Monday, January 30, 2006

Reasons for women wanting a Prenatal USG

Why women want prenatal ultrasound in normal pregnancy, by Gudex C, Nielsen BL, Madsen M in Ultrasound Obstet Gynecol 2006 Jan 24;27(2):145-150
"A postal questionnaire was completed by 370 pregnant women with no apparent obstetric risk factors, who had expressed a desire to have ultrasound scanning in their current pregnancy. The women were asked to indicate, from a list of 12 items, their three most important reasons for wanting scanning.
The items most frequently identified as important reasons for ultrasound were to check for fetal abnormalities (60% of women), to see that all was normal (55%) and for own reassurance (44%). Lower income was related to wanting to see the baby and wanting an ultrasound picture; higher income was related to checking that all was normal and for own reassurance. Women in their first pregnancy were more likely to want themselves and the father to see the baby,women who had given birth previously were more likely to want reassurance , as were women with a previous miscarriage or induced abortion. It would appear that women in normal pregnancy have specific reasons for wanting prenatal ultrasound that are influenced by sociodemographic, obstetric and attitudinal factors. "

PET/CT in Oncology

In an Article by von Schulthess GK, Steinert HC, Hany TF in Radiology 2006 Feb;238(2):405-22.Integrated PET/CT: Current Applications and Future Directions, The authors discuss the rationale behind and role of PET/CT in oncological imaging with PET giving the functional information and CT adding the anatomical edge.
"For the past 5 years, combined positron emission tomography (PET) and computed tomography (CT), or PET/CT, has grown because the PET portion provides information that is very different from that obtainable with other imaging modalities. However, the paucity of anatomic landmarks on PET images makes a consistent "hardware fusion" to anatomic cross-sectional data extremely useful. Clinical experience indicates a single direction: Addition of CT to PET improves specificity foremost, but also sensitivity, and the addition of PET to CT adds sensitivity and specificity in tumor imaging. Thus, PET/CT is a more accurate test than either of its individual components and is probably also better than side-by-side viewing of images from both modalities."

Sunday, January 29, 2006

From My Column on The Medical Blog Network-Patient Information about MRI

Following is an article from my column Medical Imaging from The Medical Blog Network.

This Article is about what should a person expect in MRI examination.

Initially all the formalities and paper work is checked. Jewelry, watches, coins, keys, cell phones and credit cards are incompatible with the magnetic resonance imaging procedure. These objects can be attracted by the magnet on the imager or distort the images. Certain articles of clothing, such as metal zippers, wires, and belt buckles, are also incompatible with the imaging. Some contradictions to MRI are-cardiac pacemaker, cochlear implants, metal filings, shrapnel, or ferromagnetic clips or pins in the body. MR scanner is long tunnel like structure. Some claustrophobic individuals may get anxious in such a situation.Initially the MR technician puts an imaging coil around the part to be examined. Examination takes around 30-60minutes. The changing magnetic field gradients create a knocking sound which may be distressing to some where wearing of ear plugs is advised. The MR technician operates the imaging system from the control room. In addition there is a computer room and a reading room where a Radiologist with view-box reports the MR scans. In addition to a technician, and a Radiologist, there are some nursing personnel also to aid in basic nursing procedure.Finally MRI is interpreted by a Radiologist and the end result is used in addition to the clinical scenario by the referring physician for further management.

Good Link for Lung radiology teaching files

Just came across this excellent teaching files for Pulmonary Pathologies. Something which we all agree is that Chest Radiology forms the basis of all examinations whether in Medical School or Residency Programs. This particular link has an option to test your skill by trying to diagnose the cases on the Diagnosis Off mode and then check your diagnosis by switching on the Diagnosis. A real stimulating exercise for all especially Radiology Residents.

Have We Radiologists Oversold Mammography?

Here is one beautiful article by Leonard Berlin, MD, FACR, is chairman, Department of Radiology, Rush North Shore Medical Center, Skokie, Ill, and professor of radiology, Rush Medical College, Chicago.

From cigarettes to pharmaceuticals to financial services, all advertisements feature a disclaimer: Why not those for mammography?
"The allegation of a delay in the diagnosis of breast cancer is the leading cause of medical malpractice litigation in the United States today, and has been for the past decade. Of all medical malpractice lawsuits lodged against radiologists, the most frequent cause is the allegation of a missed breast cancer on mammography. Why has "missed breast cancer" risen to first place in the medical malpractice standings? Author suggests that it is because we have oversold mammography. We have marketed mammography without informing the public all that we know about not only the benefits, but more important the limitations and potential harms of mammography. "
Read The Full Article Here-

Saturday, January 28, 2006

Now you can listen to your favourite Sumer's Radiology Site Podcast-Blog via Text-to-Speech

Feed2Podcast automatically converts blog text to audio via Text-to-Speech. It turns the last 7 items from my RSS feed into a podcast.

Listen Here

Blog readers can listen to the posts immediately or subscribe to the automatically generated podcast and listen with an iPod later.The text is read by a computer-generated voice. Click on the button in the sidebar of this blog: "Blog2Podcast. Listen now"
The Brilliant Concept via-

Thursday, January 26, 2006

Unfair comments in the Press About Mammography interpretations

Radiologist's misdiagnosis endangers 17 (Source United Press International)
"At least 17 British women's lives are at risk because a suspended radiologist wrongly told them they were clear of breast cancer, reports said Tuesday. The unnamed doctor -- the only radiologist at Trafford General and North Manchester General in the Manchester, England, area -- was suspended last April based on co-workers' concerns about the accuracy of his diagnoses, Sky News and The Times of London reported. Nearly 2,500 mammograms read by the radiologist since April 2003 were rechecked, 28 of which were misdiagnosed. "

Mammography per se has its own limitations and public should be educated about the possibility of false negative in this test. And so that they develop reasonable expectations of this test or more and more Radiologists will shy away from this test.
Interpretations of mammograms can be difficult because a normal breast can appear differently for each woman. Also, the appearance of an image may be compromised if there is powder or salve on the breasts or if you have undergone breast surgery. Because some breast cancers are hard to visualize, a radiologist may want to compare the image to views from previous examinations. Not all cancers of the breast can be seen on mammography.
From the literature-
N J Med. 2005 Jan-Feb;102(1-2):45-9.
"Concerns about screening mammography include questions of efficacy, high recall rates, false positives, and age at which to institute annual screening. Annual screening mammography can decrease breast cancer mortality by 45% in women over fifty and 23% in women between forty and fifty years of age. Patient recall rates and accuracy of interpretation vary among radiologists. Suggestions for improving accuracy of mammographic interpretation include continuing education with emphasis on quality of interpretation, computer-assisted detection, double reading, increased volume per reader, and performance-related skills testing. Having fewer radiologists reading more mammograms may result in decreased patient access to mammography services. Poor reimbursement for mammography and high prevalence of breast cancer-related litigation are disincentives for radiologists to provide mammography services; these issues must be addressed to ensure patient access to mammography. The public must be educated so that reasonable expectations on the benefits and limitations of mammography will develop."

Normal Chest X-ray in Heart Failure

Chest Radiographs Negative for One in Five Acute Heart Failure Patients
"Nearly one in five patients admitted to an emergency department with decompensated heart failure will have negative chest radiography results, a new analysis of registry data suggests.
The findings are consistent with past research suggesting that the test will find no signs of congestion in a substantial proportion of acute heart failure patients. The chest X-ray is still really an invaluable tool in the emergency physician's workup of heart failure But physicians who suspect heart failure in a patient should not conclude it isn't there if a chest radiograph is negative

Reference- Ann Emerg Med 2006;47:13-21.

Source- Reuters Health Information

Google for Radiologists!!

"Google has proved very useful to physicians and clinical researchers. As one fellow told his professor during grand rounds in a New York hospital, "I entered the salient features into Google, and [the diagnosis] popped right up" (Giustini, BMJ, 12/24/05).
Google operates both the general search engine, as well as Google Scholar. Google Scholar is not linked to the general search engine but instead uses an algorithm to targeted so-called scholarly material. Google also offers an image search, which is useful to clinicians who can search clinical cases and then find corresponding images online. This image search is particularly useful for radiologits as this speciality is an image based science."
Reference and More Info on Role of Google in Helath here-

Indian Medical Journals Full text Online

There have been a lot of queries regarding where to access Online Indian Medical journals. medIND is a One point resource of peer reviewed Indian biomedical literature covering full text of IndMED journals. It has been designed to provide quick and easy access through searching or browsing. Now it includes Indian Journal Of Radiology and Imaging too.
Here is the link-

Monday, January 23, 2006

MRCP at 3.0 Tesla and 1.5 Tesla- A comparison

In an article A comparison of MR cholangiopancreatography at 1.5 and 3.0 Tesla by O'Regan DP et al in Br J Radiol 2005 Oct;78(934):894-8 comparison has been made between MRCP done at 1.5 Tesla and 3.0 Tesla
"Clinical MR systems operating at 3.0 Tesla have the potential to significantly improve spatial resolution due to the boost in intrinsic signal to noise ratio. However, body imaging at these field strengths presents a number of technical challenges. Authors performed a prospective pilot study in which 10 patients underwent an MR cholangiopancreatography (MRCP) examination consecutively on 1.5 and 3.0 Tesla systems (both Philips Intera). Their pilot study shows that MRCP is feasible at 3.0 Tesla with some improvement in image quality and signal characteristics. Further development may be achieved with sequence optimization and improved coil design."

What is new in the Medical Imaging Research

Authors discuss how more newer techniques are being utilized in Medical Imaging and are in the process of research.
"Medical images are created by detecting radiation probes transmitted through or emitted or scattered by the body. The radiation, modulated through interactions with tissues, yields patterns that provide anatomic and/or physiologic information. X-rays, gamma rays, radiofrequency signals, and ultrasound waves are the standard probes, but others like visible and infrared light, microwaves, terahertz rays, and intrinsic and applied electric and magnetic fields are being explored. Some of the younger technologies, such as molecular imaging, may enhance existing imaging modalities; however, they also, in combination with nanotechnology, biotechnology, bioinformatics, and new forms of computational hardware and software, may well lead to novel approaches to clinical imaging."

Sunday, January 22, 2006

Indian Medical Informatics News-Telemedicine link for Air India

"A telemedicine link between Air India facilities in Mumbai and Narayana Hrudayalaya has been launched. The hospital has installed ECG machines, one each at the Mumbai airport, at Nariman Point and the Air India clinic, and started interpreting the ECG data here.
If an Air India passenger, staff or crew develop chest pain or other symptoms of possible heart trouble, he/she can be immediately checked and referred without delay to cardiologists at Narayana Hrudayalaya."
Full article with details at-
Thought for the future- May be in future we will have top hospitals catering to passengers and customers at all major Airports etc with systems of Telemedicine and Teleradiology.....

Saturday, January 21, 2006

How Relevant are Peer Review Journals Nowadays?

Well, of late a lot of debate has been on the net as well as my site and my letter to the editor on Radiographics discussing Web Versus Peer Review. This is what Richard Smith, Former editor for the BMJ for 25 years has to say,
"The most conspicuous example of medical journals' dependence on the pharmaceutical industry is the substantial income from advertising, but this is, I suggest, the least corrupting form of dependence. The advertisements may often be misleading and the profits worth millions, but the advertisements are there for all to see and criticise.
The much bigger problem lies with the original studies, particularly the clinical trials, published by journals. A large trial published in a major journal has the journal's stamp of approval (unlike the advertising), will be distributed around the world, and may well receive global media coverage, particularly if promoted simultaneously by press releases from both the journal and the expensive public-relations firm hired by the pharmaceutical company that sponsored the trial."
Full Article Here-

Screening Carotid artery in patients with CAD

Prevalence of carotid artery stenosis in patients with coronary artery disease in Japanese population.
In a study by Tanimoto et al in Stroke 2005 Oct;36(10):2094-8. Epub 2005 Sep 22 The study populations consisted of 632 consecutive patients who underwent coronary angiography because of suspicion of CAD. All patients underwent carotid ultrasonography to screen carotid artery stenosis before coronary angiography. They concluded Prevalence of carotid stenosis in patients with CAD is high in Japan as well as in Western countries. Screening of carotid artery stenosis is recommended especially in older patients with multivessel CAD.

Thursday, January 19, 2006

All India Pre PG examination (AIPG)2006-Radiology MCQs

With loads of queries coming from various medical students over a last few weeks regarding Radiology questions in the AIPG-2006 exam, I am posting the answers to all the radiology questions in that exam held in this January. Reference for most of the questions- Review of Radiology By Dr Sumer K Sethi, Peepee Publishers.
Any feedback is welcome in the comments section.

1.The following features are true for Tetralogy of Fallot, except:
a. Ventricular septal defect
b. Right ventricular hypertrophy
c. Atrial septal defect
d. Pulmonary stenosis.

2. The most common retrobulbar orbital mass in adults is:
a. Neurofibroma b. Meningioma
c. Cavernous haemangioma
d. Schwannoma

3. Expanisle type osseous metastases are characteristic of primary malignancy of:
a. Kidney b. Bronchus
c. Breast d. Prostate

4. Which is the objective sign of identifying pulmonary plethora in a chest radiograph?
a. Diameter of the main pulmonary/ artery> 16mm.
b. Diameter of the left pulmonary artery > 16mm
c. Diameter of the descending right pulmonary artery> 16mm
d. Diameter of the descending left pulmonary artery > 16 mm

5. The most accurate investigation for assessing ventricular function is:
a. Multislice CT
b. Echocardiography
c. Nuclear scan
d. MRI

6.The most important sign of significance of renal artery stenosis on an angiogram is:
a. A percentage diameter stenosis> 70%
b. Presence of collaterals
c. A systolic pressure gradient> 20 mm Hg across the lesion
d. Post stenotic dilatation of the renal artery

7. The MR imaging in multiple sclerosis will show lesion in:
a. White matter b. Grey matter c. Thalamus d. Basal ganglia

8. The most common location of hypertensive intracranial haemorrhage is:
a. Subarachnoid space
b. Basal ganglia
c. Cerebellum
d. Brainstem

9. Which of the following causes rib- notching on the chest radiography?
a. Bidirectional Glem shunt
b. Modified Blalock- Taussing shunt
c. IVC occlusion
d. Coarctation of aorta

10. The most sensitive imaging modality to detect early renal tuberculosis is:
a. Intravenous urography
b. Computed tomography
c. Ultrasound
d. Magnetic Resonance imaging

11. All of them use non- ionizing radiation, except:
a. Ultrasonography
b. Thermography
c. MRI
d. Radiography

12. The most radiosensitive tumor among the following is:
a. Bronchogenic carcinoma
b. Carcinoma parotid
c. Dysgerminoma
d. Osteogenic sarcoma

13. All of the following modalites can be used for in – situ ablation of liver secondaries, except:
a. Ultrasonic waves
b. Cryotherapy
c. Alcohol
d. Radiofrequency

14. All of the following radioisotopes are used as systemic radionucleide, except:
a. Phosphorus- 32 b. Strontium – 89
c. Iridium- 192 d. Samarium – 153

15. Phosphorous – 32 emits:
a. Beta particles b. Alfa particles
c. Neutrons d. X- rays

16. Which of the following is used in the treatment of differentiated thyroid cancer:
a. 131I b. 99mTc
c. 32P d. 131I-MIBG

17. Which one of the following imaging techniques gives maximum radiation exposure to the patient?
a. Chest X-ray b. MRI
c. CT scan d. Bone scan

18. Which one of the following has the maximum ionization potential ?
a. Electron b. Proton
c. Helium ion
d. Gamma (y)-Photon

19. Typically bilateral inferior lens subluxation of the lens is seen in:
a. Marfan’s syndrome
b. Homocystinuria
c. Hyperlysinaemia
d. Ocular trauma

20. The procedure of choice for the evaluation of an aneurysm is:
a. Ultrasonography
b. Computed tomography
c.Magnetic resonance imaging
d. Arteriography

21. The common cause of subarachnoid hemorrhage is:
a. Arterio- venous malformation
b. Cavenous angioma
c. Aneurysm
d. Hypertension

22. Spalding’s sign occurs after:
a. Birth of live foetus
b. Death of foetus in uterus
c. Rigor mortis of infant
d. Cadaveric spasm.

23. Renal artery stenosis may occur in all of the following, except:
a. Atherosclerosis
b. Fibromuscular dysplasia
c. Takayasu’s arteritis
d. Polyarteritis nodosa

24. Which one of the following congenital malformation of the fetus can be diagnosed in first trimester by ultrasound?
a. Anencephaly
b. Inencephaly
c. Microcephaly
d. Holoprosencephaly

25. Which of the following conditions is least likely to present as an acentric osteolytic lesion:
a. Aneurysmal bone cyst
b. Giant cell tumor
c. Fibrous cortical defect
d. Simple bone cyst

26. “Rugger Jersey Spine” is seen in :
a. Fluorosis
b. Achondroplasia
c. Renal Osteodytrophy
d. Marfan’s Syndrome

27. Brown tumours are seen in:
a. Hyperparathyroidism
b. Pigmented villonodular synovitis
c. Osteomalacia
d. Neurofibromatosis

28. Which of the following malignant tumours is radioresistant?
a. Ewing’s sarcoma
b. Retinoblastoma
c. Osteosarcoma
d. Neuroblastoma

Wednesday, January 18, 2006

Carotid plaque can be characterized now by simply measuring the plaque density

Plaque density on CT, a potential marker of ischemic stroke.
In an article in- Neurology. 2006 Jan 10;66(1):118-20 by Serfaty JM et al
The authors sought to determine in a retrospective analysis whether carotid plaque soft TD on CT is associated with recent ischemic neurologic events. Authors found an odds ratio for neurologic events associated with a 10-point decrease in density of 1.54 (p = 0.002), showing an association between plaque density and neurologic events.

A new sign-Hyperdense Posterior Cerebral Artery Sign as marker of ischemia

The Hyperdense Posterior Cerebral Artery Sign. A Computed Tomography Marker of Acute Ischemia in the Posterior Cerebral Artery Territory.
In the anterior circulation, the hyperdense middle cerebral artery (MCA) sign is a well-established marker for early ischemia. Similarly, the hyperdense basilar artery sign or the MCA "dot" sign may be a diagnostic clue for basilar artery or distal MCA branch thrombosis.
In this article in Stroke 2006 Jan 5; [Epub ahead of print] authors (Kring T et al) have found that an Hyperdense posterior cerebral artery was detected in more than one third of all patients with PCA ischemia, suiting the incidence of the hyperdense MCA. Based on their results, this sign may not only be helpful in the early diagnosis of PCA infarction but might also act as a prognostic marker in acute PCA territory ischemic stroke.

Sumer's Radiology Site wins The Best Clinical Weblog Award

Thanks to all the readers and supporters, Sumer's Radiology site wins the Best Clinical Weblog-2005 award!!
This is what the editors had to say about the site-
The winner of Best Clinical Weblog is...
"Sumer's Radiology Site. Anyone could plainly see how this guy would win the Clinical category. Sumer's writing probes the murky aspects of radiology, illuminating the most obscure facets of this often impenetrable field. We're sure he's glowing from all the praise you've bestowed on him. Congratulations!"

Tuesday, January 17, 2006

Image Quiz-Chest CT

What is the diagnosis and what is this sign known as?

Answer- Left Empyema With Split Pleura Sign

Leave your answers in the comments section. The correct answer and the winners will be published right here next week.


Monday, January 16, 2006

Link about Signs in Chest Radiology (useful link for CXR interpretation)

Chest X-Ray is something which is very basic to Radiology Practise even in todays world of complicated machines and imaging devices. Very often the competence of a Radiology Resident is judged by his interpretation of a chest X-ray and application of various signs in Chest Roengtenology. Here is a link from which lists a few of commonly used signs in Chest Radiology.
A must check for all Radiology Residents, Pulmonary physicians and Medical students.

Radiology in Pulmonary Tuberculosis

Chest X-Ray Findings that Can Suggest ACTIVE TB:
Infiltrate or consolidation
Any cavitary lesio
Nodule with poorly defined margin
Pleural effusion
Hilar or mediastinal lymphadenopathy
Linear, interstitial disease (in children only
Other—Any other finding suggestive of active TB, such as miliary TB.

Chest X-Ray Findings that Can Suggest INACTIVE TB:
Discrete fibrotic scar or linear opacity
Discrete nodule(s) without calcification
Discrete fibrotic scar with volume loss or retraction
Other—Any other finding suggestive of prior TB, such as upper lobe bronchiectasis.

OTHER Chest X-Ray Findings:
Follow-up needed:
Musculoskeletal abnormalities
Cardiac abnormalities
Pulmonary abnormalities

No follow-up needed:
Pleural thickening
Diaphragmatic tenting
Blunting of costophrenic angle (in adults
Solitary calcified nodules or granuloma
Minor musculoskeletal findings
Minor cardiac findings
Full article here-

Signs in Thoracic Radiology-For the Radiology Residents

CT angiogram sign-Enhancing braching pulmonary vesseles visualised against a low attenuation lung parenchyma.
The CT angiogram sign was initially described as a specific sign of lobar bronchoalveolar cell carcinoma; specificity can be as high as 92.3%. Recently, the results of several retrospective studies have challenged the specificity of the CT angiogram sign; the CT angiogram sign was reported to be seen in both benign and malignant entities, including bronchoalveolar cell carcinoma, pneumonia, pulmonary edema, obstructive pneumonitis due to central lung tumors, lymphoma, and metastasis from gastrointestinal carcinomas.
An excellent article with image, differentials and findings here-

Tuesday, January 03, 2006

Vote for my site, Polls for 2005 Medical Weblog awards are open!!

Dear Friends and Readers
As you all know your favourite Sumer's Radiology Site has been nominated in three categories in 2005 Medical Weblog Awards..
So please support this site by voting in all three links given below

Monday, January 02, 2006

Calcaneal Fractures-Role of CT

Fractures of the Calcaneus: A Review with Emphasis on CT
RadioGraphics 2005;25:1215-1226
Aditya Daftary, MB, BS, Andrew H. Haims, MD and Michael R. Baumgaertner, MD

"The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. Advances in cross-sectional imaging, particularly in computed tomography (CT), have given this modality an important role in identifying and characterizing calcaneal fractures. Fracture characterization is essential to guide the management of these injuries. Calcaneal fractures have characteristic appearances based on the mechanism of injury and are divided into two major groups, intraarticular and extraarticular. Most calcaneal fractures (70%–75%) are intraarticular and result from axial loading that produces shear and compression fracture lines. Of the two major systems for classifying intraarticular fractures–Hannover and Sanders–the latter is used most often and is helpful in treatment planning and determining prognosis. Extraarticular fractures account for about 25%–30% of calcaneal fractures and include all fractures that do not involve the posterior facet. Familiarity with calcaneal anatomy and fracture patterns is essential for radiologists to guide the treating physicians. "
Read the full article here-

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