Journals RSS : Gourt

MRI findings of prostate stromal tumour of uncertain malignant potential: a case report

Malignant peripheral nerve sheath tumour presenting as a pneumothorax

Fluorine-18-fluorodeoxyglucose PETCT rare finding of a unique multiorgan involvement of Wegeners granulomatosis

Valsalva manoeuvre effect on distribution of lung damage in heroin inhalation

Seeding of tumour cells following breast biopsy: a literature review

The value of diffusion-weighted MRI in the diagnosis of malignant and benign urinary bladder lesions

Screening for atherosclerotic plaques in the abdominal aorta in high-risk patients with multicontrast-weighted MRI: a prospective study at 3.0 and 1.5 tesla

A method to produce and validate a digitally reconstructed radiograph-based computer simulation for optimisation of chest radiographs acquired with a computed radiography imaging system

Monte Carlo radiotherapy simulations of accelerated repopulation and reoxygenation for hypoxic head and neck cancer

Conventional 3D staging PETCT in CT simulation for lung cancer: impact of rigid and deformable target volume alignments for radiotherapy treatment planning

Disease control using low-dose-rate brachytherapy is unaffected by comorbid severity in oral cancer patients

Acoustic radiation force impulse elastography in distinguishing hepatic haemangiomata from metastases: preliminary observations

Imaging the oral cavity: key concepts for the radiologist

Progressive onset of low back pain: unusual imaging findings on CT and MRI

What are the implications of the proposed revision of the eye dose limit for interventional operators

O Smedby and M Fredrikson. Visual grading regression analysing data from visual grading experiments with regression models British Journal of Radiology 2010 83: 767-775 doi: 10.1259bjr35254923

Value of subtraction MRI in assessing treatment response following image-guided loco-regional therapies for hepatocellular carcinoma.

Value of subtraction MRI in assessing treatment response following image-guided loco-regional therapies for hepatocellular carcinoma. Clin Radiol. 2012 Jan 31; Authors: Winters SD, Jackson S, Armstrong GA, Birchall IW, Lee KH, Low G Abstract AIM: To compare contrast-enhanced subtraction magnetic resonance imaging (MRI) with contrast-enhanced standard MRI in assessing treatment response following loco-regional therapies for hepatocellular carcinoma (HCC). METHOD AND MATERIALS: Institutional review board approval was obtained and informed consent was waived for this retrospective study. All patients were analysed from our institution's liver tumour database that had loco-regional HCC therapy and the following: (1) a contrast-enhanced MRI ≤6 weeks post-treatment, (2) an unenhanced T1-weighted high-signal treatment zone (TZ) ≥1 cm, (3) follow-up contrast-enhanced MRI performed ≥6 months post-treatment. Randomized standard and subtraction TZ datasets were independently assessed by three blinded radiology readers for either complete treatment necrosis or residual disease. The standard of reference (SOR) comprised a consensus read by two radiologists with knowledge of the follow-up MRI and all available clinical data. Statistical analyses were performed using receiver operating characteristics (ROC), t-test, and kappa statistic. RESULTS: Twenty-six patients (19 male and seven female patients; mean age 60 years, standard deviation 10.9 years, range 46-88 years) had a total of 45 corresponding HCCs and TZs. For ROC, the area under the curve (AUC) was 0.93 (subtraction protocol) versus 0.90 (standard protocol; p = 0.49). For the t-test, the mean reader confidence level was 4.4, 3.6, and 4.4 (subtraction protocol) versus 3, 3, and 3.7 (standard protocol; p ≤ 0.011). The kappa statistic for reader-to-SOR agreement was 0.83, 0.63, and 0.71 (subtraction protocol) versus 0.51, 0.36, and 0.64 (standard protocol). CONCLUSION: Subtraction MRI significantly improves the reader confidence level in the assessment of treatment response following loco-regional therapies for HCC. PMID: 22300821 [PubMed - as supplied by publisher]

A proposed new imaging pathway for patients with suspected lung cancer.

A proposed new imaging pathway for patients with suspected lung cancer. Clin Radiol. 2012 Jan 31; Authors: Macpherson R, Benamore R, Panakis N, Sayeed R, Breen D, Bradley K, Carter R, Baldwin D, Craig J, Gleeson F Abstract AIMS: PET-CT scans are routinely performed in patients with lung cancer after investigation by chest x-ray (CXR) and CT scan, when these have demonstrated potentially curable disease. If the majority of patients with lung cancer potentially suitable for curative treatment could be identified earlier in the diagnostic pathway on the basis of CXR findings they could be referred for PET-CT imaging without a prior CT scan. We investigated the clinical and financial implications of adopting such a strategy. MATERIALS AND METHODS: The details of 1187 patients referred with suspected lung cancer between July 2006 and August 2009 were analysed. The initial CXR and subsequent imaging of patients fit for curative treatment (Performance Status 0/1, FEV1 > 1.0) were reviewed (n = 251). The clinical and financial implications of referring patients for first line PET-CT if deemed potentially curable based on CXR findings were assessed. RESULTS: 107 of 1187 patients had potentially curable lung cancer on PS, lung function, CT and PET-CT. 96 of these 107 patients (90%) were correctly identified on CXR. 149 patients overall were diagnosed as potentially curable on CXR. Referring suitable patients for an immediate PET-CT scan resulted in a reduction in the time to complete staging investigations. CONCLUSIONS: Early PET-CT scanning for patients with suspected lung cancer, potentially suitable for curative therapy could result in more efficient staging with little additional cost. PMID: 22300820 [PubMed - as supplied by publisher]

Re: Imaging male breast cancer.

Re: Imaging male breast cancer. Clin Radiol. 2012 Jan 31; Authors: Westerland O, Shaw A, Howlett D PMID: 22300819 [PubMed - as supplied by publisher]

Medico-legal issues in breast imaging.

Medico-legal issues in breast imaging. Clin Radiol. 2012 Jan 31; Authors: Purushothaman HN, Wilson R, Michell MJ Abstract AIM: To identify medico-legal issues that occur in the diagnosis and radiological management of breast disease and to propose measures to reduce the risk of patient complaints and legal action in breast radiology and diagnosis. MATERIALS AND METHODS: Institutional review board approval was not applicable for this study. A retrospective study was undertaken and records of 120 medico-legal investigations over a 10 year period were examined. The reports were compiled by two consultant breast radiologists. RESULTS: The mean age of the patients represented in this study was 48.3 years. The main complaint in this series was a delay in diagnosis (92%) followed by inappropriate or inadequate treatment (8%). 81% of cases were patients who had presented to the symptomatic clinic. The main presenting symptom was a palpable lump (65%). Substandard care was cited in 49/120 cases (41%). The mean average delay in diagnosis was 15.6 months. Of the cases cited as substandard care, 61% were considered the fault of the radiologist and 14% considered the fault of the breast surgeon. Of the cases where the radiologist was considered to be at fault, microcalcification was the most common mammographic sign to be missed or misinterpreted (12/26 cases, 46%). CONCLUSION: The most common complaint in this series was delay in diagnosis with microcalcification being the main mammographic sign that was either not seen or misinterpreted by the radiologist. Clear and precise written protocols are recommended for all breast imaging practice to ensure that medico-legal investigations will be greatly reduced. PMID: 22300818 [PubMed - as supplied by publisher]

Shoulder arthroplasty. Part 1: Prosthesis terminology and classification.

Shoulder arthroplasty. Part 1: Prosthesis terminology and classification. Clin Radiol. 2012 Jan 31; Authors: Sheridan BD, Ahearn N, Tasker A, Wakeley C, Sarangi P Abstract Shoulder arthroplasty is the third most common joint replacement procedure in the UK, and there are a number of different implant options available to surgeons to treat a variety of shoulder disorders. With an increasing burden placed on clinical follow-up, more patients are remaining under the care of their general practitioners and musculoskeletal triage assessment services and are not necessarily being seen by specialists. Referrals to orthopaedic specialists are therefore often prompted by radiological reports describing evidence of implant failure. This article is the first of two reviews on shoulder arthroplasty, concentrating on implant features and the indications for their use. The second article will address the modes of failure of shoulder arthroplasty and describe the relevant associated radiological features. PMID: 22300817 [PubMed - as supplied by publisher]

Differentiation of Necrotizing Infectious Fasciitis from Nonnecrotizing Infectious Fasciitis with MR Imaging.

Differentiation of Necrotizing Infectious Fasciitis from Nonnecrotizing Infectious Fasciitis with MR Imaging. Radiology. 2012 Feb;262(2):732-3 Authors: Rahmouni A, Chosidow O, Kim YJ PMID: 22282192 [PubMed - in process]

Radiologic evaluation of autoimmune pancreatitis.

Radiologic evaluation of autoimmune pancreatitis. Radiology. 2012 Feb;262(2):731-2 Authors: Liang W, Xu S, Manfredi R, Pozzi Mucelli R PMID: 22282191 [PubMed - in process]

The two-county breast screening trial cannot provide a reliable estimate of the effect of breast cancer screening.

The two-county breast screening trial cannot provide a reliable estimate of the effect of breast cancer screening. Radiology. 2012 Feb;262(2):729-30 Authors: Jørgensen KJ, Keen JD, Zahl PH, Gøtzsche PC, Tabár L, Smith RA, Chen TH, Duffy SW PMID: 22282190 [PubMed - in process]

Overdiagnosis and screening mammography.

Overdiagnosis and screening mammography. Radiology. 2012 Feb;262(2):727-8 Authors: Vazquez-Caruncho M, Gøtzsche PC, Keen JD, Jørgensen KJ, Kopans DB PMID: 22282189 [PubMed - in process]

All structured reporting systems are not created equal.

All structured reporting systems are not created equal. Radiology. 2012 Feb;262(2):726 Authors: Johnson AJ, Schwartz LH, Panicek DM, Hricak H PMID: 22282188 [PubMed - in process]

Case 178: parry-romberg syndrome.

Case 178: parry-romberg syndrome. Radiology. 2012 Feb;262(2):721-5 Authors: Sharma M, Bharatha A, Antonyshyn OM, Aviv RI, Symons SP PMID: 22282187 [PubMed - in process]

Case 182.

Case 182. Radiology. 2012 Feb;262(2):719-20 Authors: Lee AY, Godwin JD, Pipavath SN PMID: 22282186 [PubMed - in process]

American Thoracic Society Documents: An Official American Thoracic Society/Society of Thoracic Radiology Clinical Practice Guideline--Evaluation of Suspected Pulmonary Embolism in Pregnancy.

American Thoracic Society Documents: An Official American Thoracic Society/Society of Thoracic Radiology Clinical Practice Guideline--Evaluation of Suspected Pulmonary Embolism in Pregnancy. Radiology. 2012 Feb;262(2):635-646 Authors: Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, James AH, McCullough LB, Menda Y, Paidas MJ, Royal HD, Tapson VF, Winer-Muram HT, Chervenak FA, Cody DD, McNitt-Gray MF, Stave CD, Tuttle BD, Abstract Background: Pulmonary embolism (PE) is a leading cause of maternal mortality in the developed world. Along with appropriate prophylaxis and therapy, prevention of death from PE in pregnancy requires a high index of clinical suspicion followed by a timely and accurate diagnostic approach. Methods: To provide guidance on this important health issue, a multidisciplinary panel of major medical stakeholders was convened to develop evidence-based guidelines for evaluation of suspected pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. In formulation of the recommended diagnostic algorithm, the important outcomes were defined to be diagnostic accuracy and diagnostic yield; the panel placed a high value on minimizing cumulative radiation dose when determining the recommended sequence of tests. Results: Overall, the quality of the underlying evidence for all recommendations was rated as very low or low with some of the evidence considered for recommendations extrapolated from studies of the general population. Despite the low quality evidence, strong recommendations were made for three specific scenarios: performance of chest radiography (CXR) as the first radiation-associated procedure; use of lung scintigraphy as the preferred test in the setting of a normal CXR; and performance of computed-tomographic pulmonary angiography (CTPA) rather than digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic ventilation-perfusion (V/Q) result. Discussion: The recommendations presented in this guideline are based upon the currently available evidence; availability of new clinical research data and development and dissemination of new technologies will necessitate a revision and update. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11114045/-/DC1 © American Thoracic Society, 2011. PMID: 22282185 [PubMed - as supplied by publisher]

Hepatocellular Adenoma and Focal Nodular Hyperplasia: Value of Gadoxetic Acid-enhanced MR Imaging in Differential Diagnosis.

Hepatocellular Adenoma and Focal Nodular Hyperplasia: Value of Gadoxetic Acid-enhanced MR Imaging in Differential Diagnosis. Radiology. 2012 Feb;262(2):520-9 Authors: Grazioli L, Bondioni MP, Haradome H, Motosugi U, Tinti R, Frittoli B, Gambarini S, Donato F, Colagrande S Abstract Purpose: To retrospectively evaluate the utility of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the differential diagnosis of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH). Materials and Methods: This study had institutional review board approval; the requirement for informed consent was waived. Eighty-two patients (58 patients with FNH and 24 patients with HCAs) with 111 lesions were included in the study. There were 74 female patients and eight male patients (mean age, 41.9 years ± 13.2 [standard deviation]; age range, 11-78 years). Two readers reviewed all images in terms of signal intensity (SI) features on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), and SI ratio on dynamic and hepatobiliary phase images were calculated. Results: The CER of FNH in the arterial phase (mean, 94.3% ± 33.2) was significantly higher than that of HCAs (mean, 59.3% ± 28.1) (P < .0001). During the hepatobiliary phase, the LLC of FNH showed minimally positive values (mean, 0.05 ± 0.01) and that of HCAs demonstrated strong negative values (mean, -0.67 ± 0.24) (P < .0001). The area under the receiver operating characteristic curve of the hepatobiliary phase SI ratio for differentiation of the two tumors was 0.97, and a sensitivity of 92% and specificity of 91% were found with a cutoff value of 0.87. Among six FNH lesions that showed atypical hypointensity during the hepatobiliary phase, four had a large central scar, one contained a substantial fat component, and one had abundant radiating fibrous septa. Three HCAs were isointense during the hepatobiliary phase owing to severe hepatic steatosis. Conclusion: Gadoxetic acid-enhanced MR imaging facilitates the differentiation of FNH from HCA. © RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101742/-/DC1. PMID: 22282184 [PubMed - in process]

Enhancement Patterns and Parameters of Breast Cancers at Contrast-enhanced US: Correlation with Prognostic Factors.

Enhancement Patterns and Parameters of Breast Cancers at Contrast-enhanced US: Correlation with Prognostic Factors. Radiology. 2012 Feb;262(2):450-9 Authors: Wan CF, Du J, Fang H, Li FH, Zhu JS, Liu Q Abstract Purpose: To investigate the correlation between enhancement patterns and parameters of contrast material-enhanced ultrasonography (US) with prognostic factors in breast cancers. Materials and Methods: The study was approved by the institutional ethics committee, and written informed consent was obtained. Surgical resection specimens of 74 malignant breast lesions in 74 women (mean age, 55 years; age range, 32-78 years) who had undergone contrast-enhanced US were included. Different contrast enhancement patterns (enhancement degree, order, and margin; internal homogeneity; perfusion defect; and radial or penetrating vessels) and parameters (wash-in time, peak intensity, time to peak, area under the time-intensity curve, ascending slope, and descending slope) were evaluated. Pathologic prognostic factors, including histologic grade, lymph node status, tumor diameter, microvessel density (MVD), estrogen and progesterone receptor status, and c-erb-B2, p53, and Ki-67 expression were determined. Correlation of enhancement patterns and parameters with prognostic factors was analyzed with the Pearson χ(2) test, Spearman rank correlation test, and logistic regression analysis. Results: Some enhancement features were associated, albeit not significantly, with prognostic factors. Perfusion defect was the most accurate enhancement criterion for higher histologic grade (grade III) (P = .016), negative estrogen receptor expression (P = .006), positive c-erb-B2 expression (P = .013), larger tumor diameter (≥2 cm) (P = .016), and increased MVD (P = .019). Radial or penetrating vessels were associated with lymph node status (P = .010). Hyperenhancement may be useful in reflecting increased MVD (P = .008) and positive p53 expression (P = .037). For contrast enhancement parameters, ascending slope was the best discrimination criterion for proliferative activity (P = .003). Conclusion: Enhancement patterns and parameters of contrast-enhanced US may be useful in the noninvasive prediction of prognostic factors of breast cancers. © RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110789/-/DC1. PMID: 22282183 [PubMed - in process]

Shear-wave Elastography Improves the Specificity of Breast US: The BE1 Multinational Study of 939 Masses.

Shear-wave Elastography Improves the Specificity of Breast US: The BE1 Multinational Study of 939 Masses. Radiology. 2012 Feb;262(2):435-449 Authors: Berg WA, Cosgrove DO, Doré CJ, Schäfer FK, Svensson WE, Hooley RJ, Ohlinger R, Mendelson EB, Balu-Maestro C, Locatelli M, Tourasse C, Cavanaugh BC, Juhan V, Stavros AT, Tardivon A, Gay J, Henry JP, Cohen-Bacrie C, Abstract Purpose: To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses. Materials and Methods: From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-to-fat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined. Results: Median participant age was 50 years; 289 of 939 (30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303 (2.6%) BI-RADS category 3 masses, 18 of 193 (9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57 (74%) category 4c lesions, and 180 of 187 (96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P < .001); AUC increased to 0.962 (P = .005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P < .001 for both), without significant improvement in sensitivity or AUC. Conclusion: Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity. © RSNA, 2012 Clinical trial registration no. NCT00716482 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110640/-/DC1. PMID: 22282182 [PubMed - as supplied by publisher]

Cardiac MR Imaging of Nonischemic Cardiomyopathies: Imaging Protocols and Spectra of Appearances.

Cardiac MR Imaging of Nonischemic Cardiomyopathies: Imaging Protocols and Spectra of Appearances. Radiology. 2012 Feb;262(2):403-22 Authors: O'Donnell DH, Abbara S, Chaithiraphan V, Yared K, Killeen RP, Martos R, Keane D, Cury RC, Dodd JD Abstract Recent technologic advances in cardiac magnetic resonance (MR) imaging have resulted in images with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MR is a valuable imaging technique for detection and assessment of the morphology and functional characteristics of the nonischemic cardiomyopathy. It has gained acceptance as a standalone imaging modality that can provide further information beyond the capabilities of traditional modalities such as echocardiography and angiography. Black-blood fast spin-echo MR images allow morphologic assessment of the heart with high spatial resolution, while T2-weighted MR images can depict acute myocardial edema. Contrast material-enhanced images can depict and be used to quantify myocardial edema, infiltration, and fibrosis. This review presents recommended cardiac MR protocols for and the spectrum of imaging appearances of the nonischemic cardiomyopathies. © RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11100284/-/DC1. PMID: 22282181 [PubMed - in process]

View from above.

View from above. Radiology. 2012 Feb;262(2):399-401 Authors: Hricak H, Brody WR, Debatin JF, Grossman RI, Zerhouni EA PMID: 22282180 [PubMed - in process]

The Federal Government's Oversight of CT Safety: Regulatory Possibilities.

The Federal Government's Oversight of CT Safety: Regulatory Possibilities. Radiology. 2012 Feb;262(2):391-8 Authors: Harvey HB, Pandharipande PV PMID: 22282179 [PubMed - in process]

Trainee Research Prizes from the 2011 RSNA Scientific Assembly and Annual Meeting.

Trainee Research Prizes from the 2011 RSNA Scientific Assembly and Annual Meeting. Radiology. 2012 Feb;262(2):387-90 Authors: PMID: 22282178 [PubMed - in process]

Stepping out further from the shadows: disclosure of harmful radiologic errors to patients.

Stepping out further from the shadows: disclosure of harmful radiologic errors to patients. Radiology. 2012 Feb;262(2):381-6 Authors: Brown SD, Lehman CD, Truog RD, Browning DM, Gallagher TH PMID: 22282177 [PubMed - in process]

Diffusion-weighted MR Imaging for Liver Lesion Characterization: A Critical Look.

Diffusion-weighted MR Imaging for Liver Lesion Characterization: A Critical Look. Radiology. 2012 Feb;262(2):378-80 Authors: Taouli B PMID: 22282176 [PubMed - in process]

Science to practice: is t2* enough to assess oxygenation?

Science to practice: is t2* enough to assess oxygenation? Radiology. 2012 Feb;262(2):375-7 Authors: Bryan RN PMID: 22282175 [PubMed - in process]

Lawrie B. Morrison.

Lawrie B. Morrison. J Am Coll Radiol. 2011 Oct;8(10):737 Authors: Linton O PMID: 21962793 [PubMed - indexed for MEDLINE]

Improving membership retention rates among new graduates.

Improving membership retention rates among new graduates. J Am Coll Radiol. 2011 Oct;8(10):735-6 Authors: Krishnaraj A, Hawkins CM PMID: 21962792 [PubMed - indexed for MEDLINE]

Pointers for optimizing radiation dose in abdominal CT protocols.

Pointers for optimizing radiation dose in abdominal CT protocols. J Am Coll Radiol. 2011 Oct;8(10):731-4 Authors: Kalra MK, Singh S, Thrall JH, Mahesh M PMID: 21962791 [PubMed - indexed for MEDLINE]

Faculty attestation statements for resident-generated radiology reports.

Faculty attestation statements for resident-generated radiology reports. J Am Coll Radiol. 2011 Oct;8(10):727-30 Authors: Hunter TB, Krupinski E PMID: 21962790 [PubMed - indexed for MEDLINE]

Learning from high-reliability organizations.

Learning from high-reliability organizations. J Am Coll Radiol. 2011 Oct;8(10):725-6 Authors: Prasanna P, Nagy P PMID: 21962789 [PubMed - indexed for MEDLINE]

Medical imaging data reconciliation, part 2: clinical order entry and imaging report data reconciliation.

Medical imaging data reconciliation, part 2: clinical order entry and imaging report data reconciliation. J Am Coll Radiol. 2011 Oct;8(10):720-4 Authors: Reiner BI Abstract Data reconciliation in medical imaging is designed to ensure the accuracy and integrity of data across multiple steps in the imaging cycle, ultimately leading to improved continuity of patient care. An integral component of this data reconciliation is tied to the steps of clinical order entry and radiology report creation. The clinical data presented at order entry by the referring clinician influence a number of important imaging decisions, including examination selection, protocol design, image acquisition and processing, and interpretation of the imaging data set. The subsequent data derived from the radiology report have a profound impact on diagnosis, treatment, and overall clinical management. As a result, the reconciliation of clinical order entry and radiology report data affect health care delivery and in many respects are dependent on each other for optimal outcomes. The creation of a standardized reconciliation database that proactively records, tracks, analyzes, and provides feedback to radiologists and clinicians offers the potential to improve the quality and efficiency of patient care, while providing objective accountability measures for individual and institutional health care providers. PMID: 21962788 [PubMed - indexed for MEDLINE]

Variability in study withdrawal rates among academic neuroradiologists participating in a radiology utilization management program.

Variability in study withdrawal rates among academic neuroradiologists participating in a radiology utilization management program. J Am Coll Radiol. 2011 Oct;8(10):716-9 Authors: Friedman DP, Smith NS Abstract PURPOSE: The aim of this study was to analyze variability in study withdrawal rates among academic neuroradiologists participating in a utilization management (UM) program. METHODS: The activities of 5 academic neuroradiologists participating in a UM program were assessed. The project period spanned 42 months. Participating neuroradiologists received identical training and used identical rule sets to evaluate the appropriateness of outpatient CT and MRI studies. Neuroradiologists could approve studies on the basis of available electronic data or contact referring physicians for further information. The rate of withdrawals (defined as "study not performed by consensus" or "study changed by consensus" with the referring physician) was compared among the neuroradiologists. RESULTS: A total of 5,256 studies were reviewed (mean, 1,051; median, 1,043). There were 573 studies (10.9%) not performed by consensus and 298 studies (5.7%) changed by consensus, resulting in a total of 871 withdrawals (16.6%). Among the neuroradiologists, withdrawal rates varied by approximately a factor of 2 (mean, 16.5%; median, 15.2%; range, 12.8%-23.5%). Although rate of studies not performed by consensus varied by approximately a factor of 2 (mean, 10.8%; median, 8.1%; range, 7.6%-18.0%), the rate of studies changed by consensus showed little variation (mean, 5.7%; median, 5.5%; range, 4.8%-6.6%). CONCLUSIONS: Variability in withdrawal rates was related to cases in which referring physicians were asked not to perform studies; there was little variation when referring physicians were asked to change studies. These data imply agreement among the neuroradiologists regarding appropriateness of rule sets but suggest that personality characteristics such as persuasiveness, persistence, and desire for conflict avoidance may play an important role in outcomes. PMID: 21962787 [PubMed - indexed for MEDLINE]

Introducing medical students to radiology as paid emergency department triage assistants.

Introducing medical students to radiology as paid emergency department triage assistants. J Am Coll Radiol. 2011 Oct;8(10):710-5 Authors: Davis DJ, Moon M, Kennedy S, DelBasso S, Forman HP, Bokhari SA Abstract PURPOSE: The aim of this report is to provide a detailed description of a program employing medical students to assist with triaging off-hour diagnostic imaging studies at a major academic medical center. METHODS: Current and former participants of the Medical student Emergency Department (ED) Radiology Triage Program were interviewed regarding the inception, development, and impact of this program. Student participation and triage activities were compiled and tabulated from scheduling records and triage assistant call logs. RESULTS: Opportunities for medical students to obtain an intensive, well-organized experience in radiology are often absent or occur relatively late during medical school, which can be problematic for developing basic imaging literacy and for making timely, well-informed decisions regarding radiology as a career path. The authors describe a program that provides students with a rigorous, hands-on experience in radiology relatively early in their training by employing medical students to assist the emergency department radiology staff with managing off-hour radiology workflow. Students work with the off-hour emergency department radiologists and staff members answering phone calls and help to facilitate the ordering and protocoling of studies and the dissemination of results to clinicians. CONCLUSIONS: The employment of medical student triage assistants provides in-depth exposure to clinical radiology relatively early in medical school, while providing an effective system to help streamline the off-hour workflow for attending radiologists, residents, technicians, and support staff members. PMID: 21962786 [PubMed - indexed for MEDLINE]

Trends in utilization rates of the various imaging modalities in emergency departments: nationwide Medicare data from 2000 to 2008.

Trends in utilization rates of the various imaging modalities in emergency departments: nationwide Medicare data from 2000 to 2008. J Am Coll Radiol. 2011 Oct;8(10):706-9 Authors: Rao VM, Levin DC, Parker L, Frangos AJ, Sunshine JH Abstract PURPOSE: To study utilization trends in the various imaging modalities in emergency departments (EDs) over a recent multiyear period. METHODS: The nationwide Medicare Part B databases for 2000 to 2008 were queried. Medicare's location codes were used to identify imaging examinations done on ED patients. All diagnostic imaging Current Procedural Terminology(®) codes were grouped by modality. For each code, the database provides procedure volume; utilization rates per 1,000 beneficiaries were then calculated. Medicare's physician specialty codes were used to determine provider specialty. Utilization trends were studied between 2000 and 2008. RESULTS: The overall utilization rate per 1,000 beneficiaries for all imaging in EDs increased from 281.0 in 2000 to 450.4 in 2008 (+60%). The radiography utilization rate rose from 227.3 in 2000 to 294.3 in 2008 (+29%, 67 accrued new studies per 1,000). The CT rate rose from 40.0 in 2000 to 130.7 in 2008 (+227%, 90.7 accrued new studies per 1,000). The ultrasound rate rose from 9.6 in 2000 to 18.7 in 2008 (+95%, 9.1 accrued new studies per 1,000). Other modalities had much lower utilization. In 2000, CT constituted 14% of all ED imaging, but by 2008, it constituted 29%. In 2008, radiologists performed 96% of all ED imaging examinations. CONCLUSIONS: The rate of utilization of imaging is increasing in EDs. Growth is by far the most pronounced in CT, in terms of both the growth rate itself and the actual number of accrued new studies per 1,000 beneficiaries. Radiologists strongly predominate as the physicians of record for all ED imaging. PMID: 21962785 [PubMed - indexed for MEDLINE]

Addenda to the radiology report: what are we trying to convey?

Addenda to the radiology report: what are we trying to convey? J Am Coll Radiol. 2011 Oct;8(10):703-5 Authors: Hussain S, Allende MB, Karam AR, Hussain JS, Vijayaraghavan G Abstract PURPOSE: The aims of this paper are to describe addenda to radiology reports and to discuss the communication gaps in radiology addenda reaching referring physicians. The authors examine impediments to compliance with an addendum policy and suggest possible solutions. METHODS: A total of 62,500 radiology reports were reviewed to analyze the occurrence of report addenda. Addenda types were separated into clinical, generated by radiologists, and administrative (for billing or regulatory reasons). Two radiologists reviewed all clinical addenda and classified them as significant or not significant. Significant addenda were further analyzed for various aspects. An e-mail survey was also conducted to assess prevailing practices in academic departments of radiology. RESULTS: There were 1,069 reports with addenda (1.7%). Of these, 575 were generated by radiologists. Forty-nine (8.5%) were for clinically significant errors and 526 (91.5%) were not. Of the 49 significant addenda, 9 (18%) were fully compliant with departmental addendum policies, 27 (55%) were noncompliant, and 13 (27%) were partially compliant. Of the 49 clinically significant addenda, 17 (55%) were dictated within 1 hour and 40 (82%) within 24 hours of the finalized original reports. CONCLUSIONS: Poor compliance with an addendum policy was found. The reasons for noncompliance and possible remedies are discussed, with the hope of beginning a dialogue in the radiology literature on the risks of poor communication processes and the benefits of full implementation of well thought-out addendum policies. PMID: 21962784 [PubMed - indexed for MEDLINE]

White paper from the ACR Task Force on Print Media in Radiology.

White paper from the ACR Task Force on Print Media in Radiology. J Am Coll Radiol. 2011 Oct;8(10):692-702 Authors: Duszak R, Haines GR, Van Duyn Wear V, Lexa FJ, Bashir M, D'Souza S, Carlos R, Chen JY, King BF, Wald C Abstract The rapidly changing technological and business environment in which scientific journals are published will necessitate ongoing reassessment of operations, goals, and priorities. In this white paper, the ACR Task Force on Print Media in Radiology reviews the history and role of print media in radiology; discusses current and anticipated societal, technological, and financial challenges; and explores a variety of strategies to help ensure the relevance of professional society publishing in the future. PMID: 21962783 [PubMed - indexed for MEDLINE]

Unintended consequences of health care legislation.

Unintended consequences of health care legislation. J Am Coll Radiol. 2011 Oct;8(10):687-91 Authors: Thrall JH Abstract Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders. PMID: 21962782 [PubMed - indexed for MEDLINE]

ACR Appropriateness Criteria® chronic chest pain--high probability of coronary artery disease.

ACR Appropriateness Criteria® chronic chest pain--high probability of coronary artery disease. J Am Coll Radiol. 2011 Oct;8(10):679-86 Authors: Earls JP, White RD, Woodard PK, Abbara S, Atalay MK, Carr JJ, Haramati LB, Hendel RC, Ho VB, Hoffman U, Khan AR, Mammen L, Martin ET, Rozenshtein A, Ryan T, Schoepf J, Steiner RM, White CS Abstract Imaging is valuable in determining the presence, extent, and severity of myocardial ischemia and the severity of obstructive coronary lesions in patients with chronic chest pain in the setting of high probability of coronary artery disease. Imaging is critical for defining patients best suited for medical therapy or intervention, and findings can be used to predict long-term prognosis and the likely benefit from various therapeutic options. Chest radiography, radionuclide single photon-emission CT, radionuclide ventriculography, and conventional coronary angiography are the imaging modalities historically used in evaluating suspected chronic myocardial ischemia. Stress echocardiography, PET, cardiac MRI, and multidetector cardiac CT have all been more recently shown to be valuable in the evaluation of ischemic heart disease. Other imaging techniques may be helpful in those patients who do not present with signs classic for angina pectoris or in those patients who do not respond as expected to standard management. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID: 21962781 [PubMed - indexed for MEDLINE]

Learning to lead: best practices for getting started.

Learning to lead: best practices for getting started. J Am Coll Radiol. 2011 Oct;8(10):677-8 Authors: Lexa FJ PMID: 21962780 [PubMed - indexed for MEDLINE]

How IT tools can help improve current protocolling performance gaps.

How IT tools can help improve current protocolling performance gaps. J Am Coll Radiol. 2011 Oct;8(10):675-6 Authors: Khorasani R PMID: 21962779 [PubMed - indexed for MEDLINE]