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Ultrasound (US) imaging is an important diagnostic tool following renal transplantation. Unfortunately, due to the heterogeneity of the recipients and their multimorbidity, imaging procedures in the early phase after kidney transplantation are difficult and of limited use. We performed a study to evaluate the use of a contrast enhancer for US examination as a standardized method in the follow-up of kidney transplant recipients.The study included 40 recipients: 32 were examined on the 5th to 7th day following transplantation and 8 patients at the time when clinically suspicious findings occurred (acute rejection, tumor, acute tubular necrosis). Following the intravenous application of the contrast medium, pictures were taken during the arterial and parenchymatous phase and compared with conventional B-mode and power Doppler pictures of the same visual plane. Three examiners assessed different parameters of the transplant organ (max. vascularized area, suspected hematomas, tumors, rejection, acute tubular necrosis). Findings were confirmed by histological results of a biopsy if rejection, tumor, or acute tubular necrosis were suspected. Application of ultrasound contrast medium significantly increased visualization of the vascularized kidney area. Also, US findings in the follow-up after acute rejection therapy corresponded with the clinical course; 19 hematomas could be detected with contrast medium compared to only 9 without. With contrast medium a perfusion deficit was detectable in three patients compared to one patient with power Doppler US. Also, US contrast medium helped to detect tumor vascularization in two patients in whom conventional sonography suspected no abnormality. Ultrasound contrast medium enhancement is a reproducible, reliable, and easy to apply method which is superior to conventional sonography in the follow-up after kidney transplantation. This method is also helpful to detect and control acute rejections and to better visualize hematomas, deficits of perfusion, and tumors. [ABSTRACT FROM AUTHOR]

Background: The first cases of coronavirus disease 2019 were officially confirmed in Germany and its European neighbors in late January 2020. In France and Italy, there is evidence that coronavirus disease 2019 was spreading as early as December 2019., Case Presentation: We report on a 71-year-old male patient from Germany who was admitted to our hospital on 30 December 2019 with pneumonia of unclear etiology and chest computed tomography findings typical of COVID-19 pneumonia., Conclusion: This case may indicate that coronavirus disease 2019 was already spreading in Germany as early as December 2019., (© 2023. The Author(s).)

Objectives: To find out the opinion of radiological inpatient and outpatient medical staff regarding the measures taken in relation to the COVID-19 pandemic during the first and second waves and to identify the measures that are still perceived as needing improvement., Materials and Methods: We conducted an anonymous online survey among more than 10 000 radiologists/technicians in Germany from January 5 to January 31, 2021. A total of 862 responses (head physicians, n = 225 [inpatient doctors, n = 138; outpatient doctors, n = 84; N/A, n = 3]; radiologic personnel, n = 637 [inpatient doctor, n = 303; outpatient doctor, n = 50; inpatient technician, n = 217; outpatient technician, n = 26; N/A, n = 41]) were received. Questions of approximation, yes/no questions, and Likert scales were used., Results: During the first/second wave, 70 % (86/123)/43 % (45/104) of inpatient and 26 % (17/66)/10 % (5/52) of outpatient head physicians agreed that they received financial support from the authorities but the majority rated the financial support as insufficient. During the first and second wave, 33 % (8/24) and 80 % (16/20) of outpatient technicians agreed that they were adequately provided with personal protective equipment. The perceived lack of personal protective equipment improved for all participants during the second wave. Inpatient [outpatient] technicians perceived an increased workload in the first and second wave: 72 % (142/198) [79 % (19/24)] and 84 % (146/174) [80 % (16/20)]., Conclusion: Technicians seem increasingly negatively affected by the COVID-19 pandemic in Germany. Financial support by the competent authorities seems to be in need of improvement., Key Points: · The accessibility of personal protective equipment resources improved in the second wave.. · In particular, radiology technicians seem increasingly negatively affected by the COVID-19 pandemic.. · Financial and consulting support from the government could be improved.., Citation Format: · Bernatz S, Afat S, Othman AE et al. Impact of the COVID-19 Pandemic on Radiology in Inpatient and Outpatient Care in Germany: A Nationwide Survey Regarding the First and Second Wave. Fortschr Röntgenstr 2022; 194: 70 - 82., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: Image analysis is one of the most promising applications of artificial intelligence (AI) in health care, potentially improving prediction, diagnosis, and treatment of diseases. Although scientific advances in this area critically depend on the accessibility of large-volume and high-quality data, sharing data between institutions faces various ethical and legal constraints as well as organizational and technical obstacles., Methods: The Joint Imaging Platform (JIP) of the German Cancer Consortium (DKTK) addresses these issues by providing federated data analysis technology in a secure and compliant way. Using the JIP, medical image data remain in the originator institutions, but analysis and AI algorithms are shared and jointly used. Common standards and interfaces to local systems ensure permanent data sovereignty of participating institutions., Results: The JIP is established in the radiology and nuclear medicine departments of 10 university hospitals in Germany (DKTK partner sites). In multiple complementary use cases, we show that the platform fulfills all relevant requirements to serve as a foundation for multicenter medical imaging trials and research on large cohorts, including the harmonization and integration of data, interactive analysis, automatic analysis, federated machine learning, and extensibility and maintenance processes, which are elementary for the sustainability of such a platform., Conclusion: The results demonstrate the feasibility of using the JIP as a federated data analytics platform in heterogeneous clinical information technology and software landscapes, solving an important bottleneck for the application of AI to large-scale clinical imaging data.

Background: Magnetic resonance imaging (MRI) examinations with intravenous (IV) contrast are performed worldwide in routine daily practice. In order to detect and enumerate even rare adverse events (AE) and serious adverse events (SAE), and to relate them with patients' baseline characteristics and diagnostic effectiveness, high quantity sample size is necessary., Purpose: To assess safety, diagnostic effectiveness, and baseline characteristics of patients undergoing IV gadoteric acid (Dotarem®) MRI in routine practice., Material and Methods: Data from two observational post-marketing surveillance (PMS) databases compiled by 139 and 52 German centers in 2004-2011 and 2011-2013, respectively, were pooled, yielding data on a total of 148,489 patients examined over a 10-year period. Radiologists used a standardized questionnaire to report data including patient demographics, characteristics of MR examinations, and results in terms of diagnosis and patient safety., Results: Overall, 712 AEs were reported in 467 (0.3%) patients, mainly nausea (n = 224, 0.2%), vomiting (n = 29, <0.1%), urticaria (n = 20, <0.1%), and feeling hot (n = 13, <0.1%). AEs were considered related to gadoteric acid in 362 (0.2%) patients. Higher frequencies of AEs were observed among patients with a previous reaction to a contrast agent (2.0%), liver dysfunction (0.7%), bronchial asthma (0.7%), and a history of allergies (0.6%). There were 49 SAEs in 18 (<0.1%) patients, including two children. No fatal SAE was reported. Examinations were diagnostic in 99.8% of all patients, and image quality was excellent or good in 97.7% of the patients., Conclusion: Gadoteric acid is a safe peri-examinational and effective contrast agent for MRI in routine practice.

Objectives: Our study sought to reevaluate the safety and diagnostic efficacy of iobitridol as a nonionic contrast medium after almost 20 years of use., Materials and Methods: This noninterventional postmarketing surveillance noncontrolled, multicenter (168 centers in Germany) study enrolled 94,960 patients receiving intravenous or intra-arterial iobitridol. The majority of the adjusted population (n = 92,550, 98.2%) underwent either computed tomography examination (n = 46,502, 49.3%) or intravenous urography (n = 46,048, 48.8%). A standardized questionnaire was used to ascertain patient's information, known risk factors, renal function status, premedication, type of examination, injection of contrast agent, imaging quality, diagnostic value, and safety., Results: A total of 469 patients (0.49%) experienced an adverse event (AE), and 24 patients (0.025%) reported a serious AE (SAE). All patients recovered and no fatal event occurred. The prevalence of AE was significantly higher in patients with at least one risk factor, with premedication, with a history of AE, in female and patients younger than 60 years old (P < 0.05). Presence of at least one risk factor is the only predictive factor for the prevalence of SAE (P = 0.042). In patients with a history of AE, premedication did not significantly lower the AE rate (P = 0.737). No statistically significant difference in the prevalence of AE between the different combination of cortisone and/or antihistamines as pretreatment was found., Conclusions: Iobitridol is a safe contrast medium with a high tolerability and efficacy. Presence of risk factors such as cardiovascular diseases, allergies, or asthma was the only significant predictive factor for an AE and an SAE. Premedication did not significantly lower the occurrence of an AE and an SAE.

Objectives: To assess the feasibility, image quality, and accuracy of freehand biopsies of liver, bone, muscle, vertebral disc, soft tissue, and other lesions using balanced steady-state free precession (SSFP, balanced fast field echo: bFFE), spoiled and nonspoiled gradient echo (FFE), and turbo spin echo (TSE) sequences for interactive continuous navigation in an open magnetic resonance imaging (MRI) system at 1.0 tesla (T)., Methods: Twenty-six MR-guided biopsies (five liver, five bone, four muscle, four vertebral disc, one lung, one kidney, one suprarenal gland, and five soft or other tissue) were performed in 23 patients in a 1.0-T open magnetic resonance (MR) scanner (Panorama HFO, Philips Healthcare, Best, the Netherlands). A total of 42 samples were obtained. Depending on lesion size and location, 14-18-gauge MR-compatible biopsy sets with a length of 100 or 200 mm (Somatex Medical, Teltow, Germany), 14-18-gauge MR-compatible semiautomatic biopsy guns with a length of 100 or 150 mm (Invivo, Schwerin, Germany), or 11-gauge MR-compatible bone marrow biopsy needles with a length of 100 mm (Somatex Medical, Teltow, Germany) were employed., Results: All lesions were visible with continuous interactive imaging. Our initial results indicate that bFFE is particularly suitable for fast-moving organs (pulmonary, paracardial); moving organs are targeted better with T1-weighted (T1W) TSE, T1W FFE (liver) or T2-weighted (T2W) TSE (complicated cysts, adrenal glands), and static organs are successfully approached with proton density (PD) (spine) or T1W TSE (peripheral bones, musculoskeletal system). No adverse events related to the use of MRI were obtained. No complications occurred according to the Society of Interventional Radiology (SIR) clinical practice guidelines., Conclusion: Applying tailored interactive dynamic imaging sequences for continuous navigation to liver, bone, muscle, vertebral disc, soft tissue, and other lesions can improve the feasibility, image quality, and interventional accuracy of freehand MR-guided biopsies and may hence reduce the risk of complications.

Unlabelled: New technical and clinical developments of sonography and magnetic resonance imaging include improved detection, localization and staging as well as active surveillance of prostate cancer. Multiparametric MRI can best answer these typical clinical questions. However, ultrasound elastography seems to be suitable for the detection of significant prostate cancer as well. The structured reporting system for multiparametric MRI of the prostate according to PI-RADS Version 1 led to improved and reproducible diagnosis of prostate cancer. The new PI-RADS Version 2 aims to minimize the limitations of Version 1 and make PI-RADS standardization more globally acceptable., Key Points: The detection, staging, and active monitoring of prostate cancer are common clinical questions. The best method for answering these questions is multiparametric MRI. Ultrasound elastography also seems to be suitable for the detection of significant prostate cancer. The new PI-RADS Version 2 claims to eliminate the limitations of PI-RADS Version 1 and to allow globally recognized standardized diagnostic reporting., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aims: The teleradiological examinations performed at the Charité were analyzed for the purpose of internal quality and efficiency control. Data included the type and number of examinations performed, the time of day and week the examination was performed and the differences in teleradiologist report turnaround times., Material and Methods: A retrospective analysis of the radiology information system (RIS) database of all teleradiological computed tomography examinations performed at the Charité from 2011 through 2013 was carried out. The search retrieved 10,200 teleradiological examinations which were included in the analysis. The records were analyzed for the time of the day and week the examination was performed, the interval between examination and time of reporting, the type of teleradiological examination and the campus in which they were performed., Results: The number of teleradiological examinations performed increased continuously during the observation period. Computed tomography of the head was the most frequently performed type of examination with 86%. Taking all forms of examination into consideration it took an average of 34 min until a report was written. Over the 3-year observation period the times remained virtually unaltered., Conclusion: During the 3-year observation period nearly constant report times could be observed in spite of the increased numbers of examinations. This indicates an efficiency enhancement and rational integration of teleradiology into the radiological workflow.

Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain., Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated., Results: The mean intervention time was 24.9 min. (range: 12 - 36 min.) for MRI-guided infiltration and 19.7 min. (range: 5 - 54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76., Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance., (© Georg Thieme Verlag KG Stuttgart · New York.)

The balanced scorecard (BSC) represents a comprehensive management tool for organizations with the aim to focus all activities on a chosen strategy. Targets for various perspectives of the environment such as the customer, financial, process, and potential perspective are linked with concrete measures, and cause-effect relationships between the objectives are analyzed. This article shows that the BSC can also be used for the comprehensive control of a radiology department and thus provides a meaningful contribution in organizing the various diagnostic and treatment services, the management of complex clinical environment and can be of help with the tasks in research and teaching., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To compare the costs of CT-guided radiofrequency ablation (RFA) and MR-guided laser ablation (LA) for minimally invasive percutaneous treatment of osteoid osteoma., Materials and Methods: Between November 2005 and October 2011, 20 patients (14 males, 6 females, mean age 20.3±9.1 years) underwent CT-guided RFA and 24 patients (18 males, 6 females; mean age, 23.8±13.8 years) MR-guided LA (open 1.0 Tesla, Panorama HFO, Philips, Best, Netherlands) for osteoid osteoma diagnosed on the basis of clinical presentation and imaging findings. Prorated costs of equipment use (purchase, depreciation, and maintenance), staff costs, and expenditure for disposables were identified for CT-guided RFA and MR-guided LA procedures., Results: The average total costs per patient were EUR 1762 for CT-guided RFA and EUR 1417 for MR-guided LA. These were (RFA/LA) EUR 92/260 for equipment use, EUR 149/208 for staff, and EUR 870/300 for disposables., Conclusion: MR-guided LA is less expensive than CT-guided RFA for minimally invasive percutaneous ablation of osteoid osteoma. The higher costs of RFA are primarily due to the higher price of the disposable RFA probes., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Magnetic resonance (MR) imaging has been described as the most important medical innovation in the last 25 years. Over 80 million MR procedures are now performed each year and on average 2.3% (95% confidence interval: 2.0 to 2.5%) of all patients scheduled for MR imaging suffer from claustrophobia. Thus, prevention of MR imaging by claustrophobia is a common problem and approximately 2,000,000 MR procedures worldwide cannot be completed due to this situation. Patients with claustrophobic anxiety are more likely to be frightened and experience a feeling of confinement or being closed in during MR imaging. In these patients, conscious sedation and additional sequences (after sedation) may be necessary to complete the examinations. Further improvements in MR design appear to be essential to alleviate this situation and broaden the applicability of MR imaging. A more open scanner configuration might help reduce claustrophobic reactions while maintaining image quality and diagnostic accuracy., Methods/design: We propose to analyze the rate of claustrophobic reactions, clinical utility, image quality, patient acceptance, and cost-effectiveness of an open MR scanner in a randomized comparison with a recently designed short-bore but closed scanner with 97% noise reduction. The primary aim of this study is thus to determine whether an open MR scanner can reduce claustrophobic reactions, thereby enabling more examinations of claustrophobic patients without incurring the safety issues associated with conscious sedation. In this manuscript we detail the methods and design of the prospective "CLAUSTRO" trial., Discussion: This randomized controlled trial will be the first direct comparison of open vertical and closed short-bore MR systems in regards to claustrophobia and image quality as well as diagnostic utility., Trial Registration: ClinicalTrials.gov: NCT00715806.

Unlabelled: BACKGROUND/MOTIVATION: To directly determine isovolumetric cardiac time intervals by magnetic resonance elastography (MRE) using the magnitude of the complex signal for deducing morphological information combined with the phase of the complex signal for tension-relaxation measurements., Methods: Thirty-five healthy volunteers and 11 patients with relaxation abnormalities were subjected to transthoracic wave stimulation using vibrations of approximately 25 Hz. A k-space-segmented, ECG-gated gradient-recalled echo steady-state sequence with a 500-Hz bipolar motion-encoding gradient was used for acquiring a series of 360 complex images of a short-axis view of the heart at a frame rate of less than 5.2 ms. Magnitude images were employed for measuring the cross-sectional area of the left ventricle, while phase images were used for analyzing the amplitudes of the externally induced waves. The delay between the decrease in amplitude and onset of ventricular contraction was determined in all subjects and assigned to the time of isovolumetric tension. Conversely, the delay between the increase in wave amplitude and ventricular dilatation was used for measuring the time of isovolumetric elasticity relaxation., Results: Wave amplitudes decreased during systole and increased during diastole. The variation in wave amplitude occurred ahead of morphological changes. In healthy volunteers the time of isovolumetric elasticity relaxation was 75 ± 31 ms, which is significantly shorter than the time of isovolumetric tension of 136 ± 36 ms (P < 0.01). In patients with relaxation abnormalities (mild diastolic dysfunction, n = 11) isovolumetric elasticity relaxation was significantly prolonged, with 133 ± 57 ms (P < 0.01), whereas isovolumetric tension time was in the range of healthy controls (161 ± 45 ms; P = 0.053)., Conclusion: The complex MRE signal conveys complementary information on cardiac morphology and elasticity, which can be combined for directly measuring isovolumetric tension and elasticity relaxation in the human heart.

Purpose: To document immediate and short-term changes in uterine perfusion after uterine artery embolization (UAE)., Materials and Methods: Fifteen patients (median age, 42 years) underwent UAE with tris-acryl gelatin microspheres and a limited embolization protocol. Contrast-enhanced magnetic resonance imaging was performed before therapy and 1 hour (immediate), 48-72 hours (subacute), and a median of 5 months (short-term follow-up) after UAE to determine uterine and leiomyoma perfusion. Leiomyomas with a minimum diameter of 10 mm were included. Changes in regional (ie, fundus/body/cervix), zonal (ie, endometrium/inner/middle and outer myometrial layer), and leiomyoma perfusion were documented., Results: UAE was technically successful in all patients. Immediate contrast-enhanced MR imaging revealed ischemia of the uterine body and fundus. The endometrium and inner myometrial layer was involved in all 15 patients; the middle layer was also involved in 13. Ischemic defects were seen in the outer layer in one patient but never in the cervix. Subacute follow-up showed reperfusion of the myometrium in 73% of patients. Ischemic defects occurred in the endometrial and junctional zone in four patients and in the middle zone in one. Five-month follow-up showed perfusion of all uterine layers in all patients. Ten patients had complete infarction of all leiomyomas; five presented with 11 partially perfused leiomyomas., Conclusions: Limited bilateral UAE leads to transient uterine ischemia, particularly involving the endometrium and inner and middle zone of the myometrium of the uterine body and fundus. The cervix and subserosal layer are spared. Complete reperfusion of myometrial tissue is observed within 48-72 hours in most cases, whereas ischemic leiomyomas undergo irreversible infarction., (Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the 12-month clinical and magnetic resonance (MR) imaging results of an ongoing two-center registry involving acrylamido polyvinyl alcohol (PVA) microspheres for uterine artery embolization (UAE) for leiomyomas., Materials and Methods: A total of 69 patients underwent UAE with 500-700-microm, 700-900-microm, and 900-1,200-mum acrylamido PVA microspheres (BeadBlock). Thirty-three patients underwent UAE with a limited embolization (protocol A) and 36 patients underwent UAE with stasis as the angiographic endpoint (protocol B). Primary objectives were clinical efficacy measured by a leiomyoma-specific quality of life (QOL) questionnaire and infarction rate of leiomyomas on early contrast agent-enhanced MR imaging. Secondary objectives were in-hospital complications, patient satisfaction, and frequency of clinical failure., Results: Bilateral embolization was technically successful in 68 of 69 patients. A significant decrease (P < .001) in symptom severity and increase in health-related QOL was observed at 3 and 12 months with no significant differences between embolization protocols. However, contrast agent-enhanced MR imaging showed a significantly lower rate of completely infarcted leiomyomas in protocol A compared with protocol B (P < .05). Early clinical failures in patients treated according to protocol A were caused by incomplete tumor infarction. Minor complications occurred in five of 69 patients. Patient satisfaction was similar between protocols., Conclusions: Acrylamido PVA microspheres are a clinically effective and safe embolic agent for UAE. The use of 500-700-microm spheres and a limited embolization results in an unacceptably high rate of failed tumor infarction. Superior imaging results and fewer repeat interventions can be achieved with use of 700-900-microm spheres and stasis as the angiographic endpoint.

Purpose: To investigate the influence of sublingual glycerol trinitrate (1.2 mg, Nitrate [nitroglycerine], Nitrolingual N Spray) on the coronary artery diameter on multislice computed tomography (MSCT) coronary angiography., Materials and Methods: Out of our database of patients who underwent MSCT (slice thickness of 0.5 mm, Aquilion, Toshiba) coronary angiography between July 2003 and November 2005 (950 patients) we retrospectively identified patients with follow-up examinations who received Nitrate for one examination while another examination was performed without Nitrate (10 patients). Another 10 patients who underwent two MSCT examinations with sublingual Nitrate administration were randomly selected from this database to serve as control group. For the resulting 40 MSCT examinations, blinded MSCT datasets were prepared, which were randomly evaluated by a reader blinded to the patient information and whether or not Nitrate had been given. The proximal coronary artery diameters were measured for the left main coronary artery (LMA), the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the right coronary artery (RCA) in all 40 datasets, resulting in altogether 160 measurements., Results: The proximal diameters of all four coronary arteries were significantly larger on the MSCT coronary angiograms obtained after sublingual administration of Nitrate compared with the examinations in the same 10 patients without Nitrate (p < 0.001). The average diameters without and with Nitrate for the LMA, LAD, LCX, and RCA were 4.3 +/- 1.1 vs. 4.8 +/- 0.9 mm (12 % increase, p < 0.005), 3.0 +/- 0.6 vs. 3.5 +/- 0.5 mm (17 % increase, p < 0.001), 2.7 +/- 0.6 vs. 3.2 +/- 0.7 mm (19 % increase, p < 0.005), and 2.9 +/- 0.9 vs. 3.5 +/- 0.7 mm (21 % increase, p < 0.005), respectively. In the control group of 10 patients who underwent two MSCT coronary angiographies after sublingual Nitrate, no significant difference in the proximal diameter of all four main coronary vessels was observed., Conclusion: Sublingual administration of Nitrate results in significantly larger proximal coronary artery diameters on MSCT coronary angiography and might thus be recommended for routine examinations.

Electron beam tomography (EBT) has been scientifically evaluated to a much lesser degree for non-cardiac indications than for cardiac purposes. Therefore, four groups of investigators in Berlin (2), Mannheim and Munchen, which were supported by the Deutsche Forschungsgemeinschaft (DFG), included applications outside the heart in their evaluation of EBT technology. EBT has proven useful to look for pulmonary embolism and to assess other vessels (aorta, aortic branches, and intracranial arteries). Imaging of the lung parenchyma benefits from its intrinsic high contrast and from the fast data acquisition of EBT. Limited photon efficiency, higher radiation exposure, increased noise levels and other artifacts, however, markedly reduce the value of EBT for imaging of low contrast objects compared to conventional spiral CT and multislice CT (MSCT), compromising, in particular, the morphologic depiction of parenchymal abdominal organs and the brain. Consequently, scientific studies to further evaluate EBT for scanning of the brain and parenchymal abdominal organs were not pursued. Radiation exposure for non-cardiac EBT studies is up to three times higher than that for respective spiral CT studies, and in children EBT can only be advocated in select cases. Radiation exposure for the various prospectively triggered cardiac examination protocols of EBT is lower than that for conventional coronary angiography. Radiation exposure in cardiac multislice CT exceeds severalfold that of EBT, but the dose efficiency of EBT and MSCT are similar due to higher spatial resolution and less image noise of MSCT. In addition, modifications of MSCT (ECG pulsing) can further reduce radiation exposure to the level of EBT. Technical improvements of the EBT successor scanner "e-Speed" enable faster data acquisition at higher spatial resolution. Within comparative studies, the "e-Speed" will have to prove its value and competitiveness, particularly in comparison with multislice CT. After profound scientific assessment in a multicenter evaluation supported by the Deutsche Forschungsgemeinschaft (DFG) and regardless of the specific suitability of electron beam tomography for various cardiac and some non-cardiac indications, the investigators unanimously find the electron beam tomograph Evolution C150 XP not suitable as a whole body CT scanner.

Purpose: Applicability and benefits of digital speech recognition in diagnostic radiology were tested using the speech recognition system SP 6000., Methods: The speech recognition system SP 6000 was integrated into the network of the institute and connected to the existing Radiological Information System (RIS). Three subjects used this system for writing 2305 findings from dictation. After the recognition process the date, length of dictation, time required for checking/correction, kind of examination and error rate were recorded for every dictation. With the same subjects, a correlation was performed with 625 conventionally written finding., Results: After an 1-hour initial training the average error rates were 8.4 to 13.3%. The first adaptation of the speech recognition system (after nine days) decreased the average error rates to 2.4 to 10.7% due to the ability of the program to learn. The 2nd and 3rd adaptations resulted only in small changes of the error rate. An individual comparison of the error rate developments in the same kind of investigation showed the relative independence of the error rate on the individual user., Conclusion: The results show that the speech recognition system SP 6000 can be evaluated as an advantageous alternative for quickly recording radiological findings. A comparison between manually writing and dictating the findings verifies the individual differences of the writing speeds and shows the advantage of the application of voice recognition when faced with normal keyboard performance.

Demands for increased productivity despite cuts in financial resources have renewed the discussion of cost effectiveness in medical care. Unfortunately, there is a lack of reliable data for evaluating the cost effectiveness of diagnostic procedures. The present article discusses various aspects of this topic and presents examples from the diagnostic evaluation of the upper abdomen. It is argued that modern imaging procedures have in the past helped to reduce costs and that they can become cost effective when they replace established combinations of diagnostic procedures. The present discussion is severely hampered by the fact that there are no generally accepted standards for evaluating diagnostic strategies and that there are no well-founded studies of the cost effectiveness of the strategies used in abdominal diagnosis. Cost effectiveness will in the future become an additional criterion for assessing the quality of medical care.