Jay Acharya

EOS Low-Dose Radiography: A Reliable and Accurate Upright Assessment of Lower-Limb Lengths

BACKGROUND Children with lower-limb-length discrepancy require repeated radiographic assessment for monitoring and as a guide for management. The need for accurate assessment of length and alignment is balanced by the need to minimize radiation exposure. We compared the accuracy, reliability, and radiation dose of EOS, a novel low-dose upright biplanar radiographic imaging system, at two different settings, with that of conventional radiographs (teleoroentgenograms) and computed tomography (CT) scanograms, for the assessment of limb length. METHODS A phantom limb in a standardized position was assessed ten times with each of four different imaging modalities (conventional radiographs, CT scanograms, EOS-Slow, EOS-Fast). A radiation dosimeter was placed on the phantom limb, on a portion closest to the radiation source for each modality, in order to measure skin-entrance radiation dose. Standardized measurements of bone lengths were made on each image by consultant orthopaedic surgeons and residents and then were assessed for accuracy and reliability. RESULTS The mean absolute difference from the true length of the femur was significantly lower (most accurate) for the EOS-Slow (2.6 mm; 0.5%) and EOS-Fast (3.6 mm; 0.8%) protocols as compared with CT scanograms (6.3 mm; 1.3%) (p < 0.0001), and conventional radiographs (42.2 mm; 8.8%) (p < 0.0001). There was no significant difference in accuracy between the EOS-Slow and EOS-Fast protocols (p = 0.48). The mean radiation dose was significantly lower for the EOS-Fast protocol (0.68 mrad; 95% confidence interval [CI], 0.60 to 0.75 mrad) compared with the EOS-Slow protocol (13.52 mrad; 95% CI, 13.45 to 13.60 mrad) (p < 0.0001), CT scanograms (3.74 mrad; 95% CI, 3.67 to 3.82 mrad) (p < 0.0001), and conventional radiographs (29.01 mrad; 95% CI, 28.94 to 29.09 mrad) (p < 0.0001). Intraclass correlation coefficients showed excellent (>0.90) agreement for conventional radiographs, the EOS-Slow protocol, and the EOS-Fast protocol. CONCLUSIONS Upright EOS protocols that utilize a faster speed and lower current are more accurate than CT scanograms and conventional radiographs for the assessment of length and also are associated with a significantly lower radiation exposure. In addition, the ability of this technology to obtain images while subjects are standing upright makes this the ideal modality with which to assess limb alignment in the weight-bearing position. This method has the potential to become the new standard for repeated assessment of lower-limb lengths and alignment in growing children. CLINICAL RELEVANCE This study assesses the reliability and accuracy of a diagnostic test used for clinical decision-making.

Minimizing Radiation Exposure in Evaluation of Pediatric Head Trauma: Use of Rapid MR Imaging

This study is a retrospective review of 103 pediatric patients who underwent initial head CT and subsequent follow-up rapid MR imaging between January 2010 and July 2013. Patients had minor head injuries that required imaging. There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (kappa = 0.84). Evaluation of hemorrhagic contusion/hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (kappa = 0.61). The authors conclude that rapid MRI is an adequate imaging technique for the follow-up of pediatric patients with minor head trauma. BACKGROUND AND PURPOSE: With >473,000 annual emergency department visits for children with traumatic brain injuries in the United States, the risk of ionizing radiation exposure during CT examinations is a real concern. The purpose of this study was to assess the validity of rapid MR imaging to replace CT in the follow-up imaging of patients with head trauma. MATERIALS AND METHODS: A retrospective review of 103 pediatric patients who underwent initial head CT and subsequent follow-up rapid MR imaging between January 2010 and July 2013 was performed. Patients had minor head injuries (Glasgow Coma Scale, >13) that required imaging. Initial head CT was performed, with follow-up rapid MR imaging completed within 48 hours. A board-certified neuroradiologist, blinded to patient information and scan parameters, then independently interpreted the randomized cases. RESULTS: There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (κ = 0.84, P < .001). Evaluation of hemorrhagic contusion/intraparenchymal hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (κ = 0.61, P < .001). The ability of MR imaging to detect a skull fracture also showed a substantial level of agreement with CT (κ = 0.71, P < .001). Detection of diffuse axonal injury demonstrated a slight level of agreement between MR imaging and CT (κ = 0.154, P = .04). However, the overall predictive agreement for the detection of an axonal injury was 91%. CONCLUSIONS: Rapid MR imaging is a valid technique for detecting traumatic cranial injuries and an adequate examination for follow-up imaging in lieu of repeat CT.

Extended Outlook: Description, Utilization, and Daily Applications of Cloud Technology in Radiology

OBJECTIVE The purpose of this article is to discuss the concept of cloud technology, its role in medical applications and radiology, the role of the radiologist in using and accessing these vast resources of information, and privacy concerns and HIPAA compliance strategies. CONCLUSION Cloud computing is the delivery of shared resources, software, and information to computers and other devices as a metered service. This technology has a promising role in the sharing of patient medical information and appears to be particularly suited for application in radiology, given the fields inherent need for storage and access to large amounts of data. The radiology cloud has significant strengths, such as providing centralized storage and access, reducing unnecessary repeat radiologic studies, and potentially allowing radiologic second opinions more easily. There are significant cost advantages to cloud computing because of a decreased need for infrastructure and equipment by the institution. Private clouds may be used to ensure secure storage of data and compliance with HIPAA. In choosing a cloud service, there are important aspects, such as disaster recovery plans, uptime, and security audits, that must be considered. Given that the field of radiology has become almost exclusively digital in recent years, the future of secure storage and easy access to imaging studies lies within cloud computing technology.

Cybersecurity in radiology: Access of public hot spots and public Wi-Fi and prevention of cybercrimes and HIPAA violations.

OBJECTIVE The purpose of this article is to review the steps that can be taken to ensure secure transfer of information over public and home networks, given the increasing utilization of mobile devices in radiology. CONCLUSION With the rapid technologic developments in radiology, knowledge of various technical aspects is crucial for any practicing radiologist. Utilization of mobile devices, such as laptops, tablets, and even cellular phones, for reading radiologic studies has become increasingly prevalent. With such usage comes a need to ensure that both the users and the patients private information is protected. There are several steps that can be taken to protect sensitive information while using public networks. These steps include being diligent in reviewing the networks to which one connects, ensuring encrypted connections to web-sites, using strong passwords, and using a virtual private network and a firewall. As the role of information technology in modern radiology practice becomes more critical, these safety mechanisms must be addressed when viewing studies on any mobile device.

Continuous Certification Within Residency: An Educational Model.

Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program.

CT Angiography of the Head in Extracorporeal Membrane Oxygenation

SUMMARY: Extracorporeal membrane oxygenation is an artificial cardiopulmonary bypass technique used to support patients with severe pulmonary failure or both pulmonary and cardiac failure. The hemodynamic changes produced by extracorporeal membrane oxygenation affect the appearance of CTA of the head images, often confounding interpretation if the correct history and understanding of extracorporeal membrane oxygenation are not known. This technical report describes the principles of extracorporeal membrane oxygenation, techniques to optimize intracranial CTA imaging, and pitfalls.