Kostenanalyse einer kontrastgestützten MRT des Schädels an einem Universitätsklinikum

Schreyer, A. G.; Friedrich, Cheri; Mrosek, S.; Hoffstetter, Patrick; Rennert, Janine; Framme, Carsten; Jung, EM; Feuerbach, Stefan; Schöffski, Oliver; Zorger, N.

doi:10.1055/s-0029-1245511

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…MRI scans of ICU patients are time-consuming and complex examinations in the everyday hospital routine. Critical care physicians have to carefully weigh the indication for an MRI examination because of the complexity, cost 16 , and potential risks 7 posed to ICU patients during in-house transport.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value and Operational Risks of MRI in ICU patients – A Retrospective Analysis Performed at a University Medical Center

Pawlik,

Dendl,

Achajew

et al. 2023

Rofo

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Purpose Intensive care unit (ICU) patients have a high risk of developing complications when leaving the ICU for diagnostic procedures or therapeutic interventions. Our study examined the frequency of adverse events associated with magnetic resonance imaging (MRI) of intensive care patients and the extent of changes in therapy due to the MRI scan to weigh the risks associated with the scan against the potential benefits of an MR scan, using a change in therapy as an indicator of benefit. Materials and Methods 4434 ICU patients (January to December 2015) were identified by Hospital Information System (SAP-R/3 IS-H, Walldorf, Germany), ICU patient data management system Metavision (iMDsoft, Israel), and Radiology Information System (Nexus.medRIS, Version 8.42, Nexus, Germany). All intensive care and medical records (HIS) and MRI reports (RIS) were matched and further evaluated in a retrospective case-to-case analysis for biometric data, mechanical ventilation, ICU requirements, planned postoperative vs. emergency diagnostic requirements, complications and impact on further diagnosis or therapy. Results Out of 4434 ICU patients, 322 ICU patients (7.3 %) underwent a total of 385 MRI examinations. 167 patients needed a total of 215 emergency scans, while 155 patients underwent 170 planned postoperative MRI exams. 158 (94.6 %) out of 167 emergency scan patients were ventilated under continuous intravenous medication and monitoring. In the planned postoperative group, only 6 (3.9 %) out of 155 were ventilated, but a total of 38 (24.5 %) were under continuous medication. 111 patients were accompanied by nurses only during MRI. Only one severe adverse event (0.3 %) was noted and was attributed to study preparation (n = 385). In 8 MRI examinations (2.1 %), the examination was interrupted or cancelled due to the patients’ condition. While all MRI examinations in the planned group were completed (n = 170, 100 %) (e. g., postoperative controls), only 207 out of 215 (96.3 %) could be performed for emergency diagnostic reasons. MRI influenced the clinical course with a change in diagnosis or therapy in 74 (19.2 %) of all 385 MRI examinations performed, and in the emergency diagnostic group it was 31.2 % (n = 67/215). Conclusion Nearly 20 % of MRI examinations of ICU patients resulted in a change of therapy. With only one potentially life-threatening adverse event (0.3 %) during transport and the MRI examination, the risk seems to be outweighed by the diagnostic benefit. Key Points:

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Section: Discussionmentioning

confidence: 99%

Clinical Value and Operational Risks of MRI in ICU patients – A Retrospective Analysis Performed at a University Medical Center

Pawlik,

Dendl,

Achajew

et al. 2023

Rofo

View full text Add to dashboard Cite

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“…al. deutlich, bei der über einem Monat lediglich eine Untersuchungsart zur Ermittlung der Kosten erfasst wurde [23]. Die Literatur geht bei der MMH im Allgemeinen von einem bis zu 70 % geringeren zeitlichen Aufwand als bei vergleichbaren Zeitaufnahmeverfahren aus [24].…”

Section: Methoden Der Eigenen Untersuchungenunclassified

Analyse der Arbeitsabläufe eines radiologischen Zentrums mittels Multimoment-Häufigkeits-Studie: Methodische Grundlagen

Reifenrath

Wacker

Alten

et al. 2012

Fortschr Röntgenstr

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Radiology departments at hospitals are closely watched for their economy. The introduction of fast scanner technology usually triggers questions about simultaneously reducing final report times. The aim of the present study was first to examine, if the multi-moment analysis (MMH) is an appropriate method for structural and quantitative analysis of complex work flows in Radiology, and second, if factors negatively influencing the core processes can be quantitatively evaluated. The study was performed in the Departments of Radiology and Neuroradiology at a major University Hospital in Northern Germany. Randomized monitoring of the workflow of more than 80 doctors and radiology technicians assistants resulted in 800 observations per workplace. The high observation rate yielded a high accuracy (95% confidence interval width of less than +3,5%) to determine the proportion of different work patterns. MMH proved to be an appropriate means to analyze and quantify complex work flows at a university radiology centre. Different workplaces could be compared and total daily labor time could be derived from the observations. Circadian variabilities could be differentiated. The potential of the MMH to guide workflow optimization was identified. On the basis of data collected, MMH restructuring and control systems can be planned.

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Post mortem cadaveric and imaging mapping analysis of the influence of cochlear implants on cMRI assessment regarding implant positioning and artifact formation

Arnold,

Fries,

Beck

et al. 2024

Eur Arch Otorhinolaryngol

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Objectives In times of an aging society and considering the escalating health economic costs, the indications for imaging, particularly magnetic resonance imaging (MRI), must be carefully considered and strictly adhered to. This cadaver study aims to examine the influence of cochlear implant (CI) on the assessment of intracranial structures, artifact formation, and size in cranial MRI (cMRI). Furthermore, it seeks to evaluate the potential limitations in the interpretability and diagnostic value of cMRI in CI patients. Additionally, the study investigates the imaging of the brain stem and the internal ear canal and the feasibility of excluding cholesteatomas in cMRI for CI patients. Materials and methods Two cadaveric specimens were implanted with cochlear implants at varying angular positions (90°, 120°, and 135°), both unilaterally and bilaterally, with and without magnet in situ. MRI acquisition consisted of sequences commonly used in brain MRI scans (T1-MP-RAGE, T2-TSE, T1-TIRM, DWI, CISS). Subsequently, the obtained MRI images were manually juxtaposed with a reference brain from the Computational Anatomy Toolbox CAT12. The size and formation of artifacts were scrutinized to ascertain the assessability of 22 predefined intracranial structures. Furthermore, the internal auditory canal, middle ear and mastoid were evaluated. Results The cadaveric head mapping facilitated the analysis of all 22 predefined intracranial structures. Artifacts were assessed in terms of their minimum and maximum impact on image comparability. Image quality and assessability were stratified into four categories (0–25%, 25–50%, 50–75%, and 75–100% of assessability restriction). The visualization of the central, temporal, parietal, and frontal lobes was contingent upon CI positioning and the choice of imaging sequence. Diffusion-weighted cMRI proved inadequate for monitoring cholesteatoma recurrence in ipsilateral CI patients, regardless of magnet presence. The ipsilateral internal auditory canal was inadequately visualized in both magnet-present and magnet-absent conditions. We divided our results into four categories. Category 3 (orange) indicates considerable limitations, while category 4 (red) indicates no interpretability, as the image is entirely obscured by artifacts. Conclusion This study provides detailed predictive power for the assessability and therefore the relevance of performing cMRIs in CI patients. We advocate consulting the relevant CI center if artifact overlay exceeds 50% (categories 3 and 4), to evaluate magnet explantation and reassess the necessity of cMRI. When suspecting cholesteatoma or cholesteatoma recurrences in patients with ipsilateral cochlear implants, diagnostic investigation should preferably be pursued surgically, as the necessary MRI sequences are prone to artifact interference, even in the absence of a magnet. The ipsilateral internal auditory canal remains inadequately evaluable with a magnet in situ, while without the magnet, only rudimentary assessments can be made across most sequences.

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Kostenanalyse einer kontrastgestützten MRT des Schädels an einem Universitätsklinikum

Cited by 5 publications

References 7 publications

Clinical Value and Operational Risks of MRI in ICU patients – A Retrospective Analysis Performed at a University Medical Center

Clinical Value and Operational Risks of MRI in ICU patients – A Retrospective Analysis Performed at a University Medical Center

Analyse der Arbeitsabläufe eines radiologischen Zentrums mittels Multimoment-Häufigkeits-Studie: Methodische Grundlagen

Post mortem cadaveric and imaging mapping analysis of the influence of cochlear implants on cMRI assessment regarding implant positioning and artifact formation

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