MedWorm: Radiologists

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www.MidEssexRay.com — Sun, 06 Jul 2008 06:00:00 +0100

Looking for an RSS feed for a journal? Can't find it on their website? You could try googling it, or you could look in Medworm. I was looking for an RSS feed for Clinical Radiology and found it through Medworm. They didn't have one for the British Journal of Radiology, though, and I couldn't find it on the BIR site either, but located it via Google.As an aside, I used to use iGoogle as a means of getting RSS feeds, but have since switched to Google reader. On iGoogle, a maximum of 9 items are displayed, which is not sufficient for all the articles in one issue of a journal. I also find Google reader easier to organise. I'm sure there are lots of other feed readers out there, but I seem to do most things through Google, and the reader works fine for me, so I haven't bothered to try any of the others. (Source: www.MidEssexRay.com)

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Acute pyelonephritis

Sumer's Radiology Site — Sat, 05 Jul 2008 10:43:00 +0100

This a a young female presented with symptoms of urinary tract infection with CT shwoing bulky right kidney with inhomogenous striated nephrogram, likely acute pyelonephritis.Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Central pontine myelinolysis

Sumer's Radiology Site — Sat, 05 Jul 2008 10:38:00 +0100

This is 19-month old girl with severe diahorrhea, MRI brain showing altered signal intensity in the central pons. Rarely reported in this age group but can be central pontine myelinolysis.Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical Sciences From Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Myositis ossificans

Sumer's Radiology Site — Sat, 05 Jul 2008 10:36:00 +0100

Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesThis is a post head injury follow up case shwoing myositis ossificans surrounding the hip joint.From Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

The national health service is 60 years old today

www.MidEssexRay.com — Sat, 05 Jul 2008 08:21:00 +0100

Illustration from the cover of todays BMJThe British National Health Service started on 5 July 1948, 60 years ago today.The online Guardian has an interesting page to mark this event, with lots of articles and features, and I recently posted a 1948 public information film explaning the new service, as well as a clip from Michael Moore's film Sicko, which you can see here. (Source: www.MidEssexRay.com)

Reducing unnecessary mri and ct scans could cut wait times: study

www.MidEssexRay.com — Fri, 04 Jul 2008 21:22:00 +0100

Pietro Longhi. The Pharmacist. Galleria dell'Accademia, VeniceWait times for MRI and CT scans in Ontario - and probably elsewhere in Canada - could be reduced by cutting back on unnecessary scans ordered by doctors, a new study suggests."I think all of Canada is experiencing challenges with wait times. And I guess our message would be if you can cut down the inappropriate use, then you can actually improve access for the people who actually will benefit," lead author Dr. John You said.The title of this post is taken from an article in the website of the Canadian Broadcasting Corporation (CBC). Radiologists might smile wearily, but I guess it's intended for the general public who may not be aware of what we all take for granted. In fact, there are some interesting findings about variations in imaging utilisation and the diagnostic yield of various common investigations. The authors of the study suggest that: The province should develop a web-based ordering system that would capture, in real time, the reasons why imaging tests are ordered and test results. Such a system would make it easier to audit the appropriateness of ordering patterns.Read more here.The study is said to have been published in the June issue of the Canadian Association of Radiologists Journal but I couldn't find it in the table of contents. Perhaps they meant July. (Source: www.MidEssexRay.com)

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Killer spect/ct?

Dalai's PACS Blog — Thu, 03 Jul 2008 23:15:00 +0100

OK, wrong Hawkeye, but the title is correct.To keep at the bleeding edge of nuclear technology, my hospital is in the market for a hybrid SPECT/CT. This latest and greatest idea in nuclear medicine recapitulates the brilliance and innovation that brought us PET/CT, and applies it to PET's cousin SPECT.I'm going to assume that you know what these modalities are all about. PET uses positron-emitting radioisotopes to produce an image, while SPECT, Single Photon Emission Computed Tomography, uses more conventional radiopharmaceuticals, generally labelled with Technetium 99m, or Indium 111, or Gallium 67. PET is acquired with a ring detector, and SPECT uses two rotating gamma camera heads (sometimes one, rarely three) to produce an image. You really don't want me to get into the mathematics of the process, not that I really could; suffice it to say that by rotating all around the radiation source (the patient), the radioactivity detected by the heads is reassembled into a series of slices. This technology has been around for a long time.In the early days of PET, there were attempts to modify gamma cameras to act as cheap PET scanners. We had one, the ADAC Vertex, which used thicker NaI (Sodium Iodide) crystals to stop the higher energy annihilation gamma rays (511 KeV vs 140 KeV for the main gamma emission from Technetium). It was a good way to get our feet wet, but the images weren't great.One of the SPECT gamma-cameras that was marketed as having PET capabilities started life as the Elscint Varicam:This was a camera well ahead of its time, with body cowling designed by Jaguar (or was it Porsche?). Its computer was a little esoteric, and I'm not sure many were ultimately sold. But with thick crystals, it could be made to do PET imaging.In 1998, GE bought Elscint, and assimilated the Varicam into its collective product line, where it became the Hawkeye. (As an interesting historical aside, I was actually talking MRI with some of the developers at Elscint HQ in Haifa, Israel, the very week everyone else at Elscint was in Milwaukee completing the deal.)I think the innovation to put a CT in the same machine as the SPECT gantry came from UCSF, where an old GE 9800 and a GE 600 XR/T SPECT were sort of loosely combined:I suppose I should stop at this point to answer the question of why one would want to do this. As with PET and its marriage to CT, there are two reasons. First, the human body is inhomogeneous, i.e., it is full of things that block x-rays to varying degrees. Bones block more than watery structures (like organs), which block more than air in the lungs. To properly reconstruct a tomographic, SPECT image, the computer should know what the anatomy looks like. Most of the time in SPECT we ignore this, although in cardiac work, where chest wall or breast or diaphragmatic attenutation (blocking) could create false defects in the image of the heart, attenuation correction is critical. This correction can be accomplished by sweeping a radioactive source across the area in question, sometimes during the scan itself, or one could use CT. CT actually works much better, because it is designed to look at anatomy, not physiology. Second, linking CT and SPECT gives me a better chance to localize those pesky little hot-spots, just like we see with PET/CT.Anyway, under GE tutilage, the Varicam became the Infinia. A bit later, a low-resolution CT was added to create the Hawkeye:The "bump" to the right of the ring holds the x-ray tube, and the black strip to the left, inside the ring, is a detector. Thus, a rather limited CT is created. GE continues to sell this device today, and it now has 4-slice capability (Hawkeye Infinia 4).Philips and Siemens have gone more traditional, with offerings hearkening back to the original UCSF design with a real CT scanner. The Symbia from Siemens uses their Emotion CT scanner (in various slice increments, either one, two, or six, and soon 64) mated with a dual-head gamma camera. Very pretty cowling; you have to love that Bondi-Blue made famous by the original iMacs.Philips Precedence SPECT/CT mates a Philips CT (which is coincidentally a descendant of an Elscint design as well) to an ADAC (I mean Philips) Skylight gamma-camera:I've heard that the Skylight, a room-sized framework suspending two gamma camera heads, was commissioned to do bone scans on racehorses, and having two in my lab (Skylights, not racehorses), I can see where this might have been the case. However, the RT-Image chart indicates that the BrightView SPECT platform, which has a more conventional design, will now be the basis for a second SPECT/CT, available in 2009.So, once I get my hands on one of these, what will I do with it? The possibilities are really endless. Anything we do with SPECT, we can do better with SPECT/CT. A lesion on a bone scan can be precisely located with the CT component. The blobs of activity that are almost unreadable from a ProstaScint scan suddenly become diagnostic of nodes invaded by prostate cancer when I can see where they actually lie. Cardiac scans gain accuracy with the improvement in attenuation correction. And so on. But there is one theme common to these new and exciting applications: They depend heavily on the CT component. The nuclear literature is chock-full of reports of improvements in diagnosis when using SPECT/CT, especially with diagnostic quality CT's done with IV and oral contrast.Which leads us into the editorial part of this opus.The Medical University 100 miles down the road is getting four Symbias. Yes, I said FOUR. Our community hospital here in the boonies has to be competitive, but with luck, I will get one SPECT/CT scanner, so I had better choose the right one.Equipment vendors are in the business of selling equipment, oddly enough, and they try hard to convince you that their machine is the best, and the other guy's is trash. When I was looking at PET/CT scanners, GE sent me at least a dozen articles that "proved" their older BGO crystals were better than Siemen's LSO crystals. I didn't fall for it, and I'm happy with my PET/CT choice of the Siemens Biograph. (However, I'm very UNhappy with the fact that Siemens released their higher resolution TruePoint machine within a year of our system's purchase, which can't be retrofit our older model.)GE knows very well that I'm not a Hawkeye fan, but they continue to try to convince me of the error of my ways. I'll make the assumption that the gamma camera (i.e., the SPECT) components are similar, and that the attenuation correction on each will yield good images. The only reference I could find indicates that the Hawkeye's SPECT resolution is slightly better than that of the Symbia series. But.... When my Chief Tech asked about the quality of the Hawkeye's CT, she was told, "Why would you need more than attenuation correction?" Excuse me? Obviously, there is a little lack of understanding of one's product here. Attenuation correction is only part of the story, and as the interpreting radiologist, it is the lesser part. When I see hand-waving like this, I know there is something to hide. And it is indeed the CT component.The Hawkeye's CT (we'll be generous and call it that) can acquire 4 slices simultaneously, although I'm not sure how fast it rotates. You sure as heck wouldn't want the open gantry rotating beyond a snail's pace, or someone is going to get hurt. Slice thickness is (per RT-Image) 5mm. OK, but the darn thing puts out only 1-2.5 mA with a 350 Watt generator! Compare this to the Symbia T6, with a 6-slice CT, that has a 50 KW (50,000 Watts), that can develop 20-345 mA. The Emotion CT platform can scan down to 0.63 mm. That's a real CT, with diagnostic images for correlation. In a departmental pinch, a Symbia can even be used as a stand-alone CT. Why do I need more than attenuation correction? Because CT is what SPECT/CT is all about, folks. Yes, attenuation correction is important, and it greatly improves the image. But I need the diagnostic CT, and it needs to register perfectly with the SPECT image. In this way, I can match the anatomy to the physiology, and that is what I need to do. Sadly, GE doesn't want to acknowledge this, mainly because its product doesn't have a diagnostic CT component. No doubt they will couple their gamma camera with a proper CT someday, but until then, this little deficiency doesn't seem to bother them. In fact, their strategy takes a rather different turn: The following link is to an article regarding the possible link between multiple CTs and cancer risks, especially in children. Aiding us in our cause for our low-dose SPECT/CT Infinia Hawkeye 4 system. Maximum patient dose with the Infinia Hawkeye 4 is 2.5ma. Why more dose for Attenuation Correction and Anatomical Mapping in Nuclear Medicine environment?http://news.yahoo.com/s/time/20080630/hl_time/howdangerousarectscansMaximum patient dose is 2.5 ma? I'm not quite sure what that is supposed to mean. The initials "mA" stand for milliamperes, a measure of current, or loosely, flow of electricity. The Hawkeye's tube current is indeed rated at 2.5 mA. Yes, this lower-powered tube does yield a lower radiation dose. The article in the link discusses the supposed danger of too much radiation from too many CT scans, and was inspired by a now-infamous New England Journal article. There has been tremendous debate in our literature, both before and after this somewhat inflammatory piece, concerning the carcinogenic potential of diagnostic radiological procedures in general, and CT in particular. I won't rehash that now. But most agree that it is desireable to keep the amount of radiation to the lowest reasonable level. GE deserves accolades for its attempts to reduce radiation exposure from its devices, especially in the realm of cardiac CT. But in the SPECT/CT venue, the argument is hollow at best. Because the Hawkeye's CT images are not diagnostic, the patient will have to undergo another CT, and the dose will be added to that from the Hawkeye. In other words, the total dose will exceed what the patient would have received had he or she been scanned on a SPECT/CT unit that had a diagnostic CT in the first place.Now, being board-certified in both Nuclear Medicine and Radiology, I rather take offense to that last line in the quote from GE about the "Nuclear Medicine Environment". The implication here is that Nuclear Medicine doesn't need diagnostic images. Well, sorry to disappoint you guys, but likely the majority of nuclear medicine exams are read by diagnostic radiologists, and because of PET/CT, most pure Nuc Med physicians are now pretty well versed in reading CT's, so don't even think of going there. One simply cannot justify the purchase of a SPECT/CT camera on the basis of attenuation correction alone, and that seems to be the majority of what the Hawkeye offers. So, let's not play the radiation dose card, when ultimately a patient scanned on the Hawkeye might get a higher dose than someone scanned on a Symbia or a Precedence. If the extra radiation is so dangerous, and it needs to be limited as much as possible so the scans don't turn out to be harmful (or maybe fatal?), then we need to do only one CT scan and not two, yes?I'm anxiously awaiting the day that GE delivers a SPECT/CT camera with a real CT in the box. No doubt this will occur. But you will forgive me if I have to pass on the Hawkeye. It just isn't going to be my "killer app". (Source: Dalai's PACS Blog)

Cisterna chyli

Radiology Picture of the Day — Thu, 03 Jul 2008 12:29:01 +0100

83 male had a CT for follow-up of gastrointestinal stromal tumour. A low-density structure (arrow) is seen in a right retrocrural location, adjacent to the azygous vein (curved arrow). While this might be mistaken for lymphadenopathy, it could be followed superiorly to a thin vascular structure in the posterior mediastinum. The retrocrural structure represents the cisterna chyli, and its continuation in the thorax is the thoracic duct. Not normally seen on CT, it is however a normal structure, and should be recognised as such. The cisterna chyli drains lymph from the abdomen - a variable number of intestinal and lumbar lymph trunks. Under cover of the right crus is its typical location, in front of the bodies of L1 and L2. The thoracic duct commences at the upper end of the cysterna chyli, at the T12 level. It inclines to the left as it ascends, passing behing the oesophagus. At the left lung apex it arches forward over the dome of the pleura to enter the confluence of left subclavian and internal jugular veins. Reference: McMinn RMH. Last’s Anatomy. 9th edition. Churchill Livingstone. 1994. (Source: Radiology Picture of the Day)

Nephrocalcinosis

cochinblogs — Thu, 03 Jul 2008 11:55:00 +0100

In this newest page of my gallery of ultrasound images, I have added some pictures of nephrocalcinosis in neonate. Check: http://www.ultrasound-images.com/ped-abdomen.htmThe images are self explanatory and show a relatively common problem in neonates following long term (weeks or months) of parenteral therapy besides certain medications. On another page, I describe the same disease in adults (see: http://www.ultrasound-images.com/renal-calculi.htm ). But it is in neonates that the pathology is so clearly evident on sonography, the reason being the better visualization of the pediatric abdomen and also the extent of involvement of the kidneys. In fact, it is often difficult to distinguish nephrocalcinosis from renal calculi, so dense is the extent of calcification.Editor. .adHeadline {font: bold 10pt Arial; text-decoration: underline; color: blue;} .adText {font: normal 10pt Arial; text-decoration: none; color: black;}Your Ad Here (Source: cochinblogs)

Surf the web, send emails, view ct scans and more on your ultrasound scanner

www.MidEssexRay.com — Thu, 03 Jul 2008 00:46:00 +0100

The Siemens Acuson P50 ultrasound scanner is powered by an Apple MacBook Pro , Apple MacBook laptop with 2 GB RAM, a 160 GB hard disk and a 2.0GHz Intel Dual-Core Pentium M processor. It's intended for cardiac and vascular applications.Apparently they've placed an order at the Royal London.It can be connected to the internet and function as a normal Mac laptop, so I guess you could install Osirix on it and use it as a DICOM workstation. (Source: www.MidEssexRay.com)

Agfa's two suitors

Dalai's PACS Blog — Wed, 02 Jul 2008 18:11:00 +0100

The Slaying of the Suitors, image courtesy of http://www.mainlesson.comI've written before about Agfa being for sale, and Siemens needing a PACS product. In an article yesterday, AuntMinnie.com put these seemingly disparate facts together like chocolate and peanut butter in a Reese's cup: Agfa-Gevaert of Mortsel, Belgium, reportedly has spoken with Erlangen, Germany-based Siemens about the possibility of selling Agfa HealthCare as part of its strategic review process, according to published reports. The Financial Times reported that Los Angeles-based equity group Gores Group also has shown interest in acquiring Agfa HealthCare. If Gores were to acquire the division, the story added that Gores is likely to leave management of the healthcare operations in place. Gores already has holdings in the healthcare market. In July 2007, the group purchased the diagnostic imaging division of HealthSouth of Birmingham, AL. The new company, Diagnostic Health, is one of the larger imaging center chains in the U.S.The report also noted that an acquisition of Agfa HealthCare by Gores could generate opposition from organized labor in Belgium, adding that the transaction would result in some short-term layoffs.In 2007, Agfa HealthCare posted net sales of approximately $2.2 billion (U.S.). Representatives for Agfa and Siemens Healthcare of Malvern, PA, declined to comment to AuntMinnie.com on the report.Just remember, boys. As the Mossad (the Israeli equivalent of the CIA) puts it, "Never say 'No comment.' 'No comment' is a comment." (Source: Dalai's PACS Blog)

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Ganglioglioma of the optic nerve

Radiology Picture of the Day — Wed, 02 Jul 2008 13:44:30 +0100

This patient presented with gradual decrease in vision, and partial excision confirmed a ganglioglioma of the optic nerve. Gangliogliomas are a low grade tumour (WHO Grade I or II) which typically occur in the temporal lobes of young patients and present with temporal lobe epilepsy. 80% of cases are found in (Source: Radiology Picture of the Day)

Chronic pancreatitis-ct

Sumer's Radiology Site — Wed, 02 Jul 2008 10:25:00 +0100

Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Colloid cyst-mri

Sumer's Radiology Site — Wed, 02 Jul 2008 10:24:00 +0100

Here is classical image of colloid cyst located in relation to the foramen of monro appearing hyperintense on T1 WI and hypointense on T2 WI.Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Agenesis of the corpus callosum

Sumer's Radiology Site — Tue, 01 Jul 2008 11:02:00 +0100

A case of seizure disorder with partial agenesis (hypoplasia), the anterior portion (posterior genu and anterior body) is formed, but the posterior portion (posterior body and splenium) is not formed. The rostrum and the anterior/inferior genu are also not formed. Note the colpocephaly.Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Lymphocytic hypophysitis-mri

Sumer's Radiology Site — Tue, 01 Jul 2008 10:28:00 +0100

This is a case of histopathologically proved case of lymphocytic hypophysitis. MRI revealed enlargement of the pituitary gland and fossa, with traingular-dumbell shaped mass with significant heterogenous post contrast enhancement. There is suprasellar extension and alteration of the optic chiasm. Pituitary stalk cannot be identified.Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

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Hypoxic brain injury-mri

Sumer's Radiology Site — Tue, 01 Jul 2008 10:24:00 +0100

This is patient who had a cardiorespiratory arrest and MRI was done which revealed hypoxic injury. T2/FLAIR and diffusion images are provided, and show symmetrical hyperintensity in the bilateral thalami, basal ganglia and brainstem.Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Post-intubation tracheal stenosis

Radiology Picture of the Day — Tue, 01 Jul 2008 04:27:13 +0100

This road traffic accident victim was intubated (endotracheal tube) for 2 weeks. He developed dyspnea and stridor following extubation. CT scan shows upper tracheal stenosis. Axial images show circumferential irregular granulation tissue internal to normal appearing tracheal ring. 3D external rendering shows location and length of the stenosis. 3D internal rendering “virtual endoscopy” shows the upper orifice of the stenosis (long arrow) distal to vocal cords (short arrows). Post-intubation stenosis may be acute or chronic: Acute: results from edema of the tracheal wall or intraluminal granulation tissue (as in present case). Dynamic imaging shows little change in tracheal dimensions. Chronic: results from fibrosis with deformity of tracheal cartilage. CT scan shows deformity of the tracheal cartilage or posterior tracheal membrane with absent or mild thickening of mucosa & submucosa. Dynamic imaging may show tracheomalacia. Reference: Webb R and Higgins B: Thoracic imaging: The trachea. Lippincott Williams & Wilkins 2005. (Source: Radiology Picture of the Day)

Dead green servers

Dalai's PACS Blog — Mon, 30 Jun 2008 19:57:00 +0100

In a recent post, I relayed the information that the GE migration to the Linux server had to take place because the Sun Solaris servers upon which Centricity had been based were now at end-of-life status. In particular, the most recent version used for Centricity, the SunFire V480, is "retired and no longer orderable" according to Sun's website. But wait, all is not lost! It seems that the SunFire V490 is now available to meet all your Solaris needs, and you can get it from $30,995.00 (US). Could it have done the job for Centricity? More than likely: Pack your racks with UltraSPARC IV+ processors driving this 5 RU server and get over 5x faster performance compared to UltraSPARC III based Sun Fire V480 servers. Up to four processors per box with eight threads and 64GB of memory make it ideal for securing and delivering multiple applications and business processes or distributed databases. Yeah, I think the V490 is probably beyond the V480's capabilities: The Sun Fire™ V480 server is designed to deliver compute density and enterpriseclass RAS features at an affordable price. Its space-efficient, rack-optimized 5RU, 24-inch-depth enclosure provides excellent value per rack unit and contains up to four 1.05/1.2-GHz UltraSPARC® III Cu processors, each with 8 MB cache(L2), up to 32 GB of memory, integrated dual 10/100/1000-Mb/sec. Ethernet, and the Sun Fireplane Interconnect operating at 9.6 GB/sec.OK, so what's the real reason behind the upgrade? Well, I dunno. To be fair, GE has been selling the Linux servers for several years, well before the Dynamic Imaging acquisition. And far be it from me to criticize them for being willing to change some software that I was not terribly pleased with in the first place. But was it the server reaching end-of-life that forced the issue? Or the software? (Source: Dalai's PACS Blog)

Radiology grand rounds-xxv

Sumer's Radiology Site — Mon, 30 Jun 2008 13:49:00 +0100

Here is a case of Renal Hydatid for the Radiology Grand Rounds submitted by Dr MGK Murthy and Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand RoundsEchinococcosis is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. Adult worm lives in the proximal small bowel of the definitive host, attached by hooklets to the mucosa. Eggs are released into the host's intestine and excreted in the feces. Humans may become intermediate hosts through contact with a definitive host (usually a domesticated dog) or ingestion of contaminated water or vegetables. The ovum loses its protective layer as it is digested in the duodenum. Once the parasitic embryo passes through the intestinal wall to reach the portal venous system or lymphatic system, the liver acts as the first line of defense and is therefore the most frequently involved organ. Renal hydatid is rare accounting for 2% usually. There are no clincal symptoms except cystic rupture into the collecting system, which leads to acute renal colic and hydatiduria .Imaging findings in hydatid disease depend on the stage of cyst growth (ie, whether the cyst is unilocular, contains daughter cysts, or is partially or completely calcified [dead]) . A difference in attenuation and signal intensity between the fluid in the central portion of the cyst and that in the peripheral cysts is a typical finding in echinococcosis due to a difference in content .Daughter vesicles (brood capsules) are small spheres that are formed from rests of the germinal layer and appear as cysts within a cyst. They contain the scolices and hooklets, along with sodium chloride, proteins, glucose, ions, lipids, and polysaccharides . When daughter cysts are separated by the hydatid matrix, they demonstrate a "wheel spoke" pattern . Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical Sciences) From Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Rathke’s cleft cyst

Radiology Picture of the Day — Mon, 30 Jun 2008 12:17:14 +0100

Rathke’s cleft cyst is a non-neoplastic epithelium-lined cyst arising from the embryologic remnants of Rathke’s pouch. On imaging it is a well-defined non-enhancing midline cyst in the sellar region, arising between the anterior and intermediate lobes of the pituitary. 40% are purely intrasellar and 60% have suprasellar extension. Purely suprasellar lesions are rare. On CT it is typically non-calcified and of homogenous low density. Uncommonly it may be of mixed isodensity and low density, or contain small curvilinear calcifications in the wall. On MRI the signal characteristics vary according to the cyst content which may be mucoid or serous. On T1, 50% are hyperintense and 50% are hypointense. On T2, 70% are hyperintense and 30% are iso or hypointense. 70% have a small non-enhancing intracystic nodule consisting of mucinous material; this feature is virtually pathognomic of a Rathke’s cleft cyst. There is no contrast enhancement of the cyst but a thin enhancing rim of adjacent compressed pituitary tissue may be seen. The main differential differential diagnoses are craniopharyngioma, cystic pituitary adenoma and other non-neoplastic cysts such as an arachnoid cyst or epidermoid cyst. Rathke’s cleft cysts are typically asymptomatic and are found in up to 1/3 of autopsies. If large, they may cause visual disturbance due to compression of the optic chiasm or pituitary dysfunction due to compression of adjacent pituitary tissue. References: 1. Osborn A. & Preece M. Intracranial Cysts: Radiologic-Pathologic Correlation and Imaging Approach, Radiology 2006; 239:650-664 2. StatDx 3. eMedicine.com (Source: Radiology Picture of the Day)

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An update of the newest additions to my website

cochinblogs — Mon, 30 Jun 2008 09:13:00 +0100

Dear readers,Just added a nice case, of pelvic kidney in a neonate at: http://www.ultrasound-images.com/ped-abdomen.htm The child had an imperforate anus with suspected recto-uterine fistula. Placed the high resolution ultrasound probe on the pelvis and saw a pelvic kidney, the left kidney not being seen in the left renal fossa. A clear example of renal ectopia! I have added 7 ultrasound images for this case of pelvic kidney at the link above. This page is freshly created and devoted to pediatric abdomen. What was interesting was that the pelvic kidney appeared round or oval in shape, suggestive of some degree of malrotation of the renal axis. Your Ad Here (Source: cochinblogs)

Safety of buscopan (it's safe)

www.MidEssexRay.com — Sat, 28 Jun 2008 19:21:00 +0100

Buscopan (hyoscine-N-butylbromide) is widely used as a spasmolytic for barium enemas, CT colonography, and abdominal MRI to improve the quality of the examination. It's a safe drug: safer than many people realise. Here is some sensible advice from the authors of a recent review articleAll radiologists and radiographers either supervising examinations where this drug is used or those administering it directly to the patient need to be aware of the true contraindications. This should not include all patients with ischaemic heart disease or those with glaucoma. We would recommend that only patients with unstable cardiac disease have Buscopan withheld and that all patients are told to attend hospital immediately if, following the examination, they develop painful, blurred vision, in one or both eyes.R. Dyde, A.H. Chapman, R. Gale, A. Mackintosh and D.J.M. TolanPrecautions to be taken by radiologists and radiographers when prescribing hyoscine-N-butylbromideClinical Radiology 2008 July; 63 (7): 739-743.doi:10.1016/j.crad.2008.02.008PubmedMost radiologists feel that Buscopan is more effective than glucagon, and there are studies to support this view, such as this one by Rogalla et al (Radiology 2005;236:184-188).I really can't figure out why it's not licensed in the United States. In the US it is approved for the treatment of flatulent colic in horses although not if the horses are going to be eaten by humans. (Link to product info) (Source: www.MidEssexRay.com)

Peacock.

scan man's notes — Sat, 28 Jun 2008 05:55:42 +0100

Coloured chalk on vinyl blackboard. My daughter’s latest effort at home. (Source: scan man's notes)

Ependymal cyst

Radiology Picture of the Day — Fri, 27 Jun 2008 08:15:57 +0100

This 53-year-old patient presented with headaches. CT and MRI demonstrated a large non-enhancing thin-walled cyst following CSF signal in the lateral and 3rd ventricles, causing obstructive hydrocephalus. Histology of the excised lesion confirmed an ependymal cyst. Ependymal cysts are benign neuroepithelial cysts lined by ependymal cells, thought to arise from sequestration of developing neuroectoderm during embryogenesis. They are thin-walled and contain clear serous fluid secreted by the lining ependyma. They are most commonly intraventricular, typically in the lateral ventricles, but rarely may be found in the periventricular white matter or subarachnoid spaces. Most are small and asymptomatic. On imaging they are well-defined, thin-walled and do not contrast enhance. On CT they are isodense to CSF. On MRI they follows CSF signal on all sequences and do not demonstrate diffusion restriction. Occasionally the cyst may be hyperintense to CSF if there is a high protein content. The main differential diagnoses, which may be difficult to distinguish, are intraventricular arachnoid cyst and asymmetric ventricles. Other diagnoses to consider, although they have distinguishing features, are choroid plexus cyst, epidermoid cyst, neurocysticercosis and porencephalic cyst. References: 1. Osborn A. & Preece M. Intracranial Cysts: Radiologic-Pathologic Correlation and Imaging Approach, Radiology 2006; 239:650-664 2. StatDx (Source: Radiology Picture of the Day)

The radiology assistant

www.MidEssexRay.com — Thu, 26 Jun 2008 22:58:00 +0100

the Radiology Assistant is the educational web site of the Radiological Society of The Netherlands, focusing on common radiological issues in a problem oriented way for radiology residents and radiologists. This is an excellent site and a superb source of reference, with lots of succinct articles written by experts in the field. Highly recommended. Check it out. It's been added as a link in the sidebar of this blog. (Source: www.MidEssexRay.com)

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A sonographic atlas of the appendix-in ebook format

cochinblogs — Thu, 26 Jun 2008 16:49:00 +0100

Here is a great (e-book) Atlas of sonographic images (version 1.0) of the appendix in Microsoft Power Point (.pps format). Covering almost all major pathologies of the appendix, this will be useful as a guide to normal and the abnormal appendix. It contains more than 25 high resolution ultrasound images, all of which are well labelled and captioned, leaving little to the imagination. Among the topics covered in this e-book are 1) normal appendix 2) acute appendicitis 3) chronic appendicitis 4) subhepatic and pelvic locations of the appendix 5) perforation 6) color doppler imaging of the appendix 7) appendicolith etc. It can be downloaded instantly for a mere $ 5.0 via secure site.Or perhaps you might want to download another version 2.0 of this sonographic Atlas priced at a mere $ 7.0 at this secure site. This e-book (version 2.0) is in .pdf (adobe acrobat reader) format and can be downloaded at:https://www.regnow.com/softsell/nph-softsell.cgi?item=16637-3Adobe reader can be downloaded for free from http://www.adobe.com/Version 2.0 contains more than 40 high res ultrasound images of appendicular pathology. .adHeadline {font: bold 10pt Arial; text-decoration: underline; color: blue;} .adText {font: normal 10pt Arial; text-decoration: none; color: black;}Your Ad Here (Source: cochinblogs)

Giant hemangioma of liver-triple phase ct

Sumer's Radiology Site — Thu, 26 Jun 2008 08:54:00 +0100

Cavernous hemangioma is the most common benign hepatic tumor. It typically occurs in women. Lesions measuring more than 4 cm in diameter are known as "giant hemangiomas" and often cause symptoms such as vague abdominal distention and pain. The constellation of giant hemangioma, thrombocytopenia, and localized consumption coagulopathy is known as the Kasabach–Merritt syndrome. This is a case of 40 year old female with giant hemangioma of liver with triple phase CT showing classical centripetal fill-in.Dr Jaya Shankar, MD and Dr.Sumer K Sethi, MDSr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Secondary hyperparathyroidism

Radiology Picture of the Day — Thu, 26 Jun 2008 03:30:19 +0100

Plain X-ray hands of a young patient with CRF shows signs of secondary hyperparathyroidism (HPTH): -Irregular, frayed and ill-defined cortical outline, pronounced at radial aspect of middle phalanges –> subperiosteal bone resorption -Multiple lytic expansile lesions –> brown tumors (arrows) -Osteosclerosis -Accentuated trabecular pattern (non essential trabeculae are resorbed; those that remain appear prominent). Renal osteodystrophy: - Constellation of musculoskeletal abnormalities that occur in patients with CRF. Manifestations include: -Osteomalacia (adults) / rickets (children). -Secondary HPTH: bone resorption, osteosclerosis, soft tissue & vascular calcifications and brown tumors. -Aluminum intoxication if the patient is on dialysis (beyond description here). Comment: Subperiosteal bone resorption is the hallmark of HPTH and is first identified in hands. References: 1. Manaster B.J.: Handbook of skeletal radiology: Trauma 1997. Mosby. 2. Youchum and Rowe’s: Essentials of Skeletal Radiology 2005. Lippincott, Williams & Wilkins (Source: Radiology Picture of the Day)

Csf rhinnorrhea-ct

Sumer's Radiology Site — Wed, 25 Jun 2008 12:08:00 +0100

Dr.Sumer K Sethi, MDSr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Renal cell carcinoma-ct

Sumer's Radiology Site — Wed, 25 Jun 2008 11:46:00 +0100

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Dalai does dallas

Dalai's PACS Blog — Wed, 25 Jun 2008 01:15:00 +0100

I had a rather quick turn-around last week. I arrived back home from New Orleans at 5 P.M., and had to fly out to the West the next morning. We were booked on American Airlines, and we knew this was going to be problematic when the ticket agent predicted American's bankruptcy within the next 6 months. Always reassuring before a flight. To make matters worse, I used my smartphone to check for the connecting gate in Dallas, and lo and behold, it had been cancelled. Fortunately, we were able to rebook on US Air to our destination, and all was well.American blamed the cancellation on weather in Dallas, and truly there was a big storm there that day. However, the storm lasted less than an hour, and I personally think American was looking for excuses to suspend flights and save fuel. Maybe that's why they tell some of their gate agents to be nasty to the flying public; one less customer, one less gallon. However, given their rather unfortunate habit of letting their planes sit idling with the engines running while waiting for their gates to clear probably eats more fuel than they save with cancelled flights and lost customers. Scratch one more airline.I actually wasn't planning to travel again quite so soon, but I received a call from Amicas asking me to fly out West to speak with some potential customers. They thought the doctor-to-doctor thing might be helpful, since the group was somewhat similar to mine, and what they wanted to do with the product was rather close to the way we use it. So, off I went. Lest anyone dare call this a junkett, I'll reiterate that I really didn't want to go anywhere at that time, and I certainly wasn't interested going West where the temperatures were well above 100 degrees. But faith in the product, and maybe a little vanity, made me decide to do it anyway.The radiology group in question is sort of like mine, about the same size, with a few guys older than I am, and more that are younger. They are rather spread out, covering several towns rather far from their base, as do we.Now, I won't reveal the particulars this group sought, but portability was a critical factor. They had narrowed their choices down to Amicas and another company, and they were having some trouble deciding beyond that. On the advice of my very wise, and occasionally politically-correct friend, Mike Cannavo, the One and Only PACSMan, I won't name the other company, but suffice it to say they are definitely one of the BIGGER players.I had the chance to speak briefly with some of my counterparts in this Western group, as well as their IT guru. It became clear that they saw the viewers of both PACS as equal. They made the assumption that both could serve their needs, but they still had some hesitation about Amicas as a smaller company vs. the "security" of the BIGGER company. I'm not sure I got all of my points across in person, but I'm told that many of them read this blog, so here is everything I should have said, just in case I didn't.First and foremost, Amicas is a scrappy little company that isn't going anywhere. They have a great deal of money in the bank, the company is buying back its stock, and 20% of revenue goes into R&D. It is acquiring new technology such as RadStream (the acute-event reporting software from Cincinnati Children's that I have discussed elsewhere.) Sure, if some company like Siemens offered them double what they are now worth, I'm sure they would sell out (I would), but I don't see that happening any time soon. Let's put this takeover idea to bed for today, shall we?Somehow, there has emerged the illusion that there is safety with purchasing from the BIGGER company. Hmmnmmm... Just ask anyone who bought Centricity in the last few years how safe that is. Or the old Philips PACS from Sectra. Sadly, the BIGGER folks have an easier time of buying some new technology and requiring a forklift upgrade (usually hardware needs replacing as well as software in these circumstances) for you and me to get it. And, they are not worried (at least not as much as they should be) about whether or not you and I will pony up the charge for the next latest and greatest. After all, the BIGGER company was the safe bet, wasn't it? I can't see that we are particularly worse off dealing with a smaller company that isn't looking to swap out its product for something new, rather than improve and grow what it has. There are those who still believe the old "no one gets fired for choosing BIGGER" philosophy, but I guess I'm not in charge of their particular operation. Only a few of the BIGGER folks have totally web-based technology, but most don't, and that is the case with the BIGGER company in question here. Is that a problem? Well, it depends upon how many software clients you wish to play with. Amicas has just one GUI, called LightBeam, which is deployed over the web to anywhere you happen to have a computer and broadband. To be totally accurate, there is a second client called LightView, that is simply LightBeam without a couple of features such as spine labelling. Which client and features are activated depends upon your status as a radiologist, clinician, tech, etc. Our friends at the BIGGER company seem to use several clients, some thin, some thick, and as I understand it, I could not put the thick client on my computer myself without help (authorization, I guess) from IT or the PACS team. Hmmmm.How does the system distribute images? Most everyone is now going to a central repository. Amicas basically ties a web-server to a SQL database. (Note: Amicas now uses the IBM DB2 database which in turn runs SQL.) Why reinvent the wheel? This architecture works pretty well for other web applications, so why not use it? Is this what the BIGGER company does? Well, to some extent, but there seems to be a lot more complexity added, without necessarily getting a lot of additional advantage. This could be quite critical to my new friends out West, as their enterprise spreads far and wide, and the way the system deals with connectivity (or the lack thereof) could make or break the system. Amicas will allow a modality to automatically resume sending once a broken communication line is repaired. It seems that the BIGGER company requires a manual resend in this situation. Could be a problem.Service should be a given. I've had a few glitches with Amicas service, but our downtime on our group's system has totaled only an hour or two in two years, and most things get caught before they cause chaos. I sure can't say that about some of the BIGGER companies I deal with daily. As for the BIGGER company I'm referring to here....well, I'll let someone else answer for them.To me, the background operations don't matter as much as the actual interface, the client, the GUI. I like the way Amicas works. It doesn't get in my way, and it lets me bang through studies as fast as I feel comfortable doing so. Can we say this about the BIGGER GUI? I guess it depends upon which one of the options you actually use in practice.Bottom line here is that BIGGER is not necessarily better. Look honestly at the products themselves, with no preconceived notions about BIGGER companies being safer than smaller companies, and the like. See what works for you and your group, and be sure they all get time on the GUI before you sign on the line. You might find that Smaller works for you. I have lived through situations where the purchase was directed to the BIGGER, "safer" choice, and for three times the expenditure, we got half the product.And no, I don't get a commission, so I have no vested interest in which way my friends out West decide to go. But I'm sure they will make an informed choice. They DO read my blog, after all! (Source: Dalai's PACS Blog)

No rip for erad

Dalai's PACS Blog — Tue, 24 Jun 2008 20:27:00 +0100

According to a very reliable source, eRAD had given up the corporate ghost. HOWEVER, I just heard from a friend at eRAD that they are alive and kicking, so word of their demise is premature. Glad to hear it! My apologies to eRAD and my friends there, but I promise my source was trustworthy in the extreme! Perhaps his/her source needs to be impeached. (Source: Dalai's PACS Blog)

10 penny nail found pre mri

MRI LINKS AND OTHER COOL THINGS — Sun, 22 Jun 2008 14:59:00 +0100

You ever have one of thoose days that you just wanted to put a 10 penny nail into your bladder? What? I know this sounds crazy but that is exactly what this woman did. The pt came into the ER with slurred speech. The CT scan from the night before had revealed a hypodense area in her brain therefore an MRI was ordered. Before the MRI could be performed the patient had to be Xrayed to find out if she did have a nail in her body. The patient reported it was in her Uterous but upon Ultrasound localization it was found to be in her bladder. (source NEJM). ……Read more here to find out why? (Source: MRI LINKS AND OTHER COOL THINGS)

Gall bladder sludge in neonate:

cochinblogs — Sun, 22 Jun 2008 14:13:00 +0100

These ultrasound images of a neonatal abdomen show a large amount of dense sludge in the gall bladder. Such sludge formation in neonates is often seen following parenteral nutrition and is usually self resolving.Reference: http://www.jultrasoundmed.org/cgi/content/abstract/6/5/243Visit the page: http://www.ultrasound-images.com/pediatric.htm for ultrasound images of pediatric and neonatal diseases. At present I have added a few cases of neonatal intracranial/ germinal matrix hemorrhage and its complications, notably porencephaly. There is also a nice case of inguinal hernia containing ovary. .adHeadline {font: bold 10pt Arial; text-decoration: underline; color: blue;} .adText {font: normal 10pt Arial; text-decoration: none; color: black;}Your Ad Here (Source: cochinblogs)

"a centrally funded health service, free at the point of delivery"

www.MidEssexRay.com — Sun, 22 Jun 2008 11:17:00 +0100

This public information film from 1948, when the British National Health Service was founded, is a timely reminder of what it's all about....the hunt for a better funding model is never called off, with each new foray unfolding along similar lines. It begins with the NHS being judged as seriously underperforming. The real reason for this, whether admitted by the government of the day or not, is because not enough money is being spent on it. Early in the hunt comes sightings of the "bottomless pit" of insatiable healthcare demands, quickly followed by assertions that substantial increases in healthcare spending are "unsustainable." When asked for their advice, economists tell politicians that a tax based system provides governments and patients with the best deal. As a sideshow to the main event are the hucksters, peddling their own funding models, hoping that some of the billions spent on the NHS might end up in their pockets, or those of their backers.Tony Delamothe, BMJ 2008;336:1410-1412 (21 June), doi:10.1136/bmj.a292Free full textHere is an excerpt from Michael Moore's Sicko (2007).Link: Keep our NHS public (Source: www.MidEssexRay.com)

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Hydatid cyst- ct

Sumer's Radiology Site — Sun, 22 Jun 2008 10:10:00 +0100

Imaging--Separation of the laminated membrane from the penicyst produces a split wall or floating membrane appearance.Dr.Sumer K Sethi, MDSr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Graham’s commencement address.

scan man's notes — Sun, 22 Jun 2008 08:51:50 +0100

.. Found this through Kevin, MD. Graham Walker, former medical student and freshly graduated doctor and author of the blog OVER!MY!MED!BODY!, delivers the Commencement Address (you can read the text of his speech at his blog) to the 2008 graduating class of the Stanford University School of Medicine. .. .. I delivered the address at my medical college graduation day many years ago, and I wish mine was this good!! Great job Graham. Congrats and Good Luck. There must be something in the water or air at Stanford that makes people talk so well. Watch Steve Jobs delivering the commencement speech to the graduates of Stanford University in 2005. .. (Source: scan man's notes)

Italy, for real.

scan man's notes — Sun, 22 Jun 2008 07:22:42 +0100

Saw this in Paul Levy’s blog. For those who love Italy as much as I do, I offer the following humorous link: http://tcc.itc.it/people/rocchi/fun/europe.html It’s a Flash movie that takes some time to load. Well worth the wait. What struck me was the fact that you could replace Italy with India and it would be true for most of what is depicted in the movie!! (Source: scan man's notes)

A web page of ultrasound images of renal calculi

cochinblogs — Sun, 22 Jun 2008 04:25:00 +0100

Just added some great images of renal calculi..from the usual to the unusual staghorn calculi. Just visit: http://www.ultrasound-images.com/renal-calculi.htm Staghorn calculi or triple phosphate calculi can be silent until they reach phenomenal proportions like this calculus which occupied half of the kidney. Luckily, in the case described at the link above, there was only mild hydronephrosis of the affected kidney.Editor.http://www.ultrasound-images.com/index.html .adHeadline {font: bold 10pt Arial; text-decoration: underline; color: blue;} .adText {font: normal 10pt Arial; text-decoration: none; color: black;}Your Ad Here (Source: cochinblogs)

High cost of ct in the us - redux.

scan man's notes — Sat, 21 Jun 2008 20:54:41 +0100

Dr. Peng Hui Lee, a Consultant Radiologist in the NHS, and author of the blog MidEssexRay, mentioned an old post of mine in his blog yesterday. The post in question, titled ‘Why does a CT scan cost so much in the USA?‘ is the one with the most comments on my blog. The comments, twenty-six as of this writing, make for interesting reading. Definitely more interesting than my post. I guess it pops up on a regular basis on search engines whenever someone with a huge bill for a CT scan searches the web for answers. It was even mentioned by my famous blog pal Dr. Val in her blog. Dr. Lee has found a YouTube video of a news report about the incident that prompted the post. Watch it at the YouTube site if it doesn’t open here. The video contains a short interview with Dr. Kevin Pho, another famous medblogger and author of the blog Kevin, MD, who regularly writes about Defensive Medicine. Dr. Lee adds… There has been a lot of grumbling in Britain about the “Stalinist” National Health Service (NHS), but there are worse ways to organise a country’s healthcare. I work for the NHS, and I am only too aware of its deficiencies, but those who wish to dismantle it should consider the possible consequences of alternative systems. Privatisation of the previously state-owned British railways did not lead to improved service. There is no inherent reason why a privatised national healthcare system in the UK will fare any better. (Source: scan man's notes)

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"why does a ct scan cost so much in the usa?"

www.MidEssexRay.com — Sat, 21 Jun 2008 16:16:00 +0100

There's a post in Vijay's blog from October 2007 discussing the cost of healthcare in the United States http://www.catscanman.net/blog/?p=267. It makes interesting reading, as do the comments that have been posted by various people describing their experiences. Here is the video about the incident:There has been a lot of grumbling in Britain about the "Stalinist" National Health Service (NHS), but there are worse ways to organise a country's healthcare. I work for the NHS, and I am only too aware of its deficiencies, but those who wish to dismantle it should consider the possible consequences of alternative systems. Privatisation of the previously state-owned British railways did not lead to improved service. There is no inherent reason why a privatised national healthcare system in the UK will fare any better. Railway journeys in the UK are extremely expensive compared to the rest of the UK. I'm always being told how cheap it is to go shopping in the US compared to the UK. What will happen if our healthcare is privatised?Link: Keep our NHS public (Source: www.MidEssexRay.com)

Radiology party trick

www.MidEssexRay.com — Sat, 21 Jun 2008 15:08:00 +0100

"What's wrong?""Someone stepped on me during the last dance.""Want me to have a look at it?""OH MY GOD!!"Read on.....I've added the Samurai Radiologist's blog Not Totally Rad to my list. His posts cover all sorts of things other than radiology. There are imaging-related article as well, of course, including this one which reviews studies from the published literature, but may nevertheless be inaccessible from hospital PCs due to "adult content": Radiology comes through for sexual imaging.My thanks to Vijay, : I found this indirectly via his blog. (Source: www.MidEssexRay.com)

Central neurocytoma-ct imaging

Sumer's Radiology Site — Sat, 21 Jun 2008 10:07:00 +0100

Imaging of central neurocytoma is usually characteristic. Most of them occur as an exophytic, well circumscribed, globular mass that protrudes into the ventricles. Calcifications are common. This is a postoperative post shunting case of neurocytomas, note the intraventricular nature of tumour, calcification and operative pneumocephalus. Tumour showed immunoactivity for synaptophysin. Radiological differential diagnoses include oligodendroglioma, ependymoma, subependymal giant cell astrocytoma, and intraventricular meningioma.Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Pigmented villonodular synovitis of shoulder

Sumer's Radiology Site — Fri, 20 Jun 2008 04:42:00 +0100

These are MRI pictures of a case of PVNS. Pigmented villonodular synovitis is well known in knee and shoulder involvement is reported rarely. Note the erosive defects in the humeral head.Case by Dr MGK Murthy, Sr Consultant Radiologist&Dr.Sumer K Sethi, MDSr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Contrast induced nephropathy

Sumer's Radiology Site — Fri, 20 Jun 2008 04:27:00 +0100

"In Radiology 2008;248:97-105 Shaun A. Nguyen et al compared effects of iso-osmolality contrast with a low-osmolality agent on renal function and concluded Intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups."From Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

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Thrombosed prosthetic tricuspid valve in ebsteins anomaly

Radiology Picture of the Day — Thu, 19 Jun 2008 16:01:33 +0100

A 68-year-old woman with known Ebstein’s anomaly (EA) was admitted for the investigation of progressive breathlessness, reduced exercise tolerance (NYHA grade 2) and increasing leg swelling. On the current admission, a 64-slice coronary CT was undertaken to exclude hemodynamicaly significant coronary disease. Thrombus was identified lodged between the medial valve flap and the valve ring. Multiphasic cine CT throughout the cardiac cycle demonstrated immobility of the tricuspid valve leaflets. Ebstein’s anomaly is a rare congenital cardiac malformation characterized by apical displacement of the septal and posterior tricuspid leaflets, resulting in atrialization of the right ventricle. Medical management includes treatment for heart failure and complex cardiac arrhythmias. Surgical tricuspid valve repair is undertaken in severe cases of tricuspid regurgitation. Recent technical advances in cardiac CT, using retrospective ECG-gated image reconstruction, have allowed evaluation of both native and prosthetic cardiac valves. In the current case, echocardiography was unable to clearly depict the precise etiology for the malfunctioning valve, which was subsequently diagnosed as thrombus-related using cardiac CT. (Source: Radiology Picture of the Day)

Sonographic gel put to novel use

Sumer's Radiology Site — Thu, 19 Jun 2008 06:28:00 +0100

Seung Ho Kim et al used sonography transmission gel as Endorectal Contrast Agent for Tumor Visualization in Rectal Cancer in MRI and concluded that it is an effective and safe endorectal contrast agent for rectal MRI. Published in AJR 2008; 191:186-189From Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)

Hyperostosis frontalis interna

Radiology Picture of the Day — Wed, 18 Jun 2008 16:01:00 +0100

Hyperostosis frontalis interna is characterised by benign overgrowth of the inner table of the frontal bone. It is seen most commonly seen in older females. The aetiology is unknown. The condition is generally of no clinical significance and an incidental finding. It is typically bilateral and symmetrical, and may extend to involve the parietal bones. It may also diffusely involve the skull, a variant known as hyperostosis calvariae diffusa. The skull thickening may be sessile or nodular, and may affect the bone in a focal or diffuse manner. Other differential diagnoses for focal skull thickening include Paget’s disease, fibrous dysplasia, metastases and meningioma. Reference: 1. Medcyclopaedia.com 2. Radiopaedia.org (Source: Radiology Picture of the Day)

Tethered spinal cord

Sumer's Radiology Site — Wed, 18 Jun 2008 11:14:00 +0100

Here is a case of epidural/intradural lipoma showing signal suprresion on fat sat images and a low lying tethered spinal cord. Dr.Sumer K Sethi, MDConsultant Radiologist ,VIMHANS and CEO-Teleradiology Providers Editor-in-chief, The Internet Journal of Radiology Director, DAMS (Delhi Academy of Medical SciencesFrom Sumer's Radiology Site http://www.sumerdoc.blogspot.com -The Top Radiology Magazine (Source: Sumer's Radiology Site)