Continuous quality improvement process to track lost radiographs and reduce losses.

OBJECTIVE: To describe a quality improvement process that was initiated in a Department of Radiology to reduce the number of incomplete or "lost" imaging studies and decrease the time from the initiation of an imaging study to printing of the final report. METHODS: Incomplete cases were defined as those imaging studies that did not have a signed final report more than 3 days and less than 90 days after imaging. A computer program was written to generate a monthly incomplete case list from the radiology information system database; each step in the process, from patient arrival to final report printing, was analyzed and a list of root causes (for the incomplete cases) was developed. Short- and long-term interventions were introduced and the effects were monitored from 1992-1999. RESULTS: Problems were identified at each step in the process. Although some of the root causes originated outside the authority of the Department of Radiology, interventions we implemented within the department reduced the incomplete list by 72%, from a high of 2.8% of all imaging examinations to less than 0.8%. Continual monitoring of the problem is necessary to maintain this level. CONCLUSION: The number of incomplete or "lost" imaging studies can be decreased using a continuous quality improvement process. This leads to improved patient care and increased revenue.

Hepatic radioembolization with yttrium-90 containing glass microspheres: preliminary results and clinical follow-up.

UNLABELLED: The treatment of hepatic tumors remains unsatisfactory. These lesions receive most of their blood supply from the hepatic artery, therefore the hepatic artery administration of beta-emitting particulate radiopharmaceuticals is an attractive approach to deliver therapeutic irradiation to the liver and differentially to tumors within the liver. METHODS: A Phase I dose escalation study of the hepatic tolerance to radiation delivered by 90Y containing glass microspheres was carried out in 24 patients with hepatic malignancy. Doses of 90Y microspheres to achieve an estimated whole-liver nominal absorbed radiation dose of 5000 cGy (two patients), 7500 cGy (six patients), 10,000 cGy (seven patients), 12,500 cGy (six patients), and 15,000 cGy (three patients) were administered via the hepatic artery. The administered nominal absorbed radiation dose (NARD) was estimated based on liver volume determined from CT scans and the assumption of uniform distribution of microspheres throughout the liver. RESULTS: No hematologic, hepatic or pulmonary toxicity was encountered in the dose range examined during a mean follow-up period of up to 53 mo. Reversible gastritis or duodenitis was encountered in four patients without imaging or biopsy evidence for extrahepatic deposition of microspheres. Response data, based on CT scans obtained 16 wk after treatment, showed progressive disease in eight patients, stable disease in seven patients, minimal response in four patients and partial response in five patients. Subsequent follow-up revealed three long-term survivors at 204, 216 and 228 wk. CONCLUSIONS: These preliminary data demonstrate that in the examined dose range, radiation may be safely delivered to liver tumors by means of 90Y glass microspheres with encouraging response data.

Unit rod segmental spinal instrumentation for the treatment of neuromuscular scoliosis.

The Unit Rod was developed at the Hospital for Sick Children in Toronto for the surgical correction of scoliosis and pelvic obliquity associated with neuromuscular disease. Its unique contour and design allows fixation into the pelvis and decreases complications encountered with other segmental systems. Perioperative nursing care and the psychosocial impact of surgery on the family are addressed in this article. A case study is included.

Slow maxillary expansion: skeletal versus dental response to low magnitude force in Macaca mulatta.

Low-magnitude continuous force (1 to 2 pounds) was applied in a transverse direction to the palatal vault and posterior teeth of three rhesus monkeys to assess linear and angular changes of the maxilla versus those of the maxillary posterior teeth.