Assessment of an online radiology reporting system.

This study was designed to assess the efficiency of radiology reporting in the Royal Adelaide Hospital Department of Radiology, which introduced online reporting in November 1994. Seventeen radiologists were monitored without their knowledge, and recordings were made of the times between report dictation and report typing, and the time that the report waited on computer for verification. The total median values for verification time for 9/17 radiologists were less than 12 h and for 14/17 were less than 24h. On average, reports were available from all reporting areas within 24 h. However, some reports waited up to 13 and 14 days to be verified and to be available on computer for treating clinicians. This report demonstrates that on average rapid reporting is occurring, however some areas need to be considered further to maximize efficiency.

Carbon localisation of impalpable mammographic abnormalities.

A prospective study was undertaken to assess the usefulness, safety and cost-effectiveness of stereotactically guided carbon localisation of impalpable breast lesions. Fifty six lesions in 53 patients were localised by this method, some in combination with fine-needle aspiration and hookwire localisation. Some modification of the study was required due to ready acceptance of the technique by surgeons, who preferred carbon to hookwire localisation. The technique was proven to be safe and accurate, and highly acceptable to patients, referring clinicians and radiology staff. It is now the preferred procedure for localising impalpable breast lesions prior to excision biopsy.

Placenta praevia--a review with emphasis on the role of ultrasound.

Considerable confusion exists in the literature as a result of the wide range of classification systems for placenta praevia (PP) and low-lying placenta. The discrepancy between frequency of low-lying placentas in the second trimester and PP at term reflects to a certain extent the lack of understanding of the anatomy and physiology of the pregnant uterus. It seems that 'placental conversion' is a real phenomenon and is probably due to the differential growth rates of the placenta and uterus. Maternal bladder overdistension and myometrial contractions account for only a small part of the discrepancy. Diagnostic ultrasound obviously has an important role in placental localization. The role of Magnetic Resonance Imaging remains to be determined. The management of patients with low-lying placenta diagnosed in the second trimester, and the frequency of repeat scans is determined largely by the management protocol of the attending obstetrician.

A comparative study of a digital radiography system.

The present study aimed to examine the efficiency of a new digital radiography system that was installed in the Royal Adelaide Hospital in September 1997, as compared to the existing conventional radiography system. A total of 55 examinations were observed over a 3-week period in January, and these consisted of 18 digital and 10 conventional chest examinations, and 27 conventional orthopaedic examinations. These were combined with 18 digital orthopaedic examinations recorded from a prior study. Total examination time was broken into several components, of which reporting time was of the most interest. The mean reporting times for digital and conventional chest examinations were 17 and 25 min, respectively, a significant (P < 0.1) 8-min difference. The orthopaedic examinations revealed mean reporting times of 8 and 26 min for digital and conventional systems, respectively; a significant (P < 0.001) 18-min difference. These results demonstrate that the digital system is a faster, more efficient system for the reporting of X-rays.

Ultrasonic measurement of fetal femoral length in singleton and twin pregnancies.

The fetal femoral length and biparietal diameter were measured by ultrasound on 1657 occasions in 1289 singleton pregnancies between 12 and 41 weeks' gestation. Mean values for fetal femoral length were significantly lower than those demonstrated in previous studies, with the difference becoming greater approaching term. Three hundred twenty-two measurements of fetal femoral length were made on 57 patients with twin pregnancies, with no significant difference noted between the means of these recordings and the means of the singleton pregnancies.

Fine needle aspiration cytology in the diagnosis of solid renal and adrenal masses.

In the eight-year period 1977-1984, 83 renal and adrenal mass lesions which were not clearly simple cysts by ultrasonographic examination (US) were investigated by percutaneous fine needle aspiration (FNA) biopsy. Initially, biopsy was often guided by fluoroscopy, later US was by far the most commonly used modality. There were 77 renal and 6 adrenal masses; 69 lesions were malignant and 14 were benign. A positive cytological diagnosis of malignancy was given in 62 cases, a diagnostic sensitivity of 90%. One false positive diagnosis occurred, an angiomyolipoma was misinterpreted as a low grade renal cell tumour. One significant complication was recorded, post biopsy haemorrhage into a large, extensively necrotic renal adenocarcinoma causing severe pain. The place of FNA in the preoperative investigation of solid renal tumours is discussed on the basis of this experience and results reported in the literature.

Ultrasonic assessment of hydronephrosis of pregnancy.

Real-time renal ultrasonographic scans were obtained of 204 subjects, comprising 159 pregnant and 45 control subjects. A classification of hydronephrosis based on calyceal diameters was established, and the overall incidence of hydronephrosis was found to be 90% on the right side and 67% on the left side. Calyceal diameters for both kidneys were found to increase gradually throughout pregnancy, the right more rapidly than the left. Neither parity nor a history of urinary tract problems was found to be relevant to the degree of dilatation.

A time-motion study of digital radiography at implementation.

With increasing budgetary restraints on the health system, it is apparent that the main contribution that radiology departments can make to significant cost reduction in hospitals is to decrease the length of time between requesting an X-ray examination and receiving the report (and images). Digital radiography (DR) was introduced into the Radiology Department at the Royal Adelaide Hospital as a pilot project to research the cost-benefits and efficiency of the system, and to determine future directions for planning a digital department. The business plan developed prior to implementation of this pilot project predicted a saving of one bed-day per inpatient when a fully digital department with a picture archiving and communication system (PACS) is installed. This initial study comparing DR and conventional radiography (convR) provides baseline data and shows encouraging results for more rapid transmission of reports to clinicians.

Detection of articular defects using magnetic resonance imaging: an experimental study.

This study evaluates magnetic resonance imaging (MRI) in the detection of surgically created articular defects in bovine knees. A total of 26 articular defects was created in 2 fresh cadaveric cows' knees. The defects created include chondromalacic grade 2 defects, chondral and osteochondral defects from 3 to 15 mm in diameter. The knee joints were repaired in a normal saline bath to exclude air in the joint prior to MR scanning. T1 weighted spin echo (SE) images and 3D gradient echo (FISP 40 degrees 3D) images were obtained. The T1 weighted SE imaging technique detected 15 defects (57.7%) compared with FISP 3D imaging technique detection of 17 defects (65.4%). The two techniques combined enable 21 of 26 defects (80.8%) to be detected. The imaging techniques used in this study were not able to detect chondromalacic defects less than 10 mm in diameter, nor chondral defects less than 5 mm in diameter. However, small osteochondral defects of 3 mm in diameter are detectable provided the depth of the defect is not less than 10 mm. The FISP 3D imaging technique alone is more sensitive in detecting chondral defects. Both imaging techniques have similarly high sensitivities in detecting osteochondral defects. The imaging time for combined T1 weighted SE and FISP 3D sequence is short (16.5 mm) and this combined technique may be useful for MR scanning of knee joints suspected to have articular defects.

Prenatal diagnosis. A preliminary study of first-trimester chorionic villous biopsy.

Biopsy of the developing placenta before the thirteenth gestational week was performed by transcervical cannula aspiration guided by real-time ultrasound in 21 consecutive patients. Chorionic villi were obtained in 20 patients and chromosomal analysis was possible in 19. One significant complication occurred: perforation of one gestational sac in the only patient in the series with a twin pregnancy. More studies are required in order to provide an adequate assessment of the risk--of fetal loss, culture failure and trophoblastic chromosomal abnormalities not representative of the mature fetus--associated with the technique. In practised hands, the procedure may provide a preferable and safe alternative to amino-centesis and fetoscopy for the prenatal diagnosis of genetic defects.

The estimation of bladder volume by sonocystography.

Real-time ultrasonography was used to measure bladder volumes. Volumes were calculated as the product of 3 internal bladder diameters (height, width and depth). The true bladder volume was obtained from the voided volume or by catheterization. There was a good correlation between calculated and true volumes provided a correction factor of 0.6 was applied. It also was found that a simpler method using only 2 diameters and a correction factor of 0.15 was nearly as reliable. The accuracy of this quantitative method was shown to be limited to an average error of plus or minus 25 per cent for bladder volumes between 100 and 500 ml. Smaller volumes could be assessed only qualitatively. False negative readings were common for bladder volumes less than 50 ml.

Soft-tissue sarcoma of the extremity. Experience with limb-sparing surgery.

OBJECTIVES: To assess the degree to which limb-sparing surgery is implemented in patients with soft-tissue sarcoma, and its outcome. DESIGN AND SETTING: A detailed review of 40 patients who were all tertiary referrals to one surgeon, and general review of all 215 patients with sarcoma treated in South Australia between 1986 and 1992. INTERVENTIONS: Conservation of the limb by wide resection or marginal resection of soft tissue, combined when necessary with radiotherapy. Amputation was used when limb conservation failed or was not possible. MAIN OUTCOME MEASURES: Median survival time after treatment. RESULTS: Limb-sparing treatment was successful in 37 of the group of 40 patients. Thirty-two patients received adjuvant radiotherapy, and 19 received chemotherapy. Median survival time was 35 months. Review of all 215 patients with sarcoma revealed a higher initial amputation rate and a lower use of combined treatment methods than in our series. Twenty-six patients (65%) were initially incorrectly diagnosed before referral, resulting in a median delay in treatment of 16 weeks. CONCLUSIONS: The concept of limb-sparing surgery is well established, but is not yet as widely practised for limb sarcomas as it could be. Delay in diagnosis is a significant problem.

Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate, and advantageous.

STUDY OBJECTIVE: This study was conducted to determine whether emergency physicians with relatively limited training and experience can accurately identify the presence or absence of abdominal aortic aneurysms (AAAs) by performing bedside ultrasound scanning, and to assess the potential impact of ultrasound scanning on clinical management. METHODS: Patients in whom AAAs were suspected, including those patients older than 50 years presenting with abdominal/back pain of unclear origin or presumed renal colic, were eligible for study entry. Consenting adults had ultrasound scanning by an emergency physician who was not responsible for their primary care. Treating physicians remained blinded to the results unless an unexpected AAAs was discovered. Scan accuracy was ascertained by comparing our ultrasound results with preselected gold standards. The clinical impact of the ultrasound studies was determined by comparing the preultrasound and postultrasound assessment sheets that detailed the presumed diagnosis, proposed investigations and therapies, and patient disposition. RESULTS: Our convenience sample includes 68 scans for AAAs; findings of 26 scans were positive, 40 scans yielded negative findings, and 2 scans were indeterminate. Scan interpretations were 100% accurate. The ultrasound results would have improved the care of 46 patients without adverse sequelae. Ultrasound scanning served primarily to exclude AAA in patients who proved not to have aneurysms; however, scans also provided significant benefits for those with AAAs and improved patient management plans. CONCLUSION: Relative neophytes can perform aortic ultrasound scans accurately. These scans appear useful as a screening measure in high-risk emergency department patients; they may also aid in rapidly verifying the diagnosis in patients who require immediate surgical intervention.

Accuracy of emergency department bedside ultrasonography.

OBJECTIVES: To determine which focused ultrasound examinations can be interpreted accurately by emergency physicians who have limited training and experience. To determine whether image quality and/or the operator's level of confidence in the findings correlates with accurate scan interpretation. METHODS: A prospective sample of consenting adult emergency department patients with the conditions was selected for study. Scans were performed by emergency physicians who had attended a 3-day focused ultrasound examinations instruction course. All scans were videotaped and subsequently reviewed by a radiologist. Accuracy was determined by comparing the emergency physicians scan interpretation with preselected gold standards. Chi-squared tests were employed to determine if the individual performing the scan, the type of scan, patient's body habitus, image quality and/or operator confidence were reliable predictors of accuracy. RESULTS: Between September 1997 and January 1999, 221 scans were studied. Accuracy varied widely depending on the type of scan performed: aortic scans were 100% accurate whereas renal scans had 68% accuracy. On bivariate analyses, there was little variation in the various operators' levels of proficiency and accuracy of interpretation was not associated with patient body habitus, image quality or operator confidence. CONCLUSIONS: Neophytes can accurately perform and interpret aortic scans; additional training and/or experience appear to be necessary to achieve proficiency in conducting most of the other scans studied. Inexperienced operators are unable to discern whether their scan interpretations will prove accurate.

Costs of magnetic resonance imaging services in public hospitals.

Audited cost data from two public hospital installations participating in a trial of the utilisation and efficacy of magnetic resonance imaging are presented. The data cover the period July 1987 to June 1988 when both installations had attained stable patterns of operation. One hospital operated a superconductive system and the other a resistive magnetic resonance imaging unit. Depreciation and salaries represented the major components of cost.