Search

Purpose An increasing number of implantable or external devices can impact whether patients can receive radiological imaging examinations. This study examines and tests the Neulasta (pegfilgrastim) Onpro on‐body injector in multiple imaging environments. Methods The injector was analyzed for four imaging modalities with testing protocols and strategies developed for each modality. In x‐ray and computed tomography (CT), scans with much higher exposure than clinical protocols were performed with the device attached to an anthropomorphic phantom. The device was monitored until the completion of drug delivery. For magnetic resonance imaging (MRI), the device was assessed using a hand‐held magnet and underwent the magnetically induced displacement testing in a 1.5T clinical MRI scanner room. For ultrasound, magnetic field changes were measured around an ultrasound scanner system with three transducers. Results For x‐ray and CT no sign of device error was identified during or after the high radiation exposure scans. Drug delivery was completed at expected timing with expected volume. For MRI the device showed significant attractive force towards the hand‐held magnet and a 50‐degree deflection angle at 50 cm from the opening of the scanner bore. No further assessment from the gradient or radiofrequency field was deemed necessary. For ultrasound the maximum magnetic field change from baseline was measured to be +11.7 μT in comparison to +74.2 μT at 4 inches from a working microwave. Conclusions No device performance issue was identified under the extreme test conditions in x‐ray or CT. The device was found to be MR Unsafe. Magnetic field changes around an ultrasound system met the limitation set by manufacture. Patient ultrasound scanning is considered safe as long as the transducers do not inadvertently loosen the device.

Metastatic lymph nodes of the head and neck are often associated with locoregional spread of mucosal squamous carcinoma, but in rare instances visceral malignancies may bypass Virchow's node. The possibility of distant metastasis should be considered.

The coronavirus disease 2019 (COVID-19) pandemic has various radiological imaging findings. Although paediatric cases are generally asymptomatic, they may be affected by the disease. Here, we aimed to discuss a case with atypical imaging findings.Chest computed tomography characteristics of coronavirus disease 2019 (COVID‐19) in paediatric patients have been reported to be atypical and different compared to adults. Although pneumatocele has not been reported in paediatric COVID‐19 pneumonia cases in the literature, physician should be familiar with atypical imaging findings.

This was followed by an interactive discussion of investigation and management plan. Appropriate radiological imaging such as an MRI brain scan was shown to the group using the “share‐screen” function. Other clinical information such as laboratory results can likewise be displayed. The session was completed after thorough discussion on the appropriate treatment plan with respect to the patient’s scenario.

Aim Elderly physical abuse (EPA) is defined as injury or assault to or the restriction of an elderly person. Although EPA is an important social problem, its diagnosis is difficult because of tendency to cover up the event. In this study, patients aged 65 years and over who presented at the emergency department (ED) for forensic reasons and in whom physical abuse was suspected were examined. The aim of this study was to raise ED awareness of EPA and thereby to contribute to treatment plans for these patients in the ED. Methods The study was conducted over a 4-year period between January 2013 and January 2017. Patients were selected retrospectively from the hospital information system according to the following criteria: (i) admission to ED with trauma; (ii) aged 65 and older; and (iii) evaluated as having forensic trauma by an ED specialist based on either the patient's history or the specialist's observations and suspicions. Results The patients included 80 men (69%) and 36 women (31%), with a mean age of 73.92 ± 7.08 years. The length of ED stay was 0-1 h in 27.6% of patients and 1-6 h in 46.6%. When the causes of physical trauma were examined, general assault was seen as the most prevalent, occurring in nearly 63% of the patients. Conclusions There may be three conclusions for the current study: First, although EPA is a rare problem for patients referred to emergency services, health professionals should be suspicious when examining patients 65 years or older because of the difficulties of diagnosing EPA. Second, in patients with no history of suspicious trauma or suspicious radiological imaging results, EPA is also common. Third, because of the undetected EPA mechanism, patients should be examined forensically in suspicious cases and deaths.

Quality assurance for radiological imaging equipment typically consists of analyzing data on images of physical phantoms and, if the results meet certain standards, it is assumed that clinical images obtained using the equipment will automatically be of good quality. Some claim, however, that such purely physical characterization of the quality of medical images does not adequately reflect their clinical quality. This is the premise debated in this month's Point/Counterpoint. This article is protected by copyright. All rights reserved.

Radiological imaging plays an important role in oncological trials to provide imaging biomarkers for disease staging, stratifying patients, defining dose setting, and evaluating the safety and efficacy of new candidate drugs and innovative treatment. This paper reviews the techniques of most commonly used quantitative magnetic resonance imaging (qMRI) biomarkers (dynamic contrast enhanced, dynamic susceptibility contrast, and diffusion weighted imaging) and their applications in oncological trials. Challenges of incorporating qMRI biomarkers in oncological trials are discussed including understanding biological mechanisms revealed by MRI biomarkers, consideration of rigorous trial design and standardized implementation of qMRI protocols. Keywords: Quantitative magnetic resonance imaging, Biomarkers, Oncological clinical trials

Background A study conducted at an Australian hospital between 2007 and 2009 led to the implementation of a clinical prediction algorithm for pulmonary embolism (PE) consisting of the Wells criteria and D-dimer testing. Since then, studies conducted in other countries have recommended new D-dimer cut-offs to the algorithm. Aims To appraise the implemented algorithm and see if its ability to stratify patient risk has been maintained and to test retrospectively new D-dimer thresholds. Methods Data from 300 patients with computed tomography pulmonary angiograms (CTPA) scans between February 2010 and March 2012 were included. Results were reviewed for algorithm compliance, patient risk stratification and PE prevalence. A higher D-dimer and an age-adjusted D-dimer cut-off were then retrospectively applied to the algorithm and results were re-evaluated. Results Pre-test probabilities between the current and original study remain within 1%, with slightly higher PE prevalence in the original study (12.7% vs 13.8%). Of the imaged cases, 14% (42/300) were not compliant with the algorithm. Of the low- and moderate-risk patients that underwent D-dimer testing, the retrospective application of 0.5 mg/L D-dimer cut-off resulted in a further 12.1% (95% confidence intervals 8.0-17.1%) of patients excluded from undergoing a CTPA. When combined with an age-adjusted D-dimer cut-off, 27.9% (60/215 95% confidence intervals 22.0-34.3%) were excluded from undergoing a CTPA. Conclusion The implemented algorithm has maintained risk stratification and PE prevalence results. Along with evidence in other studies, we have shown that raising the D-dimer and applying age-adjusted D-dimer cut-offs might improve the efficiency of the clinical prediction algorithm in patients aged over 50.

Background and Aim Excretion of the patency capsule (PC) within a certain time frame may be used to demonstrate luminal patency prior to capsule endoscopy (CE). We aimed to determine how often further radiological imaging is needed to confirm luminal patency after PC, assess radiologists' ability to locate the PC on plain abdominal films, and evaluate the outcomes of a novel computed tomography (CT) protocol for PC localization. Methods A study of the ability of radiologists to localize PC using plain abdominal films was performed. A novel protocol targeting a limited CT at the level of the PC identified on the “scout” film if retained 30 h post-ingestion was prospectively evaluated in 400 consecutive patients undergoing PC. Results In a study of the confidence with which radiologists could localize the PC on plain films, radiologists preferred abdominal CT to localize PCs identified on plain films in 74% of cases. In a protocol based on the use of a PC and targeted, limited CT scan to confirm small bowel patency in those failing to excrete the PC 30 h post-ingestion, the sensitivity, specificity, positive, and negative predictive value were 99.4%, 90.0%, 99.7%, and 81.0%, respectively. Crohn's disease was the only statistically significant predictor associated with higher risk of luminal stricture (P = 0.001) in post-hoc analysis. Conclusions Excretion of the PC 30 h post-ingestion reliably predicts safe CE passage. Plain abdominal radiology is unreliable and a scout film targeted, limited CT scan offers an accurate minimal radiation method of determining small bowel patency.

Cardiologists are increasingly becoming involved in procedures associated with the atrial septum and ventricular septum, such as transseptal puncture and selective site pacing. Moreover, detailed knowledge about the architecture of the atrial septum and ventricular septum is now available from studies by radiologists and anatomists. However, from the viewpoint of clinical cardiologists, many questions about the three-dimensional cardiac structural anatomy that relate closely to routine invasive procedures remain unresolved. Although modern multidetector-row computed tomography could provide answers, interventional cardiologists might have not considered the potential of this equipment, as only a few have performed studies with both radiological imaging and cadaveric hearts. Detailed knowledge of the three-dimensional fluoroscopic cardiac structural anatomy could help to reduce the need for contrast medium injection and radiation exposure, and to perform safe interventions. In this article, we present a series of cardiac structural images, including images of the atrial septum and ventricular septum, reconstructed in combination with the cardiac contour using multidetector-row computed tomography. We also discuss the clinical implications of the findings on the basis of accumulated insights of research pioneers. We hope that the present images will serve as a bridge between the fields of cardiology, radiology, and anatomy, and encourage cardiologists to integrate their accumulated insights into the three-dimensional clinical images of the living heart. Clin. Anat., 2015. © 2015 Wiley Periodicals, Inc.

The correlated-error ANOVA method proposed by Obuchowski and Rockette (OR) has been a useful procedure for analyzing reader-performance outcomes, such as the area under the receiver-operating-characteristic curve, resulting from multireader multicase radiological imaging data. This approach, however, has only been formally derived for the test-by-reader-by-case factorial study design. In this paper I show that the OR model can be viewed as a marginal-mean ANOVA model. Viewing the OR model within this marginal-mean ANOVA framework is the basis for the marginal-mean ANOVA approach, the topic of this paper. This approach (1) provides an intuitive motivation for the OR model, including its covariance-parameter constraints; (2) provides easy derivations of OR test statistics and parameter estimates, as well as their distributions and confidence intervals; and (3) allows for easy generalization of the OR procedure to other study designs. In particular, I show how one can easily derive OR-type analysis formulas for any balanced study design by following an algorithm which only requires an understanding of conventional ANOVA methods.

Haematuria is a sign that can arise from a constellation of disorders, ranging from urinary tract infection to invasive malignancy. The authors review imaging modalities for the investigation of haematuria and highlight how imaging is key to the exclusion of potentially serious causative aetiologies. Copyright © 2011 Wiley Interface Ltd

Aim: The aim of this study was to evaluate the safety and short-term outcome of ourmanagement of asymptomatic children with antenatally diagnosed congenital thoracicmalformations (CTM), compared with recommendations from a recent review andmeta-analysis. Methods: Twenty-two asymptomatic children with CTM, born in January 1, 2002 toJanuary 8, 2009 were reviewed. Data on complications and respiratory symptoms werecollected. Results: No severe respiratory symptoms were recorded. Seventeen children werereferred to surgery. Complications were seen in one child. The final diagnoses were con-genital pulmonary airway malformation (CPAM) in 13 children, two had sequestrations,and two had other significant malformations. Five children had minor malformations anddid not undergo surgery. No malignancies were reported. Conclusion: Elective surgery at 1 year of age is safe and carries no apparent risk toasymptomatic children with CTM. The rate of complications was equal to that reportedin a recent review and meta-analysis.INTRODUCTIONDetection of congenital thoracic malformations (CTM) inutero by ultrasonography (US) has increased during the lastdecade because of both advances in technology and imple-mentation of routine investigations at week 18–20 of gesta-tion (1,2). The true nature of CTM is not always obvious onfoetal US, which has caused a somewhat confusing changein nomenclature (3).One challenging subset of these malformations is congen-ital pulmonary airway malformation (CPAM) (Fig. 1). Thisis a rare malformation with a variable reported incidencebetween 1 per 8300 and 1 per 25 000–35 000 births (4,5).The majority of these are large and small cyst CPAM, for-merly known as congenital cystic adenomatoid malforma-tion (CCAM) (6).Most children with CTM are asymptomatic at birth andgive rise to the complex question of which approach to take,regarding timing of radiological imaging and, if any, choiceof treatment (7,8).A recent systematic review and meta-analysis recom-mends surgical intervention before 10 months of age inantenatally diagnosed CTM(9).This ledtothe presentretro-spective study of safety and short-term outcome of our strat-egy of postponing both computer tomography (CT)examinations and surgery until after 1 year of age.Abbreviations

Introduction: To investigate the use of inferior vena cava (IVC) filters in a tertiary referral centre, looking at indication, types of filters and, with temporary/optional filters, removal rates. Methods: Data was collected from a prospective database of all IVC filters inserted from January 2003 to January 2007. Patients' records and radiological imaging were all reviewed. Results: 66 patients (40 males) had IVC filters inserted during the study period. The median age of the male patients was 57.5 (21–79) years, and females 56 (24–81). There were 49 (74.2%) temporary/optional filters and 17 (25.8%) permanent filters. The most common indication for filter was a contraindication to anticoagulation for both permanent (64.7%) and temporary/optional filters (77.6%). In the temporary/optional filter group, 38 of 49 (77.6%) patients had documented venous thromboembolism, while in the permanent filter group, this was 14 of 17 (82.4%). Of the optional filters, 22 of 49 (45.8%) have been removed. Conclusion: More than half (54.2%) of temporary/optional filters were not removed and with potential for long-term complications. A protocol has now being instituted for vascular surgeons to authorize the insertion of filters and to then be responsible for ensuring their removal.

A hospital‐based magnetic guidance system (MGS) was installed to assist a physician in navigating catheters and guide wires during interventional cardiac and neurosurgical procedures. The objective of this study is to examine the performance of this magnetic field‐guided navigation system. Our results show that the system's radiological imaging components produce images with quality similar to that produced by other modern fluoroscopic devices. The system's magnetic navigation components also deflect the wire and catheter tips toward the intended direction. The physician, however, will have to oversteer the wire or catheter when defining the steering angle during the procedure. The MGS could be clinically useful in device navigation deflection and vessel access. PACS numbers: 07.55.Db, 07.85.‐m

Purpose: To develop and demonstrate application of a method that characterizes deviation of linac x-ray beams from the centroid of the volumetric radiation isocenter as a function of gantry, collimator, and table variables. Methods: A set of Winston-Lutz ball-bearing images was used to determine the gantry radiation isocenter as the midrange of deviation values resulting from gantry and collimator rotation. Also determined were displacement of table axis from gantry isocenter and recommended table axis adjustment. The method, previously reported, has been extended to include the effect of collimator walkout by obtaining measurements with 0 and 180 degree collimator rotation for each gantry angle. Twelve images were used to characterize the volumetric isocenter for the full range of available gantry, collimator, and table rotations. Results: Three Varian True Beam, two Elekta Infinity and four Versa HD linacs at five institutions were tested using identical methodology. Varian linacs exhibited substantially less deviation due to head sag than Elekta linacs (0.4 mm vs. 1.2 mm on average). One linac from each manufacturer had additional isocenter deviation of 0.3 to 0.4 mm due to jaw instability with gantry and collimator rotation. For all linacs, the achievable isocenter tolerance was dependent on adjustment of collimator position offset, transverse position steering, and alignment of the table axis with gantry isocenter, facilitated by these test results. The pattern and magnitude of table axis wobble vs. table angle was reproducible and unique to each machine. Conclusion: This new method provides a comprehensive set of isocenter deviation values including all variables. It effectively facilitates minimization of deviation between beam center and target (ball-bearing) position. This method was used to quantify the effect of jaw instability on isocenter deviation and to identify the offending jaw. The test is suitable for incorporation into a routine machine QA program. Software development was performed by Radiological Imaging Technology, Inc.

Purpose The anatomical integrity of an eye bearing an OOKP depends on the integrity and dimensions of the OOKP lamina itself. The lamina is anchored onto the corneo-scleral envelope initially through suturing. Later on, the overlying buccal mucous membrane graft adheres onto the soft tissues invested into the bone of the lamina, retaining it and providing a seal to guard against entry of microbes into the eye. The integrity and dimensions of the lamina is ascertained clinically at each hospital visit, and this is aided by periodic radiological imaging. Methods We studied the relative merits of volumetric analysis, multislice CT vs Aquilion, and texture analysis. We also studied the feasibility of inserting radioopaque markers into the optical cylinder to aid inter examination orientation thus allowing subtraction radiology. Results Volumetric analysis has proven useful but cannot detect fractures in the lamina. The Aquilion provides slightly superior images but its major advantages are speed of acquisition and a much lower radiation dosage, allowing more frequent examination in cases where there is a suspicion of rapid dissolution of the lamina. Asymmetric markers placed with an optical cylinder can be imaged successfully. Conclusion Much work remains to be done to improve imaging of the OOKP lamina. Consideratons include image resolution, speed of acquisition, radiation dosage, costs, and repeatibility.

Differential Diagnosis in Musculoskeletal MRI is written by eminent radiologists working with the University of Rochester Medical Centre, New York with numerous publications between them on radiological imaging. Published by Thieme, a well respected, award winning, international publisher for more than 125 years, this handsome‐looking book invites investigation. Thieme is known for high quality books and journals in both print and electronic format keeping the medical community up to date with the latest scientific and medical advances. The book begins with a list of useful medical and magnetic resonance imaging (MRI) abbreviations followed by a brief introduction to MRI for evaluation of musculoskeletal abnormalities. It is then divided roughly into two sections, the first dedicated to lesions of the joints and the second covering bone and soft tissue lesions and tumours. The abnormalities are listed in table format with descriptions of the MRI findings and comments which include clinical presentation, percentage occurrence within age groups and mechanisms of injury. Alongside these are high quality annotated images to illustrate the findings with multiple examples of abnormalities and their appearances. At the end of each section the authors have provided extensive references and suggestions for further reading. As an experienced MRI radiographer I found this an excellent reference containing high quality paper print and clear images. A list of abbreviations is always a helpful refresher in reading imaging requests in our daily work as well as making sense of the annotated images in this text. However, the table style used in this book took some getting used to and may not suit everyone. I found the more I looked into the book the quicker I found what I was looking for so maybe practice and familiarity are the key to getting the most out of it. The suggested reading and references provide useful background when writing up case studies or further learning and reading lists for continuing professional development (CPD) purposes. Although this book is aimed at practicing radiologists, fellows, residents and other clinicians, I think it is useful for increasing the breadth of knowledge for all radiographers, particularly those given the opportunity to report MRI. The quality images allow for direct comparison with those on PACS and, along with accompanying descriptions, be able to identify pathology with a greater degree of confidence. This resource should have a place on the reference bookshelf of any MRI facility particularly those specialising in musculoskeletal studies.

SUMMARY A dermold cyst, arising from the posterior aspects of the prostate and seminal vesicles, and extending into the pelvis to masquerade as a full bladder, must be exceedingly rare. Ultrasound, computed tomography and especially magnetic resonance imaging (MRI) proved to be invaluable in making the diagnosis, and MRI in particular was very useful in providing an anatomical road map for surgery.

Summary A comparative study was made in fifty-three patients with functional diseases of the stomatognathic system and twelve healthy probands by means of anamnestic exploration, clinical examination, occlusal analysis, computed tomography (CT) and magnetic resonance imaging (MRI). Connections between functional and structural changes of the diseased stomatognathic system were found. The results showed the possibilities and applications of CT and MRI as supplementary diagnostic methods in the diagnosis of functional TMJ disorders.

A brief overview of the radiological imaging problem is presented, emphasizing the need for parametrizing components for the user, medical physicist, or system designer. Against this background a method is proposed for reducing MTF data. The single parameter obtained is analogous to criteria of “sharpness” used in other optical applications. The example of x‐ray tube focal spots is examined in detail; results are presented and compared with other criteria. Finally, a prescription for cascading elements into a system is given and applied to the case of magnification radiography.

Summary— The manner of presentation and tumour stage in 16 consecutive patients with renal carcinoma who were treated surgically between 1976 and 1980, and in 37 patients treated similarly between 1981 and 1985, were reviewed. Two patients (13%) were discovered incidentally between 1976 and 1980 compared with 13 (35%) between 1981 and 1985. The renal tumours were discovered incidentally at the time of intravenous urography (IVU), ultrasound, computed tomography (CT) and angiography. There were 13 stage I and two stage II lesions, as assessed pathologically after nephrectomy. The tumours were less than 6 cm in diameter. Thirteen of 15 patients are alive between 6 and 90 months after surgery. No patient died of renal carcinoma. Our data have shown an increase in the proportion of incidentally diagnosed cases. The routine use of intravenous urography, ultrasound and computed tomography has led to earlier diagnosis, lower stage and possibly longer survival in patients with incidentally detected renal carcinomas compared with patients where the diagnosis was suspected.