Department of Defense Picture Archiving and Communication System Acceptance Testing: Results and Identification of Problem Components

The PACS implementation process is complicated requiring a tremendous amount of time, resources, and planning. The Department of Defense (DOD) has significant experience in developing and refining PACS acceptance testing (AT) protocols that assure contract compliance, clinical safety, and functionality. The DOD’s AT experience under the initial Medical Diagnostic Imaging Support System contract led to the current Digital Imaging Network–Picture Archiving and Communications Systems (DIN-PACS) contract AT protocol. To identify the most common system and component deficiencies under the current DIN-PACS AT protocol, 14 tri-service sites were evaluated during 1998–2000. Sixteen system deficiency citations with 154 separate types of limitations were noted with problems involving the workstation, interfaces, and the Radiology Information System comprising more than 50% of the citations. Larger PACS deployments were associated with a higher number of deficiencies. The most commonly cited systems deficiencies were among the most expensive components of the PACS.     

Leiomyosarcoma of the rectum: The military experience

Leiomyosarcoma of the rectum is a rare neoplasm and may behave in a highly malignant manner. Our experience with a single case prompted a review of the Armed Forces Central Medical Registry (AFCMR), where six other cases were found from the total AFCMR population. Four patients were treated with abdominoperineal (AP) resection; three had local excision only. Three patients developed metastatic disease and two of those died. The authors recommed prompt wide excision (AP resection) for any case of leiomyosarcoma of the rectum. This communication does not necessarily represent the view of the U.S. Air Force. Reprints of this article are not available.     

Continuous gastric suctioning decreases measured esophageal temperature during general anesthesia

Objective. This study sought to determine whether continuous gastric suctioning influences esophageal temperature measurements.Methods. This study evaluated 21 patients scheduled for extremity or lower abdominal surgery. After induction of general endotracheal anesthesia, an orogastric tube, and esophageal and nasopharyngeal temperature probes were placed in functional positions. Baseline esophageal (Tes) and nasopharyngeal (Tnas) temperatures were recorded and the orogastric tube was placed on continuous suction. After the first 11 patients (Group I) were studied, 10 additional patients (Group II) were studied with more frequent data collection to improve the time resolution of temperature changes. Temperatures were recorded for patients in Group I at 2 and 10 min with suctioning and 10 min after cessation of suctioning. In Group II, temperatures were recorded at 1, 2, 5 and 10 min with suctioning and 10 min after cessation of suctioning. Analysis of data was performed using repeated measures analysis of variance and pairedt-tests with the Bonferroni correction.Results. In Group I, Tes decreased significantly from 35.9 ± 0.2 °C (mean ± SE) to 35.1 ± 0.4 °C at 2 min and 34.8 ± 0.3 °C at 10 min of suctioning (p < 0.01). Ten minutes after cessation of suctioning, Tes was not significantly different from the baseline measurement. Tnas did not change significantly over the 20 min observation period. In Group II, Tes continually decreased from 36.2 ± 0.1 °C to 34.8 ± 0.3 °C after 10 min of suctioning (p < 0.006) and returned to near baseline 10 min after cessation of suctioning. There was no significant change in Tnas over the 20 min observation period.Conclusion. We conclude that continuous gastric suctioning decreases esophageal temperature measurements. This phenomenon should be recognized as an artifactual change in esophageal temperature and not a reflection of core temperature.This study was presented, in part, at the 1995 Annual Meeting of the American Society of Anesthesiologists, Atlants, GA, October 1995.     

Computed tomography and magnetic resonance imaging evaluation of patellofemoral instability

Malalignment and tracking abnormalities of the patellofemoral joint are common causes of anterior knee pain,which are often difficult to evaluate clinically. Conventional radiography, as well as the cross-sectional imaging modalities of computed tomography (CT) and magnetic resonance imaging (MRI) are useful tools for both detecting and quantifying these abnormalities. Acute transient dislocation of the patella, on the other hand, is a relatively uncommon injury accounting for only 2% to 3% of all acute injuries of the knee, and can also be a difficult diagnosis to establish on the basis of history and physical findings alone. MRI is a sensitive, noninvasive method for detecting prior acute transient dislocation of the patella. This article begins by describing the role of CT and MRI as it pertains to the detection of abnormal patellofemoral tracking. Both static and dynamic techniques are described along with the standard criteria used to establish and quantify patellofemoral malalignment abnormalities. Next, the constellation of MRI findings most commonly encountered after acute transient dislocation of the patella are described. These findings include a typical bone bruise pattern involving the anterolateral aspect of the lateral femoral condyle and inferomedial patella, hemarthrosis, and injury to the medial soft-tissue restraints (especially the medial patellofemoral ligament). After transient dislocation of the patella, patients with significant osteochondral injury or disruption of the medial soft-tissue restraints may benefit from surgical repair. The role of MRI in preoperative planning is discussed as it relates to the detection of osteochondral injuries as well as injury to the medial soft-tissue restraints.