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ABSTRACT |
Sebastian S.; Kalra M.K.; Saini S.; Radiology, Emory University School of Medicine, Atlanta, GA.
Address correspondence to S. Sebastian (drssunit{at}yahoo.com)
Background: Increasing use of radiation based procedures, especially CT scanning, has raised concerns about risk of radiation-induced cancer. Based on existing evidence, the National Institute of Environmental Health Sciences (NIEHS), a subsidiary of the Department of Health and Human Services, United States, has recently declared that "X-ray radiation and gamma-radiation are "known human carcinogens" at low doses. Although most radiologists are aware of the risk of radiation-induced cancer, there is little awareness about proposed beneficial effects (hormesis) of radiation. Indeed, the effect of radiation can be summarized in four perspectives: low level radiation dose risk, unknown risk, no documented harmful effect or beneficial effect of low level radiation dose, and harmful effect of low level radiation exposure. Proponents of radiation hormesis reject the linear non-threshold theory of radiation induced cancer at low-level of radiation exposure, citing evidence from epidemiological and animal studies that have documented reduced risk of cancer following exposure to low-level of radiation dose. Radiation hormesis does assume critical importance in the era of heightened awareness about risk of cancer from low levels of radiation. In this educational exhibit, we will describe the concept of radiation hormesis and its mechanism, with help of diagrams, illustrations and tables from several interesting animal, human and epidemiological studies that have validated its existence. In addition, we will also describe controversies associated with radiation hormesis.
Format: Didactic.
Teaching Points: After reading this exhibit, the readers will be able to understand 1. Four perspectives on effects of radiation: low dose risk, unknown risk, no documented harmful effect or beneficial effect of low level radiation dose, and harmful effect of low level radiation exposure. 2. Concept of radiation hormesis and its mechanism. 3. Controversies associated with radiation hormesis.
E080. Volumetric 64-Slice MDCT Dose: What Every Radiologist Should Know
Ghoshhajra B.B.; Kruger A.Y.; Blackwood M.S.; Beasley H.S.; Department of Radiology, The Western Pennsylvania Hospital, Pittsburgh, PA.
Address correspondence to B.B. Ghoshhajra (ghoshhajra{at}yahoo.com)
Background: Since its inception in 1972, CT scanning has revolutionized the practice of medicine. CT exams now account for 15% of all radiologic examinations, yet contribute 60-70% of overall medical ionizing radiation dose. In the era of BEIR VII (Committee on the Biological Effects of Ionizing Radiations) and the principles of ALARA (doses As Low As Reasonably Achievable), CT dose plays an increasingly important role in the practice of radiology. The advent of clinical 64-slice multidetector CT (64-MDCT) requires that the radiologist have a fundamental understanding of MDCT physics in order obtain increased diagnostic information while minimizing radiation dose.
Key Issues: The exhibit will briefly review the concepts of basic radiation dose (i.e. exposure, dose, effective dose, and effective dose equivalent) and emphasize CT and MDCT radiation dose determination (kVp, mAs, pitch, CTDI, MSAD, DLP). Factors affecting image quality will be discussed (signal-to-noise, slice thickness, reconstruction interval, patient size). Technical parameters that can reduce dose will be explained (dose modulation software, beam energy, pitch). Finally, typical doses for routine protocols at our institution will be compared using 4-slice MDCT and 64-slice MDCT to illustrate the concepts of CT dose as related to volumetric MDCT.
Format: The format will be didactic. A short quiz to test the key points needed to understand MDCT dose will be included.
Teaching Points: 1. The viewer will review the basic physics behind radiation dose and CT dose determinants. 2. The viewer will gain an understanding of the tradeoffs and parameters that determine CT dose and image quality. 3. The viewer will understand the doses typical doses involved in 64-slice MDCT and be able to compare doses to single-slice and 4-slice MDCT.
E081. Simple Semi-automated 3DCT Reconstruction Protocols for Abdominal Viscera at 16-MDCT Scanner Console—A Time-Saving and Cost-Effective Approach Improving Workflow
Singh A.H.1; Sahani D.V.1; Joshi M.2; Mueller P.R.1; 1. Abdominal Imaging, Massachusetts General Hospital, Boston, MA; 2. CT Engineering, GE Healthcare, Belmont, MA.
Address correspondence to A.H. Singh (dranandsingh{at}yahoo.com)
Background: Three-dimensional CT is now considered an integral part of imaging for pre-operative planning of abdominal viscera. However, generation of reconstructed 3D images requires an expensive setup like a dedicated 3D workstation and trained technologists. Also the process of image transfer from the scanner, and the image generation by the technologist at the 3D workstation delays the needy availability of these images to the radiologist for interpretation which can vary from several hours to days depending on the workload and the efficiency of these 3D workstations in image generation.
Key Issues: The exhibit outlines a simple post processing method utilizing the capabilities of 16-MDCT-scanner console wherein such images are produced by organ specific semi-automated protocols in few minutes. By using the volume viewer of the 16 slice MDCT console and the thin sections of source CT data for the region of interest, stacks of images along the desired axis of the organ were planned and stored at the console as a protocol for organ reconstruction. The images of desired algorithm like thick slab and thin slab, maximum and minimum intensity projections (MIP&MinIP) were incorporated in the protocol plan along with various desired oblique angles and rotational view.
Format: In this didactic format exhibit we exemplify the value of high quality and fast 3D reconstruction techniques for pre-operative planning of liver, pancreas and kidneys using preset protocols.
Teaching Points: To emphasize the need for simple, cost-effective CT image post processing due to limitations posed by advanced 3D workstations. To illustrate the capabilities of 16 slice MDCT-scanner console for production of desired organ specific 3D images and angiography through semi-automated protocols. To understand the efficacy of this method with its impact on workflow.
E082. CT, MR & DF Field-Trial Examples Analyzed and With Properties Accurately Measured by the De-convolution Technique
Chui S.L.2; Chui K.M.1; Stanfield D.B. 1; 1. Research & Development, Image Enhancement Technology, Uxbridge, United Kingdom; 2. Radiology, Alexandra Hospital, Redditch, United Kingdom.
Address correspondence to K.M. Chui (ming-chui{at}iet.org.uk)
Objective: A new post processing De-Convolution Technique was used to identify image edges to sub-pixel accuracy and to subsequently enhance them without any increase in noise. CT, MR & DF images obtained from field trials were analyzed with this technique. Properties such as width (distance), area, volume and intensity of a liver tumor, tear of a meniscus and dimensions of a stenosed artery were accurately measured.
Materials and Methods: (1) CT acquisition from Spiral Philips Tomoscan AV at 120 KVp; 200 mA; 1 second/slice; Slice-thickness = 10 mm; (2) MR acquisition from Siemens Symphony 1.5T Scanner with Gradient Echo Sequence (TE:26 ms; TR:1,160 ms: Slice-thickness:3.5 mm) were used for the studies; and, (3) Digital Fluorograph (DF) using Siemens AXIOM Artis. Technique factors/properties: 110 mA at 66kVp; Exposure time, 8 ms. Focal spot, 0.6 mm. A 035 J guide wire was inserted into the artery. Iodine contrast was injected via a femoral artery sheath. A Region of Interest (ROI) was centered onto the effect(s); magnified by 7x, 5x, & 7x respectively. The edge positions were located by the software and enhanced. The edge profiles of the effects were outlined to form enclosures for the measurements of properties in (1) & (2), and percentage diameter of stenosis in artery in (3).
Results: Examples: (1) CT Liver Tumor of a 79 year old female patient: ROI was magnified 7x. Measurements within tumor enclosure: Area = 88.56±1.96 mm2; Volume = AreaSlice-thickness = 885.61±19.55 mm3; Intensity = 88 CTU; Std = 14CTU. Intensity in the surrounding tissues outside of tumor = 112 CTU; Std = 16 CTU. (2) MR Knee Tear of a 56-year-old male patient: ROI was magnified 5x. Measurements of tear enclosure: Length of Tear = 16.07±0.01 mm; Maximum Width = 2.29±0.01 mm; Minimum Width = 1.37±0.01 mm; Area = 20.68±0.57 mm2; and Volume = 72.38±1.98 mm3; and (3) Absolute measurements in DF in patient: ROI was magnified 7x and enhanced. Diameter of wire = 2.29±0.02 pixels (= 0.89 mm). Normal patient vessel lumen diameter = 13.29±0.02 pixels => 5.17±0.01 mm. Stenosed vessel lumen diameter = (13.29-5.29)±0.02 pixels => 3.11±0.01 mm. Percentage diameter stenosis of superficial femoral artery = 60.15±0.80%
Conclusion: The edge profile and enhancement and the sensitive and accurate measurements of properties have potential in radiological diagnosis, oncological treatment response monitoring, surgery, and radiotherapy treatment planning.
E083. Radiology Health Failure Mode and Effect Analysis
Abujudeh H.; Asfaw B.; Palumbo D.; Thrall J.; Radiology, MGH, Boston, MA.
Address correspondence to H. Abujudeh (habujudeh{at}partners.org)
Background: The Health Failure Mode and Effect Analysis (HFMEA) is more relevant in this era of increasing awareness of quality and safety in medicine. Radiology is being increasingly challenged to provide strategic plans to deliver high quality and safe imaging services. Radiology HFMEA (R-HFMEA) is one way with which radiology can meet some of those challenges. The purpose of this exhibit is to provide a guide to radiology practitioners on how to perform a R-HFMEA.
Key Issues: Accurate knowledge of the evolving R-HFMEA and the impact is has on patient care. Definitions of various R-HFMEA terms such as failure mode, effective control measure, hazard analysis, and hazard score. The background information about the origin, and relative merits of the parameters currently in use will be discussed. The complex interplay of various radiology and patient-related factors on the probability of occurrence of a failure point will be discussed. Discussion of topics such as assembling a team, brainstorming failure modes, identifying and refining failure modes, conducting a hazard analysis, determining the possible causes of a failure mode, action and outcome measures, and the final report. Schematic diagrams are provided for clarification of the complex R-HFMEA principles.
Format: Didactic.
Teaching Points: 1. To discuss and familiarize radiology practitioners with R-HFMEA and the value it brings to patient care. 2. To demonstrate several key point on how to conduct a successful R-HFMEA. 3. To reach and maintain R-HFMEA objectives.
E084. Introduction to Radiology Communicating Critical Test Results: The Time Has Come!
Abujudeh H.; Radiology, MGH, Boston, MA.
Address correspondence to H. Abujudeh (habujudeh{at}partners.org)
Background: Communicating Critical Test Results (CCTR) is a patient safety initiative. The JCAHO requires that facilities have a process in place to guide communication of such results. Laboratory critical results have made significant strides to meet those goals. The term "critical test results" also applies to imaging studies. The JCAHO future goals include Radiology CCTR (R-CCTR). The purpose of this exhibit is to introduce radiologists to R-CCTR.
Key Issues: This exhibit will discuss the background information about the origin of CCTR. The role of JCAHO and the national goals for improving communication among care givers. Issues that pertain to radiology will be discussed such as who should receive the report, what results and what time frames should be considered, sequential notification, reliability of the communication systems, and support and maintaining the systems. The radiologist role as a licensed caregiver will be discussed.
Format: Didactic.
Teaching Points: To discuss and familiarize radiologists with R-CCTR, its current and future status.
E085. A Free, Multilingual and Interactive Radiology Publication-, Communication- and Teaching Platform in the Internet
Talanow R.; Radiology, Cleveland Clinic Foundation, Cleveland, OH.
Address correspondence to R. Talanow (roland{at}talanow.info)
Background: There are only a few pediatric radiology platforms in the internet, which are either not available for free or at all times, don't allow exchange of radiological knowledge in an open discussion, or which don't own their own databases. We created PedRad.info as an open-source, case-oriented publication and teaching platform.
Key Issues: PedRad.info is currently suited for teaching purposes in Pediatric Radiology but can easily be adapted by other radiological subspecialties. PedRad.info is running on a 1.1 GHz Pentium processor with Linux as operating system and Apache as web-server. The scripting languages include PERL, JAVA, Javascript and DHTML. The images are stored in subdirectories and the information stored in text files on the server. This program is freely available over the Internet. Minimum requirements for the user is a common Internet browser and a 28.8 KB modem.
Format: PedRad.info is divided into four areas, the author's area, user's area, educational area and interactive communication area. The author's area offers a easy-to-use and fast case submission system. After peer-reviewing the cases are automatically integrated in this project and presented in different modes for teaching purposes. The platform and cases are available in a multilingual format for a broader, world-wide audience. In the user's area the user may view cases of all appropriate articles in summation using the search option. The search function corresponds to the functionality of well-known search engines like www.google.com. Additionally, a systematized search for criteria like "Organ/Region" and "Pathogenesis" is possible. The educational area presents cases to the user in various ways for the purpose of continuing education and knowledge acquisition. The interactive communication area presents unclear cases and questions to existing casuistics which appear automatically following the case and in the general discussion forum.
Teaching Points: To create an open-source case-oriented publication and teaching platform in the Internet with an easy-to-use case submission system, publish peer reviewedradiology cases, exchange radiological knowledge in an open discussion, available free of charge, everywhere and at all times for laypersons, students and professionals, multilingual for a world wide audience. Teaching will be provided in multiple ways by offering cases without initial diagnosis, multiple choice quizzes, direct selection from a variety of menus and interactive knowledge exchange in discussion forums.
E086. Radiologyteacher (www.Radiologyteacher.com) - An Internet Based, Individualized and Free of Charge Radiology Teaching File Server for Creating Interactive Radiological Teaching Files and Presentations
Talanow R.; Radiology, Cleveland Clinic Foundation, Cleveland, OH.
Address correspondence to R. Talanow (roland{at}talanow.info)
Background: At this time there is no program available which creates interactive teaching files in real-time, is user tailored, accessible from every computer worldwide and free of charge.
Key Issues: We developed the online program RadiologyTeacher, which allows the user to create interactive teaching files for presentations and teaching purposes. It is available over the internet and accessible worldwide from every computer with internet connection. We made this program easily usable even for authors who are and are not well computer experienced. The special effects for enhancing the learning experience as well as the linking and the source code are created automatically by the program. The created website is immediately available worldwide over the internet. The author can change the teaching files at any time and the changes will be done on-the-fly. There is no need for a file transfer after each change. The program can be tailored for the individual author's needs.
Format: RadiologyTeacher is divided into seven areas: the case edit, image edit, annotation edit, quiz edit, presentation edit, preferences and viewing areas. The case edit area allows the author to create, edit and delete cases and save and delete their images with description. The program offers the author a variety of predefined and user-defined fields and categories. The image edit area allows the author to make individual changes on the images to enhance their appearance. The annotation edit area allows users to create image annotations by crosslinking to the program Annotate. In the quiz edit area the author may create quizzes for the individual cases. The presentation edit area allows users to create complex presentations from individual cases. The preferences area offers a variety of program functions (over 50) to individualize the editor and viewing section for the author and the users. The viewing area presents the individual cases or presentations to the users.
Teaching Points: RadiologyTeacher was developed for creating and changing interactive teaching files and presentations in real-time. It is available anytime and anywhere, free of charge, user tailored and easy to use. There are no programming skills and no additional program file downloads needed. It may be used in different modes by individuals and institutions to share cases of multiple authors in a single database. RadiologyTeacher is an easy to use automatic teaching file program which may enhance the user's learning experience by offering different modes of user-defined presentations.
E087. Referring Physician Attitudes Toward Offshore Interpretation of Radiologic Images
Lester N.A.1; Durazzo T.1; Kaye A.; Kaye A.2; Ahl M.; Forman H.P.1; 1. Diagnostic Radiology, Yale University School of Medicine, New Haven, CT; 2. Diagnostic Radiology, Bridgeport Hospital, Bridgeport, CT.
Address correspondence to N.A. Lester (neil.lester{at}yale.edu)
Objective: We evaluated referring physician attitudes toward international interpretation of radiologic images.
Materials and Methods: A five-question, scenario-based survey describing features of a local radiology firm compared with those of its overseas counterpart, international radiology, was sent by mail to 350 physicians from a broad range of medical and surgical specialties. Referring physicians were asked to indicate preference for local versus international in each scenario using a 5-point Likert scale, with "-2" indicating strong preference for international services, "0" indicating no preference, and "+2" indicating strong preference for local.
Results: All variables held equal, referring physicians strongly prefer local services (Mean = 1.77, S.D. = 0.77). When international provides either a one day faster turnaround time for reports or a $30 lower out-of-pocket cost to the patient, referring physicians still prefer local services, although less than they did with all variables held equal (Mean = 0.42-0.44, S.D. = 1.30 1.40). When international provides both a one day faster turnaround time and a $30 lower out-of pocket cost to the patient, referring physicians preferred international, albeit only slightly (Mean = -0.25, S.D. = 1.50). Finally, when the credentials of the international radiologists are perceived to be less than those of the local radiologists, even in the face of faster turnaround time and $30 lower cost to the patient, referring physicians overall strongly prefer local services (Mean = 1.51, S.D. = 0.86).
Conclusion: Referring physicians prefer local interpretation of radiologic images to international interpretation, all things equal. However, timeliness of image interpretation and cost to patient are important factors in this decision.
E088. So You Want To Be an Inventor?
Vining D.J.; Department of Radiology, University of Maryland Medical, Baltimore, MD.
Address correspondence to D.J. Vining (dvining{at}umm.edu)
Background: Radiologists are often creative and ingenious people with novel ideas for new products and improvements to existing technologies. In order to protect the commercial value of such discoveries, one must patent their intellectual property - a task that is fraught with hidden pitfalls for the uninitiated.
Key Issues: This exhibit outlines the steps necessary to successfully obtain a new patent, including initial disclosure, retaining competent legal counsel, researching prior art, writing a broad-reaching application, navigating through the maze of U.S. Patent and Trademark Office procedures, and prosecuting a patent after it issues.
Format: Educational poster describing the U.S. Patent process.
Teaching Points: Comprehend the steps necessary to successfully obtain a U.S. Patent: 1. Initial disclosure 2. Retaining competent legal counsel 3. Researching prior art 4. Writing a broad-reaching application 5. Navigating the maze of U.S. Patent and Trademark Office procedures 6. Prosecuting a patent after it issues.
E089. Why Did the Radiologist Get Sued? A Review of the Torts Most Commonly Encountered in Radiology
Laing G.; Dalrymple N.C.; Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX.
Address correspondence to G. Laing (glaing1{at}satx.rr.com)
Background: Most residency curricula lack formal preparation for navigating the often treacherous medico-legal environment that may be encountered in radiology as it is practiced in the United States. While tort reform may lie on the horizon, the radiology trainee will benefit from advanced knowledge of common medico-legal pitfalls and suggestions for how to avoid them.
Key Issues: We present an interactive learning module intended to introduce residents of all levels to the more common torts encountered in the practice of radiology. A systematic approach to malpractice claims was obtained from the annual Risk Management Review of Malpractice Claims assembled by the Physician Insurers Association of America. Topics include claims listed by most prevalent medical misadventures, claims listed by most prevalent medical conditions, comparative specialty data, and claims listed by severity of patient injury. An interactive quiz format provides a self-paced introduction to this critical topic that affects both academic and private practice radiologists. Developing a practice of regular risk management review may help to prevent future medical legal claims.
Format: The exhibit is in an interactive quiz created using Microsoft PowerPoint including hyperlinks embedded in presentation slides. The examinee is presented a series of multiple choice questions. After selecting each intended answer, the participant is given a brief synopsis of the medico legal concept. Completing the questions and exploring the links provides a review of basic risk management and preventive strategies pertinent to radiology.
Teaching Points: 1. Review the most common causes of malpractice claims against radiologists. 2. Consider preventive strategies that may help the radiologist decrease risk of future claims. 3. Risk management review can be integrated into resident training and should become a regular part of career-long practice improvement.
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