Search

Purpose: The safe delivery of radiation therapy is dependent in part on the provision and organization of oncology professionals. General recommendations for staffing of radiation oncologists, medical physicists, and radiation therapists have been published, but most of these provide little detail, especially in the case of radiation therapists (RTs). In Canada, there are no guidelines or national standards for the staffing of RTs, and there is a paucity of Canadian data on the existing staffing levels of RTs and the models used to establish these levels. This project sought to identify and compare the staffing models used for Canadian RTs, and the staffing levels and workload resulting from these models., Methods and Materials: In January 2016, a survey was sent to managers of the 46 radiation treatment centres in Canada. This survey sought information on a range of staffing and practice variables for the fiscal year 2014/2015. Respondents were requested to provide the staffing model used for RTs at each centre and enough additional information to calculate the staffing levels and workload resulting from their staffing model. The survey included further variables that had the potential to influence staffing levels and workload, and centres were compared to establish if these variables did indeed impact staffing., Results: Of the 46 centres contacted, 37 centres responded, representing an 80.4% response rate. Survey results showed there are a variety of ways used to determine staffing across the country. Twenty of the 37 responding centres include some type of workload measurement in their staffing model, whereas 17 centres base staffing solely on historic levels or operating funds. There is a great deal of variation in the staffing levels and workload of RTs in Canada, with staff at some centres planning and treating twice the number of patients as RTs at other centres. Radiation therapist staffing levels at most radiation treatment centres in Canada are below the level recommended in recent publications. Differences in staffing levels or workload could not be accounted for by treatment complexity, number of specialty programs, use of relief staff, or number of RTs working in specialty nontreatment roles., Conclusions: A high degree of variability in staffing levels and workload exists for RTs in Canada, which is not explained by differences in patterns of practice. It is likely that workload for RTs exceed safe levels at some Canadian centres. It is recommended that treatment centres use an up-to-date staffing model for RTs and continue to review staffing levels at regular intervals., (Copyright © 2019. Published by Elsevier Inc.)

Introduction: Clinical incidents are an unfortunate reality in the health care system. Patients and their families are the first victims of these incidents. The health care providers involved in the error are considered the second victims. This research aimed to evaluate the level of awareness of the second victim phenomenon (SVP) in Canadian radiation therapists, determine the post-incident emotional and physical reactions experienced, and determine the existing and/or recommended systems for support., Methods: Mixed method design comprised two phases. In phase I, Canadian radiation therapists were invited to view an informational presentation about the SVP and complete an online survey. In phase II, participants partook in an online discussion forum., Results: Survey results indicate that 31% of respondents were previously aware of the SVP and 86% of respondents report having been involved in a clinical incident. In addition, the results confirm that Canadian radiation therapists who have been involved in health care-related incidents do experience emotional and physical reactions. Most respondents indicated they lacked appropriate organizational support to help them recover from the clinical incident. Support from a colleague is the preferred method of support immediately after the incident. Finally, survey respondents indicated a clear desire for implementation of defined processes for postclinical incident supports., Discussion: The reported level of awareness of the SVP surprised the authors as it was anticipated to be lower; however, there is an obvious need for greater knowledge of the subject. Reported frequency of involvement in a clinical incident as well as the post-clinical reactions experienced are comparable for other health care providers as indicated in the literature. Survey results revealed that emotional and physical reactions were experienced to a greater degree in those unfamiliar with the SVP, indicating potential value to adding an educational component to radiation therapist's training programs as well as on the job training for staff in the workforce. Most respondents requested specific methods of support for recovery after a clinical incident. In addition, an unexpected number of radiation therapists indicated the need for a "no-blame" work environment, which was an unanticipated finding., Conclusion: This study highlights the lack of awareness of the SVP in Canadian radiation therapists. It identifies the gap between the needs of the second victims and the perceived lack of supports offered by their facilities. This issue is important for organizations wanting to positively manage clinical incidents and create a culture of safety for the patients and employees., (Copyright © 2018. Published by Elsevier Inc.)

The sharing of radiologic images has become a fundamental part of radiology services and is essential for delivering high-quality care. Film is quickly becoming obsolete as a means of transporting and sharing large volumes of imaging data. Image sharing has evolved from film to transportable media (eg, compact disks) to direct electronic exchange over the Internet. The latter two means of image sharing have associated work flow-related and technical challenges for which solutions are being developed. Integrating the Healthcare Enterprise (IHE) provides a standards-based approach to the development of robust, universally accepted solutions. Several IHE profiles have been developed to provide a framework for current image sharing efforts. The Philadelphia and New Jersey Health Information Exchanges and the Canada Health Infoway represent efforts to apply IHE technical profiles to facilitate the secure and confidential exchange of electronic images over the Internet. The research community is concomitantly developing solutions that solve image exchange issues that are specific to research (eg, the sharing of deidentified data) but that might also be encountered in the general population. The personal health record is a more recent development that may provide consumers with direct control over the process of sharing images electronically with their healthcare providers.

Purpose: The 21st century has raised new and significant challenges to the practice of diagnostic imaging. Radiologists will have to navigate a difficult path as they face threats from disruptive technologies, adverse demographic changes, pressures to limit reimbursement both from the public and from the private sectors, increased domestic and crossborder competition, and many others. Success in these trying times will require greater attention to strategic planning if we are to thrive and survive in radiology., Methods: Strategic planning and tactical implementation methodologies were reviewed, from Sun Tzu to the present day, for applicability to the needs of modern radiology groups., Results: A framework for developing and implementing strategic plans was constructed to assist radiology leaders and groups in considering the spectrum of tasks, from gathering intelligence, to developing scenarios, to implementing and evaluating tactical plans., Conclusions: Strategy and tactics are too important to be ignored or left to others. They need to be core activities for all radiology leaders. Frameworks can be used to help in providing structure and rigour to strategic planning efforts at the department and group level.

Clinical decision rules to guide physicians in the appropriate use of diagnostic imaging studies need to be developed, in part, to control the overutilization of imaging studies. These rules need to be evidence based. Randomized control trials can be designed to assess the value of imaging studies and interventional procedures at levels five and six, patient outcome and societal efficacies, in Fryback and Thornbury's hierarchical model of efficacy. Results of these trials can be used to develop clinical decision rules. However, the efficacy of most diagnostic imaging studies can be assessed better at levels three and four, diagnostic thinking and therapeutic efficacies. Studies can be designed to determine clinical situations in which imaging studies will be of no value or to determine clinical criteria for the use of imaging studies. Systematic reviews of the literature and other techniques of analysis of evidence, such as decision trees, also can be used to develop evidence-based clinical decision rules for the use of diagnostic imaging procedures.

We analyzed surveys from 42 (91%) of 46 responding directors of pediatric emergency departments with fellowship programs to ascertain the scope of radiology services and the level of satisfaction. X-ray units but not computed tomography scanners were usually located on the same floor as the emergency department, but only 14 (33%) had imaging capacity within the department. In 67% of programs, emergency physicians provided the initial interpretation. Turnaround time varied from 30 minutes or less (31%) to 90 minutes or more (10%). Overall, 22 (52%) of the directors were satisfied with radiology services. A turnaround time of 45 minutes or less occurred more often with an x-ray unit in the department (P = 0.015), and directors tended to be more satisfied with this arrangement (P = 0.27). We conclude that the current state of the art consists of an x-ray unit in close proximity to the emergency department and a turnaround time of 60 minutes or less, but directors expressed more satisfaction with the service to their patients when a unit was in the department and turnaround time was shorter than 60 minutes.