Radiology

Specializing in all the modalities of on-site and remote radiologic coverage, plus after-hours final reads, we deliver prompt, accurate preliminary and final reads interpretations.

Sheridan’s industry-leading quality management program ensures that our discrepancy rates are consistently well below the national average. Radiology turnaround routinely transcends contracted times and 24/7 coverage is available. Sheridan radiologists are always available for additional consultation.

The stability of our clinical staff is evidenced by a 95% retention rate. All physicians are fellowship-trained or board-certified, locally licensed and based in the United States. We follow NCQA certification for credentialing and conduct our own approved physician review process. Learn more about our radiology management services.

Read our radiology-related posts:

19 January2017

Integrating Telemedicine Responsibly

Providers and patients alike view telemedicine as an increasingly important healthcare delivery modality. Per a recent article in Medical Economics, “How to balance telemedicine advances with ethics,” the American Telemedicine Association (ATA) reports that more than half of all U.S. hospitals use some form of telemedicine; and IHS Technology predicts the number of patients using telehealth services will jump from fewer than 350,000 in 2013 to 7 million in 2018.

But this modality can also be challenging to implement responsibly.

Telehealth Benefits

The dramatic growth of telemedicine is driven by its ability to further the goals of the “quadruple aim” framework for value-based care.

More Efficient Care

The recent American Hospital Association (AHA) issue brief on telehealth cited several examples of significant telehealth-driven savings, including the Veterans Health Administration’s “nearly $1 billion in system-wide savings associated with the use of telehealth in 2012.” A major contributor was the dramatic decrease in hospitalizations.

In addition, doctors who offer telehealth services can spend more time caring for additional patients – time that otherwise would have been spent traveling between offices or facilities.

Better Outcomes

The AHA brief also describes the efficiencies and improved outcomes resulting from the innovative Hospital at Home (HaH) care model developed by Johns Hopkins researchers. HaH is being used effectively to provide hospital-level care at home in place of acute hospital care for older adults. Per the brief, “When a patient is treated at home, clinical staff travel to the home as needed to provide treatment, while telehealth is used to monitor the patient’s condition and enable daily meetings with the physician.” According to the program’s website, HaH patients experience better clinical outcomes, higher patient and family satisfaction, reduced caregiver stress and better functional outcomes compared to similar hospitalized patients.

Expanded Access to Care

Traveling to medical facilities can be a hardship for people who are physically challenged/housebound, live far from the nearest medical center or cannot afford to take time off from work. The ability to meet with a clinician remotely via a secure audiovisual device or application can mean the difference between those patients seeking – and getting – the care they need versus going without.

More Convenient Care

While it’s early days yet, “virtual visits” are beginning to be offered for more and more types of medical care. For example, St. Vincent Heart Center in Indianapolis is piloting a telecardiology program, per a recent article in Cardiovascular Business.

There is also increasing demand by health care consumers for “at home” virtual visits. A recent ATA-WEGO Health survey of active health care users found that consumers are very interested in using telehealth to complement (or even replace) their in-person care, primarily because of convenience. Other commonly cited reasons included scheduling conflicts and issues with transportation. 

Expanded Access to Specialized Clinical Expertise

Many small or rural hospitals often don’t have the budget or volume to support staffing a range of staff specialists or subspecialists. Even hospitals that have the budget may be in areas that make it difficult to recruit those types of physicians.

Dr. Lynn Palmeri, National Medical Director of Telehealth for Sheridan’s Women’s and Children’s Division, explains that telehealth carts can allow doctors at these facilities to consult remotely with specialists or subspecialists as needed. For example, an obstetrician may see an expectant mother with high-risk findings that require her to be referred out to see a perinatologist. Rather than having the mother drive three or four hours to the nearest perinatologist – potentially putting her and her baby at even greater risk – the obstetrician could have a remote telehealth consult with the subspecialist to determine whether the mother can be given appropriate care locally with the help of follow-up telehealth consults with the perinatologist.

Telemedicine is equally valuable in emergency medicine. Physicians in the adult emergency department (ED) at Jupiter Medical Center consult remotely with neurologists at the Cleveland Clinic using a telehealth cart approximately 10–30 times per month, most often to expedite implementation of tissue plasminogen activator (tPA) therapy for stroke patients.

Sophisticated telemedicine robots can allow remote specialists and subspecialists to perform much more in-depth examinations. Dr. Palmeri says “there are robots with sensors that can, for example, allow a neonatologist to remotely inspect a patient, auscultate bowel, breath and heart sounds, examine a neonate’s eyes for retinal findings, and even palpate to see if there is abdominal pathology or edema. These patient care modalities augment the in-person physical examinations by the nurse and neonatal nurse practitioner at the bedside.”

Radiology’s many subspecialties make it a prime candidate for expanding access to highly specialized clinical expertise remotely while also increasing efficiency. For example, Sheridan’s distributed teleradiology network includes hundreds of the country’s best radiology subspecialists who can provide hospitals of any size with affordable, 24/7/365 coverage and faster turnaround times for final reads. 

Challenges to Responsible Implementation

The promise of telemedicine is exciting, and pertinent logistical and quality matters will be ensured prior to its implementation and expansion.

Protecting Patient Privacy

Maintaining patient confidentiality is a cornerstone of ethical medical practice. Telemedicine systems will be HIPAA-compliant and hospitals must make data security a top criterion when selecting robot cart and software options.

Maintaining Care Quality

The same standards of care must be maintained regardless of the delivery modality, and that’s a key challenge of telemedicine. The American Medical Association (AMA) released its Guidance for Ethical Practice in Telemedicine in June. In the policy announcement, AMA Board Member Jack Resneck, M.D. said, "Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions. The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians' fundamental ethical responsibilities do not change.” The AMA also released its Principles to Promote Safe, Effective mHealth Applications in November. 

Telemedicine can make continuity of care challenging, especially when patients seek care from doctors who are not affiliated with their primary care physicians or who use different EHRs. But in some situations telehealth can improve care continuity. “In a pediatric unit, for example, an attending physician might see the baby during morning rounds, but by the time the parents can come to the hospital that evening after work that physician’s shift may have ended and the parents may not speak directly to that same doctor,” explains Dr. Palmeri. “Telemedicine has the potential to overcome those types of scheduling conflicts so that parents can speak with the doctor ‘face-to-face’ through the telemedicine robot screen whenever needed.”

Telehealth will play an increasingly important role in care delivery and physicians will carefully adopt remote care technology in a manner that ensures patient safety and privacy.

5 January2017

Our 10 Most Popular Blog Posts of 2016

The most-read posts on the Sheridan blog in 2016 focused on key topics – ranging from the challenges involved in the transition to value-based care and this country’s physician burnout epidemic to exciting technology innovations and trends in clinical practice.

The 10 most popular posts from the past year are:

  1. How to Manage the Burdens of Change on Physicians and Health Care Practitioners, a summary of Chief Quality Officer Dr. Gerald Maccioli’s presentation at the 2016 Health:Further Summit about the overwhelming burdens on providers created by current and planned changes to the U.S. health care landscape and strategies for managing them.

  2. Sheridan’s 2016 Leadership Conference Recognizes Eight Outstanding Clinical Leaders: Dr. Mike Adkins, Anesthesia Services Chief of the Year; Dr. Joseph Toscano, Emergency Medicine Chief of the Year; Dr. Frank Seidelmann, Radiology Chief of the Year; Dr. Mitchell Stern, Women’s and Children’s Chief of the Year; Dr. Adam Blomberg, Diamond Award Winner; Cindy Houck, CRNA, Platinum Award Winner; Dr. Gary Gomez, Innovation Award Winner; and Dr. Jonathan Katz, Innovation Award Winner.

  3. Six Physician Communication Strategies to Increase Patient Engagement and Improve Outcomes, including encouraging patients to talk about psychosocial factors that might be related to their conditions, tailoring communications to each patient based on his/her culture, values and beliefs to avoid inadvertent offense or mistrust, educating patients on care best practices and about responsible antibiotic stewardship, providing compassionate, personalized care and reassurance, and providing online information resources to educate patients and set appropriate expectations.

  4. Technology Innovations That Will Transform the Future of Radiology, including the groundbreaking work of the IBM Watson Health medical imaging collaborative, in which Sheridan and its chief of teleradiology, Dr. Glenn Kaplan, are playing a key role.

  5. Five Medical Practices That Soon May Be Outdated, including hospitals advising doctors not to apologize, prescription labels that don’t include what condition the drug is treating, monitoring handwashing by hospital staff, doctors spending more time on paperwork than on patient care, and making it difficult for patients to get their medical records quickly.

  6. The AMA’s New Tools to Ease MACRA Transition for Physicians, including the MACRA Assessment (aka Payment Model Evaluator), new MACRA-focused modules in the AMA STEPS Forward interactive, online practice transformation series, and the Inside Medicare’s New Payment System ReachMD podcast series.

  7. The Physician Burnout Epidemic, Part 1: Root Causes of This Alarming Trend, which looked at the factors fueling the increase in U.S. physician burnout. Part 2 offered strategies physician leaders can use to help combat burnout.

  8. Career Advice from Sheridan’s Chief Medical Officer for Radiology Services, Dr. Frank Seidelmann, including being proactive in managing your career, embracing technology and investing in your professional development and of the physicians you lead. 

  9. How Video Laryngoscopy Is Shaping the Future of Anesthesiology, which highlighted a discussion by Regional Medical Director Dr. Joseph Loskove, Chief Quality Officer Dr. Gerald Maccioli and National Education Director, Anesthesiology Division, Dr. Adam Blomberg in their Anesthesia News article, The Shift Toward Video Laryngoscopy: The Good, the Bad, and the Future.

  10. Pain Management Boosts Patient Satisfaction, which addressed the significant impact of addressing patients’ and caregivers’ concerns and setting their expectations appropriately – as well as treating patients’ physical pain – on their satisfaction with their pain management and overall care. 

19 December2016

Identify Pain Points First to Effectively Implement Radiology Process Improvements

Radiology departments are under tremendous pressure to increase efficiency without sacrificing quality, as nearly every department in the hospital depends on them to produce and read images in a timely manner. Hospital workflows are complex, and investments in new software, equipment or people that are not informed by a thorough understanding of the underlying causes of inefficiencies are unlikely to deliver the desired improvements.

An article in Radiology Today earlier this year advised department heads to do a full assessment of workflow processes to identify the “pain points” that result in inefficiencies. Pain points can be areas that may need improvement, like patient throughput, or areas where variability is introduced to the workflow. Dr. Paul Chang, vice chairman of Radiology at the University of Chicago School of Medicine, said software can often eliminate variability, particularly in workflow management. In situations that require judgment of complex results, it is best to identify strategies to facilitate the radiologists’ reading and decision-making. Solutions introduced into a workflow should address a specific existing problem, particularly given the high cost of investments in new software, equipment or staff.

In radiology, pain points are often procedural, rather than technical. Inefficient protocols that impede patient flow like ineffective patient transport or MRI triage processes can hugely impact the entire hospital by slowing radiology. An American College of Radiology case study detailed the effort to improve MRI patient throughput at Howard County General Hospital in Columbia, Maryland. Patricia Rabette, the hospital’s CT/MRI Manager, led an MRI quality improvement project that aligned everyone involved in imaging processes to eliminate pain points. Rabette scheduled regular meetings with a team including medical-surgical nurses and managers, patient care technologists, the unit secretary, the med-surg directors, MRI technologists, and a transport dispatcher to discuss inefficiencies and solutions. By unifying all the stakeholders into a single team to collaborate on solving the problems and emphasizing open-minded consideration of all ideas, the hospital was able to decrease MRI throughput times by three hours and increase patient satisfaction by 60 percent.

Using cross-functional teams to solve problems collaboratively is also at the center of Sheridan’s approach to continuous process improvement. For example, at one South Florida radiology department, a Sheridan Kaizen facilitator helped a team that included the registration desk, lab, physicians and nurses to closely examine and improve the department’s workflow. Based on the team’s recommendations, a change was made so that instead of requiring outpatients to wait in bed alone for one to two hours while lab results were pending, patients could remain in the waiting room while they awaited their lab results. This simple change decreased radiology wait times by 40 minutes.

Jupiter Medical Center’s Chief of Radiology Dr. Lee Fox, and CEO John Couris discuss how the Sheridan partnership and Kaizen-facilitated process improvements have been transforming radiology at the hospital.

8 December2016

McLaren Hospital’s CEO Discusses the Value of Sheridan’s Distributed Radiology Services

When William “Bill” Lawrence became CEO of McLaren Central Michigan Hospital eight years ago, he saw no significant clinical issues with the three-physician radiology group at the 118-bed acute-care hospital, per a new article in Radiology Today. He did, however, find problems typical of a hospital that size: slow turnaround times, lack of consistency and significant gaps in the radiology services and modalities offered. Lawrence turned to an old friend, radiology leader Frank Seidelmann, D.O., to ask for his thoughts on solutions that could improve McLaren’s radiology services at a reasonable cost. 

Both men had worked at the renowned Cleveland Clinic and had known each other for many years. Dr. Seidelmann suggested the distributed radiology services from Radisphere, a company he had co-founded with a colleague. Lawrence was extremely impressed with the solution, which could provide his three on-site radiologists with 24/7 remote access to Radisphere’s large network of highly respected radiology subspecialists from around the country, all of whom agreed to accept accountability for the quality of their work.

Lawrence, who naturally assumed this sophisticated solution would come with a hefty price tag, was surprised to learn about Radisphere’s fee-for-service business model. Dr. Seidelmann also explained that his company was willing to assume most of the set-up costs and build the data interfaces. That clinched the deal, and McLaren signed on soon thereafter.

Eight years later, Lawrence continues to be impressed with the quality improvements at McLaren since contracting with Radisphere, including “stellar” turnaround times and very low error rates, which are consistently less than five percent overall and less than one percent for errors that would have made a difference in diagnosis.

Following its acquisition last year by Sheridan, Radisphere has evolved into Sheridan’s Distributed Radiology Services (DRS), which uses teleradiology technology to give partner hospitals of any size access to more than 400 highly specialized radiologists nationwide. Dr. Seidelmann is now Chief Medical Officer and National Medical Director for Sheridan’s Radiology Services. 

To learn more about how our distributed radiology services have improved both the quality and efficiency of McLaren’s radiology offerings, read the Radiology Today article “Enhancing Workflow with Distributed Radiology Services.”

29 November2016

Three Radiology Research Projects to Better Understand Concussions

A recent article in Radiology Today illustrates how radiological imaging is becoming an increasingly important tool in studying and diagnosing concussions.

The Centers for Disease Control and Prevention estimate that 248,000 children and teens visit the emergency department each year to evaluate concussions suffered during physical activity. Concussions, also known as mild traumatic brain injuries, have serious short- and long- term effects on thinking, sensation, language and emotion. In the short run, repeated concussions can potentially cause dramatic, fatal brain swelling. In the long run, they have increasingly been linked to Chronic Traumatic Encephalopathy (CTE), Alzheimer’s, Parkinson’s disease and other brain disorders.

Public awareness of the alarming short- and long-term effects of concussions is growing quickly, but timely diagnosis remains difficult. Most diagnostic methods for concussions – particularly on athletic fields – are dependent on evaluation of symptoms that are often understated by athletes. Although radiological imaging is not yet a practical sideline solution, researchers have used it to better understand the physiological effects of concussions and track the brain’s recovery. The September 2016 issue of Radiology Today presented three current projects demonstrating how researchers are using imaging to better diagnose concussions, understand their severity and determine how they impact athletes’ brains. 

  • MRI Blood Flow Examination – Researchers at the Medical College of Wisconsin presented a study at the American Academy of Neurology’s Sports Concussion Conference in July on cerebral blood flow in football players. The study found that while concussed players’ symptoms would often improve to baseline levels by the eighth day following the injury, MRIs indicated ongoing low blood flow after the same amount of time. Decreased blood flow is often used as an indicator of cerebral microbleeds. Microbleeds are most commonly found in people over 60, and should not be present in high school students. Youth athletes demonstrating signs of microbleeds could potentially be at risk for CTE, which is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression and progressive dementia, according to Boston University’s CTE Center.  
  • Combining TechniquesResearchers at the University of Texas Southwestern Medical Center, Wake Forest School of Medicine and Children’s National Medical Center published a study in the May Journal of Neurotrauma finding that a single season of football can result in brain changes. The techniques they used include:
  1. Equipping helmets with sensors that detect impacts players received.
  2. MRI diffusion kurtosis imaging that detects both normal development and pathological changes in the white matter that allows the brain to make proper neurological connections.
  3. PET scans to detect tau proteins that are believed to cause cognitive impairment in Alzheimer’s patients.

The researchers are next looking to conduct longitudinal studies to observe long-term brain development. They are also planning to study non-helmeted athletes through alternative techniques such as equipping mouth guards with sensors.

  • Ultrasound Examination – In May, the American Association of Neurology presented a study that used ultrasound to map changes in blood flow after an injury. Although traditional ultrasound could only differentiate between concussed and control groups 60 percent of the time, the advanced software improved diagnostic accuracy to 83 percent. 

How Sheridan Healthcare, Jupiter Medical Center and Joe Namath Developed a Groundbreaking Treatment Protocol for Traumatic Brain Injuries

In 2014, Sheridan began a partnership with Jupiter Medical Center and legendary Jets quarterback Joe Namath to study the effectiveness of hyperbaric oxygen therapy to treat traumatic brain injuries. The FDA-approved clinical trial led by co-directors of the Joe Namath Neurological Research Center, Barry Miskin, MD, FACS and Sheridan Healthcare Radiology Medical Director Lee A. Fox, MD, MA, investigates how breathing pure oxygen in a pressurized chamber can stimulate the growth of new blood vessels to help the brain recover. After seeing improvements in Namath’s cognition and memory as a result of his continued hyperbaric oxygen therapy, the team hopes the study will provide valuable insights into how to combat the degenerating effects of concussions. While research and development of treatment options for concussions are in their early stages, the future applications could literally be game-changing.

For more information, see our blog post on hyperbaric oxygen therapy research.

17 November2016

Career Advice from Sheridan’s Chief Medical Officer for Radiology Services

One of the best ways to achieve success is to emulate and seek advice from someone who already has achieved that success. Frank Seidelmann, DO, one of this country’s foremost radiology experts, serves as an excellent role model for anyone looking to become a successful leader in radiology. Dr. Seidelmann is Chief Medical Officer and National Medical Director for Sheridan’s Radiology Services, the largest hospital-based radiology practice in the United States and the only unified, national standards-based radiology service provider. He recently was honored with Sheridan’s 2016 Leadership Award. 

In a recent article in Radiology Life, Dr. Seidelmann shared his path to the top of his profession and offered career advice on attaining a radiology leadership position.

Be Proactive in Managing Your Career

He advises those who aspire to follow in his footsteps to be proactive and forward-thinking in managing their careers. Thriving in a field that is constantly changing and facing widespread, fundamental disruption requires “developing expertise in areas that interest you and that you believe will be important.”

Dr. Seidelmann started down that path during his 1972-1976 residency at the Cleveland Clinic, where he was the chief resident in radiology and president of the house staff. Cleveland Clinic owned one of the first head CT scanners and the first whole body CT scanner and he was one of the first radiologists to work with cross-sectional imaging. Early in his career he chose to practice and develop expertise in several of the first radiology subspecialties that evolved from these new imaging technologies, before eventually narrowing his focus to MRI imaging interpretations.  

Embrace Technology

Dr. Seidelmann urges would-be radiology leaders to constantly stay abreast of emerging trends and technologies and to look for opportunities to solve problems with creative, technology-enabled solutions – something he has done throughout his career.

Dr. Seidelmann had co-founded what became a large, multi-state, multi-hospital radiology group with its own MRI imaging center. Seeing an opportunity when that practice was sold, he co-founded a software company whose product helps imaging centers understand their referral patterns, volumes and trends.

He was a pioneer in distributed teleradiology. In 2001, two years after launching his first teleradiology practice, he and a colleague merged their practices to bring to life their visionary concept: finding the best subspecialty radiologists in the country and connecting them in a distributed practice with teleradiology services. The new practice grew rapidly and in 2007 became a full-service radiology group, Radisphere National Radiology. Dr. Seidelmann also designed a QA process that was embedded into the company’s enterprise software system to enable real-time, daily QA assessment of cases. The software, analytics and business processes were so valuable that they eventually were split off from the professional services and launched as an independent software company. Sheridan acquired Radisphere last year.

Invest in Your Own Development and That of the Physicians You Lead

Dr. Seidelmann also advises those pursuing a leadership role in radiology to invest time and effort not only into the development of the physicians under their leadership but also into their own professional development. Despite his lifetime certification, Dr. Seidelmann has recertified multiple times over the course of his career to maintain and expand his skills and expertise.

Learn much more about his remarkable career and helpful career advice in his Radiology Life article, “How-To Guide: Becoming the Chief Medical Officer of a Radiology Practice.”

15 November2016

Radiology Subspecialization Is Creating New Challenges

Advances in medical imaging technology in the past several decades have transformed the practice of radiology. The simple X-rays of the past have largely been replaced by digital images of astounding quality and 3D imaging. But being able to interpret the much more detailed information to make better diagnoses requires highly specialized diagnostic expertise, and the increasing subspecialization of the radiology field is creating new challenges.

Better Image Quality Requires a High Degree of Specialization

In a recent Radiology Life article on “The Radiologist’s Role in Improving Diagnoses,” Frank Seidelmann, DO, Sheridan’s chief medical officer for radiology services, said “there is absolutely no area of the body that cannot be explicitly imaged with the tremendous diagnostic tools we have.” In fact, those images are so good that currently radiology is broken out into three different disciplines spanning 13 areas of subspecialty: diagnostic radiology, including six subspecialties; interventional radiology/diagnostic radiology, including five subspecialties; and radiation oncology, including two subspecialties. 

Clearly it isn’t possible for individual radiologists to develop expertise in all these areas. But since most radiology groups comprise 10 or fewer radiologists, radiologists are increasingly required to interpret studies outside their areas of expertise. And Dr. Seidelmann explained that even though larger radiology groups may have expertise in a wider range of subspecialties, they still face the challenge of insufficient clinical information. 

Insufficient Clinical Information Hampers More Accurate Diagnoses

Sheridan’s chief of teleradiology, Glenn Kaplan, M.D., agrees, saying the biggest challenge radiologists face is that referring physicians rarely give them all the relevant patient information they need to make their readings more accurate. In his article “Technology Innovations That Will Transform Radiology and Patient Care” in Healthcare Tech Outlook, he said the most common “reason for exam” listed on the order sheet is simply “pain,” adding that lack of interoperability of EMR systems often prevents radiologists from accessing the patient’s medical history themselves.

The volume and negative impact of diagnostic errors is a significant problem. According to the 2015 report “Improving Diagnosis in Health Care” by the National Academy of Medicine, 5 percent of U.S. adults who seek outpatient care each year experience a diagnostic error. The report also found that diagnostic errors contribute to approximately 10 percent of patient deaths and account for 6 to 17 percent of hospital adverse events. 

Dr. Seidelmann called fixing this problem “a moral imperative” and stressed the need for greater collaboration between referring physicians, patients and radiologists to improve diagnostic accuracy.

Technology also will play a big part in solving this problem in the future. The Watson Medical Imaging Collaborative, of which Sheridan is a founding member, is leveraging IBM Watson’s highly advanced cognitive imaging and computing capabilities, and their work promises to give radiologists unprecedented diagnostic support, enabling them to provide much more accurate readings and significantly reducing the number of human diagnostic errors. The potential benefits to patients are significant: Dr. Kaplan estimates that reducing U.S. radiologist errors by just 1 percent could save or improve the lives of thousands of patients per year.  

8 November2016

Wilhelm Roentgen’s Legacy and the Future of Radiology

​November 8, 2016 marks the 121st anniversary of the discovery of X-rays by Wilhelm Roentgen. Today Sheridan pays homage to Roentgen and the others whose discoveries have contributed to the evolution of radiology and expresses its appreciation to the hospitals, equipment manufacturers, radiologists, and radiology technologists and technicians who have developed and advanced the science and art of medical imaging. 

Key Milestones in Radiology

X-rays

The year after Roentgen’s discovery brought the first handheld fluoroscopic device (by Thomas Edison) and the first diagnostic radiograph in the U.S. Plain X-rays, most often used to determine the type and extent of fractures, remain the most commonly used form of imaging, per the International Society for the History of Radiology

Ultrasound

Ultrasound, whose widespread clinical use began in the 1950s and ‘60s, is the second most commonly used form of imaging exam. Some of its uses include echocardiography, checking the development of the fetus in pregnant women, guiding needle placement when injecting local anesthetics near nerves and assessing gallbladder abnormalities. Modern scanners’ Doppler capabilities enable duplex ultrasound for diagnosing arterial and venal disease, and continuous wave Doppler ultrasound that can be used at the patient’s hospital or ICU bedside for patients who are too ill to be moved safely to the radiology suite. 

Nuclear Medicine and Molecular Imaging

The concept of emission and transmission tomography, introduced in the late 1950s, plays an essential role in many medical specialties including cardiology, oncology, neurology and psychiatry. Molecular imaging uses biomarkers to help image specific targets or pathways and interact chemically with their surroundings, changing the image according to molecular changes occurring within the target area.

Positron emission tomography (PET) imaging includes FDG-PET that can, for example, detect differences between cancer and normal cells by their glucose consumption, and single photon emission computed tomography (SPECT) that is used extensively to study cardiac health and blood flow to the brain.

Magnetic Resonance Imaging (MRI) became a clinical tool in the 1980s and is arguably the most flexible diagnostic imaging modality, allowing radiologists to view everything from a patient’s metabolism and physiology to his or her tissue microstructure. In the 2000s, 3T scanners came into widespread use. MRI scanners continue to become not only faster and more accurate but also smaller, allowing limbs to be scanned without subjecting patients to the noisy, claustrophobic confines of a full-body scanner. New diagnostic tools on the horizon include combined modalities and targeted media contrast. 

Computed Tomography

CT, developed in the late 1960s, has become another essential imaging tool. It can be used to look for a wide range of problems in various parts of the body, from cysts, abscesses or tumors to pulmonary embolism or aneurysm. A CT intravenous pyelogram (IVP) is often used to look at diseases of the urinary tract. CT is increasingly used for CT angiography and coronary calcium scoring as an alternative to more invasive and expensive interventional medicine.

Hybrid Imaging

Increasingly, medical imaging techniques are being integrated to provide a more complete picture (literally) of the anatomy and function of a patient’s organs and tissues. An example is PET/CT, a hybrid imaging technique that superimposes the location of abnormal metabolic activity from a PET scan over the detailed anatomic image from a CT scan. Prostate PET/CT scans can detect cancer earlier than either CT scans alone or MRI scans. TIME magazine named the PET/CT scanner the medical invention of the year in 2000. SPECT/CT scanners are also available, and PET/MRI is an emerging technology.

Interventional Radiology

IR is often called the surgery of the new millennium. Interventional radiologists use the most modern, least invasive techniques available to minimize patient risk and improve outcomes. An example is transarterial chemo embolization (TACE), the injection of chemo-eluting beads directly into a hepatocellular carcinoma to target just the tumor, sparing patients the many side effects of traditional whole-body chemotherapy. Today’s extremely high-quality imaging also allows interventional radiologists to catheterize nearly any blood vessel in the body and perform lifesaving procedures (e.g., abdominal aortic aneurysm stent) at much lower risk than using traditional surgical procedures. IR is an exciting and important development, especially as we move to a value-based care environment.

Investing in the Future of Radiology

Until a few years ago, U.S. hospitals routinely purchased newer, more advanced radiology equipment to stay competitive. That demand drove ongoing investment by companies like GE, Siemens and Tesla in developing increasingly advanced imaging equipment. Unfortunately, that could change. In 2013, regulators began reducing reimbursements for medical imaging. The goal was to discourage problems of misuse and overuse, but those decreases may have other, very serious consequences.

Radiology represents the largest portion of most hospitals’ outpatient revenue, which has been hit hard by those reimbursement cuts. Consequently, new investments in multimillion-dollar radiology equipment will offer a lower ROI. Imaging equipment is expensive, but unless those investments continue, radiology’s progress will stagnate. Hospitals must continue to invest in the infrastructure that supports radiologists – not only imaging equipment but also ongoing education for the subspecialization required by increasingly detailed and complex imaging information. We encourage hospitals to follow the lead of others who are also investing in the future of radiology, such as IBM and other organizations (including Sheridan Healthcare) who are tapping the power of IBM’s Watson supercomputer to transform radiology and patient care

20 October2016

Postmastectomy Radiotherapy’s Value for Patients with Early-Stage, Node-Positive Breast Cancer

The American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO) recently issued a joint clinical practice guideline update for physicians who are treating breast cancer patients who have undergone a mastectomy. The update provides additional considerations to help physicians to determine which patients might benefit from postmastectomy radiotherapy (PMRT) and focuses on the role of PMRT for contemporary patients with early-stage, node-positive breast cancer.

While PMRT is clearly indicated for patients with very high risk of local regional failure, its use is controversial for patients with earlier-stage breast cancer, especially when there are three or fewer positive nodes. The new update focuses on this key area of controversy, stating that there is strong evidence showing that PMRT reduces the risk of breast cancer recurrence, but also providing evidence-based recommendations for the use of PMRT in patients with tumors smaller than 5 cm (T1-2 tumors) and 1 to 3 positive lymph nodes, as well as in patients undergoing neoadjuvant systemic therapy (NAST) and patients with T1-2 tumors and a positive sentinel node biopsy.

The expert panel that developed the updated guideline included representatives from ASCO, ASTRO and SSO. They reviewed relevant literature published between January 2001 and July 2015, including a meta-analysis of 22 clinical trials published in 2014 that provided evidence that PMRT is highly effective at preventing local breast cancer recurrence.

The focused guideline update emphasized that both the absolute benefit of PMRT and the benefit-to-risk ratio can vary substantially from one patient to another, and that doctors should obtain multidisciplinary clinical input and carefully consider factors that could reduce the potential benefit and increase the likelihood of complications before recommending postmastectomy radiation therapy. The panel also concluded that patients must participate fully in the decision-making process, and that their values as to what constitutes sufficient benefit and how to weigh the risk of complications against that benefit in the context of the treating physicians’ best information regarding PMRT must be respected and incorporated into the final choice of treatment.

Stephen B. Edge, MD, co-chair of the expert panel, said “We still don’t have a single, validated formula that can determine who needs PMRT, but we hope that the research evidence summarized in this guideline update will help doctors and patients make more informed decisions.” 

For more detailed information, read “Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update” published in the ASCO’s, ASTRO’s and SSO’s journals, Journal of Clinical Oncology, Practical Radiation Oncology and Annals of Surgical Oncology

This approach reinforces current practices at Sheridan partner Memorial Cancer Institute (MCI) which, like most cancer facilities, faces the complex considerations in deciding whether to recommend PMRT for this subset of patients. Sheridan collaborates with MCI oncologists and surgeons as part of a multi-disciplinary discussion addressing the relative risks and benefits of PMRT for each patient. This team looks at the patient’s entire clinical picture before making a recommendation, and patients are always included in the decision-making process.

19 October2016

Sheridan’s 2016 Leadership Conference Recognizes Eight Outstanding Clinical Leaders

The annual three-day Sheridan Leadership Conference is Sheridan Leadership Academy’s flagship event. This year’s conference took place Sept. 30-Oct. 2 in Orlando, Florida and was attended by nearly 600 physician and allied health leaders. 

 

Strengthening the Core

President of Physician Services Robert Coward and CEO Chris Holden provided opening remarks and introduced this year’s conference theme, “Strengthening the Core,” which focused on the key attributes required to succeed as a Sheridan clinical leader. Throughout the conference, each service line held multiple breakout sessions to promote discussion and knowledge sharing of topics related to the conference theme.

New Leadership Academy Programs

This year’s conference also marked the expansion of the Leadership Academy’s programs, whose participants are nominated by their leaders. In addition to the Emerging Leaders Program that began in 2014, the Academy added two new programs this year, the Physician Chiefs Program and the Allied Health Chiefs Program. Each of the three leadership programs kicked off its first course at the conference.

The 2016 Sheridan Leadership Award Winners

One of the highlights of the conference was the awards dinner, which took place on Oct. 1. Eight outstanding Sheridan physicians were honored with 2016 Leadership Awards:

Dr. Mike Adkins, Anesthesia Services Chief of the Year

Michael Adkins has been with Valley Anesthesiology since 1994 – providing cardiac anesthesia services for 13 years, serving as medical director at an outpatient plastic surgery center, and currently is chairman of anesthesia at Banner University Medical Center-Phoenix.

He also has filled important administrative roles during his tenure, including scheduling coordinator, division manager, board member, and principal in the formation and launch of Valley’s Mobile Services Division.

He is a former board member of the Arizona Medical Association and is president-elect of the Arizona Society of Anesthesiologists. He earned his medical degree from the University of Minnesota-Minneapolis, did a surgical internship at the University of Illinois in Chicago and received training in cardiothoracic and neuroanesthesia at Stanford University.

 

Dr. Joseph Toscano, Emergency Medicine Chief of the Year

Dr. Toscano has been an attending emergency physician at San Ramon Regional Medical Center since 1999 and chief of the department since 2013.

He has extensive experience and expertise in the field. In the early 2000s, he was a partner and corporate medical director for Pinnacle Medical Group, which operated five urgent care clinics in California and Arizona. He lectures frequently at urgent care conferences and is on the board of directors of the Urgent Care Association of America. He has been medical director of San Ramon Regional’s occupational medicine clinic since 1999.

He graduated from Dartmouth College and earned his medical degree from the Duke University School of Medicine. He trained in internal medicine at the naval hospital in San Diego and began practicing emergency medicine during an operational tour of duty with the U.S. Navy in the early 1990s. He moved to California in 1994 and has been an EM physician there ever since.

Dr. Frank Seidelmann, Radiology Chief of the Year

Dr. Frank Seidelmann is co-founder, chairman, and visionary force driving the success of Radisphere. Dr. Seidelmann brings a wealth of experience in radiology with subspecialty expertise in MRI and neuroradiology. He has more than 25 years’ experience in interpreting MRI cases and functions as a consultant on difficult cases for radiologists and clinicians around the country. He has lectured on MRI, both nationally and internationally.

Before venturing into subspecialty teleradiology in 1996, Dr. Seidelmann co-founded a highly successful hospital and outpatient imaging center based radiology group with 20 contracts in the Midwest and central states, at one time employing more than 50 physicians, which was acquired by Med Partners and later became Team Health. He also has owned several diagnostic imaging centers in Ohio and co-founded RIS Logic, a leading radiology software company that targeted diagnostic imaging centers. RIS Logic was later acquired by Merge Healthcare in 2003. Additionally, he has held staff positions at the Cleveland Clinic Foundation and Case Western Reserve University, and has expertise in small joint imaging.

Dr. Mitchell Stern, Women’s and Children’s Chief of the Year

Mitchell Stern, MD joined what was then known as Neonatology Certified in 1987, immediately after completing his Neonatal Fellowship at Babies Hospital (Columbia Presbyterian Medical Center) in New York City. He did his residency, including a chief residency, at Brookdale Hospital Medical Center in Brooklyn, New York. He attended medical school at St. George’s University School of Medicine in Grenada, WI and attended college at Cornell University in Ithaca, New York. 

Dr. Stern joined the staff of Plantation General Hospital in 1987 and became a Director of the unit shortly after Neonatology Certified became a part of Sheridan Healthcare in 1996. Besides being the clinical and administrative leader of the PGH Level III NICU, Dr. Stern has also been the Principal Investigator in several multicentered research projects and has been involved with several committees at both the hospital and HCA Corporate Levels.

Dr. Adam Blomberg, Diamond Award Winner

Adam L. Blomberg, M.D. is the Chief of Anesthesiology for Memorial Regional Hospital in Hollywood, Florida., as well as the National Education Director for Sheridan Healthcare’s Anesthesia Division. He serves on the Anesthesia Quality Committee at Sheridan as the co-chair of the Clinical Education & Best Practice Subcommittee. He has held positions at Memorial on the Physician's Satisfaction Committee and the Multidisciplinary Peer Review Committee as well as the Co-Chair of the Surgical Services Executive Committee.

Dr. Blomberg has had numerous articles published on anesthesia trends and best practices in leading industry publications, such as the Wall Street Journal, CNN Health, ASA Newsletter, Anesthesia Patient Safety Foundation Newsletter, HealthLeaders, Managed Care Outlook and Becker’s Hospital Review. In addition, he has spent more than 15 years as the national speaker for the “Driving Responsibly” campaign.

Dr. Blomberg completed his training at Brigham & Women's Hospital, a teaching affiliate of Harvard Medical School in Boston in the Department of Anesthesiology, Perioperative and Pain Medicine. During his final year of residency, he served as Chief Resident. He is a graduate of the University of Miami School of Medicine in Miami, Florida.

Cindy Houck, CRNA, Platinum Award Winner

Cynthia Houck, CRNA joined Sheridan Healthcare in 1984 after graduating from George Washington University’s Nurse Anesthesiology Program. She has witnessed the growth of Sheridan from a small private anesthesia group to the nation’s largest anesthesia outsourcing provider.

Cynthia has served as the Chief of Allied Health at Memorial Regional Hospital, a 700-bed tertiary care level-one trauma center, since 1993. She has also been the Regional Director of Allied Health, South Florida Region since 2009. Her responsibilities include oversight of all Allied Health in Dade and Broward Counties, 14 hospitals and 6 ambulatory facilities. She was the Clinical Coordinator for SRNAs from FIU from 2006 until 2012.

In addition to her clinical duties, Ms. Houck is also co-chair of the Policy & Procedure Subcommittee for Quality Improvement

 

Dr. Gary Gomez, Innovation Award Winner

Dr. Gary Gomez has served as chief of anesthesiology at Memorial Hospital Miramar since 2013 and has led several clinical improvement projects. These include enhanced recovery after surgery protocols, PONV prophylaxis tools and intrathecal catheter management protocols. He also was one of three lead physicians to develop the ClearPATh anesthesia patient readiness program and is currently collaborating to develop further clinical pathways as part of Sheridan/AMSURG’s nationwide initiatives.

Dr. Gomez received his medical degree from the University of Florida and is currently enrolled at UF’s executive MBA program. He lives in South Florida with his wife and three children.

 

Dr. Jonathan Katz, Innovation Award Winner

Dr. Jonathan Katz started with Sheridan eight years ago as a member of the cardiac team at a 227-bed hospital. He was promoted to vice chief a year later and has been a regional medical director for 1.5 years.

Dr. Katz graduated from the University of Pennsylvania School of Dental Medicine and got his medical degree from the University of Connecticut in oral and maxillofacial surgery. He completed his anesthesia residency at the University of Miami, where he served as chief resident and did his cardiothoracic anesthesia fellowship. He also worked as an attending in UM’s cardiac anesthesia subdivision and was assistant program director for the anesthesia residency.

 

 

Please join us in congratulating this year’s Sheridan Leadership Award winners.

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