Do you provide good care?

How do measure and prove that you provide good care?

That second question may prove central to radiologist’s future success, according to RSNA President Gary J. Becker, MD. In his address yesterday at RSNA 2009’s opening ceremony, Becker focused on the annual meeting’s theme: Quality Counts. Quantifiable quality and value, Becker told the audience, may be the way to avoid the further commoditization of radiology that worries so many people in radiology.

“When price is the differentiator, quality fades from view,” Becker told the audience in McCormick Place’s Arie Crown Theatre.

Quantifiably measuring quality care—something Becker noted is relatively new to most radiologists—is the first step toward proving and improving the quality of radiologic care your organization provides. Applying the quality management and improvement techniques starts with measuring. Paraphrasing Becker:

• What you can’t measure, you do not know.

• What you don’t know, you can’t improve.

• Without observation and measurement, there is no improvement.

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I’m wrapping up in the office before jumping on the plane to Chicago tomorrow morning. Check the site here beginning Monday morning for daily reports from RSNA. And don’t forget to share your views of what strikes you as interesting and/or noteworthy at the show. You can comment directly on the blog or send an email to jknaub@gvpub.com. Enjoy RSNA.

Finally, stop by booth 8939 and say hello.

Jim Knaub, editor
Radiology Today

We live in a world where we are bombarded with messages that our individual self interest is really the only thing that matters. New York Times editorial board member David Brooks wrote a piece on healthcare reform that points out what our self interest says about our society.

To me, the most important thing about the healthcare debate is that it remains in front of us and stays vigorous. As a society and government, we’ve ignored the problems of our existing system for far too long. Keeping the issue in front of Americans (who have notoriously short attention spans, but long memories) is the only way to a viable solution. Healthcare access, cost, cost transparency, and the appropriate provider payment systems need to be broadly understood to be appropriately changed.

“All we are saying is, at age 40, a woman should make an appointment with her doctor and have a conversation about the benefits and harms of having a mammography now versus waiting to age 50,”

— Diana B. Petitti, MD, MPH

It’s too bad Petitti didn’t make that clear first thing Monday morning. It might have prevented the tsunami of anger, advocacy, confusion, press releasing, fear mongering and political posturing.

Petitti is the vice chair of the U.S. Preventative Services Task Force (USPSTF) that released new mammography recommendations you’ve probably heard about. She is one of the 16-member task force that contradicted the existing American breast cancer community guidelines and now recommends routine mammography screening begin at age 50, instead of 40 for women at normal risk for breast cancer. The group recommends women at high risk for breast cancer should still be screened earlier. And, finally, women between the ages of 40 and 49 should discuss screening with their doctors rather than automatically having a mammogram.

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Radiology benefits managers (RBMs) provide imaging gatekeeper services for approximately 80 million Americans with private health insurance, according to Kathy Hardy’s article on our magazine site. Six RBMs handle the lion’s share of these services. Read the rest of this entry »

The ACR recently posted its summary analysis of the 2010 Medicare Fee Schedule Final Rule. The article looks at what changes made it through from the proposed version to the Final Rule.

You don’t see much good news about inoperable lung cancer. That hard truth makes promising results even more welcome. Well, some very good news was reported at the American Society for Radiation Oncology this week: Researchers report that stereotactic body radiation therapy (SBRT) significantly improved local control and improved three-year survival in stage 1 lung cancer patients who are not candidates for surgical treatment and should be considered a frontline treatment for such patients. Read the rest of this entry »

A first-of-its-kind study on radiation therapy after melanoma surgery reports a significantly lower recurrence rate in high-risk patients who received radiation therapy to the surgery site after having their melanomas removed.

The study, presented today at the 51st Annual Meeting of the American Society for Radiation Oncology in Chicago, found, high-risk melanoma patients who are treated with radiation after surgery have a 19% risk of their cancer returning to the lymph nodes compared a 31% risk to those patients who do not have radiation therapy. Click here for the study abstract.

“Results of this trial now confirm the place of radiation therapy in the management of patients who have high risk features following surgery for melanoma involving the lymph nodes,” said Bryan Burmeister, MD, lead author of the study and a radiation oncologist at Princess Alexandra Hospital in Brisbane, Australia. “In some institutions, radiation treatment is routine protocol, while in others, the protocol has been either for patients to just be observed, or receive some type of adjuvant chemotherapy or immunotherapy. I encourage patients with melanoma to talk to their doctors about whether radiation should be added to their treatment plan.”

When melanoma has spread from its original site to the lymph nodes, treatment typically involves surgically removing cancerous and the remaining lymph nodes in that region, a surgery called a lymphadenectomy. This multicenter, randomized trial examined the effects of external beam radiation treatment after surgery for melanoma patients who had a high risk of the cancer returning to the lymph nodes.

From March 2002 to September 2007, 217 patients from 16 cancer centers who had undergone a lymphadenectomy for melanoma cancer were randomized to receive radiation treatment within 12 weeks after surgery or be observed, with a median follow-up of 27 months. Results of the study show there was significant improvement in the control of regional recurrence among patients who underwent radiation therapy, compared to the observation group.