The Urinary Tract Philip S
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Contrast‐Enhanced Ultrasound Bibliography General Principles 1
Contrast‐enhanced Ultrasound Bibliography General Principles 1.Claudon M et al. Guidlines and Good Clinical Practice Recommendations for Contrast Ultrasound (CEUS)‐Update 2008 Ultraschall in Med 2008;29:28‐44 2.Cosgrove. D. Editorial. Eur Radiol Suppl (2004).14[Suppl 8]:1‐3 3.Burns PN, Wilson,S. Microbubble Contrast for Radiological Imaging:1 Principles. Ultrasound Quarterly 2006;22:5‐11 4.Wilson S et al. Contrast‐enhanced Ultrasound: What is the Evidence and What Are the Obstacles? AJR. 2009;193:55‐60 Safety 1.ter Haar GR. Ultrasonic Contrast Agents: Safety Considerations Reviewed. Eur J Radiol 2002;41:217‐221 2. Main MI. Ultrasound Contrast Agent Safety. J Am Coll Cardiol Img 2009:2:1057‐ 1059 3. Pisaglia F et al. SonoVue in Abdominal applications: Retrospective Analysis of 23188 Investigations. Ultrasound in Med and Biol.2006;32:1369‐1375 4. Hynynen K et al. The Threshold for Brain Damage in Rabbits Induced By Bursts of Ultrasound in the Presence of an Ultrasound Contrast Agent (Optison). Ultrasound in Med and Biol;29:473‐481 Voiding Urosonography 1.Darge K. et al. Reflux in Young Patients: Comparison of Voiding US of the Bladder and Retrovesical Space with Echo Enhancement versus Voiding Cystourethrography for Diagnosis. Radiology 1999;210:201‐207 2.Radmayr C et al. Contrast Enhanced Reflux Sonography in Children: A Comparison to Standard Radiological Imaging J Urol 2002;167:1428‐30 Liver Lesion Characterization 1.Bolondi L et al. New Perspectives for the Use of Contrast‐Enhanced Liver Ultrasound in Clinical Practice. Digestive and Liver Disease 2007;39:187‐195 2.Berry J, Sidu, P. -
Nuclear Medicine for Medical Students and Junior Doctors
NUCLEAR MEDICINE FOR MEDICAL STUDENTS AND JUNIOR DOCTORS Dr JOHN W FRANK M.Sc, FRCP, FRCR, FBIR PAST PRESIDENT, BRITISH NUCLEAR MEDICINE SOCIETY DEPARTMENT OF NUCLEAR MEDICINE, 1ST MEDICAL FACULTY, CHARLES UNIVERSITY, PRAGUE 2009 [1] ACKNOWLEDGEMENTS I would very much like to thank Prof Martin Šámal, Head of Department, for proposing this project, and the following colleagues for generously providing images and illustrations. Dr Sally Barrington, Dept of Nuclear Medicine, St Thomas’s Hospital, London Professor Otakar Bělohlávek, PET Centre, Na Homolce Hospital, Prague Dr Gary Cook, Dept of Nuclear Medicine, Royal Marsden Hospital, London Professor Greg Daniel, formerly at Dept of Veterinary Medicine, University of Tennessee, currently at Virginia Polytechnic Institute and State University (Virginia Tech), Past President, American College of Veterinary Radiology Dr Andrew Hilson, Dept of Nuclear Medicine, Royal Free Hospital, London, Past President, British Nuclear Medicine Society Dr Iva Kantorová, PET Centre, Na Homolce Hospital, Prague Dr Paul Kemp, Dept of Nuclear Medicine, Southampton University Hospital Dr Jozef Kubinyi, Institute of Nuclear Medicine, 1st Medical Faculty, Charles University Dr Tom Nunan, Dept of Nuclear Medicine, St Thomas’s Hospital, London Dr Kathelijne Peremans, Dept of Veterinary Medicine, University of Ghent Dr Teresa Szyszko, Dept of Nuclear Medicine, St Thomas’s Hospital, London Ms Wendy Wallis, Dept of Nuclear Medicine, Charing Cross Hospital, London Copyright notice The complete text and illustrations are copyright to the author, and this will be strictly enforced. Students, both undergraduate and postgraduate, may print one copy only for personal use. Any quotations from the text must be fully acknowledged. It is forbidden to incorporate any of the illustrations or diagrams into any other work, whether printed, electronic or for oral presentation. -
ACR–SPR Practice Parameter for the Performance of Voiding
The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2019 (Resolution 10)* ACR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE OF FLUOROSCOPIC AND SONOGRAPHIC VOIDING CYSTOURETHROGRAPHY IN CHILDREN PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1. -
500 Pyelograms Done After Angiocardiography. the Urinary Tract
9 Section ofRadiology 419 often transitory, it can readily be reproduced by In 200 consecutive pyelograms, analysed both instructing the child to hold back urine and we by congenital heart lesion and urinary tract now believe that this is a common variation of the abnormality, the incidence of abnormal pyelo- normal. It is probably due to distension of the grams was 13 %. The range ofabnormality in both thin-walled proximal urethra, the less distensible is very wide. Pyelogram abnormalities in this bladder neck and distal urethra forming two series and subsequently have included failure of relatively narrow segments. maturation of kidney with pelvis lying intra- renally, solitary kidney, chronic pyelonephritic A 'corkscrew urethra' has been seen in 4 boys kidney, large kidneys, renal rotation, hydro- in this series. It may be associated with reflux. nephrosis, absence of renal pelves, duplication of Cystoscopy and urethroscopy has been normal kidney and ureter (one having a pyelonephritic and in one patient recordings of pressure and lower segment and evidence of vesicoureteric flow were also normal. We can only assume that reflux - Williams 1962), hydroureter and spinal this appearance is produced by redundant folds defects with neurogenic bladder. Factors affecting of mucosa; certainly there has been no evidence cardiac development may affect organogenesis in of obstruction in any of our cases. the urinary tract. The rubella virus was the defined factor in a patient, aged 4 months, with patent Summary ductus arteriosus, pulmonary hypertension and Micturating cystograms carried out in 232 pneumonitis and a miniature left kidney (autopsy children presenting with urinary infection, but proof). -
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. -
Advantages of Hybrid SPECT/CT Vs SPECT Alone Heather A
The Open Medical Imaging Journal, 2008, 2, 67-79 67 Open Access Advantages of Hybrid SPECT/CT vs SPECT Alone Heather A. Jacene*,1, Sibyll Goetze1,2, Heena Patel1, Richard L. Wahl1 and Harvey A. Ziessman1 1Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hop- kins University, Baltimore, MD, USA 2Current Address: Department of Radiology, University of Alabama, Birmingham, AL, USA Abstract: We present our initial two year clinical experience with SPECT/CT, compare the interpretation to SPECT alone, provide illustrative cases, and review the published literature. Hybrid SPECT/CT has added clinical value over SPECT imaging alone primarily due to more precise anatomical lesion localization. After reading this report, the reader will appreciate the advantages of SPECT/CT imaging for clinical practice. We have reviewed SPECT/CT studies of 144 adult patients referred for various clinical indications in a busy nuclear medicine practice. The SPECT and fused SPECT/CT images were reviewed and interpreted separately to determine if addition of the fused CT images added in- cremental information, e.g., more definitive anatomic localization, more definitive diagnostic certainty, or changed final image interpretation compared to the SPECT images alone. Our analysis showed that SPECT/CT provided additional in- formation for image interpretation in 54% (78/144) of cases. In most of these (68/78), the CT data improved localization of abnormal and physiologic findings. Diagnostic certainty was improved in 34/144 cases (24%) and image interpretation was beneficially altered in 18/144 cases (13%). The fusion of anatomical and functional information by hybrid SPECT/CT positively impacts image interpretation and adds diagnostic value over SPECT alone. -
Use of Ultrasound As an Alternative to Fluoroscopy
Use of Ultrasound as an Alternative to Fluoroscopy Rahul Sheth, MD Massachusetts General Hospital, Boston, MA PART 1. INTERVENTIONAL PROCEDURES Fluoroscopy has significantly contributed to the advent and proliferation of image-guided interventions across the gamut of clinical medicine. While these procedures allow for the execution of often complex internal manipulations through a small skin nick rather than a surgical incision, they are not without risk, including the risks of ionizing radiation [1]. In these procedures, fluoroscopy simply serves as an image guidance tool, and as such, alternative imaging modalities that do not rely on ionizing radiation can and should be considered. For example, as a real-time, high resolution imaging modality, ultrasound shares many characteristics with fluoroscopy. However, due to its lack of reliance on ionizing radiation, ultrasound is often the imaging tool of choice for a number of image-guided interventions for which fluoroscopy may also be considered, particularly in the pediatric population. The following examples illustrate specific indications in which ultrasound is preferred over fluoroscopy for interventional procedures. Ultrasound Instead Of Fluoroscopy For Musculoskeletal Procedures Ultrasound is ideally suited for image guided interventions upon the musculoskeletal system [2], as the depth of penetration required for these procedures is typically within several centimeters. A wide array of musculoskeletal interventions can be performed with ultrasound guidance, including arthrocentesis [3,4], joint and soft tissue steroid/anesthetic injections [5,6,7], and aspirations [8,9]. Moreover, while fluoroscopy is the most common imaging modality used for cervical nerve blocks and facet injections, there has recently been tremendous growth in the use of ultrasound for these interventions. -
Diagnostic Performance of Contrast-Enhanced Ultrasound For
www.nature.com/scientificreports OPEN Diagnostic performance of contrast‑enhanced ultrasound for acute pyelonephritis in children Hyun Joo Jung1, Moon Hyung Choi2, Ki Soo Pai1 & Hyun Gi Kim2,3* The objective of our study was to evaluate the performance of renal contrast‑enhanced ultrasound (CEUS) against the 99m-labeled dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) in children for the diagnosis of acute pyelonephritis. We included children who underwent both renal CEUS and the DMSA scan or CT. A total of 33 children (21 males and 12 females, mean age 26 ± 36 months) were included. Using the DMSA scan as the reference standard, the sensitivity, specifcity, positive predictive value, and negative predictive value of CEUS was 86.8%, 71.4%, 80.5%, and 80.0%, respectively. When CT was used as the reference standard, the sensitivity, specifcity, positive predictive value, and negative predictive value of CEUS was 87.5%, 80.0%, 87.5%, and 80.0%, respectively. The diagnostic accuracy of CEUS for the diagnosis of acute pyelonephritis was 80.3% and 84.6% compared to the DMSA scan and CT, respectively. Inter-observer (kappa = 0.54) and intra-observer agreement (kappa = 0.59) for renal CEUS was moderate. In conclusion, CEUS had good diagnostic accuracy for diagnosing acute pyelonephritis with moderate inter‑ and intra‑observer agreement. As CEUS does not require radiation or sedation, it could play an important role in the future when diagnosing acute pyelonephritis in children. Urinary tract infection (UTI) is a common cause of illness with fever in children. It frequently develops in boys during their frst year of life and is more frequent in girls of older ages 1. -
Radionuclides in Nephrourology, Part 2: Pitfalls and Diagnostic Applications
Journal of Nuclear Medicine, published on March 3, 2014 as doi:10.2967/jnumed.113.133454 CONTINUING EDUCATION Radionuclides in Nephrourology, Part 2: Pitfalls and Diagnostic Applications Andrew T. Taylor Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the common clinical indications of suspected obstruction and renovascular hypertension; (2) the status of radionuclide renal imaging in the evaluation of the transplanted kidney and the detection of infection; and (3) potential pitfalls. Financial Disclosure: This review was partially supported by a grant from the National Institutes of Health (NIH/NIDDK R37 DK38842). Andrew T. Taylor is entitled to a share of the royalties for the use of QuantEM software for processing MAG3 renal scans, which was licensed by Emory University to GE Healthcare in 1993. He and his coworkers have subsequently developed in-house, noncommercial software that was used in this study and could affect their financial status. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest policies. The author of this article has indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. -
Introducing PET/CT at AIMS, Kochi
Nuclear medicine investigations use small amounts of FDA approved sterile radioactive materials for imaging. These investigations are safe, can be used in all age groups even extremes of age and are painless. Small amounts of radiopharmaceuticals are introduced into the body by injection, swallowing, or inhalation. These radiopharmaceuticals are substances, which are organ specific and get bound within a period of time to the organ and facilitate imaging. The amount of radiopharmaceutical used is carefully selected to provide the least amount of radiation exposure to the patient but ensure an accurate test. A special camera (PET, SPECT gamma camera) is then used to take pictures of your body. The camera detects the radiopharmaceutical in the organ, bone or tissue and forms images that provide data and information about the area in question. Nuclear medicine differs from an x-ray, ultrasound or other diagnostic test because it determines the presence of disease based on biological changes rather than changes in anatomy. Hence it helps in early detection of a disease much before other anatomical imaging modality picks up. GAMMA CAMERA (SPECT/CT) GAMMA CAMERA APPLICATIONS: Cardiac Applications: Coronary Artery Disease Measure Effectiveness of Bypass Surgery Measure Effectiveness of Therapy for Heart Failure Detect Heart Transplant Rejection Select Patients for Bypass or Angioplasty Identify Surgical Patients at High Risk for Heart Attacks Identify Right Heart Failure Measure Chemotherapy Cardiac Toxicity Evaluate Valvular Heart Disease Identify -
Value of Imaging After Urinary Tract Infections. Arch Dis Child: First Published As 10.1136/Adc.72.5.393 on 1 May 1995
Archives ofDisease in Childhood 1995; 72: 393-396 393 Long term follow up to determine the prognostic value of imaging after urinary tract infections. Arch Dis Child: first published as 10.1136/adc.72.5.393 on 1 May 1995. Downloaded from Part 2: scarring Malcolm V Merrick, Alp Notghi, Nicholas Chalmers, A Graham Wilkinson, William S Uttley Abstract under 1 year or in children of any age Long term follow up of children with with bladder control. No case can be urinary tract infections, in whom imag- made for any abbreviated schedule of ing investigations were performed at pre- investigation. These risk factors should sentation, has been used to identify be taken into account when designing fol- features that distinguish those at greatest low up protocols. risk of progressive renal damage. No (Arch Dis Child 1995; 72: 393-396) single investigation at presentation was Keywords: vesicoureteric reflux, urinary tract able to predict subsequent deterioration infection, reflux nephropathy. but, by employing a combination of imaging investigations, it was possible to separate groups with high or low proba- bility of progressive damage. In the low Imaging investigations are generally con- risk group the incidence of progressive sidered essential in the work-up of children damage was 02% (95% confidence with a urinary tract infection.' Much attention interval (CI) 0 to 1.3%). The combination has been paid to the importance of identifying of both scarring and reflux at vesicoureteric reflux before the development of presentation, or one only of these but overt reflux nephropathy, although the limita- accompanied by subsequent documented tions of the tests that detect reflux have been urinary tract infection, was associated largely overlooked.2 The prognostic impor- with a 17-fold (95% CI 2*5 to 118) increase tance of focal scarring is widely recognised; in the relative risk of progressive renal that of diffuse scarring is less well docu- damage compared with children without mented.3 However, most series with follow up these features. -
Intra- and Interobserver Variability in Interpretation of DMSA Scans Using a Set of Standardized Criteria
Pediatr Radiol (1993) 23:506-509 Pediatric Radiology Springer-Verlag 1993 Intra- and interobserver variability in interpretation of DMSA scans using a set of standardized criteria K. Patel, M. Charron, A. Hoberman, M. L. Brown, K.D. Rogers Division of Nuclear Medicine and Department of Pediatrics, Children's Hospital and University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA Received: 24 May 1993/Accepted: 10 August 1993 Abstract. A set of criteria was developed to standardize various limitations with respect to sensitivity, accuracy or assessment of DMSA renal scintigraphy which were per- feasibility [6-8]. formed to evaluate children for acute pyelonephritis and More recently, the Tc-99m dimercaptosuccinic acid renal scarring. This study was undertaken to assess intra- (DMSA) scintigraphy has been shown to be an accurate and interobserver variability in the interpretation of method to diagnose acute pyelonephritis in experimental DMSA renal scintigraphy using these criteria. Renal con- and clinical studies [9-14]. However, various authors have tours and parenchyma were assessed in three zones. Con- used different criteria for the interpretation of DMSA tours were assessed as normal or abnormal and parenchy- renal scintigraphy. real defects were evaluated in terms of character, shape In this study, criteria developed by Maid [15], Conway and degree in three regions (upper and lower pole and [16], and other authors [17, 18] were unified and modified midzone). Two nuclear medicine physicians blindly re- into a set of standardized criteria for interpreting renal viewed 57 DMSA scintigraphy on two occasions each. Dis- cortical scintigrams (DMSA or glucoheptonate), in an at- agreement of each observer's evaluation of the same scinti- tempt to (1) enhance accuracy and reliability of interpre- graphy on two different occasions was described as in- tation, and (2) enable more valid comparison of results of traobserver variability, and the comparison between read- different studies.