Howard Forman | Yale University (original) (raw)

Papers by Howard Forman

Journal of the American College of Radiology: JACR

PURPOSE Many hypothesize that the decrease in overall imaging costs following the Deficit Reducti... more PURPOSE Many hypothesize that the decrease in overall imaging costs following the Deficit Reduction Act’s (DRA) price cuts for in-office imaging solved utilization problems. We investigate the effect of these price cuts on the utilization of non-invasive musculoskeletal imaging and discuss implications. METHOD AND MATERIALS We analyze the national Medicare Part B data from 2004, 2006, and 2008. We compare overall growth rates of non-invasive musculoskeletal imaging before the DRA took effect (2004-2006) and after (2006-2008). Also, using regression analysis, we investigate the relationship between the change in growth rate for each imaging examination and the size of its respective price cut. RESULTS Overall, the annual growth rate of non-radiologists’ per capita in-office non-invasive musculoskeletal imaging decreased from 3.1% to 1.3%; for radiologists, it decreased from 5.2% to 2.5%. Excluding x-rays, which experienced slow growth and minimal price cuts, the growth rates decrease...

Journal of Radiology Nursing, 2015

ABSTRACT The aim of this article is to introduce nurses and other health professionals to legal a... more ABSTRACT The aim of this article is to introduce nurses and other health professionals to legal aspects that may arise in their specialized field of radiology and ways to avoid triggers for litigation. Although the aim of the nurse is to provide optimum care with an eye toward the best possible patient outcomes, intervening issues will regularly arise in this specialty as in all others. The reader will be provided with an introduction to negligence in the health setting, otherwise known as medical malpractice. Understanding the major tenets of duty, breach of duty, harm, and damages is key in understanding how to optimize the patient's outcomes from a legal perspective. A key legal trigger for nurses in radiology is around communication, whereas misdiagnosis is in the lead for radiologists. An intervention is offered to illustrate how to manage breakdowns in the provision of care in radiology.

PURPOSE To determine the cost effectiveness of mammographic screening using combined Digital Brea... more PURPOSE To determine the cost effectiveness of mammographic screening using combined Digital Breast Tomosynthesis (DBT) and Full-Field Digital Mammography (FFDM) vs. FFDM alone based on direct costs resulting from differences in the recall rate. METHOD AND MATERIALS Screening recall rates for combined DBT and standard FFDM screening studies were calculated at a single institution over a five month period. Studies were interpreted by a total of 7 board-certified radiologists, with 4-23 years of experience, all with tomosynthesis training. All DBT images were acquired using a single unit (Dimensions, Hologic, Bedford, MA) and all FFDM studies were performed on Selenia units (Hologic). Recall rates and number of diagnostic studies (unilateral mammograms, bilateral mammograms, and ultrasound studies) resulting directly from the recall were calculated. The direct costs of these studies were assessed using regional Medicare reimbursements. Downstream direct costs, indirect costs, and inta...

AJR. American journal of roentgenology, Jan 21, 2015

Over the past decade, efforts have increasingly been made to decrease radiation dose from medical... more Over the past decade, efforts have increasingly been made to decrease radiation dose from medical imaging. However, there remain varied opinions about whether, for whom, by whom, and how these potential risks should be discussed with patients. We aimed to provide a review of the literature regarding awareness and communication of potential radiation-induced cancer risks from medical imaging procedures in hopes of providing guidance for communicating these potential risks with patients. We performed a systematic literature review on the topics of radiation dose and radiation-induced cancer risk awareness, informed consent regarding radiation dose, and communication of radiation-induced cancer risks with patients undergoing medical imaging. We included original research articles from North America and Europe published between 1995 and 2014. From more than 1200 identified references, a total of 22 original research articles met our inclusion criteria. Overall, we found that there is in...

Journal of Critical Care, 2015

PURPOSE Time-motion studies have been used to evaluate the emergency department (ED) work environ... more PURPOSE Time-motion studies have been used to evaluate the emergency department (ED) work environment; however, no studies have included emergency radiologists, despite their increasing importance to acute care. Our objective was to quantify the proportion of time spent by ED radiologists and physicians on direct and indirect patient care tasks to assess their roles in ED patient evaluation. METHOD AND MATERIALS Our study took place at the Yale New Haven ED and involved resident and attending ED radiologists and physicians. The observation period was 2 weeks and each participant was observed for a continuous 2-hour period. Participants’ tasks were timed and categorized into one of the following categories: patient history, physical exam, assessment/plan, procedures, technical/administration, paperwork, and personal time. We used bivariate analyses to compare the proportion of time spent on each category of tasks between specialties. RESULTS Twenty physicians (10 ED physicians and 10...

Stroke; a journal of cerebral circulation, 2014

The purpose of this study is to perform a comprehensive cost-effectiveness analysis of all possib... more The purpose of this study is to perform a comprehensive cost-effectiveness analysis of all possible permutations of computed tomographic angiography (CTA) and digital subtraction angiography imaging strategies for both initial diagnosis and follow-up imaging in patients with perimesencephalic subarachnoid hemorrhage on noncontrast CT. Each possible imaging strategy was evaluated in a decision tree created with TreeAge Pro Suite 2014, with parameters derived from a meta-analysis of 40 studies and literature values. Base case and sensitivity analyses were performed to assess the cost-effectiveness of each strategy. A Monte Carlo simulation was conducted with distributional variables to evaluate the robustness of the optimal strategy. The base case scenario showed performing initial CTA with no follow-up angiographic studies in patients with perimesencephalic subarachnoid hemorrhage to be the most cost-effective strategy ($5422/quality adjusted life year). Using a willingness-to-pay th...

Emergency radiology, Jan 10, 2014

American Association for the Surgery of Trauma (AAST) abdominopelvic organ laceration grading is ... more American Association for the Surgery of Trauma (AAST) abdominopelvic organ laceration grading is used to determine which patients can be managed non-operatively. We assess a change in the use of AAST grading system by radiologists at a single, large, academic institution before and after a one-time departmental intervention and reviewed non-graded reports evaluating if grading could be inferred. After IRB approval, a keyword search for "laceration" identified traumatic abdominopelvic CT reports in a 2-year period before and after the one-time intervention. Reports were reviewed to determine if an organ laceration was seen, if it was graded by AAST criteria, and if grading could be inferred for non-graded reports. T test was performed to assess statistical significance. Before the intervention, 348 reports contained the keyword "laceration," 81 with lacerations, 31 graded (38 %). After the intervention, 302 reports were found, 79 with lacerations, 59 graded (75 %)...

Circulation. Cardiovascular quality and outcomes, 2014

The Ochsner journal, 2006

In Wolff-Parkinson-White syndrome (WPW) patients the loss of pre-excitation in a single heartbeat... more In Wolff-Parkinson-White syndrome (WPW) patients the loss of pre-excitation in a single heartbeat during exercise stress testing (EST) is a predictor of low risk of sudden death. The purpose of this study was to: 1) assess the frequency of loss of pre-excitation in a single heartbeat during exercise testing, and 2) compare the cost of EST versus trans-catheter electrophysiology study (EPS) in the risk assessment of WPW patients. A retrospective review of 50 cases of patients with WPW who underwent EST was conducted including demographics, history of supraventricular tachycardia, associated congenital heart disease, maximum heart rate achieved, and loss of pre-excitation in a single heartbeat. Hospital costs of EST and EPS were compared. Of the 50 patients who underwent EST, 4 (8%), lost pre-excitation in a single heartbeat during EST. No differences were found regarding gender, age at diagnosis or EST, history of supraventricular tachycardia, presence of congenital heart disease or ...

AJR. American journal of roentgenology, 2000

The purpose of this article is to report 1999 data on the job market in diagnostic radiology dete... more The purpose of this article is to report 1999 data on the job market in diagnostic radiology detected using a help wanted index of job advertisements and to profile trends in practice type, location, and subspecialty using our previously published data as a basis for comparison. Each advertised job for a diagnostic radiologist in the American Journal of Roentgenology and RADIOLOGY: between January 1991 and December 1999 was coded by practice type, location, and subspecialty. In 1999, 3926 positions were advertised for diagnostic radiologists, representing a 75% increase from 1998. Private practice jobs, which represented 53% of advertisements from 1991 through 1994 and 64% of ads from 1995 through 1998, increased to 66% of ads in 1999. Geographic trends in 1999 were characterized by a relative increase of jobs in the Midwest and California and a decrease in percentage (but increase in total number of ads) in the Northeast and Southwest. The demand for subspecialists continued in 199...

Emergency Radiology, 2003

The purpose of the study was to determine the feasibility of international teleradiology, utilizi... more The purpose of the study was to determine the feasibility of international teleradiology, utilizing day-night time differences, for online interpretation of overnight computed tomography (CT) studies. One hundred and two consecutive Emergency Room patients who underwent CT examinations between the hours of 11 pm and 7 am were enrolled. All age groups and study types were included. CT studies were transmitted from the in-hospital PACS system (Kodak, Fremont, Calif.) to a web-based server (Medweb, San Francisco, Calif.). A radiologist in Bangalore, India, working an 8 amto 4 pm day shift, downloaded and reviewed the studies on a desktop PC using a 128-kbps internet connection at 10-20:1 wavelet compression and generated a report. The report was then uploaded to the server, noting the time at upload. Each study report was compared with the official in-house diagnostic report and concordance assessed on a three-point scale. Mean download time was 8.14 s per image. For head CT reports ( n=47), the mean turnaround time for a final transcribed report was 39.5 min. For abdomen/pelvis CT reports ( n=48) the mean turnaround time was 84.4 min. Out of 106 cases, there was discordance between the clinical diagnostic report and the study report in 20 (19%); however, on subsequent review the teleradiology report was found to be correct in 13 of these. Day-night time differences across the globe can be utilized to provide overnight emergency radiology coverage using web-based teleradiology. Scan download and report upload times are within acceptable limits.

Emergency Radiology, 2013

Our objective was to characterize the tasks of emergency radiologists and emergency physicians an... more Our objective was to characterize the tasks of emergency radiologists and emergency physicians and quantify the proportion of time spent on these tasks to assess their roles in patient evaluation. Our study involved emergency radiologists and emergency physicians at an urban academic level I trauma medical center. Participants were observed for continuous 2-h periods during which all of their activities were timed and categorized into the following tasks: patient history, patient physical findings, assessment/plan, procedures, technical/administration, paperwork, and personal time. We performed multivariate analyses to compare the proportion of time spent on task categories between specialties. Twenty physicians (10 emergency medicine and 10 radiology) were observed for a total of 146,802 s (2,446.7 min). Radiologists spent a significantly larger combined proportion of time on determining physical findings and paperwork than emergency physicians (61.9 vs. 28.3 %, p<0.0001). Emergency physicians spent a significantly larger proportion of time than radiologists on determining patient history (17.5 vs. 2.5 %, p=0.0008) and assessment/plan (42.3 vs. 19.3 %, p<0.0001). Both specialties devoted minimal time toward personal tasks. Radiologists play a major role in the diagnostic evaluation of a subset of acute patients, spending significantly more of their time determining physical findings than their emergency physician counterparts.

Journal of Healthcare Risk Management, 2011

Research into emergency medicine (EM) diagnostic errors identified imaging as a contributing fact... more Research into emergency medicine (EM) diagnostic errors identified imaging as a contributing factor in 94% of cases. Discrepancies between the preliminary (trainee) and the final (attending) diagnostic imaging interpretation represent a system issue that is particularly prone to creating diagnostic errors. Understanding the types of systematic communication and documentation strategies developed by academic radiology departments to address differences between preliminary and final radiology interpretations to clinicians are threshold steps toward minimizing this risk. This study investigates policies and practices associated with the communication and documentation of preliminary and final radiologic interpretations among U.S. academic radiology departments through a questionnaire directed at radiology department chairs.