Imaging nodules within cirrhotic liver: how do I do it?

Cirrhosis is a chronic liver disease characterized by the presence of diffuse parenchymal necrosis, reactive fibrosis and nodular regeneration. These regenerative nodules may evolve into dysplastic nodules and finally nodules of hepatocellular carcinoma (HCC). Improved survival of cirrhotic patients with HCC depends on eligibility to liver transplantation. The purpose of this paper is to review the imaging features of liver nodules within cirrhotic liver and to propose the imaging strategies when considering the possibility of liver transplantation.     

Splenic Trauma: What is New?

Evaluation for splenic injury is an important component of patient assessment after blunt abdominal trauma. Key imaging modalities include ultrasound, particularly for rapid identification of hemoperitoneum, and computed tomography (CT), which permits a more detailed and accurate determination of splenic integrity. Specific findings at contrast-enhanced multidetector CT (MDCT) should prompt the consideration of catheter angiography with arterial embolization as an adjunct to nonsurgical management. This article reviews the roles of imaging in the management of splenic trauma, illustrates the MDCT appearance of various splenic injuries, and discusses imaging-based indications for operative and angiographic intervention.     

Sports doctors' resuscitation skills under examination: do they take it seriously?

As 64% of sports medicine doctors were unable to show proficiency at basic life support and assessment and management of a seriously injured patient with a potential spinal injury in the last two examinations for a University of Bath diploma in sports and exercise medicine, it was decided that a reminder is required of the importance of acquiring, at the very least, some basic resuscitation skills. An analysis and comment on the results from the first aid component of the examination is also presented.     

Coronary CT angiography: How should physicians use it wisely and when do physicians request it appropriately?

Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease due to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with 64- and more slice CT scanners and in selected patients, coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. Although the tremendous contributions of coronary CT angiography to cardiac imaging are acknowledged, appropriate use of cardiac CT as the first line technique by physicians has not been well established. Optimal selection of cardiac CT is essential to ensure acquisition of valuable diagnostic information and avoid unnecessary invasive procedures. This is of paramount importance since cardiac CT not only involves patient risk assessment, prediction of major cardiac events, but also impacts physician decision-making on patient management. Applications of CT in cardiac imaging include coronary artery calcium scoring for predicting the patient risk of developing major cardiac events, followed by coronary CT angiography which is commonly used to determine the diagnostic and prognostic accuracy in the coronary artery disease. This review presents an overview of the applications of CT in cardiac imaging in terms of coronary calcium scoring and coronary CT angiography. Judicious use of both cardiac CT tools will be discussed with regard to their value in different patient risk groups with the aim of identifying the appropriate criteria for choosing a cardiac CT modality. An effective diagnostic pathway is finally recommended to physicians for appropriate selection of cardiac CT in clinical practice.     

Characterization and guided-procedures of breast suspicious microcalcifications: can MicroPure ultrasound do it?

Objective

To assess the diagnostic value of high-frequency (MicroPure) ultrasound in evaluating suspicious microcalcifications and to determine its capability in biopsy guidance.

Subjects and methods

Sixty-two cases with suspicious microcalcifications detected on mammographic examination had been re-evaluated by MicroPure US. The studied cases underwent true cut tissue/surgical excision biopsy. Histopathology revealed 25 benign and 37 malignant lesions and was considered the gold standard of reference.

Results

Malignant microcalcifications were easier to be visible at MicroPure US, as they were detected in 86.5% (n = 32/39) compared to only 68% (n = 17/25) of the benign lesions. US depicted more breast masses associated with malignant microcalcifications in 78% (n = 29/37) than those associated with benign ones seen in 36% (n = 9/25).Visibility of suspicious microcalcifications at US was aided by preliminary mammogram. Given known mammography location of these microcalcifications had made their visualization accessible by MicroPure US in 79% (n = 49) of the cases.

Conclusion

MicroPure ultrasound cannot discriminate benign from malignant breast microcalcifications. MicroPure can be useful in detecting clustered microcalcifications that are not accessible by B-mode ultrasound; provided knowledge of their mammographic location and thus can provide better guidance for pre-surgical wire localization and ultrasound-guided biopsies.     

Clinical effectiveness: how much do radiographers know about it and what do they think of the concept?

Purpose: The dual concepts of evidence-based practice (EBP) and clinical effectiveness have become ever more important in the health service in recent years. In order that suitable initiatives can be derived and future policy shaped and evaluated it is important that the current level of knowledge and attitudes towards the concepts are recorded. The current study aimed to examine these in a representative sample of radiographers.Methods: A total of 138 individual radiographers selected at random from the population of radiographers within Wales were approached and requested to complete a postal questionnaire. Of those approached, 76 completed and returned the questionnaire.Results: Individuals considered themselves to be lacking in certain key skills essential for evidence-based practice. Specifically, these appeared to be related to the more ‘technical’ research-related skills and there was limited evidence that individuals were undertaking many of these components. However, attitudes towards EBP and clinical effectiveness were, by and large, positive.Conclusion: The current underlying culture provides a firm foundation for the necessary education and encouragement required for the fuller implementation of evidence based practice in radiographers.     

Trainee reporting of computed tomography examinations: do they make mistakes and does it matter?

AIM: To determine the accuracy of trainees reporting computed tomography (CT) examinations. MATERIAL AND METHODS: Over a 6-month period a single consultant reviewed all the CT examinations reported by registrars in one radiology department. After recording a provisional registrar report each examination was jointly reviewed by the consultant and registrar. The consultant's opinion was regarded as the gold standard. Data collected included: the error rate, whether an error was significant, leading to a change in patient management, and whether the mistake was a false-negative or positive. RESULTS: Three hundred and thirty-one patients were included in the study. There was an overall error rate of 21.5%. A significant error leading to a change in management was made in 10% of reports, and a significant error that did not lead to a change in management was made in 9.3%; 2.1% of reports had insignificant errors; and 69% of errors were false-negatives. CONCLUSION: Registrars make a significant number of errors affecting patient management when reporting CT and ideally all examinations should be reviewed by a consultant.     

Radon: is it a problem?

Radon gas is a major source of radiation exposure to the general public. Radon-222 is a product of uranium-238, present in varying concentrations in all soils. Radon enters buildings from soil, water, natural gas, and building materials. Its short-lived breakdown products, termed "radon daughters," include alpha-emitting solids that can deposit in the lungs. Firm evidence links lung cancer risk in miners with high exposure to radon daughters. The amount of risk associated with the much lower but chronic doses received in buildings is difficult to establish. By some extrapolations, radon daughters may be responsible for a significant number of lung cancer deaths. The existence or extent of synergism with smoking is unresolved. Local conditions can cause high levels of radon in some buildings, and measures that reduce indoor radon are of potential value.     

Calcifications in the cuff: take it or leave it?

Objectives

The aim of this study was to evaluate whether removing the calcifications in the rotator cuff tendons during surgical subacromial decompression improves outcome in patients with calcific tendonitis.

Methods

Two groups of 20 patients with a subacromial impingement syndrome and cuff calcifications were operated on. In group A, patients had an anterolateral acromioplasty according to Neer with excision of calcifications. In group B, the same procedure was performed without additional excision of calcifications. After a minimum follow‐up of 3 years the patients were assessed with the disabilities of arm, shoulder and hand score (DASH), the visual analogue scale (VAS) for pain, measurements of range of motion (ROM) in all planes, and satisfaction with treatment.

Results

The results for the DASH score, ROM, VAS and satisfaction with treatement showed no significant difference between the two groups.

Conclusion

The results of our study suggest that removal of calcific deposits with anterolateral acromioplasty does not influence patient outcome. Further prospective studies are needed to determine the optimal surgical treatment for calcific tendonitis.Calcific tendonitis of the shoulder is a common and painful disorder and is characterised by calcifications in the tendons of the rotator cuff (fig 1​1).). The incidence in the healthy population is 2.7%, rising to 6.8% in patients with shoulder pain.^1,2 The predominant age is 30–60 years and women are affected slightly more often than men. The calcifications are most often seen in the tendon of the supraspinatus muscle.¹ Risk factors for shoulder pain due to problems of the rotator cuff include overhead activities and sports.^3,4 The treatment of choice is primarily conservative. This includes rest, physiotherapy, non‐steroidal anti‐inflammatory drugs and at a later stage a subacromial infiltration with corticosteroids. When conservative treatment fails, surgery can be recommended. In most studies on surgical treatment of calcific tendonitis, removal of the calcifications in combination with a subacromial decompression is only recommended when there are signs of subacromial irritation.^{5,6,7,8,9,10,11} However, it has also been advocated that a subacromial decompression alone might be sufficient, stating that the calcifications will dissolve as a matter of natural course.¹² The aim of this study was to evaluate whether it is beneficial for patient outcome to remove the calcifications of the tendons of the rotator cuff when performing a subacromial decompression.Open in a separate windowFigure 1 Example of a calcification in the rotator cuff on an x ray of the shoulder.     

Multislice CT coronary angiography: how to do it and what is the current clinical performance?

The introduction of multislice computed tomography (MSCT) has allowed non-invasive coronary angiography. Although widely applied, extensive information on technical details of the technique is lacking. This survey offers detailed information on patient preparation, data acquisition, reconstruction and interpretation. In addition, a summary of the available studies using MSCT for non-invasive angiography is provided. Based on pooled analysis of direct comparisons between MSCT and invasive angiography, the weighted mean sensitivity and specificity of current 16-slice MSCT for the detection of coronary artery disease are 88% and 96%, respectively. At present, the technique is particularly well suited for reliable exclusion of coronary artery disease. It is important to emphasise that MSCT only provides anatomical images, visualising the presence of atherosclerosis; information on the haemodynamic significance of these lesions (i.e. ischaemia) cannot be derived.