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Re: “Patient-centered Imaging: Opportunities and Challenges”
LETTERS TO THE EDITOR Re: “Patient-centered Imaging: Opportunities and Challenges” I read the opinion piece by Jha and Boonn [1] in JACR with great interest. It echoes my own views on how to individualize the performance of imaging examinations. There is indeed an important balance to be struck between standardized scanning and a more interactive mode of using all the advanced possibilities we have at our disposal, to be able to offer each patient the best examination he or she deserves. The authors correctly identify most of the pros and cons of patientcentered radiology. One of the main drawbacks is that radiologist supervision of ongoing examinations takes more time. However, there are ways to do this more effectively. Assuming that requests for examinations that allow an individualized approach, such as CT and MRI, are being vetted as they arrive in the radiology information system and are run through the process of justification, this is the ideal time to identify requests, and patients, that will benefit from nonstandardized scans. This can be accomplished if the clinical information has sufficient quality and if previous examinations and reports are available at the time of vetting.
Knowledge of the radiologic history simplifies the process of deciding whether a patient is equally well served using a standard imaging protocol or if an individualized examination is indicated. Early identification of these patients allow better planning and scheduling, not only of the patients and the examination rooms, but also of the radiologists, thus minimizing the time needed to accomplish a more patient-centered workflow. Two situations are especially important to recognize: patients with unclear symptoms, when the presence of a radiologist during the examination is prescribed to adjust the imaging in real time, and patients with multiple diseases and several clinical queries, when any single standard protocol is insufficient and the creative use of the modality enables most, if not all, queries to be answered in a single examination. In the latter case, it is usually possible to prescribe exactly how the individualized protocol should be performed, thus enabling the examination to be performed without direct supervision. However, there is clearly a need to document, at the time of vetting, the reasons to deviate from standard protocols and exactly how an examination has been planned, or
possible alternative variations that might be appropriate, depending on initial findings. Some indications can routinely benefit from radiologist interaction, to avoid for example unnecessary radiation and contrast media injections, if initial scans or nonenhanced scans are sufficient. This should then be a part of the standardized protocol, not a decision made for each patient. Within the European Union, radiation protection directives and subsequent national legislation are based on 3 principles: justification for each examination, optimization of each scanning protocol, and minimizing the dose to the individual. A more patient-centered approach to imaging is clearly a way to achieve these goals. Anders von Heijne, MD Department of Radiology Danderyd Hospital Karolinska Institute S182 88 Stockholm Sweden e-mail: [email protected] REFERENCE 1. Jha S, Boonn W. Patient-centered imaging: opportunities and challenges. J Am Coll Radiol 2012;9:157-9. http://dx.doi.org/10.1016/j.jacr.2012.03.007 ● S1546-1440(12)00147-0
450 0091-2182/12/$36.00
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© 2012 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2012.03.007
Knowledge of the radiologic history simplifies the process of deciding whether a patient is equally well served using a standard imaging protocol or if an individualized examination is indicated. Early identification of these patients allow better planning and scheduling, not only of the patients and the examination rooms, but also of the radiologists, thus minimizing the time needed to accomplish a more patient-centered workflow. Two situations are especially important to recognize: patients with unclear symptoms, when the presence of a radiologist during the examination is prescribed to adjust the imaging in real time, and patients with multiple diseases and several clinical queries, when any single standard protocol is insufficient and the creative use of the modality enables most, if not all, queries to be answered in a single examination. In the latter case, it is usually possible to prescribe exactly how the individualized protocol should be performed, thus enabling the examination to be performed without direct supervision. However, there is clearly a need to document, at the time of vetting, the reasons to deviate from standard protocols and exactly how an examination has been planned, or
possible alternative variations that might be appropriate, depending on initial findings. Some indications can routinely benefit from radiologist interaction, to avoid for example unnecessary radiation and contrast media injections, if initial scans or nonenhanced scans are sufficient. This should then be a part of the standardized protocol, not a decision made for each patient. Within the European Union, radiation protection directives and subsequent national legislation are based on 3 principles: justification for each examination, optimization of each scanning protocol, and minimizing the dose to the individual. A more patient-centered approach to imaging is clearly a way to achieve these goals. Anders von Heijne, MD Department of Radiology Danderyd Hospital Karolinska Institute S182 88 Stockholm Sweden e-mail: [email protected] REFERENCE 1. Jha S, Boonn W. Patient-centered imaging: opportunities and challenges. J Am Coll Radiol 2012;9:157-9. http://dx.doi.org/10.1016/j.jacr.2012.03.007 ● S1546-1440(12)00147-0
450 0091-2182/12/$36.00
●
© 2012 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2012.03.007