Survey of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans and non-ortho-polychlorinated biphenyls in US meat and poultry, 2012-13: toxic equivalency levels, patterns, temporal trends and implications.

The US Department of Agriculture (USDA) conducts a statistically based survey of the domestic meat supply (beef, pork, chicken and turkey) to determine current levels of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and non-ortho-polychlorinated biphenyls (no-PCBs) every 5 years. Fat samples for each slaughter class were collected from US federally licensed slaughter facilities. The samples were processed and analysed for 17 PCDD/Fs and three no-PCBs. The sum of PCDD, PCDF and no-PCB toxic equivalencies (sum-TEQ) calculated using 2005 toxic-equivalency factors for all slaughter classes ranged from non-detect (n.d.) to 6.47 pg TEQ g-1 lipid. The median sum-TEQs, when n.d. = 0.5 LOD, for beef, pork, chicken and turkey were 0.66, 0.12, 0.13 and 0.34 pg TEQ g-1 lipid respectively. A comparison of the current survey with the previous three surveys shows a declining trend, with decreasing differences between medians; differences between the median sum-TEQs from 2007-08 and 2012-13 were -10%, -29%, -33% and -25% for beef, pork, chicken and turkey respectively. Several beef samples underwent further characterisation and congener patterns from these beef samples suggested pentachlorophenol treated wood as the likely exposure source. US consumer exposure to these compounds is relatively low and no slaughter class contributed more than 26% to the US Environmental Protection Agency (USEPA) chronic oral reference dose of 0.7 pg TEQ kg-1 bw day-1.

Exposure to ionizing radiation and estimate of secondary cancers in the era of high-speed CT scanning: projections from the Medicare population.

PURPOSE: The aims of this study were to analyze the distribution and amount of ionizing radiation delivered by CT scans in the modern era of high-speed CT and to estimate cancer risk in the elderly, the patient group most frequently imaged using CT scanning. METHODS: A retrospective cohort study was conducted using Medicare claims spanning 8 years (1998-2005) to assess CT use. The data were analyzed in two 4-year cohorts, 1998 to 2001 (n = 5,267,230) and 2002 to 2005 (n = 5,555,345). The number and types of CT scans each patient received over the 4-year periods were analyzed to determine the percentage of patients exposed to threshold radiation of 50 to 100 mSv (defined as low) and >100 mSv (defined as high). The National Research Council's Biological Effects of Ionizing Radiation VII models were used to estimate the number of radiation-induced cancers. RESULTS: CT scans of the head were the most common examinations in both Medicare cohorts, but abdominal imaging delivered the greatest proportion (43% in the first cohort and 40% in the second cohort) of radiation. In the 1998 to 2001 cohort, 42% of Medicare patients underwent CT scans, with 2.2% and 0.5% receiving radiation doses in the low and high ranges, respectively. In the 2002 to 2005 cohort, 50% of Medicare patients received CT scans, with 4.2% and 1.2% receiving doses in the low and high ranges. In the two populations, 1,659 (0.03%) and 2,185 (0.04%) cancers related to ionizing radiation were estimated, respectively. CONCLUSIONS: Although radiation doses have been increasing along with the increasing reliance on CT scans for diagnosis and therapy, using conservative estimates with worst-case scenario methodology, the authors found that the risk for secondary cancers is low in older adults, the group subjected to the most frequent CT scanning. Trends showing increasing use, however, underscore the importance of monitoring CT utilization and its consequences.

The radiologist's guide to health services and policy research training.

OBJECTIVE: This article will briefly describe the driving forces of radiology's changing landscape because of health care reform and outline opportunities for radiologists in training to use health services and policy research skills to help show the value of radiologists in patient care, define the future business model of radiology, and shape wide-reaching public policy. CONCLUSION: The ability of our specialty to continue to thrive will require the presentation of sound evidence showing our added value to patients' overall health and well-being.

Creating a patient-centered imaging service: determining what patients want.

OBJECTIVE: The purpose of this study is to determine patients' preferences for how, from whom, and how soon they receive imaging results. MATERIALS AND METHODS: Hard copies of our survey were randomly distributed to patients at an academic medical center outpatient imaging facility for 9 weeks, during August through October 2008, to collect data regarding patient preferences for how they received results ("Method"), from whom ("Person"), and how quickly ("Speed"). RESULTS: A total of 129 (23%) of 557 patients (47.4% male; median age, 55 years) undergoing CT (62%) and MRI (38%) completed the survey. According to survey responses, results needed to be communicated within a few hours for an "acceptable" rating from 95% of patients. Thirty-one percent preferred to receive normal results by the fastest method, whereas 35% preferred to receive abnormal results by telephone. Patients did not show an overwhelming preference regarding which physician communicates the results. More than 25% of patients were indifferent as to who was giving the results and cared only about the speed of delivery. For normal results, 12% chose from the radiologist, 41% from the referring physician, 14% from both, and 33% from whoever is faster (p < 0.0001). For abnormal results, 6% chose from the radiologist, 41% from the referring physician, 27% from both, and 26% from whoever is faster (p < 0.0002). CONCLUSION: Patients in our study wanted their results communicated much sooner than is currently practiced. Optimizing patient satisfaction may require a new communication model.

The positive effect of targeted marketing on an existing uterine fibroid embolization practice.

PURPOSE: Although uterine fibroid embolization is an effective treatment option for symptomatic women, it is unclear what methods can be used to expand referrals in an already established practice. The authors tested the hypothesis that an advertising strategy focused on a defined target market can expand an existing uterine fibroid embolization practice. MATERIALS AND METHODS: A market-driven planning sequence was employed. This included a determination of goals, an examination of current competition, determination of target market based on local environment and previous consumer use, pretest of product sample, and implementation of advertisement. Based on the analysis the authors determined that the target audience was professional black women aged 35 to 45. A specific weekly magazine was selected due to readership demographics. An advertisement was run for 8 consecutive weeks. The authors prospectively tracked patient inquiries, clinic visits, cases performed, and revenues generated for 3 months following the initial advertisement. All patients were seen in a fully staffed, preexisting fibroid clinic located within an urban, university-based academic practice performing 250 uterine fibroid embolizations annually. RESULTS: Ninety calls were received directly related to the advertisement. There were 35 clinic visits, which resulted in 17 uterine fibroid embolizations and 52 total MR imaging procedures. Eighteen patients were not considered candidates based on established protocols. The 17 extra cases performed over 3 months represented a 27% increase in case volume. Total professional cash collections for these cases (including MR imaging) were 58,317 US dollars. The cost of advertising was 8,000 US dollars. As a result of existing infrastructure, no additional costs were necessary. This resulted in a net revenue gain 50,317 US dollars and a nonannualized rate of return of approximately 625%. CONCLUSION: As Interventional Radiologists look to develop and expand existing practices, traditional marketing tools such as those utilized in this study can be used to facilitate practice growth for specific clinical programs, such as uterine artery embolization. Defining a target market can significantly expand an existing uterine fibroid embolization practice. The optimal choice of targeted media awaits verification from future studies.

Endometriosis of the vastus lateralis muscle.

We report an unusual case of a woman who sought medical attention for a painful mass within her anterolateral left thigh. The patient's symptoms waxed and waned with her menses. Magnetic resonance imaging revealed a 3 cm mass isointense to muscle and surrounded by a rim of decreased signal intensity on T1-weighted images. T2-weighted images with fat saturation revealed a low signal intensity mass with a surrounding rind of high signal intensity edema. Based on its magnetic resonance imaging characteristics, the lesion was initially thought to represent the sequela of prior trauma or perhaps a small fibrous tumor. An excisional biopsy of the mass, however, revealed endometrial tissue, and a pathologic diagnosis of intramuscular endometriosis was rendered.