Tuesday, February 28, 2006

Computed tomographic in acute carbon monoxide poisoning

A classic case of CO posioning CT image here-
VCU MCV Hospital Emergency Department Residency's Site

Further Reading-Selective necrosis and degeneration of the globus pallidus are characteristic autopsy findings in patients with severe carbon monoxide (CO) poisoning.
The most common abnormal CT findings are low-density areas in the basal ganglia. These lesions vary from small (limited to the globus pallidus) to large (extending to the internal capsule). Awareness of the potential for basal ganglia lesions in CO poisoning leads to more accurate CT interpretation and may have significant prognostic implications.

5-D Imaging

The display and interpretation of images obtained by combining three-dimensional data acquired with two different modalities (eg, positron emission tomography and computed tomography) in the same subject require complex software tools that allow the user to adjust the image parameters. With the current fast imaging systems, it is possible to acquire dynamic images of the beating heart, which add a fourth dimension of visual information—the temporal dimension. Moreover, images acquired at different points during the transit of a contrast agent or during different functional phases add a fifth dimension—functional data.
Antoine Rosset et al in RadioGraphics 2006;26:299-308 talks about an open-source software, called OsiriX, allows the user to navigate through multidimensional image series while adjusting the blending of images from different modalities, image contrast and intensity, and the rate of cine display of dynamic images. The software is available for free download at http://homepage.mac.com/rossetantoine/osirix

Role of Multi–Detector Row CT in Hemoptysis

John F. Bruzzi et al in RadioGraphics 2006;26:3-22 discuss the role of MDCT in hemoptysis.

"Hemoptysis is symptomatic of a potentially life-threatening condition and warrants urgent and comprehensive evaluation of the lung parenchyma, airways, and thoracic vasculature. Multi–detector row computed tomographic (CT) angiography is a very useful noninvasive imaging modality for initial assessment of hemoptysis.
The bronchial arteries are the source of bleeding in most cases of hemoptysis. Contributions from the non-bronchial systemic arterial system represent an important cause of recurrent hemoptysis following apparently successful bronchial artery embolization. Vascular anomalies such as pulmonary arteriovenous malformations and bronchial artery aneurysms are other important causes of hemoptysis.
Multi–detector row CT angiography permits noninvasive, rapid, and accurate assessment of the cause and consequences of hemorrhage into the airways and helps guide subsequent management. "

Friday, February 24, 2006

Lymph Nodes-Imaging

Lymph node imaging: Basic principles.
Luciani A, Itti E, Rahmouni A, Meignan M, Clement O
"Lymph nodes are involved in a wide variety of diseases, particularly in cancer. In the latter, precise nodal staging is essential to guide therapeutic options and to determine prognosis. For long, imaging of the lymphatic system has been limited to lymph vessel,especially via the exclusive use of conventional lymphography, at the expense of invasive procedures and patient's discomfort. Three main technical advances, however, have recently completed the clinical armamentarium for lymph node imaging: first, the refinement of cross sectional imaging, i.e. CT and MRI, combined or not with dedicated contrast agents, has progressively replaced conventional lymphography in oncology situations; second, the development of intra-operative sentinel node mapping has profoundly modified the diagnostic and therapeutic procedures in several cancer situations, mostly melanoma and breast cancer; finally, the increased availability of functional imaging, especially through the use of FDG-PET, has greatly contributed to the accuracy improvement of nodal metastases identification."

Wednesday, February 22, 2006

Shortage of Pediatric Radiologists

A portrait of pediatric radiologists in the United States.
Merewitz L, Sunshine JH
"Approximately 3% of radiologists are pediatric radiologists. Unlike other radiologists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corresponding reduction in income) than desire an increase in workload. Pediatric radiologists are disproportionately women, hospital-based, in academic practices, and in the main cities of large metropolitan areas.
A shortage of pediatric radiologists exists and is likely to intensify. Access to pediatric radiologists is probably a problem except for children in large metropolitan areas who connect readily to academic hospitals. Means to overcome these problems need to be actively sought."

Newer techniques like CT, MRI etc are increasily being used more & more

Inpatient radiology utilization: trends over the past decade.
Matin A, Bates DW, Sussman A, Ros P, Hanson R, Khorasani R
New study suggests-Newer imaging technologies (nuclear medicine, CT, and MRI) are replacing older ones in the evaluation of inpatients. Despite the significant decrease in the total number of imaging examinations per Admission, authors observed a significant increase in relative value units per case-mix-adjusted admission during the 10-year study period. Understanding the impact of this change in practice on the quality of care would be useful in justifying the increasing use of these new technologies, and decreasing their inappropriate use should be a priority in efforts that focus on controlling imaging expenditures.

Tuesday, February 21, 2006

Things that should be taught to medical students

"Medical students need to be taught, to help them become better doctors.
1. How to talk to patients
2. How to run a business
3. How to network with colleagues
4. How to manage money ( including learning how to speculate).
These are "real-life" skills - all of which can be taught. Most doctors learn them "on the job" - but some never do !"

Excellent thought this, other day i was reading in a Indian Newspaper an episode of a patient's relative and a Resident Doctor getting involved in a fight. Something i believe would never happen if only Residents were taught how to take with patients. Then i have seen Doctors learn how to manage money by "hit and trial", when everybody else was learning about commerce we doctors were being taught Molecular structure of DNA which i being a Diagnostic Radiologist dont remember a bit about...
I really wish that people with vision for the future should be a part of the team that makes the Med school Curriculum...

Full article here-By Dr Malpani
Why don't they teach doctors useful stuff ?

Sunday, February 19, 2006

Renal Colic-Initial Test Plain Abdominal Film or Low Dose CT

  • A low-dose abdominal computed tomography (LDCT) protocol should replace the initial abdominal plain film (APF) in patients with a clinical suspicion of renal colic, according to the results of a study reported in the January issue of Urology.
  • The current study indicates that a strategy of initial LDCT for patients with suspected renal colic is superior to APF in terms of stone detection, the need for follow-up radiologic procedures, and total radiation exposure.

Urology. 2006;67:64-68

Saturday, February 18, 2006

Free access is valued by authors

Authors value free access to research articles
"Free access to research articles on bmj.com is an important factor in authors' decision on whether to submit their papers to the BMJ. In a cross sectional electronic survey by Schroter, over half of responding authors said that ending free access to research articles would make them slightly less likely to submit to the BMJ in the future, and two thirds said their view of the journal would change if it closed access to research articles."

Thursday, February 16, 2006

Image Quiz-Gastrointestinal Tract

What is the diagnosis in this 'Barium Meal Follow Through' Image?
Leave your answers in the comments section. Correct answer and winners will be published here next week.

Answer- Ascariasis
Winners-Chaitanya, Massoud Pezeshki Rad

Teleradiology-Future lies in more liberal ACR guidelines

This is what the new issue of NEJM has to say about teleradiology. I know there would be varied views about how stringent the ACR guidelines should be about outsourcing but just one practical question how many Radiologists will you find-Board certified and living out of USA. Answer is-very limited.
"Imagine two patients arriving in the emergency department of a Maine hospital at midnight. The first has a presentation consistent with pulmonary embolism; the second, appendicitis. A decade ago, the first patient might have been started on heparin therapy and scheduled for an early-morning ventilation–perfusion scan. The second patient would have been seen by a surgeon, who would have made a judgment call regarding the diagnosis of appendicitis and the need for surgery. Today, both of these patients and hundreds of others like them would receive middle-of-the-night CT scans, taxing the hospital's radiologists. But midnight in Bangor, Maine, is 10:30 a.m. in Bangalore, India. There — and in Switzerland, Australia, and Israel — sit teams of radiologists ready to read the scans and fax their findings back to the United States (urgent findings are phoned back).
The technical and logistic hurdles of remote teleradiology have been overcome, and the practice of having radiologists who were trained and credentialed in the United States read films overseas is now largely accepted. If the ACR guidelines hold, the growth of overseas teleradiology will be markedly constrained by the limited supply of U.S.-trained radiologists who are willing to work abroad. It seems likely that battles over licensure, credentialing, and reimbursement will determine whether providers who were trained and credentialed overseas will be allowed to compete openly with U.S. radiologists. The outcome of these battles will strongly influence the diffusion of international outsourcing to other areas of U.S. medicine. "

Full Article Here-
NEJM Volume 354:662-663, February 16, 2006, Number 7

Wednesday, February 15, 2006

Medical Imaging Research looks at a New Breast Scanner

New scanner boosts breast-cancer tests
"Duke University scientists have built a new type of breast scanner that they say is better at finding small tumors than standard breast-cancer screening, while exposing patients to less radiation. And the new scanner does all that without having to smash a woman's breasts as a traditional mammogram does. The new Duke device is a computerized tomography, or CT, scanner powered by potent gamma radiation. It produces a three-dimensional image that does not require flattening the breast and produces a clearer image of suspicious masses.

Physicians widely acknowledge that mammograms are not good at spotting tumors in women with many glands and connective tissues in their breasts, a description that applies to about 40 percent of patients. Also, women with breast implants typically cannot be scanned with a mammogram. However, The Duke scanner would have to be used on large numbers of patients in a long-term clinical trial and produce excellent results to win approval by the U.S. Food and Drug Administration and wide use by physicians. "

Now Blackberry Fruit can be used as an oral MRI contrast

In an Article "Blackberry (Rubus spp.): a pH-dependent oral contrast medium for gastrointestinal tract images by magnetic resonance imaging." in Magn Reson Imaging 2006 Feb;24(2):195-200. Epub 2005 Dec 27. by Espinosa MG et al,
"They studied seven fruits have been tested on their magnetic properties, paramagnetic metal content and contrast enhancement in magnetic resonance imaging (MRI) of phantom and in vivo. Magnetic susceptibility was determined for the fruit pulps, as well as the contents of paramagnetic metals; iron, manganese and copper. They concluded blackberry (Rubus spp.) contrast enhancement was the highest among the fruits in T(1)-weighted images. Furthermore, this fruit's contrast enhancement shows to be pH-dependent. These characteristics and the wide availability of the Rubus spp. suggest that it should be implemented as an oral contrast agent in images by MR to assess the function of the gastric section of the GI tract. Furthermore, it has the advantage of being a natural meal, so that it can be well tolerated by the patients and use as much as it is needed without side effects."

Monday, February 13, 2006

Obesity and its Implications on Medical Imaging

"How many times have Radiologists written “study limited due to body habitus” on their reports without thinking for moment the problem faced by obese people in general for imaging studies. According to Dr. Raul N. Uppot and colleagues at Massachusetts General Hospital obesity disrupted 0.15% of all studies, with a statistically significant increase rate of 0.01% per year in the number of studies affected by body habitus since 1989. Ultrasound came up as the imaging modality most affected by obesity, followed by chest x-ray. The RSNA took notice of Uppot’s work and awarded him the 2004 Research Fellow Trainee Prize.
Fallout from Uppot’s study has been nonstop. The government of Virginia requested his testimony as an expert witness before it approved the installation of an MR scanner especially designed to fit larger patients. Several hospitals have approached him for talks on obesity and its impact on radiology. He has consulted for Siemens Medical Solutions, which unveiled its Definition CT scanner for obese patients at the 2005 RSNA meeting. (Similarly, Toshiba unveiled its “obese” scanner, the Aquilion LB, in 2005.) "
Detailed article here-

29 Percent Radiologists if given a choice would not choose Medicine as a career again

Many Radiologists Wouldn't Choose Medicine Again - As Physician Shortage Continues, More Radiologists Seek Work-Life Balance.
Reflecting the frustrations of modern medical practice, 29% of radiologists responding to a 2005 survey conducted by a physician recruiting firm said they would not choose medicine if they could decide their career paths all over again. This is paradoxical because Radiologists have the highest pay packages amongst physicians.
Reasons for this according to the survey-
"However, most physicians choose medicine for reasons beyond a paycheck and many of them today are seeking better work-life balance"

Saturday, February 11, 2006

Irritable Bowel Syndrome-Possible Role of TVS

Crade M, Pham V. Ultrasound Obstet Gynecol. 2006 Feb;27(2):206-9

Ultrasound examination of the sigmoid colon: possible new diagnostic tool for irritable bowel syndrome.
"Irritable bowel syndrome (IBS) affects about 10% of the population, and is primarily a disease of women. It may cause chronic pelvic pain. As yet there is no imaging test to aid in diagnosis, which relies upon history. The majority of those 27 reporting a history of IBS had thickening of the wall of the sigmoid colon.
Transvaginal ultrasound may be useful in identifying patients at risk for IBS. Consideration of colon wall measurement during pelvic ultrasound should be studied, as IBS may be a cause of chronic pelvic pain."

Spilled Abdominal stone-Role of USG

In an article "Abdominal spilled stones: ultrasound findings." in Abdominal Imaging 2006 Jan 30; [Epub ahead of print] by Viera et al points towards the role of USG in spilled gall stones.

"Laparoscopic cholecystectomy (LC) is the treatment of choice for uncomplicated symptomatic gallstones. Spillage of stones due to gallbladder rupture has been reported in up to 33% of all LCs, but clinical sequelae caused by dropped gallstones are uncommon. Authors found that Abdominal US revealed hypoechoic focal lesions containing hyperechoic images with posterior shadowing of the liver and spleenand in the Morison pouch during a routine US examination. Their experience suggests that US can be very useful in the detection of gallstones spilled during LC."

Monday, February 06, 2006

MRI- A New Test of truth telling and deception

In an article "Brain Mapping of Deception and Truth Telling about an Ecologically Valid Situation: Functional MR Imaging and Polygraph Investigation—Initial Experience" By Feroze B. Mohamed, PhD, Scott H. Faro, MD, Nathan J. Gordon, MA, Steven M. Platek, PhD, Harris Ahmad, MD and J. Michael Williams, PhD in Radiology 2006;238:679-688 the authors examined the neural correlates during deception and truth telling by using a functional magnetic resonance (MR) imaging technique and an ecologically valid task and to compare the results with those of a standard polygraph examination. They Found During the deception process, specific areas of the frontal lobe (left medial and left inferior frontal lobes), temporal lobe (right hippocampus and right middle temporal gyrus), occipital lobe (left lingual gyrus), anterior cingulate, right fusiform gyrus, and right sublobar insula were significantly active. During the truth telling process, specific areas of the frontal (left subcallosal gyrus or lentiform nucleus) and temporal (left inferior temporal gyrus) lobes were significantly active. The polygraph examination revealed 92% accuracy in deceptive subjects and 70% accuracy in truthful subjects.
Specific areas of the brain involved in deception or truth telling can be depicted with functional MR imaging.

More on Diffusion Tensor Imaging Utility

Diffusion tensor tractography in patients with cerebral tumors: a helpful technique for neurosurgical planning and postoperative assessment.

The relationship between tracts and tumors was classified as three types: type I is simple displacement, type II is displacement with disruption and type III is simple disruption. DTT allowed for visualization of the exact location of tumors relevant to eloquent tracts and was found to be beneficial in the neurosurgical planning and postoperative assessment.
By- Yu CS, Li KC, Xuan Y, Ji XM, Qin W

Journal Watch-Curvilinear T1 hyperintense lesions representing cortical necrosis after cerebral infarction.

Curvilinear T1 hyperintense lesions in the cerebral cortex in patients with subacute infarction were investigated for: (1) the presence or absence of T2* hypointensity and (2) correlations with neuropathologic findings. Pathological correlation was performed in a patient with middle cerebral artery infarction and curvilinear hyperintense lesions on postmortem T1-weighted images. In the autopsied brain, curvilinear T1 hyperintense lesions corresponded to necrosis of all the cortical layers on histological examination. These data suggest that curvilinear hyperintense lesions in the cerebral cortex on T1-weighted images during the subacute to chronic period of cerebral infarction may not represent hemorrhage.
by- Kinoshita T, Ogawa T, Yoshida Y, Tamura H, Kado H, Okudera T

Sunday, February 05, 2006

Radiology-Job Hazards

Life as a Radiologist although lucrative and may be has easier life style than the clinical counterparts, Radiologists have to deal with pressure of being correct everytime...
An interesting post here-
"If, seven years later, someone says “What did you say during that phone call?” and accuses you of misjudgement, you will likely say, “It was too long ago to remember, but I am sure I never have said anything like that”.Maybe you did, maybe you did not. We shall never know.If you work in hospital medicine as either a Consultant Radiologist or a Consultant Hispto-pathologist you make a hundred decisions a day. And each and every decision is recorded and stored away for ever. Five hundred decisions a week or more. Twenty five thousand decisions a year. That is probably a million decisions in a working life time.Make a one in a million mistake and some one may die. Make a one in thousand mistake and, over your career, a thousand people may die. Ask yourself, could you live to that standard? Could you honestly say that for every thousand decisions you make at work, not even one is wrong? And if you did have to live to that standard, how much pressure would it put you under."

A New Health Search Engine

A new search engine created by Indian creators http://www.kosmix.com is available now. Google basically searches pages based on a sort of popularity contest and not necessarily its content but Kosmix' creators say they took a different approach and developed a new kind of 'categorisation' technology.
You can Browse Results by following categories-
Alternative Medicine
Diet & Fitness
Babies & Kids
Clinical Trials
Women's Health

History of Radiology: X-Ray Discovery

Even though i am a Radiologist with keen interest in History, i never knew this X-Rays may have been produced more than a century before Roengten!!
"In 1895, Wilhelm Conrad Roentgen's discovery of x-rays in this laboratory revolutionized science and medicine but did you know that x-rays may have been produced by William Morgan, a Welsh mathematician, more than a century before Roentgen's discovery?
In 1785, Morgan was conducting experiments on electrical discharges in a vacuum when he noted that "according to the length of time during which the mercury was boiled, the 'electric' light turned violet, then purple, then a beautiful green...and then the light became invisible." Morgan's experiment was witnessed by American diplomat Benjamin Franklin, a fellow investigator in electrical phenomena."

Saturday, February 04, 2006

iPod Helps Radiologists Manage Medical Images

Technology coming from the consumer market is changing the way we do things in the radiology department.— Osman Ratib, M.D., PhD
The iPod is not just for music any more. Radiologists from the University of California, Los Angeles, and their colleagues at other institutions from Europe and Australia are now using iPod devices to store medical images.

"This is what we call using off the shelf, consumer market technology," says Osman Ratib, M.D., Ph.D., professor and vice-chairman of radiologic services at UCLA. "Technology coming from the consumer market is changing the way we do things in the radiology department."
Dr. Ratib and Antoine Rosset, M.D., a radiologist in Geneva, Switzerland, recently developed OsiriX, Macintosh-based software for display and manipulation of complex medical image data.
How did the developers go from a music player to a medical storage device? "We basically wanted something that everybody could use," explains Dr. Ratib. "That's why OsiriX can be used with the iPod, iChat and other tools."
"Radiologists deal with a very large amount of medical imaging data," Dr. Ratib explains. "I never have enough space on my disk, no matter how big my disk is—I always need more space. One day I realized, I have an iPod that has 40 gigabytes of storage on it. It's twice as big as my disk on my laptop and I'm using only 10 percent of it for my music. So, why don't I use it as a hard disk for storing medical images?"
Full article here-

Friday, February 03, 2006

Acute Chest Pain- Role of MDCT in evaluation

Acute Chest pain is a medical emergency and causes a lot of anxiety to the patient and the physician as well in view of the risk of mortality and morbidity. However, Causes of chest pain can be cardiac or non-cardiac with sometimes cardiac cases having non-specific presentation. Physicians and Radiologists are always in a quest of a comprehensive method of Chest Pain Evaluation.

“Chest pain is one of the most frequent complaints for patients seen in the emergency department. There is a lot of discussion focusing on the potential utility use of cross-sectional imaging, particularly multidetector CT, in the evaluation of chest pain in the emergency department.”
Reference- White C, Read K, Kuo D in Eur J Radiol. 2006 Jan 21; Assessment of chest pain in the emergency room: What is the role of multidetector CT?

“In a previous Article by White et al, a study was done to determine whether MDCT can provide a comprehensive assessment of cardiac and noncardiac causes of chest pain in stable emergency department patients. Patients with chest pain who presented to the emergency department without definitive findings of acute myocardial infarction based on history, physical examination, and ECG were recruited immediately after the initial clinical assessment.

The images were evaluated for cardiac (coronary calcium and stenosis, ejection fraction, and wall motion and perfusion) and significant noncardiac (pulmonary embolism, dissection, pneumonia, and so forth) causes of chest pain. Sixty-nine patients met all criteria for enrollment in the study, of whom 45 (65%) would not otherwise have undergone CT. Fifty-two patients (75%) had no significant CT findings and a final diagnosis of clinically insignificant chest pain. Thirteen patients (19%) had significant CT findings (cardiac, 10; noncardiac, 3) concordant with the final diagnosis. CT failed to suggest a diagnosis in two patients (3%), both of whom proved to have clinically significant coronary artery stenoses. In two patients (3%), CT overdiagnosed a coronary stenosis. Sensitivity and specificity for the establishment of a cardiac cause of chest pain were 83% and 96%, respectively. Overall sensitivity and specificity for all other cardiac and noncardiac causes were 87% and 96%, respectively. "

ECG-gated MDCT appears to be logistically feasible and shows promise as a comprehensive method for evaluating cardiac and noncardiac chest pain in stable emergency department patients. Further hardware and software improvements will be necessary for adoption of this paradigm in clinical practice.

Reference-White CS, Kuo D, Kelemen M, Jain V, Musk A, Zaidi E, Read K, Sliker C, Prasad R. AJR Am J Roentgenol. 2005 Aug;185(2):533-40. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation?

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