CONCLUSION. Many organizations are challenged to meet stakeholder demands of providing additional CT capacity and reduction of patient waiting lists. However, much can be achieved through workflow redesign, the addition of key personnel, and implementation of information system platforms and databases.

MATERIALS AND METHODS. We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that guaranteed respondents' confidentiality and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists and radiology practices in the United States. We used univariate analysis and multiple logistic regression.

RESULTS. In 2003, PACS, wet-reading telephone lines, film-hanging staff, and templates (standard report language) were each used in practices that encompassed approximately half of U.S. radiologists. In contrast, only 42% of radiologists were in practices that used nurse practitioners or physician assistants for tasks beyond what technologists may do, and only 18% were in practices that used speech recognition software (SRS). Twenty-one percent of radiologists were in practices reported to have neither film-hanging staff nor PACS. The percentage of practices (as opposed to radiologists) that used various technologies ranged from 13% for SRS to 49% for templates. Multiple logistic regression showed that, other factors equal, academic practices were particularly likely to use some of the technologies and solo practices and other small practices were particularly likely not to have some of the technologies.

CONCLUSION. Most operational technologies are fairly widely diffused, but a surprising number of radiologists work without some basic supports.

SUBJECTS AND METHODS. In this multinational prospective study, image quality and patient radiation doses were surveyed in 12 countries in Africa, Asia, and Eastern Europe, covering 45 hospitals. The rate of unsatisfactory images and image quality grade were noted, and causes for poor image quality were investigated. The entrance surface doses for adult patients were determined in terms of the entrance surface air kerma on the basis of X-ray tube output measurements and X-ray exposure parameters. Comparison of dose levels with diagnostic reference levels was performed.

RESULTS. The fraction of images rated as poor was as high as 53%. The image quality improved up to 16 percentage points in Africa, 13 in Asia, and 22 in Eastern Europe after implementation of a quality control (QC) program. Patient doses varied by a factor of up to 88, although the majority of doses were below diagnostic reference levels. The mean entrance surface air kerma values in mGy were 0.33 (chest, posteroanterior), 4.07 (lumbar spine, anteroposterior), 8.53 (lumbar spine, lateral), 3.64 (abdomen, anteroposterior), 3.68 (pelvis, anteroposterior), and 2.41 (skull, anteroposterior). Patient doses were found to be similar to doses in developed countries and patient dose reductions ranging from 1.4% to 85% were achieved.

CONCLUSION. Poor image quality constitutes a major source of unnecessary radiation to patients in developing countries. Comparison with other surveys indicates that patient dose levels in these countries are not higher than those in developed countries.