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Friday, August 19, 2005
Wednesday, August 17, 2005
Musculoskeletal sonography-especially useful in infants
Musculoskeletal sonography in the neonate and infant.
Babies are ideal subjects for investigation by sonography. They are small and easily examined with the use of high-frequency transducers. Their unique status in US imaging tends to get lost amid the array of other available modalities, such as MRI and CT imaging. Some of the questions posed in pediatric musculoskeletal imaging that are routinely directed to other imaging modalities can be solved quickly at a lower cost by sonography in neonates and infants without sedation or any known clinical risk. These small children not only have thinner soft tissues but they have long bones and midline spine structures whose ends are largely composed of cartilage, which provides an early opportunity to examine these regions by US. And we cannot overestimate the value of new parents being able to stay next to their baby during imaging in a warm, friendly and non-threatening environment.
Full Article at-
Tuesday, August 16, 2005
Image Case-Gynecology Ultrasound
A longitudnal US image of a female who presented with urinary incontinence with a previous history of obstructed labor.
What is the diagnosis?
ANSWER- VESICOVAGINAL FISTULA (almost all got it correct)
WINNER-NADEEM
Dear Nadeem drop me a mail at sumerdoc-AT-yahoo-DOT-com with your postal address to claim your prize.
Winner will get a free copy of the book "Review of Radiology" by Dr Sumer K Sethi, a small handbook of Radiology for medical students
COPYRIGHT (SUMER)
Thursday, August 11, 2005
IMAGING REFFERAL-A revolutionary concept for the radiologists in India
CONCEPT OF IMAGING REFFERAL
This is something that I have felt in my days as a diagnostic radiologist. Sometimes the physicians order imaging investigations just like they order an ECG or any other minor investigation. I have always believed that what a clinician should do instead of ordering an investigation he should write an imaging referral to a Radiologist who should then guide the patient accordingly. What investigation should be done should not be decided by the referring physician but by the Radiologist. That way the number of repeat X-rays done would reduce dramatically. Also this would enable the Radiologist to look at the patient as a whole not as a radiograph or a CT scan. That the patient is referred for Imaging to Radiologist, with the possible Differential Diagnoses that thereferring clinician wants to be considered, and the Radiologist decides which all imaging modalities and how should they be done.
In last some time Radiology has gradually but surely got to the peak of the medical branches opted by a medical graduate. In times to come if we the current radiologists promote this beautiful subject as an imaging specialty where patients are referred for imaging and you guide the patient to the diagnosis. Anyhow we radiologists are making the majority of diagnosis!!!!
In times to come we can have a “Diagnostic Referral” instead of “Imaging Referral” where cases would be referred to a Radiologist and a Pathologist for diagnosis by the physician.
This is something that I have felt in my days as a diagnostic radiologist. Sometimes the physicians order imaging investigations just like they order an ECG or any other minor investigation. I have always believed that what a clinician should do instead of ordering an investigation he should write an imaging referral to a Radiologist who should then guide the patient accordingly. What investigation should be done should not be decided by the referring physician but by the Radiologist. That way the number of repeat X-rays done would reduce dramatically. Also this would enable the Radiologist to look at the patient as a whole not as a radiograph or a CT scan. That the patient is referred for Imaging to Radiologist, with the possible Differential Diagnoses that thereferring clinician wants to be considered, and the Radiologist decides which all imaging modalities and how should they be done.
In last some time Radiology has gradually but surely got to the peak of the medical branches opted by a medical graduate. In times to come if we the current radiologists promote this beautiful subject as an imaging specialty where patients are referred for imaging and you guide the patient to the diagnosis. Anyhow we radiologists are making the majority of diagnosis!!!!
In times to come we can have a “Diagnostic Referral” instead of “Imaging Referral” where cases would be referred to a Radiologist and a Pathologist for diagnosis by the physician.
Any comments and suggestions are welcome....
Tuesday, August 9, 2005
What is Pseudo-SAH? An interesting article in Neurology..
Pseudo-subarachnoid hemorrhage: a CT-finding in spontaneous intracranial hypotension.
Schievink WI, Maya MM, Tourje J, Moser FG
Increased attenuation in the basilar cisterns or along the tentorium cerebelli resembling subarachnoid hemorrhage (SAH) may be found on CT in the absence of blood (pseudo-SAH). The authors found pseudo-SAH on CT in four of 40 patients with spontaneous intracranial hypotension. All four patients had brain sagging with obliteration of the cisterns and pachymeningeal enhancement along the tentorium cerebelli. Spontaneous intracranial hypotension should be included in the differential diagnosis of pseudo-SAH.
Full article at-
Friday, August 5, 2005
Usefulness of US in Radiologically negative ankle injuries in children-article in Ped Radiol
Sonographic detection of radiographically occult fractures in paediatric ankle injuries.
Simanovsky N, Hiller N, Leibner E, Simanovsky N
In some paediatric ankle injuries, the clinical picture is suggestive of a fracture despite negative three-view radiographs. Objective: To determine the effectiveness of high-resolution US to differentiate radiographically occult fractures from sprains. A total of 20 children were examined. In 13, US did not reveal a fracture; small fractures were detected in 7. All patients with negative US studies had negative follow-up radiographs. In six patients with positive US the follow-up radiographs demonstrated a periosteal reaction. In one child in whom a fracture line identified by US was in the depth of the lateral malleolus, the follow-up radiograph demonstrated an area of increased bone density.
US is effective for the detection of radiographically silent fractures of the paediatric ankle. It may be used as an adjunct to radiography in clinically suspicious, but radiographically negative ankle injuries.
Full Article at-
Tuesday, August 2, 2005
Imaging in peripheral arterial disease-an interesting article in Radiology
Imaging Peripheral Arterial Disease: A Randomized Controlled Trial Comparing Contrast-enhanced MR Angiography and Multi–Detector Row CT Angiography
Rody Ouwendijk, MD, MSc, Marianne de Vries, MD, Peter M. T. Pattynama, MD, PhD, Marc R. H. M. van Sambeek, MD, PhD, Michiel W. de Haan, MD, PhD, Theo Stijnen, PhD, Jos M. A. van Engelshoven, MD, PhD and M. G. Myriam Hunink, MD, PhD
PURPOSE: To prospectively evaluate clinical utility, patient outcomes, and costs of contrast material–enhanced magnetic resonance (MR) angiography compared with multi–detector row computed tomographic (CT) angiography for initial imaging in the diagnostic work-up of patients with peripheral arterial disease.
RESULTS: A total of 157 consecutive patients with peripheral arterial disease were prospectively randomized to undergo MR angiography (51 men, 27 women; mean age, 63 years) or CT angiography (50 men, 29 women; mean age, 64 years). For one of the 78 patients in the MR group, no data were available. Mean confidence for MR angiography (7.7) was slightly lower than that for CT angiography (8.0, P = .8). During 6 months of follow-up, 13 patients in the MR group compared with 10 patients in the CT group underwent additional vascular imaging (P = .5). Although not statistically significant, there was a consistent trend of less improvement in the MR group across all patient outcomes. The average cost for diagnostic imaging was 359 ($438) higher in the MR group than in the CT group (95% confidence interval: 209, 511 [$255, $623]; P < .001). Therapeutic costs were higher in the MR group, but the difference was not significant.
RESULTS: A total of 157 consecutive patients with peripheral arterial disease were prospectively randomized to undergo MR angiography (51 men, 27 women; mean age, 63 years) or CT angiography (50 men, 29 women; mean age, 64 years). For one of the 78 patients in the MR group, no data were available. Mean confidence for MR angiography (7.7) was slightly lower than that for CT angiography (8.0, P = .8). During 6 months of follow-up, 13 patients in the MR group compared with 10 patients in the CT group underwent additional vascular imaging (P = .5). Although not statistically significant, there was a consistent trend of less improvement in the MR group across all patient outcomes. The average cost for diagnostic imaging was 359 ($438) higher in the MR group than in the CT group (95% confidence interval: 209, 511 [$255, $623]; P < .001). Therapeutic costs were higher in the MR group, but the difference was not significant.
CONCLUSION: The results suggest that CT angiography has some advantages over MR angiography in the initial evaluation of peripheral arterial disease.
Full article in-
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