Gautham P Reddy

Seattle Children's Hospital, Seattle, Washington, United States

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Publications (142)264.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Patient safety is a priority for patients undergoing magnetic resonance imaging (MRI). This article reviews MRI safety issues related to devices, pharmacologic stress agents, contrast agents, anesthesia, and external equipment, focusing on cardiothoracic MRI.
    Journal of Thoracic Imaging 09/2014; 29(5):262-269. · 1.26 Impact Factor
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    ABSTRACT: PURPOSE/AIM 1. To discuss the spectrum of congenital cardiac conditions representing a functional single ventricle. 2. To describe the imaging of common operative therapies. 3. To describe the role of imaging in evaluation and management of a functional single ventricle. CONTENT ORGANIZATION 1.Overview a.Physiology b.Clinical presentation 2.Single Ventricle Anomalies a.Dominant Left Ventricle -Mitral valve atresia -Aortic atresia -Double inlet left ventricle -Unbalanced atrioventricular canal(AVC) -Hypoplastic right ventricle b.Dominant Right Ventricle -Hypoplastic left ventricle -Tricuspid atresia -Double inlet/outlet right ventricle -Unbalanced AVC 3.Operative procedures a.Three stage palliation b.Pre-operative evaluation c.Common surgical procedures -Norwood -Pulmonary artery banding -Bidirectional cavopulmonary anastomosis -Fontan -Conduits 4.Imaging modalities a.MRI b.CT c.Echo d.Angiography SUMMARY 1. Numerous cardiac anomalies present with single ventricle physiology. Knowledge of the underlying anatomy, physiology, and surgical interventions is necessary to effectively contribute to the complex evaluation of these disorders. 2. MRI, CT, and other imaging modalities can be utilized to evaluate the anatomy and functionality of single ventricle lesions and assist in management.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE To evaluate DTS as a diagnostic pulmonary angiographic modality and as a venographic method for assessment of DVT. METHOD AND MATERIALS Prospective digital tomosynthesis (DTS) examination of 12 healthy male volunteers was performed after injecting 100cc of iodinated contrast in the antecubital vein at 5cc/sec. Female subjects were excluded by design as inclusion would entail radiation exposure to the breast tissue without any added advantage. All scans were performed on Volume Rad (GE Healthcare, Waukesha, WI). Four radiologists reviewed studies and rated the quality of enhancement on a 3-point ordered scale for each branch level of pulmonary arteries as (1) non-diagnostic, (2) diagnostic for disease other than pulmonary embolism (PE), or (3) diagnostic for PE. Veins of the upper extremity on the injected side were scored as (1) non-diagnostic, (2) diagnostic for disease other than deep vein thrombosis (DVT), or (3) diagnostic for DVT. Inter-observer agreement was evaluated using weighted Cohen’s κ and linear weights. RESULTS Subject ages ranged from 19 to 55 years (median: 35 years). All pulmonary artery branches were rated as diagnostic for PE in 46% of readings, and diagnostic for disease other than pulmonary embolism in 92% of the readings. The enhancement of upper extremity veins was diagnostic for DVT in 77% of readings and diagnostic for disease other than DVT in 100%. Inter-observer agreement for pulmonary artery ratings was poor (k=0.05 (95% CI: -0.02, 0.12)). However, inter-observer agreement improved when diagnostic for vascular diseases other than PE and diagnostic for PE were grouped into a single category (k=0.13 (95% CI: -0.35, 0.56)). Agreement for the assessment of upper extremity veins was moderate (k=0.47 (95% CI: 0.32, 0.60). CONCLUSION DTS pulmonary angiography is feasible and may be diagnostic for non-PE vascular diseases. DTS may be a potential low dose alternative to CT venography and a quicker alternative to MR venography. Further study will be required to assess DTS in patients who have pulmonary vascular disease or DVT. CLINICAL RELEVANCE/APPLICATION DTS pulmonary angiography can be used to evaluate pulmonary vasculature. DTS venography is a potential new way of assessing upper extremity venous system.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE Measure sensitivity and specificity of digital tomosynthesis (DT), dual-energy radiography (DE), and conventional radiography (CXR), alone and in combination, for detection of pulmonary nodules and for determining actionability in an international, multi-institution, multi-reader study. METHOD AND MATERIALS This IRB-approved, HIPAA-compliant study enrolled 158 subjects (115 positive, 43 negative for CT-confirmed pulmonary nodules) at four tertiary care institutions. Subjects were imaged by chest CT, CXR (PA and lateral), DE, and DT on a flat-panel imaging device (VolumeRAD, GE Healthcare, Chalfont St. Giles, UK). Three experienced thoracic radiologists confirmed presence and location of nodule(s) by CT and determined their actionabilty using Fleishner Society guidelines. Five general radiologists, using free-response methodology and scoring on a 5-point likelihood scale, marked nodules and then determined actionablilty using CXR alone, CXR plus DE, DT alone, and DT plus DE (2193 total markings). Overall sensitivity, specificity, and JAFROC figure-of-merit (FOM; overall measure of observer performance) for various nodule size categories were determined using CT data as the reference standard. RESULTS 516 nodules (344 of 3-5 mm, 130 of >5-8 mm, and 42 of >8-20 mm) were identified by CT. Overall detection sensitivity was 3.8%, 5.7%, 13.5%, and 13.4% for CXR, CXR+DE, DT, and DT+DE, respectively, for all nodules (3-20 mm; n=516); and 9.0%, 13.5%, 27.8%, and 28.1%, respectively, for nodules >5-mm; n=172. On a per-subject basis, sensitivity (and specificity) for actionability was 41.3% (75.0%) for CXR, 50.4% (69.4%) for CXR+DE, 60.6% (78.4%) for DT, and 52.6% (80.3%) for DT+DE. On a per-nodule basis (diam > 5 mm), JAFROC FOM was 0.453, 0.446, 0.575, and 0.573 for CXR, CXR+DE, DT, DT+DE, respectively; DT FOM was significantly better than CXR (p<.0001) with or without DE; the addition of DE was not significant. CONCLUSION DT outperformed CXR for lung nodule detection and for determination of actionability using Fleishner Society criteria. The addition of DE improved determination of actionability when paired with CXR but not when paired with DT. CLINICAL RELEVANCE/APPLICATION DT shows significantly improved clinical performance over CXR for pulmonary nodule detection and is recommended for imaging nodules of actionable size.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE/AIM 1. To illustrate anatomy and embryology. 2. To describe the spectrum of congenital and acquired conditions. 3. To exemplify the role of different imaging modalities including echocardiography, CT and MR in the evaluation of the tricuspid valve. CONTENT ORGANIZATION 1. Introduction 2. Anatomy and embryology 3. Use of imaging techniques (echocardiography, CT and MRI). 4. Congenital anomalies: a) Stenosis/atresia b) Ebstein anomaly c) Valve dysplasia d) Double-orifice tricuspid valve (DOTV) 5. Acquired conditions: a) Functional regurgitation from RV failure and pulmonary hypertension b) Myxomatous degeneration c) Infectious endocarditis d) Rheumatic heart disease e) Carcinoid syndrome f) Iatrogenic and traumatic injuries g) Marfan syndrome h) Systemic lupus erythematosus 6. Indications for valvular replacement. SUMMARY Upon reviewing this exhibit, the radiologist will become familiar with the spectrum of congenital and acquired conditions involving the tricuspid valve. Ecocardiography, CT and MRI are useful tools in the evaluation and characterization of these disease entities and provide significantly important anatomical and functional information not only in the initial workup, but also in future management decisions.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: As survival rates continue to increase for patients with childhood and adult malignancies, imaging utilization in these patients will likely increase substantially. It is important to detect disease recurrence and to recognize the potential complications that occur after treatment with oncologic medications and therapeutic radiation. The most common cardiotoxic side effect of the anthracycline drug class is a dose-dependent decline in ejection fraction, which may result in dilated cardiomyopathy. Multiple-uptake gated acquisition (MUGA) scanning plays an important role in diagnosis of this subclinical cardiac dysfunction. Other less common cardiotoxic side effects of chemotherapeutic medications include arrhythmia, myocarditis, coronary artery disease, tamponade, pericarditis, and pericardial effusion. Radiation therapy can also lead to cardiotoxicity when the heart or pericardium is included in the radiation portal. Radiation-induced conditions include pericardial disease, coronary artery disease, valvular disease, and cardiomyopathy. Many of these side effects are asymptomatic until late in the course of the disease. With imaging, these pathologic conditions can often be diagnosed before symptom onset, which may allow early intervention. Radiologists should be familiar with the current knowledge and pathophysiology regarding cardiac complications related to chemotherapy and radiation therapy of malignant neoplasms and the appearances of treatment-related cardiotoxicity that can be found at radiography, nuclear medicine examinations, and cross-sectional imaging. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.336125005/-/DC1. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1801-1815. · 2.79 Impact Factor
  • Journal of the American College of Radiology 09/2013; 10(9):718-720. · 2.10 Impact Factor
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    ABSTRACT: In a move to emphasize the educational outcomes of training programs, the ACGME has created the Next Accreditation System (NAS). The stated goals of NAS include aiding the ACGME in the accreditation of programs based on educational outcome measures, decreasing program burdens associated with the conventional process-based approach to ACGME accreditation, allowing good programs to innovate while enabling struggling programs to steadily improve, and providing public accountability for outcomes. Diagnostic radiology is among the first group of specialties to undergo NAS implementation and began operating under the NAS in July 2013. This article describes the various components of the NAS and explains the new elements, including the clinical learning environment review program, the milestones, the clinical competency committee, and the self-study visits.
    Journal of the American College of Radiology 09/2013; · 2.10 Impact Factor
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    ABSTRACT: OBJECTIVE. Large-airway tumors and tumorlike conditions are uncommon, but a systematic approach aids in narrowing the differential diagnosis. In this article, we describe an approach to dealing with large-airway lesions and discuss their imaging characteristics and clinical presentations. CONCLUSION. We have found it useful to separate these entities into groups on the basis of the distribution pattern (focal vs diffuse) and location (trachea vs bronchi).
    American Journal of Roentgenology 08/2013; 201(2):301-13. · 2.90 Impact Factor
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    ABSTRACT: Tetralogy of Fallot (TOF) is one of the most common congenital heart diseases for which patients are referred for postoperative magnetic resonance (MR) imaging evaluation. The most common surgical procedures for TOF repair include infundibulectomy, transannular pulmonary artery patch repair, and right ventricle-pulmonary artery conduit placement. In the past few decades, surgery has proved successful, but most patients require repeat imaging throughout their lives. MR imaging is now frequently used for morphologic and functional evaluation after TOF repair. The most common late postoperative sequelae and residual lesions include right ventricular outflow tract aneurysm and dyskinesis, conduit failure, pulmonary regurgitation, tricuspid regurgitation, right ventricular failure, residual main and branch pulmonary artery stenosis, branch pulmonary artery aneurysm, left pulmonary artery kinking, and residual or recurrent ventricular septal defect. The imaging approach for the evaluation of patients with repaired TOF should be guided by the surgical procedure used and the complications that are expected. Knowledge of the most common postoperative problems and their cardiovascular MR imaging appearances is essential for good radiology practice in this clinical setting.
    Radiographics 07/2013; 33(4):1037-1052. · 2.79 Impact Factor
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    ABSTRACT: Daily routine chest radiographs in the intensive care unit (ICU) have been a tradition for many years. Anecdotal reports of misplacement of life support items, acute lung processes, and extra pulmonary air collections in a small number of patients served as a justification for routine chest radiographs in the ICU. Having analyzed this practice, the ACR Appropriateness Criteria Expert Panel on Thoracic Imaging has made the following recommendations: • When monitoring a stable patient or a patient on mechanical ventilation in the ICU, a portable chest radiograph is appropriate for clinical indications only. • It is appropriate to obtain a chest radiograph after placement of an endotracheal tube, central venous line, Swan-Ganz catheter, nasogastric tube, feeding tube, or chest tube. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The strongest data contributing to these recommendations were derived from a meta-analysis of 8 trials comprising 7,078 ICU patients by Oba and Zaza [1].
    Journal of the American College of Radiology 03/2013; 10(3):170-4. · 2.10 Impact Factor
  • Journal of thoracic imaging 01/2013; · 1.42 Impact Factor
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    ABSTRACT: Congenital or acquired communication between left ventricle and right atrium is rare and can be easily overlooked as an eccentric tricuspid regurgitation jet. MRI is the ideal modality for accurate diagnosis, providing details for surgical planning about the location and size of the defect.
    The international journal of cardiovascular imaging 07/2012; · 2.15 Impact Factor
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    ABSTRACT: Tumorlike conditions of the pleura are rare, but diagnosis is facilitated by recognizing certain imaging patterns and interpreting them in the clinical context. A tumorlike condition of the pleura is any nonneoplastic lesion of the pleura itself, or within the pleural space, that resembles a tumor. An approach to diagnosis of the tumorlike conditions of the pleura is provided, and these conditions are grouped into focal or diffuse conditions, with an emphasis on specific imaging features. Focal tumorlike conditions of the pleura include pleural plaque, thoracic splenosis, thoracic endometriosis causing catamenial pneumothorax, and pseudotumor caused by pleural effusion. Thoracic splenosis should be considered in a patient who has a healed left lower rib fracture, an absent spleen, and left lower pleural nodules. Thoracic endometriosis with catamenial pneumothorax should be considered in a woman of childbearing age who presents with right scapular pain and recurrent pneumothorax occurring at or around the onset of menses. Extrapleural hematoma is a nonpleural mimic of pleural tumor and shares some imaging features with focal tumorlike conditions of the pleura, despite residing in the extrapleural space. Diffuse tumorlike conditions of the pleura include diffuse pleural thickening and rare conditions such as Erdheim-Chester disease and diffuse pulmonary lymphangiomatosis. Erdheim-Chester disease should be considered when diffuse pleural thickening occurs with a perirenal soft-tissue halo or distal femoral sclerosis. Diffuse pulmonary lymphangiomatosis should be considered when findings include diffuse pleural thickening, interlobular septal and peribronchovascular interstitial thickening, and mediastinal fat infiltration limited to the thorax and when these findings persist despite diuretic therapy.
    Radiographics 07/2012; 32(4):971-85. · 2.79 Impact Factor
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    Journal of thoracic imaging 07/2012; 27(4):W87. · 1.42 Impact Factor
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    Journal of thoracic imaging 01/2012; 27(1):W1. · 1.42 Impact Factor
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    ABSTRACT: Subjects infected with human immunodeficiency virus (HIV) have increased risk for atherosclerosis. Carotid artery intima-media thickness (IMT) assessed using ultrasound and coronary artery calcium (CAC) detected using computed tomography predict cardiovascular risk in the general population; however, their usefulness and comparability in patients with HIV are less well defined. The purpose of this study was to compare IMT and CAC in the detection of atherosclerosis in subjects with HIV. CAC and IMT were measured in 253 HIV-infected and 58 uninfected adults. Associations among HIV-related factors, traditional risk factors, and CAC and IMT were evaluated. The distribution of IMT among subjects with and without CAC was compared. Among the patients with HIV, 37% had detectable CAC compared to 28% of controls (p = 0.19); 16% of the patients with HIV had CAC >100 compared to 5% of controls (p = 0.03). With either detectable or undetectable CAC, HIV-infected subjects had higher IMT compared to controls (1.02 ± 0.34 vs 0.78 ± 0.12 mm, p <0.0001), even after adjustment for traditional risk factors. Among those with undetectable CAC, 34% of patients with HIV had markedly increased IMT (≥1 mm) compared to no controls (p <0.0001). HIV-related factors were associated with IMT but not with CAC. In conclusion, patients with HIV and controls had similar rates of detectable CAC, while absolute CAC scores were modestly higher in the HIV group. Conversely, carotid IMT detected advanced subclinical atherosclerosis in patients with HIV even in the absence of CAC. Thus, with HIV, IMT is associated with disease-related factors and may be a more sensitive indicator of subclinical atherosclerosis than CAC.
    The American journal of cardiology 12/2011; 109(5):742-7. · 3.58 Impact Factor
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    ABSTRACT: High-resolution computed tomography is a necessary tool used in the diagnosis of interstitial lung disease. The interpretation of high-resolution computed tomography can be difficult given the wide spectrum of imaging appearances within the same disease and among different diseases. The authors provide a new educational method to learn about the spectrum of idiopathic interstitial lung disease through the use of a free online digital atlas and review article. This atlas can be downloaded at http://www.seattlechildrens.org/radiologyeducation/ILD.
    Academic radiology 09/2011; 18(11):1453-60. · 2.09 Impact Factor
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    ABSTRACT: Screening for pulmonary metastatic disease is an important step for staging a patient with a known or recently discovered malignancy. Here we present our recommendations for screening for metastatic disease based on recommendations from the literature and experiences of pulmonary radiologists. In short, chest computed tomographic (CT) screening is the most appropriate tool for evaluation of pulmonary metastasis in the majority of cases. Chest computed tomographic screening is also recommended for follow-up and to determine response to therapy. Other modalities such as chest radiography, magnetic resonance imaging, and scintigraphy will also be discussed. Please note that this study is a summary of the complete version of this topic, which is available on the ACR website at www.acr.org. Practitioners are encouraged to refer to the complete version.
    Journal of thoracic imaging 02/2011; 26(1):W1-3. · 1.42 Impact Factor
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    ABSTRACT: LEARNING OBJECTIVES 1) Discuss the clinical manifestations and imaging assessment of acute, nontraumatic, aortic syndromes, including aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer. 2) Describe the technical considerations underlying the use of cardiac CTA and its utility in the assessment of coronary disease and non-coronary cardiac abnormalities. 3) Discuss the role and added value of MR Imaging for the evaluation of cardiac masses, constrictive pericarditis, cardiomyopathies, and valvular heart disease. ACTIVEHANDOUT:H. PAGE MCADAMS http://media.rsna.org/media/abstract/2010/8000327/irjf936_8000327_McAdams_Aorta_RSNA_ARS_REV_6_HO.pptx
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 12/2010

Publication Stats

1k Citations
264.96 Total Impact Points

Institutions

  • 2013
    • Seattle Children's Hospital
      Seattle, Washington, United States
  • 2009–2013
    • University of Washington Seattle
      • Department of Radiology
      Seattle, WA, United States
  • 1997–2013
    • University of California, San Francisco
      • • Department of Radiology and Biomedical Imaging
      • • Division of Hospital Medicine
      San Francisco, CA, United States
  • 2012
    • University of Rochester
      Rochester, New York, United States
  • 2005–2008
    • San Francisco VA Medical Center
      San Francisco, California, United States
    • CSU Mentor
      Long Beach, California, United States