Academic medical centers have long relied on radiology residents to provide after-hours coverage, which means that they essentially function with autonomy. In this approach, attending radiologist ...review of resident interpretations occurs the following morning, often by subspecialist faculty. In recent years, however, this traditional coverage model in academic radiology departments has been challenged by an alternative model, the 24-hour attending radiologist coverage. Proponents of this new model seek to improve patient care after hours by increasing report accuracy and the speed with which the report is finalized. In this article, we review the traditional and the 24-hour attending radiologist coverage models. We summarize previous studies that indicate that resident overnight error rates are sufficiently low so that changing to an overnight attending model may not necessarily provide a meaningful increase in report accuracy. Whereas some centers completely replaced overnight residents, we note that most centers use a hybrid model, and overnight residents work alongside supervising attending radiologists, much as they do during the day. Even in this hybrid model, universal double reading and subspecialist final review, typical features of the traditional autonomous resident coverage model, are generally sacrificed. Because of this, changing from resident coverage to coverage by an attending radiologist that is 24 hours/day, 7 days/week may actually have detrimental effects to patient safety and quality of care provided. Changing to an overnight attending radiologist model may also have negative effects on the quality of radiology resident training, and it significantly increases cost.
“Defensive Medicine” in the AI Era Banja, John; Hollstein, Rolf-Dieter; Bruno, Michael A.
European journal of radiology,
November 2023, 2023-11-00, 20231101, Letnik:
168
Journal Article
Turbidite records along ocean margins and in lake basins are increasingly used as paleoseismic proxies. However, the slope remobilization processes that formed the earthquake-related turbidity ...currents are poorly understood and, therefore, it is difficult to assess the consistency of turbidite paleoseismic records. We analyzed the sedimentary imprint of the giant AD 1960 (Mw 9.5) Chile earthquake in four South-Central Chilean lakes. Mass-transport deposits and turbidites were compared by interpreting reflection-seismic profiles, sedimentary facies, volume balances and proxies for turbidite composition (i.e. grain size, radionuclides, sediment color, organic matter). Sediment lightness was used as a proxy for organic matter content. Comparison of lightness of turbidites and the underlying sediments shows that earthquake-triggered turbidites in the four lakes result from remobilization of a thin veneer (on average about 5cm) of slope sediments and do not result from disintegration of subaquatic landslides. Statistical analysis of 34 turbidites in a new 5200year sedimentary record does not show any correlation between inter-event time and turbidite thickness (and thus volume). This means that inter-event slope recharging is not a dominant factor governing turbidite recurrence and that initiation of turbidity currents by remobilization of surficial sediments is different to slope failure related to subaquatic landslides. We conclude that surficial slope sediment remobilization forms a valid mechanism that explains why turbidite paleoseismic records can be of excellent continuity and high sensitivity. Moreover, based on correlations between seismic intensity, turbidite volume and stratigraphic remobilization depth, we propose that surficial slope sediment remobilization allows for turbidite records containing information about paleo-earthquake intensity.
•Turbidites can be produced by surficial slope remobilization during earthquakes.•Subaquatic slope recharging does not influence turbidite recurrence and volume.•Surficial remobilization allows for continuous and sensitive paleoseismic records.
The use of inexpensive and widely available CO2 lasers to selectively irradiate polymer films and form a graphene foam, termed laser-induced graphene (LIG), has incited significant research ...attention. The simple and rapid nature of the approach and the high conductivity and porosity of LIG have motivated its widespread application in electrochemical energy storage devices such as batteries and supercapacitors. However, nearly all high-performance LIG-based supercapacitors reported to date are prepared from costly, petroleum-based polyimide (Kapton, PI). Herein, we demonstrate that incorporating microparticles of inexpensive, non-toxic, and widely abundant sodium salts such as NaCl and Na2SO4 into poly(furfuryl alcohol) (PFA) resins enables the formation of high-performance LIG. The embedded particles aid in carbonization and act as a template for pore formation. While increasing both the carbon yield and surface area of the electrodes, the salt also dopes the LIG formed with S or Cl. The combination of these effects results in a two- to four-order-of-magnitude increase in device areal capacitance, from 8 μF/cm2 for PFA/no salt at 5 mV/s to up to 80 mF/cm2 for some PFA/20% Na2SO4 samples at 0.05 mA/cm2, significantly higher than that of PI-based devices and most other LIG precursors.
The ACR recognizes that radiology practices are grappling with when and how to safely resume routine radiology care during the coronavirus disease 2019 (COVID-19) pandemic. Although it is unclear how ...long the pandemic will last, it may persist for many months. Throughout this time, it will be important to perform safe, comprehensive, and effective care for patients with and patients without COVID-19, recognizing that asymptomatic transmission is common with this disease. Local idiosyncrasies prevent a single prescriptive strategy. However, general considerations can be applied to most practice environments. A comprehensive strategy will include consideration of local COVID-19 statistics; availability of personal protective equipment; local, state, and federal government mandates; institutional regulatory guidance; local safety measures; health care worker availability; patient and health care worker risk factors; factors specific to the indication(s) for radiology care; and examination or procedure acuity. An accurate risk-benefit analysis of postponing versus performing a given routine radiology examination or procedure often is not possible because of many unknown and complex factors. However, this is the overriding principle: If the risk of illness or death to a health care worker or patient from health care-acquired COVID-19 is greater than the risk of illness or death from delaying radiology care, the care should be delayed; however, if the opposite is true, the radiology care should proceed in a timely fashion.
CONTEXT A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have ...comorbid conditions. OBJECTIVE To describe outcomes of patients 60 years or older after receiving minimally toxic nonmyeloablative allogeneic HCT. DESIGN, SETTING, AND PARTICIPANTS From 1998 to 2008, 372 patients aged 60 to 75 years were enrolled in prospective clinical HCT trials at 18 collaborating institutions using conditioning with low-dose total body irradiation alone or combined with fludarabine, 90 mg/m2, before related (n = 184) or unrelated (n = 188) donor transplants. Postgrafting immunosuppression included mycophenolate mofetil and a calcineurin inhibitor. MAIN OUTCOME MEASURES Overall and progression-free survival were estimated by Kaplan-Meier method. Cumulative incidence estimates were calculated for acute and chronic graft-vs-host disease, toxicities, achievement of full donor chimerism, complete remission, relapse, and nonrelapse mortality. Hazard ratios (HRs) were estimated from Cox regression models. RESULTS Overall, 5-year cumulative incidences of nonrelapse mortality and relapse were 27% (95% CI, 22%-32%) and 41% (95% CI, 36%-46%), respectively, leading to 5-year overall and progression-free survival of 35% (95% CI, 30%-40%) and 32% (95% CI, 27%-37%), respectively. These outcomes were not statistically significantly different when stratified by age groups. Furthermore, increasing age was not associated with increases in acute or chronic graft-vs-host disease or organ toxicities. In multivariate models, HCT-specific comorbidity index scores of 1 to 2 (HR, 1.58 95% CI, 1.08-2.31) and 3 or greater (HR, 1.97 95% CI, 1.38-2.80) were associated with worse survival compared with an HCT-specific comorbidity index score of 0 (P = .003 overall). Similarly, standard relapse risk (HR, 1.67 95% CI, 1.10-2.54) and high relapse risk (HR, 2.22 95% CI, 1.43-3.43) were associated with worse survival compared with low relapse risk (P < .001 overall). CONCLUSION Among patients aged 60 to 75 years treated with nonmyeloablative allogeneic HCT, 5-year overall and progression-free survivals were 35% and 32%, respectively.
We designed a minimal-intensity conditioning regimen for allogeneic hematopoietic cell transplantation (HCT) in patients with advanced hematologic malignancies unable to tolerate high-intensity ...regimens because of age, serious comorbidities, or previous high-dose HCT. The regimen allows the purest assessment of graft-versus-tumor (GVT) effects apart from conditioning and graft-versus-host disease (GVHD) not augmented by regimen-related toxicities.
Patients received low-dose total-body irradiation ± fludarabine before HCT from HLA-matched related (n = 611) or unrelated (n = 481) donors, followed by mycophenolate mofetil and a calcineurin inhibitor to aid engraftment and control GVHD. Median patient age was 56 years (range, 7 to 75 years). Forty-five percent of patients had comorbidity scores of ≥ 3. Median follow-up time was 5 years (range, 0.6 to 12.7 years).
Depending on disease risk, comorbidities, and GVHD, lasting remissions were seen in 45% to 75% of patients, and 5-year survival ranged from 25% to 60%. At 5 years, the nonrelapse mortality (NRM) rate was 24%, and the relapse mortality rate was 34.5%. Most NRM was a result of GVHD. The most significant factors associated with GVHD-associated NRM were serious comorbidities and grafts from unrelated donors. Most relapses occurred early while the immune system was compromised. GVT effects were comparable after unrelated and related grafts. Chronic GVHD, but not acute GVHD, further increased GVT effects. The potential benefit associated with chronic GVHD was outweighed by increased NRM.
Allogeneic HCT relying on GVT effects is feasible and results in cures of an appreciable number of malignancies. Improved results could come from methods that control progression of malignancy early after HCT and effectively prevent GVHD.
Online portals typically allow access to radiology reports, causing a shift in the communication. This article evaluates the studies available in the literature about patient portals and the use of ...patient portals in radiology. Patient and physician preferences and the impact on radiology reporting are presented.
Patient portals provide an opportunity for radiologists to engage with their patients via a new method of communication. Radiologist collaboration with referring physicians is important in providing care in accordance with patient preferences.
Filling defects identified in the pulmonary arterial tree are commonly presumed to represent an embolic phenomenon originating from thrombi formed in remote veins, particularly lower-extremity deep ...venous thrombosis (DVT). However, accumulating evidence supports an underappreciated cause for pulmonary arterial thrombosis (PAT), namely, de novo thrombogenesis-whereby thrombosis arises within the pulmonary arteries in the absence of DVT. Although historically underrecognized, in situ PAT has become of heightened importance with the emergence of SARS-CoV-2 infection. In situ PAT is attributed to endothelial dysfunction, systemic inflammation, and acute lung injury and has been described in a range of conditions including COVID-19, trauma, acute chest syndrome in sickle cell disease, pulmonary infections, and severe pulmonary arterial hypertension. The distinction between pulmonary embolism and in situ PAT may have important implications regarding management decisions and clinical outcomes. In this review, we summarize the pathophysiology, imaging appearances, and management of in situ PAT in various clinical situations. This understanding will promote optimal tailored treatment strategies for this increasingly recognized entity.
This report discusses a case of transient 2:1 atrioventricular block with conduction system pacing 4 hours after leadless right ventricular pacemaker implantation in a 19-year-old patient with a ...history of cardioinhibitory syncope and asystole cardiac arrest but without preexisting atrioventricular block. The atrioventricular block was resolved spontaneously. Pacing morphology was suggestive of right bundle branch pacing. Neither 2:1 atrioventricular block nor conduction system pacing has previously been a reported outcome of right ventricular leadless pacemaker implantation. The report demonstrates that conduction system pacing with leadless devices is achievable. Further study of techniques, limitations, and complications related to intentional right ventricular leadless conduction system pacing is warranted.
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