The Canadian journal of medical radiation technology最新文献

The ethics of honouring an individual's wishes for health care are clear and unequivocal in health care literature and policy. Yet health care providers are often unsure how to proceed, both in initiating an advance care planning conversation and in respecting an advance directive once a person is no longer capable of communicating. While advance directives are supported under the Canadian common law, provincial legislation differs across the country, and can create barriers to effective advance care planning.

The purpose of this article is to describe an advance care planning project undertaken by a large Canadian health authority that shifted the focus away from the document and onto the conversation. Fraser Health's “Let's Talk” initiative promotes the importance of advance care planning conversations while adults are healthy and capable and supports health care professionals in facilitating these conversations. This article will also address the system barriers and broad implementation challenges faced in the context of the Canadian health care and legal environment.

Working alone in MRI is an uneasy reality for an MRI technologist. Regardless of geographical location, facility type or size, most technologists will find themselves working alone at some point. As experts in the field, MRI technologists are acutely aware of the inherent MRI safety risks, and recognize the escalation of hazards when working alone. Conscientious technologists seek guidance and search for regulations to circumvent working alone. A review of published MRI safety documents and guidelines offers insights to the risks within the MRI environment that, in combination with careful analysis of the federal and provincial occupational health and safety legislations, can provide corroborative support based on Canadian law that justify the creation of specific strategies and policies to mitigate risk and eliminate working alone.

Health care services have the potential to impact the lives of citizens. The institutions that distribute them are therefore open to evaluation from the perspective of justice. Health care reform discussions in Canada, however, typically occur without sufficient attention to issues of justice and equity. This paper describes the link between health and justice, with a focus on how greater equity in society, as well as at the point of health care delivery, is necessary to fulfill the moral function of health care, i.e., to protect fair equality of opportunity. This is best accomplished by adopting a more explicit equity-oriented approach to health policy analysis. The core insight of such an approach is to focus our health care reform efforts on enhancing the health of the least well-off in society, and reducing social inequalities in general.

Health Canada and the Food and Drug Administration (FDA) in the United States have recently issued warnings pertaining to the use of gadolinium-based magnetic resonance contrast agents in patients with renal insufficiency. A strong temporal relationship between the administration of gadolinium agents and the development of nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis in this patient cohort has been established. This study presents a review of the literature, description of the disease, and discussion of possible contributing co-factors to its development. Best practice recommendations are provided for medical radiation technologists for management of patients with renal insufficiencies that may need to undergo magnetic resonance imaging with a gadolinium-based magnetic resonance contrast agent.

Canadian health care providers acknowledge the ethical imperative to follow patients' advance directives for medical treatment. However, fear that advance directives diminish regard for the sanctity of life and authorize euthanasia has impeded the development of the relevant Canadian law. The Criminal Code retains outdated provisions that potentially penalize health care providers who follow advance directives. Some provinces have failed to pass modern legislation that authorizes instructional advance directives. The law is disharmonized and restrictive, limiting people's rights to make advance directives and hindering health care providers from following their patients' wishes.

This paper reviews the morass of Canadian laws respecting advance directives to describe the frequent disparity between the ethical imperative and the legislation. The author argues that federal and provincial politicians are obliged to modernize the law. The legislation must enable capable people to create an advance directive that suits their life values and must help health care providers to follow their patients' treatment wishes.

Magnetic resonance imaging (MRI) has advanced as one of the major tools for diagnostic imaging. The current benchmark in clinical imaging continues to be 1.5 T scanners. This review article examines if 3 T MRI is ready for prime time clinical applications. In the first part of the article, the history of clinical scanners will be discussed, including the 3 T development. The focus will then shift to the challenges and opportunities that 3 T's increased field strength brings. Special safety considerations and the technical requirements will be described, as well as a description of specific applications, along with the benefits and challenges at 3 T. The final sections will focus on a summary of optimization strategies and the importance of understanding the differences in imaging at 3 T.

Successful human resource innovation in the cancer care sector must be compatible with the key objectives of decreasing wait times, increasing access and improving the health of our citizens. Implementing these kinds of innovations, including new models of care, is difficult in this complex environment. In the last two decades, advanced practice has seen tremendous interest and much has been written about it in recent years. Many of the themes documented in this literature occur consistently across jurisdictions and are relevant to the recent investigation of advanced practice roles for radiation therapists in Ontario.

When examining the potential implementation of any new role or model of patient care delivery, it is incumbent upon the investigators to familiarize themselves with these common issues and to develop strategies for dealing with them. Only through meticulous planning for effective communication and rigourous data collection can project managers garner stakeholder support and reduce professional territorialism, both of which need to be addressed for successful implementation of any new model of care.

This paper will outline the key activities that need to be carried out for the development of potential advanced practice roles, the key challenges and issues that surface when trying to address these activities, and outline some key strategies for overcoming them as the study of advanced practice moves ahead.

Integrative medicine, or the varied combination of conventional biomedicine with “complementary/alternative medicine” (CAM), has emerged recently as an important aspect of cancer care. Called “integrative oncology” (IO), health practitioners and certain institutions are exploring how to combine interdisciplinary modalities to ameliorate the suffering of cancer patients, and ultimately to promote wellness. As a reflection of the rising interest in and use of CAM by patients, frontline health care workers in mainstream cancer care are faced daily with patients who tell them they are combining biomedical and CAM modalities. Yet, practitioners may have little understanding or training in the principles of IO or specific CAM modalities. This lack of familiarity with CAM may lead to a number of care-related issues, including potential contraindications between modalities and the concealment by patients of their use of CAM.

In this paper, the field of IO as an aspect of integrative medicine will be reviewed, with reference to current developments in the field. Leading controversies in IO will be explored and analyzed. Finally, a summary of the experiences and perspectives of those practitioners in the medical radiation sciences—or those in frontline cancer care—will be shared to highlight issues in the clinical application of IO.