Radiology Officers Research Articles

Non-compliance of Hospital X Employee in Implementing Standard Operational Procedures of Instrument Decontamination and Chest X-Ray Services

Good hospital management is important to maintain the safety of patients, staff and hospital visitors. Each hospital employee responsible for patient safety by carrying out work according Standard Operating Procedure (SOP) guidelines agreed by organization. This study aims to identify the casues factors and the solution for hospital employees to not comply with the SOP. This study uses a qualitative descriptive approach. Methods of data collection by conducting direct observation and interviews. Subjects in the study were determined based on purposive sampling, as many as 8 respondents consisting of the inpatient room's head, nurses and radiology officers. It is important to apply a system approach in the management of an organization. The elements included in the systems approach are planning, organizing, actuating and controlling. From those elements, there are things that not properly carried in the hospital. The existing procedures were not followed by the employees, for example, procedures regarding instrument decontamination in the inpatient room and photo reading at the radiology service. Non-compliance with this procedure is influenced by several factors, namely the staff lack of discipline and responsibility, inappropriate procedures, facilities that are not available, and there is no socialization of the procedure to hospital employees. The non-compliance of employees at X hospital was caused by procedural factors, decontamination and radiology officer's performance factors and hospital's facilities. For this reason, it is necessary to conduct periodic outreach, monitoring and evaluation of the SOP and hospital employees to improve the quality of hospital services and customer satisfaction.

The Impact of Prostate Volume on the Prostate Imaging and Reporting Data System (PI-RADS) in a Real-World Setting.

Multiparametric magnetic resonance imaging (mpMRI) has emerged as a new cornerstone in the diagnostic pathway of prostate cancer. However, mpMRI is not devoid of factors influencing its detection rate of clinically significant prostate cancer (csPCa). Amongst others, prostate volume has been demonstrated to influence the detection rates of csPCa. Particularly, increasing volume has been linked to a reduced cancer detection rate. However, information about the linkage between PI-RADS, prostate volume and detection rate is relatively sparse. Therefore, the current study aims to assess the association between prostate volume, PI-RADS score and detection rate of csP-Ca, representing daily practice and contemporary mpMRI expertise. Thus, 1039 consecutive patients with 1151 PI-RADS targets, who underwent mpMRI-guided prostate biopsy at our tertiary referral center, were included. Prior mpMRI had been assessed by a plethora of 111 radiology offices, including academic centers and private practices. mpMRI was not secondarily reviewed in house before biopsy. mpMRI-targeted biopsy was performed by a small group of a total of ten urologists, who had performed at least 100 previous biopsies. Using ROC analysis, we defined cut-off values of prostate volume for each PI-RADS score, where the detection rate drops significantly. For PI-RADS 4 lesions, we found a volume > 61.5 ccm significantly reduced the cancer detection rate (OR 0.24; 95% CI 0.16-0.38; p < 0.001). For PI-RADS 5 lesions, we found a volume > 51.5 ccm to significantly reduce the cancer detection rate (OR 0.39; 95% CI 0.25-0.62; p < 0.001). For PI-RADS 3 lesions, none of the evaluated clinical parameters had a significant impact on the detection rate of csPCa. In conclusion, we show that enlarged prostate volume represents a major limitation in the daily practice of mpMRI-targeted biopsy. This study is the first to define exact cut-off values of prostate volume to significantly impair the validity of PI-RADS assessed in a real-world setting. Therefore, the results of mpMRI-targeted biopsy should be interpreted carefully, especially in patients with prostate volumes above our defined thresholds.

Dampak paparan radiasi sinar x lingkungan terhadap leukosit dari petugas radiologi

White blood cells are part of the hematopoetic system that is radiosensitive and are markers for determining the effects and intensity of ionizing radiation. This quantitative study aims to see the effect of ionizing radiation (x-rays) from x-ray services on the white blood cells of radiology officers at advanced health facilities in Pare District, Kediri Regency between September 2022, and January 2023. Using the slovin formula, a total of 60 participants were determined, 30 radiology nurses and 30 comparison groups of administrative officers. When viewed as a whole, the relative number of white blood cells there was no significant difference between the radiology officer group and the administrative officer, but the administrative officer group tended to have a a little higher white blood cell count. Significant differences occurred in the relative number of neutrophils with a significance of 0.0001 (0.05) Neutrophils of radiology officer tended to be smaller than the dissident group. The number of lymphocytes of radiology officer is different from administrative officer and tends to have higher count. Based on the findings it can be indicated if x-ray exposure affects the white blood cell count.

RANCANG BANGUN ALAT FIKSASI PEMERIKSAAN RADIOGRAFI ABDOMEN PROYEKSI LEFT LATERAL DECUBITUS

Background: Radiologic fixation device is a tool made of specially designed iron plate that is used by radiology officers to assist in treating patients. As in the LLD (Left Lateral Decubitus) projection abdominal radiography, non-cooperative patients need an assistive device to facilitate the examination. LLD projection abdominal fixation device This can be used to place cassettes of various sizes, limit patient movement, ensure that the cassette and grid remain attached to the posterior part of the patient without being touched by the patient's family, make the left side of the patient's abdomen not cut, and provide radiation safety to the patient, patient's family, and staff. This study aims to design a fixation tool for projection abdominal radiography examinations LLD and test tools.&#x0D; Methods: This research is an applied type of research by designing a fixation device for LLD. projection abdominal radiography examination as well as testing these tools through questionnaires and documentation studies. The research was conducted at the Radiology Laboratory of Awal Bros University from May to June.&#x0D; Results: The LLD projection abdominal examination fixation device, this tool composed of 5 components: patient seat, metal support, cassette holder, foam pad and strap.&#x0D; Conclusions: From the results of data collection using a questionnaire, it was found that the LLD projection abdominal examination fixation tool has met the performance test in accordance with the specifications of the tool and has good value in terms of the components of the tool, durability, efficiency of the tool and the resulting radiograph.

Prevalence of Three-Rooted Deciduous Mandibular Molars in the Children of Northwestern Iran.

Introduction Although primary teeth have a determinative role in development of normal occlusion, few studies about anomalies related to deciduous dentition have been conducted so far. Regarding recent improvements in common knowledge and the importance of maintaining primary teeth until eruption of succedaneous teeth, identifying the morphology of primary teeth and probable variations is of great importance to achieve optimal therapeutic outcome. This study aims to determine the prevalence of three-rooted mandibular primary molars in a population of northwestern Iran. Materials and Methods In this descriptive cross-sectional study, periapical radiographs of patients attending private oral and maxillofacial radiology offices in the northwestern region of Iran from 2017 to 2019 were retrospectively reviewed. A total of 300 cases in the 3–10-year age range having bilateral periapical radiographs from mandibular primary molars were screened. First and second primary molars were observed meticulously. Gender, side of the mandible (right or left), symmetry, overall prevalence, and prevalence considering the type of molar (D or E) were recorded and analyzed. Results Overall prevalence of three-rooted mandibular primary molars was 9.33% ( 28/300), 92.9% of which were unilateral. The prevalence of teeth showing supernumerary roots among all teeth examined was 2.5% (30/1200). Considering symmetry and gender, the occurrence of these three-rooted primary molars did not differ significantly (respectively, p=0.832 and p=0.541). However, there was a significant relationship between the occurrence of supernumerary roots and left side for three-rooted first molars and right side for three-rooted second molars (p=0.021). Conclusion Obtained data show that three-rooted mandibular primary molars in children of northwest region of Iran have a prevalence of approximately 10 % which urges some specific considerations in exodontic and endodontic procedures.

Correlation between Creativity and Entrepreneurial Skills in Managers of Educational Hospitals

Correlation between Creativity and Entrepreneurial Skills in Managers of Educational Hospitals

Minimally Invasive Ultrasound-Guided Carpal Tunnel Release Improves Long-Term Clinical Outcomes in Carpal Tunnel Syndrome.

BACKGROUND. Ultrasound guidance allows performance of carpal tunnel release with smaller incisions and quicker recovery than traditional open or endoscopic surgery. OBJECTIVE. The purpose of this study was to evaluate the long-term effectiveness of ultrasound-guided carpal tunnel release in improving function and discomfort in patients with carpal tunnel syndrome. METHODS. Retrospective review was conducted of 61 ultrasound-guided carpal tunnel release procedures performed on 46 patients (15 bilateral procedures) with clinically diagnosed carpal tunnel syndrome. The procedures were performed with a single-use transection device and local anesthesia at an outpatient radiology office. Patients answered three questionnaires (Quick Disabilities of the Arm, Shoulder, and Hand [QDASH] and two parts of the Boston Carpal Tunnel Syndrome Questionnaire-the symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS] scales) to assess the function of and discomfort in the affected wrist immediately before and 2 weeks and at least 1 year after the procedure. Higher scores indicated increasing disability. Patients also answered a global satisfaction question at follow-up. Preprocedure and postprocedure scores were compared by paired Wilcoxon signed rank tests. RESULTS. The 46 patients (25 women, 21 men; mean age, 60.6 years; range, 21-80 years) had median preprocedure scores of 45.4 for QDASH, 3.2 for BCTSQ-SS, and 2.5 for BCTSQ-FS. The median scores 2 weeks after the procedure were 22.5 for QDASH, 1.7 for BCTSQ-SS, and 1.9 for BCTSQ-FS. All scores decreased (p < .001) from preprocedure scores and surpassed reference standards for clinically important difference in scores. Follow-up questionnaires obtained for 90% (55/61) of wrists a median of 1.7 years (range, 1.0-2.8 years) after the procedure showed further declines (p < .001) in median scores: 2.3 for QDASH, 1.2 for BCTSQ-SS, and 1.1 for BCTSQ-FS. At long-term follow-up evaluation, 96% (52/54) of wrists had lower QDASH and 98% (53/54) had lower BCTSQ (average of BCTSQ-SS and BCTSQ-FS) scores compared with the preprocedure scores. Among the patients who participated in the survey, 93% (37/40) were satisfied or very satisfied with the long-term outcomes. No immediately postoperative complications occurred. Two patients needed surgical intervention 8 and 10 days after surgery, one for infection after injury and one for posttraumatic compartment syndrome. CONCLUSION. Ultrasound-guided carpal tunnel release quickly improves hand function and reduces hand discomfort; improvement persists beyond 1 year. CLINICAL IMPACT. Ultrasound-guided carpal tunnel release may be a safe, effective, and less invasive alternative to traditional surgery.

Recent Trends in Medicare Reimbursements to Nonradiologist Physicians for In-Office MRI and CT

PurposePrevious studies demonstrated rapid growth in payments to nonradiologist providers (NRPs) for MRI and CT in their private offices. In this study, we re-examine the trends in these payments. MethodsThe nationwide Medicare Part B master files from 2004 to 2016 were accessed. They provide payment data for all Current Procedural Terminology codes. Codes for MRI and CT were selected. Global and technical component claims were counted. Medicare specialty codes identified payments made to NRPs and radiologists, and place-of-service codes identified payments directed to their private offices. ResultsMedicare MRI payments to NRPs peaked in 2006 at $247.7 million. As a result of the Deficit Reduction Act, there was a sharp drop to $189.5 million in 2007, eventually declining to $101.6 million by 2016 (−59% from peak in 2006). The NRP specialty groups with the highest payments for MRI ownership include orthopedists, neurologists, primary care physicians, and hospital-based specialists (pathology, physiatry, and hospitalists). Medicare CT payments to NRPs peaked in 2008 at $284.1 million and declined to $94.7 million in 2016 (−67% from peak). Cardiologists, primary care physicians, internal medicine specialists, urologists, and medical oncologists accounted for the most payments made to NRPs. Dollars paid to radiologists for private office MRI and CT dropped substantially since they peaked in 2006. ConclusionsNRP private offices (and radiology offices also) experienced massive decreases in Medicare payments for MRI and CT since peaking in 2006 and 2008, respectively. These trends suggest the financial viability of private office practice may be in jeopardy. However, certain recent policy changes could promote a resurgence.

Psychometric Validation of a Nonproprietary Survey of Patient Satisfaction for Use in Outpatient Radiology Centers.

Demonstrate the psychometric evaluation process for and results from our radiology-specific patient experience measure. We developed a survey to measure five dimensions of patient experience: (1) appointment, (2) reception, (3) registration, (4) procedure, and (5) facility. Each dimension included three to five questions. Each question was answered using a Likert scale (very dissatisfied to very satisfied). Data on procedure type, facility, radiologist interaction, health rating, survey length, and demographics were collected. The survey was implemented at 12 radiology offices. Analyses were conducted using responses from March 2018 to April 2019. Construct validation of the five dimensions was accomplished using confirmatory factor analysis (CFA). Internal consistency was examined using Cronbach and Guttman analysis. The sample included 20,736 subjects. There was strong evidence for construct validity of the five dimensions of patient experience. The CFA achieved the best fit with the five-factor model relative to other models (comparative fit index: 0.98, standardized root mean square error residual: 0.0307, root mean square error of approximation: 0.0371). There was high internal consistency (Cronbach's α 0.94, Guttman coefficient 0.93). Item analysis showed that no questions were consistently skipped. Eighty-two percent of participants said the survey was not too long. Patients reported high satisfaction on all dimensions of satisfaction across modalities and office sites. The CFA and internal consistency analyses provide evidence for this survey having good psychometric properties: construct validity for five dimensions of patient experience and high internal consistency among the items. This survey is intended to be used by, and to benefit, radiology practices and their patients.

ANALISIS KUANTITAS DAN HITUNG JENIS LEUKOSIT PADA PETUGAS RADIOLOGI DI BALAI BESAR KESEHATAN PARU MASYARAKAT (BBKPM) MAKASSAR

The Radiology Officer is one of the groups that has a risk to the danger of radiation exposure and it caused of the healthy in the certain level. Then, it could cause the Chronis disease until with the death. The effect of Chronis could appear in years later. Indicator of Hematopoietic commonly used as radiation exposure. It was differential count leukocyte, lymphocyte, absolute count, neutrophil, platelet and erythrocyte. The disturbance of hematopoitic system is caused radiation exposure that the effecting of the amount erythrocytes decreased as sensitivity and the life expectancy, which was the lymphocyte reacted firstly. It is followed by granulocyte, thrombocyte, and erythrocyte. The aim of this research is to know the quantity and differential count leukocyte with radiology officer. The kind of this research was descriptive research through quantity and differential count leukocyte with the radiology officer. There were 7 samples on 24 of February 2017 until 4 March 2017 in Balai Besar Kesehatan Paru Masyarakat Makassar. The quantity of the research with the radiology office in BBMK Makassar was 85,71% normally and it increased (14,29%) while the differential count leukocyte was 100% basofil in the amount of normal, 42,86% eosinophil increased, 14,29% neutrophil decreased, 14,29% lymphocyte increased, 14,29% monocyte decreased and 14,29% monosit increased. It should be more increased the effecting of dangerous radiation and the using of personal protective equipments should be increased based on the regulation of Bapeten number 8 at 2011 and radiology officer should be more attention to the nutritional and their healthy. Keywords: Quantity of Leukocyte, Differential Count Leukocyte, The Radiology Officer

3:54 PM Abstract No. 164 - 504 cases of non-GSV EVLA: long term outcomes and comparison with GSV EVLA

Purpose To determine the effectiveness of endovenous laser ablation (EVLA) for non-great saphenous veins, and to compare to GSV EVLA outcomes. Materials and Methods IRB and HIPAA compliance were obtained. A retrospective review of electronic medical records of all patients with EVLA performed from July 2003 to March 2012, at a high volume outpatient interventional radiology office practice was performed. Data collected included age, sex, vein treated, and parameters of treatment - i.e. watts, length of vein treated, energy density (J/cm) and tumescent anesthesia volume. Follow-up ultrasound exam(s) and occlusion rates were obtained. Non- GSV veins were defined as small saphenous vein (SSV), accessory lateral tributary (ALT), and other (intersaphenous veins, perforators, non-named veins). Primary endpoint was primary occlusion rate (PO) of non-GSV ablations. PO was defined as US non-compressibility and lack of color Doppler flow in the vein segment treated with EVLA. Secondary endpoint was comparison of PO rates of non GSV veins segments with contemporaneously treated GSV. Fisher's exact and Pearson chi2 tests were performed. Results There were 504 non-GSV treated. The distribution of vein segments was 259 (51.4%) SSV, 141 (28.0%) ALT, and 104 (20.6%) other. The average US follow-up duration was 299.9 days (range 6 - 1863). The overall non GSV PO was 97.2% (490/504). PO for SSV, ALT, and other were 96.5% (250/259), 96.5% (136/141), and 100% (104/104) respectively. During the same time interval, 1301 GSV were treated with PO of 96.5% (1255/1301) with average US follow-up of 298.2 days (range 5 - 1983). The overall average age was 51.3 years (range 21-86) with sex distribution of 1458 (80.8%) women and 347 (19.2%) men. There was no statistically significant difference between non GSV and GSV in primary occlusion rates (p=0.42). There was also no statistically significant difference among SSV, ALT, other, and GSV in primary occlusion rates (p=0.207). Conclusion Non GSV (SSV, ALT, and other) EVLA has a high primary occlusion rate at long -term follow-up, with no difference compared to GSV EVLA. Results strongly support the clinically indicated treatment of non GSV with EVLA.

4:02 PM Abstract No. 165 - EVLA of lower extremity superficial venous reflux disease: relationship between long-term recanalization rates and energy density

Purpose To determine if energy density (Joules/cm) effects long-term success of EVLA of lower extremity superficial venous reflux. Materials and Methods IRB and HIPAA compliance were obtained. A retrospective review of EVLA treatments performed at a busy outpatient interventional radiology office was performed. Data collected included age, sex, vein segment treated, energy density (J/cm), length of vein treated, ultrasound follow-up intervals, and recanalization. Vein segments treated were divided into 80 J/cm. Comparison of recanalization rates among varying energy density groups were performed. Results There were 2127 vein segments treated from July 2003 to March 2012. Average age of patients were 51.3 years (range 21-86 years) with 1458 women and 347 men treated. Average follow-up was 298.7 days (range 5-1983). Average energy density was 86 J/cm with recanalization rate of 3.24% (69 of 2127). The recanalization rates for 80 J/cm were 5.57% (23 of 413), 4.77% (24 of 502), and 1.82% (22 of 1211) respectively. There is statistically significant lower recanalization rate in the > 80 J/cm group compared to 80 J/cm compared to 60-80 J/cm group almost reached statistical significance (p=0.08). The lower recanalization rate in the 60-80 J/cm group compared to the Conclusion This retrospective review of 2127 vein segments treated showed that EVLA performed with energy density >80 J/cm had the lowest long term recanalization rate. The study suggests that target energy density should be >80 J/cm to obtain highest long term success.

Adverse Events in a Freestanding Radiology Office

Adverse Events in a Freestanding Radiology Office

Scope or Scan: Patient Preference for Colon Cancer Screening

Purpose: Colon cancer screening is a vital aspect of health care for those 50 years of age and older. Several screening options exist, the two most accurate are optical colonoscopy (OC) and CT colonography (CTC). Of the two, optical colonoscopy is the ‘gold standard’ test. The aim of our study was to determine whether providing detailed information about the two screening procedures would affect patient choice between OC and CTC. Methods: The study was a cross sectional survey conducted in a community setting in internal medicine office waiting rooms, excluding both gastroenterology and radiology offices. The survey had three parts: Part I: Patient demographics, prior screening procedures for colon cancer and level of awareness about OC and CTC. Part II: Presented facts about both OC and CTC, including risks, benefits and reported accuracy of each. Part III: Asked whether additional information altered initial screening preferences and, if so, why? Results: A total of 300 patients completed the survey but 77 were excluded because of incomplete completion leaving a study population of 223. The mean age was 56 years and 57% were female. Only 32% were aware of both OC and CTC at the time prior to survey completion and 80% planned to have OC as their screening procedure. Following survey completion, 53% decided to have OC and 47% CTC. OC was chosen primarily because of perceived higher accuracy in polyp detection and CTC was chosen because it was deemed a less invasive option. Conclusion: This study shows that patient preference for OC or CTC as a screening procedure for colon cancer can be greatly influenced by simply providing detailed information about each test. Thus, it is extremely important that accurate information about all aspects of the two procedures is provided with a focus on the demonstrated cancer prevention benefits of polyp removal.

Adverse Events in a Freestanding Radiology Office

The aim of this study was to evaluate the frequency, types, and severity of adverse events that occur in a freestanding outpatient radiology office setting and discuss the actions taken for patient treatment and subsequent triage. Adverse event records from a freestanding outpatient radiology office were reviewed from January 2003 through December 2006. Data were grouped into different modalities, including computed tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and interventional radiology. Adverse reactions and events were reviewed, including what, if any, immediate treatment was provided in the office, how the patient responded, whether the patient was discharged home, and whether emergency medical services were called. A total of 106,800 patients were evaluated over 4 years, among whom 59 experienced (0.06%) adverse events. Seventy-six percent of the patients (n = 45) were treated in the office and were discharged home or returned to work. Thirty-one percent of the patients (n = 18) required assistance from emergency medical services. The outpatient radiology office setting is a safe arena for patients to undergo imaging studies and selected interventional procedures. Medical personnel in office settings are able to assess and treat those patients experiencing adverse events and can appropriately judge whether further aid is needed for patients in distress via emergency medical services or hospital care.

Hysterosalpingography with use of mobile C-arm fluoroscopy

To review radiation exposure during hysterosalpingography (HSG) examinations with use of a mobile C-arm fluoroscopic imaging system with advanced features including pulsed fluoroscopy and last-image-hold capability. Retrospective clinical study. Freestanding outpatient radiology office. Two hundred consecutive patients who were referred for HSG examinations to evaluate fertility or status of tubal ligation. Pulsed fluoroscopy (eight frames per second) and continuous fluoroscopy were used with automated exposure control and last image hold for static image capture. Fluoroscopy time (seconds), field of view (12 in., 9 in., 6 in.), mode (continuous, pulsed), and dose area product (mGycm(2)) were recorded for each patient. The total estimated surface dose then was calculated. One hundred forty-seven patients had normal results on hysterosalpingograms, and 57 patients had abnormal results on hysterosalpingograms. Selective salpingography was performed in 26 of the 38 patients with fallopian tube occlusions. Mean fluoroscopy time for normal, abnormal, and selective catheterization was 4.17, 14.3, and 56.1 seconds, respectively. Mean estimated surface dose for normal, abnormal, and selective catheterization was 2.6, 6.9, and 46.7 mGy, respectively. A mobile C-arm fluoroscopic imaging system with pulsed fluoroscopy and last-image-hold capability may be a desirable alternative for HSG to achieve lower radiation exposure with improved operator convenience and patient comfort.

Poster 40: Decreased Lower Back Pain after Noninvasive Spinal Decompression May be Due to Restored Disk Height

Objective: To investigate whether a decrease in low back pain (LBP) secondary to a standardized treatment protocol using noninvasive spinal decompression correlates with an increase in disk height. Design: Retrospective review of lumbar spine computed tomography (CT) scans. Setting: Outpatient radiology office. Participants: Patients with chronic musculoskeletal, mechanical, or diskogenic LBP. Interventions: 6-week course of noninvasive spinal decompression treatment using the DRX 9000. Main Outcome Measures: Changes in disk height as documented by lumbar spine CT scans.

Wallace Davis Buchanan

In 1964, the ACR made a decision to fight against the proposed federal Medicare program covering radiology only in hospitals and as a hospital service rather than a medical specialty. In the view of College leaders, the future of radiology hung in the balance. If the specialty was defined as a hospital service rather than a physician discipline, the ability of radiology to attract bright young physicians would be handicapped severely. If the proposed Medicare coverage in hospitals only was adopted by private health insurance carriers, the survival of private offices was in grave doubt. And if radiology offices disappeared, much of the bargaining power radiologists had with hospitals would be gone. The chance of winning the point that radiology should be treated the same as other medical disciplines in federal legislation was slim. Most radiologists worked on hospital contracts. But for Wallace Davis Buchanan, or Buck, and his colleagues on the ACR Board of Chancellors, the effort had to be made. The college hired a lobbyist and organized its members into a vigorous campaign. Against all odds, against the opposition of the American Hospital Association and even President Lyndon Johnson, the ACR's effort succeeded. Radiology was defined as a physician service, radiologist fees were separated from hospital billing, and the ACR moved to get its members out of hospital contracts specifying collective billing. No one individual can be credited with the effort. The ACR's leader was Dr Buchanan, as chairman of the board and as president. His commitment was firm, unwavering, perceptive, and determined. The effort would be made, and resources would be committed. On his numerous trips to Washington DC, his quiet, earnest manner was convincing to members of Congress and their staffs. He was equally persuasive with radiologists, whose convictions led them to end their hospital contracts and begin billing for their own professional services. After the new law was passed, with radiology on the medical benefit side, Dr Buchanan invited Wilbur Cohen, the undersecretary of health, education, and welfare and principal architect of the Medicare program, to meet with the Board of Chancellors. Mr Cohen had favored putting radiology into hospital service. But he accepted the offer and brought with him the top members of the newly created Medicare staff. Out of that meeting came the relationship that has served the program and the specialty of radiology for more than 40 years. During his time as an ACR chancellor and officer, Dr Buchanan was in a 7-member radiology practice in South Bend, Indiana. His colleagues supported him and covered the many days he spent on ACR activities. Buck Buchanan was a native Hoosier. He took his medical degree from the University of Indiana in 1933 and did his internship at Indianapolis City Hospital. For 8 years, he had a general practice in Bremen, Indiana. In 1942, he was commissioned in the navy and assigned to a military hospital in Port Lyautey, French Morocco, where he served during most of World War II. During his navy experience, he became interested in radiology and served several months in naval hospitals in Philadelphia and Portsmouth, New Hampshire. After his discharge, he completed his residency at Northwestern University's Wesley Memorial Hospital and passed the American Board of Radiology's examination late in 1946. Then he joined the South Bend practice group. In addition to his service in the ACR, Dr Buchanan was active on the board of the St. Joseph County Hospital for Tuberculosis and Chronic Disease, the local tuberculosis association, the board of the local symphony orchestra, and the United Community Services board in South Bend. After his term as ACR president, Dr Buchanan remained active, making speeches to radiology groups, participating in a College film about radiology and Medicare, and serving as a member of the Judiciary Committee. He made a final appearance before the US House Committee on Ways and Means in 1967, when the first Medicare amendments were considered. The American Hospital Association made a last, unsuccessful effort to make radiology a hospital service in Medicare. In 1976, Dr Buchanan retired from his Indiana practice and moved to Sarasota, Florida. Retirement did not suit him, and he soon joined a smaller radiology practice in Fort Lauderdale. He practiced for another decade until failed cataract replacement surgery made it impossible for him to continue reading x-ray films. Then he returned to Sarasota, where he died in 1998. His friend and mentor, Earl E. Barth of Chicago, said of Buck Buchanan in his 1968 ACR gold medal citation, “The hour provides the man. Buck Buchanan's leadership brought radiology into its new era.” And so it did.

Developing an Interventional Radiology Varicose Vein Practice

A varicose vein or phlebology practice can be incorporated into an outpatient interventional radiology practice with some proper planning. For an established interventional radiology clinic practice, the barriers to entry into such a phlebology practice are actually fairly low. A critical component in this process is establishing a business plan. An intact business plan can provide the proper foundation for any business venture, including a successful phlebology practice. Key steps in any business plan include an evaluation of the proposed venture, proper planning, organization, implementation, and periodic review. In this article, I describe how an active varicose vein practice was established in our outpatient radiology office in Charlotte, North Carolina, as well as highlight several important features that could, and probably should be, incorporated into any phlebology practice.

Infant colic and feeding difficulties

Aims: To examine the relation between colic and feeding difficulties and their impact on parental functioning for a primarily clinic referred sample. Methods: Forty three infants (and their mothers) were...