Gary Wendt

The Neurodevelopmental Impact of Childhood‐onset Temporal Lobe Epilepsy on Brain Structure and Function

Summary:  Purpose: To characterize the neurodevelopmental correlates of childhood‐onset temporal lobe epilepsy on brain structure and cognition compared with late‐onset chronic temporal lobe epilepsy and healthy controls.

Extratemporal quantitative MR volumetrics and neuropsychological status in temporal lobe epilepsy.

Neuropsychological studies of temporal lobe epilepsy have focused heavily on the nature and extent of memory dysfunction and its relationship to the neuropathological status of the hippocampus and related mesial temporal lobe structures. In this study, we examined whole brain and lobar quantitative MRI volumes and comprehensive neuropsychological performance in 58 patients with temporal lobe epilepsy and 62 healthy controls in order to determine (1) the nature and degree of extratemporal structural abnormalities in localization-related temporal lobe epilepsy: (2) the nature and degree of cognitive abnormalities outside of anterograde memory function; and (3) the relationship of volumetric abnormalities to neuropsychological status. Temporal lobe epilepsy patients exhibited significant reduction in the volume of adjusted (age, gender, height) total cerebral tissue (-5.8%), more evident in white (-9.8%) compared to gray matter (-3.0%) tissue volumes. Significant volumetric reductions were evident across frontal, temporal and parietal but not occipital lobe regions. Subarachnoid but not total ventricular CSF was significantly increased in epilepsy patients. Neuropsychological abnormality was generalized in nature, consistent with the generalized nature of the morphometric abnormalities, and reductions in cerebral tissue volumes were directly associated with poorer cognitive performance. In summary, patients with temporal lobe epilepsy exhibited clinically significant structural and functional abnormalities that extended outside the epileptogenic temporal lobe. The degree to which these structural and cognitive abnormalities are due to factors that cause the epilepsy, as opposed to reflecting the consequences of chronic epilepsy (e.g., duration and severity of epilepsy), remain to be determined.

Brain development in children with new onset epilepsy: A prospective controlled cohort investigation

Purpose:  To characterize prospective neurodevelopmental changes in brain structure in children with new and recent‐onset epilepsy compared to healthy controls.

Using commercially available off-the-shelf software and hardware to develop an intranet-based hypertext markup language teaching file.

This presentation describes the technical details of implementing a process to create digital teaching files stressing the use of commercial off-the-shelf (COTS) software and hardware and standard hypertext markup language (HTML) to keep development costs to a minimum.

CT protocol management: simplifying the process by using a master protocol concept

This article explains a method for creating CT protocols for a wide range of patient body sizes and clinical indications, using detailed tube current information from a small set of commonly used protocols. Analytical expressions were created relating CT technical acquisition parameters which can be used to create new CT protocols on a given scanner or customize protocols from one scanner to another. Plots of mA as a function of patient size for specific anatomical regions were generated and used to identify the tube output needs for patients as a function of size for a single master protocol. Tube output data were obtained from the DICOM header of clinical images from our PACS and patient size was measured from CT localizer radiographs under IRB approval. This master protocol was then used to create 11 additional master protocols. The 12 master protocols were further combined to create 39 single and multiphase clinical protocols. Radiologist acceptance rate of exams scanned using the clinical protocols was monitored for 12,857 patients to analyze the effectiveness of the presented protocol management methods using a two‐tailed Fishers exact test. A single routine adult abdominal protocol was used as the master protocol to create 11 additional master abdominal protocols of varying dose and beam energy. Situations in which the maximum tube current would have been exceeded are presented, and the trade‐offs between increasing the effective tube output via 1) decreasing pitch, 2) increasing the scan time, or 3) increasing the kV are discussed. Out of 12 master protocols customized across three different scanners, only one had a statistically significant acceptance rate that differed from the scanner it was customized from. The difference, however, was only 1% and was judged to be negligible. All other master protocols differed in acceptance rate insignificantly between scanners. The methodology described in this paper allows a small set of master protocols to be adapted among different clinical indications on a single scanner and among different CT scanners. PACS number: 87.57.QThis article explains a method for creating CT protocols for a wide range of patient body sizes and clinical indications, using detailed tube current information from a small set of commonly used protocols. Analytical expressions were created relating CT technical acquisition parameters which can be used to create new CT protocols on a given scanner or customize protocols from one scanner to another. Plots of mA as a function of patient size for specific anatomical regions were generated and used to identify the tube output needs for patients as a function of size for a single master protocol. Tube output data were obtained from the DICOM header of clinical images from our PACS and patient size was measured from CT localizer radiographs under IRB approval. This master protocol was then used to create 11 additional master protocols. The 12 master protocols were further combined to create 39 single and multiphase clinical protocols. Radiologist acceptance rate of exams scanned using the clinical protocols was monitored for 12,857 patients to analyze the effectiveness of the presented protocol management methods using a two-tailed Fishers exact test. A single routine adult abdominal protocol was used as the master protocol to create 11 additional master abdominal protocols of varying dose and beam energy. Situations in which the maximum tube current would have been exceeded are presented, and the trade-offs between increasing the effective tube output via 1) decreasing pitch, 2) increasing the scan time, or 3) increasing the kV are discussed. Out of 12 master protocols customized across three different scanners, only one had a statistically significant acceptance rate that differed from the scanner it was customized from. The difference, however, was only 1% and was judged to be negligible. All other master protocols differed in acceptance rate insignificantly between scanners. The methodology described in this paper allows a small set of master protocols to be adapted among different clinical indications on a single scanner and among different CT scanners. PACS number: 87.57.Q.

Implementing a java-based image and report distribution system in a non-picture archiving and communication system environment

The benefits and pitfalls of implementing a Java-based system to distribute results and images to referring physicians are addressed. The basic requirements for and barriers to implementing this system in a non-picture archiving and communication system (PACS) environment will also be discussed. The majority of radiology information systems (RIS) and hospital information systems (HIS) currently only distribute the text data for radiology examinations. This is generally adequate for low-acuity exams in a relatively healthy patient; however, many clinicians prefer to review images so they can correlate the reported findings with the image data, as well as review the exam themselves. A web-based solution eliminates the need for specialized review software and/or hardware at each review site. In addition, there is no need for support personnel to travel to each site to set up and upgrade software.

Automatic generation of teaching files during routine clinical dictation

ConclusionsIt is possible to implement a system that facilitates the automatic generation of teaching files through routine clinical dictation. While some training is required, user -specific options make the transition to this system relatively easy. Once the training and system is in place, control of the images and display of the images are done through the same dictation mechanism. Additionally, patient demographic data can be safely removed from the study information. Since the studies are readily available on the web immediately after the dictated report for the study is transcribed there is no additional time required for the radiologist to manage teaching file creation.

A General Framework for Monitoring Image Acquisition Workflow in the Radiology Environment: Timeliness for Acute Stroke CT Imaging

Many facets of an image acquisition workflow leave a digital footprint, making workflow analysis amenable to an informatics-based solution. This paper describes a detailed framework for analyzing workflow and uses acute stroke response timeliness in CT as a practical demonstration. We review methods for accessing the digital footprints resulting from common technologist/device interactions. This overview lays a foundation for obtaining data for workflow analysis. We demonstrate the method by analyzing CT imaging efficiency in the setting of acute stroke. We successfully used digital footprints of CT technologists to analyze their workflow. We presented an overview of other digital footprints including but not limited to contrast administration, patient positioning, billing, reformat creation, and scheduling. A framework for analyzing image acquisition workflow was presented. This framework is transferable to any modality, as the key steps of image acquisition, image reconstruction, image post processing, and image transfer to PACS are common to any imaging modality in diagnostic radiology.

Using digital certificates for radiology result receipt confirmation.

ConclusionsThe implementation of this system provides a cost-effective and easy-to-use mechanism for verifying the receipt of radiology results. This provides the radiology department with assurance that their use of internet technologies is secure, effective, and reliable. Likewise, the approach outlined can be integrated into an enterprise-wide solution for the deployment of digital certificate technologies.