Robert T. Bramson

Efficacy of Routine Screening and Lateral Chest Radiographs in a Hospital-Based Population

Abstract A prospective study of chest roentgenographic examinations was conducted to determine if the elimination of some examinations or films often routinely obtained might be medically and econo...

Perforation during hydrostatic reduction of intussusception: Proposed mechanism and review of the literature

Eight cases of children with intussusception in whom the bowel perforated during attempts at enema reduction are reviewed. Certain features in each case suggest that perforation may not be secondary to increased intraluminal pressure from the enema, but that necrotic perforated bowel is uncovered as the intussusception is reduced. A review of the basis for recommendations about the height of the enema bag during attempted reduction suggests that these guidelines are largely arbitrary and lack scientific support.

Pediatric bronchography performed through the flexible bronchoscope

Ten children, ranging in age from 2 months to 16 years, were evaluated by bronchograms performed during bronchoscopy. Nine of the ten children had significant pathology demonstrated by the bronchogram that elucidated findings unclear from other imaging procedures at the time of bronchoscopy. Despite the generally negative opinions about the utility of bronchograms in children, information obtained by bronchography can be quite useful. Bronchography during bronchoscopy proved to be quick, simple, and safe.

Achievement of substantial cost reduction through joint purchasing by the radiology departments of a large vertically integrated health care system

RATIONALE AND OBJECTIVES The authors sought to lower costs by coordinating the purchase of equipment, supplies, and services in the radiology departments of a vertically integrated health system formed by the merger of two of the largest academic medical centers in New England. METHODS The radiology departments at Massachusetts General Hospital and Brigham & Womens Hospital formed a cost-reduction task force to explore opportunities to jointly decrease costs. Data from the operating budgets of both institutions were collected and analyzed to find specific items within the budgets that could yield substantial cost savings. RESULTS The projects first phase yielded over

Barium extravasation discovered some years after pyloromyotomy.

810,000 in reduced costs from a system-wide annual budget of only

Application of wavelet compression to digitized radiographs

7 million for film and contrast material. Ongoing additional projects suggest that longer term contracts that contain steeper discounts with a decreased number of vendors will result in further decreases in the cost of materials and supplies. CONCLUSION Coordination of purchasing by the radiology members of an integrated delivery system can yield substantial savings.

Technical Cost of Radiologic Examinations: Analysis across Imaging Modalities

Two children who had surgery for pyloric stenosis are presented. Each had an unusual density discovered on an abdominal plain radiograph taken at least a year after surgery for pyloric stenosis. Subsequent investigation showed that this density represented barium from the preoperative contrast studies that had apparently leaked into the soft tissues at the time of surgery but was not recognized at that time. This unusual complication has not been previously reported but could potentially be fairly common. Unnecessary diagnostic testing could be avoided by recognition that this complication does occur.