In the 21st century, the notion that healthcare is a service business has become widespread in Japanese society. Patients now have the option of choosing hospitals. Consequently, many medical institutions implement enlightenment activities to improve the level of hospitality among staff. The Hospitality Improvement Committee at Ibaraki Seinan Medical Center Hospital, comprising members of varying professional backgrounds, has been established to improve healthcare services and hospitality skills as well as provide educational activities. As clinical radiologists, we have also established our own internal committee and incorporated a self-assessment system that individual staff use for routine self-assessment of hospitality skills. After approximately 2 years of engaging in these and other educational activities, hospitality skills among clinical radiologists have improved overall, suggesting the beneficial effect of the activities. However, some self-assessment items show no improvement above a certain level. In this study, we focused on this finding and evaluated the educational activities implemented so far.

We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.
Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.