Byrn Williamson

Role of ultrasound in medical management of patients with renal stone disease

Eighty-three patients with radiographically opaque renal stones were evaluated prospectively with ultrasound and compared to KUB (kidneys, ureters, bladder) with tomograms (KUB/T) to further define the use of ultrasound in the evaluation of renal calculi. The presence or absence and the size, number, and location of stones were analyzed and correlated for each modality. Ultrasound detected the presence of renal stones in 77 of 83 (93%) patients. However, all of the stones were detected on ultrasound in only 60% of these patients. Thirty percent (80 of 269) of the papillary-calyceal stones seen on KUB/T were missed on US; 66% of the stones missed measured 2 mm or less. Although ultrasound can be used for detection of intrarenal stones, KUB/T is a more accurate imaging examination for determination of size and number of small stones.

Low-osmolality contrast media: A current perspective

Intravascular radiographic contrast media play a major role in diagnostic imaging. Recently, low-osmolality contrast media (LOCM) have become available in the United States. Because of their lower osmolality, these new agents cause fewer undesirable physiologic effects and fewer adverse reactions than do conventional agents after intravascular administration. Unfortunately, the cost of LOCM is substantially higher than the cost of conventional contrast media. Appropriate use of these newer, more expensive contrast agents must be based on a thorough knowledge and understanding of their chemistry, physiologic features, and relative safety. Some questions remain about these new agents. Further studies are needed to determine the nephrotoxicity of LOCM relative to that of conventional agents. In addition, LOCM have less anticoagulant capacity than do the conventional media; therefore, clotting may occur when the LOCM and blood mix in syringes and small catheters. This potential decrease in anticoagulation and its clinical implications should be further investigated. Finally, the mortality rate associated with use of LOCM needs to be determined in future studies in large numbers of patients.

Picture archiving and communication system activities at the Mayo Clinic Rochester.

This report summarizes Mayo Clinic Rochester’s experience with a picture archiving and communication system (PACS) to date and discusses the principles that have guided implementation.

Radiologist-patient interactions: Implications for picture archiving and communications systems and teleradiology

We analyzed radiologist-patient interactions and found that radiologic examinations can be classified into three categories: those involving direct interaction of the radiologist with each patient, those involving interaction of the radiologist with some of the patients, and those that do not involve interaction between the radiologist and the patient. We then analyzed the staff assignments of a large academic radiology practice and a moderate-sized radiology department. Both departments include a full range of inpatient and outpatient procedures. We concluded that about 50% of the radiologists in these practices could interpret examinations at a location independent of the site where the examination was performed. This type of analysis can be helpful in planning for the reengineering of radiology processes following implementation of picture archiving and communications systems (PACS) and teleradiology.

Current status of the joint Mayo Clinic-IBM PACS project

A multi-phase collaboration between Mayo Clinic and IBM-Rochester was undertaken, with the goal of developing a picture archiving and communication system for routine clinical use in the Radiology Department. The initial phase of this project (phase 0) was started in 1988. The current system has been fully integrated into the clinical practice and, to date, over 6.5 million images from 16 imaging modalities have been archived. Phase 3 of this project has recently concluded.

Malacoplakia of the urinary tract with renal parenchymal involvement

Malacoplakia is a distinct pathologic lesion usually involving the urinary bladder. The lesions consist of smooth, yellowish brown plaques in the mucosa varying from 0.1 to 0.3 cm in diameter. The lesion was first described by Michaelis and Gutmann in 1902, and was subsequently named malacoplakia (“soft plaque”) by von Hansemann in 1903. This report describes a case of renal parenchymal malacoplakia presenting on excretory urography as a cystic renal mass associated with malacoplakia involving the ureter and bladder. The usual urographic differential diagnoses of a cystic renal mass include cystic renal cell carcinoma, mutilocular cyst, benign cystic nephroma, hemorrhagic cyst, hematoma, and renal abscess. In patients, especially females, with a renal mass associated with a history of repeated urinary tract infections, altered immune syndromes, abnormal cystoscopic findings, or filling defects in the collecting system or urter, renal parenchymal malacoplakia should be included in the differential diagnosis.

The Society for Computer Applications in Radiology. Real-time radiology.

T HE ELECTRONIC transformation of radiology will involve many changes in the way radiologists work. One of the most profound changes in radiological practice will be delivery of radiology service in a real-time mode. In part, this change will be due to the fact that electronic images can be delivered to clinicians as soon as an examination is complete. If these images are not accompanied by the radiologists interpretation, the clinician may make patient care decisions without input from the radiologist. Such a development could compromise patient careas well as distance the radiologist from clinical activities. To prevent these negative developments, radiologists will increasingly feel the need to provide interpretation and images to clinicians simultaneously. This impetus will not apply equally to all radiology examinations, but will be particularly strong in intensive care, emergency room, and other urgent examinations. The need for real-time interpretation will increase demands on raaiologists, but advancing technology will alleviate some of the burden. For example, PACS and teleradiology systems will allow radiologists to interpret images remotely, thus relieving them of the need to be on site when images are obtained. A single radiologist will be able to provide on-line interpretation of images forwarded from multiple sites, after hours or on weekends. The rapid availability of electronic images will increase the need for rapid production of radiology reports. Again, technology will alleviate some of this burden. Remote transcription services already are available in many areas, allowing electronic reports to be generated rapidly for review and approval by the interpreting radiologist. In addition, speech recognition systems continue to advance in parallel with the increasing speed and capacity of modern computers. Ultimately, radiologists should be able to produce authenticated radiology reports as rapidly as they can dictate them. The electronic transformation of radiology will challenge radiology systems and procedures. Some of these changes may make radiologists uncomfortable, but I believe that our profession will rise to this challenge as it has to others in the past. Ultimately, these changes will increase our ability to carry out our basic purpose--to serve the patient.

Teleradiology in a Large Radiology Practice

The large number of teleradiology products and features may confuse radiologists who are considering the incorporation of this technology into their practice. It is important that practice patterns and needs be evaluated prior to specification and acquisition of a teleradiology system. An appropriate beginning for this decision concerns whether the system will be utilized for primary diagnosis rather than consultation or image review. For instance, teaching or consultation at a remote location may demand realtime interactions to be of use while on-call or overreading coverage from a remote location could be performed with batch image transmission and remote interpretation without person-to-person interaction. The needs of the radiology practice determine the hardware and software requirements of a teleradiology system. We shall outline three general modes of practice before summarizing our clinical evaluations.

Introduction to SCAR 2001: The 18th symposium for computer applications in radiology

T HIS SPECIAL SUPPLEMENT to the Journal of Digital Imaging includes scientific papers and other material presented at the Annual Meeting of the Society for Computer Applications in Radiology held in Salt Lake City, UT, May 3-6, 2001. The Symposium for Computer Applications in Radiology is the 18th in a series of meetings that began in 1964, initially organized by the American College of Radiology (ACR). The meeting features the most recent advances in medical computer applications and is designed to provide important information to professionals who use or develop computer-based equipment with applications in radiology. The objectives of the meeting are to prepare attendees to: • Determine which computer applications can contribute to their practice • Evaluate components of electronic image and information management systems • Prepare for the changes that will result from implementing computer applications in their departments and their institutions • Choose promising areas for future research The Symposium consists of scientific presentations, debates, technical exhibits, special sessions, posters, and tours of electronic imaging areas at LDS Hospital, Primary Childrens Medical Center, and University of Utah Health Science Center. Presentations cover a wide range of subjects from introductory topics aimed at those desiring basic knowledge about picture archiv-

Electronic image management in radiology

During the past two decades, new imaging modalities have significantly changed the practice of diagnostic radiology. Although new imaging modalities will probably continue to be introduced the major change in diagnostic radiology in the next decade is likely to involve changes in service delivery by electronic image management systems. This paper reviews some of the factors favoring the expansion of electronic image management systems, the capabilities of such systems, and some of the issues that must be resolved before these systems can reach their full potential.<<ETX>>