Stephen I. Marglin

Intrathoracic granulocytic sarcomas

Recent trends in the treatment of intrathoracic granulocytic sarcoma (IGS) call for an overview of its radiographic manifestations. Nine patients from our institution and a review of 41 from the literature provide the basis of our conclusions on the typical and atypical appearance of IGS. Of the nine patients with IGS, all had chest radiographs, five had computed tomographic (CT) scans, and one had magnetic resonance (MR) scans. Radiographic studies and medical records were examined to establish the site and appearance of IGS. Three cases were histologically proved; in the others, the diagnosis was based on clinical presentation and response to chemotherapy. The mediastinum was the most common site of involvement (six of nine cases). A focal mass or mediastinal widening was visible on chest radiographs, and a focal mass or diffuse infiltration or replacement of fat was visible on chest CT. Less common sites of involvement were the lungs (two cases), the pleura (two), the pericardium (two), and the hilar (two). Mediastinal or hilar mass or mediastinal widening is the characteristic finding in IGS. Less common manifestations such as pleural and pericardial effusions and lung opacities should be confirmed histologically, since fluid or tissue is readily accessible.

Preliminary experience with portable digital imaging for intensive care radiography.

A digital radiography system based on reusable, photostimulable phosphor technology was evaluated in approximately 3,500 portable chest radiographs of patients in an intensive care unit. The system functioned well in this application. No major problems were encountered in the visualization of tubes or catheters or in the detection of pneumothoraces. Assessment of fluid volume status or the presence of small pleural effusions, especially when these were bilateral, was initially somewhat difficult but became easier as investigators became familiar with the system. Radiologists were quicker than nonradiologists to accept the minimized two-on-one display format. Critical evaluation of the overall performance of digital systems such as this one is needed for a better definition of the systems strengths and weaknesses. Specifically, statistical analyses of the ability to detect disease states such as pneumothoraces, interstitial lung disease, lung nodules, and pleural abnormalities need to be performed.

Nodal Involvement in Hodgkin Disease

Hodgkin Disease (HD) is an uncommon disease, accounting for less than 1% of all neoplasms that occur yearly in the United States, and only 30% of all lymphomas. Despite this, it has been estimated that nearly 8,000 new cases of HD will be diagnosed in 2003, and that approximately 1,300 patients will die, These statistics, coupled with a appreciation for the remarkable advances that have been achieved in the understanding, diagnosis, staging, treatment, and prognosis of Hodgkin’s, have caused HD to become a subject of fascination for oncologists and radiologists alike (Fig. 2.1).

Clinical aspects of quality assurance in PACS

The advent of picture archiving and communication systems (PACS) promises to confer a number of significant advantages upon the practice of medicine, in general, and upon radiology, in particular. This promise, notwithstanding, numerous important obstacles to a complete, clinically effective, implementation of this technology exist. Not the least of these obstacles pertains to the area of quality assurance (QA). The remainder of this manuscript will review the approach that many conventional departments of radiology have taken to QA problems. This information will be used as a foundation for conjecture about QA issues that are likely to be important in a totally digital environment.