Rad primer Flashcards
What is a standard elective pre med regimen for contrast allergies?
Prednisone 50 mg by mouth at 13 hours, 7 hours, and 1 hour before contrast media injection
plus Diphenhydramine (Benadryl) 50 mg by mouth 1 hour before contrast medium
What does RVU stand for?
Relative value unit
“To Err is Human: Building a Safer Health System” published in 1999, concluded that between 44,000 and 98,000 deaths per year could be attributable to medical errors. The report identified several fundamental factors contributing to the errors, including:
(1) the decentralized nature of the healthcare delivery “non-system,”
(2) the failure of the licensing systems to focus on errors,
(3) the impediment of the liability system to identify errors, and
(4) the failure of 3rd-party providers to provide financial incentive to improve safety. Most errors were felt to be system errors rather than individual problems.
Recent healthcare reform has emphasized value over volume. What is the definition of value?
Value (from the perspective of the patient) has been defined as outcomes divided by costs.
So, value can be increased by either improving outcomes (increased quality and decreased harms) or by reducing costs.
Are peer review systems protected from mediolegal discovery?
Peer review systems are fully protected from medicolegal discovery.
Peer review programs are designed to maintain standards of quality, to improve radiologist performance, and to provide credibility to oversight organizations just as the Joint Commission.
Extrinsic warming of iodinated contrast material to human body temperature (37°C) may be helpful under what circumstances?
Extrinsic warming of iodinated contrast material to human body temperature (37°C) may be helpful to minimize complications and improve vascular opacification in the following circumstances:
- For high-rate (> 5 mL/second) IV LOCM power injections.
- For injections of viscous iodinated contrast (e.g., iopamidol 370, and presumably other contrast media with a similar or higher viscosity).
- For direct arterial injections through small-caliber catheters (5 French or smaller).
-For intravenously injected arterial studies in which timing and peak
enhancement are critical features.
What is the “Choosing Wisely” campaign, and what Radiology oversight group is involved?
Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) Foundation to help providers and patients engage in conversations to reduce overuse of tests and procedures, and support patients in their efforts to make smart and effective care choices.
The American College of Radiology (ACR) has engaged with this effort to identify “five things physicians and patients should question.
https: //www.choosingwisely.org/societies/american-college-of-radiology/
1) Don’t do imaging for uncomplicated headache
2) Don’t image for suspected PE without moderate or high pre-test probability of pE
3) Avoid admission or preop chest XR for ambulatory patients with unremarkable history and physical exam
4) Don’t do computed tomography for the evaluation of suspected appendicitis in children until after US has been considered an option
5) Don’t recommend f/u imaging for clinically inconsequential adnexal cysts
6) Don’t recommend US for incidental thyroid nodules for on CT, MRI or non thyroid focused neck US in low risk patients unless the nodule meets age-based size criteria or has suspicious features
Carpel tunnel syndrome is one of the more common repetitive use injuries for radiologists. It is associated with which prolonged wrist position?
The injury comes from prolonged/repetitive wrist extension (dorsiflexion) and ulnar deviation. Suggested mitigation strategies include using split keyboards and a negative incline (tilt) to the keyboard.
In Lean Process Improvement, work accumulating in a queue is considered a fundamental source of waste. What methodology strives to eliminate this type of waste?
Pull-systems and kanbans are practical solutions to the unreality of true, consistent one-piece flow.
Inventory or work accumulating in queue is a fundamental source of waste. In theory, pull systems work to emulate one-piece flow where the next step of work on an item occurs immediately at the completion of the prior step, the prior step is not creating any more than the next step can handle, and the next step is not idly waiting on the prior step for work.
What are some examples of tools for evaluating risk and adverse events?
Root cause analysis
Failure Mode and Effects Analysis (FMEA)
Medication Reconciliation
Which regulatory body defines the levels of sedation?
Joint Commission
4 levels of sedation
Minimal sedation (valium), no effect on ventilatory or CV functions
moderate sedation (versed and fentanyl),
deep sedation, and
general anesthesia.
What is a high reliability organization?
HRO is an organization that, despite operating in a high-stress, high-risk environment, continually manages its environment mindfully, adopting a constant state of vigilance resulting in the fewest number of errors.
What are the 5 characteristics of HROs?
fixation on failure
avoidance of oversimplification
sensitivity to operations
respect of expertise
dedication of resilience
What is a “forcing function”?
A “forcing function” is an aspect of design that prevents an undesirable action from taking place. Standardization of processes improves safety by ensuring that the correct and necessary steps are performed in the correct order.
