Hungarian Radiology

[Quality cost in radiology: the cost of repeated examinations]

KIS Zsuzsanna

OCTOBER 10, 2005

Hungarian Radiology - 2005;79(05)

[INTRODUCTION - The aim of the author is to describe the definition and types of quality cost in the health care services especially in the field of radiology. The proportion of the quality cost is based on the author's data and data from the literature. The ways of reduction of the quality cost is also discussed. MATERIAL AND METHODS - The author made a research based on a prior multicentric study to determine the loss derived from the excessive use of films used during the repeated radiological examination. The cost of wrong services nationwide is calculated on the basis of the loss per 1000 German point. RESULTS - Our short research showed that 300 000 Ft HUF + VAT per year was paid because of the excessive use of the films during the repeated examination points within the given period of time. The loss percentage per 1000 German points can be calculated based on the points generated during a given time. In this way there was more than 300 million HUF spent on defective services nationwide in 2002. CONCLUSION - The cost of defective services and resulting moral and financial losses justify the need for finding and reducing the costs. Quality control and quality improvement can be used to achieve the aims of controlling the processes by the right indicators. By discussing them the processes will improve, the costs will be lower and quality also improves. The patients and insurance companies who buy our services also have the same expectations.]



Further articles in this publication

Hungarian Radiology



Hungarian Radiology

[The role of MRI in the clinical examination following breast cancer screening]


[INTRODUCTION - Breast cancer screening was performed in 27 325 female patients at the National Institute of Oncology from 1st of January 2002 to May 30th of 2005. Complementary examinations were necessary in 1876 women. MR-mammography was performed in 65 of these cases. We were curious about in which cases MR mammography helps to make the diagnosis more accurate, how does it influence the therapy. We also studied, whether the number of surgical interventions because of benign breast lesions decreases due to MR mammography. PATIENTS AND METHODS - In 65 patients MR mammography was performed using non-contrast axial and coronal T1W and STIR sequences. After the injection of gadolinium four series of 3D FLASH (fast low angle shot) dynamic gradiens echo sequences were also applied. Subtraction of the non-contrast and contrast enhanced series were evaluated in addition to the intensity curves of the postcontrast series. RESULTS - MR mammography helped to evaluate dense breasts in 21 cases, to identify multifocal lesions in 6 cases and to differentiate the malignant-benign processes. In the course of the 65 post-screening examinations, malignant processes [BI-RADS IV-V (Breast Imaging Reporting and Data System)] were diagnosed in 21 cases, benign processes (BI-RADS II-III) or negative results were found in 44 patients. CONCLUSION - MR mammography increased diagnostic accuracy, decreased the number of benign lesion-related surgical procedures and increased the accuracy in determining surgical radicality and establishing a therapeutic plan.]

Hungarian Radiology

[The force transmission of the distal endings of stent delivery systems]


[INTRODUCTION - In cases of endovascular treatment of internal carotid artery stenosis, one of the most important aspects is to minimise embolic complications. Dislodging emboli may be influenced by the shape and size of tapered endings of stent delivery systems. Our team performed measurements and calculations on the emergence of force of the various tapered endings. MATERIAL AND METHOD - Five different commercially available stent dilivery systems were investigated. The thickness of the devices were measured and taking 5 mm normal artery diameter, the lumen size was calculated, above which the delivery system should dilate the lumen mechanically. By means of geometrical computer-constructions and measurements, we analysed the forces directed ahead and laterally, emerging on the surface of tapered endings during the passing through the stenosis. RESULTS - The stent delivery systems were between 5.0 and 5.9 F in diameter, and even the stent delivery system of lowest profile would dilate a stenosis of over 89%. The different endings are tapered with variable lengths. The force transmission on the vessel wall of different directions was distinct at the various points of the cone surfaces. The forces directed ahead were less than those directed laterally on the larger part of a cone surface. Irregularity of the cone surfaces distributed the forces unfavorably. Considering the features of tapered endings, the atraumatic introduction of the devices required a range of upper limits of stenoses between 89.76-98.04%, which are more feasible values than those deternined by shaft sizes. CONCLUSIONS - Our experimental work suggests, that the shape and size of the endings of stent delivery systems influence the forces affecting vessel wall plaques, and in this manner, embolic complications, during carotid stenting. The lowest risk of embolisation could be induced by using the longest and smoothest tapered endings.]

Hungarian Radiology

[Acromesomelic dysplasia du Pan]

KAISSI Al Ali, GHACHEM Ben Maher, CHEHIDA Ben Farid, KOZLOWSKI Kazimierz

[INTRODUCTION - Cartilage derived morphogenic protein (CDMP1) mutations account for several related disorders, ranging from prenatal lethal to very mild entities such as brachydactyly C. Two similar severe manifestations of CDMP1 mutations are du Pan and Hunter-Thompson syndromes. CASE REPORTS - We report two second degree relatives with du Pan syndrome. Clinical history and full skeletal surveys were analysed and compared with the data from the literature. Frequent spontaneous abortions - probably manifestation of the lethal forms of CDMP1 mutations - were present in both families. Skeletal surveys of the patients showed similar acromesomelic abnormalities consistent with du Pan syndrome. CONCLUSION - The rare publications of du Pan syndrome present usually insufficient radiographic documentation. Better radiographic imaging is necessary to establish clear-cut criteria of differentiation between du Pan and Hunter-Thompson syndrome.]

Hungarian Radiology

[Calcification of the tentorium cerebelli]

BILONKA Viola, BENDE Mariann

[A 16-year-old female patient with high temperature and headache was hospitalized because of suspicion of meningitis. Cranial CT showed a mild hydrocephalus, massive falx calcification and calcification in the projection of the tentorium. Excluding several well known reasons of the calcification the findings was thought to be a physiological variation. The child recovered after some days and left the hospital. The authors based on prior publications on tentorium calcification consider this finding a physiological-phylogenetic origin.]

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Lege Artis Medicinae

[The future of chest X-ray screening in Hungary]

AJKAY Zoltán

[In 2001 4.095.134 chest screening examinations were carried out at 154 fixed and 50 mobile Xray screening stations in Hungary. Currently, screening for tuberculosis is mandatory by law, but a recently issued decree by the Health Minister states that the method is suitable for the screening of lung cancer as well. Unfortunately, the majority of the machines are old and since replacements are long overdue, the assessment with a high technical standard and quality is not always possible. These are the reasons why a plan must be outlined for the necessary improvement and for the renewal of the equipment pool, based on expert opinion. In the literature, there are ongoing spirited discussions on the efficacy of X-ray screening as well as on the possibilities of CT-scans for the identification of lung cancer. The size of the investment needed makes it necessary that costbenefit factors and the possibility of joining the National Health Prevention program should be considered.]

Lege Artis Medicinae

[The treatment of chronic hepatitis C with peginterferon - Peginterferon alfa-2a or alfa-2b?]


[The main purpose of the treatment of patients with chronic hepatitis C is to achieve a sustained virologic remission (SVR), which means that no hepatitis C virus ribonucleic acid (HCV RNA) is detectable 24 weeks after the cessation of treatment. In patients infected by genotype 1 virus, the chance of achieving SVR by a combination treatment with peginterferon alfa-2a or alfa-2b plus ribavirin is about 40-50%. The pharmacokinetic properties of the two peginterferons are significantly different from each other. A number of clinical trials have been performed in the past eight years to clarify whether this difference influences the clinical efficiency or safety of these drugs. Several prospective, comparative studies have been completed recently. Among these, the American IDEAL study is the largest and most important one, however, the results of numberous smaller studies are also available. More than 3000 patients with genotype 1 HCV were treated in the IDEAL study and no significant difference was found in SVR rates between the peginterferon alfa-2a and alfa-2b treatment arms. However, the doses of ribavirin used in this study raise several questions in this study. In two smaller Italian studies, significantly higher SVR was achieved with peginterferon alfa-2a plus ribavarin treatment. According to a Cochrane metaanalysis, in which reviewed data of 4335 patients from eight randomized trails have been reviewed, treatment with peginterferon alfa-2a is significantly more effective. Besides efficiency, the cost/effectiveness of the two therapies were also compared in a large American study, which also showed that peginterferon alfa-2a treatment was superior to peginterferon alfa-2b treatment.]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]