ISSUE 67 MARCH 2016

Investing in Quality

Quality health care occurs when the

patient receives care that is a) patient

centered, care which is what the patient

wants, and needs, b) timely (minimal

waiting), c) safe with no errors, d) effective,

by providing the right care according to the

best evidence, e) efficient by removing

waste in the system and f) equitable

(Institute of Medicine). The Excellent Care

for all Act which became law in Ontario in

2010 mandated strengthening a hospital’s

focus and accountability to deliver high

quality patient care. A number of

deliverables are now mandatory for

hospitals, such as patient, staff and provider

surveys, annual improvement plans, quality

committees, critical incident reporting etc.

HHS has invested additional resources to

improve quality by analyzing key processes

at the HGH ED and MCH 3C to reduce waste,

improve safety, and standardize work. The

results from these two areas will form a

larger quality strategy for the rest of the

hospital. There has been over the last few

years a real emphasis to improve quality

because when one improves quality, one

enhances the patient experience and

reduces rework and cost to the healthcare

system. Emphasis on quality, is here to stay

and will continue to be a driving force in

every area of healthcare including Imaging.

INS IDE THIS EDITION

Imaging has also embraced a focus

on improving quality over the years. Many

areas in Imaging have undergone process

reviews to streamline work flow and reduce

waste. We have implemented frequent

huddles in many of the modalities at all sites

to ensure issues are addressed and resolved

in a timely manner. Development of quality

boards and dashboards which track key

performance indicators to ensure we stay on

track is underway. We are also reviewing re-

vitalization of Peer Review of patient reports

which will create an ongoing platform for

learning and reduction of errors.

Additionally, we have an ongoing rapport

with many medical specialties to ensure we

are meeting their needs and learning from

them. There is still a lot more work to be

done to ensure a quality patient experience

and I invite you to bring forth your ideas to

improve the care we deliver to our patients.

Shairoz Kherani Director Diagnostic Imaging and Medical Diagnostic Unit

Educational News 2

Rounds Calendar 3

CME 4

Hold the Date 5

Residents 6

CARMS 7

CARMS Match 8

Radiologist News 9

Research Corner 10

THE LAST PAGE 11

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M E D I C A L I M A G I N G B U L L E T I N

Visit our Visiting Professor Program web page to view all of Visiting Professor group photos with our Radiology Residents at: http://www.fhs.mcmaster.ca/radiology/vpp/

VISITING PROFESSOR SERIES - 2015/16 SCHEDULE

EDUCATIONAL NEWS

Future Visiting Professors & Group Photo

Tuesday May 3rd and Wednesday May 4th

Annual W Peter Cockshott Lecture Dr. Zehava Rosenberg - MSK

Tuesday, April 5st, 2016 6:00 p.m.

Imaging Cardiac Emergencies: Cardiac Imaging for the Non–Cardiothoracic

Radiologist

St. Joseph’s Healthcare Hamilton CAMPBELL Auditorium—Level 2—Room T2202, Juravinski Tower

Tuesday April 5th and Wednesday April 6th , 2016

Dr. Constantine Raptis Assistant Professor, Radiology Division of Diagnostic Radiology

Cardiothoracic Imaging Section Director, Thoracic MRI Co-Director,

Emergency Radiology Barnes-Jewish Hospital

Mallinckrodt Institute of Radiology

St. Louis, MO

Dr. Zoran Rumboldt, Visiting Professor in February.

Wednesday, April 6th 2016,

7: 30 a.m. CT of Pulmonary Infections 12:00 p.m. Practical Mediastinal and

Pleural MRI

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M E D I C A L I M A G I N G B U L L E T I N

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

JURAVINSKI HOSPITAL & CANCER CENTRE

0800 Resident Rounds (all rounds in DI Conf. Rm.)

1200 Rad/Path Breast Rds (Rm 106 E Wing)

0800 MSK Rounds

1200 Resident Rounds

0800 Resident Rounds 0800 Multidisciplinary Breast Rounds

0730 Hepatobiliary Rounds

1200 Resident Rds 1310 Sarcoma Rounds - (3rd floor conference room)

1200 Interesting Case Rounds

HAMILTON GENERAL

1200 Radiology Teaching Rounds

0700 Spine Rds 0800 Regional Cardiology Rds (David Braley Centre, General Campus, Auditorium) 1200 Radiology Teaching Rounds 1200 Combined Stroke Rounds, DI Classroom, Rm 2-158 1600 Trauma Rds (Theatre Auditorium) M&M Rounds 1st Tues. of mo.

0730 Vascular Rounds (5N Teaching Room)

0800 Arrhythmia Rds. (Theatre Auditorium, HGH)

1230 M&M Rds. (DI Classroom), set once a month

0800 Stroke Rds.(David Braley Centre, General Campus, Auditorium) 0800 CNS Tumor Rds. HGH (DI Classroom) once a month 1200 Radiology Rds. Interesting Cases 1200 Dr. Bradley’s Rds, every 3rd Thurs. each month. (notify residents call Dr. Bradley & Med. Resident on 8 South)

0800 Neuroscience Rds. David Braley Centre, General Campus, Auditorium)

1200 Radiology Teaching Rounds

MUMC

0800 Resident Rds 0800 Tumor Brd (3F) 1200 OB Rds (Dr. Mohide) Rm 2S32 1200 Neuroradiology Rds Rm 3N50

0800 Resident Rds 1230 Neurooncology Rds 3F 1445 Neonatal (US) Rds Rm 2S32

0800 Resident Rounds (TBA) 0800 Adult GI Rounds, Rm.2S32 0800 RPC (3rd Wed ea. mo.) Rm 2S32

0800 Resident Rounds 0800 Surg/Rad/ Path (SRP) Rds – 4th Thurs. of ea. mo. Rm 2S32 1130 Rheumatology - ev.other wk Rm TBA 15:00 Clinical Teaching Unit (CTU) Every 4th Thursday, Room 2S32

0800 Resident Rounds

1200 GI Ped Rounds Room 2S32

ST. JOSEPH’S HEALTHCARE HAMILTON

(All rounds in DI Conference Room T0102, unless otherwise specified)

1200 – 1300 Resident Hot Seat Rounds (Rad Residents, Students, PA Clerks) 12:00 SJHH Ultrasound Rounds

0700 – 0800 ENT Rds. last Tues.of each mo. Dr.J.Coret-Simon 0730 – 0800 Small Renal Tumour Board Rounds - 1st Tues. of each mo. 0800 – 0900 Vascular Difficult Access Rounds – 1st Tues. of ea mo.. 1200 – 1300 Interesting Case Rounds presented by Fellows for Residents, Students, PA Clerks & Radiologists – 1st, 3rd & 4th Tues. of the mo. 1200 – 1300 – QA Rounds, Radiologists only – 2nd

Tues. each mo. 1300 – 1400 Resident Hot Seat Rounds – Rad Residents/Students /PA Clerks, Radiologists’ Reporting Rm. Indicated by an (*) asterisk on the weekly rad schedule

1200 – 1300 No rounds 1st Wed. of Oct/Nov/Jan/Feb/Mar/ Apr/May - MSK Radiology Rheumatology Rounds, MSK Fellows, Residents,Rads, Rheumatologists Vasculitis Rounds – 3rd Wed. of each mo. 16:30 -17:30 Gen Surg/ Radiology Colorectal Rds – 1st Wed of each mo. Surg.rads, residents, Fellows, Students, PA Clerks 1200 – 1700 Radiology Residents’ Half Day Presentation/Rds/Journal Club-Rotating sites- Juravinski/MUMC/St. Joe’s/Hamilton General

0700 Hepatobiliary Rounds, Surgeons, Rads, Residents, Fellows, Elective Students - Juravinski 0800 – 0900 Monthly Neuroradiology Rds,

nd 2 Thu ea mo. 1200 – 1300 Breast – Pathology Rounds, Rads, Residents, Pathologists, Techs, Breast Fellows 1300 – 1400 Sarcoma DST Rounds, via videoconference DI Conf Rm (T0102) 1300 – 1400 Resident Hot Seat Rounds, Rad Residents / Students/ PA Clerks, Rads’ Reporting Rm. Indicated by (*) on weekly rad schedule

0730 – 0830 (2nd Fri. of ea. month) Radio / Respirology Rds, Fellows, Residents, Rads, Respirologists, Students, Thoracic Surg., Fellows Residents, PA Clerks 1200 – 1300 US Rds. Fellows, Residents, Techs,Nurses, Rads, Elect. Students, Firestone Clinic Conf. Rm. T1152 (Tower) 1200 – 1300 Lung DST Rds,1st,2nd,4th Fri ea mo. Videocon. JCC/DIConf. T0102 1300 – 1400 Resident Hot Seat Rds, Rad Residents Elect Students,Rads’ Reporting Rm. Indicated by (*) on wkly rad schedule

ROUNDS CALENDAR

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For more information go to: https://cme.oarinfo.ca/cme/upcoming.php

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Department of Radiology

2016 R A D I O L O G Y

RESEARCH DAY

HOLD THE DATE

Wednesday, April 27, 2016

Venue: Hamilton Golf & Country Club

232 Golflinks Road, Ancaster *** Smart Casual** dress code – NO denim

More Details to follow………. (RSVP’s will be required in order to be on attendee list. Please contact Sue Gaudet for further information, gaudets@hhsc.c or Ext. 75298 )

M E D I C A L I M A G I N G B U L L E T I N

Come join us as Residents, Fellows and Graduate students present their

research projects.

Awards will be given to the best presentation within each group!

Residents & Fellows will be excused from clinical duties for the day in order to attend.

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RESIDENTS

4th CanMEDS Residency Program Retreat was held on February 10, 2016. We had a dynamic mix of speakers presenting a broad range of exciting lectures to our resident group. Dr. Koff shared his expertise on LEADS framework approach to Leadership. Jane Castello and Sandra Monteiro explored key topics on research methodology for our resident group. Our afternoon session was highlighted with a visit from the Ontario Association of Radiologist (OAR) leadership team. Mr. Ray Foley and Dr. Mark Preiditis gave an overview of OAR mission / resources and a “state of the union” regarding Radiology Practice in Ontario. The afternoon was capped off with Dr. Stefanie Lee engaging the residents in an interactive session on “Errors in Radiology”. Thank you to all for a very enjoyable day!

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CARMS 2016

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CARMS MATCH 2016

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Radiologist

Congratulations to Dr. Michael Patlas who received a Certificate of Appreciation from RSNA in recognition of the excellence of his Education Exhibit “Emergency Radiology Case of the Day”.

Congratulations to Dr. Michael Patterson on his retirement. After a long career, and having made tremendous contributions, Dr. Michael Patterson will be retiring. Mike has provided outstanding leadership to our Program and has been an exceptional colleague in providing wise counsel and strong leadership. Mike was recruited to what was then the Hamilton Regional Cancer Center in 1984. He joined the Center as a Medical Physicist and McMaster University as an Assistant Professor in the Department of Radiology. Prior to joining us, Mike had received his PhD in Medical Biophysics at the University of Toronto and had worked as a Medical Physicist at the Kingston Regional Cancer Center. Mike’s leadership included the transition of the initial “Cancer Clinic” to the more modern Hamilton Regional Cancer Center in 1992, and he was again a key contributor to the further expansion of the Cancer Center and its Radiation Treatment Program capacities in 2005. Through his leadership of our Medical Physics Department, we have benefitted enormously from Mikes’ ability to integrate the science of medical physics and new technology into the provision of patient care. Mike has also had a very successful academic career with a long list of peer-reviewed publications and book chapters and extensive peer-review funding. In 2015, Mike’s accomplishments were recognized by the Canadian Organization of Medical Physics through the Organization’s awarding to Mike its highest honour – the Gold Medal for Lifetime Achievement.

Congratulations to Michelle McAlpine, Nuclear Medicine Admin—for her 10 years of service.

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RESEARCH CORNER

Completing your resident research projects: advice from your research scientist and consultant Sandra Monteiro, PhD If you are wondering how to start your project, start with a question that you are most interested in. As I understand things, you are required to complete an audit project and a separate research project. The department prefers that you do two separate studies, however, there are opportunities to start with an audit that turns into a research project. If this is your goal, then it is really important to select a topic you really care about as you will need to chase down information for a few years and if you don’t like the topic that will feel like too much of a burden. Research gets a bad reputation from too many people selecting a topic they think is good for them, rather than a topic they find interesting. Not every project will change the world, so you might as well enjoy your time as a researcher. So what are reasonable topics? Really anything that impacts patient care, which includes administrative tasks, education of residents, communication between departments and clinically relevant protocols. For the audits, considering any aspect of your job that could be improved is one way to start. If you suspect there is a specific inefficiency in Radiology, conduct an audit to find out. You may be correct or surprised that your experiences are the exception. You might also conduct an audit on clinical aspects of patient care specifically to measure how well your site is performing compared to a global standard. Your first step: Google your question and see if anyone else has looked at this before. From what I have seen so far, there are no shortages of questions to ask, but don’t skip the review process. If you’ve completed this process of identifying a question and reviewing the literature for related articles, then design your study. If you don’t know where to start, contact me (monteisd@mcmaster.ca). If you already have a design in mind, write it out, as if you were submitting an abstract to a conference or submitting a grant proposal. This is very helpful for the day you decide to actually submit a grant, actually submit an abstract, or apply for ethics approval. All these steps will prove very useful for the day you decide to publish or present your work. If you have a protocol ready to follow, you may want to contact Jane Castelli (jane.castelli@miircam.ca) to identify the most efficient way to get your data. This may prove to be the most difficult or time consuming part of your study – just getting patient charts to review. Now to the question that seems to cause the most anxiety: How do I calculate a sample size? Be assured that for most studies that could be developed under the broader topics mentioned above (specifically in Radiology), you cannot calculate a reasonable sample size a priori. Here’s why. A sample size calculation is required in an ethics application to protect the rights of patients in clinical studies. They want to know that you have a grasp of exactly how big a difference in some health outcome you expect to measure. And the key to remember here is that the smaller the different you expect to measure, the larger your sample size will be. But most Radiology projects do not involve a clinical trial or real patients at all. Yet the question needs to be answered. In the next paragraph, I give you a way to respond to this question if you are not conducting a clinical trial. But for those of you interested in how statisticians come up with the magic number here you go: What you need to calculate a sample size:

A measure of expected variance in your population of interest (the standard deviation –SD - reported around the measure you are using - e.g. for a blood pressure drug, what is the SD for blood pressure in the population of interest).

The minimal difference you expect to measure (with the same example, how much do you expect to lower blood pressure?) – or take this from the average difference reported in the literature – which means you read a systematic review on the topic and get what they report to be the average difference.

This formula: N of each group= 16(S2/D2) – where S is SD and D is the difference [NOTE: there is a slightly different formula when your outcome measure is not a continuous variable, but is rather a proportion – just contact me if this is the case and we can work through it – you still need the same ingredients).

Now that you have that – you can probably ignore it, because the majority of studies I have seen in Radiology resident projects so far are not interventional clinical trials but audits or epidemiological studies of a certain outcome. For these studies you are describing only, and so descriptive data are usually all you need (mean, median, SD, etc.). If you have 2 groups of concern (e.g. male/female; Juravinski/St. Joe’s; patient improved/did not improve; etc.) you may be able to calculate a correlation or Chi-squared statistic to determine if proportions are different between your two groups. For the most part, if you are conducting an audit, you can explain that you will rely on a convenience sample of patients within your site or within HHS overall. You may go so far as to estimate the number of patients you will be able to include. (e.g. the number of patients the present with hip fracture at Hamilton General every year). Admittedly, this is not the most sophisticated approach to research, but truthfully, neither is an audit – it is merely a first step to identifying a problem (or lack of one). Should you want to go the next step and design an experiment to address the problem you identified, I am happy to help you design that too. If you found this helpful, let me know – or send me further questions you would like answered at the next academic half-day or in a future bulletin.

For the most part, if you are conducting an audit, you can explain that you will rely on a convenience sample of patients within your site or within HHS overall. You may go so far as to estimate the number of patients you will be able to include. (e.g. the number of patients the present with hip fracture at Hamilton General every year). Admittedly, this is not the most sophisticated approach to research, but truthfully, neither is an audit – it is merely a first step to identifying a problem (or lack of one). Should you want to go the next step and design an experiment to address the problem you identified, I am happy to help you design that too. If you found this helpful, let me know – or send me further questions you would like answered at the next academic half-day or in a future bulletin. Sandra Monteiro, PhD Education Research Scientist, Program for Education Research and Development Assistant Professor, Clinical Epidemiology and Biostatistics and Radiology, McMaster University, 905 525 9140 ext. 22614

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M E D I C A L I M A G I N G B U L L E T I N

UPCOMING DATES OF INTEREST March 13-18—SAR 2016 Annual Meeting

March 25, 2016—Good Friday

March 27, 2016—Easter

March 28, 2016—Easter Monday

April 14-17, 2016—CAR Annual Scientific Meeting

April 17—22, 2016—ARRS Annual Meeting

May 14, 2016—OAR Emergency Radiology 2016

Submissions to: Marguerite Jackson

McMaster Site, HSC - Room 4N-49 jacksonmar@hhsc.ca

The legend of Saint Patrick

The legend of Saint Patrick has evolved during the 1500-

odd years since the missionary brought Christianity to

Ireland. Much embellished in the telling, his story has

become a mixture of truth, myth and allegory.

The Shamrock

Perhaps the best-known legend of Saint Patrick involves

the shamrock, the little plant that has gone on to become

famous throughout the world as a symbol of Irish heritage.

After training as a priest and bishop, Patrick arrived in

Ireland in 432AD and immediately set about trying to

covert the pagan Celts who inhabited the island. Having

previously lived and worked there, he was very probably

already aware that the number three held special

significance in Celtic tradition (and, indeed, in many pagan

beliefs), and he applied this knowledge in a clever way.

He used the shamrock, a three-leaved clover which grows

all over the island, to explain the Christian concept of the

Holy Trinity ie the theory that God the Father, God the Son

and God the Holy Spirit are each separate elements of just

one entity. St. Patrick showed himself willing to adapt

heathen practices and symbols to Christian beliefs in order

to ease the transition from pagan to Christian.

PYSANKY—According to many scholars, the art of wax-resist (batik) egg decoration in Slavic cultures, and particularly in Ukraine, probably dates back to the pre-christian

era. They base this on the

widespread nature of the

practice, and pre-christian

nature of the symbols utilized. No ancient examples of intact pysanky exist, as the eggshells of domesticated fowl are fragile, but fragments of colored shells with wax-resist decoration on them were unearthed during the archaeological excavations in Ostrówek, Poland, (near the city of Opole), where remnants of a Slavic settlement from the early Piast Era were found. As in many ancient cultures, Ukrainians worshipped a sun god (Dazhboh). The sun was important - it warmed the earth and thus was a source of all life. Eggs decorated with nature symbols became an integral part of spring rituals, serving as benevolent talismans.

In modern times, the art of the pysanky was carried abroad by Ukrainian emigrants to North and South America, where the custom took hold, and concurrently banished in Ukraine by the Soviet regime (as a religious practice), where it was nearly forgotten. Museum collections were destroyed both by war and by Soviet cadres. Since Ukrainian Independence in 1991, there has been a rebirth of this folk art in its homeland, and a renewal of interest in the preservation of traditional designs and research into its symbolism and history.