Technology for the continuous improvement of the quality of health care.

Since medical technology impinges on the structure, process and outcome of health care it has a profound effect on attempts to achieve improvement in this field. The present article discusses the links between medical technology and continuous quality development, with particular reference to utilization, appropriateness and cost-benefit.

Benefits of coordinated action in PACS evaluation.

PACS, a health care technology still in its developmental stage, aims to improve the management of diagnostic imaging investigations. As the technology has not been comprehensively assessed, data and facts to justify its clinical, economic and other benefits are to date insufficient. Through internationally coordinated action, it is expected to obtain a faster and more comprehensive technology assessment of PACS as well as recommendations for optimization of the system and guidelines for its rational use in various health care environments.

Big ticket health technology: is rational utilization possible?

Medical technologies that have high initial and operating costs are commonly labeled 'Big Ticket Technologies'. However, technologies with lower initial and operating costs, but which are utilized extensively in patient care, should be considered Big Ticket as well. Some of these technologies are product innovations, because they represent a new product or service.

Diagnostic imaging in small hospitals.

Diagnostic imaging in small hospitals is discussed. Four key questions are answered: (1) Are diagnostic imaging technologies necessary at this level? (2) Which technologies should be chosen and why? (3) How can they be most rationally and cost effectively used? (4) How can their total impact on health care be assessed? The paper concludes that small hospitals should have diagnostic imaging facilities and that the modalities of choice are diagnostic radiology and ultrasonography. A detailed description is given of the WHO Basic Radiological System and General Purpose Ultrasonographic equipment together with WHO recommendations for the rational use of diagnostic imaging.

[International survey of the status of dosimetry for controlling quality assurance in radiotherapy (WHO)].

The results of an IAEA/WHO 14-year survey on the precision of irradiation at a preset dose (2 Gy) in radiotherapy departments in different countries have shown that nearly in 40% of cases deviations from a preset dose exceeded the tolerant rate (+/- 5%). A conclusion has been made of the necessity to develop a program of quality guarantee in radiotherapy at national and international levels.

World health organisation inter-laboratory comparison study in 12 countries on quality performance of nuclear medicine imaging devices.

Twelve countries participated in the WHO intercomparison for which transmission CAP (College of American Pathologists) brain and CAP liver phantoms and emission London liver phantoms were used. A total of 157 imaging devices were tested. Overall results from the phantoms revealed a wide range of targets detected.

Use of radiographic projections of knee.

A study to determine the routine radiography practice for the investigation of acute trauma cases and those with suspected arthritis of the knee was carried out by questionnaires sent to radiologists in 41 countries. The role of radiology in the investigation of chondromalacia patellae was also ascertained. Some of the reasons for the diversities of practice are discussed.

Radiological services throughout the world.

WHO's statistics show the doctor-to-population ratio in the Third World to have changed very little over the past decade, with radiological services among the least developed medical branches of a developing country's health care system. Data is presented on population/machine/personnel ratios, morbidity patterns, number of X-ray examinations per population and films taken, percentage of wasted film, and breakdown of types of procedures. Data collected from 89 countries show that of a total population of 1.