[show abstract][hide abstract] ABSTRACT: Teleradiology has been used for nearly 3 years at our institution to provide urgent radiologic interpretations for two outpatient clinics and an affiliated hospital. The purpose of this study was to evaluate the clinical reliability of the existing system. Teleradiology images were interpreted using 1600 x 1200 pixel display stations. The original films from the same cases were subsequently interpreted, usually by another radiologist. The initial and final interpretations were compared. Discrepancies were rated and adjudicated by another senior radiologist. These data were compared to peer review interobserver discrepancy rates. Among the 2688 teleradiology examinations evaluated, there were major discrepancies in 31 (1.5%). In three instances teleradiology rather than film interpretation was considered correct. Abnormalities missed on teleradiology were apparent in all but two at adjudication. Among the 628 peer-review cases, there were 6 (0.96%) major discrepancies. Major teleradiology discrepancy rates are statistically similar to film-based peer review discrepancy rates. Teleradiology is suitable for providing radiologic services to remote medical facilities.
Journal of Digital Imaging 06/1997; 10(2):47-50. · 1.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.
Archives of Otolaryngology - Head and Neck Surgery 09/1990; 116(8):917-9. · 1.78 Impact Factor
[show abstract][hide abstract] ABSTRACT: Peristomal varices occasionally form in patients with chronic liver disease who have surgically created intestinal anastomoses and stomas. Hemorrhage from these varices carries an estimated mortality of 3%-4% per episode, as opposed to the 30%-40% mortality associated with gastroesophageal variceal bleeding. The cases of four patients who underwent transhepatic mesenteric vein catheterization with embolization of stomal varices for recurrent, intractable bleeding are presented. In three of the four patients there was no additional hemorrhage for at least 5 months. One patient was lost to follow-up. There were no complications. Since stomal variceal hemorrhage has a low mortality, transhepatic embolization is presented as a means of hemorrhage control when sclerotherapy fails and when shunt surgery presents an unacceptably high rate of morbidity and mortality relative to the underlying disease.
[show abstract][hide abstract] ABSTRACT: A prototype 5,000-word recognizer for the generation of radiologic reports by voice entry was evaluated. The system had a capacity sufficient enough to include all radiologic examinations and all desired words in one lexicon. The lack of such a capacity had been identified as a major limitation of a 1,000-word system previously evaluated. Overall reliability in word recognition was 98%. The device may be widely applicable for use in any radiology practice.
[show abstract][hide abstract] ABSTRACT: We performed 92 computed tomography-guided percutaneous needle aspirations of pancreatic inflammatory masses in 60 patients suspected of harboring pancreatic infection. Thirty-six patients (60%) were found by Gram stain and culture to have a total of 41 separate episodes of pancreatic infection. Among 42 aspirates judged to be infected by computed tomography-guided aspiration, all but one were confirmed by surgery or indwelling catheter drainage. Among 50 aspirates judged to be sterile, no subsequent evidence of infection was found. All patients tolerated the procedure well and no complications were noted. As a result of this technique, we observed that pancreatic infection occurs earlier than has been previously appreciated (within 14 days of the onset of pancreatitis in 20 of the 36 patients) and that infection may recur during prolonged bouts of pancreatitis. We conclude that guided aspiration is a safe, accurate method for identifying infection of the pancreas at an early stage.
[show abstract][hide abstract] ABSTRACT: Voice entry has been successfully employed to generate radiology reports with a word recognizer with a 1,000-word lexicon capacity. About 50% of reports were able to be dictated with a single 900-word lexicon. This was split into five sections by anatomic or subspecialty application. Each was augmented to 900 words. By switching from one lexicon to another, it was possible to dictate more than 70% of reports. With exclusive use of three lexicons in subspecialty areas (gastrointestinal radiology, neuroradiology, and mammography), and with further modification of the respective vocabulary, it has been possible to employ the system 88% of the time. Twelve percent of cases included wording that was beyond the scope of the lexicon. Computer subsets that allow different translations of some words when used in different contexts have been used. Some of these are used as triggers that will print whole lines, sentences, or even complete reports. Dictation times with voice entry take about 20% longer. Recognition reliability has been greater than 95%.
[show abstract][hide abstract] ABSTRACT: In a review of 17 cases in which the CT diagnosis of abdominal aortic aneurysm rupture was prospectively made and for which surgical correlation was available the CT diagnosis was correct in 10 and incorrect in seven. Two of the false positives were retrospectively reinterpreted as negative for rupture. Characteristics of 10 surgically confirmed cases revealed a spectrum of appearances not always in agreement with prior published reports, probably due to the age and magnitude of the aortic leaks at the time of diagnosis. The most common characteristic of aneurysm leak (eight of 10 cases) was an abnormal soft tissue collection located adjacent to the posterior aspect of the aneurysm, a sign not previously emphasized in other reports. Renal displacement was also a valuable sign but was present in only three cases, all of which had large hemorrhages. Other characteristics of aortic rupture such as density of the collection and sharpness of its margins were not found to be generally useful.
[show abstract][hide abstract] ABSTRACT: During a 6 year period, 18 liver abscesses in 12 patients were identified by computerized tomography. Five patients had presumed hematogenous seeding. Five patients previously had bilioenteric anastomoses, stents, or both to relieve obstructive jaundice. Four patients with abscesses had recent abdominal operations. Diagnosis was established by guided needle aspiration and treatment was provided by percutaneous catheter drainage. Organism-specific antibiotics were administered to all patients. Patients were evaluated for recurrence by serial computerized tomographic studies and were clinically followed up for a minimum of 15 months. Ten of 12 patients (83 percent) and 16 of 18 abscesses (89 percent) were successfully treated by percutaneous catheter drainage. Two failures required operative intervention. In summary, the low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggests that this therapy be tried before operative intervention is considered.
The American Journal of Surgery 05/1985; 149(4):487-94. · 2.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: The original criteria for percutaneous abscess drainage were limited to simple abscesses (well-defined, unilocular) with safe drainage routes. We expanded these entry criteria to include complex abscesses (loculated, ill-defined, or extensively dissecting abscesses), multiple abscesses, abscesses with enteric fistulas or whose drainage routes traversed normal organs, as well as complicated abscesses (appendiceal, splenic, interloop, and pelvic). Using these expanded criteria, cure was achieved nonoperatively in 92 (73.6%) of 125 abscesses with ten deaths (9%), and 11 complications (9%). Cure was achieved in 82% of simple abscesses, but only 45% of complex abscesses. There was no correlation between size, depth, drainage route, or etiology of the abscess (spontaneous v postoperative) with either cure or complications. We recommend a trial of percutaneous drainage in all simple abscesses and most complex abscesses with clinical response as the key determinant of the need for operative intervention.
Archives of Surgery 03/1985; 120(2):227-32. · 4.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abdominal CT has in many cases become the initial radiographic examination to elucidate the cause of obscure abdominal pain, fever of unknown origin, and other difficult diagnostic abdominal problems. Not infrequently, unsuspected disease involving the gallbladder may be encountered. Computed tomography commonly identifies calcified gallstones, occasionally indicates acute cholecystitis, and clearly determines the extent of gallbladder carcinoma. Other less common entities such as gallbladder perforation, porcelain gallbladder, and milk of calcium bile may be diagnosed if suspicion is high and attention directed to anatomic details of the gallbladder and adjacent organs. A review of abdominal CT performed during a 4.5 year period revealed 20 instances of unusual gallbladder diseases in 16 patients. Most often these were encountered incidentally or during CT evaluation of nonspecific abdominal problems.
[show abstract][hide abstract] ABSTRACT: During evaluation for occult fever or nonspecific abdominal pain CT will occasionally identify inflammatory disease of the appendix as the underlying cause. In these cases CT may also provide useful information about the presence of associated mesenteric inflammation, abscess, or perforation. Five cases are presented in which CT provided clinically useful information supplementing that gained from barium studies and clinical presentation. When a periappendiceal lesion is found, the extent and nature of inflammatory changes are shown directly rather than inferentially.
[show abstract][hide abstract] ABSTRACT: A two-part retrospective study was conducted to assess the value of a reticular pattern as a sign of columnar-lined esophagus. Radiographic, endoscopic, and histologic findings were reviewed in 124 patients with known Barrett esophagus; then all barium esophagrams done at our institution during a 3 1/2 month period were reviewed and presence of a reticular pattern was correlated with available endoscopic and histologic data. In patients with known Barrett esophagus, the reticular pattern was found in 26% of double-contrast examinations. Twelve of these patients underwent careful esophageal mapping biopsies: the pattern was in squamous mucosa with ulceration in two, in columnar epithelium with ulceration in six, and in columnar epithelium without ulceration in four. In the group of 314 unselected patients who had double-contrast examinations, the reticular pattern was found in 26 (8%). Thirteen of the 26 had had endoscopy and biopsy: the site of the pattern was located in a squamous carcinoma in one, in squamous epithelium adjacent to squamous carcinoma in three, in squamous epithelium with esophagitis in five (two of whom had columnar mucosa distally), in normal squamous mucosa in one, and in columnar epithelium with esophagitis in three. The reticular pattern is a strong indicator of important esophageal disease, but is not specific for Barrett esophagus.
[show abstract][hide abstract] ABSTRACT: Tracheoesophageal puncture and use of a silicone prosthesis is becoming a common and highly effective procedure for voice rehabilitation in the alaryngeal patient. Radiologic evaluations were reviewed of 31 patients scheduled for tracheoesophageal puncture at this institution over the past 3 years. Barium swallow examinations were performed preoperatively to assess anatomy and muscular activity of the pharyngoesophagus. Examinations were performed postoperatively when complications were suspected, phonation was unsatisfactory, or as routine oncologic follow-up. Postoperative complications included neck abscess, cervical osteomyelitis, and feeding tube dissection into the anterior wall of the thoracic esophagus. This method of pre- and postoperative radiologic evaluation of these patients is presented, along with the radiologic manifestations of the complications.
American Journal of Roentgenology 11/1984; 143(4):745-50. · 2.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: The risk of developing esophageal cancer in Barrett's esophagus has been estimated at about 10%. This estimate is based primarily on data concerning the prevalence of that association in series of hospitalized patients and autopsies--a practice that tends to exaggerate the risk. We have reviewed retrospectively our experience with 115 patients whom we treated for Barrett's esophagus between September 1962 and March 1983, and have distinguished our data on the prevalence of esophageal cancer from that on incidence. For 8 patients, we found both Barrett's esophagus and esophageal adenocarcinoma during the initial evaluations for a prevalence ratio of 7%. We followed 105 patients not found to have esophageal cancer initially for a total of 350 person-years. Only 2 patients developed adenocarcinoma during that follow-up period for an incidence of 1 case per 175 person-years. This incidence, although some 40-fold greater than that of the general population, is substantially lower than previously estimated. Routine endoscopic and histologic surveillance has been recommended for patients with Barrett's esophagus because of the alleged high incidence of esophageal cancer. Inasmuch as that incidence now appears to be low, we question the value of such surveillance for these patients.
[show abstract][hide abstract] ABSTRACT: After diagnostic needle aspiration guided by computed tomography and/or ultrasound, 11 infected pseudocysts in ten patients were treated nonoperatively by percutaneous catheter drainage and intravenously administered antibiotics. Nine infected pseudocysts resolved after 11 to 37 days (mean, 21 days) with no recurrences at follow-up 16 to 42 months (mean, 24.4 months) later. All were confirmed by Gram's stain, culture, and elevated amylase levels. Ten of the pseudocysts were acute; one was chronic; five were polymicrobial; six had a single organism. There were no major complications. There was one failure when a pancreatic abscess developed in a patient who died following operative drainage. There was one successful palliation of a postoperative-infected pseudocyst in a patient with an obstructing nonresectable carcinoma of the head of the pancreas. A trial of percutaneous catheter drainage is indicated in patients with infected pancreatic pseudocysts.
Archives of Surgery 09/1984; 119(8):888-93. · 4.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: As part of a general safety study of iopamidol, a nonionic iodinated contrast agent, urine N-acetyl-beta-glucosaminidase enzyme assays were done to compare the renal toxicity of iopamidol with that of iothalamate and diatrizoate. In a randomized study of 30 patients for computed body tomography and another 30 patients for angiography, 10 in each group were injected with iopamidol, 10 with iothalamate, and 10 with diatrizoate. After computed tomography or angiography with the three agents, there was no significant difference in urinary enzyme levels among the groups. The nephrotoxicity of iopamidol appears equivalent to that of diatrizoate and iothalamate.
American Journal of Roentgenology 03/1984; 142(2):333-5. · 2.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: Since June 1974, 347 percutaneous transhepatic portal venographic studies were performed on 246 patients with portal hypertension who had had bleeding gastroesophageal varices. Of 234 patients in whom left gastric veins (LGV) (coronary) were demonstrated, 177 (75.6%) had a single LGV and 57 (24.4%) had multiple left gastric veins (21.8% had two LGVs, 2.1% had three LGVs, and 0.5% had five LGVs). Of 193 patients undergoing selective left gastric venography, spontaneous portosystemic communications to the left renal vein were found in 55, to the inferior vena cava in two, to the inferior pulmonary veins in five, to the pericardiophrenic vein in eight, to the right inferior phrenic vein in three, and to the left intercostal veins in one. Interportal communications with the left gastric vein and varices occurred from the left portal vein in 13, from the gastroepiploic vein in one, and from a superior mesenteric vein branch in one. The predominant drainage of esophageal varices was to the azygos vein in 78 of 155 patients, to the hemiazygos vein in 13, and to multiple small unnamed veins in the mediastinum in 57. Opacified varices did not extend above the level of the azygos vein arch in 71 of 130 patients; however, 59 continued cephalad to the azygos arch and drained through more superior veins of the thorax. Knowledge of the anatomy and incidence of each of these portosystemic or interportal venous communications is important to properly treat bleeding esophageal varices by surgery or angiographic embolization.
American Journal of Roentgenology 03/1984; 142(2):375-82. · 2.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: Computed tomography scans were taken of 21 middle-aged men (M age 46.3 years) and 20 older men (M age 69.4 years) to measure differences in body composition with age. Overall, the older men weighed 8.2 kg less than the middle-aged men, and this difference was primarily the result of their having less lean tissue. Although fat mass was only slightly less in older men, there were clear distributional differences in fat between the age groups. Total abdomen fat area was similar in both groups, although the subcutaneous portion of the abdomen fat was less in the older men, and they had correspondingly greater intra-abdominal fat. Muscle areas of the leg and arm were significantly less in the older men, as were all lean tissues of the abdomen and chest. Analysis of fat accumulation between muscles of the abdomen and leg indicated fat infiltration into lean tissue in the older men. Causes of this apparent fat redistribution and lean body mass decline with age are presently unknown.