Session of the
Management in Radiology Section
of the Italian Radiological Society (SIRM)
Magnetic Resonance accreditation criteria
in Lazio Regional Public Health Service
Stefano Canitano
Istituto Tumori Regina Elena
Roma
Milano, Sept. 12, 2012
Just because your doctor has a
name for your condition doesn`t
mean he knows what it is.
Bertrand Russell
Costituzione della Repubblica
Italiana !
Art. 32.!
The Republic safeguards health as
an individual fundamental right and
as part of a collective community
which guarantees free medical care
to the indigents
Milano, Sept. 12, 2012
1 Sistema Sanitario Nazionale SSN=
NHS
21 Servizi Sanitari Regionali
SSR
Milano, Sept. 12, 2012
Every Regional Healthcare Service can
both provide and/or buy Healthcare!
Every Region chooses his own way to
provide Healthcare system!
Milano, Sept. 12, 2012
Obviously when
the Region buys
services from
private subjects
it’s more difficult
to control
appropriatness
and quality
Milano, Sept. 12, 2012
!
!
Analisi della situazione
Aumento delle prestazioni ambulatoriali
!RM
public
private
!!
classificato
aziendalizzata
!!
2000
7.594
62.751
10.087
25.349
!
Milano, Sept. 12, 2012
2001 2002 2003 2004
33.775
232.190
19.078
55.625
Variaz.%
344%
270%
89 %
119%
+ 13,6%
300.000
+ 12,2%
250.000
200.000
150.000
MRI
100.000
50.000
Prof.C.Bartolozzi
2004
Milano, Sept. 12, 2012
2005
2006
Anno 2006
RM: 6,1 /100 inhabitants
33% for Lumbar spine
TC: 7,4 /100 inhabitants
Milano, Sept. 12, 2012
Prof.C.Bartolozzi
Trend del volume di Prestazioni della branca di Diagnostica
per immagini per comparto
Milano, Sept. 12, 2012
55.000 MRI/y
=
4 MRIph, 12h/day
365day/year
Dati ASSR 2004
Milano, Sept. 12, 2012
Milano, Sept. 12, 2012
n 
Radiology is not Photography!
R. Capa
R.Doisneau
NOT A REALISTIC, NOR ARTISTIC, NOR FANTASTIC
REPRESENTATION OF REALITY
Milano, Sept. 12, 2012
Man Ray
n 
Radiology is not Recognizing Images!
Mickey Mouse,
Huey, Dewey and Louie
A house, two windows,
three trees, six birds (?)
two sheeps, sun….
Mickey Mouse
Milano, Sept. 12, 2012
n 
Radiology is not automatic diagnosis!
Milano, Sept. 12, 2012
Radiology is Photography
…but photography can lie
Milano, Sept. 12, 2012
Radiology is recognizing images
…but images can be too little to be seen
Milano, Sept. 12, 2012
Radiology is an automatic diagnostic system
GENERAL, YOUR TANK IS A POWERFUL VEHICLE
It smashes down forests and crushes a hundred men.
But it has one defect:
It needs a driver.
General, your bomber is powerful.
It flies faster than a storm and carries more than an elephant.
But it has one defect:
It needs a mechanic.
General, man is very useful.
He can fly and he can kill.
But he has one defect:
He can think.
Bertolt Brecht (1898 - 1956)
…but a radiologist who can think is always needed
Milano, Sept. 12, 2012
Modern medicine is not only Evidence Based but also
Image Guided Medicine
So Imaging must be Medicine Guided
The Medical Clinical Radiologic Intervention is composed,
in our opinion, of several essentials steps
Milano, Sept. 12, 2012
Correct clinical request and
motivation from the physician or specialist
1) 
NO CASE HISTORY NOR CLINICAL QUERY CT AT BEDSIDE
Milano, Sept. 12, 2012
2) The Radiologist must examine the clinical-anamnesitc situation
of the patient and evaluate previous tests
3) The Radiologist must justify the examination and eventually
suggest alternative tests for the same goal
4) The Radiologist must inform the patient and obtain his/her
agreement to submit him/herself to the test
Milano, Sept. 12, 2012
5) If needed, the Radiologist MUST VISIT THE PATIENT
and then, with a Radiographer, perform the examination
Milano, Sept. 12, 2012
Recurrence
ipointensità
T1
Milano, Sept. 12, 2012
potenziamento dopo mdc
iperintensità
STIR
recidiva
emilingua destra
in paziente operata
per carcinoma
emilingua sinistra
con lembo libero
di avambraccio
(Cortesia Dr. A Vidiri)
6) Interpretation, report, communication and discussion with
physicians
7) Record keeping
Milano, Sept. 12, 2012
Became mandatory to find a tool to
control quality and quantity of MRI
examinations and to rule the
professionals involved in MRI
examinations!
Milano, Sept. 12, 2012
Milano, Sept. 12, 2012
1. A Radiologist as responsible of the system and
a medical Phisicist as responsible of safety
2. A Radiologist as responsible of the medical examination
must always be present during the preparation and
execution of the examonation
3. A radiographer and, in case of
contrast media administration, a Nurse.
Milano, Sept. 12, 2012
Milano, Sept. 12, 2012
Milano, Sept. 12, 2012
For every kind of MRI has been ruled
a Maximum Operative Capacity based on the minimum pattern
of sequences for every exam according to
the standards of American College of Radiology and
on a minimum time necessary for a acceptable quality
For the radiographer this time coincides
with the time of examination
For the radiologist is standardized in 30’
considering the overlap with fast and slow MRI
Milano, Sept. 12, 2012
For every examination are required clinical indications and
appropriate tecnique and time of execution (n.of sequences etc.)
i.e. perform MRI on
Lumbar spine only if
Symptoms persist for more
than 4 weeks
with at least 3 sequences
thickness min.
=or<5mm. sag.
=or<4mm.ax.
Milano, Sept. 12, 2012
TO HAVE AN ITALIAN STANDARD ABOUT THAT
SOCIETÀ ITALIANA DI RADIOLOGIA MEDICA
MADE A HANDBOOK OF MINIMUM TIME OF EXECUTION
Milano, Sept. 12, 2012
You can’t work
faster and
have quality
Milano, Sept. 12, 2012
SEND US RENFORCEMENTS,
WE’RE GOING TO ADVANCE
Milano, Sept. 12, 2012
SEND US THREE OR FOUR PENCE
WE’RE GOING TO A DANCE….
Milano, Sept. 12, 2012