Integration of ultrasound in a fully digital radiology department.

OBJECTIVES: The authors' experiences concerning the use of video-framegrabbers for the integration of ultrasound devices into a fully digital imaging environment are presented. METHODS: Video acquisition workstations (VAW) (Siemens, Gammasonics Inc., Hoffman Estates, IL) are used in our department to link ultrasound devices to the picture archiving and communication system (PACS). A study was carried out concerning the impact of this integration on throughput by comparing the average times for image acquisition and storage in this digital system with the times found in a conventional archive, which is still used for some ultrasound units. The annual costs for the two kinds of archives were compared. RESULTS AND CONCLUSION: Video acquisition is a feasible way of integrating ultrasound in a digital environment. No impact on throughput has been found for the radiologist carrying out the examination, but for the assisting technologist, the times for image retrieval and archiving could be reduced from 3 minutes and 8 seconds to 24 seconds per patient. The instant availability of previous studies could be increased from 93.5% to almost 100%. Archive costs could be reduced by 28%, with further reductions to be expected using different archive configurations.

Conventional film-screen versus computed storage phosphor radiography. Simulated miliary lung disease in an anthropomorphic phantom.

RATIONALE AND OBJECTIVES: In this experimental study, the authors examined whether laser printed hardcopies from digital storage phosphor radiographs yield diagnostic performance equal to conventional film-screen radiographs in the detection of simulated miliary disease, using a standardized object. METHODS: A commercially available anthropomorphic chest phantom was used for radiographic evaluation. Miliary disease was simulated by superimposing one to four sheets of millet seeds on the lungs, resembling a miliary disease pattern with varying degrees of detectability. An observer study (receiver-operating characteristic) with eight radiologists was conducted to compare the reader performance using hardcopies of computed storage phosphor radiography versus the conventional film-screen system, optimized for chest x-rays. The digitally generated images were presented as a double-image hardcopy, with a conventionally adopted version and an edge enhanced image version. RESULTS: When analyzed separately, one out of the eight observers performed slightly better using the conventional films. When treated as a group, analysis of the areas under the receiver-operating characteristic curves demonstrated no significant difference in reader performance for each of the systems under investigation (t = 0.286). The Wilcoxon test could not prove a statistical difference. CONCLUSION: Storage phosphor technology is a method that yields equal diagnostic performance as conventional film in evaluating miliary disease of the chest.

Morphine antinociception in the non-hibernating and hibernating states of the ground squirrel (Citellus lateralis).

Previous work in our laboratory demonstrated a significant reduction in the development of morphine physical dependence during hibernation, suggesting a major change in the ability of morphine to act on the central nervous system (CNS) during this naturally altered state. To further investigate the pharmacological actions of morphine during the hibernating (H) state, the present study recorded skin-twitch response (STR) latency as a measure of morphine antinociception in the golden-mantled ground squirrel (Citellus lateralis) during the non-hibernating (NH) and H states. Our results revealed that morphine antinociception continued to develop in hibernation. Moreover, the magnitude of antinociception displayed was greater during the H state than in the NH state. Tolerance to morphine's antinociceptive effects developed in both states as well. The results of the present study indicate that the hibernation-related reduction in the development of morphine dependence represents a selective, rather than a general, suppression of the CNS pharmacological actions of morphine during the H state.

Morphine and dextrorphan lose antinociceptive activity but exhibit an antispastic action in chronic spinal rats.

Within 3-4 weeks after spinal transection, morphine-induced antinociception, assessed with the tail flick reflex in rats, is profoundly reduced. The cause of this decrement is unknown. The present studies were conducted to determine whether this phenomenon reflects a general loss in opiate activity or a selective decline in opiate antinociception. This was accomplished by assessing the effect of morphine on two different responses, the tail flick reflex and the hindlimb spasticity that develops in chronic spinal rats. Because excitatory amino acid antagonists are also antinociceptive in acute spinal rats, the effect of one such drug, dextrorphan, on these two behaviors was also evaluated in chronic spinal animals. The antinociceptive and antispastic effect of subcutaneous (6 mg/kg) and intrathecal (5 micrograms) morphine injections were assessed in intact and chronic (21-28 days) spinal rats, whereas the effect of subcutaneous (25 and 40 mg/kg) and intrathecal (350 micrograms) dextrorphan was assessed in acute (1 day) and chronic spinal rats. The antinociceptive effect of both drugs was significantly reduced in chronic spinal animals, relative to saline controls. However, each drug treatment produced a significant antispastic effect in the same animals, indicating a selective decline in opiate action. This outcome also suggests that excitatory amino acid antagonists may be useful as adjunct antispastic agents.

The Vienna SMZO-PACS-project: the totally digital hospital.

This paper gives an overview of the SMZO-PACS-Project in the form of a rough specification of the system architecture and the functional parameters related to it. The PACS architecture, determined by the large amount of data volume produced in the SMZO Hospital is outlined. In both radiology and trauma departments high technical requirements concerning data throughout and fault tolerance are demanded. Therefore these PACS modules are designed to minimize the workload of the network so that the performance is not degraded in the case of fault of a single component. A PACS module includes image acquisition devices of a certain modality with related reporting workstations and a distributed electronic archive. The functionality of the modules is described, special interest is posed on the integration of the different information management systems PACS, RIS and HIS, to achieve a complete record of data input and throughput in the hospital.

Integration of radiology and hospital information systems (RIS, HIS) with PACS: requirements of the radiologist.

PACS development has now reached a stage where it can clearly be stated that the technology for storage, networking and display in a fully digital environment is available. This is reflected by an already large and rapidly increasing number of PACS installations in USA, Western Europe and Japan. Such installations consist of a great variety of information systems, more or less interconnected, like PACS, HIS, RIS and other departmental systems, differing in both hardware and software. Various data - even if they only concern one person - are stored in different systems distributed in the hospital. The integration of all digital systems into a functional unit is determined by the radiologist's need of quick access to all relevant information regardless where it is stored. The interconnection and functional integration of all digital systems in the hospital determine the clinical benefits of PACS. This paper (1) describes the radiologist's requirements concerning this integration, and (2) presents some realistic solutions such as the Siemens ISI (Information System Interface), and a mobile viewing station for the wards (visitBox).

[Strut fractures in the long-term follow-up of Günther cava filters--the results after 64 filter implantations]. / Strebenbrüche bei der Langzeitkontrolle von Günther-Kavafiltern--Ergebnisse nach 64 Filterimplantationen.

Follow-up of patients with inferior vena cava filters was performed every 3 months with clinical controls, plain radiographs and duplex sonography. Whereas the clinical results were excellent (no recurrence of pulmonary embolism), radiological controls showed broken anchoring legs in 14 cases and a broken filter basket in one patient. In two cases, the broken anchoring prongs had perforated the inferior vena cava wall. All patients with broken filters were clinically asymptomatic. CT showed no morphological changes in these cases. As experience proves, strict follow-up of caval filters for early detection of complications is mandatory even with well-established filter types.

[Laryngeal and hypopharyngeal carcinoma--the limits and advantages of sonography]. / Das Larynx- und Hypopharynxkarzinom--Grenzen und Vorteile der Sonographie.

29 patients with carcinoma of the larynx and the hypopharynx were evaluated not only for staging cervical lymph nodes but also for classification of the primary tumour. With appropriate technique it is possible to assess tumour infiltration (T4) of surrounding tissue of the larynx at all levels. Tumour classification T1 to T3 is possible in patients with tumour of the epiglottis (regio supraglottis, UICC). The endolaryngeal tumour T1 to T3 (regio glottis and subglottis, UICC) still remains the domain of the microlaryngoscopy. The limits of the method are apparent in hypopharynx carcinomas where in only 50% of the patients the tumour could be assessed.

[The value of barium double-contrast study in the aftercare of gastrectomy patients (Roux-Y)]. / Stellenwert der Barium-Doppelkontrast-Untersuchung in der Nachsorge von Gastrektomierten (Roux-Y).

We evaluated 32 patients who had undergone jejuno-oesophagostomy for gastric carcinoma. Double contrast radiography was performed 3 to 36 months after gastrectomy, 3 to 14 days prior to routine endoscopy. Endoscopy is superior to double contrast radiography in detecting tumour recurrence, particularly in small tumours, due to the possibility of biopsy. Double contrast radiography is excellent in demonstrating the afferent loop. We found a high number of jejuno-oesophageal reflux and very different small intestine transit times without correlation to clinical signs and symptoms.

[Findings of digital intensive or bed lung radiographs at the monitor vs. hard copy: a clinical ROC study]. / Befundung von digitalen Intensiv- bzw. Bettlungenaufnahmen am Monitor vs. Hardcopy: eine klinische ROC-Studie.

45 bedside chest examinations acquired with storage phosphorus radiography, were displayed on a viewing box as single-format hard copies and at a high-performance digital reporting console. 6 observers performed an ROC study. For the pathologies under question, significantly better results were shown in monitor reporting due to pneumonic infiltration whereas no significant differences were found for pulmonary or mediastinal masses, or for pneumothoraces.

Filmless digital radiology--feasibility and 20 month experience in clinical routine.

We present the clinical experiences of PACS based on 20 months routine operation of the first filmless radiology department worldwide. PACS planning and implementation strategies for potential vendors are discussed. The actual implementation status of this major teaching hospital with currently 560 acute-care beds comprises three computed radiography systems, five digital fluoroscopic units, eight ultrasound machines, five mobile units, three angio suites and two CT's interconnected with a PACS, a RIS, which is coupled with three voice-recognition systems for report generation during nights, and a HIS. Primary diagnosis is performed on 16 workstations with two to six high-resolution, high-contrast monitors. Twenty-six peripheral viewing stations provide image display on the wards and in outpatient clinics. During the first 20 months 586.047 images have been acquired, resulting in 1.3 Tbyte of data stored on optical disks. Currently the daily data production is 5-6 Gbyte, the network traffic 15-18 Gbyte. Benefits of PACS primarily are reliable access to image information, speeding up report cycle time, which contributes to the reduction of the average patient length of stay (LOS). The LOS in our hospital is the shortest (6.4 days) of all Austrian hospitals. So it may be stated that PACS improves the quality of health care.

[Clinical experiences with PACS: digital radiology]. / Klinische Erfahrungen mit PACS: Digitale Radiologie.

We present our experience during the first 21 months of using hospital-wide network technology and digital archiving in connection with digital radiology in the Radiology Department at the SMZO/Danube hospital in Vienna. This means digital generation, archiving and distribution of radiographs as well as monitor reporting embedded in HIS and RIS. The clinical use of PACS demands full integration of all subsystems and modalities in a digital way, as was first realized at the Danube Hospital. With this approach, a reduction in radiation dose, improved communication and thus a reduction in the length of hospital stay and health care cost are attained.

[Teleconsultation 2001--report of the Teleconsultation Study Circle of the Austrian Roentgen Society (ORG)]. / Telekonsultation 2001--Bericht des Arbeitskreises Telekonsultation der Osterreichischen Röntgengesellschaft (ORG).

In 1997, the working group "Teleconsultation" of the Austrian Roentgen Society (ORG) has performed a first survey about the status of teleradiological applications in Austria. Now, in 2001, a second survey was performed in order to adapt the ORG's approach in this field to the most actual needs. Most of the 38 teleradiological projects in Austria already working or shortly before inauguration are aiming at an improvement of the medical service in favour of our patients (expert consultation, image transfer to doctors requesting radiological examinations, clinical case discussion). However, a small but not unimportant fraction of teleradiology projects in Austria (11%) is performed for replacement of radiologists on duty, therefore for reasons mainly directed to minimising costs for the hospital administration. Other purposes of teleradiology projects, like quality assurance and medical education have even lost their small importance the 1997 survey already has shown. This paper discusses the professional implications from the results of the 2001 survey and the legal framework for the application of telecommunication in diagnostic radiology. The most important goal of all professional activities in radiology is the well-being of our patients, based on the immediacy of the medical profession in accordance with the "physician law".

[Differential diagnosis of a low echo thyroid gland]. / Zur Differentialdiagnose der echoarmen Schilddrüse.

Hypothyrosis as a result of inflammatory disease of the thyroid gland, often is a diagnostic problem because of the insidous onset and its lack of specific symptoms. In the rather large amount of literature about sonography of the thyroid no papers with a systematic approach to this entity are found. In a prospective study we evaluated 36 proven cases and found a characteristic sonographic pattern of the thyroid with regard to its size, contour and structure.

[Ultrasound in diagnosis of traumatic intra-abdominal lesions. Value in primary diagnosis in the shock unit]. / Sonographie in der Diagnostik intraabdominaler traumatischer Läsionen. Stellenwert bei der Primärdiagnostik im Schockraum.

AIM: To evaluate sonography as a tool for initial diagnosis in emergency room patients with abdominal trauma. METHOD: 174 cases of abdominal trauma were selected from 1837 emergency care patients. The initial sonographic findings were compared to CT-evaluation, operative and autopsy results, and both clinical and sonographic follow-up. RESULTS: In 31 cases initial sonographic findings were positive, leading to 6 laparotomies. In another 6 cases, changes of follow-up sonographic testing led to laparotomy. In 143 patients, the initial sonographic evaluation was negative. In this group, follow-up evaluation revealed changes in 16 cases leading to 3 laparotomies. In 8 patients with stab injuries, the negative sonographic study was confirmed by operative findings. CONCLUSION: Sonography is a well-tested diagnostic method in evaluating patients with abdominal trauma. Follow-up examinations-even with negative initial results-are needed. While the time interval between evaluations depends on the individual risk factors, hourly reevaluation is generally appropriate.

[Differential diagnosis of the low-echo thyroid gland]. / Zur Differentialdiagnose der echoarmen Schilddrüse.

Hypothyrosis as a result of inflammatory disease of the thyroid gland, often is a diagnostic problem because of the insidious onset and its lack of specific symptoms. In the rather large amount of literature about sonography of the thyroid no papers with a systematic approach to this entity are found. In a prospective study we evaluated 36 proven cases and found a characteristic sonographic pattern of the thyroid with regard to its size, contour and structure.

[Noninvasive diagnosis of post-puncture vascular complications of the femoral artery: i.v. DSA and duplex sonography]. / Nichtinvasive Diagnostik postpunktioneller Gefässkomplikationen der Arteria femoralis: i.v. DSA und Duplexsonographie.

In 1200 cases of angiographic or invasive procedures with puncture of the femoral artery, vascular complications occurred in 10 patients (0.8%). In a prospective study, duplex sonography and intravenous digital subtraction angiography were used as diagnostic methods in these cases. All 10 cases with vascular complications were diagnosed correctly by means of i.v. DSA, and the underlying pathology was documented exactly. Duplex sonography yielded the correct diagnosis in 8 cases, and 1 case was incorrectly diagnosed as an aneurysm; angiography suggested an arteriovenous fistula, which was surgically verified. In one case duplex sonography was negative. The noninvasive procedure of duplex sonography plays an important role in the diagnosis of post-puncture vascular complications. Because of its high accuracy, this simple method should be the first diagnostic step. Intravenous DSA should be used in cases where the results obtained with duplex sonography are equivocal.