A semi-automated assessment of sarcopenia using psoas area and density predicts outcomes after pancreaticoduodenectomy for pancreatic malignancy.

Background: Sarcopenia has been associated with increased adverse outcomes after major abdominal surgery. Sarcopenia defined as decreased muscle volume or increased fatty infiltration may be a proxy for frailty. In conjunction with other preoperative clinical risk factors, radiographic measures of sarcopenia using both muscle size and density may enhance prediction of outcomes after pancreaticoduodenectomy (PD) for malignancy.

The role of the radiologist in new payment systems.

Many economists and policy makers believe that United States healthcare costs are rising at an unsustainable rate. In response, newer payment systems such as bundled payments, accountable care organizations, and population health management have been proposed. These new paradigms all aim to encourage collaboration between health care providers to conserve costs and increase quality.

Bowel Obstruction.

Small bowel obstruction and large bowel obstruction account for approximately 20% of cases of acute abdominal surgical conditions. The role of the radiologist is to answer several key questions: Is obstruction present? What is the level of the obstruction? What is the cause of the obstruction? What is the severity of the obstruction? Is the obstruction simple or closed loop? Is strangulation, ischemia, or perforation present? In this presentation, the radiologic approach to and imaging findings of patients with known or suspected bowel obstruction are presented.

Impacts of sea level rise and climate change on coastal plant species in the central California coast.

Local increases in sea level caused by global climate change pose a significant threat to the persistence of many coastal plant species through exacerbating inundation, flooding, and erosion. In addition to sea level rise (SLR), climate changes in the form of air temperature and precipitation regimes will also alter habitats of coastal plant species. Although numerous studies have analyzed the effect of climate change on future habitats through species distribution models (SDMs), none have incorporated the threat of exposure to SLR.

Utilization management in radiology, part 2: perspectives and future directions.

Increased utilization of medical imaging in the early part of the last decade has resulted in numerous efforts to reduce associated spending. Recent initiatives have focused on managing utilization with radiology benefits managers and real-time order entry decision support systems. Although these approaches might seem mutually exclusive and their application to radiology appears unique, the historical convergence and broad acceptance of both programs within the pharmacy sector may offer parallels for their potential future in medical imaging.

Utilization management in radiology, part 1: rationale, history, and current status.

Previous growth in the utilization of medical imaging has led to numerous efforts to reduce associated spending. Although these have historically been directed toward unit cost reductions, recent interest has emerged by various stakeholders in curbing inappropriate utilization. Radiology benefits managers have widespread market penetration and have been promoted largely by the payer community as effective mechanisms to curb increases in imaging volume.

That liver lesion on MDCT in the oncology patient: is it important?

Multidetector-row computed tomography (MDCT) has become the primary imaging test for the staging and follow-up of most malignancies that originate outside of the central nervous system. Technical advances in this imaging technique have led to significant improvement in the detection of metastatic disease to the liver. An unintended by-product of this improving diagnostic acumen is the discovery of incidental hepatic lesions in oncology patients that in the past remained undetected.

The incidental cystic pancreas mass: a practical approach.

Technical advances in cross-sectional imaging have led to the discovery of incidental cystic pancreatic lesions in the oncology and non-oncology population that in the past remained undetected. These lesions have created a diagnostic and management dilemma for both clinicians and radiologists: should these lesions be ignored, watched, aspirated, or removed? In this review, recommendations concerning the assessment of the more common pancreatic cystic incidental lesions are presented.

Accountable care organizations for neuroradiologists: threats and opportunities.

Accountable care organizations (ACOs) are one of the more interesting and (perhaps) highest impact components of the 2010 Federal health care bill. Neuroradiologists should examine them carefully for opportunities to participate and contribute to ACOs as well as to understand the potential threats. Although there are questions about the viability of the proposed models, neuroradiologists should not assume this is a fad.

Strategic planning for neuroradiologists.

Strategic planning is becoming essential to neuroradiology as the health care environment continues to emphasize cost efficiency, teamwork and collaboration. A strategic plan begins with a mission statement and vision of where the neuroradiology division would like to be in the near future. Formalized strategic planning frameworks, such as the strengths, weaknesses, opportunities and threats (SWOT), and the Balanced Scorecard frameworks, can help neuroradiology divisions determine their current position in the marketplace.

Hepatic incidentalomas.

Recent advances in multidetector-row computed tomography, magnetic resonance imaging, and ultrasonography have led to the detection of incidental hepatic lesions in both the oncology and nononcology patient population that in the past remained undiscovered. These incidental hepatic lesions have created a management dilemma for both clinicians and radiologists. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidentalomas are presented.

Gallbladder imaging.

The treatment of gallbladder disease has been revolutionized by improvements in laparoscopic surgery as well as endoscopic and radiologic interventional techniques. Therapeutic success is dependent on accurate radiologic assessment of gallbladder pathology. This article describes recent technical advances in ultrasonography, multidetector computed tomography, magnetic resonance imaging, positron emission tomography, and scintigraphy, which have significantly improved the accuracy of noninvasive imaging of benign and malignant gallbladder disease.

Pathways of abdominal tumour spread: the role of the subperitoneal space.

The subperitoneal space is a large, unifying, anatomically continuous potential space that connects the peritoneal cavity with the retroperitoneum. This space is formed by the subserosal areolar tissue that lines the inner surfaces of the peritoneum and the musculature of the abdomen and pelvis. It contains the branches of the vascular, lymphatic, and nervous systems that supply the viscera.

ACR White Paper: Task Force to Evaluate the Value Add Impact on Business Models.

Radiology practices are seeing both evolutionary and revolutionary changes in their business models. The Task Force to Evaluate the Value Add Impact on Business Models was charged with considering how radiologists and their practices add value in these novel settings. Both traditional and novel forms of added value were considered.

The architecture of smart surveys: core issues in why and how to collect patient and referring physician satisfaction data.

Radiology practices are facing challenges on many fronts. As the field becomes more competitive, leaders must pay more attention to the quality of the service that groups provide to their customers. This need is also being driven by higher expectations from customers, particularly patients, who will likely act much more like consumers in the 21st century.

Imaging in intestinal ischemic disorders.

Intestinal ischemia and infarction are a heterogeneous group of diseases that have as their unifying theme hypoxia of the small bowel or colon. The incidence of bowel ischemia and infarction is on the rise for several reasons: the aging of the population, the ability of intensive care units to salvage critically ill patients, and heightened clinical awareness of these disorders. Improvements in diagnostic imaging techniques have greatly contributed to the earlier diagnosis of intestinal ischemia, which can have a positive influence on patient outcomes.

ACR white paper: the value added that radiologists provide to the health care enterprise.

Radiologists represent arguably one of medicine's 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.

Imaging in intestinal ischemic disorders.

Intestinal ischemia and infarction are a heterogeneous group of diseases that have as their unifying theme hypoxia of the small bowel and/or colon. The incidence of bowel ischemia is increasing for a number of reasons: the aging of the population, the ability of intensive care units to salvage critically ill patients, and heightened clinical awareness of these disorders. Improvements in diagnostic imaging techniques have contributed greatly to the earlier diagnosis of intestinal ischemia, which can have a positive influence on patient outcomes.

Negotiation techniques for health care professionals.

Negotiation is an essential part of health care practice and is not formally taught during medical training. This article aims to improve the negotiation skills of readers by explaining the essential components of preparation before a negotiation and reviewing common techniques for optimizing negotiated agreements. The terms reservation point, target value, and best alternative to a negotiated agreement are defined, and their importance in negotiation preparation is explained.

Strategic marketing, part 2: the 4 P's of marketing.

Marketing and branding are critical business functions that are often ignored or misapplied in the health care sector. Radiology professionals are facing unprecedented competition, turf battles, and other pressures. One tool that can help in meeting this onslaught is to improve your marketing efforts.

Strategic marketing: an introduction for medical specialists.

Marketing and branding are 2 of the most important factors for business success in the United States. They are particularly critical in service industries such as diagnostic imaging. However, in spite of their strategic importance in radiology success, a search of the peer-reviewed radiology literature reveals a paucity of published work that addresses marketing for imaging practices.