Gregory L. Katzman

Improved efficiency in double-inversion fast spin-echo imaging

Double‐inversion fast spin‐echo (FSE) pulse sequences can be designed to provide excellent suppression of blood signal in black‐blood MRI. However, because a nonselective inversion is used, these sequences typically have been highly inefficient. In this work it is demonstrated that the efficiency of double‐inversion sequences can be greatly improved by a form of interleaving in which all of the slices to be imaged in a single pass are reinverted each time a signal is obtained from any single slice. To date, several studies have demonstrated a high level of blood suppression with these more efficient techniques. Magn Reson Med 47:1017– 1021, 2002.

The evolution of filmless radiology teaching.

Purpose: The transition from hard-copy film to the picture archiving and communication systems (PACS) arena is often a long and difficult path, but the complete transformation to the digital environment does not end with the successful clinical practice utilizing PACS. The next hurdle for academic institutions is similar changes in the teaching field. The loss of hard-copy films can greatly hinder the radiology teaching file and teaching conference experiences. The next step in our growth is the conversion to digital teaching files and conferences. The original work 10 years ago with utilizing computers linked with laser disks and magneto-optical media, have now evolved into complex networks with expanding and relatively cheap storage media, such as CD-ROM and easily to navigate graphic-user interfaces such as hypertext markup language (HTML) and extensible markup language (XML). for use with multimedia teaching tools.Conclusions: The transition into the digital arena for radiology education and interdepartmental conferences can be accomplished through several different paths. These include direct transfer of images into a presentation program, as well as exportation of images into suitable image file formats for later use. There is also the ability to expand the PACS network to include conference rooms. Similar training and teaching can allow radiologists to transition into the digital environment for future digital teaching file creation as well as correlative radiology interdepartmental conferences.

A Methodology and Implementation for Annotating Digital Images for Context-appropriate Use in an Academic Health Care Environment

Use of digital medical images has become common over the last several years, coincident with the release of inexpensive, mega-pixel quality digital cameras and the transition to digital radiology operation by hospitals. One problem that clinicians, medical educators, and basic scientists encounter when handling images is the difficulty of using business and graphic arts commercial-off-the-shelf (COTS) software in multicontext authoring and interactive teaching environments. The authors investigated and developed software-supported methodologies to help clinicians, medical educators, and basic scientists become more efficient and effective in their digital imaging environments. The software that the authors developed provides the ability to annotate images based on a multispecialty methodology for annotation and visual knowledge representation. This annotation methodology is designed by consensus, with contributions from the authors and physicians, medical educators, and basic scientists in the Departments of Radiology, Neurobiology and Anatomy, Dermatology, and Ophthalmology at the University of Utah. The annotation methodology functions as a foundation for creating, using, reusing, and extending dynamic annotations in a context-appropriate, interactive digital environment. The annotation methodology supports the authoring process as well as output and presentation mechanisms. The annotation methodology is the foundation for a Windows implementation that allows annotated elements to be represented as structured eXtensible Markup Language and stored separate from the image(s).

The need for phase-encoding flow compensation in high-resolution intracranial magnetic resonance angiography

To demonstrate that the time delay between phase and frequency encoding and the presence of pulsatile blood flow in high‐resolution time‐of‐flight (TOF) imaging of the intracranial arteries (especially near the circle of Willis) can distort the appearance of blood vessels and result in a cross‐hatch—appearing artifact in surrounding tissue.

Adobe acrobat: an alternative electronic teaching file construction methodology independent of HTML restrictions.

Abstract The goal of the project was to create a method by which an in-house digital teaching file could be constructed that was simple, inexpensive, independent of hypertext markup language (HTML) restrictions, and appears identical on multiple platforms. To accomplish this, Microsoft PowerPoint and Adobe Acrobat were used in succession to assemble digital teaching files in the Acrobat portable document file format. They were then verified to appear identically on computers running Windows, Macintosh Operating Systems (OS), and the Silicon Graphics Unix-based OS as either a free-standing file using Acrobat Reader software or from within a browser window using the Acrobat browser plug-in. This latter display method yields a file viewed through a browser window, yet remains independent of underlying HTML restrictions, which may confer an advantage over simple HTML teaching file construction. Thus, a hybrid of HTML-distributed Adobe Acrobat generated WWW documents may be a viable alternative for digital teaching file construction and distribution.

Estimation of effective dose and lifetime attributable risk from multiple head CT scans in ventriculoperitoneal shunted children.

PURPOSE The purpose of this review is to determine the averaged effective dose and lifetime attributable risk factor from multiple head computed tomography (CT) dose data on children with ventriculoperitoneal shunts (VPS). METHOD AND MATERIALS A total of 422 paediatric head CT exams were found between October 2008 and January 2011 and retrospectively reviewed. The CT dose data was weighted with the latest IRCP 103 conversion factor to obtain the effective dose per study and the averaged effective dose was calculated. Estimates of the lifetime attributable risk were also calculated from the averaged effective dose using a conversion factor from the latest BEIR VII report. RESULTS Our study found the highest effective doses in neonates and the lowest effective doses were observed in the 10-18 years age group. We estimated a 0.007% potential increase risk in neonates and 0.001% potential increased risk in teenagers over the base risk. CONCLUSION Multiple head CTs in children equates to a slight potential increase risk in lifetime attributable risk over the baseline risk for cancer, slightly higher in neonates relative to teenagers. The potential risks versus clinical benefit must be assessed.

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:

MRI Findings After Surgery for Chiari Malformation Type I

OBJECTIVE Surgery plays an important role in the management of Chiari I malformation. The purpose of this article is to review expected and unexpected MRI findings after the various types of surgery performed during the treatment of Chiari I malformation and associated abnormalities. CONCLUSION Familiarity with optimal MRI techniques and findings is important when evaluating postoperative changes after treatment of Chiari I malformation.

Neoplastic cauda equina syndrome: a neuroimaging-based review.

Cauda equina syndrome refers to dysfunction of the cauda equina, the collection of ventral and dorsal lumbar, sacral and coccygeal nerve roots that surround the filum terminale. This most commonly occurs as a result of compression by a herniated lumbosacral disc. However, the syndrome may also complicate metastatic cancer or a primary neoplasm within or infiltrating the spinal canal. An accurate and timely diagnosis is critical to avoid irreversible loss of neurological function. The clinician and radiologist must therefore be aware of the many possible causes to guide timely management. Here we review the diverse neoplastic causes affecting the cauda equina nerve roots from a neuroimaging-based perspective. We divide them by location into intramedullary neoplasms at the conus (such as astrocytoma), intradural–extramedullary neoplasms (such as schwannoma and leptomeningeal metastases) and extradural neoplasms (such as spinal metastases from systemic neoplasms). We also discuss the clinical features associated with cauda equina tumours, with special focus on cauda equina syndrome.

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.