Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review

Intraoperative Diagnosis of Situs Inversus Totalis in Laparoscopic Cholecystectomy: Taking Into Consideration Patient-Centered Care in a Limited-Resource Case

Situs inversus (SI) is a rare congenital disorder in which the abdominal and thoracic organs create a mirror image orientation of their typical anatomical positions. In this article, we present the case of a 49-year-old female individual who underwent a scheduled laparoscopic cholecystectomy (LC) due to postprandial colic pain in the epigastrium. A prior ultrasound examination, conducted a year earlier, revealed the presence of small gallstones within the gallbladder, and a follow-up preoperative ultrasound suggested the possibility of SI, though the diagnosis was ruled out by a third ultrasound. Standard LC was commenced with umbilical trocar placement; however, SI was confirmed, and trocar placement was mirrored to the left side. Accurate preoperative diagnosis is crucial for surgical planning and to ensure patient safety. Performing an LC on a patient with SI poses unique challenges and requires heightened surgical skills and adaptability by the operating surgeon with extensive anatomical knowledge to mitigate risks and optimize patient outcomes.

Six Steps to Improving Health Equity Using Quality Improvement and Patient Safety Tools

Health equity is a foundational principle for providing high-quality care. The COVID-19 pandemic has increased the urgency of health systems and regulatory agencies to address longstanding health disparities. Imaging disparities have been documented in the imaging literature for decades, but there is paucity of published interventions to successfully reduce disparities in imaging. Quality and safety approaches can be successfully employed to catalyze and rigorously evaluate interventions to reduce imaging disparities. Emerging from the Toyota Production System, the lean management framework focuses on continuous quality improvement to improve efficiency and reduce waste. Lean approaches have been successfully adopted by quality and safety experts in health care for problem-solving and process improvement. This article provides readers with step-by-step guidance on how to address health equity issues by adapting selected lean tools for quality improvement and patient safety. Core steps include (a) problem identification, (b) team building, (c) creation of a data infrastructure, (d) problem analysis, (e) development and testing of solutions, and (f) change management strategies to help organizations sustain successful health equity initiatives. Readers can use these six core steps to catalyze data-driven quality improvement initiatives to reduce imaging disparities within their health systems.

Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation

Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.