Role of Tc-99m IDA scintigraphy in the evaluation of hepatobiliary trauma

Each year approximately 52 million Americans are injured, of which 11 million require hospitalization and 110,000 die. This has an associated health care cost of 3 billion dollars. Hepatobiliary injuries have always constituted a significant area of involvement. They have become more easily detectable since the advent of technetium-99m analogs of iminodiacetic acid (IDA). Biliary leakage secondary to other causes, such as inflammation, neoplasm, and iatrogenic factors are also well demonstrated in a safe, simple, and rapid manner with radionuclide imaging. The relatively low patient radiation dose that is associated with these procedures permits follow-up studies when necessary.     

Implementing a Software Solution Across Multiple Ultrasound Vendors to Auto-fill Reports with Measurement Values

Reliable transmission of ultrasound measurements into radiology reports is fraught with potential sources of error. In a conventional workflow, measurements are either written by hand on worksheets and/or dictated from worksheets or the images themselves into the radiology report. Valuable physician time is spent dictating, checking, and editing these values and this process is error-prone. Our approach was to use a transfer-software application to auto-populate measurements, with a goal of achieving >90% utilization rate by both technologists and radiologists. Implementation involved creating measurement fields for each measurement on each ultrasound unit of our multisite academic department. These fields were then mapped in both the transfer-software and the dictation software, to set up a 1:1:1 correspondence for each field. As a result, each measurement acquired by the technologist would automatically populate the radiology report within the dictation software. We created and mapped 128 fields for 39 exam templates. After implementation, technologist utilization rate was 86%-96% and overall radiologist utilization rate was 92%-93%. Radiology resident utilization rate was highest, at 95%-96%. We provide a guide for implementation and lessons learned.     

Implementing a Structured Reporting Initiative Using a Collaborative Multistep Approach

Purpose

To describe the successful implementation of a structured reporting initiative in a large urban academic radiology department.

Thyroid suppression and stimulation testing: The place of scanning in the evaluation of nodular thyroid disease

In the past, T3 suppression testing was often required to confirm the presence of autonomous thyroid function in patients with borderline clinical and laboratory findings suggestive of hyperthyroidism or in euthyroid patients with the stigmata of Graves' disease. Similarly, TSH stimulation testing was used to document the presence of "low thyroid reserve" in patients with borderline clinical and laboratory findings suggestive of hypothyroidism. The current availability of radioimmunoassays for triiodothyronine (T3) and thyrotorpin (TSH) plus the ability to evalate pituitary responsiveness by performing a TRH stimulation test permits a definitive diagnosis to be made in the majority of borderline situations without recourse to the more cumbersome suppression and stimulation tests. Suppression and stimulation thyroid scanning retain a unique position in the evaluation of localized areas in increased uptake of radionuclide (hot nodules), especially in patients who are euthyroid. Proof that such nodules are autonomously functioning thyroid adenomas (AFTN) greatly decreases the possibility that they represent malignant thyroid tumors. Suppression and stimulation scanning have a more limited role in the evaluation of patients with hyperthyroidism arising in a multinodular goiter, where TSH stimulation scanning may help to differentiate between toxic multinodular goiter and Graves' disease arising in a preexisting goiter.     

Bone trauma and related benign disease: Assessment by bone scanning

The radionuclide investigation of skeletal trauma in the past was confined generally to scintimetry and an occasional bone scan. The development of improved radiopharmaceuticals, including 99mTc-labeled compounds with their enhanced sensitivity, and the refinement of imaging devices offering superior resolution and speed have allowed a more detailed assessment of conditions resulting from trauma. Practical approaches to the diagnosis of subtle bone injury resulting in stress fracture, the differentiation between delayed healing and nonunion, and early recognition of avascular necrosis and osteomyelitis are now available. The changing pattern of radionuclide uptake in bone following damage by radiation and other abnormalities as a consequence of trauma also can be easily studied.     

Renal radiopharmaceuticals--an update

Noninvasive radionuclide procedures in the evaluation of renal disease have been accepted increasingly as effective and valuable alternatives to older clinical methods. The development of suitable radiopharmaceuticals labeled with high photon intensity radionuclides and with 99mTc in particular has stimulated this modality during the last few years. Currently several nearly ideal agents are available for anatomical and functional studies of kidney imparting very low absorbed radiation doses. These include 99mTc-GHA and 99mTc-DMSA for renal morphology and differential function evaluation, 99mTc-DTPA for GFR and 123I orthoiodohippurate for ERPF measurements. A suitable agent as a replacement for the latter labeled with 99mTc is actively being sought. Computer-assisted processing of dynamic renal function studies enables the observer to obtain a wealth of information related to the renal extraction, uptake, parenchymal transit and pelvic transit parameters of the agent administered into the bloodstream. Each of these parameters either globally or differentially contributes to a detailed evaluation of renal disease states. Several of these procedures have been validated against classical techniques clinically but more detailed information is being sought with the recently introduced radiopharmaceuticals. With the detailed validation and increasing recognition of the clinical utility of several of the radionuclidic procedures at many centers, it is hoped that radionuclide assessment of renal disorders ultimately will be made available routinely at all medical facilities.