Radiation Protection in Medicine
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The Stethoscope: Some Preliminary Investigations
695 ORIGINAL ARTICLE The stethoscope: some preliminary investigations P D Welsby, G Parry, D Smith Postgrad Med J: first published as on 5 January 2004. Downloaded from ............................................................................................................................... See end of article for Postgrad Med J 2003;79:695–698 authors’ affiliations ....................... Correspondence to: Dr Philip D Welsby, Western General Hospital, Edinburgh EH4 2XU, UK; [email protected] Submitted 21 April 2003 Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should Accepted 30 June 2003 be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope ....................... diaphragms are more appropriate. HISTORICAL ASPECTS note is increased as the amplitude of the sound rises, Hippocrates advised ‘‘immediate auscultation’’ (the applica- resulting in masking of higher frequency components by tion of the ear to the patient’s chest) to hear ‘‘transmitted lower frequencies—‘‘turning up the volume accentuates the sounds from within’’. However, in 1816 a French doctor, base’’ as anyone with teenage children will have noted. Rene´The´ophile Hyacinth Laennec invented the stethoscope,1 Breath sounds are generated by turbulent air flow in the which thereafter became the identity symbol of the physician. trachea and proximal bronchi. Airflow in the small airways Laennec apparently had observed two children sending and alveoli is of lower velocity and laminar in type and is 6 signals to each other by scraping one end of a long piece of therefore silent. What is heard at the chest wall depends on solid wood with a pin, and listening with an ear pressed to the conductive and filtering effect of lung tissue and the the other end.2 Later, in 1816, Laennec was called to a young characteristics of the chest wall. -
Radiation Protection in Paediatric Radiology at Medical Physicists and Regulators
Safety Reports Series The Fundamental Safety Principles and the IAEA's General Safety Rquirements publication, Radiation Protection and Safety of Radiation Safety Reports Series Sources: International Basic Safety Standards (BSS) require the radiological protection of patients undergoing medical exposures No.71 through justification of the procedures involved No. and through optimization. This publication 71 provides guidance to radiologists, other clinicians and radiographers/technologists involved in diagnostic procedures using ionizing radiation with children and adolescents. It is also aimed Radiation Protection in Paediatric Radiology at medical physicists and regulators. The focus is on the measures necessary to provide protection from the effects of radiation using the principles established in the BSS and according to the priority given to this issue. Radiation Protection in Paediatric Radiology INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA ISBN 978–92–0–125710–9 ISSN 1020–6450 RELATED PUBLICATIONS IAEA SAFETY STANDARDS AND RELATED PUBLICATIONS RADIATION PROTECTION IN NEWER MEDICAL IMAGING TECHNIQUES: PET/CT IAEA SAFETY STANDARDS Safety Reports Series No. 58 STI/PUB/1343 (41 pp.; 2008) Under the terms of Article III of its Statute, the IAEA is authorized to establish or adopt ISBN 978–92–0–106808–8 Price: €28.00 standards of safety for protection of health and minimization of danger to life and property, and to provide for the application of these standards. The publications by means of which the IAEA establishes standards are issued in the APPLYING RADIATION SAFETY STANDARDS IN DIAGNOSTIC IAEA Safety Standards Series. This series covers nuclear safety, radiation safety, transport RADIOLOGY AND INTERVENTIONAL PROCEDURES USING X RAYS safety and waste safety. -
Low Dose Radiation Therapy for Severe COVID-19 Pneumonia: a Randomized Double- Blind Study --Manuscript Draft
International Journal of Radiation Oncology • Biology • Physics Low dose radiation therapy for severe COVID-19 pneumonia: a randomized double- blind study --Manuscript Draft-- Manuscript Number: ROB-D-21-00260R1 Article Type: Full Length Article Section/Category: Clinical Investigation - Other Corresponding Author: Alexandros Papachristofilou University Hospital Basel: Universitatsspital Basel Basel, SWITZERLAND First Author: Alexandros Papachristofilou, MD Order of Authors: Alexandros Papachristofilou, MD Tobias Finazzi, MD Andrea Blum, MD Tatjana Zehnder, MD Núria Zellweger Jens Lustenberger, MD Tristan Bauer, MD Christian Dott Yasar Avcu, M.Sc. Goetz Kohler, PhD Frank Zimmermann, MD Hans Pargger, MD Martin Siegemund, MD Abstract: Purpose The morbidity and mortality of patients requiring mechanical ventilation for coronavirus disease 2019 (COVID-19) pneumonia is considerable. We studied the use of whole- lung low dose radiation therapy (LDRT) in this patient cohort. Methods and Materials Patients admitted to the intensive care unit (ICU) and requiring mechanical ventilation for COVID-19 pneumonia were included in this randomized double-blind study. Patients were randomized to 1 Gy whole-lung LDRT or sham irradiation (sham-RT). Treatment group allocation was concealed from patients and ICU clinicians, who treated patients according to the current standard of care. Patients were followed for the primary endpoint of ventilator-free days (VFDs) at day 15 post-intervention. Secondary endpoints included overall survival, as well as changes in oxygenation and inflammatory markers. Results Twenty-two patients were randomized to either whole-lung LDRT or sham-RT between November and December 2020. Patients were generally elderly and comorbid, with a median age of 75 years in both arms. No difference in 15-day VFDs was observed between groups (p = 1.00), with a median of 0 days (range, 0-9) in the LDRT arm, and 0 days (range, 0-13) in the sham-RT arm. -
Improving the Accuracy of Medical Diagnosis with Causal Machine Learning ✉ Jonathan G
ARTICLE https://doi.org/10.1038/s41467-020-17419-7 OPEN Improving the accuracy of medical diagnosis with causal machine learning ✉ Jonathan G. Richens 1 , Ciarán M. Lee1,2 & Saurabh Johri 1 Machine learning promises to revolutionize clinical decision making and diagnosis. In medical diagnosis a doctor aims to explain a patient’s symptoms by determining the diseases causing them. However, existing machine learning approaches to diagnosis are purely associative, 1234567890():,; identifying diseases that are strongly correlated with a patients symptoms. We show that this inability to disentangle correlation from causation can result in sub-optimal or dangerous diagnoses. To overcome this, we reformulate diagnosis as a counterfactual inference task and derive counterfactual diagnostic algorithms. We compare our counterfactual algorithms to the standard associative algorithm and 44 doctors using a test set of clinical vignettes. While the associative algorithm achieves an accuracy placing in the top 48% of doctors in our cohort, our counterfactual algorithm places in the top 25% of doctors, achieving expert clinical accuracy. Our results show that causal reasoning is a vital missing ingredient for applying machine learning to medical diagnosis. 1 Babylon Health, 60 Sloane Ave, Chelsea, London SW3 3DD, UK. 2 University College London, Gower St, Bloomsbury, London WC1E 6BT, UK. ✉ email: [email protected] NATURE COMMUNICATIONS | (2020)11:3923 | https://doi.org/10.1038/s41467-020-17419-7 | www.nature.com/naturecommunications 1 ARTICLE NATURE COMMUNICATIONS | https://doi.org/10.1038/s41467-020-17419-7 roviding accurate and accessible diagnoses is a fundamental Since its formal definition31, model-based diagnosis has been challenge for global healthcare systems. -
12VAC5-481-10. Definitions
Virginia Administrative Code Title 12. Health Agency 5. Department of Health Chapter 481. Virginia Radiation Protection Regulations 12VAC5-481-10. Definitions. Part I. General Provisions The following words and terms as used in this chapter shall have the following meanings unless the context clearly indicates otherwise: "A1" means the maximum activity of special form radioactive material permitted in a Type A package. This value is listed in Table 1 of 12VAC5-481-3770 F. "A2" means the maximum activity of radioactive material, other than special form radioactive material, LSA, and SCO material, permitted in a Type A package. This value is listed in Table 1 of 12VAC5-481-3770 F. "Absorbed dose" means the energy imparted by ionizing radiation per unit mass of irradiated material. The units of absorbed dose are the gray (Gy) and the rad. "Absorbed dose rate" means absorbed dose per unit time, for machines with timers, or dose monitor unit per unit time for linear accelerators. "Accelerator" means any machine capable of accelerating electrons, protons, deuterons, or other charged particles in a vacuum and of discharging the resultant particulate or other radiation into a medium at energies usually in excess of one MeV. For purposes of this definition, "particle accelerator" is an equivalent term. "Accelerator-produced material" means any material made radioactive by a particle accelerator. "Access control" means a system for allowing only approved individuals to have unescorted access to the security zone and for ensuring that all other individuals are subject to escorted access. "Accessible surface" means the external surface of the enclosure or housing of the radiation producing machine as provided by the manufacturer. -
Manual for ACRO Accreditation March 2016
American College of Radiation Oncology Manual for ACRO Accreditation March 2016 Powered by Patients First Our Focus is Radiation Oncology Safety! ACKNOWLEDGMENTS ACRO expresses its appreciation for the significant contribution and leadership of Jaroslaw Hepel, MD, FACRO, Chair of the ACRO Standards Committee, and ACRO Accreditation Medical Director, for his un- tiring efforts to bring this version of the Manual for ACRO Accreditation to publication. Thanks also go to Arve Gillette, MD, FACRO, ACRO Chancellor and a former President, and ACRO Ac- creditation Medical Director during 2011, who initiated most of the new procedures incorporated in the accreditation program when it was reintroduced after a board imposed administrative review for most of 2010. Appreciation also is expressed to Ralph Dobelbower, MD, FACRO, the founding medical director of ACRO Accreditation; Gregg Cotter, MD, FACRO, medical director after Dr. Dobelbower; and Ishmael Parsai, PhD, FACRO, physics chairman for many years; for their collective leadership in building the accreditation program from its inception in 1995. In addition, appreciation is expressed for ongoing support and commitment to the accreditation process to all the following ACRO members who have contributed, and continue to contribute, to the success of ACRO Accreditation: ACRO Executive Committee | Drs. James Welsh (President), Eduardo Fernandez (Vice President), William Rate (Secretary-Treasurer), and Arno Mundt (Chairman) ACRO Chancellors | Drs. Joanne Dragun, Gregg Franklin, Shane Hopkins, Sheila Rege, Charles Thomas, II, Harvey Wolkov, Catheryn Yashar, and Luther Brady (ex officio) ACRO Accreditation Disease Site Team Leaders | Dr. Jaroslaw Hepel (Breast Cancer); Drs. William Regine & Navesh Sharma (Gastrointestinal Cancer); Dr. Peter Orio III (Genitourinary Cancer); Dr. -
REGULATIONS and STATUTES Kansas Radiation Control Program
REGULATIONS AND STATUTES Kansas Radiation Control Program Unofficial Copy The regulations and statutes provided are for the convenience of the user but are not considered the official regulations. For more information on the official regulations, visit the Kansas Secretary of State website. For more information about official copies of statutes, visit the Kansas Legislature website. April 27, 2021 [email protected] Kansas Administrative Regulations Table of Contents Table of Contents Kansas Annotated Regulations ........................................... 2 Part 1. Definitions ............................................................... 2 Part 2. Radiation Producing Machines ............................. 67 Part 3. Licensing of Sources of Radiation ........................ 75 Part 4. Standards for Protection Against Radiation ........ 190 Part 5. Use of X-Rays in the Healing Arts ...................... 249 Part 6. Use of Sealed Radioactive Sources in the Healing Arts .............................................................................................. 291 Part 7. Special Requirements for Industrial Radiographic Operations ................................................................................... 294 Part 8. Radiation Safety Requirements for Analytical X- Ray Equipment............................................................................ 319 Part 9. Radiation Safety Requirements for Particle Accelerators ................................................................................ 323 Part 10. Notices, Instructions -
Digital and Advanced Imaging Equipment
CHAPTER 9 Digital and Advanced Imaging Equipment KEY TERMS active matrix array direct-to-digital radiographic systems photostimulated luminescence amorphous dual-energy x-ray absorptiometry picture archiving and communication analog-to-digital converter F-center system aspect ratio fill factor preprocessing cinefluorography frame rate postprocessing computed radiography image contrast refresh rate detective quantum efficiency image enhancement special procedures laboratory Digital Imaging and Communications image management and specular reflection in Medicine group communication system teleradiology digital fluoroscopy image restoration thin-film transistor digital radiography interpolation window level digital subtraction angiography liquid crystal display window width digital x-ray radiogrammetry Nyquist frequency OBJECTIVES At the completion of this chapter the reader should be able to do the following: • Describe the basic methods of obtaining digital cathode-ray tube cameras, videotape and videodisc radiographs recorders, and cinefluorographic equipment and discuss • State the advantages and disadvantages of digital the quality control procedures for each radiography versus conventional film/screen • Describe the various types of electronic display devices radiography and discuss the applicable quality control procedures • Discuss the quality control procedures for evaluating • Explain the basic image archiving and management digital radiographic systems networks and discuss the applicable quality control • Describe the basic methods -
GUIDELINES for WRITING SOAP NOTES and HISTORY and PHYSICALS
GUIDELINES FOR WRITING SOAP NOTES and HISTORY AND PHYSICALS by Lois E. Brenneman, M.S.N, C.S., A.N.P, F.N.P. © 2001 NPCEU Inc. all rights reserved NPCEU INC. PO Box 246 Glen Gardner, NJ 08826 908-537-9767 - FAX 908-537-6409 www.npceu.com Copyright © 2001 NPCEU Inc. All rights reserved No part of this book may be reproduced in any manner whatever, including information storage, or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission of the publisher: NPCEU, Inc. PO Box 246, Glen Gardner, NJ 08826 908-527-9767, Fax 908-527-6409. Bulk Purchase Discounts. For discounts on orders of 20 copies or more, please fax the number above or write the address above. Please state if you are a non-profit organization and the number of copies you are interested in purchasing. 2 GUIDELINES FOR WRITING SOAP NOTES and HISTORY AND PHYSICALS Lois E. Brenneman, M.S.N., C.S., A.N.P., F.N.P. Written documentation for clinical management of patients within health care settings usually include one or more of the following components. - Problem Statement (Chief Complaint) - Subjective (History) - Objective (Physical Exam/Diagnostics) - Assessment (Diagnoses) - Plan (Orders) - Rationale (Clinical Decision Making) Expertise and quality in clinical write-ups is somewhat of an art-form which develops over time as the student/practitioner gains practice and professional experience. In general, students are encouraged to review patient charts, reading as many H/Ps, progress notes and consult reports, as possible. In so doing, one gains insight into a variety of writing styles and methods of conveying clinical information. -
Diagnosing Diagnosis Errors: Lessons from a Multi-Institutional Collaborative Project
Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project Gordon D. Schiff, Seijeoung Kim, Richard Abrams, Karen Cosby, Bruce Lambert, Arthur S. Elstein, Scott Hasler, Nela Krosnjar, Richard Odwazny, Mary F. Wisniewski, Robert A. McNutt Abstract Background: Diagnosis errors are frequent and important, but represent an underemphasized and understudied area of patient safety. Diagnosis errors are challenging to detect and dissect. It is often difficult to agree whether an error has occurred, and even harder to determine with certainty its causes and consequence. The authors applied four safety paradigms: (1) diagnosis as part of a system, (2) less reliance on human memory, (3) need to open “breathing space” to reflect and discuss, (4) multidisciplinary perspectives and collaboration. Methods: The authors reviewed literature on diagnosis errors and developed a taxonomy delineating stages in the diagnostic process: (1) access and presentation, (2) history taking/collection, (3) the physical exam, (4) testing, (5) assessment, (6) referral, and (7) followup. The taxonomy identifies where in the diagnostic process the failures occur. The authors used this approach to analyze diagnosis errors collected over a 3-year period of weekly case conferences and by a survey of physicians. Results: The authors summarize challenges encountered from their review of diagnosis error cases, presenting lessons learned using four prototypical cases. A recurring issue is the sorting-out of relationships among errors in the diagnostic process, delay and misdiagnosis, and adverse patient outcomes. To help understand these relationships, the authors present a model that identifies four key challenges in assessing potential diagnosis error cases: (1) uncertainties about diagnosis and findings, (2) the relationship between diagnosis failure and adverse outcomes, (3) challenges in reconstructing clinician assessment of the patient and clinician actions, and (4) global assessment of improvement opportunities. -
Professional Practice Medical Record Documentation Guidelines
Professional Practice Medical Record Documentation Guidelines INTRODUCTION Consistent and complete documentation in the medical record is an essential component of quality patient care. All Participating Providers, defined as primary care and specialist practitioners, are required to keep medical records that contain patient demographics and current, detailed, medical information regarding services rendered to Members to facilitate communication and promote efficient and effective treatment. Medical records must be maintained in an organized medical record-keeping system and in compliance with Capital BlueCross’ documentation standards for Traditional, Comprehensive, PPO, POS, Keystone Health Plan® Central, SeniorBlue® PPO and SeniorBlue® HMO Members. Complete medical records must be maintained for every Member in accordance with accepted professional practice standards, State and Federal requirements. In addition, they must meet the Pennsylvania Department of Health’s guidelines for managed care organizations. Medical records and information must be protected from public access and any information released must comply with HIPAA guidelines. Upon request, all participating practitioners’ medical records must be available for utilization and quality improvement review studies, retrospective review of claims, as well as regulatory agencies’ requests and member relations’ inquiries, as stated in the Provider agreement. Medical records must be available at the practice site for other Providers who provide care and services to the patient. Guidelines have been developed for medical record review that are intended to assist Providers in maintaining complete medical records for all Members. Each provider must meet a minimum 70% compliance with medical record guidelines. If this level of compliance is not met, a corrective action plan will be required. The guidelines, included in Exhibit 3 of this Manual, were developed to comply with state and national regulatory requirements. -
Some of the Research Tools on Allied Health Available in the Mesa College Library **************************************************************
************************************************************** SOME OF THE RESEARCH TOOLS ON ALLIED HEALTH AVAILABLE IN THE MESA COLLEGE LIBRARY ************************************************************** AHA GUIDE TO THE HEALTH CARE FIELD - Hospitals, health care systems, networks, alliances, organizations, agencies, and providers. Code chart, abbreviations list, and index. REF. RA 977 A1 A46 ALTERNATIVE MEDICINE: THE DEFINITIVE GUIDE – Specific diseases and alternative remedies. Drawings, tables, charts, recommended readings, notes, and index. REF. R 733 A46 AMERICAN MEDICAL ASSOCIATION COMPLETE GUIDE TO WOMEN’S HEALTH - Information on women’s health issues, supplemented by illustrations, tables, charts, graphs, diagrams, and index. REF. RA 778 A485 AMERICAN MEDICAL ASSOCIATION FAMILY MEDICAL GUIDE – Six parts cover such topics as “information to keep you healthy,” the body, first aid, symptoms, diseases and disorders, and health issues are supplemented by color photos and diagrams and b&w illustrations, terminology and drug glossaries, and an index. REF. RC 81 A543 AMERICAN MEDICAL ASSOCIATION INTERNATIONAL CLASSIFICATION OF DISEASES. CLINICAL MODIFICATION (ICD-CM) – All codes used for coding of illnesses by doctors writing diagnoses and medical staff preparing insurance forms. REF. RB 115 I343 ATLAS OF HUMAN ANATOMY – Contains detailed color diagrams of all parts of the human body, with labels. Eight sections cover the head and neck, back and spinal cord, thorax, abdomen, pelvis and perineum, upper and lower limbs, and cross-sectional anatomy. An index is at the back. REF. QM 25 N46 CIBA COLLECTION OF MEDICAL ILLUSTRATIONS - 8 vols./13 books - Detailed color illustrations, diagrams, and cross-sections of the entire human body along with text. Alphabetically arranged subject indexes in each book. REF. QM 25 N472 CLINICAL LABORATORY TESTS - Short descriptions of laboratory tests, what they are for, and what the results mean.