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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. -
Nuclide Imaging: Planar Scintigraphy, SPECT, PET
Nuclide Imaging: Planar Scintigraphy, SPECT, PET Yao Wang Polytechnic University, Brooklyn, NY 11201 Based on J. L. Prince and J. M. Links, Medical Imaging Signals and Systems, and lecture notes by Prince. Figures are from the textbook except otherwise noted. Lecture Outline • Nuclide Imaging Overview • Review of Radioactive Decay • Planar Scintigraphy – Scintillation camera – Imaging equation • Single Photon Emission Computed Tomography (SPECT) • Positron Emission Tomography (PET) • Image Quality consideration – Resolution, noise, SNR, blurring EL5823 Nuclear Imaging Yao Wang, Polytechnic U., Brooklyn 2 What is Nuclear Medicine • Also known as nuclide imaging • Introduce radioactive substance into body • Allow for distribution and uptake/metabolism of compound ⇒ Functional Imaging ! • Detect regional variations of radioactivity as indication of presence or absence of specific physiologic function • Detection by “gamma camera” or detector array • (Image reconstruction) From H. Graber, Lecture Note for BMI1, F05 EL5823 Nuclear Imaging Yao Wang, Polytechnic U., Brooklyn 3 Examples: PET vs. CT • X-ray projection and tomography: – X-ray transmitted through a body from a outside source to a detector (transmission imaging) – Measuring anatomic structure • Nuclear medicine: – Gamma rays emitted from within a body (emission imaging) From H. Graber, Lecture Note, F05 – Imaging of functional or metabolic contrasts (not anatomic) • Brain perfusion, function • Myocardial perfusion • Tumor detection (metastases) EL5823 Nuclear Imaging Yao Wang, Polytechnic -
Description of Alternative Approaches to Measure and Place a Value on Hospital Products in Seven Oecd Countries
OECD Health Working Papers No. 56 Description of Alternative Approaches to Measure Luca Lorenzoni, and Place a Value Mark Pearson on Hospital Products in Seven OECD Countries https://dx.doi.org/10.1787/5kgdt91bpq24-en Unclassified DELSA/HEA/WD/HWP(2011)2 Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development 14-Apr-2011 ___________________________________________________________________________________________ _____________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS HEALTH COMMITTEE Unclassified DELSA/HEA/WD/HWP(2011)2 Health Working Papers OECD HEALTH WORKING PAPERS NO. 56 DESCRIPTION OF ALTERNATIVE APPROACHES TO MEASURE AND PLACE A VALUE ON HOSPITAL PRODUCTS IN SEVEN OECD COUNTRIES Luca Lorenzoni and Mark Pearson JEL Classification: H51, I12, and I19 English text only JT03300281 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format DELSA/HEA/WD/HWP(2011)2 DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS www.oecd.org/els OECD HEALTH WORKING PAPERS http://www.oecd.org/els/health/workingpapers This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France. The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. -
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. -
Imaging in Double Gall Bladder with Acute Cholecystitis—A Rare Entity
Surgical Science, 2014, 5, 273-279 Published Online July 2014 in SciRes. http://www.scirp.org/journal/ss http://dx.doi.org/10.4236/ss.2014.57047 Imaging in Double Gall Bladder with Acute Cholecystitis—A Rare Entity Praveen Kumar Vasanthraj, Rajoo Ramachandran, Kumaresh Athiyappan, Anupama Chandrasekharan, Cunnigaiper Dhanasekaran Narayanan Department of Radiology, Sri Ramachandra University, Chennai, India Email: [email protected] Received 28 April 2014; revised 26 May 2014; accepted 22 June 2014 Copyright © 2014 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Duplication of gall bladder is a rare congenital anomaly of the hepatobiliary system. It is a very important entity in clinical practice as preoperative diagnosis plays a significant role in the man- agement and to avoid unnecessary bile duct injury during surgery. We report a case of duplicated gall bladder presenting as acute cholecystitis. Keywords Gall Bladder, Duplication, Cholecystitis 1. Introduction Gall bladder (GB) duplication is a rare congenital anomaly of hepatobiliary system with a reported incidence of about 1 per 4000 autopsies [1]. Duplication of gall bladder and their varying anatomical positions are associated with an increased risk of complications including biliary leak after laparoscopic or open cholecystectomy [2]-[5]. 2. Case Presentation A 45 years old lady presented with complaints of abdomen pain for the past two days. It was colicky type pain, intermittent in nature and localized to the right hypochondrium. She also gave history of three episodes of vo- miting which was non bilious, non blood stained and non foul smelling. -
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). -
Procedure Guideline for Planar Radionuclide Cardiac
Procedure Guideline for Planar Radionuclide Cardiac Ventriculogram for the Assessment of Left Ventricular Systolic Function Version 2 2016 Review date 2021 a b c d e e Alice Nicol , Mike Avison , Mark Harbinson , Steve Jeans , Wendy Waddington , Simon Woldman (on behalf of BNCS, BNMS, IPEM). a b Southern General Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK Bradford Royal Infirmary, c d e Bradford, UK Queens University, Belfast, UK Christie Hospital NHS Foundation Trust, Manchester, UK University College London Hospitals NHS Foundation Trust, London, UK 1 1. Introduction The purpose of this guideline is to assist specialists in nuclear medicine in recommending, performing, interpreting and reporting radionuclide cardiac ventriculograms (RNVG), also commonly known as multiple gated acquisition (MUGA) scans. It will assist individual departments in the development and formulation of their own local protocols. RNVG is a reliable and robust method of assessing cardiac function [1-5]. The basis of the study is the acquisition of a nuclear medicine procedure with multiple frames, gated by the R wave of the electrocardiogram (ECG) signal. The tracer is a blood pool agent, usually red blood cells labelled with technetium-99m (99mTc). One aim of this guideline is to foster a more uniform method of performing RNVG scans throughout the United Kingdom. This is particularly desirable since the National Institute for Health and Clinical Excellence (NICE) has mandated national protocols for the pre-assessment and monitoring of patients undergoing certain chemotherapy regimes [6, 7], based on specific left ventricular ejection fraction (LVEF) criteria. This guideline will focus on planar equilibrium RNVG scans performed for the assessment of left ventricular systolic function at rest, using data acquired in the left anterior oblique (LAO) projection by means of a frame mode, ECG-gated acquisition method. -
F • High Accuracy Sonographic Recognition of Gallstones
517 - • High Accuracy Sonographic f Recognition of Gallstones Paul C. Messier1 Recent advances in the imaging capabilities of gray scale sonography have increased Donald S. Hill1 the accuracy with which gallstones may be diagnosed. Since the sonographic diagnosis Frank M. Detorie2 of gallstones is often followed by surgery without further confirmatory studies, the Albert F. Rocco1 avoidance of false-positive diagnoses assumes major importance. In an attempt to improve diagnostic accuracy, 420 gallbladder sonograms were evaluated for gall- stones. Positive diagnoses were limited to cases in which the gallbladder was well visualized and contained densities that produced acoustic shadowing or moved rapidly with changes in position. Gallstones were diagnosed in 123 cases and surgery or autopsy in 70 of these patients confirmed stones in 69. There was one false-positive, an accuracy rate for positive diagnosis of 98.6%. Five cases were called indeterminate for stones; one of these had tiny 1 mm stones at surgery. The other four cases had no surgery. Of 276 cases called negative for stones, two were operated. One contained tiny 1 mm stones; the other had no stones. None of the 146 cases with negative sonograms and oral cholecystography or intravenous cholangiography had stones diagnosed by these methods. Because of its ease and simplicity, sonography is attractive as the initial study in patients suspected of having gallstones. With the criteria used here, a diagnosis of gallstones in the gallbladder can be offered with great confidence. Since 1974, the imaging capabilities of gray scale sonography have improved steadily, with corresponding increases in its accuracy in gallstone recognition. -
ACR Appropriateness Criteria® Right Upper Quadrant Pain
Revised 2018 American College of Radiology ACR Appropriateness Criteria® Right Upper Quadrant Pain Variant 1: Right upper quadrant pain. Suspected biliary disease. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US abdomen Usually Appropriate O CT abdomen with IV contrast May Be Appropriate ☢☢☢ MRI abdomen without and with IV May Be Appropriate contrast with MRCP O MRI abdomen without IV contrast with May Be Appropriate MRCP O Nuclear medicine scan gallbladder May Be Appropriate ☢☢ CT abdomen without IV contrast May Be Appropriate ☢☢☢ CT abdomen without and with IV Usually Not Appropriate contrast ☢☢☢☢ Variant 2: Right upper quadrant pain. No fever or high white blood cell (WBC) count. Suspected biliary disease. Negative or equivocal ultrasound. Procedure Appropriateness Category Relative Radiation Level MRI abdomen without and with IV Usually Appropriate contrast with MRCP O CT abdomen with IV contrast Usually Appropriate ☢☢☢ MRI abdomen without IV contrast with Usually Appropriate MRCP O Nuclear medicine scan gallbladder May Be Appropriate ☢☢ CT abdomen without IV contrast May Be Appropriate ☢☢☢ CT abdomen without and with IV Usually Not Appropriate contrast ☢☢☢☢ Variant 3: Right upper quadrant pain. Fever, elevated WBC count. Suspected biliary disease. Negative or equivocal ultrasound. Procedure Appropriateness Category Relative Radiation Level MRI abdomen without and with IV Usually Appropriate contrast with MRCP O CT abdomen with IV contrast Usually Appropriate ☢☢☢ Nuclear medicine scan gallbladder Usually Appropriate ☢☢ MRI abdomen without IV contrast with May Be Appropriate MRCP O CT abdomen without IV contrast May Be Appropriate ☢☢☢ CT abdomen without and with IV Usually Not Appropriate contrast ☢☢☢☢ ACR Appropriateness Criteria® 1 Right Upper Quadrant Pain Variant 4: Right upper quadrant pain. -
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. -
Cholecystokinin Cholescintigraphy: Methodology and Normal Values Using a Lactose-Free Fatty-Meal Food Supplement
Cholecystokinin Cholescintigraphy: Methodology and Normal Values Using a Lactose-Free Fatty-Meal Food Supplement Harvey A. Ziessman, MD; Douglas A. Jones, MD; Larry R. Muenz, PhD; and Anup K. Agarval, MS Department of Radiology, Georgetown University Hospital, Washington, DC Fatty meals have been used by investigators and clini- The purpose of this investigation was to evaluate the use of a cians over the years to evaluate gallbladder contraction in commercially available lactose-free fatty-meal food supple- conjunction with oral cholecystography, ultrasonography, ment, as an alternative to sincalide cholescintigraphy, to de- and cholescintigraphy. Proponents assert that fatty meals velop a standard methodology, and to determine normal gall- are physiologic and low in cost. Numerous different fatty bladder ejection fractions (GBEFs) for this supplement. meals have been used. Many are institution specific. Meth- Methods: Twenty healthy volunteers all had negative medical histories for hepatobiliary and gallbladder disease, had no per- odologies have differed, and few investigations have stud- sonal or family history of hepatobiliary disease, and were not ied a sufficient number of subjects to establish valid normal taking any medication known to affect gallbladder emptying. All GBEFs for the specific meal. Whole milk and half-and-half were prescreened with a complete blood cell count, compre- have the advantage of being simple to prepare and admin- hensive metabolic profile, gallbladder and liver ultrasonography, ister (4–7). Milk has been particularly well investigated. and conventional cholescintigraphy. Three of the 20 subjects Large numbers of healthy subjects have been studied, a were eliminated from the final analysis because of an abnormal- clear methodology described, and normal values determined ity in one of the above studies. -
Procedure Codes for Physician: Radiology
NEW YORK STATE MEDICAID PROGRAM PHYSICIAN - PROCEDURE CODES SECTION 4 - RADIOLOGY Physician – Procedure Codes, Section 4 - Radiology Table of Contents GENERAL INSTRUCTIONS ............................................................................................................ 4 GENERAL RULES AND INFORMATION ......................................................................................... 6 MMIS RADIOLOGY MODIFIERS .................................................................................................... 8 DIAGNOSTIC RADIOLOGY (DIAGNOSTIC IMAGING)................................................................. 9 HEAD AND NECK.................................................................................................................... 9 CHEST .................................................................................................................................. 10 SPINE AND PELVIS .............................................................................................................. 11 UPPER EXTREMITIES .......................................................................................................... 12 LOWER EXTREMITIES ......................................................................................................... 13 ABDOMEN ............................................................................................................................ 14 GASTROINTESTINAL TRACT ............................................................................................... 15 URINARY