[Quality assessment using AGIR: results and experience]. / Qualitätsmanagement mittels AGIR: Ergebnisse und Erfahrungen.

PURPOSE: To evaluate whether a new software from the working group for interventional radiology (AGIR) is an appropriate tool for quality assurance in interventional radiology, and presentation of results acquired within the quality improvement process in 1999. PATIENTS AND METHODS: AGIR-defined parameters such as patient data, risk profile, given interventions as well as complications were registered by a recently developed software. Based on monthly data analyses, possible complications were identified and discussed in morbidity and mortality conferences. RESULTS: 1014 interventions were performed in our institution in 1999. According to criteria established by AGIR, the complication rate was 2.7%. In addition and according to SCVIR criteria, complications were distinguished quantitatively in five classes and semiquantitatively in minor and major groups. The result was a minor complication rate of 1.8%, and a major rate of 0.9%. There were no cases of death associated with the intervention. Further strategies were developed in order to reduce the complication rate. CONCLUSION: Extensive quality assurance methods can be integrated in daily routine work. These methods lead to an intensive transparency of treatment results, and allow the implementation of continuous quality improvements. The development of the software is a first step in establishing a nation-wide quality assurance system. Nevertheless, modification and additional definition of the AGIR predefined parameters are required, for example, to avoid unnecessary procedures.

[Optimizing intravenous bolus contrast medium injection in cervical CT diagnosis]. / Optimierung der intravenösen Kontrastmittelbolusinjektion in der zervikalen CT-Diagnostik.

PURPOSE: A prospective, comparative study of 60 patients for optimizing contrast medium (CM) administration for spiral CT of the neck. METHODS: Prior to the investigation, the patients were randomly assigned to three groups (n = 20 each): a) conventional CT technique, interscan duration 10 s, CM volume 150 ml of Ultravist 300 (30 ml at a flow rate of 1.5 ml/s, the remaining 120 ml as maintenance dosage of 0.5 ml/s); b) so-called dynamic CT technique, interscan duration 5 s, CM volume 100 ml (200 ml at a flow rate of 2 ml/s and 80 ml with a flow rate of 0.5 ml/s); c) spiral CT technique, total investigation time to store the crude data was 30 s, a CM dosage of 50 ml at a flow rate of 2 ml/s (30 ml) in the first phase and 0.7 ml/s (20 ml) in the second phase was studied. RESULTS: The current evaluation of the CM time-density course, image quality, diagnostic efficiency, and investigation time showed that a good to very good contrast medium enhancement of the neck vessels was achieved in all groups so that pathological findings were well differentiated. CONCLUSIONS: The CM volume could be reduced to a third of the original used amount without loss of diagnostic security by use of the spiral CT technique.

Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET.

PURPOSE: To compare the diagnostic accuracy of magnetic resonance (MR) imaging with that of positron emission tomography (PET) with 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) for detecting metastatic lymph nodes in patients with cervical cancer. MATERIALS AND METHODS: Before radical hysterectomy and pelvic lymphadenectomy in 35 patients with International Federation of Gynecology and Obstetrics stage IB or II cervical cancer, abdominal FDG-PET and MR imaging were performed. Malignancy criteria were a lymph node diameter of 1 cm or more at MR imaging and a focally increased FDG uptake at PET. The findings of FDG-PET and MR imaging were compared with histologic findings. RESULTS: Histologic examination revealed pN0-stage cancer in 24 patients and pN1-stage cancer in 11 patients. On a patient basis, node staging resulted in sensitivities of 0.91 with FDG-PET and 0.73 with MR imaging and specificities of 1.00 with FDG-PET and 0.83 with MR imaging. The positive predictive value (PPV) of FDG-PET was 1.00 and that of MR imaging, 0.67 (not significant). The metastatic involvement of lymph node sites was identified at FDG-PET with a PPV of 0.90; at MR imaging, 0.64 (P <.05, Fisher exact test). CONCLUSION: Metabolic imaging with FDG-PET is an alternative to morphologic MR imaging for detecting metastatic lymph nodes in patients with cervical cancer.