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The disabled residency candidate and federal law: Implications of the Americans with disabilities act
M e t h o d s : Surveys were mailed by the RSNA Office of Research Develo p m e n t to m e m b e r s of t h e SCAROP and the SCARD. Tllree mailings were sent to 224 m e m b e r s with 131 responses to date for a response rate of 64.7%. Results: Based on preliminary results, 83% reported they had s o m e level of funding and 68% indicating funding of m o r e than $100,000 in 1995. Fifty p e r c e n t indicated they had no m o r e than 9 faculty (fulltime or part-time) w h o c o n d u c t e d research; Fifty percent said they had no more than 6 faculty with research funding (internal or external); and fifty p e r c e n t reported that n o m o r e than one faculty m e m b e r was involved with radiology research o n a full-time basis. C o n c l u s i o n s ; O n a department basis, c o m m i t m e n t of resources to radiological research is relatively low and only about half t h e departments have a current plan for conducting radiological research or recruiting faculty with research expertise. Take H o m e P o i n t s : Average ftmding from outside (the department setting) sources in 1995 w a s $1.2 million. An average of 3.7 faculty members p e r institution conduct research on a flail-time basis.
Results: There were 21 females and 29 males with the m e a n age of 41 years. The most c o m m o n presenting complaint w a s abdominal pain. CT scans were positive in 25 cases, m o r e c o m m o n l y w h e n the patient had been evaluated by a consultant service. (25/38, 66% vs. 0/12 0% respectively p<0.0002). CT diagnosis was concordant with clinical diagnosis in only 48% of cases. Elevated white cell c o u n t greater than 12,000 was t h e only laboratory finding predictive of a positive CT scan. CT scan results changed the m a n a g e m e n t in 12 patients (24%). Conclusions: Abdominal CT scans are rarely positive w h e n ordered from t h e ER. CT scans are more likely to be positive if there is an elevated WBC or if t h e patient is seen by a consultant prior to the scan. Possible explanations m a y include that this is an overutllized study by t h e ER, underutilization of consult services or incomplete clinical assessment by the ER.
4- 25 The Disabled R e s i d e n c y C a n d i d a t e a n d Federal Law: Implications of t h e A m e r i c a n s with Disabilities A c t
Patricia A. Smith, MD, Johns Hopkins Hospital, Baltimore, MD, Andrew Klein, MD, Elliot K. Fishman, MD
John J. Smith, MD, JD, University of Virginia Health Sciences Center, Charlottesville, VA, SpencerB. Gay, MD P u r p o s e : To investigate t h e potential impact of the Americans with Disabilities Act (ADA) on radiology residency programs. M e t h o d s : Review of t h e ADA, court decisions based on t h e ADA and related federal statutes in LEXIS/NEX/S and WESTLAW databases. Results: Medical students with physical disabilities have sought residency positions in diagnostic radiology. There is little doubt that any significant physical disability qualifies an individual as "disabled" under t h e ADA, a federal statute that prohibits discrimination against the disabled solely on the basis of their disability. The ADA imposes an obligation on an employer to make reasonable accommodations for otherwise qualified disabled applicants, unless u n d u e hardship w o u l d result. The application of disabled individuals raises the question of whether substantive residency requirements demanding certain levels of physical dexterity m u s t be altered to a c c o m m o d a t e those with physical disabilities. Conclusion: Accommodations that fundamentally alter the content of a residency training program are not required by the ADA. Residency requirements demanding physical dexterity that are essential to the training of diagnostic radiologists are allowable. Such requirements should be prospectively identified and their relevancy to the residency documented to aid in the defense of any legal challenge.
4. 26 Has t h e Physical E x a m i n a t i o n B e c o m e Obsolete? T h e Usefulness of A b d o m i n a l C o m p u t e d T o m o g r a p h y Ordered from t h e E m e r g e n c y Room
PeterB. Park, MO, Mount Sinai Medical Center, New York, NY, John O. Cunningham, MD, Neville Glajchen, MB, BOh Purpose: To determine the diagnostic usefulness of abdominal CT scans ordered from the e m e r g e n c y r o o m and to determine their impact on patient management. Materials: A retrospective chart review was performed on 50 consecutive patients from the e m e r g e n c y r o o m for c o m p u t e d tomography. Charts were reviewed for presenting complaints, physical findings, laboratory findings, and plain abdominal x-ray evaluations. The ER diagnosis was d o c u m e n t e d as was the consultant diagnosis. These diagnoses were correlated with the CT fmdings.
5- 27 Dual Phase Spiral CT Angiography with V o l u m e t r i c 3D Rendering for Liver T r a n s p l a n t Evaluation: Preliminary Observations
P u r p o s e : To help determine w h e t h e r dual phase spiral CT anglographic examination with 3D volume rendering can be used to evaluate potential liver transplantation candidates. The goal w o u l d be to develop a single, noninvasive examination that provides all necessary information for presurgical planning and patient selection. M a t e r i a l s a n d M e t h o d s : 36 consecutive potential candidates for liver transplantation were evaluated with dual phase spiral CT with 3D volttme rendering. The protocol consisted of a dual phase spiral CT (arterial phase acquisition at 30 seconds after initiation of contrast injection followed by portal venous p h a s e beginning around 60 seconds) with scan parameters of 0.75 scans, 3 m m collimation, 5-6 ram/see table speed and reconstruction at 3 m m intervals for both e x a m components. All scan information was then sent to a free standing workstation (Silicon Graphics Onyx, Mountain View, CA) w h e r e interactive real time 3D volume rendering was performed. The arterial phase was used to create vascular m a p s of the celiac axis including the origin(s) of t h e hepatic artery and SMA. The portal phase was used to define portal venous patency as well as the hepatic venous anatomy. All images were analyzed for vascular patency, shunting or collateralization as well as t h e status of the underlying liver (i.e., cirrhosis, tumor, etc.). Results: All studies were successfully completed without complication. 3D vascular m a p s defined key arterial and venous structures ineluding origin(s) of t h e hepatic artery, portal vein and/or SMV thrombosis, cavernous transformation of the portal vein or other collateral pathways. Underlying liver tumors (including hepatic adenomas) as well as parenchymal liver disease were well defmed. Conclusion: Preliminary results suggest that dual phase spiral CT with 3D reconstruction can provide a comprehensive pre-liver transplant evaluation. This should significantly impact patient care by minimizing procedures, limiting costs and avoiding potential complications. T a k e H o m e Points: (1)Proper spiral CT protocols and rendering techniques are critical to producing quality 3D images. (2)Dual p h a s e spiral CT coupled with CT anglography m a y provide a single comprehensive e x a m for preoperative liver transplantation candidates. F i n a n c i a l D i s c l o s u r e : Elliot Fishman, MD Medical Advisor, Siemens Medical Systems, Iselin, NJ
5- 28 M u c o s a l Apposition Artifacts in Double Contrast Radiography
Vahid Yaghmai, MD, Evanston Hospital, Evanston, IL, Gary G. Ghahremani, MD, E. MaureenWhite, MD, Richard M. Gore, MD Objective: To investigate the m e c h a n i s m s for development o f m u cosal apposition artifacts and to illustrate the resulting pseudolesions during double contrast radiography. M a t e r i a l s a n d M e t h o d s : Experiments were performed by graded
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Results: There were 21 females and 29 males with the m e a n age of 41 years. The most c o m m o n presenting complaint w a s abdominal pain. CT scans were positive in 25 cases, m o r e c o m m o n l y w h e n the patient had been evaluated by a consultant service. (25/38, 66% vs. 0/12 0% respectively p<0.0002). CT diagnosis was concordant with clinical diagnosis in only 48% of cases. Elevated white cell c o u n t greater than 12,000 was t h e only laboratory finding predictive of a positive CT scan. CT scan results changed the m a n a g e m e n t in 12 patients (24%). Conclusions: Abdominal CT scans are rarely positive w h e n ordered from t h e ER. CT scans are more likely to be positive if there is an elevated WBC or if t h e patient is seen by a consultant prior to the scan. Possible explanations m a y include that this is an overutllized study by t h e ER, underutilization of consult services or incomplete clinical assessment by the ER.
4- 25 The Disabled R e s i d e n c y C a n d i d a t e a n d Federal Law: Implications of t h e A m e r i c a n s with Disabilities A c t
Patricia A. Smith, MD, Johns Hopkins Hospital, Baltimore, MD, Andrew Klein, MD, Elliot K. Fishman, MD
John J. Smith, MD, JD, University of Virginia Health Sciences Center, Charlottesville, VA, SpencerB. Gay, MD P u r p o s e : To investigate t h e potential impact of the Americans with Disabilities Act (ADA) on radiology residency programs. M e t h o d s : Review of t h e ADA, court decisions based on t h e ADA and related federal statutes in LEXIS/NEX/S and WESTLAW databases. Results: Medical students with physical disabilities have sought residency positions in diagnostic radiology. There is little doubt that any significant physical disability qualifies an individual as "disabled" under t h e ADA, a federal statute that prohibits discrimination against the disabled solely on the basis of their disability. The ADA imposes an obligation on an employer to make reasonable accommodations for otherwise qualified disabled applicants, unless u n d u e hardship w o u l d result. The application of disabled individuals raises the question of whether substantive residency requirements demanding certain levels of physical dexterity m u s t be altered to a c c o m m o d a t e those with physical disabilities. Conclusion: Accommodations that fundamentally alter the content of a residency training program are not required by the ADA. Residency requirements demanding physical dexterity that are essential to the training of diagnostic radiologists are allowable. Such requirements should be prospectively identified and their relevancy to the residency documented to aid in the defense of any legal challenge.
4. 26 Has t h e Physical E x a m i n a t i o n B e c o m e Obsolete? T h e Usefulness of A b d o m i n a l C o m p u t e d T o m o g r a p h y Ordered from t h e E m e r g e n c y Room
PeterB. Park, MO, Mount Sinai Medical Center, New York, NY, John O. Cunningham, MD, Neville Glajchen, MB, BOh Purpose: To determine the diagnostic usefulness of abdominal CT scans ordered from the e m e r g e n c y r o o m and to determine their impact on patient management. Materials: A retrospective chart review was performed on 50 consecutive patients from the e m e r g e n c y r o o m for c o m p u t e d tomography. Charts were reviewed for presenting complaints, physical findings, laboratory findings, and plain abdominal x-ray evaluations. The ER diagnosis was d o c u m e n t e d as was the consultant diagnosis. These diagnoses were correlated with the CT fmdings.
5- 27 Dual Phase Spiral CT Angiography with V o l u m e t r i c 3D Rendering for Liver T r a n s p l a n t Evaluation: Preliminary Observations
P u r p o s e : To help determine w h e t h e r dual phase spiral CT anglographic examination with 3D volume rendering can be used to evaluate potential liver transplantation candidates. The goal w o u l d be to develop a single, noninvasive examination that provides all necessary information for presurgical planning and patient selection. M a t e r i a l s a n d M e t h o d s : 36 consecutive potential candidates for liver transplantation were evaluated with dual phase spiral CT with 3D volttme rendering. The protocol consisted of a dual phase spiral CT (arterial phase acquisition at 30 seconds after initiation of contrast injection followed by portal venous p h a s e beginning around 60 seconds) with scan parameters of 0.75 scans, 3 m m collimation, 5-6 ram/see table speed and reconstruction at 3 m m intervals for both e x a m components. All scan information was then sent to a free standing workstation (Silicon Graphics Onyx, Mountain View, CA) w h e r e interactive real time 3D volume rendering was performed. The arterial phase was used to create vascular m a p s of the celiac axis including the origin(s) of t h e hepatic artery and SMA. The portal phase was used to define portal venous patency as well as the hepatic venous anatomy. All images were analyzed for vascular patency, shunting or collateralization as well as t h e status of the underlying liver (i.e., cirrhosis, tumor, etc.). Results: All studies were successfully completed without complication. 3D vascular m a p s defined key arterial and venous structures ineluding origin(s) of t h e hepatic artery, portal vein and/or SMV thrombosis, cavernous transformation of the portal vein or other collateral pathways. Underlying liver tumors (including hepatic adenomas) as well as parenchymal liver disease were well defmed. Conclusion: Preliminary results suggest that dual phase spiral CT with 3D reconstruction can provide a comprehensive pre-liver transplant evaluation. This should significantly impact patient care by minimizing procedures, limiting costs and avoiding potential complications. T a k e H o m e Points: (1)Proper spiral CT protocols and rendering techniques are critical to producing quality 3D images. (2)Dual p h a s e spiral CT coupled with CT anglography m a y provide a single comprehensive e x a m for preoperative liver transplantation candidates. F i n a n c i a l D i s c l o s u r e : Elliot Fishman, MD Medical Advisor, Siemens Medical Systems, Iselin, NJ
5- 28 M u c o s a l Apposition Artifacts in Double Contrast Radiography
Vahid Yaghmai, MD, Evanston Hospital, Evanston, IL, Gary G. Ghahremani, MD, E. MaureenWhite, MD, Richard M. Gore, MD Objective: To investigate the m e c h a n i s m s for development o f m u cosal apposition artifacts and to illustrate the resulting pseudolesions during double contrast radiography. M a t e r i a l s a n d M e t h o d s : Experiments were performed by graded
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