Albert L. Blumberg

Enhancing the role of case-oriented peer review to improve quality and safety in radiation oncology: Executive summary

This report is part of a series of white papers commissioned for the American Society for Radiation Oncology (ASTRO) Board of Directors as part of ASTROs Target Safely Campaign, focusing on the role of peer review as an important component of a broad safety/quality assurance (QA) program. Peer review is one of the most effective means for assuring the quality of qualitative, and potentially controversial, patient-specific decisions in radiation oncology. This report summarizes many of the areas throughout radiation therapy that may benefit from the application of peer review. Each radiation oncology facility should evaluate the issues raised and develop improved ways to apply the concept of peer review to its individual process and workflow. This might consist of a daily multidisciplinary (eg, physicians, dosimetrists, physicists, therapists) meeting to review patients being considered for, or undergoing planning for, radiation therapy (eg, intention to treat and target delineation), as well as meetings to review patients already under treatment (eg, adequacy of image guidance). This report is intended to clarify and broaden the understanding of radiation oncology professionals regarding the meaning, roles, benefits, and targets for peer review as a routine quality assurance tool. It is hoped that this work will be a catalyst for further investigation, development, and study of the efficacy of peer review techniques and how these efforts can help improve the safety and quality of our treatments.

ACR White Paper: The Value Added That Radiologists Provide to the Health Care Enterprise

Radiologists represent arguably one of medicines least heralded but most important specialties. Although they carry sterling credentials as imaging and radiation safety experts, radiologists have lacked widespread public recognition. As public and private stakeholders cast an even more intense spotlight on imaging, the vital role of radiologists must be better understood. During the January 2008 ACR Forum on Future Practice Models for Radiology, participants and ACR leaders discussed the value added that radiologists bring to the health care enterprise and recommended that the ACR further study that topic. The ACR, dedicated to providing quality patient care since its inception in 1924, convened the Task Force on Value Added to address these issues. The task force determined the component stakeholders in the health care enterprise to whom value is added, defined the nature of the value for each constituent component, described the process of adding that value, and anticipated future trends that may affect the value proposition. Recommendations to the ACR for future action are offered.

AIUM practice guideline for the performance of an ultrasound examination of the abdomen and/or retroperitoneum

These guidelines are an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the American College of Radiology cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

Permanent radioactive iodine seed implants following radical resection in recurrent human malignant high grade astrocytomas

Radical brain tumor resection coupled with iodine seed (I-125) implantation was performed 9 times on 8 patients with recurrent malignant cerebral gliomas. Sodium fluorescein dye was administered intravenously at the time of craniotomy as a ‘tumor marker’. Fluorescent-stained tissues were identified by mercury arc lamp illumination and subsequently removed using an ultrasonic surgical tissue aspirator. I-125 seeds were placed intraoperatively at nonfluorescent tumor margins. The seed number and activity were determined graphically from a computer model for ‘shell’ irradiation. A calculated tumor dose of 25–30,000 cGy (rads) (complete decay) was delivered.

Radiation Oncology Resident In-Training Examination

Radiation Oncology Resident In-Training Examination Sandra S. Hatch, MD, FACR,* Neha Vapiwala, MD,y Seth A. Rosenthal, MD, FACR,z John P. Plastaras, MD, PhD,y Albert L. Blumberg, MD, FACR,x William Small Jr, MD, FACR,jj Matthew J. Wenger, BBA,{ and Marie E. Taylor, MD, FACR, *University of Texas Medical Branch, Galveston, Texas; yUniversity of Pennsylvania, Philadelphia, Pennsylvania; zDepartment of Radiation Oncology, Sutter Cancer Center, Sacramento, California; xGreater Baltimore Medical Center, Baltimore, Maryland; jjStritch School of Medicine, Loyola University, Chicago, Illinois; {ITPG, Inc., Vienna, Virginia; and Baptist Memorial Hospital East, Memphis, Tennessee

The Maryland Self-Referral Law: History and Implications

Many previous studies have shown that nonradiologist physicians who can refer advanced MRI and CT examinations to themselves or within their practices use these modalities at a much higher rate than those who refer their examinations to unaffiliated radiology facilities. This led Maryland to pass a unique self-referral law in 1993 to directly address self-referred advanced imaging. The authors discuss the politics and economics of self-referral and provide a comprehensive review of the creation, progression, and impact of this landmark law.