FAIR IMAGING A presentation by Annabel Cleland and Annabel Merrett Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
PRIMUM NON NOCERE First do no harm Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Less is More ● “ Cured yesterday of my disease, I died last night of my physician ” - Matthew Prior, The Remedy Worse Than the Disease (1714) ● In medicine, more testing, interventions or treatments are not always better. Doing more can harm patients, generate excess costs, and defy patient’s wishes Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Less is More Examples in medicine where more harm was done than good: ● Thalidomide for morning sickness and sleeplessness, which caused major birth defects in the 1950s ● Smoking used to be encouraged as a remedy for asthma ● The use of epidural spinal steroids for lower back pain leading to an outbreak of spinal meningitis in the United States in 2012 ● Medicine overuse headache from regular use of anti-inflammatories and other pain killers. And so on... Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Less is More ● The ‘Less is More’ movement encourages the use of lower cost approaches, clinical thought in the care of patients, and evidence-based practice ● It is not only about cost-cutting (although reducing wasteful spending is a further advantage). The primary goal of the Less is More movement is avoiding harm. ● It is does not reduce access to necessary care for patients ● This movement has gained traction over the last two decades through campaigns such as “Slow Medicine” and “Choosing Wisely”. Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Slow Medicine ● Slow medicine stems from the broader “slow movement,” which includes slow food, slow fashion, slow parenting and others ● A rewarding approach to medicine which allows health professionals sufficient time to evaluate and care for patients ● Time for listening, understanding, reflection, consultation, and emotional support Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Slow Medicine Italy’s Slow Medicine founded in 2011 aimed to promote a thoughtful patient ● centred and evidence based approach to clinical care emphasising careful clinical decision making ‘An equitable patient-physician relationship’ Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Slow Medicine Peoples values, expectations Doing more does not Appropriate and good and desires are different and mean doing better quality care for all inviolable Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Choosing Wisely ● A campaign launched in 2012 in an effort to encourage conversations aimed at reducing unnecessary tests and treatments in healthcare ● Medical specialties were asked to identify five tests and treatments which are overused in their specialty and did not provide meaningful benefit for patients, known as “The top five list” ● Encourages doctors and patients to have conversations about what care is truly needed and to lose the notion more is better Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Choosing Wisely ● Choosing care that is… ○ Supported by evidence ○ Not duplicative of other tests or procedures already received ○ Free from harm ○ Truly necessary ● The ultimate goal is to reduce wasteful care Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Choosing Wisely Examples in Radiology: ● Do not order advanced imaging studies (MRI or CT) for most musculoskeletal conditions in a child until all appropriate clinical, laboratory and plain radiographic examinations have been completed ● Do not obtain spinal imaging for patients with acute low-back pain during the six weeks after onset in the absence of red flags ● Don’t recommend ultrasound for incidental thyroid nodules found on CT, MRI or non-thyroid- focused neck ultrasound in low-risk patients unless the nodule meets age-based size criteria or has suspicious features Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Image Gently ● Image Gently is a campaign that began in 2006, developed by the Society of Paediatric Radiology ● Their goal: to change paediatric practice through education of health professionals to lower radiation dose delivered to children Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Image Gently ● A particular issue, raised in an article in the New England Journal of Medicine (1) is that of increasing number of CT scans performed on children ● The risk of cancer for the individual is small, but the public health implications are large if the number of CT scans performed continues to increase ● Children are more radiosensitive than adults and have more remaining years of life during which the radiation induced cancer could develop Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation. N Engl J Med 2007;357:2277-2284. Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Image Gently A and B show estimated organ damage (mGy) based on organ imaged and age. C and D show lifetime risk of death from cancer. Figure from: Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation. N Engl J Med 2007;357:2277-2284. Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
Image Gently ● Concerns with harms caused by paediatric CT’s led to the creation of the campaign “One Size Does Not Fit All” ● Four key points of this campaign are: 1. Reduce or ‘child size’ the amount of radiation used 2. Scan only when necessary 3. Scan only the indicated region 4. Scan once Collated by Annabel Cleland and Annabel Merrett , final year medical students at the University of Otago, New Zealand. Placed at Cisanello University Hospital, Radiodiagnostica 1 (Prof. Davide Caramella).
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