Decision Support
-Selection of imaging procedures is a key cost driver in Radiology.
This for the most part depends upon the education of the referring physician. Decision support in order entry can greatly assist.
-ACR appropriateness criteria- applies values for exam to a clinical condition.
Also includes a relative radiation level for each procedure.
-rather than allow a secretary to order the exam the physician is required to order the exam so she can receive feedback from the decision support order entry system to help them avoid low yielding exams.
-Virginia Mason uses a imaging decision support tool with check boxes to guide the ordering physician to order the correct exam.
– ER setting is challenging due to time constraints
-CPOE for radiology is a helpful way to integrate a decision support system into the workflow.
-Medicalis offers a decision support system based on Brigham and Women’s work.

Speaker quotes:
-Education is knowledge when you can’t use it
-Decision support is information you can use when you’re too busy to learn

-accuracy of decision support tool or radiologist separately aren’t as great as the synergy of accuracy when they are combined

Program to Enhance Relational and Communication Skills for Radiologists
This class wasn’t exactly what I expected but I enjoyed it very much. An interactive workshop on relational and communication skills by Harvard.
Giving Bad News
-must overcome possible communication barrier, relate to patient and deliver news so that patient can understand.
-establish expectations by asking why patient is being seen, find out what they are looking for.
-if Rads don’t connect with patient and require the primary physician to deliver news making the patient wait then they may feel abandoned and in limbo until they get results.
-give patient the option to review results with Radiologist or wait to learn results from Primary.

Relaying radiology dose to patient’s and their families
– relative uncertainty in determining effective dose is plus or minus 40 percent.
– when communicating with patients on dose it is helpful to relate to environmental exposure such as a trip across the country or hiking at high altitude where exposure is higher to the exposure of the ordered procedure
-ALARA is still best approach to radiation exposure
– CT machines are for the most part calibrated using adult phantoms.
-radiologists are often left defending the position of the ordering physician’s decision to risk Radiation exposure leading to the Radiologists also considering the ordering practiononer’s clinical effectiveness.
-Radiologist must sometimes be the gatekeeper when multiple exams are ordered multiplying the dose.