Automated Quantitative Analysis of American College of Radiology PET Phantom Images.

Evaluation of PET image quality is central to annual physics surveys, quality assurance, and laboratory accreditation. A common method is to image the American College of Radiology (ACR) PET phantom, which contains hot and cold structures of various sizes in a warm background. Performance evaluation involves qualitative assessment of hot and cold structure visibility and overall image quality. Some criteria are quantitative and rely on manually drawn regions of interest (ROIs) to measure SUV. Fully automated scoring of ACR PET phantom images would improve efficiency, avoid observer-related dependencies, and possibly provide more robust evaluation of image quality. Methods: Software was developed to coregister PET images to a phantom template and to compute ROI measurements of hot vial activity (SUVmax) and background activity (SUVmean) automatically. In addition, 3-dimensional volumes of interest (VOIs) were generated to measure hot vial activity (SUVvial), background activity, and cold rod contrast. Consistency of the ROI-based and VOI-based methods was evaluated using phantom data from a total of 17 annual physics surveys of 3 PET/CT scanners with the same PET detector design. Results: The automated software processed all PET phantom datasets successfully. SUV consistency for hot vials was improved through use of cylindric VOIs and through normalization with respect to assayed activities and dilution volumes used in phantom preparation. Average vial SUV SD improved from 8.0% for standard SUVmax to 3.2% for normalized SUVvial Similarly, the SD for the SUV ratio of 16- to 25-mm vials improved from 5.0% for SUVmax to 3.2% for SUVvial Background SUVmean had a similar consistency between the ROI and VOI methods. Cold rod contrast was highly consistent, offering a potential alternative to qualitative visual assessment of low-contrast performance. Conclusion: Automated quantitative scoring of the ACR PET phantom is feasible and offers the advantages of more efficient, consistent, and thorough performance characterization. Acceptance ranges for SUVs and ratios likely can be tightened if normalized VOI measurements are used. Further testing with phantom data from a variety of PET scanners is necessary to establish suitable quantitative thresholds for acceptable performance.

Impact of regulatory science on global public health.

Regulatory science plays a vital role in protecting and promoting global public health by providing the scientific basis for ensuring that food and medical products are safe, properly labeled, and effective. Regulatory science research was first developed for the determination of product safety in the early part of the 20th Century, and continues to support innovation of the processes needed for regulatory policy decisions. Historically, public health laws and regulations were enacted following public health tragedies, and often the research tools and techniques required to execute these laws lagged behind the public health needs. Throughout history, similar public health problems relating to food and pharmaceutical products have occurred in countries around the world, and have usually led to the development of equivalent solutions. For example, most countries require a demonstration of pharmaceutical safety and efficacy prior to marketing these products using approaches that are similar to those initiated in the United States. The globalization of food and medical products has created a shift in regulatory compliance such that gaps in food and medical product safety can generate international problems. Improvements in regulatory research can advance the regulatory paradigm toward a more preventative, proactive framework. These improvements will advance at a greater pace with international collaboration by providing additional resources and new perspectives for approaching and anticipating public health problems. The following is a review of how past public health disasters have shaped the current regulatory landscape, and where innovation can facilitate the shift from reactive policies to proactive policies.

What can family medicine practices do to facilitate knowledge management?

BACKGROUND: Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics. PURPOSE: To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM. METHODOLOGY/APPROACH: We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role). FINDINGS: Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes of these effects were not substantially changed even when practice members perceived their practice environment as more chaotic. PRACTICE IMPLICATIONS: Steps to facilitate KM should be considered when evaluating more intensive and costly organizational solutions for enhancing family medicine practice performance.