Goal 1: Students will be clinically competent.Learning Outcomes1.1 Students will apply knowledge of radiographic procedures.1.2 Students will produce quality images.
radiographic pathology for technologists pdf 74
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The Program of Radiologic Technology at Grady Health System fulfills the curricular requirements for national certification through the American Registry of Radiologic Technologists (ARRT). The program is accredited by The Joint Review Committee on Education in Radiologic Technology (JRCERT). The state of Georgia does not currently require radiologic technologists to become licensed or certified to work in the state of Georgia.
The development of multidisciplinary team meetings (MDTMs) for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines.
The number of meetings to which pathology and radiology contribute at a large university teaching hospital, ranges from two to eight per day, excluding grand rounds, and amounts to approximately 50 meetings per month for each department. For one month, over 300 h were spent by pathologists and radiologists on 81 meetings, where almost 1000 patients were discussed. For each meeting hour, there were, on average, 2.4 pathology hours and 2 radiology hours spent in preparation. Two to three meetings per week are conducted over a teleconferencing link. Average meeting time is 1 h. Preparation time per meeting ranges from 0.3 to 6 h for pathology, and 0.5 to 4 for radiology. The review process in preparation for meetings improves internal quality standards. Materials produced externally (for example imaging) can amount to almost 50% of the material to be reviewed on a single patient. The number of meetings per month has increased by 50% over the past two years. Further increase is expected in both the numbers and duration of meetings when scheduling issues are resolved. A changing trend in the management of referred patients with the development of MDTMs and the introduction of teleconferencing was noted.
Difficulties are being experienced by pathology and radiology departments participating fully in several multidisciplinary teams. Time spent at meetings, and in preparation for MDTMs is significant. Issues of timing and the coordination of materials to be reviewed are sometimes irreconcilable. The exchange of patient materials with outside institutions is a cause for concern when full data are not made available in a timely fashion. The process of preparation for meetings is having a positive influence on quality, but more resources are needed in pathology and radiology to realise the full benefits of multidisciplinary team working.
Pathologists and radiologists are important contributors to multidisciplinary teams [9], and the role of these two specialists is different from other multidisciplinary team participants in that they often belong to several groups and actively contribute in many MDTMs. Radiology and pathology, with respect to their work organisation and input to meetings, have more similarities than differences. This paper analyses the work associated with MDTMs (and clinical pathology or radiology meetings) and identifies emerging effects in relation to time management, scheduling and pre-meeting work that the development of such meetings have on radiology and pathology departments. We show that senior staff in radiology and pathology now spend almost 20% of their time either preparing for, or participating in, meetings with clinical staff.
Terminology for meetings between radiology, pathology and clinical teams varies. The term multidisciplinary is applied to team meetings where both pathology and radiology contribute and at which physicians, surgeons, radiation and clinical oncologists, at a minimum, have input. Clinical-pathology and clinical-radiology conferences (CPCs and CRCs) are held between clinical teams and pathology and radiology staff respectively. Internal departmental processes are the same for MDTMs and CPCs or CRCs.
Participant observation of work practices, semi-structured interviews, literature review and the analysis of organizational records for quantitative data provided the material for this study. Meeting agendas and notes, radiological images and pathology samples used at meetings were examined. Internal pathology department records for 2003 enabled comparison with November 2005 data for pathology.
Meeting preparation work by medical staff was self-reported. Senior radiology and pathology staff were asked to prospectively note the time they spent on meeting preparation for the month of November 2005. At the end of that month, the time spent was reported in interview.
Figures quoted here are agreed averages and take account of the mixture of cases one would expect to encounter (biopsies, resections, type of image sets and repeat review) for an average meeting. Technical and administration work estimations are not fully quantified here. This paper focuses on the time spent by senior medical staff in radiology and pathology, i.e. at specialist registrar and consultant level.
Special focus was given to the month of November 2005, a 30-day month with 22 working days (Monday to Friday inclusive). The numbers and types of meetings held, the patients discussed, the radiological images used and pathology samples reviewed were counted. November 2005, was a typical working month and hence gives a representative view of MDTMs at St. James's hospital. Grand rounds and internal meetings, as part of postgraduate specialist training, were excluded.
The patient cases discussed at the selection of meetings involving radiology and pathology (Table 1) were also examined to measure the frequency of cases being discussed within the same type of MDTM and across different MDTMs for the period under study. For a sample of the MDTMs in November 2005, a more detailed examination was conducted to quantify the pathology specimens and radiological images reviewed that were the product of procedures performed elsewhere. Patient referral patterns were noted.
Table 1 gives an overview of the meeting schedule, the preparation involved and the mean numbers of patients discussed. The table includes all MDTMs, CPCs and CRCs. There are six meetings scheduled per week that involve both radiology and pathology together (MDTMs). There are an additional eight CRCs and seven CPCs per week. There are also twice monthly, monthly and other less frequent meetings. Table 1 summarises the meeting schedule, and those meetings held in November 2005. A total of 94 meetings were scheduled and 81 held that took 75.5 h. Eight CRCs, two CPCs and two MDTMs were cancelled due to unavailability of key personnel and one MDTM was cancelled because late circulation of the agenda did not allow adequate time for meeting preparation. Pathology was represented at 55 meetings that lasted a total of 57.75 h, while radiology was represented at 52 meetings that took 42.5 h in total for the month under study. Table 2 summarises the time spent in preparation and at meetings during the month of November 2005. Reported values take account of situations where images or samples might be quickly reviewed, might not be considered relevant to the discussion tabled, and hence would not be presented to the meeting.
At least one consultant radiologist and pathologist always attends an MDTM, and often two are designated members of a single multidisciplinary team (and hence two regularly attend). The total compliment of consultant staff in pathology and radiology is 7.9 and 9 full time equivalents (FTE) respectively, and almost 0.5 FTE is spent in attendance at meetings for each department.
Meetings held with either radiology or pathology, (CRCs and CPCs), represent situations where either (a) radiology or pathology serve more important clinical needs, (b) there is a high volume of work with limited discussion time, or (c) there is no time within the schedules for the people involved to be in the same place at the same time. Examples are: in vascular surgery, imaging is of key importance and pathology is not so significant; dermatologists rely heavily on pathology but do not have a great need for radiology. Dermatology hold two meetings: a weekly meeting to review non-cancer pathology and a second, twice monthly, to deal with skin cancer. For head, neck and thyroid (HNT), it was not possible to find a time for everyone to meet together, so the HNT specialists met with radiology and pathology on alternate weeks (which was less than satisfactory).
The review of external work serves as a check on the original report, both for opinion differences and expression. For radiology, the full image set is rarely available. For pathology, slides and processed tissue are received from referring institutions.
The internal review serves an internal quality assurance function within pathology and radiology. The material to be discussed is reviewed by the consultant, often in association with a registrar, and material for presentation is selected and prepared. Typically, the person reviewing the specimen for discussion is not the same person who undertook the initial examination within the main work process. Discrepancies in reports will be discussed within the department in the first instance and a revised or amended report can be issued in the light of those discussions. Practice differs in radiology and pathology with regard to the issue of contradictory reports, particularly in the absence of full image sets, and a formal policy remains to be agreed and established.
The issues of internal quality assurance for radiology and pathology will not be further covered here. It is sufficient to note that the practice of a second review of materials is a recognised method of improving quality in work processes [13]. In November 2005, the pathology department reviewed tissue samples on 628 patient cases. This represents almost 47% of the total caseload for that month. While an exact figure is not available for radiology for November 2005, the radiology department performs approximately 10 CT thorax scans per week, and reviews approximately 25 CT thorax scans for a Monday morning respiratory meeting. Approximately 2200 imaging studies are performed each week, and it is therefore conservatively estimated that between 10 to 15% of the radiology workload is reviewed in preparation for MDTMs. 2ff7e9595c
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