David M. Paushter

Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer: Results of a multi-institutional cooperative trial

Abstract Background. In 1987, a cooperative study group consisting of five institutions was formed to determine the relative benefits of magnetic resonance imaging (MRI) and endorectal (transrectal) ultrasonography in evaluating patients with clinically localized prostate cancer (stage Ta or Tb). Methods. Over a period of 15 months, 230 patients were entered into the study and evaluated with identical imaging techniques. We compared imaging results with information obtained at the time of surgery and on pathological analysis. Results. MRI correctly staged 77 percent of cases of advanced disease and 57 percent of cases of localized disease; the corresponding figures for ultrasonography were 66 and 46 percent (P not significant). These figures did not vary significantly between readers; moreover, simultaneous interpretation of MRI and ultrasound scans did not improve accuracy. In terms of detecting and localizing lesions, MRI identified only 60 percent of all malignant tumors measuring more than 5 mm on pat...

Nuclear Magnetic Resonance of the Spine: Clinical Potential and Limitation

&NA; Magnetic resonance can visualize the vertebral bodies, discs, neural structures, cerebrospinal fluid (CSF), neural foramina, and extradural structures in the sagittal, axial, and coronal planes. The normal nucleus pulposus can be differentiated from the anulus and changes associated with degeneration. Infection, trauma, and neoplastic conditions can be identified. The signal intensity of the CSF relative to extradural and neural structures can be increased to provide evaluation of the size and configuration of the contents of the thecal sac without the use of an intrathecal contrast medium. Impingement by disc, tumors, fracture segments, and expansile masses can then be accurately evaluted, It is the most accurate modality for the evaluation of the foramen magnum, Chiari malformation, syringomyelia, infection, and degeneration of intervertebral discs. It can identify paravertebral soft tissue and bony changes when plain films and computed tomographic (CT) studies are negative or equivocal. Not only can lesions be localized, but significant information regarding the nature of the process can be obtained. Using variations of the spin‐echo technique with appropriate T1 and T2‐weighted images, magnetic resonance can produce tissue contrast distinctions not possible with CT scans or conventional angiography. (Neurosurgery 15:583‐592, 1984)

Follicular aspiration: a comparison of an ultrasonic endovaginal transducer with fixed needle guide and other retrieval methods

Ultrasonic techniques have been developed as alternatives to conventional laparoscopic aspiration for oocyte retrieval for in vitro fertilization (IVF). Given the advantages (less risk, lower cost, and greater patient acceptance) of these alternative techniques, it is appropriate to assess their efficacy compared with traditional laparoscopic retrieval. This article examines the recovery rate of oocytes and their subsequent fertilization rate with the use of an ultrasonic endovaginal transducer with fixed needle guide and compares these results with other retrieval methods. Comparisons were made between laparoscopic harvesting (n = 71, group I), ultrasonic transabdominal transvesical (n = 21, group II), and ultrasonic vaginal transducer (n = 76, group III). The data demonstrate comparable success using an ultrasonic endovaginal transducer with fixed needle guide. The authors believe this technique to be the procedure of choice for all routine oocyte retrievals during IVF treatment.

Fibrotic lesions of the testicle: Sonographic patterns mimicking malignancy

All testicular sonograms performed over a 2.5-year period were retrospectively reviewed, yielding eight patients with pathologically proven lesions consisting primarily of tubular sclerosis and interstitial fibrosis. Only two patients (25%) had a palpable abnormality. A variety of sonographic patterns was found, including focal hypoechoic or hyperechoic lesions and diffuse heterogeneity of the testicular parenchyma. The clinical and sonographic findings prompted open biopsy or orchiectomy in all cases. In the same time period, nine pathologically proven testicular malignancies were evaluated sonographically and displayed either well-defined hypoechoic or diffusely heterogeneous echo patterns. All but two of these patients (78%) had palpable abnormalities. This study demonstrates a significant overlap in the sonographic appearance of benign fibrotic lesions and testicular malignancies. When careful palpation of a sonographically heterogeneous or focal hypoechoic lesion fails to reveal a mass and serum tumor markers are negative, an open biopsy with frozen section analysis should be considered rather than proceeding directly to orchiectomy. Homogeneously hyperechoic masses can be considered benign and do not require surgery.

Comparison of iohexol-240 versus iohexol-300 in abdominal CT.

Forty patients without evidence of liver, kidney, or significant cardiac disease were prospectively divided into two groups of 20, receiving either iohexol-240 or iohexol-300. A contrast load of 150 ml was administered in conjunction with a rapid scanning technique at a preselected, fixed level to include liver, renal cortex, and aorta. Peak enhancement was calculated as change in Hounsfield units (HU) over baseline for each area of interest. Mean peak enhancement and standard deviation were calculated for each organ, and the difference between the means for the two contrast agents was compared using the Studentst test.Differences were not statistically significant with allp values greater than 0.05. Our results suggest iohexol-240 is preferred to iohexol-300 for body computed tomography (CT) due to its lower cost and iodine load without statistically significant change in diagnostic quality of the examination.

Hypoechoic renal pyramids: Sonographic visualization in older children and young adults

The frequency and degree of visualization of medullary pyramids in a normal population, aged 10–29 years, was analyzed. Hypoechoic pyramids were visualized in 42% of right kidneys in subjects aged 10–18 years and in 27% of subjects aged 19–29 years. Prominently hypoechoic pyramids, mimicking the appearance of neonatal kidneys, were seen in an additional 34% of subjects aged 10–18 years and in 16% aged 19–29 years. Prominent pyramids were present in 50% of subjects with renal cortical echogenicity (RCE) equal to liver, but also in 21% of subjects with RCE less than liver. Our study expands the age at which prominently hypoechoic medullary pyramids can be considered a normal finding. This may relate to recent improvements in ultrasound technology.

The Effect of an Electronic Peer-Review Auditing System on Faculty-Dictated Radiology Report Error Rates.

meaningless or inappropriate word at a time” [9]. At our medical center, anecdotal evidence suggested that the error rate in radiology reports increased when VR was implemented. To gauge the quality of radiology reports from the standpoint of grammar, clarity, and comprehensibility, we initially implemented a manual system by which reports were proofread by a faculty member who would provide corrective feedback to the individual who generated the report. However, it quickly became obvious that this was too labor intensive and not sustainable. Thus, an IT web-based tool was created to facilitate measurement of the error rate for radiology reports within each section over time, with errors identified systematically by each attending radiologist in the department. In addition, during the period of measurement, a new version of VR was implemented. The purposes of this study were threefold:

Clinical Significance of US Artifacts

Artifacts are frequently encountered at clinical US, and while some are unwanted, others may reveal valuable information related to the structure and composition of the underlying tissue. They are essential in making ultrasonography (US) a clinically useful imaging modality but also can lead to errors in image interpretation and can obscure diagnoses. Many of these artifacts can be understood as deviations from the assumptions made in generating the image. Therefore, understanding the physical basis of US image formation is critical to understanding US artifacts and thus proper image interpretation. This review is limited to gray-scale artifacts and is organized into discussions of beam- and resolution-related, location-related (ie, path and speed), and attenuation-related artifacts. Specifically, artifacts discussed include those related to physical mechanisms of spatial resolution, speckle, secondary lobes, reflection and reverberation, refraction, speed of sound, and attenuation. The underlying physical mechanisms and appearances are discussed, followed by real-world strategies to mitigate or accentuate these artifacts, depending on the clinical application. Relatively new US modes, such as spatial compounding, tissue harmonic imaging, and speckle reduction imaging, are now often standard in many imaging protocols; the effects of these modes on US artifacts are discussed. The ability of a radiologist to understand the fundamental physics of ultrasound, recognize common US artifacts, and provide recommendations for altering the imaging technique is essential for proper image interpretation, troubleshooting, and utilization of the full potential of this modality. ©RSNA, 2017.

Building a Culture of Continuous Quality Improvement in an Academic Radiology Department.

As we enter a new era of health care in the United States, radiologists must be adequately prepared to prove, and continually improve, our value to our customers. This goal can be achieved in large part by providing high-quality services. Although quality efforts on the national and international levels provide a framework for improving radiologic quality, some of the greatest opportunities for quality improvement can be found at the departmental level, through the implementation of total quality management programs. Establishing such a program requires not only strong leadership and employee engagement, but also a firm understanding of the multiple total quality management tools and continuous quality improvement strategies available. In this article, we discuss key tools and strategies required to build a culture of continuous quality improvement in an academic department, based on our experience.

Impact of an Incentive Compensation Plan on Academic Productivity

INTRODUCTION Motivation is a key facet of management, especially in the health care setting, where individual tasks are typically complex and intellectually challenging. Though performancebased models work well for relatively simple and repetitive tasks, such as in manufacturing or manual labor, many have argued that this model of motivation does not work well for more complex tasks [1]. Regardless, incentiveand performance-based compensation plans are becoming nearly ubiquitous in the health care field [2]. However, there is a relative paucity of data in regard to whether the incentive plans in the health care field are effective in producing positive changes in physician behavior, especially in the long term. Previous papers describing incentive plans within academic medical departments have mainly focused on the description of the plan itself with relative lack of outcomes data. Few studies that have evaluated the outcomes of academic medical incentive plans are limited by short temporal ranges, mostly restricted to 3 years or less [3-5]. Therefore, the long-term effects of an incentive plan in the academic medical setting are largely unknown.