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Current Problems in Diagnostic Radiology

Bilal Mujtaba, Sameh M Nassar, Rizwan Aslam, Naveen Garg, John E Madewell, Ahmed Taher, Abdelrahman K Hanafy, Gary Whitman
Extraskeletal osteosarcoma are rare malignant mesenchymal neoplasms of soft tissues representing around 1% of all soft tissue. The exact mechanism of tumorigenesis of primary breast osteosarcoma is still unclear. However, most of the cases develop without a recognized etiologic factor. Primary osteosarcoma of the breast is often initially misdiagnosed as breast fibroadenoma. Different imaging modalities and pathology play important role in differentiating breast osteosarcoma from other benign and malignant lesions of the breast resulting in dramatic change in the management...
January 3, 2019: Current Problems in Diagnostic Radiology
David Fessell
No abstract text is available yet for this article.
January 3, 2019: Current Problems in Diagnostic Radiology
Shakunthala Revannagowda, Kiran Gangadhar, Gensuke Akaike, Manjiri Dighe
Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumor are part of a spectrum of neoplastic diseases known as the ES family of tumors, which also includes extraosseous ES, peripheral primitive neuroectodermal tumor, malignant small-cell tumor of the thoracopulmonary region (Askin's tumor), and atypical ES. Although imaging features of these tumors have been previously described, extensive discussion about intra-abdominal manifestations is scarce in the literature. We present an imaging spectrum of these tumors in the abdomen and pelvis with particular attention to multimodality approach for staging and restaging...
January 2, 2019: Current Problems in Diagnostic Radiology
Adam Daniel Singer, Yara Younan, Vandad Saadat, Monica Umpierrez, Vita Kesner, Nicholas Boulis, Felix Gonzalez, Ty K Subhawong
BACKGROUND AND PURPOSE: Chronic pain is a common problem and imaging is becoming increasingly utilized in the characterization of peripheral neuropathy, although this topic is not emphasized during medical training. We hypothesized that an electronic module and nerve atlas would be effective in improving comprehension among trainees. MATERIALS AND METHODS: In this IRB-approved study, a training module was created that included a side-by-side comparison of normal upper extremity nerves on magnetic resonance imaging and ultrasound (US), with embedded questions and cases, followed by a brief hands-on US scanning session...
January 2, 2019: Current Problems in Diagnostic Radiology
Spencer B Lewis, Ravi N Srinivasa, Prasad R Shankar, Jacob J Bundy, Joseph J Gemmete, Jeffrey Forris Beecham Chick
PURPOSE: To quantify cost drivers for thoracic duct embolization based on time-driven activity-based costing methods. MATERIALS AND METHODS: This was an Institutional Review Board-approved (HUM00141114) and Health Insurance Portability and Accountability Act-compliant study performed at a quaternary care institution over a 14-month period. After process maps for thoracic duct embolization were prepared, staff practical capacity rates and consumable equipment costs were analyzed via a time-driven activity-based costing methodology...
December 18, 2018: Current Problems in Diagnostic Radiology
Sheila Boateng, Nikki Tirada, Gauri Khorjekar, Stephanie Richards, Olga Ioffe
There is an enduring dilemma on the appropriate management of high-risk breast lesions; is surgical excision always warranted or can conservative management be utilized? We present cases of high-risk breast lesions diagnosed at core needle biopsy at our institution along with relevant factors to consider for appropriate management. We conclude that a nuanced approach is warranted over the broad stroke approach of surgical excision of all high-risk breast lesions.
December 18, 2018: Current Problems in Diagnostic Radiology
Nicole Restauri, Eric Nyberg, Toshimasa Clark
The socioeconomic dynamics of the current healthcare system can challenge physicians to remain engaged with meaningful work, which is problematic given its role in mitigating burnout. In Man's Search For Meaning, Victor Frankl proposes that meaningful work is a prerequisite for a meaningful life. This article provides a road map for radiologists by applying key guiding principles outlined by Frankl as they intersect with current evidence in the field of physician burnout.
December 8, 2018: Current Problems in Diagnostic Radiology
Cory M Pfeifer
No abstract text is available yet for this article.
December 7, 2018: Current Problems in Diagnostic Radiology
Creighton Lewis, Nicole Restauri, Toshimasa Clark
Radiologists experience higher than average rates of burnout. Contributing factors include job tedium, a lack of a sense of autonomy, and decreasing compensation in the context of practices closely monitoring relative value unit output. Increasing radiologist efficiency may be a strategy for mitigating burnout, as freeing up time may allow radiologists to focus their attention on the aspects of their job that they enjoy and find most meaningful. In this work we propose several strategies of distraction minimization and time optimization that radiologists may employ to increase their efficiency...
December 7, 2018: Current Problems in Diagnostic Radiology
Thomas R Mulvey, Xiangyang Tang, Elizabeth A Krupinski, Pardeep K Mittal, Courtney C Moreno
PURPOSE: To determine the incidence and impact of overlying radiopaque personal items (e.g., cellular phones, zippers) on CT dose and image quality with use of automated tube current modulation. METHODS: Topogram images from 100 consecutive adult outpatient CT abdomen pelvis studies were retrospectively reviewed, and the number and type of overlying radiopaque personal items were recorded. Additionally, an anthropomorphic phantom was imaged with overlying personal items 1) present in topogram and axial images; 2) present in topogram but removed prior to axial acquisition; and 3) present in topogram positioned outside the field of view of the axial acquisition...
November 2, 2018: Current Problems in Diagnostic Radiology
Brigid A Bingham, Steven Y Huang, Pamela L Chien, Joe E Ensor, Sanjay Gupta
BACKGROUND: To evaluate the significance of aspirin, as well as, other potential confounding risk factors, on the incidence and volume of pulmonary hemorrhage in patients undergoing percutaneous computed tomography-guided lung biopsy. METHODS: This retrospective study was approved by the institutional review board. Between September 2013 and December 2014, 252 patients taking aspirin underwent transthoracic computed tomography-guided lung biopsy. Patient, technical, and lesion-related risk factors were evaluated...
November 2, 2018: Current Problems in Diagnostic Radiology
Andrew J Degnan, Paul H Yi, Nathan Kim, John Swietlik, Eric Huh, Jie C Nguyen
INTRODUCTION: Nonradiologist providers increasingly perform diagnostic imaging examinations and imaging-guided interventions traditionally performed by radiologists, which have raised concerns regarding appropriate utilization and self-referral. The purpose of this study was to assess the contribution of imaging studies to Medicare reimbursements for highly compensated nonradiologist providers in specialties often performing imaging studies. METHODS: The Medicare Provider Utilization and Payment Database was queried for provider information regarding overall reimbursement for providers in anesthesiology, cardiology, emergency medicine, neurology, obstetrics and gynecology, orthopedic surgery, neurology, and vascular surgery...
November 2, 2018: Current Problems in Diagnostic Radiology
Christian A Barrera, Hansel J Otero, Ammie M White, David Saul, David M Biko
PURPOSE: Evaluate the feasibility and determinants of image quality of ECG-triggered High-Pitch Dual-Source Computed Tomography Angiography (CTA) for cardiovascular assessment in Children. MATERIAL AND METHODS: All children that underwent ECG-triggered High-Pitch Dual-Source CTA between August 2014 and September 2017 were identified. Scanner parameters and patients' information were retrieved. Objective image quality was evaluated measuring the Hounsfield units (HU) and standard deviation of regions of interests in the left ventricle, ascending and descending aorta...
October 29, 2018: Current Problems in Diagnostic Radiology
Barun Bagga, Atin Kumar, Anurag Chahal, Shivanand Gamanagatti, Subodh Kumar
Airway Injuries are rare but often immediately life threatening. Incidence ranges from 0.5-2 % in blunt and 1-6 % in penetrating trauma. Upper airway injuries (UAI) are often clinically apparent and get shunted during the primary survey in the emergency department. Few UAI and majority of lower airway injuries (LAI) are occult on primary survey and need a high suspicion index. Clinically, the diagnosis of tracheobronchial injury is delayed in many patients because the airway column is maintained by the peribronchial tissue...
October 29, 2018: Current Problems in Diagnostic Radiology
Peeyush Bhargava, Guillermo Sangster, Kabiul Haque, John Garrett, Maren Donato, Horacio D'Agostino
Adrenal tumors are very commonly encountered in the practice of radiology. They may arise from the adrenal gland itself, either the cortex or the medulla, or they could be secondary lesions. They may be benign or malignant. The functioning adrenal tumors lead to hypersecretion of adrenal hormones leading to clinical syndromes. Computed tomography is the most common imaging modality used for the initial evaluation of adrenal tumors. Magnetic resonance imaging and functional scintigraphic techniques are frequently used for atypical presentations or further evaluation...
October 25, 2018: Current Problems in Diagnostic Radiology
Nikkole M Weber, Chi Wan Koo, Lifeng Yu, Brian J Bartholmai, Ahmed F Halaweish, Cynthia H McCollough, Joel G Fletcher
OBJECTIVE: Chest computed tomography (CT) imaging enables detailed visualization of the pulmonary structures and diseases. This article reviews how continued innovation and improvements in modern CT system hardware and software now facilitate a wider range of image acquisition options and generate unique qualitative and quantitative information that can benefit patients RESULTS: Dual energy imaging utilizes two x-ray energies to highlight differences in tissue properties and increase iodine signal to improve diagnosis or reduce metal artifacts...
October 24, 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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