Ography C Virtual Colonoscopy for Screening
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Focal Spot, Spring 2006
Washington University School of Medicine Digital Commons@Becker Focal Spot Archives Focal Spot Spring 2006 Focal Spot, Spring 2006 Follow this and additional works at: http://digitalcommons.wustl.edu/focal_spot_archives Recommended Citation Focal Spot, Spring 2006, April 2006. Bernard Becker Medical Library Archives. Washington University School of Medicine. This Book is brought to you for free and open access by the Focal Spot at Digital Commons@Becker. It has been accepted for inclusion in Focal Spot Archives by an authorized administrator of Digital Commons@Becker. For more information, please contact [email protected]. SPRING 2006 VOLUME 37, NUMBER 1 *eiN* i*^ MALLINCKRC RADIOLO AJIVERSITY *\ irtual Colonoscopy: a Lifesaving Technology ^.IIMi.|j|IUII'jd-H..l.i.|i|.llJ.lii|.|.M.; 3 2201 20C n « ■ m "■ ■ r. -1 -1 NTENTS FOCAL SPOT SPRING 2006 VOLUME 37, NUMBER 1 MIR: 75 YEARS OF RADIOLOGY EXPERIENCE In the early 1900s, radiology was considered by most medical practitioners as nothing more than photography. In this 75th year of Mallinckrodt Institute's existence, the first of a three-part series of articles will chronicle the rapid advancement of radiol- ogy at Washington University and the emergence of MIR as a world leader in the field of radiology. THE METABOLISM OF THE DIABETIC HEART More diabetic patients die from cardiovascular disease than from any other cause. Researchers in the Institute's Cardiovascular Imaging Laboratory are finding that the heart's metabolism may be one of the primary mechanisms by which diseases such as diabetes have a detrimental effect on heart function. VIRTUAL C0L0N0SC0PY: A LIFESAVING TECHNOLOGY More than 55,000 Americans die each year from cancers of the colon and rectum. -
SAGES Clinical Spotlight Review: Intraoperative Cholangiography
SAGES Clinical Spotlight Review: Intraoperative cholangiography William W. Hope, MD, Robert Fanelli MD, Danielle S. Walsh MD, Ray Price MD, Dimitrios Stefanidis MD, William S. Richardson MD, and the SAGES Guidelines Committee Preamble The following clinical spotlight review regarding the intraoperative cholangiogram is intended for physicians who manage and treat gallbladder/biliary pathology and perform laparoscopic cholecystectomy. It is meant to critically review the technique of intraoperative cholangiography, alternatives for intraoperative biliary imaging, and the available evidence supporting their safety and efficacy. Based on the level of evidence, recommendations may or may not be given for their use in clinical practice. Disclaimer Guidelines for clinical practice and spotlight reviews are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Spotlight reviews are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to convey recommendations based on a focused topic; within the defined scope of review, they indicate the preferable, but not necessarily the only acceptable approaches due to the complexity of the healthcare environment. Guidelines and recommendations are intended to be flexible. Given the wide range of specifics in any health care problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines, spotlight reviews, and recommendations are developed under the auspices of the Society of American Gastrointestinal Endoscopic Surgeons and its various committees, and approved by the Board of Governors. -
Rectal Water Contrast Transvaginal Ultrasound Versus Double-Contrast Barium Enema in the Diagnosis of Bowel Endometriosis
Open Access Research BMJ Open: first published as 10.1136/bmjopen-2017-017216 on 7 September 2017. Downloaded from Rectal water contrast transvaginal ultrasound versus double-contrast barium enema in the diagnosis of bowel endometriosis Jipeng Jiang, Ying Liu, Kun Wang, Xixiang Wu, Ying Tang To cite: Jiang J, Liu Y, Wang K, ABSTRACT Strengths and limitations of this study et al. Rectal water contrast Objectives The aim of study was to compare the transvaginal ultrasound versus accuracy between rectal water contrast transvaginal ► This is the first comparison of the accuracy between double-contrast barium enema ultrasound (RWC-TVS) and double-contrast barium enema in the diagnosis of bowel rectal water contrast transvaginal ultrasound (RWC- (DCBE) in evaluating the bowel endometriosis presence as endometriosis. BMJ Open TVS) and double-contrast barium enema (DCBE) in well as its extent. 2017;7:e017216. doi:10.1136/ the diagnosis of bowel endometriosis. Design and setting 198 patients at reproductive age with bmjopen-2017-017216 ► This study demonstrated RWC-TVS as a very reliable suspicious bowel endometriosis were included. Physicians technique to determine the bowel endometriosis ► Prepublication history for in two groups specialised at endometriosis performed presence and extent and it has similar accuracy to this paper is available online. RWC-TVS as well as DCBE before laparoscopy and both To view these files please visit that of DCBE. groups were blinded to other groups’ results. Findings the journal online (http:// dx. doi. ► We demonstrate that DCBE is related to more from RWC-TVS or DCBE were compared with histological org/ 10. 1136/ bmjopen- 2017- tolerance than RWC-TVS. -
Impact of Preoperative Endoscopic Ultrasound in Surgical Oncology
REVIEW Impact of preoperative endoscopic ultrasound in surgical oncology Endoscopic ultrasound (EUS) has a strong impact on the imaging and staging of solid tumors within or in close proximity of the upper GI tract. Technological developments during the last two decades have increased the image quality and allowed very detailed visualization of local tumor spread and lymph node affection. Current indications for EUS of the upper GI tract encompass the differentiation between benign and malignant lesions, the staging of esophageal, gastric and pancreatic cancer, and the procurement of a biopsy specimen through fine-needle aspiration. Various technical innovations during the past two decades have increased the diagnostic quality and have simultaneously strengthened the role of EUS in the clinical setting. This article will give a compressed summary on the current state of EUS and possible further technical developments. 1 KEYWORDS: 3D imaging elastosonography endoscopic ultrasound miniprobes Sascha S Chopra & oncologic surgery Michael Hünerbein† 1Department of General & Transplantation Surgery, Charité Campus Virchow-Clinic, Berlin, Conventional endoscopic ultrasound the so-called ‘miniprobes’ into the biliary system Germany Linear versus radial systems or the pancreatic duct in order to obtain high-res- †Author for correspondence: Department of Surgery & Surgical Endoscopic ultrasound (EUS) with flex- olution radial ultrasound images locally. Present Oncology, Helios Hospital Berlin, ible endoscopes is an important diagnostic and mini probes show a diameter of 2–3 mm and oper- 13122 Berlin, Germany Tel.: +49 309 417 1480 therapeutic tool, especially for the local staging ate with frequencies between 12 and 30 MHz. Fax: +49 309 417 1404 of gastrointestinal (GI) cancers, the differen- The main drawbacks of these devices are the lim- michael.huenerbein@ tiation between benign and malignant tumors, ited durability and the decreased depth of penetra- helios-kliniken.de and interventional procedures, such as biopsies tion (~2 cm). -
ACR Manual on Contrast Media
ACR Manual On Contrast Media 2021 ACR Committee on Drugs and Contrast Media Preface 2 ACR Manual on Contrast Media 2021 ACR Committee on Drugs and Contrast Media © Copyright 2021 American College of Radiology ISBN: 978-1-55903-012-0 TABLE OF CONTENTS Topic Page 1. Preface 1 2. Version History 2 3. Introduction 4 4. Patient Selection and Preparation Strategies Before Contrast 5 Medium Administration 5. Fasting Prior to Intravascular Contrast Media Administration 14 6. Safe Injection of Contrast Media 15 7. Extravasation of Contrast Media 18 8. Allergic-Like And Physiologic Reactions to Intravascular 22 Iodinated Contrast Media 9. Contrast Media Warming 29 10. Contrast-Associated Acute Kidney Injury and Contrast 33 Induced Acute Kidney Injury in Adults 11. Metformin 45 12. Contrast Media in Children 48 13. Gastrointestinal (GI) Contrast Media in Adults: Indications and 57 Guidelines 14. ACR–ASNR Position Statement On the Use of Gadolinium 78 Contrast Agents 15. Adverse Reactions To Gadolinium-Based Contrast Media 79 16. Nephrogenic Systemic Fibrosis (NSF) 83 17. Ultrasound Contrast Media 92 18. Treatment of Contrast Reactions 95 19. Administration of Contrast Media to Pregnant or Potentially 97 Pregnant Patients 20. Administration of Contrast Media to Women Who are Breast- 101 Feeding Table 1 – Categories Of Acute Reactions 103 Table 2 – Treatment Of Acute Reactions To Contrast Media In 105 Children Table 3 – Management Of Acute Reactions To Contrast Media In 114 Adults Table 4 – Equipment For Contrast Reaction Kits In Radiology 122 Appendix A – Contrast Media Specifications 124 PREFACE This edition of the ACR Manual on Contrast Media replaces all earlier editions. -
MRCP Vs. ERCP
MRCPMRCP vs.vs. ERCPERCP SteveSteve Harrell,Harrell, MD,MD, MSPHMSPH AdvancedAdvanced TherapeuticTherapeutic EndoscopyEndoscopy DecemberDecember 6,6, 20072007 University of Louisville InitialInitial ThoughtsThoughts ““So,So, itit isis mymy predictionprediction thatthat MRCPMRCP willwill havehave aa hugehuge effecteffect onon ERCPERCP practicepractice inin thethe UnitedUnited States.States.”” ““IfIf II hadhad aa pancreaticpancreatic oror biliarybiliary problemproblem II wouldwould searchsearch outout …… aa centercenter withwith thethe mostmost sophisticatedsophisticated noninvasivenoninvasive techniquestechniques…… veryvery quickly.quickly.”” ““WeWe allall wantwant thethe bestbest forfor ourour patients;patients; shouldshould wewe treattreat themthem differentlydifferently thanthan wewe wouldwould ourselves?ourselves?”” 5/15/985/15/98 Peter B. Cotton, MD, FRCP Medical University of South Carolina Charleston, South Carolina Universityhttp://www.ddc.musc.edu/ddc_pro/pro_development of Louisville /hot_topics/impact_MRCP-cotton.htm LearningLearning GoalsGoals KnowKnow whatwhat ERCPERCP andand MRCPMRCP standstand forfor AdvantagesAdvantages andand disadvantagesdisadvantages ofof MRCPMRCP IndicationsIndications forfor ERCPERCP PoorPoor IndicationsIndications forfor ERCPERCP ClinicalClinical UseUse inin commoncommon disordersdisorders forfor MRCPMRCP EffectsEffects ofof MRCPMRCP onon ERCPERCP inin trainingtraining CasesCases University of Louisville ERCPERCP EndoscopicEndoscopic retrograderetrograde cholangiopancreatographycholangiopancreatography -
Virtual Colonoscopy
Virtual Colonoscopy National Digestive Diseases Information Clearinghouse Virtual colonoscopy (VC) uses x rays and • You will be asked to hold your breath computers to produce two- and three- during the scan to avoid distortion on dimensional images of the colon (large the images. intestine) from the lowest part, the rectum, • The scanning procedure is then National all the way to the lower end of the small Institute of repeated with you lying on your Diabetes and intestine and display them on a screen. Digestive stomach. and Kidney The procedure is used to diagnose colon Diseases and bowel disease, including polyps, diver- After the examination, the information ticulosis, and cancer. VC can be performed from the scanner must be processed to NATIONAL INSTITUTES with computed tomography (CT), some- create the computer picture or image of OF HEALTH times called a CAT scan, or with magnetic your colon. A radiologist evaluates the resonance imaging (MRI). results to identify any abnormalities. You may resume normal activity after the VC Procedure procedure, although your doctor may While preparations for VC vary, you will usually be asked to take laxatives or other oral agents at home the day before the pro- cedure to clear stool from your colon. You Conventional Colonoscopy may also be asked to use a suppository to In a conventional colonoscopy, the cleanse your rectum of any remaining fecal doctor inserts a colonoscope—a long, matter. flexible, lighted tube—into the patient’s VC takes place in the radiology department rectum and slowly guides it up through of a hospital or medical center. -
Virtual Colonography
Virtual Colonography Radiologists at the VCU Medical Center were among the first in Virginia to develop, test and adopt for routine use a more patient-friendly way to screen for colon polyps and colon cancer. The noninvasive treatment procedure known medically as - Virtual Colonography (VC) or CT Colonography (CTC) - uses computed tomography (CT) scanning to determine whether or not colon polyps are present. Because Virtual Colonography does not require the use of a colonoscope as in a conventional colonoscopy procedure, it is sometimes referred to as a “Virtual Colonoscopy”. What makes Virtual Colonography an ideal option for screening? Because the procedure is noninvasive, safe, quick (lasting only a few minutes), and does not require sedation, Virtual Colonography is an excellent screening technology, and often preferred by patients over the conventional or standard colonoscopy. There are no risks of complications such as bowel perforation or complications from sedation associated with standard colonoscopy. Patients may return to their usual activities as soon as the test is over. Virtual Colonography also allows for evaluation of the entire colon, something a standard colonoscopy may not be able to do in all cases because normal twists and turns in the large intestines make navigating the colonoscope difficult. Virtual Colonography is accurate in identifying significant polyps and offers an alternative screening option for those who are simply not willing to undergo conventional colonoscopy, which is invasive, can be uncomfortable, and requires sedation. How accurate is Virtual Colonography compared to conventional colonoscopy? Early studies show that Virtual Colonography is comparable to conventional colonoscopy in terms of identifying polyps six millimeters or greater in size. -
Digestive Endoscopy in Five Decades
■ COLLEGE LECTURES Digestive endoscopy in five decades Peter B Cotton ABSTRACT – The world of gastroenterology scopy. So-called semi-flexible gastroscopes were changed forever when flexible endoscopes cumbersome and used infrequently by only a few became available in the 1960s. Diagnostic and enthusiasts. therapeutic techniques proliferated and entered the mainstream of medicine, not without some Diagnostic endoscopy controversy. Success resulted in a huge service demand, with the need to train more endo- The first truly flexible gastroscope was developed in 1 This paper is scopists and to organise large endoscopy units the USA, following pioneering work on fibre-optic 2 based on the Lilly and teams of staff. The British health service light transmission in the UK by Harold Hopkins. Lecture given at struggled with insufficient numbers of consul- However, commercial production of endoscopes was the Royal College tants, other staff and resources, and British rapidly dominated by Japanese companies, building of Physicians on endoscopy fell behind that of most other devel- on their earlier expertise with intragastric cameras. 12 April 2005 by oped countries. This situation is now being My involvement began in 1968, whilst doing bench Peter B Cotton addressed aggressively, with many local and research with Dr Brian Creamer at St Thomas’ MD FRCP FRCS, national initiatives aimed at improving access and Hospital, London. An expert in coeliac disease (and Medical Director, choice, and at promoting and documenting jejunal biopsy), he opined that gastroscopy might Digestive Disease quality. Many more consultants are needed and become useful and legitimate only if it became pos- Center, Medical some should be relieved of their internal medi- sible to take target biopsy specimens – since no one University of South Carolina, cine commitment to focus on their specialist seriously believed what endoscopists said that they Charleston, USA skills. -
Diagnosis and Management of Primary Sclerosing Cholangitis
AASLD PRACTICE GUIDELINES Diagnosis and Management of Primary Sclerosing Cholangitis Roger Chapman,1 Johan Fevery,2 Anthony Kalloo,3 David M. Nagorney,4 Kirsten Muri Boberg,5 Benjamin Shneider,6 and Gregory J. Gores7 Preamble classification used by the Grading of Recommendation This guideline has been approved by the American Asso- Assessment, Development, and Evaluation (GRADE) ciation for the Study of Liver Diseases and represents the workgroup with minor modifications (Table 1).3 The position of the Association. These recommendations pro- strength of recommendations in the GRADE system are vide a data-supported approach. They are based on the classified as strong (class 1) or weak (class 2). The quality following: (1) formal review and analysis of the recently- of evidence supporting strong or weak recommendations published world literature on the topic (Medline search); is designated by one of three levels: high (level A), mod- (2) American College of Physicians Manual for Assessing erate (level B), or low-quality (level C). Health Practices and Designing Practice Guidelines1; (3) guideline policies, including the AASLD Policy on the Definition and Diagnosis Development and Use of Practice Guidelines and the Definitions. Primary sclerosing cholangitis (PSC) is a American Gastroenterological Association Policy State- chronic, cholestatic liver disease characterized by inflam- ment on Guidelines2; and (4) the experience of the au- mation and fibrosis of both intrahepatic and extrahepatic thors in the specified topic. bile ducts,4 leading to the formation of multifocal bile Intended for use by physicians, these recommenda- duct strictures. PSC is likely an immune mediated, pro- tions suggest preferred approaches to the diagnostic, ther- gressive disorder that eventually develops into cirrhosis, apeutic and preventative aspects of care. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Is Intravenous Cholangiography an Alternative to the Routine Per-Operative Cholangiogram? Simon P.J
Postgraduate Medical Journal (1989) 65, 896 - 899 Postgrad Med J: first published as 10.1136/pgmj.65.770.896 on 1 December 1989. Downloaded from Is intravenous cholangiography an alternative to the routine per-operative cholangiogram? Simon P.J. Huddy and John A. Southam Epsom District Hospital, Dorking Road, Epsom, Surrey, UK Summary: Ultrasonography, although an accurate method ofdetecting stones within the gall bladder, is unreliable for the detection of bile duct stones for which per-operative cholangiography remains the standard investigation. Fifty seven patients undergoing elective cholecystectomy had both a pre-operative intravenous cholangiogram and per-operative cholangiography. The pre-operative investigation is shown to be at least as effective in the detection of common bile duct stones and only missed a duct stone in one patient. The substitution of pre-operative intravenous cholangiography for routine per-operative cholangiography would result in a significant reduction in operating time, may provide advance knowledge on the biliary anatomy and would allow advance planning of the likely procedure. It is suggested that pre-operative intravenous cholangiography, carried out on the day of admission, should be considered as a preferred alternative investigation to per-operative cholangiography. Introduction Protected by copyright. Per-operative cholangiography, first introduced by An intravenous cholangiogram was performed as Mirizzi in 1932,' is now a commonly performed an outpatient procedure before admission for procedure. It is considered by many authorities to be cholecystectomy. A control film was taken prior to an investigation which should be routinely performed infusion of 100 ml of meglumine iodoxamate at the time of cholecystectomy in order to identify (Endobil, E.