Occupational risk among magnetic resonance workers. Analysis of the literature [Il rischio professionale negli addetti alla Risonanza Magnetica. Analisi della letteratura.]

It was observed that "medical diagnosis utilizing Magnetic Resonance (MR) scanners may be one of the first modalities in which there is more risk for the operator of the equipment than for the patient" (Young, 1984). Despite this statement, only a few studies have been devoted to the assessment of occupational hazard in MR imaging personnel. The principal features associated with MR systems are: static magnetic fields, time-varying magnetic fields, and radiofrequency irradiation. Potential medical effects related to these hazards are reviewed. Static magnetic fields are known to induce in vitro changes in enzyme kinetics, orientation changes of macromolecules and subcellular components, distortion of ion currents and magnetohydrodynamic effects. Possible mechanisms for static magnetic field bioeffects include the exertion of magnetic forces, the induction of voltages, and other mechanisms (proton tunneling, ion cyclotron resonance) that are yet scarcely known. Human epidemiological studies on static magnetic fields are mainly based on subjective observations, and lack adequate control for confounding factors. Time-varying magnetic fields in the extremely-low frequency range have been associated with both occupational and non-occupational adverse health effects. Exposure to electromagnetic fields in office workers has been related to an increased rate of abortion; the vast majority of studies in this field, however, did not reach any significant result. Many literature reports support the evidence of an elevation of cancer risk in subjects exposed to residential and occupational ELF fields. Although such observations are not yet proved, the alleged occupational risk in magnetic fields exposure should induce to optimize exposure in MR imaging workers

Malpractice claims in radiology: First analysis of Italian data [Analisi delle denunce assicurative di responsabilit\ue0 civile nella radiologia. Primi dati Italiani]

The purpose of this study is to provide information to Italian radiologists regarding claims and patient injuries in medical malpractice claims. The assurance claims of Italian radiologists over a two-year period (1994-95) were anonymously analyzed, based on pertinent data provided by the Insurance Company of the Italian Society of Medical Radiology. The incidence risk-rate of claims was 9.1 per thousand person/year. Alleged malpractice accounted for more than 85% of the claims. In nearly one-half of the cases (44.4%), the plaintiff's argument was based on a \uabfailure to diagnose\ubb. The most common misdiagnosis was failure to diagnose fracture or dislocation. The second most common claim category (40.7%) were complications, most commonly occurring during interventional radiology and contrast media injection. The third claim category (14.8%) was patient's accidents occurring during the diagnostic procedure. The most frequent types of injuries experienced by patients were death (6 cases), loss of chance for survival and permanent disability. Claims were more frequent in public health services, and mostly related to emergency examinations and interventional procedures. Misdiagnoses almost exclusively involved public health radiologists. Private health care, on the other hand, had a higher rate of fatal injuries, mostly related to technical complications

Malpractice lawsuits in Radiology - Comparison of the Italian and American situations

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Malpractice claims related to musculoskeletal imaging. Incidence and anatomical location of lesions.

Obiettivo. La mancata osservazione di lesioni dell\u2019apparato muscolo-scheletrico \ue8 una frequente causa di denunce contro i radiologi. Materiali e metodi. Sono state esaminate tutte le denunce assicurative per presunti errori in indagini radiologiche riguardanti l\u2019apparato scheletrico rivolte contro i radiologi italiani in un periodo di 14 anni (1993\u20132006). Risultati. Nel periodo in esame sono state sporte contro i radiologi 416 denunce per presunti errori diagnostici relativi all\u2019apparato scheletrico: di queste, 389 (93,5%) erano relative all\u2019omessa indicazione di fratture e 15 (3,6%) a mancata diagnosi di tumore. Conclusioni. L\u2019errata interpretazione della patologia ossea \ue8 tra le pi\uf9 frequenti cause di contenzioso verso i radiologi; da sola essa rappresenta il 36,4% di tutte le denunce per presunto errore diagnostico pervenute nel periodo di osservazione. La consapevolezza del rischio dovrebbe indurre alla massima prudenza e diligenza.Purpose. Failure to detect lesions of the musculoskeletal system is a frequent cause of malpractice claims against radiologists. Materials and methods. We examined all the malpractice claims related to alleged errors in musculoskeletal imaging filed against Italian radiologists over a period of 14 years (1993\u20132006). Results. During the period considered, a total of 416 claims for alleged diagnostic errors relating to the musculoskeletal system were filed against radiologists; of these, 389 (93.5%) concerned failure to report fractures, and 15 (3.6%) failure to diagnose a tumour. Conclusions. Incorrect interpretation of bone pathology is among the most common causes of litigation against radiologists; alone, it accounts for 36.4% of all malpractice claims filed during the observation period. Awareness of this risk should encourage extreme caution and diligence

Violence against radiologists. I: prevalence and preventive measures

PURPOSE: Violence in the workplace is a specific risk for healthcare workers. Radiologists, especially when involved in emergency services, share that risk. Very few studies in the literature have researched this topic. This study aimed to evaluate the prevalence of violent behaviour in a large sample of Italian radiologists and analyse the phenomenon and its consequences with a view to proposing preventive measures. MATERIALS AND METHODS: A total of 992 radiologists (61.5% men) taking part in a national radiology congress agreed to respond to a questionnaire on violence that contained the Violent Incident Form by Arnetz for the description of violent incidents in healthcare practice. RESULTS: Some 6.8% of radiologists in public hospitals experienced physical abuse in the previous 12 months, for the most part from patients or their companions. The prevalence of physical abuse is greatest among younger healthcare individuals with less clinical experience, with no differences between sexes. Among younger radiologists, one in five suffered at least one act of physical abuse in a working year. Nonphysical violence is more widespread and throughout radiologists' working lives affects 65.2% of them. In this case, almost half of the violent incidents originate from colleagues. A total of 5.5% of respondents stated that they were victims of abuse at the time of the survey. In most cases, the violent incidents remain unreported. The immediate consequences of violence in the workplace are emotions such as anger, disappointment, humiliation, anxiety, fear, distress, a feeling of helplessness and isolation, occasionally a feeling of guilt or of having done wrong and a desire to take revenge, change behaviour or change workplace. CONCLUSIONS: The extent of the problem calls for the adoption of a series of measures aimed at eliminating the causes of the various forms of workplace violence

Radiologic malpractice litigation risk in Italy: an observational study over a 14-year period

The purpose of this study is to assess the risk of medical malpractice litigation for Italian radiologists, compared with the corresponding data in the literature

Detection of telomerase activity in prostate massage samples improves differentiating prostate cancer from benign prostatic hyperplasia

Purpose. We performed a case-control study in which we tested the ability of a non-invasive assay to detect telomerase activity and to distinguish between prostatic cancer (Pca) and benign prostatic hyperplasia (BPH) on samples of epithelial cells obtained after prostatic massage. Methods. Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay. We selected 60 patients with histologically proven Pca (30 cases) or BPH (30 cases). Specimens included in this study were from patients who had no suspicious findings on digital rectal examination for cancer, had clinical evidence of lower urinary tract symptoms, had no sonographic signs of Pca at the transrectal ultrasound evaluation, had total PSA values moderately elevated (2.6-15 ng/ml), and had no evidence of other urological cancers. The whole procedure was conducted in double blind between pathologists and molecular biology operators. Results. Telomerase activity was detected in 90% of Pca cases and in 13% of BPH cases. The sensitivity (90%) and specificity (76%) of this method were calculated. The positive predictive value, negative predictive value, and diagnostic efficiency were 87%, 90%, and 88% respectively. Conclusion. Our data indicate that telomerase activity detected by TRAP assay on prostate epithelial cells collected by prostate massage can substantially improve the distinction between Pca and BPH conditions. One of the clinical benefits resulting from the use of this new assay would be to refine the biopsy indication and to avoid for several patients without Pca the unnecessary cost and the complications of prostate biopsy