Quality management in a radiology department

Purpose. To increase the quality of internal and external interactions (patients, clinical colleagues, technicians, radiologists) in a department of radiology. Method. Accompanied by a well-experienced adviser workshops have been performed dealing with different topics like “contact to patients”, “performance of the radiological report and interaction with the referring colleague” or “research and teaching”. A catalogue of different actions was defined to reduce hindrances within the internal and external work-flow. Results. A total number of 53 actions was defined and related to different persons who were responsible for the realisation of the measures within a time interval. Six months after starting the quality management 46 (86%) of the defined actions were realised successfully, and another 4 (8%) measures were still running. There was a moderate increase of satisfaction of the patients and clinical colleagues considering the waiting time. Conclusions. A quality management in a radiological department allows an optimisation of the internal and external interactions. However, the guidance of a well-experienced adviser is as essential as the continuous control of successful finished measures.     

Spiral-CT der Lunge Technik,Befunde, Stellenwert

Zusammenfassung Die Spiral-CT erm?glicht es, den Thorax innerhalb einer Atemphase kontinuierlich zu erfassen. Im Vergleich zur Standard-CT zeigt die Spiral-CT eine erh?hte Sensitivit?t zum Nachweis intrapulmonaler Rundherde, kleiner mediastinaler und bronchopulmonaler Lymphome, pleuraler Plaques sowie eine verbesserte morphologische Charakterisierung von L?sionen. Neue diagnostische Aufgaben umfassen den Nachweis subtiler diffuser Lungenerkrankungen, den Nachweis von Pulmonalembolien sowie vaskul?rer Malformationen. Für die Diagnostik tracheobronchialer Pathologie stellt die Spiral-CT eine ideale Erg?nzung zur Bronchoskopie dar. Eingegangen am 16. Februar 1996 Angenommen am 19. Februar 1996     

Ossäre Manifestationen beim Non-Hodgkin-Lymphom im Kindes- und Jugendalter

PURPOSE: Skeletal manifestation of Non-Hodgkin's lymphoma is rare in pediatric patients. Objective of the study was to determine imaging features, before and after treatment, and to correlate these features with clinical outcome. METHODS: A retrospective analysis of 1246 patients from two therapy studies (NHL-BMF-90 and 95) was performed. Imaging studies of 63 patients with bone involvement of lymphoma were reevaluated. RESULTS: Incidence of initial bone involvement in Non-Hodgkin's lymphoma was 6.8%. Distribution was best assessed by bone scan, MRI revealed larger areas of marrow involvement and detected additional lesions. Sites of predilection were long bones of the lower extremities with epiphyseal involvement in 39%. Residual signal alterations in MRI after successful therapy remained in 71%. Osteonecrosis after therapy was a common finding. Clinical outcome war not correlated to the presence of bone involvement. CONCLUSIONS: Since clinical outcome is not effected by bone involvement in childhood NHL, value of screening may be limited. Knowledge of imaging characteristics is mandatory for initial evaluation of primary osseous lymphomas and symptomatic lesions as well as for therapy controls.     

Traumatic temporomandibular joint injuries

Injuries of the temporomandibular joint are mostly due to injuries or fractures of the mandibular condyle. Fractures of the skull base involving the temporomandibular joint are rare. Classification of fractures refers to their anatomical positions and the presence or absence of a luxation. Further, it is important whether the fracture is intra- or extracapsular. The primary imaging method should be orthopantomography. As for therapy planning, especially surgery, also evaluation of soft tissue is necessary, computed tomography is the imaging method of choice. For diagnosis of complications or internal derangement of the temporomandibular joint, magnetic resonance imaging is to be recommended.     

Planungen der Deutschen Röntgengesellschaft und des Berufsverbandes zur Qualitätssicherung bei Mammographie

A high level of quality is an unequivocal prerequisite for obtaining the highest possible accuracy in symptomatic patients and for reproducing the results concerning mortality reduction, which were obtained in large screening trials. Present deficiencies in Germany are due to legal regulations, which have not been updated and which are thus below European standard. Furthermore the quality assurance program has not proven sufficiently effective for mammography. In order to promote mammographic quality assurance, the German Roentgen Society proposes an accreditation program. The accreditation, which concerns A.) mammographic technique and positioning and B.) mammographic reporting is not obligatory, but will allow acquisition of special official certificates, which may support the patients to find doctors who perform and read mammograms with high quality and expertise. The accreditation shall be performed by personnel and/or institutions who are specifically trained surveyed.     

Wert und Bedeutung der digitalen Vollfeldmammographie im Rahmen eines Mammographie-Screenings

To evaluate the digital technique for screening mammography various experimental studies and clinical examinations were performed by using direct full-field digital mammography (FFDM). The findings concerning the detectability and characterization of microcalcifications and soft tissue masses as well as the radiation exposure were compared to the state-of-the-art conventional screen-film mammography (SFM). The results of these studies revealed a high performance of the digital images, which are at least equivalent to the conventional images, whereas digital spot views were significantly superior to conventional ones particularly in the detection of microcalcifications. This was especially true, when the potential of post-processing was used. In addition, the sensitivity of FFDM should be increased, if computer-aided-diagnosis (CAD) is available. Furthermore, the patient radiation dose can be significantly reduced. Additional advantages are quick and easy handling, efficient data transfer and digital archiving. Thus, FFDM will become an important tool in screening mammography.     

Primäre chronische Polyarthritis am Kniegelenk

Zusammenfassung Die chronische Polyarthritis (CP) ist eine multisystemische Erkrankung und wird charakteristischerweise von einer persistierenden inflammatorische Synovitis begleitet. Das Kniegelenk ist das h?ufigste einzeln betroffene Gelenk, seine Affektion manifestiert sich zumeist mit synovialer Hypertrophie, chronischen Ergüssen und oftmals auch Bandinstabilit?t. Schmerzen sowie Schwellungen in den dorsalen Weichteilen sind oft durch Vordringen inflammatorischer Synovia oder Ergu?ansammlungen bedingt (Baker-Zyste). Das konventionelle R?ntgenbild bildet zwar einen Grundpfeiler in der CP-Diagnostik, zeigt jedoch oft erst bei fortgeschrittenem Krankheitsverlauf Ver?nderungen auf. Mittels Sonographie k?nnen Ergüsse und Baker-Zysten suffizient nachgewiesen werden. Die Computertomographie spielt eine eher untergeordnete Rolle und findet ihren Einsatzbereich nur bei spezieller Fragestellung (Osteodestruktion, Osteoporose). Die Magnetresonanztomographie (MRT) hat sich auf Grund der ausgezeichneten Darstellbarkeit von Knorpel und Weichteilgewebe zur Methode der Wahl in der Frühdiagnostik und Verlaufsbeurteilung entwickelt. Einsatz von Kontrastmittel und sog. dynamischen Untersuchungen führen zu neuen Aspekten in der Aktivit?tsbeurteilung. Moderne Sequenzen, wie „magnetization-transfer“ bzw. fettunterdrückte T1-SE Sequenzen versprechen eine verbesserte Diskriminierung von Knorpel, Synovia und Ergu?. Eingegangen am 7. M?rz 1996 Angenommen am 26. M?rz 1996     

Auswertung der bisherigen Mammographie-Screening-Studien in Europa und in Nordamerika

The ancient randomized-controlled trials of breast cancer screening have offered clear evidence that invitation to participate in mammography screening with/without clinical examination is effective in breast cancer mortality reduction und underline the detection sensitivity of mammography. Recently published criticism of both the effect and fundamental data handling could be shown to be untenable. Randomized studies underestimate the effect while well-designed observational studies do not systematically overestimate the magnitude of the effect. To transform high-quality study results in all-day's practice is a hugh challenge, but affordable as has been demonstrated in Great-britain, the Netherlands and Sweden.     

Wertigkeit der Magnetresonanztomographie in der Diagnostik der Neurosarkoidose

Zusammenfassung Klinische Untersuchungen an Patienten mit systemischer Sarkoidose sprechen in 5%, Autopsieberichte in 25% für eine Beteiligung des Zentralnervensystems. Ziel der Studie ist eine Beurteilung der Beitrags der Magnetresonanztomographie (MRT) in der Diagnostik der Neurosarkoidose. Die MR-Tomogramme von 22 Patienten mit gesicherter Sarkoidose und neurologischer Symptomatik wurden retrospektiv ausgewertet. H?ufigstes klinisches Symptom der Neurosarkoidose war eine Fazialisparese (10 Patienten). MR-tomographisch konnte eine Vielzahl verschiedener Befunde erhoben werden: periventrikul?re und Marklagerl?sionen in T2-gewichteten Bildern in 46%, multiple bzw. miliare supratentorielle und infratentorielle L?sionen in 36%, solit?re intraaxiale Raumforderungen in 9%, solit?re extraaxiale Raumforderungen in 5% und meningeale Kontrastmittelanreicherung (nodul?r oder diffus) in 36%. Schlu?folgerung: Die MR-tomographischen Befunde bei Neurosarkoidose sind oft wenig spezifisch. Die Diagnose wird meist bei gleichzeitigem Nachweis sarkoidosetypischer Granulome in anderen Organen gestellt, eine isolierte zerebrale Manifestation kann erhebliche diagnostische Schwierigkeiten bereiten. Die Neurosarkoidose sollte bei unklaren zerebralen Symptomen und Befunden stets in die Differentialdiagnose einbezogen werden, weil sie behandelbar ist.      

Diagnostik von akuten Aortenerkrankungen mit der Mehrzeilendetektor-CT in Spiraltechnik

Acute diseases of the central arteries require an immediate investigation. An efficient, fast and reliable diagnosis is necessary because of the high mortality, if the patient remains untreated. These requirements are perfectly fulfilled by the new CT-techniques. METHODS: Suspected aortic diseases were examined with a new multi-slice helical CT. The thoracic or the abdominal aorta as well as the entire vascular tree from the supra-aortic branches to the inguinal arteries were investigated with different CT protocols. The slice-thickness and the scan mode were changed while the total examination time was kept constant for the first two groups. In the third group a monophasic examination was compared to a biphasic one. RESULTS: In the diagnosis of acute aortic diseases multi-slice helical CT proved to be a fast and reliable method with all scan protocols. The objective measurements of contrast homogeneity and image quality were comparable in the first two groups. The monophasic contrast medium injection protocol was superior to the biphasic administration mode. CONCLUSIONS: Multi-slice helical CT appears to be a very effective approach for the diagnosis of acute aortic diseases and seems to be the new gold standard.     

Dissezierendes Aneurysma der A. cerebri media bei einem 7-jährigen Mädchen

Dissections of peripheral arteries affect predominantly male, hypertonic patients from the age of 60, characteristically those with a cystic medianecrosis as a basic disease. In contrast, dissecting aneurysms of intracranial arteries are extremely rare. Here, younger patients with or without trauma in their past history are in the vast majority. We present a case of traumatic dissection of the middle cerebral artery in a 7-year-old girl and discuss the pathogenesis, symptoms and morphological findings with respect to cases described in the literature.     

Die Bedingungen der radiologischen Vergleichsuntersuchung in der rechtsmedizinischen Personenidentifikation

The authors tested the possibilities for forensic personal identification based on the comparison of ante-mortem and post-mortem radiographs. From the Dept. of Radiology University Medical School of Pécs, Hungary 946 randomly selected radiographs of 9 different skeletal regions from 458 patients were examined. The aim of this study was to find the specific parts of the skeleton, which are anatomically variable or which frequently exhibit change due to pathological development, trauma or alterations from surgery. The results of the examinations showed that the skull has the most anatomically variable features. The long bones and the pelvic girdles showed a high number of alterations due to trauma, which suggests the importance and usefulness of these radiographs. However, the radiologically visible degenerations on the vertebral column could also be useful in the personal identification process and the authors recommend using detailed examination and careful analysis of these alterations.     

Diagnostic steps in disk dislocations and other frequent illnesses of the temporomandibular joint

Modern diagnosis of the temporomandibular joint (TMJ) consists of multiple steps, based on each other and amplifying one another. The first step is the clinical functional analysis, respecting general medical as well as specific dental aspects. If need arises electronic axiography, recording the movement of TMJ hingeaxis, is being added as well as occlusal analysis on mounted plaster casts. In case of open questions at this point of analysis, magnetresonance- and computer-tomographic imaging is brought in. The present paper is an overview describing the current step by step diagnosis of TMJ disorders, with special attention to luxation-reduction mechanism in the joints.     

Abdominelle Magnetresonanztomographie beim Kind

MRI provides diagnostic information in multiple abdominal diseases in childhood. Additional information to sonographic findings can be achieved in the diagnosis of abdominal malformation as well as in several inflammatory processes. In childhood cancer imaging MRI is essential at the beginning as well as during therapy to assess response to therapy. Because of radiation protection MRI has to replace CT in abdominal imaging in children. Some technical details have to be considered when children are examined.     

Stereotaktische Vakuumbiopsie in liegender und sitzender Position

Purpose. The purpose of our study was to determine the accuracy of vacuum-assisted biopsy (VB) and to evaluate the side effects of this method depending on the positioning of the patient during the intervention. Methods. Interventions were performed with the 11-G biopsy needle either in prone position (Mammotest S, Fischer Imaging, USA) on a dedicated table for breast intervention (n = 308) or in upright position with a dedicated digital stereotactic mammography system (Mammomat 3000, Optima, Siemens, Germany). VB was indicated because of indeterminate or suspicious microcalcifications (84.1%) or because of dense lesions (15.9%). All benign results found with VB have been followed up after 6 and 12 months by mammography. All malignant or histological findings discordant to imaging features have been verified by open surgery. Results. Histology after VB offered 215 (64.4%) benign lesions. In neither case a carcinoma developed during follow-up. In 90 (27%) cases malignancy was found with VB. After reexcision the diagnosis of VB was confirmed in 85.6%. In 8.9% of the cases in which VB showed DCIS, histology after open surgery revealed also invasive tumor components. Technical problems occurred in 4 cases. Major side effects developed neither in prone position nor in upright, sitting position of the patient. Conclusion. VB is a reliable method with less side effects for the histiological evaluation of breast lesions. The accuracy and complications are not depending on the type of stereotactic device or on the patients position. The accuracy of the histological diagnosis achieved with VB can be compared to that of open surgery. The relative high costs of this method may cause a problem. But compared to the costs resulting by open diagnostic surgery this disadvantage is only a relative one.     

Die Zuordungswahrscheinlichkeit eines numerisch-topographischen Zahnstatus bei der Identifikation unbekannter Leichen

The numerical topographical dental findings of 29,862 adult patients from several German dental practices were evaluated. Taking into account the age-dependent loos of teeth the various decades were investigated separately for increased incidences of identical findings. The total number of teeth comprising the dental findings in the form of tooth number classes was a first-line criterion aiding classification. In accordance with an underlying binominal distribution, a raised incidence of identical dental findings was found both in patients edentulous jaws or few residual teeth and in patients with largly complete dentition. The raised incidence was confined to a few standard findings in each of these high or low tooth number classes. However, more than 50% of all cases were either in the intermediate tooth number classes, in which raised incidences of ≥ 0.2% generally do not occur, or showed correspondingly rare constellations of findings in the high or low tooth number classes. In more than half of all cases, there was therefore a numerical topographical dental status which can be used in identification with a matching probability of ≥ 99.8%. Dental findings which occur less frequently can be arranged clearly according to tooth number classes.