Ian A Cowan

Paediatric radiology seen from Africa. Part I: providing diagnostic imaging to a young population

Paediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children.

Measuring and managing radiologist workload: Application of lean and constraint theories and production planning principles to planning radiology services in a major tertiary hospital

We describe how techniques traditionally used in the manufacturing industry (lean management, the theory of constraints and production planning) can be applied to planning radiology services to reduce the impact of constraints such as limited radiologist hours, and to subsequently reduce delays in accessing imaging and in report turnaround.

Measuring and managing radiologist workload: a method for quantifying radiologist activities and calculating the full-time equivalents required to operate a service.

Accurate and transparent measurement and monitoring of radiologist workload is highly desirable for management of daily workflow in a radiology department, and for informing decisions on department staffing needs. It offers the potential for benchmarking between departments and assessing future national workforce and training requirements. We describe a technique for quantifying, with minimum subjectivity, all the work carried out by radiologists in a tertiary department.

Measuring and managing radiologist workload: Measuring radiologist reporting times using data from a Radiology Information System

Historically, there has been no objective method of measuring the time required for radiologists to produce reports during normal work. We have created a technique for semi‐automated measurement of radiologist reporting time, and through it produced a robust set of absolute time requirements and relative value units for consultant reporting of diagnostic examinations in our hospital.

Multiple cranial nerve palsies as the presenting features of prostate carcinoma.

Cranial nerve palsies have previously been reported in metastatic prostate carcinoma, usually occurring late in the course of the disease. We describe the case of a 55‐year‐old man whose diagnosis of prostate cancer was made following investigation of multiple cranial nerve palsies.

Measuring radiologist workload: Progressing from RVUs to study ascribable times

The need to measure reporting workload in teaching departments remains a current pertinent need. In Australia, the Pitman–Jones reporting RVUs have been in the public domain since 2003 (revised in 2009). These are expressed in arbitrary units. In New Zealand, single‐site Christchurch Hospital reporting times have been validated and placed in the public domain. Concurrently, the RANZCR has been developing a formulaic descriptor lexicon for imaging studies (the Body System Framework). There is a need to bring these three strands of work together into a common public resource. In 2015, under the auspices of the Chief Accreditation Officer, RANZCR convened the Radiologist Workload Working Group. The goal of the group was to develop a robust method of measuring radiologist workload in teaching departments in Australia and New Zealand for the RANZCR accreditation processes of teaching departments as training sites. This paper concerns itself with one aspect of the groups work, namely reaching a consensus on radiologist study ascribable times for common imaging studies.

Mastoid pneumocoele with skull base and cervical spine pneumatisation

Very uncommonly, Eustachian tube dysfunction can lead to symptomatic chronic elevation of middle ear pressure with aeration of bone and adjacent structures in the skull base and upper cervical spine, and an increased risk of fracture. We present a case demonstrating the natural history of this condition over 11 years before treatment and 10 months after treatment.