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Lean principles
POSTER SESSIONS
Posters Level 3 Central Concourse Clinical Practice Abstract No. 251 Comparison of the zerogravity radiation protection system vs. standard lead apron plus ancillary shielding during clinical interventional procedures C. Shaw, C.R. Rees, A. Bruner, C.M. Savage; Radiology, Baylor University Medical Center, Dallas, TX Purpose: This study was performed in the clinical setting to compare the radiation protective properties of conventional lead aprons and hanging shields (LA) to an alternative device intended to improve protection, eliminate weight, and allow full freedom of motion (ZG). Materials and Methods: Two interventional radiologists performed normal clinical procedures while using one of 2 methods of radiation protection. Method LA: conventional skirt, vest, thyroid shield, under-table skirt, side-table skirt, lead acrylic hanging shield. N⫽21, Fluoroscopy⫽175 minutes. Method ZG: ZeroGravity device, under-table skirt, intermittent use of side-table skirt, non-use of hanging shield. N⫽19, Fluoroscopy⫽195 minutes. The second-generation model of the overhead-supported ZeroGravity System (CFI Medical Solutions) has a curved leadacrylic head shield (0.5 mm Pb), and lead apron that extends to the distal calves (1mm Pb centrally [63.5X69.3 cm], 0.5 mm peripherally) with 0.5 mm Pb flaps that hang over the arms to the elbows. A sterile plastic drape permits quick entry and exit while maintaining sterility. Primary operators performed a variety of interventional radiologic procedures from different anatomic approaches while wearing optically stimulated luminescence dosimeter badges positioned on various body locations. Results: Exposure/minute of fluoroscopy for operator body locations are in the Table. Operator Exposures (microSieverts/minute of fluoroscopy) Chest Head (L. Arm Hip (L. (near L. Neck (L. eye) anterior) breast) (humerus) anterior) LA ZG Reduction
1.81 0.15 1.66 (92%)
1.18 M* 1.18
0.15 M* 0.15
3.70 0.82 2.88 (78%)
0.27 M* 0.27
Tibia (L.) 4.39 0.51 3.88 (88%)
Back (mid waist) 0.10 M* 0.10
Poster Sessions
*Below minimum detectable for these dosimeters in this sample size.
Conclusion: Operator exposures using ZG were substantially reduced compared to LA, especially for body areas covered by ZG but not by LA. Although reductions of under-lead doses (breast, hip, back) are consistent with increased Pb equivalency, accurate determination of under lead doses are not possible using these dosimeters in this sample size. LA Neck exposures are believed to be due to mismatch of apron and thyroid shield leaving a gap that was subsequently addressed.
Abstract No. 252 Optimizing work flow in interventional radiology using 6 Sigma/Lean principles D.B. Brown, R. Webster, V. Sarro, V.M. Rao; Thomas Jefferson University, Philadelphia, PA Purpose: To evaluate flow changes in an Interventional Radiology division after applying 6 Sigma/Lean principles to improve patient flow and satisfaction. These principles are designed to maximize efficient utilization of resources. Materials and Methods: A workgroup consisting of Hospital administrators with 6 Sigma training, IR physicians, IR technical staff and Radiology administrators reviewed workflow and operations and created a Balanced Scorecard to track outcomes. Strategic values included: Operations measured by first case start times (benchmark 8:30 am), decreased room turnover time (benchmark less than 25 minutes); Service measured by wait time for an outpatient procedure (benchmark 3 days) and Press-Ganey/ likelihood to recommend score; Growth in patient visits (benchmark 5% in FY 09 and 5% in FY 10). Changes in overtime utilization and generated RVU’s against historical data were also reviewed. Results: Several scheduling and workflow adjustments were made to achieve the target metrics after evaluation. On time starts increased from 24% to 91%. Room turnover within 25 minutes increased from 55% to 93%. The Press-Ganey score increased from 90.6 to 94.2. Increased efficiency led to expansion of the outpatient schedule dropping the outpatient wait time for an appointment from 7 days to 1 day. Overall volume increased by 14.3%. Compared to historical data, generated RVU’s increased by 10.6% from FY 2008 to 2010. IR overtime utilization and associated costs decreased by 41% from FY 2008 to 2010. Conclusion: By utilizing 6 Sigma/Lean principles, our division was able to increase efficiency, service and volume while cutting overtime utilization.
Educational Exhibit
Abstract No. 253
Cost considerations in interventional oncology: Are IO treatments expensive relative to the alternatives? D. Sella, W.S. Rilling; Medical College of Wisconsin, Milwaukee, WI Learning Objectives: Healthcare reform will demand that interventional oncology treatments demonstrate not only therapeutic benefit but also cost effectiveness. There is a perception within the medical community that interventional radiology procedures are overall more expensive than their noninvasive medical alternatives. This educational exhibit will provide basic cost data for multiple interventional oncology procedures with direct comparison to alternative therapies. The aim is to provide a simplified view of data that may be used as stepping stone in the development of future cost analysis studies. Background: Data from Medicare CPT codes as well as Medicare Part B Payment Allowances was compiled to determine the costs of various interventional procedures, chemotherapy regimens, definitive radiation and stereotactic body radiation therapy
Posters Level 3 Central Concourse Clinical Practice Abstract No. 251 Comparison of the zerogravity radiation protection system vs. standard lead apron plus ancillary shielding during clinical interventional procedures C. Shaw, C.R. Rees, A. Bruner, C.M. Savage; Radiology, Baylor University Medical Center, Dallas, TX Purpose: This study was performed in the clinical setting to compare the radiation protective properties of conventional lead aprons and hanging shields (LA) to an alternative device intended to improve protection, eliminate weight, and allow full freedom of motion (ZG). Materials and Methods: Two interventional radiologists performed normal clinical procedures while using one of 2 methods of radiation protection. Method LA: conventional skirt, vest, thyroid shield, under-table skirt, side-table skirt, lead acrylic hanging shield. N⫽21, Fluoroscopy⫽175 minutes. Method ZG: ZeroGravity device, under-table skirt, intermittent use of side-table skirt, non-use of hanging shield. N⫽19, Fluoroscopy⫽195 minutes. The second-generation model of the overhead-supported ZeroGravity System (CFI Medical Solutions) has a curved leadacrylic head shield (0.5 mm Pb), and lead apron that extends to the distal calves (1mm Pb centrally [63.5X69.3 cm], 0.5 mm peripherally) with 0.5 mm Pb flaps that hang over the arms to the elbows. A sterile plastic drape permits quick entry and exit while maintaining sterility. Primary operators performed a variety of interventional radiologic procedures from different anatomic approaches while wearing optically stimulated luminescence dosimeter badges positioned on various body locations. Results: Exposure/minute of fluoroscopy for operator body locations are in the Table. Operator Exposures (microSieverts/minute of fluoroscopy) Chest Head (L. Arm Hip (L. (near L. Neck (L. eye) anterior) breast) (humerus) anterior) LA ZG Reduction
1.81 0.15 1.66 (92%)
1.18 M* 1.18
0.15 M* 0.15
3.70 0.82 2.88 (78%)
0.27 M* 0.27
Tibia (L.) 4.39 0.51 3.88 (88%)
Back (mid waist) 0.10 M* 0.10
Poster Sessions
*Below minimum detectable for these dosimeters in this sample size.
Conclusion: Operator exposures using ZG were substantially reduced compared to LA, especially for body areas covered by ZG but not by LA. Although reductions of under-lead doses (breast, hip, back) are consistent with increased Pb equivalency, accurate determination of under lead doses are not possible using these dosimeters in this sample size. LA Neck exposures are believed to be due to mismatch of apron and thyroid shield leaving a gap that was subsequently addressed.
Abstract No. 252 Optimizing work flow in interventional radiology using 6 Sigma/Lean principles D.B. Brown, R. Webster, V. Sarro, V.M. Rao; Thomas Jefferson University, Philadelphia, PA Purpose: To evaluate flow changes in an Interventional Radiology division after applying 6 Sigma/Lean principles to improve patient flow and satisfaction. These principles are designed to maximize efficient utilization of resources. Materials and Methods: A workgroup consisting of Hospital administrators with 6 Sigma training, IR physicians, IR technical staff and Radiology administrators reviewed workflow and operations and created a Balanced Scorecard to track outcomes. Strategic values included: Operations measured by first case start times (benchmark 8:30 am), decreased room turnover time (benchmark less than 25 minutes); Service measured by wait time for an outpatient procedure (benchmark 3 days) and Press-Ganey/ likelihood to recommend score; Growth in patient visits (benchmark 5% in FY 09 and 5% in FY 10). Changes in overtime utilization and generated RVU’s against historical data were also reviewed. Results: Several scheduling and workflow adjustments were made to achieve the target metrics after evaluation. On time starts increased from 24% to 91%. Room turnover within 25 minutes increased from 55% to 93%. The Press-Ganey score increased from 90.6 to 94.2. Increased efficiency led to expansion of the outpatient schedule dropping the outpatient wait time for an appointment from 7 days to 1 day. Overall volume increased by 14.3%. Compared to historical data, generated RVU’s increased by 10.6% from FY 2008 to 2010. IR overtime utilization and associated costs decreased by 41% from FY 2008 to 2010. Conclusion: By utilizing 6 Sigma/Lean principles, our division was able to increase efficiency, service and volume while cutting overtime utilization.
Educational Exhibit
Abstract No. 253
Cost considerations in interventional oncology: Are IO treatments expensive relative to the alternatives? D. Sella, W.S. Rilling; Medical College of Wisconsin, Milwaukee, WI Learning Objectives: Healthcare reform will demand that interventional oncology treatments demonstrate not only therapeutic benefit but also cost effectiveness. There is a perception within the medical community that interventional radiology procedures are overall more expensive than their noninvasive medical alternatives. This educational exhibit will provide basic cost data for multiple interventional oncology procedures with direct comparison to alternative therapies. The aim is to provide a simplified view of data that may be used as stepping stone in the development of future cost analysis studies. Background: Data from Medicare CPT codes as well as Medicare Part B Payment Allowances was compiled to determine the costs of various interventional procedures, chemotherapy regimens, definitive radiation and stereotactic body radiation therapy