Teleradiology: threat or opportunity?

The rapid advances in information technology and communication bandwidth have spawned an equally rapid development of clinical teleradiology. Current computer technology and communication capability allow easy transfer of diagnostic images, of any complexity, to any location in the world. This provides the opportunity to acquire swift primary and secondary diagnostic opinions from the remotest of locations, often at economically attractive rates, with the potential for easing the burden on hard-pressed departments of radiology. However, this comes at the potential cost of distancing the clinical radiologist from the patient, with consequent impact upon direct clinical care. As this technology advances across the world, it is vital that UK radiologists are familiar with the clinical implications, the medicolegal framework within which the field operates and the associated governance issues. This paper reviews current practice and discusses the associated risks.     

Teleradiology from the provider’s perspective—cost analysis for a mid-size university hospital

Objectives

Real costs of teleradiology services have not been systematically calculated. Pricing policies are not evidence-based. This study aims to prove the feasibility of performing an original cost analysis for teleradiology services and show break-even points to perform cost-effective practice.

Methods

Based on the teleradiology services provided by the Greifswald University Hospital in northeastern Germany, a detailed process analysis and an activity-based costing model revealed costs per service unit according to eight examination categories. The Monte Carlo method was used to simulate the cost amplitude and identify pricing thresholds.

Results

Twenty-two sub-processes and four staff categories were identified. The average working time for one unit was 55 (x-ray) to 72 min (whole-body CT). Personnel costs were dominant (up to 68 %), representing lower limit costs. The Monte Carlo method showed the cost distribution per category according to the deficiency risk. Avoiding deficient pricing by a likelihood of 90 % increased the cost of a cranial CT almost twofold as compared with the lower limit cost.

Conclusions

Original cost analysis is possible when providing teleradiology services with complex statutory requirements in place. Methodology and results provide useful data to help enhance efficiency in hospital management as well as implement realistic reimbursement fees.

Key Points

? Analysis of original costs of teleradiology is possible for a providing hospital ? Results discriminate pricing thresholds and lower limit costs to perform cost-effective practice ? The study methods represent a managing tool to enhance efficiency in providing facilities ? The data are useful to help represent telemedicine services in regular medical fee schedules     

Imaging of tendons—adaptation,degeneration, rupture

Tendon imaging is mainly performed with ultrasonography (US) and magnetic resonance imaging (MRI) and has been improved within the last years because of technical advancements and a better understanding of tendon pathology. Several concepts concerning the etiology and the course of tendon diseases have influenced image interpretation and vice versa. Adaptive mechanisms within the tendon tissue against stress can be observed mainly on histologic specimens and not macroscopically or with in-vivo imaging. Degeneration may occur in the form of tendinitis, peritendinitis, enthesitis, or myotendinal junction abnormality. Distinct imaging findings exist for most of these forms. Many concepts that have been developed to explain tendon degeneration have been applied on virtually all tendons in the human body. They can be grouped into those which focus on hypovascularization, on biomechanical overload, and on degeneration secondary to other underlying disease. Tendon rupture seems, in many cases, to be the final stage of tendinitis. From this point of view, imaging may be used to predict the risk of tendon rupture together with other intrinsic and with extrinsic parameters. These considerations result in the concept of the ‘vulnerable zone’ and of the ‘critical phase’ in which tendon ruptures may predominantly occur.     

Do voluntary strength,proprioception, range of motion,or postural sway predict occurrence of lateral ankle sprain?

Prevention of ankle sprain, the most common sporting injury, is only possible once risk factors have been identified. Voluntary strength, proprioception, postural sway, and range of motion are possible risk factors. A systematic review was carried out to investigate these possibilities. Eligible studies were those with longitudinal design investigating ankle sprain in subjects aged > or = 15 years. The studies had to have measured range of motion, voluntary strength, proprioception, or postural sway before monitoring incidence of lateral ankle sprain. Dorsiflexion range strongly predicted risk of ankle sprain. Postural sway and possibly proprioception were also predictors. Therefore the preliminary evidence suggests that people with reduced ankle dorsiflexion range may be at increased risk of ankle sprain.     

XXXVIII Annual Meeting of the Spanish Society of Neuroradiology, 1–3 October 2009, Córdoba,Spain

Abstracts

XXXVIII Annual Meeting of the Spanish Society of Neuroradiology, 1–3 October 2009, Córdoba, Spain Scientific posters and papers     

Level of evidence and authorship trends of clinical studies in knee surgery,sports traumatology,arthroscopy, 1995–2015

Purpose

There is increasing emphasis on publication quality and internationalization of author groups in orthopaedic literature. The purpose of this review was to evaluate the type of studies and the level of evidence (LOE) published in knee surgery, sports traumatology, arthroscopy (KSSTA) from 1995 to 2015. The secondary aim was to analyze trends in authorship characteristics in KSSTA.

Methods

Two reviewers reviewed the table of contents of KSSTA and identified original papers from 1995, 2000, 2005, 2010, and 2015. The reviewers graded LOE from Levels I to IV using guidelines from the University of Oxford’s Centre for Evidence-Based Medicine. For each article, the total number of authors and country of author group were also analyzed.

Results

A total of 880 papers were analyzed. The proportions in LOE have stayed consistent throughout the study period (n.s.). There has been a significant increase in the number of published articles and the number of Level I and II studies (P?<?0.01). Therapeutic articles were the most common type. The mean number of authors per KSSTA article significantly increased from 3.9 to 5.7 over the 20-year period (P?<?0.01). The number of represented countries increased yearly and academic institutions from 40 different nationalities published articles in the Journal. Of the examined years, the percent of articles with international collaboration was 17.6%.

Conclusion

The proportion of LOE I and II articles published in KSSTA remains consistently high. Therapeutic studies are the most frequently published articles. There is an increase in international groups publishing in KSSTA.

Level of evidence

IV.

     

Comparison of high resolution CT findings of sarcoidosis, lymphoma, and lymphangitic carcinoma: is there any difference of involved interstitium?

PURPOSE: The purpose of this study was to determine distinguishing features of three diseases that are distributed along the lymphatics. METHOD: CT scans of 40 patients with lymphangitic carcinomatosis, 41 with sarcoidosis, and 44 with malignant lymphoma were retrospectively reviewed. We evaluated the degree of involvement of the interlobular septa, bronchovascular structures, subpleural interstitium, and other CT findings. RESULTS: The number of thickened interlobular septa and the extent of involvement of the subpleural interstitium in lymphangitic carcinomatosis were higher than those in sarcoidosis and malignant lymphoma (p<0.0001). Nodules of >1 cm in diameter were more often seen in malignant lymphoma (41.0%) than in the other two diseases (p < 0.001). Bilateral distribution was more common in sarcoidosis (100%) than in the others (p<0.001). CONCLUSION: The major difference among lymphangitic carcinomatosis, sarcoidosis, and malignant lymphoma is the greater involvement of the interlobular septa and subpleural interstitium in lymphangitic carcinomatosis than in either sarcoidosis or malignant lymphoma.     

Organ distribution of 4-MEC,MDPV, methoxetamine and α-PVP: comparison of QuEChERS and SPE

Purpose

An organ distribution investigation was carried out on two deceased (A and B) who consumed 4-methylethcathinone (4-MEC), methylenedioxypyrovalerone (MDPV), methoxetamine (MXE) and α-pyrrolidinopentiophenone (α-PVP).

Methods

The detection of the aforementioned drugs in the specimens was performed on a liquid chromatography–tandem mass spectrometry system. Two different extraction methods were compared with each other—a quick, easy, cheap, effective, rugged and safe (QuEChERS) approach and an automated Instrument Top Sample Preparation-solid phase extraction (ITSP-SPE). Standard addition method was used to quantify the drugs.

Results

4-MEC, MDPV and MXE were detected in all collected tissues and body fluids of the two deceased. α-PVP was also detectable in deceased A. Deceased A showed femoral blood concentrations of 97 µg/L 4-MEC, 396 µg/L MDPV, 295 µg/L MXE and 4 µg/L α-PVP measured after extraction by QuEChERS and 118 µg/L 4-MEC, 342 µg/L MDPV, 385 µg/L MXE and 4 µg/L α-PVP measured after ITSP-SPE. Deceased B revealed heart blood concentrations of 8 µg/L 4-MEC, 3 µg/L MDPV and 2 µg/L MXE after extraction by QuEChERS and 8 µg/L 4-MEC and 1 µg/L MXE after ITSP-SPE.

Conclusions

Both preparation techniques were suitable for quantifying NPS in organ tissues and body fluids. With respect to the autopsy findings, the cause of death of deceased A was determined to be an acute intoxication with NPS. No certain cause of death could be ascertained for deceased B.

     

Diagnosis,treatment, and rehabilitation of the thrower’s elbow

The overhead throwing motion generates enormous force in the elbow. Repetitive near failure loads lead to chronic adaptive changes and occasionally acute injury. The physician caring for the thrower must understand the complex anatomy and function of the elbow joint, along with the biomechanics of throwing, to accurately diagnose and treat elbow pathology. Evaluation of elbow pain in the throwing athlete must begin with a thorough and detailed throwing history including duration of symptoms, location of pain, timing during the phases of throwing motion, and associated symptoms. Physical examination should include inspection, range of motion, palpation, and specific tests to better define the pathology. A detailed history and physical examination will allow the astute clinician to obtain the proper diagnosis and start the appropriate operative or nonoperative treatment often without reliance on ancillary testing. Treatment and rehabilitation of these injuries must be tailored to the pathology present and focused towards a return to the athlete’s activity.     

Abstracts of papers on updated radiation effects,immunological effects of nuclear war,medical effects and future dangers of nuclear‐weapon tests

Biological weapons (BW), although outlawed under the 1925 Geneva Convention, were studied in World War II, but were not used except on a small scale by the Japanese in Manchuria. The UN Disarmament Commission in 1959 failed to have BW eliminated because of the absence of agreed international verification. The Pugwash movement carried out trial inspections of microbiological establishments and concluded in 1966 that verification was possible. A WHO assessment in 1969 on chemical and biological weapons was that the effects on civilian populations could be very damaging, but that BW would not be militarily useful except for sabotage. The Biological Weapons Convention (1972) renounced biological warfare but permits relevant research for defence. Research on BW has recently been increased by the USA which claims that the USSR is using genetic engineering for this purpose. Research relevant to BW should not be carried out secretly nor under military auspices.