An infant's CXR is different from that of an adult-relevant article on Radiology.

Interpretation of chest radiographs in infants with cough and fever.
Bramson RT, Griscom N, Cleveland RH

An understanding of the appearance of the infant chest radiograph requires an understanding of the anatomy and the physiologic, immunologic, and pathologic processes in the infant's chest. The authors describe the features of the infant chest that most influence the appearance of the chest radiograph in infants with cough and fever.

They discuss why confusion sometimes occurs when radiology residents and general radiologists familiar with adult chest radiographs first evaluate the infant chest radiograph.

The radiographic appearance of acute inflammation does not look the same in infants as it does in older children and adults.

The hallmark of inflammatory lung disease in the infant chest is air trapping on the chest radiograph.

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Radiology. 2005 Jul;236(1):22-9. Epub 2005 Jun 27.

Is there any significant benefit of use of CT in renal colic?Article from Radiology

Renal Colic: Comparison of Use and Outcomes of Unenhanced Helical CT for Emergency Investigation in 1998 and 2002

Anish Kirpalani, MD, Korosh Khalili, MD, Shirley Lee, MD and Masoom A. Haider, MD

PURPOSE: To determine retrospectively whether there had been any change between 1998 and 2002 in the use and outcome of computed tomography (CT) performed in the emergency department for patients presenting with symptoms of renal colic.

MATERIALS AND METHODS: Approval from the Research Ethics Board was obtained, and informed consent was waived. All CT examinations ordered from the emergency department of a tertiary care hospital and performed from July to December 1998 and July to December 2002 were identified. Reports were reviewed, and results were categorized as either (a) positive for urinary tract calculus disease (category I), (b) indicative of an alternate diagnosis (category II), or (c) negative for findings to account for the patient's symptoms (category III). The corresponding emergency department charts were reviewed for urine dipstick results for hematuria and for patient history of stone disease. For statistical analysis, 2 testing and odds ratios were used.

RESULTS: During the 6-month period in 1998, 179 CT examinations were performed in patients who were admitted to the emergency department. During the same period in 2002, 234 CT examinations were performed. After correction for the total number of emergency department visits, it was determined that there was a relative increase of 21.3% (95% confidence interval: –0.0009, 0.47) in number of CT examinations performed in the emergency department. A total of 117 (65.4%) of 179 CT studies in 1998 and 153 (65.4%) of 234 CT studies in 2002 demonstrated renal calculus disease (category I), nine (5.0%) of 179 CT studies in 1998 and 17 (7.3%) of 234 CT studies in 2002 were used to identify an alternate diagnosis for patient symptoms (category II), and 53 (29.6%) of 179 CT studies in 1998 and 64 (27.4%) of 234 CT studies in 2002 were negative (category III). There were no significant differences between the rates of category I, II, or III results and the positivity rates for hematuria and urinary tract stone history during 1998 and 2002.

CONCLUSION: Despite a definite trend of increased CT use during 1998 and 2002, there was no significant decrease in the rates of positive renal colic results or alternate diagnoses.

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Radiology 2005;236:554-558

Follow up to the image case on Carotid Imaging-An interesting abstract

Population-based study of delays in carotid imaging and surgery and the risk of recurrent stroke.

Fairhead JF, Mehta Z, Rothwell PM.

BACKGROUND: Benefit from carotid endarterectomy is greatest when performed within 2 weeks of a presenting TIA or stroke and decreases rapidly thereafter.

OBJECTIVE: To determine the delays to carotid imaging and endarterectomy in Oxfordshire, UK, and the consequences for the effectiveness of stroke prevention.

METHODS: All patients undergoing carotid imaging for ischemic retinal or cerebral TIA or stroke were identified in two populations: the population of Oxfordshire, UK (n = 680,772), from April 1, 2002, to March 31, 2003, and the Oxford Vascular Study (OXVASC) subpopulation (n = 92,000) from April 1, 2002, to March 31, 2004. The times from presenting event to referral, scanning, and endarterectomy (Oxfordshire population) and the risk of stroke prior to endarterectomy in patients with >/=50% symptomatic carotid stenosis (OXVASC population) were determined.

RESULTS: Among 853 patients who had carotid imaging in the Oxfordshire population, median (interquartile range) times from presenting event to referral, scanning, and endarterectomy were 9 (3 to 30), 33 (12 to 62), and 100 (59 to 137) days. Eighty-five patients were found to have 50 to 99% symptomatic stenosis, of whom 49 had endarterectomy. Only 3 (6%) had surgery within 2 weeks of their presenting event and only 21 (43%) within 12 weeks. The risk of stroke prior to endarterectomy in the OXVASC subpopulation with >/=50% stenosis was 21% (8 to 34%) at 2 weeks and 32% (17 to 47%) at 12 weeks, in half of which strokes were disabling or fatal.

CONCLUSION: Delays to carotid imaging and endarterectomy after TIA or stroke in the United Kingdom are similar to those reported in several other countries and are associated with very high risks of otherwise preventable early recurrent stroke.

Neurology. 2005 Jul 14; [Epub ahead of print

Image Case-Doppler-Carotid artery

A carotid Doppler Image of a chronic smoker-Showing complete absence of color signals in the internal carotid artery suggestive of complete occlusion. Carotid Doppler is an excellent and non-invasive technique for extracranial carotid artery evaluation
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An amazing article on Informatics in Radiology (infoRAD) in Radiographics

Informatics in Radiology (infoRAD)
HTML and Web Site Design for the Radiologist: A Primer

Anthony G. Ryan, FRCR, FFRRCSI, MSc, FRCSI, Luck J. Louis, FRCPC and William C. Yee, FRCPC

A Web site has enormous potential as a medium for the radiologist to store, present, and share information in the form of text, images, and video clips. With a modest amount of tutoring and effort, designing a site can be as painless as preparing a Microsoft PowerPoint presentation. The site can then be used as a hub for the development of further offshoots (eg, Web-based tutorials, storage for a teaching library, publication of information about one’s practice, and information gathering from a wide variety of sources). By learning the basics of hypertext markup language (HTML), the reader will be able to produce a simple and effective Web page that permits display of text, images, and multimedia files. The process of constructing a Web page can be divided into five steps: (a) creating a basic template with formatted text, (b) adding color, (c) importing images and multimedia files, (d) creating hyperlinks, and (e) uploading one’s page to the Internet. This Web page may be used as the basis for a Web-based tutorial comprising text documents and image files already in one’s possession. Finally, there are many commercially available packages for Web page design that require no knowledge of HTML.

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RadioGraphics 2005;25:1101-1118

Interesting abstract from British Journal of Radiology-Transient failure of opening of the lower oesophageal sphincter on upright oesophagrams

Raptis CA, Levine MS, Rubesin SE, Laufer I, Katzka DA

The purpose of our study was to determine the frequency, radiographic features, and clinical importance of transient failure of opening of the lower oesophageal sphincter (LOS) on upright double-contrast views of the oesophagus. A computerized search of radiology records identified 16 patients who had transient failure of opening of the LOS on upright views from biphasic oesophagrams or upper gastrointestinal tract examinations using high-density barium but normal opening of the LOS on prone views using low-density barium. The radiographic findings were reviewed and correlated with the clinical and manometric findings. In all cases, barium studies revealed tapered, beaklike narrowing of the distal oesophagus on upright double-contrast views, with a normal-appearing distal oesophagus, normal opening of the LOS, and intact peristalsis on prone single-contrast views. Only seven patients (44%) had dysphagia. Five of these patients had clinical follow-up, and the dysphagia improved or resolved without specific treatment for LOS dysfunction in four. The remaining patient had persistent dysphagia, but this individual had polymyositis as the likely cause for his dysphagia. Manometry revealed incomplete relaxation of the LOS in two patients and normal relaxation in one. Our experience suggests that failure of opening of the LOS may be observed as a transient finding of little clinical importance on upright double-contrast views of the oesophagus using high-density barium, with normal opening of the LOS on prone single-contrast views using low-density barium. It is important to be aware of this finding, so that it is not mistaken for achalasia or other abnormalities of the distal oesophagus.

Br J Radiol. 2005 May;78(929):411-5.

Role of MRI in Crohns Disease-Useful article

Horsthuis K, Lavini Mphil C, Stoker J.

Technological developments have extended the role of MRI in the evaluation of the gastrointestinal tract. The potential of MRI to evaluate disease activity in Crohn's disease has been investigated extensively, as MRI has intrinsic advantages over other techniques, including noninvasiveness and the absence of ionizing radiation. For perianal fistulizing disease MRI has become a mainstay in evaluation of disease, as localization and extent of disease can be very well appreciated using both T2-weighted and T1-weighted sequences, fat suppression, and intravenous contrast medium. Imaging of the small bowel and colon in Crohn's disease is more complicated due to bowel peristalsis and respiratory movement. However, using fast breathhold sequences and intravenous spasmolytic medication, images of good diagnostic quality can be acquired. To obtain sufficiently distended bowel, which in our estimation is a prerequisite for evaluation of the bowel, MR enteroclysis can be performed. However, applicability of different oral contrast media has been studied, as a noninvasive method for bowel distension would be preferable. Abdominal MRI is a valuable imaging technique for evaluation of luminal, transmural, and extraintestinal manifestations of Crohn's disease as degree of disease activity, presence of luminal pathology (e.g., stenoses), and extraintestinal manifestations of disease (e.g., abscesses, fistulas) can be accurately assessed.

J. Magn. Reson. Imaging 2005;22:1-12.

Useful article in Radiographics on Tree in bud appearance

Santiago Enrique Rossi, MD, Tomas Franquet, MD, Mariano Volpacchio, MD, Ana Giménez, MD and Gabriel Aguilar, MD

The tree-in-bud pattern is commonly seen at thin-section computed tomography (CT) of the lungs. It consists of small centrilobular nodules of soft-tissue attenuation connected to multiple branching linear structures of similar caliber that originate from a single stalk. Originally reported in cases of endobronchial spread of Mycobacterium tuberculosis, this pattern is now recognized as a CT manifestation of many diverse entities. These entities include peripheral airway diseases such as infection (bacterial, fungal, viral, or parasitic), congenital disorders, idiopathic disorders (obliterative bronchiolitis, panbronchiolitis), aspiration or inhalation of foreign substances, immunologic disorders, and connective tissue disorders and peripheral pulmonary vascular diseases such as neoplastic pulmonary emboli. Knowledge of the many causes of this pattern can be useful in preventing diagnostic errors. In addition, although the causes of this pattern are frequently indistinguishable at radiologic evaluation, the presence of additional radiologic findings, along with the history and clinical presentation, can often be useful in suggesting the appropriate diagnosis.

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RadioGraphics 2005;25:789-801