Open-source software for radiologists: a primer

There is a wide variety of free (open-source) software available via the Internet which may be of interest to radiologists. This article will explore the use of open-source software in radiology to help streamline academic workflow and improve general efficiency and effectiveness by highlighting a number of the most useful applications currently available. These include really simple syndication applications, e-mail management, spreadsheet, word processing, database and presentation packages, as well as image and video editing software. How to incorporate this software into radiological practice will also be discussed.     

Technology assessment for radiologists

Health technology assessment is the systematic and quantitative evaluation of the safety, efficacy, and cost of health care interventions. This article outlines aspects of technology assessment of diagnostic imaging. First, it presents a conceptual framework of a hierarchy of levels of efficacy that should guide thinking about imaging test evaluation. In particular, the framework shows how the question answered by most evaluations of imaging tests, "How well does this test distinguish disease from the nondiseased state?" relates to the fundamental questions for all health technology assessment, "How much does this intervention improve the health of people?" and "What is the cost of that improvement?" Second, it describes decision analysis and cost-effectiveness analysis, which are quantitative modeling techniques usually used to answer the two core questions for imaging. Third, it outlines design and operational considerations that are vital if researchers who are conducting an experimental study are to make a quality contribution to technology assessment, either directly through their findings or as an input into decision analyses. Finally, it includes a separate discussion of screening--that is, the application of diagnostic tests to nonsymptomatic populations--because the requirements for good screening tests are different from those for diagnostic tests of symptomatic patients and because the appropriate evaluation methods also differ.     

Antitrust principles for radiologists

As the practice of medicine becomes more competitive, the states' attorneys general, the Federal Trade Commission, the Justice Department, and individual competitors progressively will use the Sherman Antitrust Act to ensure a competitive market for the delivery of health care services. Therefore, radiologists must have an understanding of the purposes of the Sherman Act and an understanding of types of anticompetitive activities that will trigger civil and criminal penalties. Specifically, radiologists must avoid blatant violations, such as price fixing, division of markets, and group boycotts, any of which may elicit the interest of the Justice Department. Further, radiologists need to consult knowledgable legal counsel when carrying out peer review activities and when entering into exclusive contracts with hospitals, particularly hospitals that have significant market power.     

Nuclear medicine for general radiologists: endocrinological examinations

We reviewed nuclear endocrinological examinations of the thyroid, parathyroid, and adrenal glands that are clinically performed in Japan as well as somatostatin receptor imaging, which is widely used in Europe, the United States, and other countries. 123I thyroid scintigraphy is especially useful in detecting ectopic goiters and differentiating between Basedow's disease and subacute thyroiditis or Plummer's disease, all of which exhibit thyrotoxicosis. 201Tl is useful to detect foci metastasized from well differentiated thyroid cancer and to differentiate malignant from benign tumors. 67Ga-citrate is an agent used for patients suspected of having malignant lymphoma or undifferentiated carcinoma of the thyroid. Radioiodinated MIBG is a specific agent for medullary thyroid carcinoma. 99mTc-MIBI is a good agent for locating hyperfunctioning parathyroid tissues. 131I-adosterol is useful to locate the lesions of primary aldosteronism, Cushing's syndrome, adrenogenital syndrome, and select adenomas among incidental tumors. Radioiodinated MIBG scintigraphy has high diagnostic accuracy in locating pheochromocytomas and neuroblastomas. 111In-labeled octreotide is useful in locating, hormone-producing gastrointestinal and pancreatic tumors including carcinoids, gastrinomas, and insulinomas. Radiolabeled somatostatin receptor analogs are used not only to locate but also to treat malignant somatostatin receptor-positive tumors. We hope that Octreoscan will be available in Japan in the near future.     

Breast interventions: a primer for interventional radiologists

Breast cancer is the second leading cause of cancer related deaths in the United States. The area of breast interventions has benefited from recent advances in devices and imaging quality. Ultrasound, MRI, and stereotactic guided vacuum assisted and mechanical rotating stick freeze biopsy are the preferred methods for histologic diagnosis of breast lesions. Ablation techniques are available for the treatment of benign and malignant breast disease. The MammoSite balloon catheter can be placed percutaneously for delivering high dose short term brachytherapy. Interventional Radiologists can and should perform all of these procedures to improve the quality of women's health.     

Continuous quality improvement for radiologists

Continuous quality improvement methods provide a relatively new way to improve quality in healthcare by using a systems approach with key features of customer-mindedness, data collection, experimentation, and teamwork. CQI is not meant to solve simple problems but is increasingly applied in our complex healthcare organizations. In fact, CQI is as much philosophy as it is both a qualitative and quantitative method to assess quality. This review describes the general methods and potential application for radiologists.     

Forefoot: a basic integrated imaging perspective for radiologists

Imaging of the forefoot is increasingly requested for patients with metatarsalgia. Awareness with specific anatomic arrangements exclusive for the forefoot and widely variable pathologic entities associated with metatarsalgia helps the radiologist to tailor a cost-effective imaging approach. This will enable reaching a specific diagnosis as much as possible with subsequent proper patient management. This pictorial review aims to provide basic understanding for the different imaging modalities used in studying the forefoot. After that, certain anatomic arrangements exclusive for the forefoot are discussed. The final section of this review describes the imaging findings of some common forefoot problems.     

Tumor markers: essential diagnostic tools for radiologists]

A tumor marker is defined as a substance that is produced by the body in response to cancer or by the cancer tissue itself. Since discovery of the Bence-Jones protein in 1848 and AFP (alpha-fetoprotein), CEA (carcino-embryonic antigen), and SCC (squamous cell carcinoma antigen) in the 1960s and 1970s, a number of tumor markers have been developed for routine clinical laboratory tests. Some tumor markers are specific for one type of cancer, while others are positive for several cancer types. Furthermore, tumor markers are seen in non-cancerous conditions as well as in cancer. A positive result for one tumor marker does not necessarily indicate the presence of a malignant lesion. Because of insufficient sensitivity and specificity, most tumor markers cannot be used in screening for cancer in the early stage. When the presence of cancer is suspected, it must be confirmed using other diagnostic approaches such as radiological tests, pathological tests, or meticulous observation of disease progress. Tumor markers are useful in the follow-up of patients after treatment for malignant lesions, and they are usually superior to radiological tests in detecting recurrent lesions. When cancer is evaluated radiologically, knowledge of tumor markers is of great help to radiologists. Basic knowledge regarding tumor markers and pitfalls in their clinical usage are described.