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Focal Spot, Spring 2006

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Focal Spot, Spring 2006, April 2006. Bernard Becker Medical Library Archives. Washington University School of Medicine.

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HISTORY Nuclear Medicine Begins with a Boa Constrictor

HISTORY Nuclear Medicine Begins with a Boa Constrictor Marshal! Brucer J Nucl Med 19: 581-598, 1978 In the beginning, a boa constrictor defecated in and then analyzed the insoluble precipitate. Just as London and the subsequent development of nuclear he suspected, it was almost pure (90.16%) uric medicine was inevitable. It took a little time, but the acid. As a thorough scientist he also determined the 139-yr chain of cause and effect that followed was "proportional number" of 37.5 for urea. ("Propor inexorable (7). tional" or "equivalent" weight was the current termi One June week in 1815 an exotic animal exhibi nology for what we now call "atomic weight.") This tion was held on the Strand in London. A young 37.5 would be used by Friedrich Woehler in his "animal chemist" named William Prout (we would famous 1828 paper on the synthesis of urea. Thus now call him a clinical pathologist) attended this Prout, already the father of clinical pathology, be scientific event of the year. While he was viewing a came the grandfather of organic chemistry. boa constrictor recently captured in South America, [Prout was also the first man to use iodine (2 yr the animal defecated and Prout was amazed by what after its discovery in 1814) in the treatment of thy he saw. The physiological incident was common roid goiter. He considered his greatest success the place, but he was the only person alive who could discovery of muriatic acid, inorganic HC1, in human recognize the material. Just a year earlier he had gastric juice.
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.
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.
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 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.
Radiocarbon Revolution Chris Turney Applauds a Book on Carbon-14 and Its Key Applications

JAMES KING-HOLMES/SPL JAMES A human femur, thought to be from medieval times, being sampled for carbon dating. GEOSCIENCE Radiocarbon revolution Chris Turney applauds a book on carbon-14 and its key applications. t is nearly 80 years since the discovery — whose discoveries the carefully gathered sample and found that of carbon-14, a radioactive isotope of made possible the it was measurably radioactive. The story of the sixth element. Because its decay can theory, practice and 14C thus began with a dose of high drama. Ibe used to track the passage of time, radio- further findings we Originally expected to have a half-life of carbon has made myriad contributions now take for granted. just minutes or hours, this heavy form of car- across the Earth, environmental, biological There’s enough to sat- bon was considered a low research priority. and archaeological sciences. In the wonder- isfy the most in satiable But Kamen and Ruben’s efforts proved that fully engaging Hot Carbon, oceanographer informavore. it would be stable over millennia, opening up John Marra takes this story much further, Hot Carbon starts a breathtaking number of research avenues exploring not just the science, but why we with the extraordi- (its half-life of 5,730 years was determined should care about it. nary story of chemist Hot Carbon: some years later). Kamen never received the Carbon-14 and Radiocarbon is scarce in nature, formed in Martin Kamen, born a Revolution in credit he deserved, becoming a victim of the the upper atmosphere through the interaction in Canada to Russian Science US anti-communist fervour of the 1940s and of cosmic rays with nitrogen.
Answer Key Chapter 1

Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 1 of 101 Answer Key Chapter 1 Introduction to Clinical Coding 1.1: Self-Assessment Exercise 1. The patient is seen as an outpatient for a bilateral mammogram. CPT Code: 77055-50 Note that the description for code 77055 is for a unilateral (one side) mammogram. 77056 is the correct code for a bilateral mammogram. Use of modifier -50 for bilateral is not appropriate when CPT code descriptions differentiate between unilateral and bilateral. 2. Physician performs a closed manipulation of a medial malleolus fracture—left ankle. CPT Code: 27766-LT The code represents an open treatment of the fracture, but the physician performed a closed manipulation. Correct code: 27762-LT 3. Surgeon performs a cystourethroscopy with dilation of a urethral stricture. CPT Code: 52341 The documentation states that it was a urethral stricture, but the CPT code identifies treatment of ureteral stricture. Correct code: 52281 4. The operative report states that the physician performed Strabismus surgery, requiring resection of the medial rectus muscle. CPT Code: 67314 The CPT code selection is for resection of one vertical muscle, but the medial rectus muscle is horizontal. Correct code: 67311 5. The chiropractor documents that he performed osteopathic manipulation on the neck and back (lumbar/thoracic). CPT Code: 98925 Note in the paragraph before code 98925, the body regions are identified. The neck would be the cervical region; the thoracic and lumbar regions are identified separately. Therefore, three body regions are identified. Correct code: 98926 Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 2 of 101 6.
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.
(IKB): Absolute Dating Methods in Archaeology and the Basis Of

14C u okolišu 14C v okolju 14C in environment Ines KRAJCAR BRONIĆ i Jadranka BAREŠIĆ [email protected] IJS, Ljubljana, 9.12.2015. • 14C metoda – uvod, ciklus ugljika, produkcija 14C • Raspodjela ugljika u prirodi (atmosfera) • Određivanje starosti • Veličine i jedinice • Procjena doze • Mjerne tehnike određivanja 14C • Monitoring 14C u okolici NE • Monitoring u okolici NEK 2 Carbon isotopes 12C 13C 14C 98.89 % 1.11 % 10-10 % p = n = 6 n = 7 n = 8 T = 5730 y 1/2 3 U atmosferi - uglavnom kao CO2, 0,03 (0,04)% vol. - važna uloga za održavanje života na Zemlji - koriste biljke za proces fotosinteze ATMOSFERA 580 GtC (18.st) - 750 + (danas) 100 pMC (do 200 pMC u 20.st) Vraća se u -6,5‰ do -8‰ atmosferu disanjem biljaka i životinja, raspadanjem BIOSFERA vegetacija 600 GtC FOSILNA GORIVA biljnog i životinjskog 100 pMC Površinski ocean 10-20000 GtC tkiva, spaljivanjem (-25 ± 5)‰ 800 - 1000 GtC 0 pMC organskog 95 pMC (-25 ± 5)‰ (0 ± 2)‰ materijala, tlo 1600 GtC oslobađanjem iz <100 pMC (-25 ± 5)‰ tople morske vode i SEDIMENTNE STIJENE vulkanskim 66 - 100 x 109 GtC erupcijama. Duboki ocean 0 pMC 38-40000 GtC (0 ± 2)‰ <100 pMC 0 ‰ CO se otapa u morskoj vodi (veća 2 Izgaranjem fosilnih goriva oslobađa topivost u hladnijoj vodi), a i u vodi 4 se ugljik koji je milijunima godina koja prolazi kroz tlo, stvarajući bio spremljen u litosferi. ugljičnu kiselinu, koja može otapati vapnenačke stijene. Discovery of 14C Obituary Martin Kamen Scientist, co-discoverer of the isotope that gave archaeology carbon-dating, and innocent victim of America's Communist witchhunts (Pearce Wright , The Guardian, Monday 9 September 2002) The American scientist Professor Martin Kamen was the co-discoverer of the radioactive isotope carbon-14.
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.