Radiology Practise-which way to go?

Now with times moving fast ahead there is this dilemma all the time. On one end is the fast evolving radiology practise wherein you report your cases based on the clinical details provided sitting remotely via teleradiology, which looks like the only logical way to increase your output and meet the increasing shortage of radiologists. On the other hand every few days now i have a feeling it is much better for your practise to talk to patient directly, convey the result to him so that he understands what you have written and limitations of the same. Same applies to the talking to referring physicians but where is the time and it takes productivity for ride. May be we will see a balance in times to come.

Tuberculosis Elbow-MRI

There is evidence of erosive osseous destruction involving the lower end of humerus, olecranon process of ulna & radius. Elbow joint spaces are reduced. Also noted is altered marrow signal intensity in these bones appearing hypointense on T1WI and hyperintense on T2 and fat sat T2WI consistent with marrow edema. Fluid collection is noted in relation to elbow joint articulation & in the olecranon bursa. Also noted is soft tissue edema in surrounding muscles & soft tissue.
Opinion- Osseous destruction & marrow edema involving the elbow articulation with fluid collection & soft tissue edema likely infective etiology (Likely tubercular).

Case by-

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

Fibrous Dysplasia-CT

Bony expansile lesion with ground glass involving the right maxilla with involvement of alveolar, zygomatic arch, inferior orbital rim with partial obliteration of maxillary sinus Likely fibrous dysplasia.

Case by-

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

Os odontoideum-CT and MRI

Radiologic evaluation is utilized to confirm the diagnosis and estimate the degree of spinal instability. Os odontoideum appears as a round or oval ossicle with a smooth, uniform cortex separated from the base of the axis by a wide gap. The ossicle border does not directly match up with the axis body. The gap separating the os and the axis proper should lie above the level of the superior articular facets.

FDA clears F18-FLT

"FDA approval of a multicenter investigational new drug application has cleared away regulatory obstacles that stood in the way of definitive trials to establish the clinical efficacy of a PET imaging agent that measures cell proliferation in cancerous tumors.Molecular imaging researchers have touted F-18-labeled 3'-deoxy-3'-fluorothymidine (FLT) for the potential complementary role it could play with FDG for cancer imaging. "

Complete article here-

Diagnostic Imaging

Appearance of TB Hip following treatment

Findings-There is evidence of erosive osseous destruction involving the acetabulum & medial articular surface of left femoral head. There is synovial collection in relation to the left hip Minimal marrow edema is identified to erosive lesions in relation to the left hip along with area of patchy sclerosis. Fluid is identified in the left ilio psoas bursa.
Opinion- On treatment follow up case of TB left hip reveals:- Erosions involving the acetabulum & femoral head with minimal marrow edema and patchy sclerosis in left hip with synovial collection & fluid signal in ilio psoas bursa. Findings are consistent with partially treated tubercular hip.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Tuberculosis of Hip-Osteoarticular Involvement

Findings-There is evidence of osseous destruction and altered marrow signal intensity involving the left hip, acetabulum & femoral head / neck appearing hypointense on T1WI and heterogeneously hyperintense on T2 / fat sat T2WI, there is evidence of synovial collection in relation to the left hip. Left hip joint space is reduced.

Opinion- Osseous destruction & marrow edema involving the bones forming the left hip articulation along with synovial collection & reduced joint space. Findings are consistent with infective etiology, likely tuberculosis. Clinical & laboratory collection is advised.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Recurrent Shoulder Dislocation-MRI

25 yr old male with recurrent dislocation of shoulder ( anterior and posterior)

FINDINGS--There is evidence of mild subluxation at the glenohumeral joint with cranial migration of humeral head. Also noted in fluid distension involving the joint capsule with joint capsule laxity.
There is evidence of altered signal intensity involving the anteroinferior glenoid labrum suggestive of avulsion tear. Altered marrow signal is noted in inferior glenoid rim. Posterior glenoid labral rim is rolled up. Fluid is noted along the biceps tendon. Rotator cuff muscles including subscapularis & infraspinatus appears lax & show mild reduction in bulk. No obvious rotator cuff tear is identified. Bony defect is noted in the posterosuperior aspect of humeral head. There is fluid is subcoracoid bursa. Acromial process seen normally with reduced acromio- humeral space. Acromio clavicular joint is normal.

IMPRESSION--Fluid distension in the joint capsule with anterior & posterior labral tear (bankart’s lesion) with cranial subluxation at glenohumeral joint with laxity in rotator cuff muscles with small defect in posterior humeral head (?hill sach’s lesion).

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

Small Bowel Obstruction-Imaging

Hemophilic Arthropathy- MRI

Known case of hemophilia.
Findings-There is evidence of significant synovial collection involving the knee joint distending the suprapatellar bursa with inhomogeneous appearance with septae & areas of haemosiderin deposition seen as signal suppression on GRE. There is evidence of erosive destruction involving the tibio-femoral & patello-femoral articulation. Secondary degenerative changes noted in the tibio-femoral & patello-femoral articulation with reduction in joint space. Areas of marrow edema noted in knees in relation to bones forming the knee joint appearing hyperintense on T2 fat sat images. Anterior cruciate ligament is not well seen. Posterior cruciate ligament is stretched but intact. Internal architecture of the knee is distorted with haemosiderin deposition in relation to synovium.
Opinion-Significant synovial collection involving the knee joint & suprapatellar bursa with extensive haemosiderin deposition, erosive arthropathy involving tibiofemoral & patellofemoral articulation with marrow edema involving the bones surrounding knee joint, distorted internal architecture of knee. Likely suggestive of sequelae of long standing hemarthrosis. Patient is a known case of hemophilia. Consistent with hemophilic arthropathy.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

PACStacker for Power Point

"Khanna et al have developed PowerPoint add-in that facilitates the creation of stackable image sets in a simple and intuitive manner, permitting real-time scrolling, editing, and manipulation of imbedded image stacks. Contrast and brightness adjustments, cropping, and linking are supported. Once created, the PowerPoint presentation can be viewed without hardware or venue limitations on any computer, without reinstallation of the add-in."

Reference-

DOI:10.2214/AJR.07.3757

AJR 2009; 192:W71-W74