Appropriate imaging utilization in Japan: a survey of accredited radiology training hospitals.

PURPOSE: To survey whether imaging is being performed appropriately in Japan, and to survey whether radiologists intervene to ensure imaging requests are appropriate. METHODS: An online survey was sent to radiologists at accredited radiology training hospitals. The survey included the radiologists' perspectives on whether imaging is performed appropriately at their institutions and whether they intervene if the indication for imaging is inappropriate/ambiguous. RESULTS: The response rate was 87.3% (165/189). We observed marked variability in the frequencies that imaging not recommended by the guidelines was performed among modalities and/or body parts; the responses "very frequently/frequently performed" were more common for breast cancer related imaging examinations and for head CT/MRI. The respondents frequently reported that inappropriate/ambiguous indications included requests to expand the craniocaudal range or to perform whole-body imaging. In 80% of the hospitals (132/165), radiologists contacted the physicians who requested unrecommended examinations; the number of CT and MRI examinations that full-time radiologists need to interpret in a half-day session was significantly smaller at these hospitals (median 18 vs 24, P = 0.032). CONCLUSION: We conducted a survey to investigate appropriate imaging utilization in Japan. At the hospitals with numerous examinations to interpret, full-time radiologists may find it difficult to ensure that examinations are ordered appropriately.

[Diseases and procedures apt to conflict with patients: an analysis of medical malpractice litigation cases].

The aim of this study was to explore effective ways to prevent conflicts between patients and healthcare professionals by analyzing 836 malpractice cases. The analysis revealed two points that especially influence court decisions: disease prognosis and inadequate informed consent. Regarding prognosis, decisions are more in favor of the defendant (medical institution) in diseases with poor prognoses, such as sepsis and anaphylaxis, than in diseases with typically good prognoses, such as acute epiglottitis and strangulation ileus. Regarding insufficient informed consent, the cases fell into two groups, emergency and non-emergency. The non-emergency group consisted of cases such as preventative treatments for brain aneurysms and acute pancreatitis-related endoscopic retrograde cholangiopancreatography (ERCP), where essential information to consent to treatment, especially the prognosis with no treatment, was not given, despite sufficient time. The emergency group consisted of cases, such as acute coronary syndrome, especially treated by percutaneous coronary intervention (PCI), where there was not sufficient time to provide to patients information about treatments. This is the most difficult type of case and a subject for future efforts at clinical sites.

[Pitfalls in informed consent: a statistical analysis of malpractice law suits].

In medical malpractice law suits, the notion of informed consent is often relevant in assessing whether negligence can be attributed to the medical practitioner who has caused injury to a patient. Furthermore, it is not rare that courts award damages for a lack of appropriate informed consent alone. In this study, two results were arrived at from a statistical analysis of medical malpractice law suits. One, unexpectedly, was that the severity of a patient's illness made no significant difference to whether damages were awarded. The other was that cases of typical medical treatment that national medical insurance does not cover were involved significantly more often than insured treatment cases. In cases where damages were awarded, the courts required more disclosure and written documents of information by medical practitioners, especially about complications and adverse effects that the patient might suffer.

MR microscopy of articular cartilage at 1.5 T: orientation and site dependence of laminar structures.

OBJECTIVE: To evaluate MR microscopic images of normal-appearing porcine hyaline cartilage ( n=15) in vitro obtained with an MR microscope using an independent console system (MRMICS) at 1.5 T. DESIGN AND RESULTS: The MRMICS is a portable imaging system consisting of a radiofrequency system, gradient power supplies and a personal computer. The images from the MRMICS showed a laminar structure of porcine cartilage similar to the structure demonstrated with other MR imaging techniques. The laminar structures of the articular cartilage, were, however heterogeneous in respect of signal intensity and thickness, which varied according to the site resected. The MR laminar appearance was most comparable to the staining with Masson's trichrome for collagen. CONCLUSION: MRMICS is a useful add-on system for obtaining microscopic MR images of articular cartilage in vitro.