病案回收迟缓的调查分析

目的探讨病案回收管理工作,提高病案管理质量。方法通过回顾本院近几年病案回收情况,分析病案回收迟缓的具体原因,提出管理对策。结果近几年我院病案回收迟缓发生率有逐年升高趋势,手术科室与非手术科室病案回收迟缓发生率无显著差异,儿科和妇产科病案回收迟缓发生率低于其他科室,病案回收迟缓的原因是多方面。结论病案及时回收归档是病案管理的保证之一,须采取有效措施,以保证病案管理质量。     

PBL和PACS在医学影像学教学中的应用

目的浅析影像学教学中开展图像存档和传输系统(PACS)与以问题为导向的教学方法(PBL)相结合的教学方式的作用。方法对本院48名医学影像学医学生开展研究,研究时间开始于2018年1月,结束于2019年1月,依据随机数字法将其分成对照组24例与观察组24例,将传统教学模式应用在对照组教学中,将PBL和PACS相结合的授课形式应用在观察组教学中,比较两组理论成绩以及临床实践能力。结果在理论考核项目和临床实践考核得分方面,观察组均高于对照组(P<0.05)。结论采用PBL和PACS相结合的授课模式,可有效提升医学影像学教学质量,保障学生更加有效地掌握理论知识以及专业技能。     

Do regions of interest location and type influence liver stiffness measurement using magnetic resonance elastography?

PurposeTo assess the variability of liver stiffness measurements using magnetic resonance elastography (MRE) at 1.5 T, depending on different approaches of regions of interest (ROIs) drawing.Material and methodsFifty consecutive patients with successful liver MRE were included. There were 32 men and 18 women with a mean age of 52 ± 14 (SD) years (range: 20–85 years). MRE was acquired using a gradient recalled-echo MRE sequence. At the level of the portal bifurcation, one observer drawn in the right liver first 3 elliptical ROI and then one free-hand ROI, as large as possible based on the confidence map and the anatomy. Three additional elliptical ROIs were further drawn on the slice above and 3 other on the slice below, for a total of 9 elliptical ROIs. The average value of liver stiffness in the 3 elliptical ROIs of the central slice and the one from the 9 elliptical ROIs were computed. Three liver stiffness values were obtained for each patient from the 3 measurement methods (one free-hand ROI, 3 elliptical ROIs and 9 elliptical ROIs). Inter-method variability was assessed using the intra-class correlation coefficient (ICC) and Bland-Altman analysis.ResultsThe variability between the 3 methods was excellent with ICC > 0.978 (P < 0.0001). The Bland-Altman analysis revealed high agreement between the 3 methods with bias < 0.45 kPa and limits of agreement < ±1.13 kPa. The variability was lower when comparing a large free-hand ROI and the 3-elliptical ROIs, than when comparing the 9-elliptical ROIs to one of the other methods.ConclusionOur results show that the variability between the 3 methods of ROI drawing and placement is very low.     

基于PACS的病例导入式教学在影像学见习教学中的应用

目的评价基于影像归档和通信系统（picture archiving and communication system,PACS）的病例导入式教学在影像学见习教学中的效果。方法选取中南大学湘雅医学院2009级五年制临床医学专业学生148人为研究对象,分成10组,随机抽取组号分为实验组（n=73）和对照组（n=75）。对照组采用传统教学方法（应用胶片教学）;实验组利用PACS资源,采用病例导入式教学,分为3个步骤。实验组和对照组采用调查表和测验成绩评价教学效果。采用χ^2检验比较2组学生的理论成绩,检验水准α=0．05。结果与对照组比较,更多的实验组学生认为,基于PACS资源的病例导入式教学可以达到教学目的,提高学习兴趣,加强了对知识的掌握。测试成绩显示：实验组测试成绩90～100分及80-89分的学生百分比（14％、75％）明显高于对照组（5％、66％）（χ^2=17．932,P= 0．000）。结论基于PACS的病例导入式教学提高了学生的学习主动性及临床能力,也让教师及时补漏订讹,使影像学见习教学收到更大的实效,值得推广。     

Diagnostic performance of liquid crystal and cathode-ray-tube monitors in brain computed tomography

The aim of this study was to evaluate feasibility of reporting brain CT examinations on liquid crystal display (LCD) flat-screen monitors vs state-of-the-art cathode-ray-tube (CRT) monitors. Ninety-five brain CT examinations of 95 patients were displayed on Picture archiving and communications system (PACS) workstations equipped either with a dedicated medical imaging LCD colour monitor or on a high-resolution CRT which is used for routine reporting of CT, MRI and digital radiography images in our institution. Fifty cases were negative and 45 cases were positive for early brain infarction (EBI), the latter being defined by a combination of one or more signs: dense artery; hypodensity of brain parenchyma; and local brain swelling verified by control scans. Ten radiologists had to rate presence or absence of EBI on a five-point scale. Ratings were evaluated by CORROC2 ROC software and areas under the ROC curve (A_z) were computed. Significance of differences between the two viewing conditions were evaluated with Wilcoxon test. Mean A_z of the ten observers was 0.7901 with LCD vs 0.7695 with CRT which did not show statistical significance (p=0.2030). In the setting investigated, reporting of CT studies from high-performance LCD monitors seems feasible without significant detriment to diagnostic performance.     

Filmless radiology in the Emergency Department

The introduction of standardization in image formatting allowed the development of a picture archiving and communication system, or filmless radiology. In practice, we have found advantages in quick access and availability, image manipulation, and cost savings to outweigh the disadvantages of portability and system down time.     

Efficacy of CT-guided biopsies of the spine in patients with spondylitis--an analysis of 164 procedures

Objective

To evaluate efficacy of CT-guided spinal biopsy (CTSB) in patients with spondylitis considering patient characteristics, technical issues, antibiotic therapy, histopathological, and microbiological findings.

Materials and methods

All CTSB procedures performed between 1995 and 2009 in patients with proven spondylitis were re-evaluated. Patient sex and age, antibiotic treatment, biopsy approach, number of specimens, length of needle path, laboratory results (CRP, WBC), and histopathological/microbiological findings were documented and compared to the final diagnosis of spondylitis. Statistical analysis was performed using Chi-square test and Student's t-test. The p-value was set to 5%.

Results

164 CTSB procedures were performed in 159 patients (mean age 65 years, 60% men) in which spondylitis was histopathologically verified in 95%. Neither patient sex nor age, positioning, localization of the spinal lesion, bioptic approach, number of specimens, or depth of the needle showed significant impact on the rate of positive histopathological findings. A causative germ was identified in 40/127 biopsies (32%) with Staphylococcus aureus being identified in 50%. Tuberculous spondylitis was diagnosed in ten cases (6%). CRP significantly correlated with bacterial growth (13.3 ± 12.2 mg/dl versus 8.8 ± 7.6 mg/dl; p = .015) whereas administration of antibiotics did not show any significant impact on bacterial growth (29% versus 36% in patients without antibiotics; p = 0.428). Patients with histopathological signs of active spondylitis showed a significantly higher CRP (16.5 ± 15.8 mg/dl versus 8.9 ± 8.0 mg/dl, p < .001). Complication rate was 0.6% (one focal bleeding).

Conclusion

CTSB of the spine in suspected spondylitis is an effective and safe procedure for establishing final histopathological diagnosis. However, microbiological yield is low regardless of technical issues and antibiotic therapy. Other than CRP values, laboratory investigations added little useful information to diagnose infection in our study group. CRP values significantly correlated with bacterial growth and with histopathological signs of active spondylitis.     

医学影像传输及储存系统数据库中应用云计算的设计

目的:在医学影像传输及储存系统(PACS)中,数据库是其整个系统的主要组成部分。数据库文件结构的建立是编制程序的基础,也是维护工作的依据。为满足患者对医疗技术水平的要求,研究出不必对现有医疗设备进行升级换代或购买新软件,而是设计一个"私有云",在"云"内进行数据处理和数据储存,实现对图像储存及图像的后处理。方法:将现有的PACS系统与医疗设备及用户端的PC使用"云计算"技术将其对接,使数据储存和数据运算等工作在云内进行。结果:"云"内储存的存储空间得到了极大的提升,且单独工作站瘫痪时不会引起数据丢失;因"云"内计算采用了分布式和并行式计算,大大提高了运算能力。结论:PACS数据库中应用"云计算"能有效的提高数据存储和数据处理方面的能力。     

以提高医学影像学专业本科生实践技能水平为目标的实验课程改革

医学影像设备飞速发展,对医学影像学专业人才实践技能水平提出更高要求。然而传统（CTMR诊断学》实验教学存在图像质量差、教学资源不平衡、学生实践技能训练不足、课程考核不能体现实践技能水平等弊端,不利于人才培养。通过改善实验室硬件设施、编写实验指导、鼓励学生主动学习、加强实践技能考核、多渠道培养教师等措施,提高该课程的实验教学质量与学生实践技能。调查发现,92．9％的学生对改革后的实验课程教学表示满意。上述措施今后将应用于医学影像诊断学的所有子课程教学,以促进医学影像学专业人才培养。