Jonathan W. Berlin

Imaging benign and malignant disease of the gallbladder

This article reviews the imaging of various benign and malignant diseases of the gallbladder. Clinical findings and imaging features using ultrasound, CT, and MR for the detection and evaluation of gallstones, acute cholecystitis, xanthogranulomatous cholecystitis, adenomyomatosis, and carcinoma of the gallbladder among other disorders are discussed.

Magnetic resonance imaging of the pancreas at 3.0 tesla: qualitative and quantitative comparison with 1.5 tesla.

Objectives:We sought to perform a preliminary comparison of signal-to-noise ratio (SNR) and image quality for magnetic resonance imaging (MRI) of the pancreas at 1.5 and 3 T. Materials and Methods:Two imaging cohorts were studied using a T2-weighted, single-shot fast spin-echo pulse sequence and a T1-weighted, fat-suppressed 3D gradient-echo pulse sequence. In the first cohort, 4 subjects were imaged using identical imaging parameters before and after contrast administration at 1.5 and 3.0 T. The SNR was quantified for the pancreas as well as for the liver, spleen, and muscle. In a second cohort of 12 subjects in whom the receiver bandwidth was adjusted for field strength, SNR measurements and qualitative rankings of image quality were performed. Results:In the study cohort using identical imaging parameters at both magnetic field strengths, the mean (SD) ratios of SNR at 3.0 to 1.5 T of the single-shot fast spin-echo images for the pancreas, liver, spleen, and muscle were 1.63 (0.39), 1.82 (0.39), 1.45 (0.18), 2.01 (0.16), respectively. For the precontrast fat-suppressed 3D gradient-echo sequence, the corresponding ratios were 1.28 (0.29), 1.26 (0.30), 1.16 (0.27), and 1.76 (0.45), respectively; for the arterial phase, the corresponding ratios were 2.02 (0.28), 1.60 (0.42), 1.47 (0.26), and 1.94 (0.32), respectively; and for the delayed postcontrast phase, the corresponding ratios were 1.63 (0.51), 2.01 (0.25), 1.66 (0.06), and 2.31 (0.47), respectively. The SNR benefit of 3.0 T was significantly greater on contrast-enhanced as compared with noncontrast T1-weighted 3D gradient-echo images. In the second study cohort, SNR was superior at 3.0 T, although the use of a reduced readout bandwidth at 1.5 T substantially diminished the advantage of the higher field system. With qualitative comparison of images obtained at the 2 magnetic field strengths, the fat-suppressed 3D gradient-echo images obtained at 3.0 T were preferred, whereas the single shot fast spin-echo images obtained at 1.5 T were preferred because of better signal homogeneity. Conclusions:Our results in a small cohort of volunteers and patients demonstrate a marked improvement in SNR at 3.0 T compared with 1.5 T (by a factor of 2 in some cases) when identical imaging parameters were used. The SNR advantage at 3.0 T is diminished but persists when the receiver bandwidth is adjusted for magnetic field strength. The results suggest that 3.0 T may offer promise for improved body MRI, although further technical development to optimize SNR and improve signal homogeneity will be needed before its full potential can be achieved.

ACR White Paper: The Value Added That Radiologists Provide to the Health Care Enterprise

Radiologists represent arguably one of medicines least heralded but most important specialties. Although they carry sterling credentials as imaging and radiation safety experts, radiologists have lacked widespread public recognition. As public and private stakeholders cast an even more intense spotlight on imaging, the vital role of radiologists must be better understood. During the January 2008 ACR Forum on Future Practice Models for Radiology, participants and ACR leaders discussed the value added that radiologists bring to the health care enterprise and recommended that the ACR further study that topic. The ACR, dedicated to providing quality patient care since its inception in 1924, convened the Task Force on Value Added to address these issues. The task force determined the component stakeholders in the health care enterprise to whom value is added, defined the nature of the value for each constituent component, described the process of adding that value, and anticipated future trends that may affect the value proposition. Recommendations to the ACR for future action are offered.

Diagnosis and staging of small bowel tumours

Small bowel neoplasms comprise only 1% of gastrointestinal neoplasms. Despite their rarity, it is important to diagnose small bowel tumours early to maximize patient survival.

Imaging in Intestinal Ischemic Disorders

Intestinal ischemia and infarction are a heterogeneous group of diseases that have as their unifying theme hypoxia of the small bowel and/or colon. The incidence of bowel ischemia is increasing for a number of reasons: the aging of the population, the ability of intensive care units to salvage critically ill patients, and heightened clinical awareness of these disorders. Improvements in diagnostic imaging techniques have contributed greatly to the earlier diagnosis of intestinal ischemia, which can have a positive influence on patient outcomes. In this review, advances in multidetector computerized tomography, magnetic resonance, and ultrasound in the detection of intestinal ischemia are highlighted and placed in the context of expeditious patient management.

Evaluation of personal digital assistants as an interpretation medium for computed tomography of patients with intracranial injury

The objective of the study was to assess the feasibility of using a personal digital assistant (PDA) as a medium for the interpretation of cranial CT scans of trauma patients. Twenty-one noncontrast cranial CT scans were transferred in their entirety to a PDA from the picture archiving and communications system (PACS) utilizing General Electric (GE) PathSpeed PACS Web Server interface and synchronization. All CT scans had been interpreted by board-certified radiologists prior to the study. Seven of the scans demonstrated subarachnoid hemorrhage, seven demonstrated subdural hematomas, and the remaining scans were normal. After transfer to the PDA, all images were separately reviewed in a blinded manner by a radiologist and a neurosurgeon. Images were graded for their quality and diagnostic utility in the evaluation of intracranial hemorrhage. Image quality was categorized as excellent, very good, acceptable for diagnosis, or not acceptable for diagnosis. Based on the radiologic diagnosis, recommendation for surgical management was made by the reviewing neurosurgeon. The accuracy rate for both the radiologist and the neurosurgeon in the detection of intracranial hemorrhage was 95%. There was one false negative which was attributed to error in judgment rather than poor image quality. This diagnostic error did not affect patient management. The sensitivity and specificity for detection of intracranial hemorrhage were 93% and 100%, respectively. Image quality was judged to be excellent in 90% of the cases and very good in the remaining 10%. Our results suggest that the PDA is a robust medium for interpretation of CT scans in patients with suspected hemorrhage following intracranial injury. In this setting, the PDA should be considered for teleradiology purposes.

The Architecture of Smart Surveys: Core Issues in Why and How to Collect Patient and Referring Physician Satisfaction Data

Radiology practices are facing challenges on many fronts. As the field becomes more competitive, leaders must pay more attention to the quality of the service that groups provide to their customers. This need is also being driven by higher expectations from customers, particularly patients, who will likely act much more like consumers in the 21st century. For practices to succeed in providing exemplary service, they must pay attention to the voices of their key customer groups. It is dismaying to see practices that are struggling or even dissolving over issues created by poor service. As much as we are experts in imaging, we are unlikely to be able to provide superlative service by reading books, talking among ourselves, or hiring consultants. Rather, we must do what should be obvious, which is to actually ask our customers how we are doing. Surveys are one of the important tools that can be brought to bear on this issue. For many groups, surveying is the starting point for understanding what their patients, referring physicians, and other key stakeholders want. Groups can also find out what customers like and dislike about their experiences, and how groups compare with their competitors. This article provides a guide on how to get off to a good start in designing and deploying surveys that can help optimize the way groups take care of their patients and help their referring physicians.

That liver lesion on MDCT in the oncology patient: is it important?

Abstract Multidetector-row computed tomography (MDCT) has become the primary imaging test for the staging and follow-up of most malignancies that originate outside of the central nervous system. Technical advances in this imaging technique have led to significant improvement in the detection of metastatic disease to the liver. An unintended by-product of this improving diagnostic acumen is the discovery of incidental hepatic lesions in oncology patients that in the past remained undetected. These ubiquitous, incidentally identified hepatic lesions have created a management dilemma for both clinicians and radiologists: are these lesions benign or do they represent metastases? Naturally, the answer to this question has profound prognostic and therapeutic implications. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidental lesions detected in patients with extrahepatic malignancies are presented.

ACR White Paper: Task Force to Evaluate the Value Add Impact on Business Models

Radiology practices are seeing both evolutionary and revolutionary changes in their business models. The Task Force to Evaluate the Value Add Impact on Business Models was charged with considering how radiologists and their practices add value in these novel settings. Both traditional and novel forms of added value were considered. Types of new business models that were evaluated included hybrid groups of radiologists and other practitioners, regional or national megagroups, and novel services both within and beyond the traditional purview of radiology practice. Recommendations for both how to measure and how to capture this value were considered at both the practice and national levels.

Pathways of abdominal tumour spread: the role of the subperitoneal space

Abstract The subperitoneal space is a large, unifying, anatomically continuous potential space that connects the peritoneal cavity with the retroperitoneum. This space is formed by the subserosal areolar tissue that lines the inner surfaces of the peritoneum and the musculature of the abdomen and pelvis. It contains the branches of the vascular, lymphatic, and nervous systems that supply the viscera. The subperitoneal space extends into the peritoneal cavity and is invested between the layers of the mesenteries and ligaments that support and interconnect the abdominal and pelvic organs. As such, it provides one large continuous space in which infectious, neoplastic, inflammatory, and hemorrhagic disease may spread in many directions.