Wednesday, June 30, 2010

Subspeciality Practise in Radiology

Has the time come for the radiologists to now look into subspecialisation?

 Very often nowadays, we see clinicians, and by clinicians, i am implying good specialists in their own branches like neurology and orthopaedics, commenting-- i can see the study better than the radiologists and reports are just a formality for the insurance and claims settlement.

Further, in our own teleradiology practise, we have noticed that we have a distinct edge over other because of our subspecialty exposure in neuroradiology and musculoskeletal imaging. Further with addition of people with exposure in cardiac radiology and breast imaging we could get more work. This is probably because of peculiar way radiology practise is based in India. Although it is difficult to get fully trained radiologist at most places, getting a general radiologist is not so much of an issue. So, with most of the imaging centres looking to get things done in cost effective manner to say the least, getting routine work via teleradiology/ outsourcing has become difficult.

However, there is still a room for doubt solving wherein you get an atypical case and specialists want specific answers. I don’t know if it is a trend but sooner rather than later we might see a growing trend towards fellowships and subspeciality training in radiology also.

What are your thoughts on this?

Tuesday, June 29, 2010

Pneumocele-Frontal Sinus with Proptosis

Note the expansion of the frontal and ethmoid sinuses with resultant axial proptosis.
Reported by -- Teleradiology Providers

Diffuse Axonal Injury-MRI

Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI typically consists of several focal white-matter lesions measuring 1-15 mm in a characteristic distribution. The most common MRI finding is the presence of multifocal areas of abnormal signal (bright on T2-weighted images) at the white matter in the temporal or parietal corticomedullary junction or in the splenium of the corpus callosum.


Ataxia-telangiectasia also known as Louis-Bar syndrome, is a hereditary autosomal recessive progressive multisystem disease. The vermian atrophy is more prominent than the atrophy of the cerebellar hemispheres and is characteristic of the type of anatomic appearance seen in ataxia-telangiectasia. Also with age the degree of atrophy progresses, there are two siblings with more marked atrophy in later age group.

Friday, June 25, 2010

Is CT head relevant in current scenario?

This is what i read as a comment in yahoo news by my friend Dr Philip Chao who has worked in Delaware to produce the best MRIs possible since 1990. He has monitored hundreds of thousands of MRIs over his career at the University of Pennsylvania and working for the people of Delaware. He is a board certified neuroradiologist and recently passed his maintenance of certification examination in 2006. He is also trained in body MRI and was the body MRI fellow at the University of Pensylvania from 1988 through 1990.

This what he says
 "CT of the head is almost useless. This is a fact I tried to teach residents for years. Usually they do a CT scan of the head non contrast - this is woefully inadequate to pick up stroke, tumor or meningitis. In fact it misses bleeding in the brain if it is older than 24 hours old. The funny thing is that if the CT is negative you get an MRI because a negative CT does not rule out significant intracranial pathology. If the CT is positive you STILL get an MRI because you see the lesion margins better and additional lesions with MRI. So... in both cases a negative and a positive CT does not prevent you from getting further testing. "

Sounds like soon we will not see the plain CT anymore. Thinking of it now, how may times we have actually recommended MRI after CT, kind of makes sense. Other than head injury this logiq seems quite valid, what are your views?

All comments and discussions are welcome.

Monday, June 21, 2010

Hepatic Tuberculomas-CT

TB is a growing problem worldwide; consequently, it is vital to recognize the more unusual presentations of this disease. Intra-abdominal TB has a high mortality, but it is a difficult diagnosis to make, often requiring laparotomy. Liver tuberculoma is, in particular, rare, with fewer than 100 cases reported in the literature, most of which are secondary and associated with miliary TB. This is a case of 32 year old female with caviating right upper lobe lesion with miliary mottling and hepatic tuberculomas. Mediastinal lymphnodes are also seen.

Wednesday, June 09, 2010

Bad Radiology Practise

1) Using the term "if clinically consistent or if clinically indicated"
2) Further evaluation is "advisable", advisable often gives an unsure interpretation of the findings, and creates the confusion whether added investigation is required or not. Ideal practise should have a note justifying your choice for the further investigation
3) Where "impression is as long as the findings description". Good report will have a long description with a brief impression.
4) Being judgemental like using the words "poorly aligned fracture"
5) Not comparing with previous films or not going through old films. Mammograms especially, cannot be read without comparison and error rates for people who dont compare are very high.
6) Not communicating urgent findings to the referring physician.
7) Never refusing a study even when you feel it is totally irrelevant. Debatable!
8) Not reading.

Tuesday, June 08, 2010

Sturge Weber Syndrome-MRI

MRI reveals a pial, enhancing, angiomatous malformation, often in the occipital or posterior temporoparietal region ipsilateral to the facial angioma. Gadolinium enhancement improves visualization of the angiomatous malformation.
Reported by Teleradiology Providers

Monday, June 07, 2010


Specific CT scan findings of appendicitis include enlargement of the appendix ( more than 6 mm in the outer diameter), enhancement of the appendiceal wall, lack of opacification in an enlarged appendix, fat stranding in the periappendiceal region, and the presence of an appendicolith within the appendix.

Reported by Teleradiology Providers

Friday, June 04, 2010

Lipoma arborescens of Ankle- Rare Case

Lipoma arborescens is a rare benign fat-containing synovial proliferative lesion that is typically known to affect the knee joint in adults. The term “lipoma arborescens” has been used to describe the diffuse infiltration of fat within hypertrophic synovial villi. We present a rare case of lipoma arborescens of the ankle joint in an adult patient with involvement of the intra-articluar synovium as well as the synovial sheath of the tendons around the ankle. Note the fat density, this is old lady with past history of trauma, now presented with swelling and pain. Reported by Teleradiology Providers

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