PACS utilization in radiologic research

RATIONALE AND OBJECTIVES: The authors investigated patterns of utilization of the digital picture archiving and communication system (PACS) in radiologic publications in order to ascertain whether there may be a correlation between PACS use and demographic/cultural factors such as geographic location, radiologic specialization, and use of advanced radiologic technologies. MATERIALS AND METHODS: A total of 1,037 articles in 22 randomly selected issues of AJR: American Journal of Roentgenology and of Radiology (1999-2001) were reviewed for the rate of PACS use and the type of PACS used. Articles for which PACS use or nonuse was established were further classified according to originating continent or region, imaging modality, study design (whether retrospective or prospective), and the use of advanced radiologic technology. The use of a PACS was then correlated with these factors. The data were recorded and statistics were prepared by means of statistical software. The nonparametric (chi2) test also was run by using this software. RESULTS: PACS had been used and reported in the preparation of 225 of the 1,037 articles. The type of PACS used was mini PACS (eg, systems using digital imaging and communications in medicine [DICOM] protocols or precursors) in 55 (24%) and department- or hospital-wide PACS in 161 (72%). Most of the articles for which use of a PACS was reported had originated in North America (60%), Europe (22%), or Asia (14%). PACS were used in almost half of retrospective studies and in one-fourth of prospective studies (P < .01). A low correlation was found between utilization of PACS and use of other advanced technologies. CONCLUSION: Although PACS were utilized in the preparation of a substantial proportion of articles published in the two major radiology journals, there was a great disparity in the rate of PACS use among world regions. The proportion of studies originating in North America for which a PACS was used was nearly three times the number of similar studies originating in Europe, and more than four times the number originating in Asia.     

Effect of filmless imaging on the utilization of radiologic services

PURPOSE: To determine the effect of a large-scale picture archiving and communication system (PACS) on in- and outpatient utilization of radiologic services. MATERIALS AND METHODS: Data were collected at the Baltimore Veterans Affairs (VA) Medical Center (BVAMC) before and after implementation of an enterprise-wide PACS; the numbers and types of imaging examinations performed for fiscal years 1993 and 1996 were evaluated. These data were compared with those from a similar academic medical center, the Philadelphia VA Medical Center (PVAMC), and with aggregate data obtained nationally for all VA hospitals over comparable periods. RESULTS: Inpatient utilization, defined as the number of examinations per inpatient day, increased by 82% (from 0.265 to 0.483 examinations per patient day) after a transition to filmless operation at BVAMC. This is substantially greater than the increases of 38% (from 0.263 to 0.362 examinations per patient day) and 11% (from 0.190 to 0.211 examinations per patient day) at the film-based PVAMC and nationally, respectively. Outpatient utilization, defined as the number of examinations per visit, increased by 21% (from 0.108 to 0.131 examinations per visit) at BVAMC, compared with a 1% increase (from 0.087 to 0.088 examinations per visit) at PVAMC and a net decrease of 19% (from 0. 148 to 0.120 examinations per visit) nationally. CONCLUSION: The transition to filmless operation was associated with increases in inpatient and outpatient utilization of radiologic services, which substantially exceeded changes at PVAMC and nationally over the same interval.     

Ileocecal tuberculosis: CT and radiologic evaluation

The CT and radiologic findings in 11 patients (five with AIDS and six without AIDS) with ileocecal tuberculosis are described. On CT scans, five cases showed mild circumferential wall thickening of the terminal ileum and cecum, thickening of the ileocecal valve, and a few regional nodes. One case presented as nonspecific small-bowel obstruction. In five patients a more characteristic CT appearance was detected: preferential thickening of the ileocecal valve and medial wall of the cecum, exophytic extension engulfing the terminal ileum, and massive lymphadenopathy with low-density areas consistent with caseation necrosis. Patients with AIDS had a more severe form of involvement than those who did not have AIDS. Barium studies showed ileocecal changes consistent with an inflammatory process. In conjunction with barium enema, CT is helpful in the initial evaluation of ileocecal tuberculosis, showing the location and extent of intestinal and mesenteric involvement in most cases. Characteristic CT findings are seen when the inflammatory process is severe.     

The utilization of dual source CT in imaging of polytrauma

Despite the growing role of imaging, trauma remains the leading cause of death in people below the age of 45 years in the western industrialized countries. Trauma has been touted as the largest epidemic in the 20th century. The advent of MDCT has been the greatest advance in trauma care in the last 25 years. However, there are still challenges in CT imaging of the polytrauma individual including time restraints, diagnostic errors, radiation dose effects and bridging the gap between anatomy and physiology. This article will analyze these challenges and provide possible solutions offered by the unique design of the dual source CT scanner.     

Benefits and safety of CT fluoroscopy in interventional radiologic procedures

PURPOSE: To determine the benefits and safety of computed tomographic (CT) fluoroscopy when compared with conventional CT for the guidance of interventional radiologic procedures. MATERIALS AND METHODS: Data on 203 consecutive percutaneous interventional procedures performed with use of CT fluoroscopic guidance and 99 consecutive procedures with conventional CT guidance were obtained from a questionnaire completed by the radiologists and CT technologists who performed the procedures. The questionnaire specifically addressed radiation dose measurements to patients and personnel, total procedure time, total CT fluoroscopy time, mode of CT fluoroscopic guidance (continuous versus intermittent), success of procedure, major complications, type of procedure (biopsy, aspiration, or drainage), site of procedure, and level of operator experience. RESULTS: The median calculated patient absorbed dose per procedure and the median procedure time with CT fluoroscopy were 94% less and 32% less, respectively, than those measurements with conventional CT scanning (P <.05). An intermittent mode of image acquisition was used in 97% of the 203 cases. This resulted in personnel radiation dosimetric readings below measurable levels in all cases. CONCLUSION: As implemented at the authors' institution, use of CT fluoroscopy for the guidance of interventional radiologic procedures markedly decreased patient radiation dose and total procedure time compared with use of conventional CT guidance.     

Right-pneumonectomy syndrome: radiologic findings and CT correlation

The clinical history and radiographic and bronchoscopic findings were reviewed retrospectively in five patients with right-pneumonectomy syndrome, a rare, delayed complication of pneumonectomy of the right lung. Four patients had undergone pneumonectomy in childhood or adolescence. Presenting symptoms of dyspnea and recurrent pulmonary infections in the left lung were associated with radiographic evidence of marked rightward and posterior deviation of the mediastinum, counterclockwise rotation of the heart and great vessels, and herniation of the left lung into the right, anterior side of the chest. Computed tomography, performed in four patients, best demonstrated resultant compression of the distal trachea and left main bronchus between the aorta and pulmonary artery. Malacia of the major airways (n = 4 cases) and mediastinal shift was visualized only with fluoroscopy and was confirmed by bronchoscopy. Because of the morbidity and mortality associated with dyspnea and recurrent pulmonary infections, proper radiologic evaluation is crucial, and surgical intervention is often necessary.     

临床信息对影像医生CT报告的影响

目的 探讨临床信息对CT报告的影响作用及甚或导致的结果改变.方法 对150例患者分别行头、胸、腹部及盆腔CT扫描.盲法研究,每例在获知其临床信息前后均由3位CT医生中2位分别判读及予以CT诊断报告.结果 57例因获知临床信息而改变诊断报告.对其中45例予以临床随访,30例因得知进一步临床信息而使诊断报告准确,15例因获知更多临床信息而使诊断报告不够准确,后者中9例临床信息是不准确的.结论 临床信息可改变CT报告.     

Hidden shot pellets on postmortem computed tomography and their utilization for radiologic identification of decedents

We describe the case of a decomposed male cadaver found in an apartment who was transported to our institute for identification purposes. Computed tomograp     

多层螺旋CT技术在肠梗阻诊断的应用探讨

目的:探讨多层螺旋CT(MSCT)扫描技术在肠梗阻诊断中的应用价值。方法:回顾分析78例临床怀疑为肠梗阻病例的MSCT检查结果。所有患者均进行双期增强扫描,32例行MPR-冠状位、矢状位图像重建,并将其中MSCT确诊为肠梗阻的病例与临床最终结果对照。结果:经手术病理证实或临床随访证实共78例。CT提示肠梗阻阴性5例,阳性73例,与临床最终结果符合,诊断肠梗阻敏感性达100%。大肠各段及十二指肠的定位诊断准确率达100%(43/43),空肠及回肠的定位诊断准确率达84.3%(27/35)。影像对于病因诊断符合率达90.4%(66/73),不符合率6.7%(7/73)。结论:MSCT技术的应用发展,已成为肠梗阻检查的重要手段。在肠梗阻定位诊断、病因诊断、血供情况的了解具有极大的优势,值得进一步研究。     

The radiologic evaluation of tinnitus

Tinnitus (“ringing in the ears”) is a prevalent symptom in the general population, and often brings patients to medical attention. Many causes of tinnitus are evident radiographically. The most frequently-encountered causes of tinnitus are discussed, and imaging recommendations are provided.     

Sensitivity of CT scout radiography and abdominal radiography for revealing ureteral calculi on helical CT: implications for radiologic follow-up

OBJECTIVE: We compared the sensitivity of CT scout radiography with that of abdominal radiography in revealing ureteral calculi on unenhanced helical CT. MATERIALS AND METHODS: Over a 6-month period, patients presenting to the emergency department with acute flank pain were examined with standard abdominal radiography and unenhanced helical CT, which included CT scout radiography. In 60 patients in whom a diagnosis of ureteral calculus was made, CT scout radiographs and abdominal radiographs were examined by two interpreters who assessed whether stones could be visualized. All CT scout radiographs were viewed on a workstation using optimized window settings. RESULTS: CT scout radiography and abdominal radiography revealed 28 (47%) and 36 (60%) of 60 ureteral calculi, respectively. All ureteral calculi that appeared on CT scout radiography also appeared on abdominal radiography. However, eight calculi that were visible on abdominal radiography were not visible on CT scout radiography. CT scout radiography and abdominal radiography revealed 28% and 46% of 39 calculi less than or equal to 3 mm in diameter, respectively. For 21 calculi larger than 3 mm, the sensitivity of CT scout radiography and abdominal radiography was 81% and 86%, respectively. CONCLUSION: Abdominal radiography is more sensitive than CT scout radiography in revealing ureteral calculi; however, some calculi revealed on unenhanced helical CT cannot be seen on either abdominal radiography or CT scout radiography. Ureteral calculi not visible on either study can only be followed, when necessary, with unenhanced helical CT.     

Filling defect in a pulmonary arterial stump on CT after pneumonectomy: radiologic and clinical significance

OBJECTIVE: The objectives of our study were to determine the incidence of filling defects in pulmonary arterial stumps on CT after pneumonectomy and to evaluate their radiologic and clinical significance. MATERIALS AND METHODS: We retrospectively reviewed 401 contrast-enhanced chest CT scans of 147 consecutive patients (male-female ratio, 123:24; mean age, 60 years) who underwent pneumonectomy (right, 60; left, 87) from 1996 to 2002 in our institution. CT findings were analyzed for the presence or absence of a filling defect in the vascular stump and its size, shape, and interval change on follow-up CT. CT findings were also evaluated for the length of the vascular stump and the presence of embolism in the contralateral pulmonary arteries, pneumonia, bronchopleural fistula, and bronchiolitis obliterans with organizing pneumonia. Intrathoracic or stump recurrence was also assessed in patients with lung cancer. The medical records of lung cancer patients were reviewed for the cause of pneumonectomy and stage and cell type of cancer at surgery. Statistical tests were performed to determine the relationship between the filling defect and other radiologic and clinical findings. RESULTS: A filling defect in the vascular stump was seen on CT scans of 18 patients after pneumonectomy (12%), and all had undergone the surgery for lung cancer. It was more frequently found in the right-sided stump (23.3%) than in the left-sided stump (4.6%) (p = 0.001). The vascular stump was longer in patients with a filling defect (37.2 +/- 6.8 [1 SD] mm) than those without this finding (25.0 +/- 12.5 mm) (p < 0.001). Other radiologic and clinical findings were not significantly related to the presence of the filling defect in the vascular stump. CONCLUSION: A filling defect in the pulmonary arterial stump seen on CT after pneumonectomy is thought to be an in situ thrombus caused by stasis of blood flow and is not related to pulmonary embolism, tumor recurrence, or other complications after pneumonectomy.