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Item A Quality Improvement Initiative to Reduce Unneeded Screening Chest Radiographs in a Pediatric Cardiovascular ICU(Daedalus Enterprises, 2023) Malin, Stefan W.; McCallister, Anne E.; Abu-Sultaneh, Samer M.; Valentine, Kevin M.; Pediatrics, School of MedicineBackground: Adult critical care and radiographical societies have recommended changing practice from routine screening radiographs to on-demand chest radiographs (CXRs) for stable mechanically ventilated adult patients. There are no similar recommendations for patients in the pediatric ICU. Reducing the frequency with which unneeded CXRs are obtained can decrease radiation exposure and reduce waste, a substantial contributor to rising health care costs. We aimed to reduce unneeded daily screening CXRs in a pediatric cardiovascular ICU (CICU) by 20% in 6 months. Methods: Criteria delineating which subjects in the CICU required daily screening CXRs were created and added to the daily rounding sheet for discussion for each subject. The primary goal of this study was to reduce CXRs in mechanically ventilated subjects as our previous practice had been to order daily CXRs. Respiratory therapists increased the frequency of evaluating and documenting endotracheal tube positioning prior to the initiation of this project. The outcome measure was the percentage subjects who received a daily screening CXR. The ratio of daily screening CXRs to the number of total CXRs ordered and unplanned extubations were followed as balancing measures. Results: The number of subjects who received a daily screening CXR decreased from a baseline of 67% to 44% over the course of this project. There was no change in the ratio of daily screening CXRs to the number of total CXRs ordered or an increase in unplanned extubations. With an estimated cost of $268 per CXR, a reduction of 33% in routine screening CXRs saves an estimated $250,000 annually. Conclusions: A decrease in daily screening CXRs can be sustained through the development of specific criteria to determine which patients need screening radiographs. This can be achieved without an increase in CXRs obtained at other times throughout the day or an increase in unplanned extubations. This eliminates unneeded health care expenditures, improves resource allocation for radiology technicians, and decreases disruptive interventions for patients.Item An in vitro comparison of working length accuracy between a digital system and conventional film when vertical angulation of the object is variable(2009) Christensen, Shane R. (Robert), 1977-; Vail, Mychel Macapagal, 1969-; Legan, Joseph J.; Parks, Edwin T. (Edwin Thomas), 1955-; Zunt, Susan L., 1951-; Spolnik, Kenneth Jacob, 1950-Accurate determination of working length during endodontic therapy is critical in achieving a predictable and successful outcome. Working length is determined by the use of electronic apex locators, tactile perception, knowledge of average tooth lengths and dental radiography. Due to the increasing use of digital radiography in clinical practice, a comparison with conventional film in working length determination is justified. The purpose of this study is to determine if there is a difference between Schick digital radiography and Kodak Ultra-speed film in the accurate determination of working lengths when vertical angulation of the object is variable. Twelve teeth with #15 K-flex files at varying known lengths from the anatomical apex were mounted in a resin-plaster mix to simulate bone density. A mounting jig for the standardization of projection geometries allowed for exact changes in vertical angulation as it related to the object (tooth) and the film/sensor. Each tooth was imaged using Schick CDR and Kodak Ultra-speed film at varying angles with a consistent source-film distance and exposure time. Four dental professionals examined the images and films independently and measured the distance from the tip of the file to radiographic apex and recorded their results. The error in working length was calculated as the observed value minus the known working length for each tooth type. A mixed-effects, full-factorial analysis of variance (ANOVA) model was used to model the error in working length. Included in the ANOVA model were fixed effects for type of image, vertical angulation, and the interaction of angle and film type. Tooth type and examiner were included in the model as random effects assuming a compound symmetry covariance structure. The repeatability of each examiner, for each film type, was assessed by estimating the intra-class correlation coefficient (ICC). The ICC was determined when 12 randomly selected images and radiographs were reevaluated 10 days after initial measurements. The repeatability of each examiner for Schick CDR was good with ICCs ranging from 0.67 to 1.0. Repeatability for the conventional film was poor with ICCs varying from -0.29 to 0.55. We found the error in the working length was not significantly different between film types (p = 0.402). After adjusting for angle, we found that error in the working length from the digital image was only 0.02 mm greater (95-percent CI: -0.03, 0.06) than the conventional film. Furthermore, there was not a significant difference among the angles (p = 0.246) nor in the interaction of image type with angle (p = 0.149). Based on the results of our study, we conclude that there is not a statistically significant difference in determining working length between Schick CDR and Kodak Ektaspeed film when vertical angulation is modified.