OBJECTIVE:

Arteriovenous fistulas (AVFs) are abnormal communications with shunting of blood from an artery to a vein. AVFs mainly involve the peripheral vascular system but can affect virtually any organ or system in the body. They may be congenital, created surgically for hemodialysis, or caused by pathologic processes. This review describes the diverse origins of AVFs and illustrates the spectrum of imaging findings at radiography, ultrasound, CT, MRI, and digital angiography for AVFs in different locations: the CNS, thorax, abdomen, musculoskeletal system, and peripheral vascular system. We also discuss syndromes associated with AVFs and describe recent interventional techniques for treating AVFs.

CONCLUSION:

Familiarity with the spectrum of imaging findings in AVFs is essential for the accurate interpretation of images and facilitates diagnosis and therapeutic management. Radiologists can play a critical role in the diagnosis and treatment of AVFs. Digital angiography is helpful in elaborating a vascular map for endovascular treatment.

Keywords: arteriovenous fistulas - arteriovenous malformations - fistula therapeutic embolization - hemodynamics - vascular system

Purpose:

The aim of this study was to seek patients' perspectives on radiology reporting systems, so that reporting systems can begin to be reorganized and made more patient-centered by giving patients greater access to their personal health information.

Methods:

Focus group methodology was used to explore which aspects of radiology information are important to patients and to identify their preferred means of access to and format of this information. Subjects for the two groups were outpatients who had recently undergone MR imaging at a single academic medical center. Transcripts were analyzed using thematic content analysis.

Results:

Most subjects were dissatisfied with current reporting systems, citing delays and a lack of detail as the most important problems. Subjects varied with regard to preferences for who should relay results to them, with some expressing a desire for increased direct input from radiologists because they have greater expertise in imaging interpretation. Most subjects wanted results in writing and in detail, with attached lay language explanations, though a few subjects preferred less detail. Subjects were decidedly in favor of having the option to access results immediately via an online system, proposing some potential problems and potentially multiple benefits of such a system.

Conclusions:

Whatever system revisions are attempted to increase the patient-centeredness of care as regards to radiology reporting, patients will need to be able to choose their preferred levels of access and will need to have the option of accessing full details.

Key Words: Patient-centered, radiology reporting, qualitative

ABSTRACT:

Sarcoidosis is a systemic disorder of unknown cause that is characterized by the presence of noncaseating granulomas. The radiological findings associated with sarcoidosis have been well described. The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium). However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis. Many atypical forms of intrathoracic sarcoidosis have been described sporadically. We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well. The understanding of a wide range of the radiological manifestations of sarcoidosis will be very helpful for making a proper diagnosis.

Keywords: Sarcoidosis, Thorax, Computed tomography (CT).

Abstract:

Purpose: To investigate whether ethanol ablation by using a multipronged needle delivery system (multipronged ethanol ablation) could eradicate hepatocellular carcinoma (HCC) up to 5.0 cm in diameter with a single-session high-dose strategy.

Materials and Methods: The hospital ethics committee approved the prospective study, and each patient provided written informed consent. One hundred forty-one patients (125 men, 16 women; mean age, 53 years; range, 27–76 years) with 164 primary or recurrent HCC ranging from 1.3 to 5.0 cm in diameter (mean, 2.9 cm ± 0.9) were treated with high-dose multipronged ethanol ablation. Patients were unsuitable for surgery, declined surgery and radiofrequency ablation, or had tumors located at unfavorable sites. Primary technique effectiveness (PTE) (complete ablation within two sessions), local tumor progression (LTP), and complications after the treatment were observed. Twenty risk factors of local effectiveness and complications were analyzed by means of univariate and multivariate analysis.

Results: Mean number of treatment sessions was 1.1. The mean volume of ethanol per tumor was 31 mL (range, 8–68 mL). PTE was achieved in 134 (95%) of 141 patients and was significantly associated with tumor pattern (capsulated vs noncapsulated, P = .018). After a mean follow-up period of 25 months, LTP was observed in 16 (12%) of 134 patients, and in nine (56%) patients, LTP occurred in tumors 3.1–5.0 cm in diameter. Alanine aminotransferase level (P = .023) was the independent risk factor for LTP. Three (2%) of 141 patients had major complications.

Conclusion: Multipronged ethanol ablation with a high-dose strategy can be used to treat HCC up to 5.0 cm in diameter effectively and safely, often in a single session.

Rationale and Objective

In 2004, Harvard Medical School initiated a pilot program, the Cambridge Integrated Clerkship, in which students study the core third-year medical disciplines in a longitudinal yearlong experience. In this paper, the authors describe the design of the radiology portion of this program and compare outcomes to those of students in a traditional curriculum.

Materials and Methods

Students in the integrated curriculum were compared to students in traditional clerkships on the basis of Objective Structured Clinical Examination cases, final exams, fourth-year comprehensive exam scores, and choice of specialty.

Results

Scores on Objective Structured Clinical Examination cases and imaging final exams were not statistically different between the two groups, but Integrated Clerkship students had statistically lower scores on final exams. Integrated Clerkship students scored higher on the fourth-year radiology comprehensive exam than traditional students, but differences were not statistically significant. Choice of radiology as a specialty was not statistically different between the two groups.

Conclusions

Teaching radiology in an integrated yearlong curriculum is feasible, with a minimal drop in exam scores but no changes in other evaluative measures and no decrease in the choice of radiology as a specialty. The program may give students a better appreciation of the role of radiology in an ambulatory setting and in relationship to other specialties.

Key Words: Radiology Education, case-based teaching, problem-based learning

SUMMARY:

This article reviews a number of portable CT scanners for clinical imaging. These include the CereTom, Tomoscan, xCAT ENT, and OTOscan. The Tomoscan scanner consists of a gantry with multisection detectors and a detachable table. It can perform a full-body scanning, or the gantry can be used without the table to scan the head. The xCAT ENT is a conebeam CT scanner that is intended for intraoperative scanning of cranial bones and sinuses. The OTOscan is a multisection CT scanner intended for imaging in ear, nose, and throat settings and can be used to assess bone and soft tissue of the head. We also specifically evaluated the technical and clinical performance of the CereTom, a scanner designed specifically for neuroradiologic head imaging. The contrast performance of this scanner permitted the detection of 4-mm low-contrast lesions, and the limiting spatial resolution was 7 line pairs per centimeter. The measured volume of the CT dose index (CTDIvol) for a standard head CT scan was 41 mGy (120 kV/14 mAs). All clinical images were of diagnostic quality, and the average patient effective dose was 1.7 mSv. We conclude that the CereTom portable CT scanner generates satisfactory clinical images at acceptable patient doses.

OBJECTIVE:

The use of imaging-guided treatments for deep venous thrombosis (DVT) is accelerating. Increased appreciation of the impact of postthrombotic syndrome on DVT patients' quality of life and advances in thrombolytic methods have together sparked an unprecedented degree of interdisciplinary collaboration in developing contemporary DVT treatment guidelines and a pivotal clinical trial to establish the risk-benefit ratio of interventional DVT therapy.

CONCLUSION:

Radiologists should improve their DVT education, support ongoing clinical trials, and collaborate with DVT-focused nonradiologists in their institutions. Keywords: ATTRACT Trial - deep venous thrombosis - DVT - postthrombotic syndrome - thrombolysis

Purpose:

The aim of this study was to assess discrepancies in the spinal levels of abnormalities stated in the findings or impression (or both) sections of radiology reports of magnetic resonance (MR) imaging.

Materials and Methods:

Radiology reports from January 2006 through December 2007 (n = 2,097,966) were analyzed using an online radiology report search engine. Reports were searched for presence of the key words MR spine and addendum. The addended reports were then manually assessed for any discrepancies in the reported spinal levels between the body and impression sections; the addenda corrected these errors (identified errors). In addition, all reports with the search term MR spine from January 2006 (n = 1,183) and January 2007 (n = 1,354) were assessed manually to recognize unidentified errors in spinal locations of reported pathology. Two neuroradiologists independently graded the clinical significance of errors on a 5-point scale (1 = definitely not significant, 5 = definitely significant).

Results:

Of the 11,427 spinal MR reports analyzed in 2006, 7 had identified errors in the sites (levels of the spine) of the lesions. In 2007 (n = 11,785 spinal MR reports), 4 reports were detected with identified errors in spinal levels. In January 2006 and January 2007, 8 and 12 reports, respectively, had unidentified erroneous vertebral levels. Errors were related to discrepant vertebral regions (eg, cervical vs thoracic) in 16% of cases (5 of 31), the wrong number of vertebrae (eg, L2 instead of L3) in 68% of cases (21 of 31), and both in 16% of cases (5 of 31). The average time taken to issue an addendum was 5 ± 7 days in 2006 and 11 ± 13 days in 2007. Fifteen reports (48%) scored <3 on the scale of clinical significance, 1 report scored 3, and 15 scored >3.

Conclusions:

Errors in lesion level on spinal MR do occur in radiology reports. The number of unidentified errors is substantially higher than that of identified errors. Care should be taken before signing off on radiology reports to identify erroneous mentions of the vertebral levels of abnormalities.

Key Words: Radiology reporting, quality, errors, spinal MR

Summary:

With the introduction of a Picture Archiving and Communication System, Computed (CR) and Digital Radiography (DR), reading digital images takes place from a computer screen. Laser paper print rather than laser film would be a significantly more cost-effective option for hard copy production, but would need to demonstrate acceptable diagnostic quality compared to the reference standard of screen reading. A comparative study of 51 digital paediatric CR radiographs presented in laser paper print and soft copy format to determine the diagnostic value of the paper print when compared to the reference standard of screen reading. Chest radiography had a poor sensitivity of 66.1% while musculoskeletal and abdominal radiography had acceptable sensitivities of 90% and 99%, respectively. Specificity was excellent for the different regions (98.6-99.5%). The paper print format should not be used for diagnostic purposes in paediatric chest radiography, but may still be used for demonstration when accompanied by the radiology rapport obtained from soft copy reading. Further studies would be needed to investigate the use of paper prints in abdominal and musculoskeletal radiography owing to the low number of abdominal radiographs and lack of musculoskeletal case variety in our study.

Key words: paper print; radiography comparison; screen reading.

Summary:

Nowadays, most drugs reach the market after research has established their pharmacology, safety and efficacy. That was not always the case 50 years ago. Thalidomide was used before its target cell or mode of action were known. Commencing with the thalidomide catastrophe – an epidemic of gross birth defects (1958–1962) – thalidomide’s origins are revisited to show how this drug came to be made and sold in the 1950s. Thalidomide intersected with Australian radiology in the 1970s. The site and mode of action of the drug was deduced from X-rays of thalidomide-induced bone defects, which have classical radiological signs of sensory neuropathic osteoarthropathy. The longitudinal reduction deformities follow the distribution of segmental sensory innervation of the limb skeleton, indicating neural crest as the target organ. Injury to one level of neural crest halts normal neurotrophism and deletes the dependent segment – a previously unrecognised embryonic mechanism that explains most non-genetic birth defects. The final common pathway is neural crest injury and failure of normal neurotrophism to result in longitudinal reduction deformities, for example, phocomelia.

Key words: birth defects; embryonic neuropathy; neural crest injury; phocomelia/dysmelia; thalidomide.

Abstract

Purpose: To assess the feasibility and safety of ultrasonographic (US) guidance in the placement of nontunneled central venous catheters (CVCs) in patients with cancer who had altered coagulation profiles.

Materials and Methods: The study was approved by the institutional review board; informed consent was obtained. Medical charts of all patients with cancer who underwent nontunneled CVC placement at the European Institute of Oncology, Milan, from September 2001 to August 2008 were retrospectively reviewed. Patients were considered to have coagulation disorders or risk of bleeding when they had the following: prothrombin time more than 1.2 times normal or activated partial thromboplastin time more than 1.2 times normal and/or platelet count less than 150 x 109/L. Patients with a prothrombin time and partial thromboplastin time more than 2.2 times normal and/or a platelet count less than 50 000/mm3 were considered to be at high risk for bleeding. Two hundred thirty-nine nontunneled CVCs were placed with US guidance in 157 patients.

Results: One hundred twenty-two (51%) of 239 nontunneled CVCs were inserted in patients with cancer who had hemostasic disorders. Forty-five (37%) of 122 nontunneled CVCs were implanted in patients considered to be at high risk for bleeding. All catheters were successfully placed at the first needle pass with no major complications such as bleeding or pneumothorax. Two hundred thirty-three (97%) nontunneled CVCs were placed in the subclavian vein, and six (3%) were placed in the internal jugular vein. No patient underwent any correction for an abnormal coagulation profile.

Conclusion: In patients with cancer who had coagulation disorders, nontunneled CVC placement with US guidance was feasible and safe and did not require correction of coagulation parameters.