomatosis with polyangitis, and infection can cause cavitary lesions, in the setting of sepsis, septic pulmonary emboli should be considered. It is important to realize that pulmonary artery pseudoaneurysms can be caused by erosion of the vascular wall by neoplasms or infection.

What did you learn from working on the case?

This case gave me the opportunity to review causes of both cavitary lung lesions and pulmonary artery pseudoaneurysms. Because mycotic pulmonary artery aneurysms are uncommon, it was also a great opportunity to review existing literature regarding treatment options.

How did guidance from senior staff at your institution impact your learning and case development?

Senior staff interpreted this case independently, but shared the imaging findings to promote learning. I took the opportunity to review the imaging, clinical history, and available literature. When unique cases are encountered, imparting knowledge to trainees is invaluable.

Why did you choose Case in Point for submission of your case?

Case in Point is an excellent avenue to distribute cases amongst fellow radiology residents and radiologists. I have enjoyed many case learning opportunities through CIP, and wanted to share this rather uncommon case.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

Online learning in a case-based format with selected pertinent images is appealing for several reasons. First, accessing the cases is easy, especially when linked through email notification. Second, the question-type format highlighting differential diagnoses followed by a summary provides concise and directed learning. In addition, there is variety to daily cases, which is especially important for radiology trainees.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, and as a regular reader my favorite types of cases are the rare but important ones. CIP offers outstanding exposure to images of unusual cases encountered at various institutions. I also like the collection of uncommon presentations of common entities.

Is there anything else you'd like readers to know about your case?

The patient highlighted in this case had a very good clinical outcome following endovascular intervention, which is remarkable considering the reported mortality rate for patients with pulmonary artery pseudoaneurysm.

September Case of the Month

Access case here.

Authors: Jessica Lien, BS, MS-IV, Medical Student, University of Wisconsin Hospital and Clinics, Madison, Wis.; Gregory Avey, MD , Professor of Ophthalmology, Oculofacial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Hospital and Clinics, Madison, Wis.; Mark Lucarelli, MD, FACS, Professor of Ophthalmology, Oculofacial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Hospital and Clinics, Madison, Wis.

Why did you select this case for submission?

This case was recommended to me by my attending, Dr. Lucarelli, and I thought the topic was very interesting and informative.

What should readers learn from this case?

The goal of the case is to remind the reader that an orbital pseudotumor is a diagnosis of exclusion. Other causes of orbital inflammation need to be considered to ensure the appropriate treatment.

What did you learn from working on the case?

I didn’t know much about the diagnosis of orbital pseudotumors and the other causes of orbital inflammation. I learned a lot from researching the various diagnoses to write the case.

How did guidance from senior staff at your institution impact your learning and case development?

I couldn’t have written the case without the knowledge and teaching of Drs. Lucarelli and Avey. They spent the time with me to help me better understand the different diagnoses and imaging modalities.

Why did you choose Case in Point for submission of your case?

We chose Case in Point because we liked the format and online learning portion of the cases.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

With everything moving online, it seemed like a great place for our case. The question format and immediate feedback allows for critical thinking and makes it more likely that people will remember what they learned in the case.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, and as a regular reader my favorite types of cases are the rare but important ones. CIP offers outstanding exposure to images of unusual cases encountered at various institutions. I also like the collection of uncommon presentations of common entities.

 

October Case of the Month

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Authors: Katie Davis, DO, Resident Physician, Diagnostic Radiology,Department of Radiology,MetroHealth Medical Center, Cleveland, Oh.; Vikas Jain, MD, Assistant Professor, Assistant Program Director, Diagnostic Radiology, Neurology, Department of Radiology, MetroHealth Medical Center, Cleveland, Oh.

Why did you select this case for submission?

I selected this case for submission because it emphasizes the difference between impending rupture, contained rupture, and rupture of abdominal aneurysms. Distinguishing between these entities is important for clinical care.

What should readers learn from this case?

Although there is some overlap regarding the radiographic signs of contained rupture and rupture of abdominal aortic aneurysms, prompt recognition of contained abdominal rupture is critical to decreasing the overall patient morbidity and mortality, as there is a benefit from preoperative assessment and urgent surgery rather than emergent surgery.

What did you learn from working on the case?

I learned about the “draping aorta” sign, which is an indicator of aortic wall insufficiency. It is defined as an irregular contour of the posterolateral wall of the aorta, which is not identifiable as distinct from adjacent structures. The posterolateral wall of the aorta will closely follow the contour of the adjacent vertebral bodies.

How did guidance from senior staff at your institution impact your learning and case development?

The guidance from senior staff supplemented and enriched my understanding of the pathologies affecting abdominal aortic aneurysms.

Why did you choose Case in Point for submission of your case?

I submitted a case to Case In Point once before, so I felt very comfortable with the submission requirements and the format.

What is the appeal of online learning, like Case in Point, as opposed to other learning venues, such as print?

Gone are the days of card catalogs and heading to the library in the hopes that a radiology text will be available! Online learning is an easily accessible, time-efficient, and more cost-effective option for residents.

Are you a regular reader of Case in Point? What are your favorite types of cases?

 I am a regular reader of Case in Point. My favorite types of cases are those relating to women's health issues. 

What else should we know about the case that you'd like to share?

This case came across our board as an outpatient study. We were able to quickly diagnose the entity and coordinate vascular surgery referral with the primary provider. The patient underwent surgery and did well!

November Case of the Month

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Authors: Ghadir H Kassab, BMBCh, PGY-IV, Radiology Resident, FFR RCSI Residency Program, Kuwait, Diagnostic Radiology, Department of Clinical Radiology; Nayanatara Swamy, MD, Specialist Radiologist, Diagnostic Radiology, Department of Clinical Radiology; Ahmed H. El Beltagi, MD, FRCR, FFRRCSI, EDiNR, Consultant, Neuroradiology, Head and Neck Radiology, Department of Clinical Radiology, Al Sabah Hospital, Zain ENT Hospital and Kuwait Cancer Center, Kuwait City, Kuwait

Why did you select this case for submission?

I selected this case because it demonstrates the imaging appearances of a rare condition.

What should readers learn from this case?

Readers should learn an awareness of this entity, CAPNON, its different imaging appearances, and differential diagnosis considerations.

What did you learn from working on the case?

I learned to consider this rare entity in the differential diagnosis of an extra medullary spinal axis calcified lesion, and about the differentiating features of CAPNON from more common diagnoses, such as meningioma. 

How did guidance from senior staff at your institution impact your learning and case development?

My senior staff urged me to consider the diagnosis and plan the needed diagnostic work-up. They referred me to a number of scientific articles on the topic.

Why did you choose Case in Point for submission of your case?

ACR’s Case In Point has an excellent reputation.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

Online learning is a great privilege for radiologists during all stages of their career. It provides simple, to-the-point brain teasers, and accessible references to a wide range of complex work experiences.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes I am. My favorites are the neuroradiology cases.

What else should we know about the case that you'd like to share?

A pattern recognition approach should be the first step in image readings. Secondly, the most appropriate diagnoses and differential diagnoses should be built upon the first step. Common things are common, and do apply. However, awareness of inclusion and exclusion features of different diagnostic possibilities can lead to a safer diagnosis without unnecessary intervention.

December Case of the Month

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Authors: Hollie Gallagher Zate, DO, PGY-3,Radiology Resident, Department of Diagnosis Radiology, MetroHealth Medical Center, Cleveland, Ohio.; Vikas Jain, MD, Assistant Professor of Radiology, Department of Diagnosis Radiology, MetroHealth Medical Center, Cleveland, Ohio

Why did you select this case for submission?

My attending and I selected this case because it beautifully depicted a rare and interesting case of isolated neurosarcoidosis, from its initial presentation to biopsy and on to treatment response.

What should readers learn from this case?

Readers hopefully learn about the multitude of ways sarcoidosis can present in the nervous system and start including it in their differential diagnosis.

What did you learn from working on the case?

I learned about the various ways neurosarcoidosis can present and how difficult it can be to test for it (unlike the simple blood test obtained in systemic sarcoidosis). Additionally, submitting this case helped me get a feel for publishing cases and presentations.

How did guidance from senior staff at your institution impact your learning and case development?

My attending greatly impacted my education on the topic and helped with the process of submitting the case, from acquiring the images to the layout of the graphics and the difficulty level of the questions.

Why did you choose Case in Point for submission of your case?

People visit Case in Point every day because it only takes a short amount of time to learn a great deal of information spanning all aspects of radiology. The image quality is top-notch, and the quiz questions are a fun way to learn and take a little break from the day.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

The appeal of online learning is that it can be done from any place at any time and doesn't require lugging around a giant book. Furthermore, online learning reaches many more people these days than print (I could even have my family see it despite them living hours away).

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes! My favorites are the neuroradiology cases.

January Case of the Month

Access case here.

Authors: Andrea L. Magee, MD, PGY2, radiology resident, and Steven M. Montner, MD, assistant professor of radiology, Thoracic Imaging, Department of Radiology, University of Chicago, Chicago, Ill.

Why did you select this case for submission?

Pulmonary capillary hemangiomatosis (PCH) is a rare cause of pulmonary arterial hypertension (PAH), and many radiologists often don’t encounter it. Dr. Montner and I chose to submit the PCH case to provide a refresher of the clinical and imaging findings associated with this diagnosis.

What should readers learn from this case?

Patients with PCH may present with nonspecific findings such as progressive dyspnea, fatigue, and chronic cough. Pulmonary function tests may be completely unremarkable. Critically, the management of PCH differs from the management of other causes of PAH, and the routine use of vasodilators can be fatal in patients with PCH. Radiologists are well-positioned to recognize the imaging findings and suggest PCH in the correct clinical setting.

What did you learn from working on the case?

Although imaging findings may suggest PCH, it is a microscopic diagnosis. Patients are often unable to tolerate lung biopsy, and so most cases are confirmed only at autopsy, if at all.

How did guidance from senior staff at your institution impact your learning and case development?

Working with Dr. Montner was essential in understanding the pathophysiology of PCH and how this manifests in the imaging findings. He walked me through the findings in other PCH cases and provided additional cases with common differential considerations for PCH.

Why did you choose Case in Point for submission of your case?

We chose to submit this case in order to provide a digestible, but still informative, summary of PCH for radiologists who might not have seen a case recently. CIP allowed us to share our case with a large number of radiologists in varying levels of training and practice.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, I receive the daily CIP emails and make it a point to complete each case. I especially appreciate cases showing unusual etiologies or abnormal presentations of common etiologies.

What else should we know about the case that you'd like to share?

We feel that we provided high-yield facts in our case and would like to emphasize to others the importance of considering PCH in patients with PAH and appropriate imaging findings. We're glad our case was well-received!

February Case of the Month

Access case here.

Authors: Dmitriy Shnayderman, MD, PGY-2, Diagnostic Radiology Resident and Paul M. Knechtges, MD, associate professor of radiology, abdominal/body imaging, Department of Diagnostic Radiology, Medical College of Wisconsin, Milwaukee, Wis.

Why did you select this case for submission?

We chose this case because it beautifully demonstrates the frequently talked about and rarely seen condition, Mirizzi syndrome.

What should readers learn from this case?

Residents hopefully will learn the differential diagnosis for the biliary obstruction. Attendings will be introduced to a Csendes cholecystobiliary fistula classification, if they haven’t been already.

What did you learn from working on the case?

As a trainee, working on this case helped me become more familiar with Mirizzi syndrome, learn the important differential diagnoses, and discover that a fistula can be associated with this condition.

How did guidance from senior staff at your institution impact your learning and case development?

My senior staff was indispensable, helping me proofread the case, choose the perfect image slices for the submission, and assisting me with a better understanding of this diagnosis.

Why did you choose Case in Point for submission of your case?

I consider CiP a part of my daily morning routine for learning new and interesting cases. I’ve always wanted to be a part of it.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Definitely, it’s how I start my day – a latte with my case of the day. I enjoy seeing rare cases and hope I will be able to recall them if I see them in the future.

March Case of the Month

Access case here.

Authors: Turner K. Fishpaw, MD, PGY1, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, N.D.; Daniel Amirhamzeh, MD, PGY-5, radiology resident, diagnostic radiology, Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, Calif.; Laura E. Traube, MD, MPH, attending radiologist, interventional and diagnostic radiology, Department of Radiology; Arthur A. Lee, MD, attending radiologist, vascular and interventional radiology, department of radiology, Santa Barbara Cottage Hospital, Santa Barbara, Calif.; and Bernard Chow, MD, program director, musculoskeletal imaging, Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, Calif.

Why did you select this case for submission?

My senior staff steered my attention to this case to illustrate that chest radiographs remain a powerful imaging modality, and to demonstrate how subtle findings and broad differential diagnoses can lead to early identification and treatment of life-threatening pathology.

What should readers learn from this case?

This case should act as a teaching aid for posterior mediastinal masses and as an example of how an aortic aneurysm may present on a chest radiograph.

What did you learn from working on the case?

As my first case submission, the process of selecting representative images and composing a report worth reading was rewarding. Beyond the requisite radiology subject matter, I learned that with enthusiasm, creativity, and willingness to see a project through to completion, even a medical student can coordinate a project that produces an award-worthy case report.

How did guidance from senior staff at your institution impact your learning and case development?

As a visiting medical student at Santa Barbara Cottage Hospital, I was stunned by how supportive and enthusiastic the residents and faculty were when I informed them early in my rotation that I wanted to submit a case report. With no shortage of interesting cases, we quickly identified a case with salient teaching points and subtle, interesting radiological findings. Senior staff experience with academic publication was critical in molding and polishing our final draft.

Why did you choose Case in Point for submission of your case?

All steps of the submission process were streamlined and easy to interpret. I especially appreciate the case suggestion step. Preliminary case approval prior to a full case write-up and submission was crucial, as I had never submitted a case before. Early approval helped confirm that I did indeed have a case worth publishing.

Are you a regular reader of Case in Point? What are your favorite types of cases?

I do read Case in Point regularly. My favorite cases are those that inspire a broad differential diagnosis and effectively keep the reader thinking and second-guessing until close to the end of the case. I also prefer cases that include a variety of imaging modalities.

What else should we know about the case that you would like to share?

I owe the success of this CIP submission to the support and guidance of the incredible faculty and residents at Santa Barbara Cottage Hospital. My rotation with them was an intensive introduction to radiology and they continue to enrich my life as a doctor and a medical learner!

The Perfect Radiology Report

For the greatest impact on patient care, radiologists must write clear and concise reports.

PRRsmallFORWEB

It might be tough to imagine now, but referring physicians used to visit radiology reading rooms daily to review film-based images and talk with radiologists about exam findings.

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A Quality Assist

As new informatics challenges arise, radiologists support their referring clinicians and health systems in becoming more efficient. 

QualityAssist
Michael Jordan is arguably the greatest NBA basketball player of all time. Not because he won the most league titles (Bill Russell won 11 to Jordan’s six), nor because he scored the most points (Kareem Abdul-Jabbar holds that honor).

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Lung Cancer Screening Resource Roundup

Start here to learn more about lung cancer screening.

Lungs blog

November 2015

It’s been a big year for lung cancer screening. In February, years of research and advocacy efforts paid off when tens of thousands of Medicare patients gained access to this life-saving screening. Since then, providers and patients have been figuring out what this access looks like in practice.

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3 Things to Read Today

Intriguing Links from Around the Web

Links11 11

November 2015

This week, we're reading about how metrics can add to value-based care, how radiologists can reduce unecessary imaging, and more.

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On the Road to Value-Based Care

How can a newly funded CMS grant program position you for success in demonstrating value and making a difference in patient care?

ArticleHed

November 2015

The journey to value-based reimbursement is full of twists and turns, ups and downs. On paper, the map to the future of health care seems simple enough — provide the best possible care for patients and you’ll be rewarded.

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3 Things to Read Today

Intriguing Links from Around the Web

Fall

October 2015

This week, we’re reading about taking extra steps for quality care, and how important CT scans are to the emergency department, and more.

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Informatics Meets Patient Care

A new video series traces the patient experience and aligns informatics tools along each step of the way.

Informatics

October 2015

John is somewhere over the Midwest, trying to read an inane magazine from his seatback pocket, when his head begins to spin and he’s hit with a wave of fatigue. But by the time the plane lands, John is experiencing chest pain, calf swelling, and a high heart rate. He hasn’t officially finished his trip and he is headed to the nearest emergency department.

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3 Things to Read Today

Intriguing Links from Around the Web

iStock 000012621647 Large

July 2015

This week we’re reading about how radiologists can do more with less, why imagers should be circumspect when it comes to using GBCAs for MRIs, and the patient perspective from John Steinbeck.

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Everything in Its Place

One North Carolina practice establishes a business case for structured reports.
Blueprint

June 2015
“Rigor” is not a word most people associate with eastern North Carolina. Known more for its laid-back, friendly attitude and proximity to the ocean, it’s a place where the pace of life is often a little slower. However, in this place of perpetual sunshine, one practice has streamlined its workflow into machine-like precision, helping its referring clinicians — and the practice’s bottom line — in the process.

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Radiology in the News

How do we get a more balanced approach to reporting the benefits and risks of medical radiation?

reporting

June 2015

Helping our patients understand the true benefits and risks of radiation exposure has been challenging. The Image Gently® and Image Wisely® campaigns, which the ACR cofounded, have had success in partnering with the media to publicize patient resources such as the top questions patients should ask their providers about prescribed medical imaging exams. Still, most patients are given little information about risks and few avenues to find more substantial answers. So it was an exciting milestone this past March, when radiologyinfo.org, the patient information site ACR co-manages with RSNA, received over one million monthly visitors.

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The Physics of Imaging

No longer working only behind the scenes, today’s medical physicists are providing clinical guidance to improve patient care.

Physics ADJUSTED

June 2015
When the radiology department at Cincinnati Children’s Hospital hired a full-time medical physicist about three years ago, the chief of thoracic imaging, Alan S. Brody, MD, didn’t expect the move to significantly impact the department’s operations.

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Embracing Risk Adds Value

There's a simple way to define value: Ask why imaging exists.

Risk

June 2015

Imaging exists because clinicians are uncomfortable with uncertainty. Imaging exists because emergency physicians feel that being 98 percent correct about the absence of pulmonary embolism is not good enough.

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3 Things to Read Today 

Intriguing links from around the web.

 

LinksRoundup

June 2015

This week in links we have transparency on hospital and physician utilization, radiologists engaging more directly with patients, and more.

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Focus on Quality and Safety

Experiences as an Amis Fellow

acr2015hall

June 2015

Manisha Bahl, MD, MPH, is a fourth-year radiology resident at Duke University Medical Center and the 2014–15 E. Stephen Amis, Jr., MD, Fellow in Quality and Safety.

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Moreton Lecture: Imaging in the Era of Precision Medicine

Radiology is well-positioned as health care becomes increasingly person-based.

201505190238

May 2015

On Tuesday morning, James H. Thrall, MD, FACR, chair emeritus at Massachusetts General Hospital and Distinguished Taveras Professor of Radiology at Harvard Medical School, delivered the highly anticipated Moreton Lecture: “Imaging in the Era of Precision Medicine.”

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Imaging Appropriateness Made Easy 

Quality experts weigh in on the radiologist’s important role in ensuring imaging appropriateness.

Quality
May 2015

During the ACR 2015 presentation titled “Imaging Appropriateness in the Era of Imaging 3.0,” Margaret Ferguson, MD, vice president and chief value officer at the Colorado Permanente Medical Group, pinpointed an issue facing much of radiology: radiologists are often blamed for inappropriate imaging when, in fact, it’s not their fault. To combat this perception problem, radiologists should not grow frustrated but, instead, take action.

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Incidental Findings, Without Incident

We’re encountering more incidental findings than ever, thanks to exciting advances in imaging technology. How are radiologists managing these unexpected discoveries? 

Incidental

May 2015

A referring physician suspects that a patient with flank pain has a kidney stone and orders a CT study. But while interpreting the imaging exam, the radiologist detects something abnormal in the patient’s pancreas. Unexpected and unrelated to the patient’s clinical condition, the finding is classified as incidental.

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The Root of the Matter

When adverse events occur, institutions turn to root cause analysis to pinpoint weak areas and improve patient care

root

Two patients with the same last name were on the same floor of a major hospital in Houston, Texas, both scheduled for procedures on the same day. Attendants wheeled the patients to their respective procedure areas in the hospital.

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Putting Together the Pieces

Radiologists sometimes hold the key to diagnosing inter-partner violence, but are they watching for the signs?

puttingpieces 

Do a search in PubMed for “domestic violence,” and you will discover over 40,000 results. Add “radiology,” and the numbers drop to 836. Now eliminate the articles dealing with child and elder abuse from that search —meaning you are searching only for information on inter-partner violence — and the numbers go down to just 19.

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"Turnkey" ACR PQI Project Helps Demonstrate Value and Earn MOC Credit

The College unveils the Value-Based Radiology PQI project.

PR

April 2015

From the College: 

Radiologists can earn American Board of Radiology Maintenance of Certification (MOC) credit, engage referring physicians and demonstrate value in emerging health care delivery systems by using American College of Radiology (ACR) Value-Based Radiology Practice Quality Improvement (PQI) Project tools and resources.

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Lung Cancer Screening Update

As this valuable coverage rolls out to patients, the Commission on Economics works to tie up loose ends with CMS.

EconChairMic 

April 2015

On April 6, Dr. Ella A. Kazerooni and I gave a webinar on lung cancer screening.  More than 1,500 people signed up for the webinar. We were able to accommodate only 1,000, so a recorded version is available.

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Survey Says

Are you getting the data you need from your patient surveys?

SurveyBlog

April 2015

“Good information comes from good surveys,” says Joseph R. Steele, MD, MMM, professor at University of Texas MD Anderson Cancer Center in Houston. At the 2015 ACR Conference on Quality and Safety, Steele outlined steps to optimize the data your practice receives from patient surveys around quality.

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What's New With PI-RADS

The PI-RADS committee reaches out across borders to standardize prostate imaging across the globe.

PIRADS

 

April 2015

The Bulletin sat down with Jeffrey C. Weinreb, MD, FACR, co-chair of the MR Prostate Imaging Reporting and Data System (PI-RADS) Steering Committee, to find out about the latest edition of PI-RADS and why international standardization is so important.

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The New LI-RADS

The latest edition offers an expanded lexicon and clearer guidance for interpreting and reporting on imaging of the liver.

LIrads

March 2015

The Bulletin sat down with Claude B. Sirlin, MD, chair of the ACR Liver Imaging Reporting and Data System (LI-RADS),

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Medicare Coverage of Screening CT Colonography

The ACR and its partners have submitted solid recommendations. Now we wait for the results.blueribbon

March 2015

March is Colon Cancer Awareness Month, and I cannot think of a better time to reengage policy-makers about the value of CT colonography

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Quality and Safety Pathway

QSFORWEB

Prep for sessions in this pathway by using the following resources. Find out more about the transition from volume to value, the latest from Imaging 3.0™, and hot topics in quality and safety.


If you're going to these sessions: Quality and Safety: Definition and Basics (Radiology Quality Officer Series), read...

The Effective Quality Officer: The Role of Trust, Boundaries, and Relationships

Fundamentals of Quality and Safety in Diagnostic Radiology

ACR Radiation Safety Resource Page 

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If you're going to this session: Radiation Dose Optimization Strategies in Medical Imaging, read...

JACR Radiation Dose Optimization in CT: An Online Resource Center for Radiologists

Opportunities for Radiation-Dose Optimization Through Standardized Analytics and Decision Support

ImageWisely

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If you're going to this session: A Global Approach on Radiation Dose Reduction, read...

ImageWisely

ACR White Paper– Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT

Effectiveness of Policies on Reducing Exposure to Ionizing Radiation From Medical Imaging: A Systematic Review

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If you're going to this session: Transitioning to Value – The How: Using Quality Tools and QI Project Work (Radiology Quality Officer Series), read...

Root-Cause Analysis and Health Failure Mode and Effect Analysis: Two Leading Techniques in Health Care Quality Assessment

The Lean Concept of Waste in Radiology

Approaching the Practice Quality Improvement Project in Interventional Radiology

Quality Improvement Projects for Residents

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If you're going to this session: Transitioning to Value – The How: Using Quality Tools and QI Project Work (Radiology Quality Officer Series), read...

The Root of the Matter

The Customer is Always Sometimes Right

The Disruptive Radiologist

 Adding Value as Young Radiologists: Challenges and Opportunities, Part 2

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If you're going to this session: Performance Improvement & the Diagnostic Imaging Improvement Community (Radiology Quality Officer Series)read...

              ACR Diagnostic Imaging Center of Excellence Page

              ACR National Radiology Data Registry Page

              Utility of Medical Data Registries

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If you're going to this session: Developing a Culture of Safety in Your Practice (Radiology Quality Officer Series)read...

              Fundamentals of Quality and Safety in Diagnostic                               Radiology

              CR Radiation Safety Resource Page

              Opportunities for Radiation-Dose Optimization Through                     Standardized Analytics and Decision Support

              Developing a Culture of Safety in an Imaging Department

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If you're going to this session: Getting Ready for Value-Based Radiologyread...

              On the Road to Value-Based Care

              R-SCAN Website

Getting the Message

How can radiologists best communicate critical test results?

MESSAGE

March 2015

Nearly every radiologist has been there: you discover an incidental finding that requires prompt clinical attention. 

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Are You Ready for ICD-10?

Find out how practices are gearing up for the big switch.

ICD10IMAGE

March 2015

In 2009, health and human services and CMS dropped their first handful of change into the meter marked ICD-10.

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No Grace Period for ICD-10

numbers

February 2015

The Centers for Medicare & Medicaid Services (CMS) will not allow for dual processing of International Classification of Diseases (ICD)-9 and ICD-10 codes for dates of service on or after the ICD-10 implementation date of Oct. 1, 2015.

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Opening Channels

 

You've heard about ACR Appropriateness Criteria® and clinical decision support. Here's why you should pay attention.

OpeningChannelsLarge

February 2015

Imagine you are new to a place and looking to take your friends out to dinner. Everyone has different ideas about where they'd like to eat, so you head to the Yelp app for restaurant reviews.

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The Same Page

Radiologists discuss the future of the profession's most fundamental product — the radiology report.

The Same Page

February 2015

"It's like the children's game Operation, only for doctors." That's how David J. Vining, MD, professor of diagnostic radiology at the University of Texas MD Anderson Cancer Center in Houston, characterizes a new radiology reporting technology he has developed.

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A Win for Our Patients and Our Communities

The journey to obtain Medicare coverage for lung cancer screening with low-dose CT

ChairColumn2

February 2015

Any new practice innovation is a journey that begins with solid scientific research. The new ACR Strategic Plan emphasizes our commitment to innovation in one of the five goal areas: “Innovation and Research: From Science to Practice and Policy.” However, in the era of health reform, innovation alone will not be enough. We have to do much more than show a new innovation is safe and effective; we also have to demonstrate that it improves outcomes and can be delivered at a reasonable cost.

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 Heading Toward the Future

The ACR Head Injury Institute works to advance the study of traumatic brain injury and bring the latest technology into the clinical arena.

Note: Click on image below to enlarge

January 2015

Much attention has been devoted to traumatic brain injury (TBI) in the news lately. Millions of Americans have watched as athletes ranging from little league players to professional snowboarders step out of competition to be imaged for concussions. This increased awareness of the tragic long-term effects of head trauma puts radiology front and center in the push to understand and treat TBI.

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Tracing Patient Outcomes

The chair of the annual PET/CT Symposium discusses today’s trends, the intersection of PET/CT and Imaging 3.0™, and what attendees from any specialty can take from this year’s meeting.

Tracing Patient Outcomes, PET/CT Symposium

The Bulletin sat down with PET/CT Symposium chair Eric M. Rohren, MD, PhD, chief of PET imaging at the University of Texas MD Anderson Medical Center in Houston, to discuss what’s new in PET/CT, what to expect at this year’s symposium, and how radiologists can create value in PET/CT.

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Breathing Easy

The premiere of Lung-RADS promises aid to radiologists creating lung cancer screening programs.

Breathing Easy, Lung-RADS

The first edition of lung-rads is out and ready to help practices implement their own programs. Ella A. Kazerooni, MD, MS, chair of the ACR Committee on Lung Cancer Screening, and Mythreyi Bhargavan-Chatfield, PhD, leader of the ACR Lung-RADS team, explain what you can expect from the atlas and why it’s important for practices to adopt.

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Roadmap to Quality

This year’s ACR Conference on Quality and Safety gives attendees the tools they need to transform their practices and bring new value to their patients.

ACR Conference - Roadmap to Quality

The Bulletin caught up with Quality and Safety Conference chair C. Daniel Johnson, MD, FACR, who also chairs the department of radiology at Mayo Clinic Arizona in Scottsdale, Ariz., to discuss what participants can look forward to at the 2015 conference and why it’s time to get involved in quality and safety projects.

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A Breath of Fresh Air

Get up to date with all of the changes in lung cancer screening with these resources.

breathe

Over the course of the past year, many exciting developments have occurred in the world of lung cancer screening. According to Ella A. Kazerooni, MD, FACR, principal investigator at the University of Michigan in the National Lung Screening Trial (NLST), "We're committed to widespread coverage for lung cancer screening, and providing an array of tools radiologists need to make that happen."

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Accounting for Quality

A Maine-based accountable care organization ensures quality and lower costs.accounting for quality

Fear of the unknown: It’s a phenomenon we all experience. This trepidation is well exemplified by health professionals approaching the uncharted waters of accountable care organizations (ACOs).

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Striking a Balance

The ACR Dose Index Registry® helps hospitals retain scan quality while successfully lowering radiation dose.striking a balance

There can be a fine line between maintaining the quality of an image and lowering radiation dose for patients. One solution for establishing this equilibrium is ACR’s Dose Index Registry® (DIR).

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Making Meaning

The Chair of the Annual PET/CT Symposium discuesses making the most out of reports to referring physicians and explains what's new in PET/CT.HiRes

The Bulletin sat down with PET/CT Symposium chair Marc A. Seltzer, MD, associate professor of radiology and director of the PET/CT program at the Dartmouth-Hitchcock Medical Center, to discuss what’s new in PET/CT, what to expect at this year’s symposium, and why it’s important to understand what referring physicians are looking for in reporting.

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Tools for the Future

Quality and Safety initiatives help readiologists meet the demands of the new health care environment.83622197 thumbnail

As health care in the United States moves toward new models for the provision of care, reimbursement, and valuebased purchasing, ACR members will be challenged to demonstrate the value of their service to patients, referring providers, administrators, and payers.

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Weathering the Storm

Providing the best quality care is challenging during periods of crisis. Knowing what to do before, during, and after a crisis ensures you are able to tackle difficult situations.weathering the storm

The old adage “better to be safe than sorry” never rings more true than in situations of crisis. Hurricanes, earthquakes, blizzards, terrorist attacks — even something as simple as a power outage — can cause disruptions in the radiology department and affect the quality of patient care.

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New Reliable

The chair of the ACR Annual Conference on Quality and Safety explains how a radiology department is like a Japanese car factory.new reliable

The Bulletin caught up with conference chair C. Dan Johnson, MD, FACR, chair of the department of radiology at Mayo Clinic Arizona in Scottsdale, Ariz., to discuss what's hot in quality and safety, what to expect at this year's conference, and which skills radiologists aren't learning in medical school.

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Reaction Time

A severe contrast reaction can be life-threatening. Do you know what to do?reaction time

Few circumstances arise in radiology departments that require immediate medical intervention. Yet, when patients have an allergic reaction to contrast material, there are definite risks concerning morbidity and mortality.

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Announcing the ACR Head Injury Institute

"Chances are someone you love will sustain a brain injury at some point during your lifetime. When they do, you'll want the best research, you'll want top-quality care, and you'll want local services and support that make life worth living." — Susan H. Connors, president and CEO, Brain Injury Association of Americahead institute

"The American College of Radiology has formed the ACR Head Injury Institute (HII) to use its skills in the areas of image management, transfer, and archiving; education; research and the development of appropriateness criteria; guidelines and standards to help advance the diagnosis; and understanding and treatment of head injuries," states Alexander M. Norbash, MD, FACR, steering committee chair for this latest ACR initiative.

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Optimistic Outcomes

Experts from ACR's Clinical Research Center discuss their efforts to improve the outcomes and quality of life of women diagnosed with breast cancer.optimistic outcomes

ACR's clinical research efforts bring together physicians throughout the medical community in search of new tools in the fight against breast cancer. In recognition of National Breast Cancer Awareness Month, the Bulletin spoke with ACRIN and Radiation Therapy Oncology Group (RTOG®) breast cancer leadership about trials, results, and the future of breast cancer research.

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Quality in the Spotlight

The ACR Conference on Quality and Safety brings together a diverse group with a common goal: improving patient safety and imaging quality.quality in spotlight

In February, radiologists ranging from residents and fellows to practice leaders gathered in Scottsdale, Ariz., to discuss one of radiology's most important topics: the safety of patients and the quality of radiology.

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Patient Safety Organizations and Accreditation

The ACR Department of Quality and Safety examines the pros and cons of becoming a PSO.patient safety organizations

On November 21, 2008, CMS published its final rule on the Medicare physician fee schedule, implementing the Patient and Quality Improvement Act of 2005.

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Rise and Shine

Contemporary work environments can pose serious health risks, so here are some tips for staying healthy while putting in a full day of reading images.rise and shine

A recent British study reported on the dangers of sitting down all day. Researchers found that remaining sedentary for long stretches of time increase the risk of heart disease, diabetes, and ultimately death, even if the person in question exercises regularly.

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ACRIN and RTOG Research in the Spotlight

Exciting new findings lead to advances in patient care.ACRIN and RTOG research

The annual meetings of the American Society for Radiation Oncology (ASTRO) and RSNA provide an excellent venue to showcase RTOG® and ACRIN® research.

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In the Game

As sports concussions gain more attention, radiologists dive in to help prevent further injuries.in the game

Anyone who's been to a football game knows the sound of helmet meeting helmet, an icy and distinct "crack." Some spectators feel energized by the sport's telltale soundtrack as they anticipate mind-blowing plays and complex strategies.

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Taking Back Imaging

Can radiologists keep imaging decisions within the specialty without interference from RBMs?taking back imaging

Many payers may see radiology benefits management (RBM) companies which analyze the appropriateness of high-tech imaging procedures, as tools to keep their costs down.

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Chance Encounter

The rise in the number of incidental findings brings ethical and medical dilemmas to the forefront.chance encounter

The increase in CT scans and other medical imaging in recent years has been accompanied by an increase in the number of incidental findings, both in clinical medicine and in research. In many cases, incidental findings can cause ethical and clinical dilemmas for radiologists.

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Saving Face

Imaging plays a vital role in successful facial transplantations.Saving Face 1

Some accidents leave survivors with a visual reminder of their trauma, which can range from a scar to severe facial deformities.

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Sharing Data Safely

The role of technology in productivity and patient safety explored at new ACR meeting.Sharing Data Safely

The relationship between radiologists and technology is complicated. Strides in digital imaging technology enable radiologists to do more work in less time and provide more data that needs to be evaluated.

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Plan to Pause and Pulse

The new phase of the Image Gently™ campaign concentrates on pediatric fluoroscopy.pause and pulse

Continuing its mission to increase awareness of optimizing radiation dose in pediatric imaging, the Alliance for Radiation Safety in Pediatric Imaging is launching the Image Gently™ campaign's fourth phase — "Pause and Pulse," which focuses on diagnostic fluoroscopic procedures.

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Invested in Improvement

What motivates ACR clinical research trial volunteers and leaders?invested in improvement

Members of the radiation oncology and radiology communities volunteer countless hours to carry out trials supported by ACR's Clinical Research Center.

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Protecting Your Peer-Review Rights

ACR's Counsel elaborate on legal issues within the federal and local peer-review processes.protecting your peer review

The ACR General Counsel's Office and the Quality and Safety Department are often asked whether RADPEER™ materials can be subpoenaed or "discovered" in court. As with most legal matters, the answer is more complicated than a simple "yes" or "no."

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Tackling Trauma

Radiologists act fast, think smart to streamline care in the emergency department.tackling trauma

All hospitals maintain one department unlike all the rest: the emergency department (ED).

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The Right to Speak?

Experts weigh in on giving imaging results directly to patients.the right to speak

Radiologists have traditionally served as the "strong, silent type" in the health-care arena. Although they are a critical bridge between the patient and the referring physician, their voices were often unheard or deemed unnecessary.

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