Latest Articles Include:
- Quality Initiatives: Strategies for Establishing a Comprehensive Quality and Performance Improvement Program in a Radiology Department
Kruskal JB Anderson S Yam CS Sosna J - Radiographics 29(2):315-329 (2009)
To improve the safety and quality of the care that radiologists provide, and to allow radiologists and radiology personnel to remain competitive in an increasingly complex environment, it is essential that all imaging departments establish and maintain managed, comprehensive, and effective performance improvement programs. Although the structure and focus of these programs can vary, a number of common components exist, many of which are now widely mandated by organizations that regulate the field of radiology. Basic components include patient safety, process improvement, customer service, professional staff assessment, and education, each of which requires strategies for implementing continuous programs to monitor performance, analyzing and depicting data, implementing change, and meeting regulatory requirements. All of these components are part of a comprehensive quality management system in a large academic radiology department. For smaller departments or practices, ! the gradual introduction of one or more of these components is useful in ensuring the safety and quality of their services. (C) RSNA, 2009 - MR Imaging of Hypervascular Liver Masses: A Review of Current Techniques
Silva AC Evans JM McCullough AE Jatoi MA Vargas HE Hara AK - Radiographics 29(2):385-402 (2009)
Major technologic advances in magnetic resonance (MR) imaging, including the advent of novel pulse sequences (eg, diffusion-weighted and steady-state free precession sequences) and the use of hepatocyte-specific contrast agents, have led to better image quality and shorter acquisition times, resulting in dramatic improvements in the noninvasive detection and characterization of hepatic lesions, particularly hypervascular neoplasms. However, as the role of MR imaging in clinical evaluation of the liver continues to evolve, keeping abreast of new developments can be daunting as well as confusing. A systematic approach that makes use of a simple decision algorithm can help differentiate hypervascular hepatic lesions on the basis of their distinguishing MR imaging characteristics and related clinical information. (C) RSNA, 2009 - Multimodality Assessment of Esophageal Cancer: Preoperative Staging and Monitoring of Response to Therapy
Kim TJ Kim HY Lee KW Kim MS - Radiographics 29(2):403-421 (2009)
Esophageal cancer is a leading cause of cancer mortality worldwide. Complete resection of esophageal cancer and adjacent malignant lymph nodes is the only potentially curative treatment. Accurate preoperative staging and assessment of therapeutic response after neoadjuvant therapy are crucial in determining the most suitable therapy and avoiding inappropriate attempts at curative surgery. Computed tomography (CT) is recommended for initial imaging following confirmation of malignancy at pathologic analysis, primarily to rule out unresectable or distant metastatic disease. With the advent of multidetector CT, use of thin sections and multiplanar reformation allows more accurate staging of esophageal cancer. Endoscopic ultrasonography (US) is the best modality for determining the depth of tumor invasion and presence of regional lymph node involvement. Combined use of fine-needle aspiration and endoscopic US can improve assessment of lymph node involvement. Positron emiss! ion tomography (PET) is useful for assessment of distant metastases but is not appropriate for detecting and staging primary tumors. PET may also be helpful in restaging after neoadjuvant therapy, since it allows identification of early response to treatment and detection of interval distant metastases. Each imaging modality has its advantages and disadvantages; therefore, CT, endoscopic US, and PET should be considered complementary modalities for preoperative staging and therapeutic monitoring of patients with esophageal cancer. (C) RSNA, 2009 - Small Bowel Obstruction: What to Look For
Silva AC Pimenta M Guimarães LS - Radiographics 29(2):423-439 (2009)
Small bowel obstruction (SBO) is a common clinical syndrome for which effective treatment depends on a rapid and accurate diagnosis. Despite advances in imaging and a better understanding of small bowel pathophysiology, SBO is often diagnosed late or misdiagnosed, resulting in significant morbidity and mortality. A comprehensive approach that includes clinical findings, patient history, and triage examinations such as plain abdominal radiography will help the clinician develop an individualized treatment plan. When an SBO is accompanied by signs of strangulation, emergent surgical treatment is advised. If surgery cannot be performed immediately or if a partial obstruction is suspected, then a more detailed radiologic work-up is needed. The imaging techniques used subsequently vary according to the initial findings. If a low-grade partial obstruction is suspected, volume-challenge enteral examinations such as enteroclysis and computed tomographic (CT) enteroclysis are p! referred. If a complete or high-grade obstruction is suspected, cross-sectional studies such as ultrasonography or multidetector CT are used to exclude strangulation. An algorithmic approach to imaging is proposed for the management of SBO to achieve accurate diagnosis of the obstruction; determine its severity, site, and cause; and assess the presence of strangulation. Radiologists have a pivotal role in clinical decision making in cases of SBO by providing answers to specific questions that significantly affect management. (C) RSNA, 2009 - Complications of Continuous Ambulatory Peritoneal Dialysis
Stuart S Booth TC Cash CJ Hameeduddin A Goode JA Harvey C Malhotra A - Radiographics 29(2):441-460 (2009)
Continuous ambulatory peritoneal dialysis (CAPD) is used to treat end-stage renal failure in an increasing number of patients. CAPD has an advantage over hemodialysis in that it allows patients greater freedom to perform daily activities; it also provides other clinical benefits. However, the long-term effectiveness of CAPD is limited by complications, which have various causes. Complications with an infectious cause include bacterial peritonitis, tuberculous peritonitis, and infections of the catheter exit site and tunnel. Noninfectious complications include catheter dysfunction, dialysate leakage, hernias, and sclerosing encapsulating peritonitis. Many imaging modalities--radiography, ultrasonography, peritoneal scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging--are useful for characterizing these complications. CT peritoneography and MR peritoneography are techniques specifically suited to this purpose. Imaging plays a critical role in ensu! ring that complications are detected early and managed appropriately. (C) RSNA, 2009 - CT Findings in Urinary Diversion after Radical Cystectomy: Postsurgical Anatomy and Complications
Catalá V Solà M Samaniego J Martí T Huguet J Palou J De La Torre P - Radiographics 29(2):461-476 (2009)
Numerous surgical procedures have been developed for urinary diversion in patients who have undergone a radical cystectomy for bladder cancer or, less frequently, a benign condition. Because urinary diversion procedures are complex, early and late postsurgical complications frequently occur. Possible complications include alterations in bowel motility, anastomotic leaks, fluid collections (abscess, urinoma, lymphocele, and hematoma), fistulas, peristomal herniation, ureteral strictures, calculi, and tumor recurrence. Computed tomography (CT) is an accurate method for evaluating such events. Multiplanar reformatting and three-dimensional volume rendering of multidetector CT image data are particularly useful for achieving an accurate and prompt diagnosis of complications and obtaining information that is essential for adequate surgical management. In addition, knowledge of urinary diversion procedures, normal postsurgical appearances, and optimal CT technique for postsu! rgical evaluations is essential for detecting complications and avoiding misdiagnosis. (C) RSNA, 2009 - Painful Penile Induration: Imaging Findings and Management
Bertolotto M Pavlica P Serafini G Quaia E Zappetti R - Radiographics 29(2):477-493 (2009)
A number of benign and malignant diseases with different causes, clinical features, management, and outcome can manifest as painful penile induration. The most common such conditions are active Peyronie disease, inflammation, trauma, venous or corporal thrombosis, acute ischemic disorders, and primary or secondary tumors. In patients with painful penile induration, a preliminary differential diagnosis is based on the patient's history and results of laboratory studies, penile inspection, and palpation. Imaging is often required to confirm the clinical diagnosis, assess the extent of disease, and determine patient treatment. A basic clinical investigation comprising penile inspection and palpation should be performed by the radiologist before imaging; such an evaluation is a great help in selecting the best imaging modality and examination technique. Moreover, acquisition of preliminary clinical information eases interpretation of the imaging features and facilitates id! entification of clinically relevant information that may result in a change in patient treatment. In standard clinical practice, color Doppler ultrasonography is often the first imaging modality used to evaluate patients with painful penile induration. This technique clearly demonstrates normal penile anatomy and its corresponding changes in most of the clinically relevant situations. Magnetic resonance imaging is the optimal imaging modality for tumor staging. Other imaging modalities are required less frequently. (C) RSNA, 2009 - MR Imaging Findings of Hydrosalpinx: A Comprehensive Review
Kim MY Rha SE Oh SN Jung SE Lee YJ Kim YS Byun JY Lee A Kim MR - Radiographics 29(2):495-507 (2009)
Hydrosalpinx is a common adnexal lesion that may occur either in isolation or as a component of a complex pathologic process (eg, pelvic inflammatory disease, endometriosis, fallopian tube tumor, or tubal pregnancy) that leads to distal tubal occlusion. On magnetic resonance (MR) images, hydrosalpinx appears as a fluid-filled C- or S-shaped tubular structure that arises from the upper lateral margin of the uterus. Although hydrosalpinx is most often seen on ultrasonographic images, it also may be delineated on multiplanar MR images. MR imaging also may be useful for determining the cause of a hydrosalpinx or its associated adnexal process by characterizing the nature of the contents of the dilated tube. Tubal fluid with high signal intensity on T1-weighted images is suggestive of hematosalpinx associated with endometriosis and tubal pregnancy. A thickened wall of a dilated fallopian tube that displays variable or heterogeneous signal intensity may be indicative of pyos! alpinx as a component of a tubo-ovarian abscess. The presence of an enhancing solid mass within a dilated tube is suggestive of fallopian tube carcinoma, whereas enhancement of the dilated tubal wall surrounding a saclike cystic mass may be indicative of a tubal pregnancy. Understanding the pathogenesis and clinical manifestations of conditions associated with hydrosalpinx may aid in the timely diagnosis of complex adnexal masses at MR imaging, enabling avoidance of unnecessary procedures. (C) RSNA, 2009 - Nipple-Areolar Complex: Normal Anatomy and Benign and Malignant Processes
Nicholson BT Harvey JA Cohen MA - Radiographics 29(2):509-523 (2009)
The nipple-areolar complex may be affected by many normal variations in embryologic development and breast maturation as well as by abnormal processes of a benign or malignant nature. Benign processes that may affect the nipple-areolar complex include eczema, duct ectasia, periductal mastitis, adenomas, papillomas, leiomyomas, and abscesses; malignant processes include Paget disease, lymphoma, and invasive and noninvasive breast cancers. Radiologists should be aware of the best methods for evaluating each of these entities: Many disorders of the nipple-areolar complex are unique or differ in important ways from those that occur elsewhere in the breast, and they require a diagnostically specific imaging evaluation. Patients may present with benign developmental variations; inversion, retraction, or enlargement of the nipple, which may have either a benign or a malignant cause; a palpable mass; nipple discharge; skin changes in and around the nipple; infection with resul! tant nipple changes or a subareolar mass; or abnormal findings at routine mammographic screening. Further diagnostic imaging may include repeat mammography, breast ultrasonography, galactography, and magnetic resonance imaging. When skin changes are present, a clinical evaluation by the patient's primary care physician, dermatologist, or surgeon should be part of the diagnostic work-up. (C) RSNA, 2009 - Unusual Causes of Varicose Veins in the Lower Extremities: CT Venographic and Doppler US Findings
Jung SC Lee W Chung JW Jae HJ Park EA Jin KN Shin CI Park JH - Radiographics 29(2):525-536 (2009)
There are various causes of varicose veins in the lower extremities. Among the causes are venous insufficiency of the saphenofemoral junction, saphenopopliteal junction, or usual perforating veins. Traditionally, Doppler ultrasonography (US) has been used for evaluation of varicose veins. Sometimes, varicose veins arise from an unexpected anatomic source; in these cases, computed tomographic (CT) venography can provide an overview of the varicose veins. Doppler US with complementary CT venography is useful for determining the precise cause of varicose veins. Between November 2003 and March 2008, the authors evaluated 1350 cases of varicose veins in the lower extremities with both CT venography and Doppler US. The varicose veins were classified according to their causes; unusual causes were studied and included vulvoperineal varicosity, intraosseous perforating vein incompetence, round ligament varicosity, persistent sciatic vein incompetence, Klippel-Trenaunay syndrome! , and portosystemic collateral pathways. Radiologists should be familiar with the complete range of primary causes of varicose veins in the lower extremities and with their radiologic manifestations and should recognize the complementary role of CT venography in their evaluation. (C) RSNA, 2009 - Multidetector CT of Thoracic Aortic Aneurysms
Agarwal PP Chughtai A Matzinger FR Kazerooni EA - Radiographics 29(2):537-552 (2009)
Thoracic aortic aneurysms (TAAs) can be broadly divided into true aneurysms and false aneurysms (pseudoaneurysms). True aneurysms contain all three layers of the aortic wall (intima, media, and adventitia), whereas false aneurysms have fewer than three layers and are contained by the adventitia or periadventitial tissues. Multidetector computed tomographic (CT) angiography allows the comprehensive evaluation of TAAs in terms of morphologic features and extent, presence of thrombus, relationship to adjacent structures and branches, and signs of impending or acute rupture, and is routinely used in this setting. Knowledge of the causes, significance, imaging appearances, and potential complications of both common and uncommon aortic aneurysms, as well as of the normal postoperative appearance of the thoracic aorta, is essential for prompt and accurate diagnosis. Supplemental material available at http://radiographics.rsnajnls.org/cgi/content/full/29/2/537/DC1. (C) RSNA, ! 2009 - ALCAPA Syndrome: Not Just a Pediatric Disease
Peña E Nguyen ET Merchant N Dennie G - Radiographics 29(2):553-565 (2009)
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly. There are two types of ALCAPA syndrome: the infant type and the adult type, each of which has different manifestations and outcomes. Infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the 1st year of life. Rarely, ALCAPA syndrome manifests in adults; it may be an important cause of sudden cardiac death. Historically, ALCAPA syndrome was diagnosed at conventional angiography. However, the development of electrogardiographically gated multidetector computed tomographic (CT) angiography and magnetic resonance (MR) imaging enables accurate noninvasive imaging. At MR imaging and multidetector CT angiography, findings include direct visualization of the left coronary artery arising from the main pulmonary artery. Reversed flow from the left coronary artery into the main pulmonary artery may! be seen at steady-state free-precession cine and fast cine phase-contrast MR imaging. Because of its ability to assess myocardial viability, which can be used as a prognostic factor to direct the need for surgical repair, MR imaging plays an important role in patient treatment. Restoration of a dual-coronary-artery system is the ideal surgical treatment for ALCAPA syndrome. (C) RSNA, 2009 - Interventional Radiology Procedures in Pediatric Patients with Complications after Liver Transplantation
Miraglia R Maruzzelli L Caruso S Marrone G Carollo V Spada M Luca A Gridelli B - Radiographics 29(2):567-584 (2009)
Interventional radiologists play a key role in treating vascular and nonvascular complications of pediatric liver transplantation, improving graft and patient survival and in most cases avoiding the need for surgical revision or repeat transplantation. The interventional radiology procedures most commonly used in this context include percutaneous and transjugular liver biopsies performed with ultrasonographic and fluoroscopic guidance for the diagnosis of graft disease; angioplasty and stent placement for treatment of vascular and biliary occlusion, stenosis, and stricture; and catheter placement for drainage of fluid collections. Since interventional radiology procedures themselves may lead to complications, it is important that the radiologist be familiar with the indications for a particular procedure, the technical considerations, and the expected results, as well as with normal and abnormal postintervention imaging appearances. (C) RSNA, 2009 - Schatzker Classification of Tibial Plateau Fractures: Use of CT and MR Imaging Improves Assessment
Markhardt BK Gross JM Monu JU - Radiographics 29(2):585-597 (2009)
The Schatzker classification system for tibial plateau fractures is widely used by orthopedic surgeons to assess the initial injury, plan management, and predict prognosis. Many investigators have found that surgical plans based on plain radiographic findings were modified after preoperative computed tomography (CT) or magnetic resonance (MR) imaging. The Schatzker classification divides tibial plateau fractures into six types: lateral plateau fracture without depression (type I), lateral plateau fracture with depression (type II), compression fracture of the lateral (type IIIA) or central (type IIIB) plateau, medial plateau fracture (type IV), bicondylar plateau fracture (type V), and plateau fracture with diaphyseal discontinuity (type VI). Management of type I, II, and III fractures centers on evaluating and repairing the articular cartilage. The fracture-dislocation mechanism of type IV fractures increases the likelihood of injury to the peroneal nerve or popliteal! vessels. In type V and VI fractures, the location of soft-tissue injury dictates the surgical approach and the degree of soft-tissue swelling dictates the timing of definitive surgery and the need for provisional stabilization with an external fixator. CT and MR imaging are more accurate than plain radiography for Schatzker classification of tibial plateau fractures, and use of cross-sectional imaging can improve surgical planning. (C) RSNA, 2009 - MR Imaging Assessment of the Spine: Infection or an Imitation?
Hong SH Choi JY Lee JW Kim NR Choi JA Kang HS - Radiographics 29(2):599-612 (2009)
Magnetic resonance (MR) imaging is a powerful diagnostic tool that can be used to help evaluate spinal infection and to help distinguish between an infection and other clinical conditions. In most cases of spinal infection, MR images show typical findings such as vertebral endplate destruction, bone marrow and disk signal abnormalities, and paravertebral or epidural abscesses. However, it is not always easy to diagnose a spinal infection, particularly when some of the classic MR imaging features are absent or when there are unusual patterns of infectious spondylitis. Furthermore, noninfectious inflammatory diseases and degenerative disease may simulate spinal infection. It is necessary to be familiar with atypical MR imaging findings of spinal infection and features that may mimic spinal infection to avoid misdiagnosis and inappropriate treatment. (C) RSNA, 2009 - From the Archives of the AFIP: Secondary Tumors and Tumorlike Lesions of the Peritoneal Cavity: Imaging Features with Pathologic Correlation
Levy AD Shaw JC Sobin LH - Radiographics 29(2):347-373 (2009)
Tumors and tumorlike lesions that secondarily involve the mesothelial or submesothelial layers of the peritoneum are a diverse group of disorders that range in biologic behavior from benign to highly malignant. The anatomy of peritoneal ligaments and mesenteries and the normal circulation of peritoneal fluid dictate location and distribution of these diseases within the peritoneal cavity. Peritoneal carcinomatosis is the most common secondary tumor to affect the peritoneal cavity. When it arises from carcinomas of the gastrointestinal tract or ovary, the prognosis is grave. However, when low-grade mucinous adenocarcinoma of the appendix spreads to the peritoneal cavity, the consequence is typically pseudomyxoma peritonei, which is a clinical syndrome, characterized by recurrent and recalcitrant voluminous mucinous ascites due to surface growth on the peritoneum without significant invasion of underlying tissues. Carcinomas from elsewhere in the body, as well as lymphom! as and sarcomas, may also produce diffuse peritoneal metastasis. Granulomatous peritonitis is the consequence of disseminated infection such as tuberculosis or histoplasmosis, foreign materials, or rupture of a tumor or hollow viscus. Finally, a group of benign miscellaneous conditions that range from common disorders such as endometriosis and splenosis to very rare conditions such as gliomatosis peritonei and melanosis may also affect the peritoneum diffusely. Secondary tumors and tumorlike lesions of the peritoneum have overlapping imaging features when compared with each other and primary peritoneal tumors. Knowledge of peritoneal anatomy, normal fluid circulation within the peritoneal cavity, and clinical and pathologic features of secondary peritoneal lesions is essential for identification of these lesions. - Best Cases from the AFIP: Invasive Aspergillosis of the Brain: Radiologic-Pathologic Correlation
Almutairi BM Nguyen TB Jansen GH Asseri AH - Radiographics 29(2):375-379 (2009)
- Best Cases from the AFIP: Telangiectatic Osteosarcoma: Radiologic and Pathologic Findings
Discepola F Powell TI Nahal A - Radiographics 29(2):380-383 (2009)
- Education Techniques for Lifelong Learning: Lifelong Learning in the 21st Century and Beyond
Collins J - Radiographics 29(2):613-622 (2009)
Lifelong learning is now recognized by educators, governing bodies, accreditation organizations, certification boards, employers, third-party payers, and the general public as one of the most important competencies that people must possess. Promoting lifelong learning as continuous, collaborative, self-directed, active, broad in domain, everlasting, positive and fulfilling, and applicable to one's profession as well as all aspects of one's life has emerged as a major global educational challenge. Meeting this challenge will require changes in the way teachers teach and learners learn, as teachers take on a more facilitative role and learners take more responsibility for setting goals, identifying resources for learning, and reflecting on and evaluating their learning. For physicians, this will require less dependence on traditional educational venues, such as passive continuing medical education activities, and greater participation in self-assessment, peer assessment,! evaluation of performance in practice, documentation of practice-based learning and improvement activities, and learning at the point of care. Radiologists in an academic setting are exposed to multiple opportunities for practicing lifelong learning, such as teaching others, participating in multidisciplinary conferences and journal clubs, and engaging in research. All radiologists can participate in self-audits and group audits of performance and become active participants in national radiology societies, where they can learn from each other. Participation in the American Board of Radiology's Maintenance of Certification program reflects a commitment to actively engage in lifelong learning and is one way of demonstrating to the general public a commitment to maintaining competence. (C) RSNA, 2009 - Informatics in Radiology: Problem-centric Organization and Visualization of Patient Imaging and Clinical Data
Bashyam V Hsu W Watt E Bui AA Kangarloo H Taira RK - Radiographics 29(2):331-343 (2009)
A patient's electronic medical record contains a large amount of unstructured textual information. As patient records become increasingly dense owing to an aging population and increased occurrence of chronic diseases, a tool is needed to help organize and navigate patient data in a way that facilitates a clinician's ability to understand this information and that improves efficiency. A system has been developed for physicians that summarizes clinical information from a patient record. This system provides a gestalt view of the patient's record by organizing information about each disease along four dimensions (axes): time (eg, disease progression over time), space (eg, tumor in left frontal lobe), existence (eg, certainty of existence of a finding), and causality (eg, response to treatment). A display is generated from information provided by radiology reports and discharge summaries. Natural language processing is used to identify clinical abnormalities (problems, sy! mptoms, findings) from these reports as well as associated properties and relationships. This information is presented in an integrated format that organizes extracted findings into a problem list, depicts the information on a timeline grid, and provides direct access to relevant reports and images. The goal of this system is to improve the structure of clinical information and its presentation to the physician, thereby simplifying the information retrieval and knowledge discovery necessary to bridge the gap between acquiring raw data and making an informed diagnosis. (C) RSNA, 2009 - Editor's Page: Editorial Note
- Radiographics 29(2):313 (2009)
- RSNA Support for Lifelong Learning
Bisset GS Bresolin LB - Radiographics 29(2):623-624 (2009)
- RadioGraphics: Residency Training to Lifelong Learning
Buchmann RF Greenberg SB - Radiographics 29(2):625-626 (2009)
- Re: Respiratory Instructions for CT Examinations of the Lungs
- Radiographics 29(2):637-638 (2009)
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