Improvement in breast magnetic resonance imaging after a sentinel procedure for breast cancer with superparamagnetic tracers.

The superparamagnetic iron oxide tracer Sienna+® was introduced as an alternative to the radioisotope 99Tc Nanocoll to preoperatively mark sentinel lymph nodes in breast cancer. As previously reported, this tracer causes susceptibility artifacts on magnetic resonance imaging (MRI), potentially hampering the diagnostic performance of follow-up breast MRI. This short report illustrates the temporal development of these artifacts in a patient who was followed up at 6, 12, and 18 months after administration of Sienna+® with MRI systems of different magnetic field strengths (1.5 T and 3.0 T) and using an MRI protocol with sequences optimized for artifact reduction. Although the artifacts were severe and predominant at the higher magnetic strength in the early postoperative period, they diminished over time and the image quality could be further improved by adapting the sequences. These findings indicate the possible use of MRI even after administration of a superparamagnetic tracer for post-treatment monitoring in breast cancer.

Accuracy of Ex Vivo Semiautomatic Segmentation of Urinary Stone Size in Computed Tomography Compared With Manual Size Estimation in Radiographic Correlation.

OBJECTIVE: To evaluate the accuracy of semiautomated segmentation of urinary stone size in computed tomography (CT) compared with manual measurement. MATERIALS AND METHODS: A total of 103 patients (32f, 71m ; mean age 52 years±18 that were diagnosed with urolithiasis and collected stones received standardized ex vivo CT-scans and radiography of the stones. Stone size was segmented semiautomatically using commercial software (syngo.via, Siemens, Germany) and compared with manual caliper measurement on digital radiography. RESULTS: Mean size was 4.4 mm in CT and 4.6 mm in radiography. Depending on number of stones analyzed per patient, estimation of stone size showed moderate to excellent correlation for both methods. There was no significant difference in overall size measurement. CONCLUSION: Semiautomatic segmentation of urinary stone size in CT is possible and reduces measurement errors, allowing more precise estimation especially for smaller concrements. Neighboring stones may hamper segmentation of stone size.

[Radiographic, MR or ultrasound contrast media in pregnant or breast-feeding women: what are the key issues?]. / Röntgen-, MR- oder Ultraschallkontrastmittel während der Schwangerschaft oder Stillzeit: Was ist zu beachten?

The use and the safety of radiographic, MR- or ultrasound contrast media in the diagnostic work-up of pregnant or lactating patients is a frequently discussed question. As only sparse clinical data is available, a careful benefit-risk assessment must contain physico-chemical properties, preclinical data including teratogeneity and embryotoxicity, as well as maternal and foetal exposure. With consideration to the individual risks, iodinated contrast media, macrocyclic MR contrast media with increased stability or sulphur hexafluoride ultrasound contrast media may, if clinically justified, be administered in the smallest possible doses throughout pregnancy. After parental administration of an iodinated contrast medium after the 12th week of pregnancy, the neonate's thyroidal function should be checked during the first week after birth. After parental administration of iodinated, stable macrocyclic, gadolinium or ultrasound contrast media, lactation can be continued normally. In any case, contrast media should be used with caution and only if the benefits outweigh the risk.

Specialising in radiology in Switzerland: still attractive for medical school graduates?

PURPOSE: To gain insight into the professional characteristics of radiologists in Switzerland and to determine how to enhance the attractiveness of radiology to medical graduates as a specialty. MATERIALS AND METHODS: Data from 262 members of the Swiss Society of Radiology (m:f = 76:24%) obtained in a questionnaire survey were analysed regarding socio-demographic variables, working status, specialty, main fields of interest, career success, mentoring and reasons for the shortage of radiologists. RESULTS: 35 (56.4%) female and 85 (45.5%) male radiologists were aged ≤ 45 years. 228 (87%) were board-certified; 44 (17.9%) had completed a sub-specialisation. Men worked part-time mostly just before retirement, while women worked part-time at a younger age. As reasons for specialty choice, the wide range of clinical work and the combination of technology and medicine were ranked highest. Women reported significantly less career success and support. To improve the attractiveness of radiology to graduates, radiology should be visible on medical school curricula. CONCLUSION: In Switzerland, more female radiologists work part-time than male ones, and there is less career success and support for women. In order to make radiology more attractive to medical graduates as a specialty, structured residency programmes and reliable gender-respecting career support are needed.

[Torsion of a pedunculated subserous myoma - a rare differential diagnosis of the acute abdomen]. / Torsion eines gestielten subserösen Myoms - eine seltene Differentialdiagnose des akuten Abdomens.

We report about a rare case of acute abdomen in a 43 years old female patient who noticed a sudden onset of severe lower abdominal pain, increasing in strength within a few hours. The transabdominal and transvaginal ultrasound showed an enlarged leiomyomatous uterus with a questionable torsion of a pedunculated subserous leiomyoma. The following magnetic resonance imaging confirms this diagnosis. During the laparoscopy a myomectomy has been performed.

Workplace experience of radiographers: impact of structural and interpersonal interventions.

PURPOSE: Within the framework of organisational development, an assessment of the workplace experience of radiographers (RGs) was conducted. The aims of this study were to develop structural and interpersonal interventions and to prove their effectiveness and feasibility. METHODS: A questionnaire consisting of work-related factors, e.g. time management and communication, and two validated instruments (Workplace Analysis Questionnaire, Effort-Reward Imbalance Scale) was distributed to all RGs (n = 33) at baseline (T1). Interventions were implemented and a follow-up survey (T2) was performed 18 months after the initial assessment. RESULTS: At T1, areas with highest dissatisfaction were communication and time management for ambulant patients (bad/very bad, 57% each). The interventions addressed adaptation of work plans, coaching in developing interpersonal and team leadership skills, and regular team meetings. The follow-up survey (T2) showed significantly improved communication and cooperation within the team and improved qualification opportunities, whereas no significant changes could be identified in time management and in the workplace-related scales 'effort' expended at work and 'reward' received in return for the effort. CONCLUSION: Motivating workplace experience is important for high-level service quality and for attracting well-qualified radiographers to work at a place and to stay in the team for a longer period.

[Abdominal mass and colicky pain in a 16-years-old patient]. / Abdominale Resistenz mit krampfartigen Oberbauchschmerzen bei einer 16-jährigen Frau.

We report about a 16-years-old patient with a newly developed palpable mass and pain in the epigastrium. On computed tomography, a trichobezoar was diagnosed. Complementary history, gathered retrospectively, revealed trichophagia and swallowing of chewing gum. Gastroscopic disintegration of the trichobezoar was unsuccessful and it therefore had to be removed by open surgery.

[Acute thoracic pain]. / Akuter Thoraxschmerz.

We report the case of a 56 year-old female patient without previous medical history presenting in the emergency room with acute left-sided thoracic pain and dyspnea. Initial lab exams, ECG and chest X-ray in supine position were normal and excluded most common pathologies, e.g. a large pneumothorax or myocardial infarction. A subsequent computed tomography to exclude an aortic dissection or pulmonary embolism showed left-sided sero-pneumothorax and mediastinal air. A spontaneous esophageal rupture (Boerhaave Syndrome) was diagnosed. An additional fluoroscopic study was performed to evaluate the exact site of rupture.

[Gastrointestinal stromal tumor (GIST): imaging findings and differential diagnosis]. / Gastrointestinaler Stroma- Tumor (GIST): Radiologische Bildgebung und Differentialdiagnosen.

We report the preoperative imaging findings of a 75 year old man with a large tumor of the lower abdomen. Computed tomography showed a large intraabdominal mass. In the differential diagnosis a gastrointestinal stromal tumor (GIST) or a metastasis of an unknown primary neoplasia were considered. Histology confirmed the diagnosis of a gastrointestinal stromal tumor (GIST).

[Posttraumatic right sided diaphragmal hernia]. / Posttraumatische Zwerchfellhernie.

This case report demonstrates a post-traumatic right sided diaphragmal hernia presenting 17 years after trauma with acute abdominal pain. An incarcerated duodenal bowel loop was radiologically suspected and confirmed by subsequent surgery.

[Which factors influence job satisfaction and motivation in an institute of radiology?]. / Welche Faktoren beeinflussen die Arbeitszufriedenheit und -motivation an einem Institut für Radiologie?

PURPOSE: As empirically shown, increasing job satisfaction and motivations correlates with reduced job fluctuation and costs of absenteeism in an organisation. To provide a motivating environment for employees becomes more important in the health-care system and thus also in radiology. The purpose of our study was therefore to evaluate job satisfaction of our team and to define important influencing factors. METHODS: For data collection, as standardized questionnaire was designed. As a result of a discussion in a focus group, 9 indicators characterizing job satisfaction and motivation were determined (four-point ordinal scale), in addition there were open questions as well as space for comments. The questionnaires were distributed to all employees at the institute during the study period 11/2005. It was assured in the study design that data analysis was anonymous. For statistical analysis, all replies were coded (scale 1-4) and transferred to an excel sheet. RESULTS: Rate of return was 92% (46/50). In general, employees enjoyed work (mean 3.37 +/- 0.5); no significant difference between physicians, technicians and other staff members were observed. Factors most important for personal motivation were good working climate (3.85 +/- 0.4), good reputation of the institute (3.56 +/- 0.8) and personal recognition (3.54 +/- 0.6). Wage raise (3.01 +/- 0.9) and bonus payments (3.11 +/- 0.9) were rated less important. Communication between groups of employees could be improved (2.78 +/- 0.7). When asked, which factors would improve motivation, common answer included teamwork and communication (n = 9), more participation in planning processes (n = 8), more appreciation (n = 7) and continuing education (n = 5). CONCLUSIONS: Profound knowledge of factors influencing job satisfaction and motivation of employees allows for the implementation of targeted strategies for continuous improvement.

[Right sided lower abdominal pain two weeks after delivery]. / Rechtsseitige Unterbauchschmerzen zwei Wochen postpartal.

We report the CT imaging findings of a 33 year old patient who presented to the emergency department with increasing right lower abdominal pain and shivering. She delivered a healthy baby two weeks ago after induction in the 39th week of pregnancy due to a large fetus. Two days after delivery, sterilisation was performed. Clinically the primary differential diagnosis was appendicitis. However, computed tomography revealed thrombosis of the right ovarian vein. Consequently, management was altered appropriately with administration of antibiotics as well as a therapeutic dose of low molecular weight heparin.

[Pelvic congestion syndrom]. / Beckenvenensyndrom.

We describe imaging findings and interventional therapy of a 37-year old female patient suffering from chronic pelvic pain with associated vulvar varicosis. MR-angiography showed multiple varices in the left hemi-pelvis, a dilated draining vein from the left ovary as well as a left-sided vulvar varicosis, which was clinically evident. In addition, the MRI suggested insufficiency of the great saphenous vein with varicosis of its tributaries. After crossectomy and infragenual stripping of the great saphenous vein, we proceeded with a left phlebectomy and ligation of the supplying veins. Due to post-operative persistence of the vulvar varicosis the patient underwent coil-embolisation and liquid sclerotherapy (Aethoxysklerol) of the varicose pelvic veins and the left ovarian vein with good results.

[Ovarian fibrothecoma: MR imaging findings and differential diagnosis]. / Fibrothekom des Ovars: MR-bildgebung und Differentialdiagnose.

We report the preoperative MR imaging of a 70 year old woman with a large tumor of the lower abdomen. MRI shows a extensively large mass with low signal in T2-weighted images. The origin of this tumor was suspected to be either the left ovary or the uterus. In the differential diagnosis a large subserous pedunculated leiomyoma or a low cellular, primarily benign ovarian tumor were considered.

[Evaluation of a tumor of the rib]. / Abklärung einer kostalen Raumforderung.

A 39-year old man was referred for evaluation of a left sided tumor in the region of the third and fourth rib. Computed tomography revealed a slightly enhancing costal tumor with mainly intrathoracic expansion. Calcifications inside the tumor were present. Assuming a chondrogenic tumor of unknown dignity, en bloc tumor resection and reconstruction of the chest wall was performed. By means of the histopathological examination the diagnosis of a chondrosarcoma grade I was made.