Journal of the American College of Radiology : JACR
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A recent report by the Medicare Payment Advisory Commission to Congress indicated that the utilization of diagnostic imaging is growing more rapidly than that of any other type of physician service. This has engendered concern among those who pay for health care. In this article, the authors review the role of self-referral in driving up imaging utilization. ⋯ These have consistently shown that when nonradiologist physicians operate their own imaging equipment and have the opportunity to self-refer, their utilization is substantially higher than among other physicians who refer their patients to radiologists. It has also been shown that the vast bulk of the recent increases in imaging utilization are attributable to nonradiologists who self-refer. The authors estimate that the cost to the American health care system of unnecessary imaging resulting from self-referral by nonradiologists is $16 billion per year.
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As a result of dramatic changes in the health care environment, the importance of the teaching mission to the future of radiology is gaining greater recognition. A new breed of "clinician educators" has a presence in most academic radiology departments. A clear understanding of the differences between teaching and educational scholarship is necessary for the purpose of defining the role of the clinician educator. ⋯ Medical schools can improve the retention of their best teachers by defining tracks and criteria for rewarding teaching efforts. Universities, medical schools, academic medical centers, and professional organizations are vital components of the infrastructure needed to promote educational scholarship. They provide a community of education scholars who share, collaborate, and exchange work and promote the science of education.
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We are currently seeing increasing opportunities to improve patient care with computed tomography (CT). At the same time, we are challenged to use this technology wisely. In particular, we are being asked to balance the benefits against the risks, chiefly those of ionizing radiation. ⋯ In addition, it is helpful to be familiar with measures of radiation pertinent to CT and the doses provided by this modality. This foundation then provides a context in which to discuss the issue of low-dose radiation and cancer risk as well as potential changes in CT practice guidelines and regulation. It is with an understanding of these issues that radiologists and other radiology personnel can participate in an informed discussion with referring physicians and patients and continue to optimize the practice of CT.
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This article presents the complex set of considerations and influences that resulted in the Accreditation Council on Graduate Medical Education' s (ACGME) development of rules to govern the duty hours of residents. The process is demonstrative of the complexity associated with the self-regulation of graduate medical education. At the same time, the ACGME' s development of standards for resident duty hours suggests that self-regulation can be an effective alternative to governmental regulation.