Saving Our Practice?

Dear Editor:
...[In response to] your recent letter to the editor from Dr Vennos [April 2002], regarding Radiologix and practice management companies....It is hard to feel sorry for Dr Vennos, given that he "cashed out" while others in the group did not have that opportunity. It is also amazing that anyone could, or would, sign a 40-year contract such as Dr Vennos and his partners did. How can they sign a contract that they aren't even going to be around to honor? How, in good conscience, can the old group leave that legacy to new members trying to build the practice? Of course the group will dissolve. No quality radiologists will work under the circumstances that Dr Vennos created for himself. I sure hope his group disclosed all the facts to new people brought on board, or Radiologix won't be the only entity facing litigation.

Richard M. Chesbrough, MD
Henry Ford Hospital
Detroit

Reaching Out to John Q. Public

Dear Editor:

As former president of SCVIR [Society of Cardiovascular and Interventional Radiology] in 1984 and former chairman of Yale Diagnostic Radiology, I agree entirely with your Viewpoint in Decisions in Imaging Economics ["Radiology

and John Q. Public," April 2002], or, at least, with the premise. I have been urging interventional radiologists to develop their own practices since a New Horizons lecture given at RSNA in 1985. We have a lot of publications supporting the effectiveness of our approach.

1. Practice like doctors first and interventional radiologists second. It really is not our name change that is important.

2. Schedule one or two clinics a week to see patients before and after procedures.

3. Develop widespread use of admitting privileges for interventional radiologists.

4. Educate medical students that there is a clinical subspecialty that offers them

the best of imaging and patient care before they reach clinical years and differentiate into surgeons/internists/pediatricians or OBs.

5. Establish a separate pathway through diagnostic radiology that allows students

planning on becoming interventional radiologists to get training earlier in their residency in both research and patient care.

Happily, the status of admitting privileges for vascular and interventional radiology (VIR) practices appears to be improving. According to a paper presented by my associate Michael Wyoski, MD, at last week's SCVIR meeting in Baltimore, 78% of the institutions with approved fellowship programs in VIR that participated in a recent survey reported that they are admitting patients. This compares to 33% in 1989 and 20% in 1986.

Robert White, MD
Yale-New Haven Hospital
New Haven, Conn

Dear Editor:

I second your Viewpoint ["Radiology and John Q. Public"] in the April 2002 Decisions in Imaging Economics. As a new multimodality freestanding center in south central Kentucky since 1996, in a competitive medical environment, our facility has brought physician/patient communications to a new level. Our radiologists spend time with patients explaining procedures, providing education, and going over results when appropriate. This level of direct communication lends itself to a better patient awareness of the radiology craft, alleviates patient anxiety concerning examination techniques and results, pushes for higher levels of radiology standards in our medical community, and drives patient demand to control and direct more of their health care dollars appropriately.

Our facility physician/management staff has extended our discussions with most employer groups in the area in order to show them the value a patient-friendly environment can bring to their benefit package. These mechanics are a great way for radiologists to thrive and gear patient referrals through their doors. We believe direct face-to-face contact, among other patient amenities, is doing "what is best" for the patient and work hard to impress this fact upon everyone from the insurance carrier, employer, and referring physician to, finally and most important, the patient.

Western Kentucky Diagnostic Imaging encourages these same efforts in all radiology practice settings!

Shonna Galloway
Business Manager
Western Kentucky Diagnostic Imaging
Bowling Green, Ky

...an Unfortunate Switch

Dear Editor:

I read several articles [in the Decisions in Imaging Economics April 2002]...with great interest, including "Digital Fluoroscopy: Is It Worth the Cost? I would point out a minor-but not trivial-error in the latter (page 40, near the bottom of the first column): "Overall, the median dose area product was 56% lower with pulsed fluoroscopy, the total radiation dose being 580 cGy/cm2 versus 1,310 cGy/cm2 with the continuous-beam examination."

I believe the switch from "dose area product" to "total radiation dose" in that sentence was erroneous. (To determine "total dose," it would

be necessary to measure the irradiated area and then divide the [dose area product] by that area. The resulting value would have units of cGy, not cGy/unit area.) I think the intended parameter for that entire sentence was "dose area product," which is properly expressed as "cGy cm2," that is, the "/" (indicating division) in the text was quite superfluous.

Barry Freed, PhD
Diagnostic X-Ray Quality Assurance Laboratory
New York Weill Cornell Medical Center
New York City