Action in the event tent! Medical-legal issues facing the volunteer event physician.

CONTEXT: Physicians need to consider medical-legal issues when volunteering their time to assist with community mass-participation and athletic events. This article also reviews medical-legal aspects of the volunteer physician's out-of-state practice. Seven cases illustrate the importance of expertise and planning to avoid legal issues for the volunteer event physician. EVIDENCE ACQUISITION: Relevant studies, expert opinion, medical-legal legislation, and medical-legal cases were reviewed. RESULTS: Physicians typically make 4 common assumptions regarding these types of events: Good Samaritan legislation, event liability insurance, personal liability insurance, and waivers. We discuss the intent of these assumptions and the reality of how, or how not, they provide any protection to the volunteer event physician. CONCLUSION: The intent of this article is to make physicians aware of medial-legal issues when volunteering their time for community and athletic events.

Compare display schemes for lung nodule CT screening.

This study investigated the relative efficiencies of a stereographic display and two monoscopic display schemes for detecting lung nodules in chest computed tomography (CT). The ultimate goal was to determine whether stereoscopic display provides advantages for visualization and interpretation of three-dimensional (3D) medical image datasets. A retrospective study that compared lung nodule detection performances achieved using three different schemes for displaying 3D CT data was conducted. The display modes included slice-by-slice, orthogonal maximum intensity projection (MIP), and stereoscopic display. One hundred lung-cancer screening CT examinations containing 647 nodules were interpreted by eight radiologists, in each of the display modes. Reading times and displayed slab thickness versus time were recorded, as well as the probability, location, and size for each detected nodule. Nodule detection performance was analyzed using the receiver operating characteristic method. The stereo display mode provided higher detection performance with a shorter interpretation time, as compared to the other display modes tested in the study, although the difference was not statistically significant. The analysis also showed that there was no difference in the patterns of displayed slab thickness versus time between the stereo and MIP display modes. Most radiologists preferred reading the 3D data at a slab thickness that corresponded to five CT slices. Our results indicate that stereo display has the potential to improve radiologists' performance for detecting lung nodules in CT datasets. The experience gained in conducting the study also strongly suggests that further benefits can be achieved through providing readers with additional functionality.

Characterization of radiologists' search strategies for lung nodule detection: slice-based versus volumetric displays.

The goal of this study was to assess whether radiologists' search paths for lung nodule detection in chest computed tomography (CT) between different rendering and display schemes have reliable properties that can be exploited as an indicator of ergonomic efficiency for the purpose of comparing different display paradigms. Eight radiologists retrospectively viewed 30 lung cancer screening CT exams, containing a total of 91 nodules, in each of three display modes [i.e., slice-by-slice, orthogonal maximum intensity projection (MIP) and stereoscopic] for the purpose of detecting and classifying lung nodules. Radiologists' search patterns in the axial direction were recorded and analyzed along with the location, size, and shape for each detected feature, and the likelihood that the feature is an actual nodule. Nodule detection performance was analyzed by employing free-response receiver operating characteristic methods. Search paths were clearly different between slice-by-slice displays and volumetric displays but, aside from training and novelty effects, not between MIP and stereographic displays. Novelty and training effects were associated with the stereographic display mode, as evidenced by differences between the beginning and end of the study. The stereo display provided higher detection and classification performance with less interpretation time compared to other display modes tested in the study; however, the differences were not statistically significant. Our preliminary results indicate a potential role for the use of radiologists' search paths in evaluating the relative ergonomic efficiencies of different display paradigms, but systematic training and practice is necessary to eliminate training curve and novelty effects before search strategies can be meaningfully compared.

Cardiovascular emergency preparedness in recreation facilities at major US universities: college fitness center emergency readiness.

Recent American Heart Association/American College of Sports Medicine (AHA/ACSM) guidelines advocate preparticipation screening, planning, and rehearsal for emergencies and automated external defibrillators in all health/fitness facilities. The authors evaluated adherence to these recommendations at 158 recreational service departments in major US universities (51% response rate for 313 institutions queried). Many made their facilities available to unaffiliated residents, with 39% offering programs for those with special medical conditions. Only 18% performed universal preparticipation screening. Twenty-seven percent reported having 1 or more exercise-related instances of cardiac arrest or sudden cardiac death within the past 5 years. Seventy-three percent had an automated external defibrillator, but only 6% reported using it in an emergency. Almost all had written emergency plans, but only 50% posted their plans, and only 27% performed the recommended quarterly emergency drills. The authors' findings suggest low awareness of and adherence to the AHA/ACSM recommendations for identifying individuals at risk for exercise-related cardiovascular complications and for handling such emergencies in university-based fitness facilities. (

Medical-legal issues of mild traumatic brain injury.

Numerous concussions/mild traumatic brain injuries occur each year during athletic participation by a variety of athletes not only in the United States but around the globe. A variety of standards-type statements have been developed by various athletic and sports medicine groups that can be used to improve and standardize the diagnosis and treatment of these injuries. These standards can also be used to assist practitioners in sports medicine clearance for participation and return-to-play decisions. In a medical-legal arena these statements can be used to support the care that is provided to athletes and thus serve as a "shield" to medical-legal claims and suits. However, these standards can also be used to attack the service that is provided and then be used as a "sword." Legal issues surrounding standards statements regarding these injuries and the diagnosis and management of them should be recognized and appreciated by sports medicine providers and used to balance the applicable medical and legal risks associated with their practices.

Practice Guidelines Take Center Court.

In brief An unintended result of practice brief guidelines, meant to codify and streamline high-quality patient care, is their role in the courtroom: to attack or to defend the delivery of medical care to athletes. Researchers predict that patients' attorneys will make greater use of practice guidelines in malpractice claims. The best tactic sports medicine physicians can use to prevent claims is to become familiar with and adopt applicable practice guidelines. Also, physicians need to know when they're deviating from the guidelines and how to defend such decisions.