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Die Neuen Medien, allen voran das Smartphone, erobern die Welt und sind längst Bestandteil des Alltags für viele von uns. Wie kann sich die Fremd- und Zweitsprachendidaktik diese Entwicklung zu Nutze machen? Bieten die tragbaren Geräte doch die perfekte Möglichkeit, Lernen auch in den Alltag einzubauen. Lingophant ist eine junge App, die genau damit arbeitet: Mit ihr kann man neuen Wortschatz selbst aufnehmen – oder ihn eine_n Erstsprachler_in aufnehmen lassen. Daraufhin übersetzt die App und erstellt automatisch eine Karteikarte mit der integrierten Audioaufnahme. Diese Arbeit stellt einen ersten wissenschaftlichen Zugang zur Nutzung von Lingophant dar und untersucht sie in Sprachlerntandems, die durch ihre authentische Kommunikation als fruchtbare Quelle für neuen Wortschatz angesehen werden. Diese Tandemtreffen wurden aufgezeichnet, um zu sehen, wodurch mögliche Einsätze von Lingophant ausgelöst werden und wie diese vonstattengehen. Zudem stellten die Teilnehmenden ihre Vokabellisten für eine Analyse aller gesammelten Inhalte zur Verfügung, z. B. bezüglich Wortart, Länge und Register. Schließlich wurden diese Daten durch eine Gruppendiskussion ergänzt, in der am Ende der Erhebungsphase individuelle Erfahrungen von den Teilnehmenden preisgegeben wurden. Ernüchterndes Fazit ist, dass trotz des Potentials, das die Teilnehmenden der App durchaus zusprechen, das Tandem als ungeeigneter Kontext für das Nutzen der App angesehen wird und sie auch im Alltag eher selten benutzt wurde, sei es zum Aufnehmen neuer Inhalte oder folglich zum Üben. Das klassische Modell der zweisprachigen Vokabelliste wurde nur vereinzelt aufgebrochen und meist wurde die App isoliert benutzt. Der Einsatz von Lingophant im Alltag erfor-dert sehr viel Eigeninitiative. Der Druckversion liegt eine CD bei.

AIM Evaluation of high resolution ultrasound to diagnose rupture of the medial head of gastrocnemius muscle in patients with uncharacteristic calf pain. METHOD 66 patients with clinically unclear calf pain were examined in a prospective study. RESULTS Out of 66 patients, 51 showed sonographic criteria of a partial rupture of the medial gastrocnemius head. 47 ruptures were located in musculotendineus transition zone. CONCLUSION High resolution sonography detect minimal lesions of the medial gastrocnemius muscle in patients with clinically uncharacteristic calf pain.

BACKGROUND: Endoluminal stent graft repair is emerging as a less invasive alternative to conventional open surgery in the management of diseases of the descending thoracic aorta. In this overview we will discuss the current concept of stent graft therapy of various diseases of the thoracic aorta from an interventional radiologist's point of view. METHODS: Since 1996, 84 patients with atherosclerotic aneurysms of the descending thoracic aorta, aortic dissections, acute traumatic ruptures, chronic traumatic aneurysms and penetrating atherosclerotic ulcers underwent endoluminal stent graft repair at our institution. 18 patients presented with life-threatening symptoms and were treated on an emergency basis. All procedures were performed in an angiographic suite with state-of-the-art digital subtraction angiographic equipment. Follow-up was at 1, 3, 6, and 12 months after treatment and yearly thereafter. RESULTS: The primary technical success rate ranged from 78% to 95%, the 30-day mortality rate was 7% if including elective as well as emergency interventions. Endoleaks were the most common procedure-related complications. They occurred at a rate of 11% and had to be treated by extension cuffs or additional endograft segments. Data of our institution are presented in comparison to the current literature. CONCLUSIONS: Stent graft repair of thoracic aortic aneurysms, aortic dissections and related pathologies is a fascinating new technique offering a less invasive treatment option to patients who are unsuitable for surgical repair. For patients at high surgical risk, endovascular stent graft placement can be advocated as standard therapy.

Uber die interventionelle Behandlung atherosklerotischer Verschlussprozesse in der A. femoropoplitea mit Hilfe des HemobahnTM-Stentgrafts wurden divergente Behandlungsergebnisse mitgeteilt.

Our objective was to develop and evaluate a non-invasive device for rigid immobilisation during extremity angiography. The patented BodyFix immobilisation device (Medical Intelligence, Schwabmünchen, Germany) consists of a vacuum pump connected to special cushions and a plastic foil that covers the body part to be immobilised. First, the patient's extremity is covered by a thin plastic bag and then wrapped in one of the cushions, placed on the top of the therapy couch, and covered with the plastic foil. The air is evacuated from the cushion under the covering foil by the vacuum pump, resulting a hardening of the cushion and thus immobilisation of the patient's extremity. The rigid immobilisation resulted in a complete absence of motion artefacts in the majority of patients. No pixeling of the images was required in any of the 100 patients vs 32% in the control group. Repetition of series could be avoided in all cases and a substantial increase in the quality of the images was obtained. Setup of the device takes an additional 1-2 min. Vacuum immobilisation allows for comfortable, effective immobilisation during digital subtraction angiography, eliminating motion artefacts. This device has become an indispensable tool in daily clinical routine at our department.

To compare volume rendering (VR) and maximum intensity projection (MIP) as postprocessing techniques of magnetic resonance (MR) angiography for detection and quantification of renal artery stenosis.Twenty-seven patients underwent three-dimensional contrast material-enhanced MR angiography of the renal arteries with a 1.5-T imager. For each renal artery, targeted MIP and VR images were reconstructed in oblique coronal and transverse orientations. For each modality, image generation and evaluation were performed interactively by two independent radiologists blinded to angiographic results. In comparison with digital subtraction angiography (DSA) findings, stenosis quantification and detection by using MIP and VR were evaluated with the use of 50% and 70% cutoff points by using linear regression analysis and 2 x 2 tables. Overall image quality and vascular delineation on MIP and VR images were also compared.All main and accessory renal arteries depicted at DSA were also demonstrated on MIP and VR images. VR performed slightly better than MIP for quantification of stenoses greater than 50% (VR: r(2) = 0.84, P.001; MIP: r(2) = 0.38, P =.001) and significantly better for severe stenoses (VR: r(2) = 0.83, P.001; MIP: r(2) = 0.21, P =.1). For detection of stenosis, VR yielded a substantial improvement in positive predictive value (VR: 95% and 90%; MIP: 86% and 68% for stenoses greater than 50% and 70%, respectively). Image quality obtained with VR was not significantly better than that with MIP; however, vascular delineation on VR images was significantly better.The VR technique of renal MR angiography enabled more accurate detection and quantification of renal artery stenosis than did MIP, with significantly improved vascular delineation.

To evaluate the usefulness of virtual endoscopy (VE) in planning neuroendoscopic intraventricular surgeries, the technique was applied in 20 of 22 consecutive procedures. Thirteen endoscopic third ventriculostomies (ETV) in 12 patients, 3 endoscopic colloid cyst removals, 1 third ventricular arachnoidal cyst fenestration, 1 endoscopic ventricul-cysto-cisternostomy (suprasellar arachnoidal cyst), 1 endoscopic tumor biopsy, one third ventricular gross total tumor removal and 2 septostomies at the foramen of Monro due the septal occlusion were performed. Contrast medium-enhanced MR images (3DMPRAGE, Siemens, Germany) were semi-automatically segmented with a surface-rendering technique ("Navigator" software, General Electric Medical, Buc, France) to produce the virtual endoluminal views. Surgery was performed with cerebral ventriculoscopes by Wolf (Richard Wolf, Knittlingen, Germany). VE was feasible in all patients and the virtual endoscopic images were comparable with the real intraventricular views obtained by standard rod lens systems. After contrast medium administration intra- and paraventricular vessels such as the thalamocaudate vein, the septal veins, the basilar artery and its branches (distal BA complex) and the choroid plexus were identified on the virtual endoscopic images. In 8 patients, the additional anatomic information provided by VE profoundly influenced surgical planning. VE provides the neurosurgeon with additional morphological information supporting the planning process of neuroendoscopic intraventricular surgeries, contributing to the safety of the procedures.

Objective: To evaluate blood flow changes inside normally functioning transjugular intrahepatic portosystemic shunts (TIPS), using color Doppler ultrasound (CDUS) and pulsed Doppler ultrasound (PDUS). Methods: A total of 72 patients (mean age 54, range 36–78 years) underwent TIPS placement, portal angiography, CDUS and PDUS examinations. Measurements inside the stent were taken at the portal side, at the central part and at the venous end of the TIPS. Results: In well functioning TIPS the mean peak velocity (PV) on the portal side was 37 m/s (range 22–65 cm/s), in the area of the incoming intrahepatic portal branch the mean PV was 59 cm/s (range 40–95 cm/s) and at the side of the incoming hepatic vein the mean PV was 135 cm/s (range 88–220 cm/s). In the punctured hepatic and portal veins the mean PV was 25 cm/s (range 15–30 cm/s) and 18 cm/s (10–22 cm/s), respectively. The flow increase from the portal to the mid part (P≤0.001) and to the venous side was statistically significant (P≤0.001). Conclusion: A velocity gradient between the portal and the venous side of a TIPS is a normal finding caused by branches of the portal and hepatic vein joining the TIPS from the side and it is characteristic of a normally functioning TIPS.

We evaluated the usefulness and reliability of intraventricular virtual neuroendoscopy based on a comparative anatomical study. Virtual intraventricular endoscopic images were calculated from 3D magnetic resonance images in five anatomic specimens. Contiguous 1.2 mm slices of the specimen heads were acquired at a 1.5 T MR scanner using a 3D-gradient echo sequence. The images were then transferred to an independent 3D-workstation (Sun Spark 20). After scanning the specimen heads, real endoscopy within the cerebral ventricles of these brains was performed with a standard rod lens system. Comparison between real and virtual endoscopic views of the intraventricular topography was based on the same anatomical reference and landmarks. Acquisition of MR data and virtual image post-processing have been possible in all specimens. The virtual endoscopic images of the ventricles were comparable to the intraventricular views obtained by a standard rod lens system. Virtual intraventricular neuroendoscopy can be employed for planning and simulating neuroendoscopic procedures. It enables the neurosurgeon to simulate the endoscopic procedure within the cerebral ventricles on the basis of the patient's individual anatomy prior to surgery.

PURPOSE To assess the feasibility of image transfer for teleradiologic consultations using the Austrian Academic Computer Network (ACOnet). The ACOnet corresponds between the main universities to a MAN (Metropolitan Area Network) with a transfer rate of 4 Mbps. Its use is free of charge for university institutions. MATERIALS AND METHODS 1740 test image data sets and 620 image data sets for teleradiological consultations were exchanged without annotations between the Departments of Diagnostic Radiology of the universities of Innsbruck and Graz, using the ACOnet. RESULTS Data transmission was reliable and fast with an average transfer capacity of 170.2 kBytes/s (94-341 kBytes/s). There were no major problems with image transfer during the test phase. CONCLUSION Due to its high transfer capacity, the ACOnet is considered a reasonable alternative to the ISDN service.

UNLABELLED The teleradiological connection between the University Hospital in Innsbruck, Tyrol, and the Regional Hospital in Zwettl, Lower Austria, is presented as an example of a routine online connection of two helical CT systems. PURPOSE To establish a practicable and cost-efficient emergency CT service in a remote hospital during night time and on weekends. MATERIAL AND METHODS Online connection of a GE HiSpeed Advantage-Spiral-CT and a GE Prospeed-Spiral-CT via two Sun SPARC 10 work stations and ISDN. RESULTS The transmission of 121 CT data sets from 116 patients revealed a sufficiently fast average transmission time of 15 (6-53) minutes and average transmission costs of DM 9.00 per examination. The system was technically reliable, cost-efficient and practicable in clinical routine application. CONCLUSIONS Teleradiology enables remote hospitals to provide an emergency CT service even if there is no radiological specialist available outside office hours. Thus time-consuming and cost-intensive patient transfers and delay of therapy can be reduced.

Die funktionelle Untersuchung mittels des Score nach Constant und Murley ergab durchschnittlich 97 von 100 moglichen Punkten (Minimum 72, Maximum 100) in beiden Gruppen, sowohl nach konservativer als auch nach operativer Therapie. Bei der Nachuntersuchung wiesen 9 von 10 konservativ (90%) behandelten Patienten nach drittgradiger AC-Luxation ein positives Klaviertastenphanomen und eine vermehrte Horizontalverschieblichkeit der Klavikula im Gegensatz zu 18 (44%) von 41 operierten Patienten auf (p

Purpose In this article a new method - the Smart-Scan-Technique - for dose reduction during spiral computed tomography is described. This technique allows a dynamical adaptation of the tube current according to the measured local density structure form and absorption values of the object of interest. Its clinical applicability for dose reduction is investigated. In addition, changes in image quality are evaluated. Methods Specially designed, water filled plexiglas-phantoms, an Alderson-Rando phantom, and 20 patients were used to simulate possible measures of patients within the thoracic and abdominal region. For those two regions the dose reduction, the modulation transfer function, and the pixel noise were measured. Results Depending on patient geometry dose reduction up to 20% could be achieved with the Smart-Scan-Technique. This technique also enabled a decrease of the modulation transfer function and an increase of the pixel noise by 8%. Conclusion Relevant dose reductions can be achieved by applying the Smart-Scan-Technique in spiral computed tomography.

Adamantinoma of the long bones is a rare skeletal tumor and its MR features have seldom been reported. It is difficult to distinguish from other bone lesions (such as osteofibrous dysplasia or osteosarcoma) by means of conventional radiography and CT. MR imaging, however, may be useful in differentiating adamantinoma from such lesions. With this presentation of a typical case, we hope to draw the attention of radiologists to this lesion and contribute information on its MR appearance

Objectives: to determine medium term technical and clinical success of kissing stents for aortoiliac occlusive disease. Design: retrospective study. Subjects: twenty-five patients presenting with intermittent claudication (IC) or critical limb ischaemia (CLI) due to aortoiliac disease (41 complex stenoses, 8 occlusions). Methods: balloon- or self-expanding kissing stents, with or without predilatation depending upon the nature of the disease, were inserted via bilateral retrograde femoral artery punctures. Clinical examination, ABPI, exercise testing and duplex ultrasound were performed at 1, 3, 6, and 12 months, and then annually. Results: technical success was achieved in 86% segments. All patients with CLI improved and 6 of 7 ulcerated limbs showed complete healing. During follow-up, 7 patients died and two patients required major amputation at 7 and 8 months. The primary assisted patency rate was 94, 91 and 65% at 6, 12, and 24 months, respectively. Conclusions: despite acceptable short-term technical and clinical success, as the medium term patency rates are clearly inferior to those of bypass surgery, the kissing stent technique should be reserved for high risk patients with a limited life expectancy. Eur J Vasc Endovasc Surg 26 , 161-165 (2003)

The purpose of this study was to compare volume rendering and maximum intensity projection as postprocessing techniques of MR angiography in the detection and characterization of intracranial aneurysms.Three-dimensional time-of-flight MR angiography studies performed in 82 patients were retrospectively evaluated by two independent reviewers who were unaware of digital subtraction angiography findings, the standard of reference. Panoramic maximum-intensity-projection and volume-rendered angiograms were produced from each data set to investigate the presence of underlying aneurysms. Each detected aneurysm was then interactively evaluated with subvolume maximum-intensity-projection and targeted volume-rendering algorithms to evaluate aneurysm morphology and size. Aneurysm detection and characterization were evaluated by means of the receiver operating characteristic analysis, and aneurysm size was evaluated using the limits-of-agreement method. Image quality, aneurysm neck depiction, and vascular delineation were also compared between maximum-intensity-projection and volume-rendered images. The time required for the generation and interpretation of maximum-intensity-projection and volume-rendered images was assessed.Volume rendering tended to improve the diagnostic confidence (A(z) [area under the receiver operating characteristic curve] = 0.95 vs A(z) = 0.90 for maximum intensity projection) and yielded a considerable improvement in sensitivity (89% vs 71% for maximum intensity projection), particularly in the detection of small cerebral aneurysms. Regarding aneurysm morphology, volume rendering performed significantly better than maximum intensity projection in lobulation detection (p0.001) and slightly better in neck categorization (p0.238). Limits-of-agreement analysis showed a trend toward improved assessment of the aneurysm size by volume rendering (-0.31 +/- 1.62 mm vs -1.27 +/- 2.84 mm by maximum intensity projection). Overall image quality and vascular delineation of involved vessels on volume-rendered images were rated better than that obtained by maximum intensity projections (por = 0.007 and por = 0.001, respectively). Evaluation of time-of-flight MR angiography data sets was significantly facilitated with volume rendering (p0.001).The volume-rendering technique facilitates the evaluation of cerebral time-of-flight MR angiography data sets and allows better detection and more reliable characterization of intracranial aneurysms than does maximum intensity projection.

The aim of this study was to compare between volume rendering (VR) and maximum intensity projection (MIP) as post processing techniques of MR angiography in detection and characterization of intracranial aneurysms.

CONTRAST ECHOCARDIOGRAPHY (CE) is a valuable diagnostic tool that is being used increasingly for the detection of intracardiac and intrathoracic extracardiac shunts.1-4 CE should be a part of the investigation of patients with penetrating chest injury as a first-line screening test for arteriovenous malformations.5,6 CE is commonly employed in evaluating intracardiac shunts, whereas pulmonary angiography is considered the gold standard in evaluating and localizing extracardiac shunts,1,5 especially in diagnosing pulmonary arteriovenous malformations and traumatic pulmonary arteriovenous fistulae. A case of a traumatic pulmonary arteriovenous fistula diagnosed by transesophageal CE and confirmed by pulmonary angiography is presented. This case shows the efficacy of transesophageal CE with the aid of a pulmonary artery catheter to differentiate between intracardiac and extracardiac shunts. To some extent, CE also helped to localize the shunt lesion and estimate the amount of shunt.

To evaluate the feasibility and safety of endovascular stent-graft placement in treating Stanford type B aortic dissection.Seven patients underwent endovascular stent-graft placement for type B aortic dissection. Five patients had acute and two had chronic dissection. In five patients, the proximal entry tear was within 2 cm of the origin of the left subclavian artery, and in two patients it was beyond this site. In three patients, the noncovered proximal portion of the stent-graft was placed across the origin of the left subclavian artery. The efficacy of the procedure was assessed at follow-up studies 3, 6, 12, and 24 months after intervention.The procedure was technically and clinically successful in six patients (86%). The left subclavian artery remained patent in all patients. In two patients with involvement of aortic branches, endovascular stent-graft placement restored adequate blood flow to the compromised branches. One patient was readmitted 1 month later because the dissection extended into the ascending aorta. In all but this patient, closure of the entry tear and thrombosis of the false lumen along the stent-graft were achieved. All false lumina shrank considerably. The mean follow-up time was 14 months (range, 1-25 months).Type B aortic dissections within and beyond 2 cm of the origin of the left subclavian artery can be treated safely and effectively by means of endovascular stent-graft placement.

Evaluation of high resolution ultrasound to diagnose rupture of the medial head of gastrocnemius muscle in patients with uncharacteristic calf pain.66 patients with clinically unclear calf pain were examined in a prospective study.Out of 66 patients, 51 showed sonographic criteria of a partial rupture of the medial gastrocnemius head. 47 ruptures were located in musculotendineus transition zone.High resolution sonography detect minimal lesions of the medial gastrocnemius muscle in patients with clinically uncharacteristic calf pain.

Malignant appendix tumours are rare entities. Especially adenocarcinomas, which only appear in about 10% of appendix tumours, are very seldom. Preoperative diagnosis is very difficult due to a lack of typical clinical signs and a clinical appearance mimicking perforated appendicitis. Nevertheless, sonography is able to show indirect signs and therefore it can provide the surgeon with more information for a better operative treatment.

To assess the feasibility of image transfer for teleradiologic consultations using the Austrian Academic Computer Network (ACOnet). The ACOnet corresponds between the main universities to a MAN (Metropolitan Area Network) with a transfer rate of 4 Mbps. Its use is free of charge for university institutions.1740 test image data sets and 620 image data sets for teleradiological consultations were exchanged without annotations between the Departments of Diagnostic Radiology of the universities of Innsbruck and Graz, using the ACOnet.Data transmission was reliable and fast with an average transfer capacity of 170.2 kBytes/s (94-341 kBytes/s). There were no major problems with image transfer during the test phase.Due to its high transfer capacity, the ACOnet is considered a reasonable alternative to the ISDN service.

Virtual CT-colonoscopy is a post-processing method which allows for reconstruction of inner bowel surface structures from helical CT datasets. The reconstructed images simulate the views which are known from fiberoptic endoscopy. Since colorectal cancer is the second main cause of death in USA and Europe today and since recent screening recommendations are often ignored by the public, a non-invasive or minimal-invasive procedure for colonic evaluation would offer some benefits. Virtual CT-colonoscopy generally involves three essential steps: patient preparation with cleansing of the bowel and administration of an air enema, helical CT-examination by using appropriate scan parameters, and interactive 3D rendering of the volume data-set. Although recent studies have demonstrated that polypoid lesions of about 5 mm size are well detectable and although virtual colonoscopy offers many advantages over fiberoptic endoscopy, some technical and clinical limitations must still be noted. Thus, the current inability of virtual colonoscopy to provide texture and color leads to problems in identifying flat lesions; the presence of retained or adherent fecal matter may result to false positive diagnosis and collapsed segments of bowel may cause problems as they cannot subsequently be evaluated during image reconstruction. Virtual endoscopy is still in its infancy and further technical and clinical developments are necessary. Virtual CT-colonoscopy may then prove to be equal or superior to colonoscopy in sensitivity and specificity for polyp detection and be able to reduce the number of unnecessary colonoscopic procedures.

Background and Study Aims: The aim of the present study was to establish a suitable method for virtual computed tomography (CT) gastroscopy. Patients and Methods: Three-millimeter helical CT scans of a pig stomach were obtained after air insufflation and instillation of diluted diatrizoic acid (Gastrografin), and with double contrast. In addition, three patients with gastric tumors were studied after ingestion of an effervescent agent (Duplotrast, 6 g) and intravenous injection of hyoscine butylbromide (Buscopan, 1 ml). Virtual endoscopy images were computed on a Sun Sparc 20 workstation (128 megabytes of random access memory, four gigabytes of hard disk space), using dedicated software (Navigator, General Electric Medical System Company). The endoscopy sequences were compared with real endoscopic examinations and with anatomical specimens. Results: In the cadaver studies, the best results were obtained with plain air insufflation, whereas virtual CT gastroscopy with diluted contrast and with double contrast showed artifacts simulating polyps, erosions, and flat ulcers. Patient studies showed good correlation with the fiberoptic endoscopy findings, although large amounts of retained gastric fluid substantially reduced the quality of the surface reconstruction. Conclusion: These preliminary results show that virtual CT gastroscopy is able to provide insights into the upper gastrointestinal tract similar to those of fiberoptic endoscopy. However, due to the limited spatial resolution of the CT protocol used, as well as inherent image artifacts associated with the Navigator program's reconstruction algorithm, the form of virtual CT gastroscopy studied was not capable of competing with the imaging quality provided by fiberoptic gastroscopy.

The purpose of this work was to test a newly developed, post-processing software for virtual CT endoscopic methods. Virtual endoscopic images were generated from helical CT data sets in the region of the shoulder joint (n = 2), the tracheobronchial system (n = 3), the nasal sinuses (n = 2), the colon (n = 2), and the common carotid artery n = 1). Software developed specifically for virtual endoscopy ("Navigator") was used which, after a previous threshold value selection, makes the reconstruction of internal body surfaces possible by an automatic segmentation process. We have evaluated the usage of the software, the reconstruction time for individual images and sequences of images as well as the quality of the reconstruction. All pathological findings of the virtual endoscopy were confirmed by surgery.The post-processing program is easy to use and provides virtual endoscopic images within 50 seconds. Depending of the extent of the data set, virtual tracheobronchoscopy as a cine loop sequence required about 15 minutes. Through use of the threshold value-dependent surface reconstruction the demands on the computer configuration are limited; however, this also created quality problems in image calculation as a consequence of the accompanying loss of data.The Navigator software enables the calculation of virtual endoscopic models with only moderate demands on the hardware.

A review on the theoretical challenges and potential risks of teleradiology is given. Based on the authors two years clinical experience and the current literature unsolved problems are discussed, which are to a smaller extent the technical implementation but much more the still missing regulation of various concomitant circumstances.

We carried out a cost analysis of a teleradiology system for emergency computerized tomography CT examinations. Teleradiology was implemented by connecting two spiral CT scanners in the University Hospital in Innsbruck and the Regional Hospital in Zwettl. It enabled the remote hospital in Zwettl to get fast and competent reports of emergency CT examinations when there was no specialist radiologist available. In 13 months use for routine night and weekend service, the system proved fast and reliable. During the study period 121 emergency examinations of 116 patients were transmitted from Zwettl to Innsbruck. The fixed costs of teleradiology were for the ISDN connection and amounted to DM230 plus DM696 year rental. The average cost of one emergency CT examination by teleradiology was DM372 range 308-453 . One possible alternative, transporting the films by taxi for reporting elsewhere, was cheaper estimated cost DM156 , but would have been much slower. Another alternative, transporting the patient to the nearest central hospital for scanning, was much more expensive: DM524 by road or DM4667 by helicopter ambulance.

The teleradiological connection between the University Hospital in Innsbruck, Tyrol, and the Regional Hospital in Zwettl, Lower Austria, is presented as an example of a routine online connection of two helical CT systems.To establish a practicable and cost-efficient emergency CT service in a remote hospital during night time and on weekends.Online connection of a GE HiSpeed Advantage-Spiral-CT and a GE Prospeed-Spiral-CT via two Sun SPARC 10 work stations and ISDN.The transmission of 121 CT data sets from 116 patients revealed a sufficiently fast average transmission time of 15 (6-53) minutes and average transmission costs of DM 9.00 per examination. The system was technically reliable, cost-efficient and practicable in clinical routine application.Teleradiology enables remote hospitals to provide an emergency CT service even if there is no radiological specialist available outside office hours. Thus time-consuming and cost-intensive patient transfers and delay of therapy can be reduced.

Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group Ia) and 19 patients were treated conservatively (group Ib), while in group II, 41 patients were treated surgically (group IIa) and 10 patients were treated conservatively (group IIb). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservative treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group IIa P0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radiographs (P0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.

In this article a new method - the Smart-Scan-Technique - for dose reduction during spiral computed tomography is described. This technique allows a dynamical adaptation of the tube current according to the measured local density structure form and absorption values of the object of interest. Its clinical applicability for dose reduction is investigated. In addition, changes in image quality are evaluated.Specially designed, water filled plexiglas-phantoms, an Alderson-Rando phantom, and 20 patients were used to simulate possible measures of patients within the thoracic and abdominal region. For those two regions the dose reduction, the modulation transfer function, and the pixel noise were measured.Depending on patient geometry dose reduction up to 20% could be achieved with the Smart-Scan-Technique. This technique also enabled a decrease of the modulation transfer function and an increase of the pixel noise by 8%.Relevant dose reductions can be achieved by applying the Smart-Scan-Technique in spiral computed tomography.

A new investigation technique in computed tomography--the Smart Scan process--and the associated reduction in tube current are discussed. In addition, the reduced dosage values resulting from the reduced current values are compared with those of a standard measurement and image characteristics such as picture unit noise are evaluated. By means of three special water phantoms with dimensions corresponding to those of actual patient geometries and a pool of 183 patients, the Smart Scan process was tested by the control algorithm implemented on a spiral computer tomograph. The dosage values with and without the Smart Scan being activated were determined. Dosage reductions of up to 18% can be realized with this new examination technique. In particular, patients with transverse oval head profiles will benefit from this modality.

Spinal cord compression due to extradural and subdural haemorrhage is a neurosurgical emergency. Differences in clinical presentation in relation to localisation of the haematoma, value of MRI as a diagnostic tool, surgical treatment, and prognosis were investigated in a retrospective case series of eight patients with extradural (n = four) and subdural (n = four) haematomas. Results of MRI were compared with operative findings and proved to be of high sensitivity in defining the type of bleeding and delineating craniocaudal extension and ventrodorsal location. Surgical treatment by decompressive laminectomy, haematoma evacuation, and postoperative high dose corticosteroids resulted in resolution of symptoms in five patients and improvement in the clinical situation in two patients. One patient with a chronic subdural haematoma had a second operation because of arachnoidal adhesions. One patient presented with a complete cord transection syndrome due to an acute subdural haematoma and remained paraplegic. It is concluded that prompt, reliable, and non-invasive diagnosis by MRI leads to efficient surgical treatment and a favourable outcome in this rare condition.

Epidural and subdural spinal hematomas were previously diagnosed by myelography and computed tomography (CT). Recent reports indicate that noninvasive detection is possible with magnetic resonance imaging. We report on nine patients who were investigated by magnetic resonance imaging (MRI) prior to surgery for epidural and subdural spinal hematoma. The MR examinations were performed on 1.5-T and 1-T units. We used surface coils and employed T1-, PD- and T2-weighted spin echo sequences and a T2*-weighted gradient echo sequence. CT was available in four patients and myelography in two patients. Surgical correlation was available in all patients. The hematomas were located in the cervical spine (n = 2), thoracic spine (n = 6) and lumbar spine (n = 2). They were epidural in five patients and subdural in four. Blinded reading correctly identified all five epidural hematomas and three of the subdural hematomas; one subdural hematoma was misjudged as epidural. Peracute hematomas (24 h) in three patients appeared isointense or slightly hyperintense on T1-weighted images and had mixed signal intensity on T2- and T2*-weighted images. Acute hematomas (1-3 days) in four patients were also isointense on T1-weighted images but were more hypointense on T2- and T2*-weighted images. Chronic hematomas in two patients (7 days and 14 days) were hyperintense on all sequences. Differentiation between epi- and subdural hematomas required transverse T2*-weighted gradient echo sequences. Our results underline that MRI at 1 and 1.5 T is capable of identifying epidural and subdural spinal hematoma in the acute and peracute stage.(ABSTRACT TRUNCATED AT 250 WORDS)