In pediatric care settings, hybrid PET/MR imaging combines “exquisite soft-tissue information obtained by MR imaging with functional information provided by PET, including metabolic markers, receptor binding, perfusion and neurotransmitter release data.”
So state the authors of a pediatric PET/MRI primer published online this month in the American Journal of Neuroradiology. Lead author Christian Pedersen, MD , of Yale, senior author Ana Marija Franceschi, MD, PhD , of Northwell Health and colleagues take up considerations related to radiopharmaceuticals, imaging protocols and challenges checking PET/MR from broadening its clinical adoption in pediatrics. They also flesh out clinical indications for which pediatric PET/MRI is either already growing or likely to do so. Among these:
1. Lymphoma. One of the most common indications for PET imaging in pediatric oncology, lymphoma typically calls for PET/CT to track disease arc before, during and after treatments. The undesirable side effect of the serial radiative imaging is high cumulative dose, the authors point out. Meanwhile, they add, “PET/MRI “provides excellent soft-tissue contrast and is either equivalent or superior for malignant lymph node detection. … [R]eduction in the cumulative dose by PET/MRI [vs. PET/CT] has been reported to be as high as 50% to 70% in pediatric lymphoma. Further dose reduction may be achieved by lowering radiopharmaceutical doses with artificial intelligence–based algorithms, which is an area of active research and product development.”
2. Neuroendocrine malignancies. While straight PET with the radiotracer fluorodeoxyglucose F 18 (FDG-PET) is the established firstline modality for several clinical scenarios, the authors comment, PET/MR with a separate tracer, 18F mFBG, can supply excellent whole-body staging in other cases. In fact, for certain children, 18F mFBC PET/MRI “may combine local and whole-body staging in one session, which is particularly helpful in pediatric patients who typically require anesthesia for medical imaging.”
3. Spinal conditions. In like manner, FDG-PET remains the go-to for assessing treatment response in spinal malignancies, tumor staging and follow-up. And spinal MRI remains the prime imaging choice for most noncancerous pathologies affecting the spine. However, PET/MR should be given serious consideration for imaging spinal infections as well as questionably cancerous pathologies of the spine such as Langerhans cell histiocytosis , the authors suggest. “Hybrid PET/MR imaging is a promising technique in pediatric neuroimaging and provides functional and anatomic information in combination with a reduction in the radiation dose, sedation time and sedation events,” Pedersen et al. conclude. “Availability and technical implementation are still limited, but the improved diagnostic capabilities are quite attractive and applicable to a wide range of oncologic and nononcologic pediatric pathologies.”
Reference:
C. Pedersen, M. Aboian, J.E. McConathy, H. Daldrup-Link and A.M. Franceschi, “PET/MRI in Pediatric Neuroimaging: Primer for Clinical Practice.” American Journal of Neuroradiology, online May 5, 2022. DOI: https://doi.org/10.3174/ajnr.A7464

3 indications auguring well for the future of pediatric PET/MRI  In pediatric care settings, hybrid PET/MR imaging combines “exq...

Cailey Gleeson & Georgina Gonzalez -
Wednesday, May 11th, 2022
The COVID-19 pandemic has caused quality leaders to seek innovative solutions to not only maintain but reinvigorate quality efforts, with renewed attention on maintaining measures as hospitalizations have dwindled since the omicron surge. While the current tally of 2,219 daily new admissions is down significantly from the omicron surge, the CDC predicts a rise through the rest of the month, with 600 to 8,700 new admissions likely reported May 27. The seven-day average of new admissions increased 16.6 percent last week compared to the week prior, according to data tracked by The New York Times. As hospitals prepare for cases to rise, they also have more bandwidth after the omicron surge to refocus efforts onto quality improvement measures and can implement them into their systems as a new influx of patients begins. This compilation features guidance from leaders at 10 systems who shared insights with Becker's via email. Question: What is one quality improvement effort that deserves more attention and why? Cathy Duquette, PhD, RN. Chief Nursing Executive and Executive Vice President of Quality and Safety of Lifespan (Providence, R.I.): One of the key drivers to top clinical quality and patient experience outcomes is full team member engagement in local quality improvement efforts. The COVID pandemic created staffing and care challenges that made it difficult to maintain our focus on engaging our front-line team members in these important efforts. As we emerge from the peak hospitalization demands of COVID and as staffing moves toward stabilization, we are working to reengage with our front-line team members in owning, leading and driving changes needed to address patient experience and quality improvement opportunities. One of our top priorities right now is improving the patient experience. We are focusing on bedside shift reports and other efforts that were unable to be sustained during the pandemic. Peter Silver, MD. Chief Quality Officer of Northwell Health (New Hyde Park, N.Y.): Although the inpatient surge from COVID-19 has passed, one thing that was clear from seeing which patients became so critically ill from COVID was the inequity in care delivery to minority patients in our communities. The issue, then, that deserves our most immediate attention is trying to eradicate these health inequities in every aspect of healthcare delivery. One notable component of this is the high rate of maternal mortality among Black women. Reducing this mortality rate by identifying and treating women at risk has become a major focus of Northwell's quality efforts going forward. We recently announced the launch of Northwell's Center for Maternal Health, which will take a 360-degree approach to improving maternal health, working throughout the continuum of care and in the community to address health conditions that can occur from preconception through the first year after delivery, as well as social determinants that raise the risk of those problems among Black women. Graham Snyder, MD. Medical Director of Infection Prevention and Hospital epidemiology at UPMC (Pittsburgh): We are renewing our efforts to reduce central line-associated bloodstream infections. National surveillance has demonstrated a rise in CLABSI rates with the emergence of COVID-19. Due to the collective stress of a pandemic, disruptions to healthcare delivery and healthcare workers' personal lives, and compounded by widespread staffing shortages , it has been more difficult than ever to maintain attention and diligence to infection prevention measures in every moment of care. At UPMC, we are reemphasizing evidence-based CLABSI reduction measures to push this healthcare-associated infection toward zero. Fritz François, MD. Executive Vice President and Vice Dean, Chief of Hospital Operations at NYU Langone Health (New York City): The acuity of the patients who presented during the pandemic underscored the importance of maintaining quality standards and the need to address health inequities. With the launch of its Institute of Excellence in Health Equity, NYU Langone Health has extended its commitment to quality improvement and has been actively applying a health equity lens to those efforts to ensure excellent outcomes across patient populations. Lisa Maragakis, MD. Senior Director of Infection Prevention at Johns Hopkins Health System (Baltimore): One quality improvement effort that deserves renewed attention is prevention of central line-associated bloodstream infections. CLABSI is associated with patient harm through increased morbidity and mortality. It also prolongs patients’ length of hospital stays and increases healthcare costs. After a decade of improvement, CLABSI rates in the U.S. rose sharply, by about 30 percent, during the pandemic, according to the Centers for Disease Control and Prevention. There are likely several reasons for this including high patient volumes, increased patient acuity and intensive care utilization, disruptions to normal workflows, and burnout and high turnover among healthcare personnel. We need a back-to-the-basics approach that emphasizes the evidence-based best practices for CLABSI prevention. At Johns Hopkins Medicine, we are utilizing a multidisciplinary team approach with well-defined CLABSI prevention roles to regain lost ground and reinvigorate CLABSI prevention to protect our patients from harm. Matthew Miller, DO. Associate Chief Quality Officer at Cleveland Clinic: The COVID-19 pandemic has highlighted the unfortunate, long-standing disparities in healthcare. There are systemic changes that must be made in our delivery of care to achieve health equity. There is no true quality improvement without ensuring that our care is delivered equitably. Cleveland Clinic continues to shine the light on opportunities for improvement around health equity — to identify disparities, map out the root cause(s) and design care interventions that reduce and eliminate disparities. Daniel Roth, MD. Executive Vice President and Chief Clinical Officer at Trinity Health (Livonia, Mich.): An effort that deserves particular attention in American healthcare is the importance of health equity. At Trinity Health, we are exploring how we can proactively identify how our patients’ social needs limit their ability to achieve health goals, and how we can connect the dots to address those needs. We are committed to this work so we better enable everyone to achieve their optimal health no matter their race, ethnicity, or socioeconomic status. Jeffrey Boord, MD. Chief Quality and Safety Officer at Parkview Health (Fort Wayne, Ind. ): The experience of the pandemic has highlighted the urgent need to focus on the safety and well-being of our workforce. Healthcare personnel bore the brunt of workforce-related injury and illness during the pandemic. Alongside the rise in COVID-19, the entire country saw an increase in incidents of incivility and violence directed at healthcare workers. According to the Bureau of Labor Statistics, the healthcare and social assistance sector saw a 40 percent increase in total injury and illness cases in 2020. As a result, we’re seeing high rates of burnout and people leaving the healthcare profession altogether. Workforce safety and patient safety are co-equal and interdependent — you can’t have one without the other. In order to maintain and grow our workforce, the physical and psychological safety of personnel needs to be a top priority for all healthcare leaders. Hilary Babcock, Chief Quality Officer at BJC HealthCare (St. Louis): During COVID-19 surges, when staffing was tight, hospital censuses were high, and patients were very sick and complicated, we all did our best to continue to deliver safe and high quality care, but the situation was definitely a challenge. Now that our patient census is more manageable, we are better able to provide additional focused attention on critical measures to prevent healthcare-associated infections, pressure injuries and other quality outcomes. Jeremy Cauwels, MD. Chief Physician at Sanford Health (Sioux Falls, S.D. ): The pandemic has placed extraordinary stress on our healthcare teams and contributed to higher rates of mental health challenges. As we continue to move forward, supporting employee well-being is an imperative that deserves more attention from a quality improvement standpoint. Sanford Health has led efforts to combat work-related stress and burnout through resiliency groups, training, a clinical assistance program, counseling, a physician wellness council and comprehensive mental health resources to help our employees take care of themselves physically and emotionally while caring for our patients. We know a burned-out physician has a statistically higher risk of adverse outcomes related to medical errors, which is why we are also comparing employee satisfaction data to patient satisfaction and outcomes. We will continue to be deliberate and purposeful in how we invest in and support our clinicians.

10 executives on quality improvement measures deserving more attention

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Northern Westchester Hospital operates a hospital. The hospital provides diagnostic and treatment services. It is based in Mount Kisco, New York.

Name	Work History	Title	Status
Joel Seligman	Mount Sinai Health System	President	Current
John Partenza		Chief Financial Officer	Current
Marla Koroly		Chief Medical Officer, Senior Vice President	Current
Hatsy Vallar		Senior Vice President	Current

Name	Joel Seligman	John Partenza	Marla Koroly	Hatsy Vallar
Work History	Mount Sinai Health System
Title	President	Chief Financial Officer	Chief Medical Officer, Senior Vice President	Senior Vice President
Status	Current	Current	Current	Current

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