Development of a novel breast MRI phantom for quality control.

OBJECTIVE: Many indications for breast MRI exist. MRI screening can identify preinvasive breast cancer in women at high risk and in that regard is superior to mammography and ultrasound. Quality control standards exist for mammography and breast ultra-sound screening with phantoms designed specifically for this purpose. Given the growing importance of breast MRI, we propose the development of a breast MRI phantom for quality control purposes. MATERIALS AND METHODS: A breast phantom with dual cavities containing water and fat was developed. A resolution plate inside the phantom contains various shapes ranging in size from 1 to 20 mm. Twenty studies of the phantom were performed with a 1.5-T system. STIR, T1-weighted fat-suppressed, and T2-weighted sequences were completed. Relaxation times of water and fat, number of step shapes resolved on STIR and T2-weighted images, number of circles resolved on T2-weighted images, and the diameter of a 20-mm circle on T1-weighted fat-suppressed images were recorded. RESULTS: On STIR images the TR of fat was 238.70±96.31 ms and of water was 1231.92±399.14 ms. On T2-weighted images the TR of fat was 778.73±62.60 ms and of water was 1737.60±121.63 ms. On STIR images, steps 3 mm and larger were visualized in 95% of instances. On T2-weighted images steps 3 mm and larger were seen in all instances. Measurements of a 20-mm circle were 19±0.3 mm. CONCLUSION: The proposed breast MRI phantom can be used to obtain reproducible measurements and allows implementation of quality control measures for a modality that is being increasingly used.

Get a kick out of this: the spectrum of knee extensor mechanism injuries.

At the end of this article, the reader should be able to (1) recognise normal anatomy and anatomical variants of the extensor mechanism of the knee on various imaging modalities, including plain film, ultrasound and MRI; (2) diagnose a broad spectrum of EM injuries in adult and paediatric patients including patellar and quadriceps tendinopathy, Osgood-Schlatter disease, Sindig-Larsen-Johansson syndrome, chondromalacia patellae and patellar fractures on various imaging modalities; and (3) appreciate the important role of imaging in the diagnosis of musculoskeletal injuries.

The experience of conducting Mortality and Morbidity reviews in a pediatric interventional radiology service: a retrospective study.

PURPOSE: To review the experience and impact of conducting multidisciplinary Morbidity and Mortality (M&M) reviews in pediatric interventional radiology (IR) and describe issues, lessons, and recommendations. MATERIALS AND METHODS: A dedicated functionality of an existing database was developed to retrospectively analyze pediatric IR M&M issues. Patient demographics, sedation/anesthesia, and procedure type were recorded. M&M issues were assigned to at least one of 10 categories and graded as major or minor per Society of Interventional Radiology (SIR) guidelines. Issues could result in recommendations, which were divided into six categories; each was classified as implemented or not implemented. RESULTS: Of 31,983 patient encounters over a period of 10 years, 516 patient events (1.6%) were discussed at M&M reviews. A total of 772 categories were assigned; they related to the procedure (34%), patient comorbidity (20%), processes (15%), device (10%), management (8%), sedation/anesthesia (4%), medication (2%), ethical issues (1%), "near-misses" (1%), and other (5%). A total of 292 issues (57%) were graded as minor (SIR class A, n = 202; class B, n = 90) and 224 (43%) as major (SIR class C, n = 42; class D, n = 151; class E, n = 6; class F, n = 27). Twenty-seven deaths were reviewed. Of 397 recommendations made, 80% were fully implemented, 11% partially implemented, and 9% not implemented. Recommendations made related to process improvements (49%), technical changes (20%), interdisciplinary discussions (15%), educational endeavors (9%), contacting manufacturers (6%), and other issues (1%). CONCLUSIONS: As a result of regular multidisciplinary M&M reviews being conducted, a large number of practical recommendations were made for improvements in quality of care, and implemented over a 10-year period. M&M reviews provide a useful forum for team discussions and are a vehicle for change and potential improvement in the delivery of care in a pediatric IR service.

Diagnostic imaging of primary hepatic neuroendocrine tumors: a case and discussion of the literature.

Neuroendocrine tumors (NETs) are derived from neuroendocrine cells that are capable of producing functional peptide hormones. These tumors occur most frequently in the GI tract and lungs. GI NETs frequently metastasize into the liver, though NETs of primary hepatic origin are extremely rare. Ultrasound, CT, and MRI are typically all employed for characterization of these lesions but their appearance on diagnostic imaging can be highly variable. Reported here is an interesting case of a primary hepatic neuroendocrine tumor (PHNET), along with a discussion of the imaging characteristics of these tumors. Additionally, the current standards for definitive diagnosis and treatment of PHNETs are discussed.