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Current Problems in Diagnostic Radiology

Karen Tran-Harding, Qiuying Shi, Richard Gibbs, Margaret Szabunio, Xiaoqin Wang
Breast Conserving Therapy (BCS) or lumpectomy has been an established treatment option for women with early-stage invasive breast cancers. Surgical margin status has a significant impact on local recurrence. However, there is much complexity in achieving a negative lumpectomy margin. There are multiple risks and predictors of positive surgical margins that the radiologist needs to be familiar with. When working as a member of a multidisciplinary team, it is important to be cognizant of the pathologist's and surgeon's roles in reducing the number of failed breast conserving surgeries...
October 10, 2018: Current Problems in Diagnostic Radiology
Kevin Spitler, Arvind Vijayasarathi, Banafsheh Salehi, Sumit Dua, Avetis Azizyan, Milos Cekic, Nazanin Yaghmai, Ronald Homer, Noriko Salamon
PURPOSE: To quantitatively and qualitatively assess the impact of attending neuroradiology coverage on radiology resident perceptions of the on-call experience, referring physician satisfaction, and final report turnaround times. MATERIALS AND METHODS: 24/7/365 attending neuroradiologist coverage began in October 2016 at our institution. In March 2017, an online survey of referring physicians, (emergency medicine, neurosurgery, and stroke neurology) and radiology residents was administered at a large academic medical center...
October 9, 2018: Current Problems in Diagnostic Radiology
Lane F Donnelly, Robert Grzeszczuk, Carolina V Guimaraes, Wei Zhang, George S Bisset Iii
PURPOSE: To use a natural language processing and machine learning algorithm to evaluate inter-radiologist report variation and compare variation between radiologists using highly structured versus more free text reporting. MATERIALS AND METHODS: 28,615 radiology reports were analyzed for 4 metrics: verbosity, observational terms only, unwarranted negative findings, and repeated language in different sections. Radiology reports for two imaging examinations were analyzed and compared - one which was more templated (ultrasound - appendicitis) and one which relied on more free text (chest radiograph - single view)...
October 9, 2018: Current Problems in Diagnostic Radiology
Neetu Soni, Sunil Kumar, Karthika Srindharan, Prabhakar Mishra, Nishant Gupta, Girish Bathla, Jyantee Kalita, Sanjay Behari
PURPOSE: To differentiate intra-axial tuberculomas (TB) from metastases based on quantitative differences in the perfusion and diffusion indices of lesion and perilesional edema using arterial spin labeling (ASL) and diffusion tensor imaging (DTI) techniques. MATERIALS AND METHODS: This prospective study included newly diagnosed untreated 12 patients of TB and 13 of metastases who underwent routine magnetic resonance imaging including DTI and ASL sequences. A region of interest analysis was performed and cerebral blood flow (CBF) values of lesion (L), perilesional edema (PE), and normal contralateral white matter (CWM) were calculated...
October 9, 2018: Current Problems in Diagnostic Radiology
Meir H Scheinfeld, Oleg Kaplun, Neville A Simmons, Jonathan Sterman, Shlomit Goldberg-Stein
Reliable transmission of ultrasound measurements into radiology reports is fraught with potential sources of error. In a conventional workflow, measurements are either written by hand on worksheets and/or dictated from worksheets or the images themselves into the radiology report. Valuable physician time is spent dictating, checking, and editing these values and this process is error-prone. Our approach was to use a transfer-software application to auto-populate measurements, with a goal of achieving >90% utilization rate by both technologists and radiologists...
October 7, 2018: Current Problems in Diagnostic Radiology
Jens Borgbjerg
Recent developments in web technology allow pixel-level manipulation of radiologic images. This paper presents an easily accessible imaging viewer for visualization of volumetric datasets which leverages modern web technology. The viewer is designed to enable on-the-fly multiplanar reconstructions with different projectional techniques, and these can be manipulated as in a Picture Archiving and Communication System. The application opens up possibilities for teaching and demonstrational purposes. Step-by-step instructions for how to use are provided and the source code is made available...
September 19, 2018: Current Problems in Diagnostic Radiology
Nicholas C Cleveland, Don N Nguyen, Kanika Goel, Cassie D Tran, Jeffrey S Mueller
Paragangliomas are extra-adrenal tumors that are derived from neuroendocrine chromaffin cells. The rare disease has a variable presentation depending upon its anatomic location and functionality. We describe the case of a 56-year-old female patient who had an incidental mass found on imaging. The patient underwent biochemical testing and a mediastinal biopsy due to the nonspecific imaging findings. The mediastinal mass was resected through hemisternotomy and found to be a functional paraganglioma. This case highlights the importance of radiologists to consider the prospect of paragangliomas in the differential diagnosis of an intra-thoracic mass...
September 11, 2018: Current Problems in Diagnostic Radiology
Jeffrey P Guenette, Charles H Cho, Raymond Y Huang, Nityanand Miskin, Varand Ghazikhanian, Thomas C Lee
OBJECTIVE: Determine computed tomography-guided percutaneous spine biopsy specimen adequacy, pathology-imaging concordance, and negative predictive value with battery-powered drill vs manual approach. MATERIALS AND METHODS: One-hundred-fourteen consecutive computed tomography-guided percutaneous spine biopsies in 109 patients (age: 61.1 ± 15.4 years; range: 17-90 years; males: 55, 50.5%; females: 54, 49.5%) performed at a single institution from September 2013 through January 2017 were retrospectively reviewed...
September 4, 2018: Current Problems in Diagnostic Radiology
Michael J Drabkin, Jeffrey Donaldson, Joshua Fogel, Junjian Huang, Andrew Klobuka, Mohammed Faisal Loya, Marwan Moussa, Karan Patel, Alexander Misono
PURPOSE: To identify factors associated with radiologist donations to radiology political action committees (PACs). MATERIALS AND METHODS: A survey was emailed to 4474 radiologists. Factors investigated include demographics, donor history, and knowledge of the federal advocacy process. Logistic regression analysis was performed to determine factors associated with donor behavior. RESULTS: In total, 336 radiologists completed the survey. Overall, 152 (46...
September 1, 2018: Current Problems in Diagnostic Radiology
Fernanda Del Campo Braojos, Lane F Donnelly
Because of issues with the previous staging system, the International Neuroblastoma Risk Group Staging System (INRG-SS) was created in 2009. The INRG-SS is based on preoperative imaging, rather than surgical, staging and emphasizes Imaging-Defined Risk Factors as the determining factors between L1 and L2 stages. Like with the introduction of any new tool, based on the authors' experience, there has been a time-lag related to adoption of the INRG-SS staging system by radiologists. This pictorial essay offers a practical approach to learning and utilizing the INRG system, emphasizing use of the descriptive terms which determine the presence or absence of imaging-defined risk factors...
September 1, 2018: Current Problems in Diagnostic Radiology
Jason Messinger, Stacey Crawford, Lane Roland, Sarah Mizuguchi
Interval breast cancers are those detected in the interim between regular screening examinations and are an unfortunate reality for breast cancer screening programs. However, their incidence can help gauge the success of breast cancer screening programs. There are four main categories of interval cancers, including true negative, false negative, minimal sign, and occult. The mammographic characteristics of each type of interval cancer are reviewed with example cases from an urban academic institution. Pitfalls and strategies to reduce interval cancers are discussed in detail...
September 1, 2018: Current Problems in Diagnostic Radiology
Jose M Net, Gary J Whitman, Elizabteh Morris, Kathleen R Brandt, Elizabeth S Burnside, Maryellen L Giger, Marie Ganott, Elizabeth J Sutton, Margarita L Zuley, Arvind Rao
PURPOSE: The purpose of this study was to investigate if human-extracted MRI tumor phenotypes of breast cancer could predict receptor status and tumor molecular subtype using MRIs from The Cancer Genome Atlas project. MATERIALS AND METHODS: Our retrospective interpretation study utilized the analysis of HIPAA-compliant breast MRI data from The Cancer Imaging Archive. One hundred and seven preoperative breast MRIs of biopsy proven invasive breast cancers were analyzed by 3 fellowship-trained breast-imaging radiologists...
August 23, 2018: Current Problems in Diagnostic Radiology
Hina Arif-Tiwari, Christian O Twiss, Frank C Lin, Joel T Funk, Srinivasan Vedantham, Diego R Martin, Bobby T Kalb
PURPOSE: To evaluate the utility of a defecography phase (DP) sequence in dynamic pelvic floor MRI (DPMRI), in comparison to DPMRI utilizing only non-defecography Valsalva maneuvers (VM). MATERIALS AND METHODS: Inclusion criteria identified 237 female patients with symptoms and/or physical exam findings of pelvic floor prolapse. All DPMRI exams were obtained following insertion of ultrasound gel into the rectum and vagina. Steady-state free-precession sequences in sagittal plane were acquired in the resting state, followed by dynamic cine acquisitions during VM and DP...
August 23, 2018: Current Problems in Diagnostic Radiology
Wonsuk Kim, Jack A Porrino, Kenneth A Hood, Tyson S Chadaz, Andrea S Klauser, Mihra S Taljanovic
We provide a comprehensive review of the clinical presentation, imaging evaluation, classification, and management of adolescent idiopathic and adult degenerative scoliosis.
August 23, 2018: Current Problems in Diagnostic Radiology
Muhammad U Aziz, Michael K Hall, Josephine Pressacco, Jeffrey H Maki
No abstract text is available yet for this article.
August 22, 2018: Current Problems in Diagnostic Radiology
Bridgette E McCabe, Clinton A Veselis, Igor Goykhman, John Hochhold, Daniel Eisenberg, Hongju Son
Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events...
August 17, 2018: Current Problems in Diagnostic Radiology
David Sadowsky, Tianyang Li, Usama Hasan, Christopher Harnain, Anthony Gilet, Perry Gerard
The Medicare Access and CHIP Reauthorization Act of 2015 was signed into law on April 16, 2015, fundamentally altering the way clinicians are reimbursed for the treatment of Medicare patients starting in 2017. Under this new pay-for-performance model, reimbursement will be tied to multiple metrics related to quality and cost of care. A scaled scoring system will require providers to compete for positive reimbursement adjustments, while also penalizing poor performers with negative adjustments. A firm understanding of this new system will be essential for all physicians looking to maximize their reimbursement, particularly diagnostic radiologists and members of other highly focused fields where special considerations lead to alterations in the scoring system...
January 2019: Current Problems in Diagnostic Radiology
Jonathan Wu, Lipika Goyal, Ryan Nipp, Jennifer Wo, Motaz Qadan, Raul N Uppot
OBJECTIVE: The purpose of this article is to review tumor staging systems for gastrointestinal tumors including pancreatic adenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, gastric adenocarcinoma, small bowel adenocarcinoma, rectal carcinoma, and anal carcinoma and identify the key imaging findings ("tipping points"), which change patient management based on changes in tumor staging. CONCLUSION: For all malignant gastrointestinal tumors, there are key imaging findings ("tipping points") including tumor size, tumor extension, lymphadenopathy, vascular invasion, and distant metastasis that dictate patient management and prognosis, based on changes in tumor stage...
January 2019: Current Problems in Diagnostic Radiology
Anuradha Singh, Ashu Seith Bhalla, Manisha Jana
BACKGROUND: Bronchiectasis is one of the causes of non-resolving, persistent or recurrent pulmonary infection which, if uncorrected may have deleterious consequences on the lung parenchyma and pulmonary circulation. High-resolution computed tomography (HRCT) is needed for the confirmation, localization and directing management accordingly. CONTENTS: Bronchiectasis is one of the major cause of morbidity worldwide. Chest radiograph is done at the initial suspicion which is supplemented by HRCT to confirm the diagnosis...
January 2019: Current Problems in Diagnostic Radiology
Courtney C Moreno, Thomas Jarrett, Brianna L Vey, Pardeep K Mittal, Elizabeth A Krupinski, David L Roberts
AIMS: To assess patient knowledge about colorectal cancer incidence and prognosis as well as willingness to undergo screening with various tests (eg, optical colonoscopy, stool-based tests, computed tomographic colonography (CTC)). MATERIALS AND METHODS: A survey was administered to consecutive patients of a general academic-based internal medicine clinic. RESULTS: Survey response rate was 86.3%. A majority of respondents (55%) reported being aware of general information about colorectal cancer, and 99% indicated a belief that colorectal cancer screening was a good idea...
January 2019: Current Problems in Diagnostic Radiology
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