Operational Strategies to Prevent Coronavirus Disease 2019 (COVID-19) Spread in Radiology: Experience From a Singapore Radiology Department After Severe Acute Respiratory Syndrome.

As coronavirus disease 2019 (COVID-19) infection spreads globally, the demand for chest imaging will inevitably rise with an accompanying increase in risk of disease transmission to frontline radiology staff. Radiology departments should implement strict infection control measures and robust operational plans to minimize disease transmission and mitigate potential impact of possible staff infection. In this article, the authors share several operational guidelines and strategies implemented in our practice to reduce spread of COVID-19 and maintain clinical and educational needs of a teaching hospital.

Quantitative Comparison of Misregistration in Abdominal and Pelvic Organs Between PET/MRI and PET/CT: Effect of Mode of Acquisition and Type of Sequence on Different Organs.

OBJECTIVE: The objective of our study was to quantitatively compare misregistration in selected abdominopelvic organs between PET/CT acquisitions and simultaneous and sequential PET/MRI acquisitions. SUBJECTS AND METHODS: PET/MR images of 15 healthy volunteers and seven patients with bladder cancer were acquired. Ten clinical PET/CT studies acquired during the same time frame of body mass index-matched control subjects were chosen. PET/MRI and PET/CT registration of selected abdominopelvic organs was measured and compared. RESULTS: The overall mean misregistration with PET/MRI was significantly higher than that with PET/CT (p < 0.001). Sequential PET/MRI acquisition was significantly inferior to PET/CT (p = 0.02), whereas there was no significant difference between simultaneous PET/MRI acquisition and PET/CT (p = 0.38). Simultaneous PET/MRI acquisition was significantly better than sequential PET/MRI acquisition (p < 0.001). The mean misregistration for all organs with the T1-weighted volumetric interpolated breath-hold examination (VIBE) sequence (2.39 cm) was significantly inferior to PET/CT (p < 0.001). Although the T2-weighted HASTE breath-hold sequence was significantly inferior to PET/CT (p = 0.04), the T2 HASTE non-breath-hold sequence and T2 STIR sequence (0.18 cm) were significantly superior to both PET/CT and the T1 VIBE sequence (p < 0.001). Within the same sequence (T1 VIBE breath-hold sequence), the mean misregistrations with sequential and simultaneous PET/MRI acquisitions were both significantly greater than with PET/CT (p < 0.001), whereas simultaneous PET/MRI acquisition was superior to sequential PET/MRI acquisition (p < 0.001). CONCLUSION: In the abdominopelvic organs, sequentially obtained PET/MRI data have significantly higher misregistration than both PET/CT data and simultaneously acquired PET/MRI data. Simultaneously obtained PET/MRI data are statistically noninferior to PET/CT. Nonradial T1 VIBE has the highest misregistration, whereas T2 STIR and T2 HASTE non-breath-hold are significantly better than both PET/CT and T1 VIBE.

Computed tomography appearance of ovarian cysts with hyperenhancing rim during the menstrual cycle in women of different ages.

OBJECTIVE: To determine the frequency and computed tomography (CT) characteristics of ovarian cysts in women of different ages. METHODS: Five hundred ninety-five contrast-enhanced CT studies performed in 430 females aged 10 or older between January 2001 and December 2006 were retrospectively reviewed. For each study, we recorded the presence of ovarian cysts larger than 5 mm in diameter, with or without a hyperenhancing rim (HR, NR). The frequencies and CT characteristics of HR and NR cysts were analyzed according to phase of the menstrual cycle and patient age. Independent-sample t test, analysis of variance, chi test, and Fisher exact test were used to compare continuous data and categorical data between groups. RESULTS: Ovarian cysts were more frequently seen on CT studies of women between the ages of 20 and 49 years than on those of women older than 50 years (P = 0.004). Cysts with no HR were seen in every age group; HR cysts were present only in patients younger than 50 years. Cysts with HR were seen more frequently during periovulatory and secretory phase than during menses and proliferative phase (P = 0.003). Cysts with HR had a mean volume of 1.8 cm; NR cysts had a mean volume of 5.3 cm (P = 0.004). Cysts with HR had a thicker wall (3.4 mm vs imperceptible) and a higher attenuation value (31.4 vs 14.8 Hounsfield units) and were more commonly associated with pelvic fluid (P = 0.005) than were NR cysts. CONCLUSIONS: Cysts with HR, previously proven to represent corpus luteal cysts, can be readily seen on contrast-enhanced CT studies in women of reproductive age. Familiarity of the varied CT appearance of these cysts is essential, lest they be misinterpreted as pathological entities.

Voice recognition software: effect on radiology report turnaround time at an academic medical center.

OBJECTIVE: Previous studies have documented reductions in turnaround time after implementation of voice recognition software in the generation of radiology reports. Our preliminary observations suggested that improvement in report turnaround time varies among users. The purpose of this study was to analyze the effect of work habits and caseload on such variations. SUBJECTS AND METHODS: Data were collected for 9 months before and after the implementation of voice recognition after a 6-month training period. Thirty faculty members were ranked according to their report turnaround time before and after implementation of voice recognition and according to their percentage reduction in report turnaround time. The report turnaround times before and after implementation of voice recognition for faculty were compared with the number of verified reports and work habit type. RESULTS: The average report turnaround time for the department before implementation of voice recognition was 28 hours. After implementation of voice recognition, the average turnaround time was 12.7 hours, and the volume of verified reports increased 5% between the two study periods. The improvement in report turnaround time for individual faculty members ranged from -33% to +93%, and the rank order did not change significantly (Spearman coefficient, 0.58; p < 0.05). Faculty members' ranks in report turnaround time did not correlate significantly with volume rank before and after implementation of voice recognition (Spearman coefficients, 0.341 and 0.346; p > 0.05). Faculty members who had type 1 work habits, that is, reviewed, revised, and finalized reports at the time of image review, benefited the most from use of voice recognition. CONCLUSION: Use of voice recognition software decreased report turnaround time for the department and for 28 of 30 individual faculty members. Improvement in report turnaround time does not correlate with workload but does correlate with work habits, suggesting human behavior may play a role in determining the outcome of adopting a productivity-enhancing technology.

Quality--a radiology imperative: interpretation accuracy and pertinence.

Physicians as a group have neither consistently defined nor systematically measured the quality of medical practice. To referring clinicians and patients, a good radiologist is one who is accessible, recommends appropriate imaging studies, and provides timely consultation and reports with high interpretation accuracy. For determining the interpretation accuracy of cases with pathologic or surgical proof, the author proposes tracking data on positive predictive value, disease detection rates, and abnormal interpretation rates for individual radiologists. For imaging studies with no pathologic proof or adequate clinical follow-up, the author proposes measuring the concordance and discordance of the interpretations within a peer group. The monitoring of interpretation accuracy can be achieved through periodic imaging, pathologic correlation, regular peer review of randomly selected cases, or subscription to the ACR's RADPEER system. Challenges facing the implementation of an effective peer-review system include physician time, subjectivity in assessing discordant interpretations, lengthy and equivocal interpretations, and the potential misassignment of false-positive interpretations.

Assessment of real-time 3D visualization for cardiothoracic diagnostic evaluation and surgery planning.

RATIONALE AND OBJECTIVES: Three-dimensional (3D) real-time volume rendering has demonstrated improvements in clinical care for several areas of radiological imaging. We test whether advanced real-time rendering techniques combined with an effective user interface will allow radiologists and surgeons to improve their performance for cardiothoracic surgery planning and diagnostic evaluation. MATERIAL AND METHODS: An interactive combination 3D and 2D visualization system developed at the University of North Carolina at Chapel Hill was compared against standard tiled 2D slice presentation on a viewbox. The system was evaluated for 23 complex cardiothoracic computed tomographic (CT) cases including heart-lung and lung transplantation, tumor resection, airway stent placement, repair of congenital heart defects, aortic aneurysm repair, and resection of pulmonary arteriovenous malformation. Radiologists and surgeons recorded their impressions with and without the use of the interactive visualization system. RESULTS: The cardiothoracic surgeons reported positive benefits to using the 3D visualizations. The addition of the 3D visualization changed the surgical plan (65% of cases), increased the surgeon's confidence (on average 40% per case), and correlated well with the anatomy found at surgery (95% of cases). The radiologists reported fewer and less major changes than the surgeons in their understanding of the case due to the 3D visualization. They found new findings or additional information about existing findings in 66% of the cases; however, they changed their radiology report in only 14% of the cases. CONCLUSION: With the appropriate choice of 3D real-time volume rendering and a well-designed user interface, both surgeons and radiologists benefit from viewing an interactive 3D visualization in addition to 2D images for surgery planning and diagnostic evaluation of complex cardiothoracic cases. This study finds that 3D visualization is especially helpful to the surgeon in understanding the case, and in communicating and planning the surgery. These results suggest that including real-time 3D visualization would be of clinical benefit for complex cardiothoracic CT cases.

Enhancing research in academic radiology departments: recommendations of the 2003 Consensus Conference.

Opportunities for funded radiologic research are greater than ever, and the amount of federal funding coming to academic radiology departments is increasing. Even so, many medical school-based radiology departments have little or no research funding. Accordingly, a consensus panel was convened to discuss ways to enhance research productivity and broaden the base of research strength in as many academic radiology departments as possible. The consensus panel included radiologists who have leadership roles in some of the best-funded research departments, radiologists who direct other funded research programs, and radiologists with related expertise. The goals of the consensus panel were to identify the attributes associated with successful research programs and to develop an action plan for radiology research based on these characteristics.

Enhancing research in academic radiology departments: recommendations of the 2003 Consensus Conference.

Opportunities for funded radiologic research are greater than ever, and the amount of federal funding coming to academic radiology departments is increasing. Even so, many medical school-based radiology departments have little or no research funding. Accordingly, a consensus panel was convened to discuss ways to enhance research productivity and broaden the base of research strength in as many academic radiology departments as possible. The consensus panel included radiologists who have leadership roles in some of the best-funded research departments, radiologists who direct other funded research programs, and radiologists with related expertise. The goals of the consensus panel were to identify the attributes associated with successful research programs and to develop an action plan for radiology research based on these characteristics.

Enhancing research in academic radiology departments: recommendations of the 2003 Consensus Conference.

Opportunities for funded radiologic research are greater than ever, and the amount of federal funding coming to academic radiology departments is increasing. Even so, many medical school-based radiology departments have little or no research funding. Accordingly, a consensus panel was convened to discuss ways to enhance research productivity and broaden the base of research strength in as many academic radiology departments as possible. The consensus panel included radiologists who have leadership roles in some of the most well-funded research departments, radiologists who direct other funded research programs, and radiologists with related expertise. The goals of the consensus panel were to identify the attributes associated with successful research programs and to develop an action plan for radiology research on the basis of these characteristics.

Hepatocellular carcinoma of diffuse type: MR imaging findings and clinical manifestations.

PURPOSE: To assess MR imaging findings and clinical manifestations of diffuse-type hepatocellular carcinoma (HCC). MATERIALS AND METHODS: We retrospectively reviewed our experience with diffuse HCC from November 1994 to October 2001. MR imaging findings and clinical features were assessed. RESULTS: Twenty-two consecutive patients with diffuse-type HCC (19 men and three women, age range 16-80 years [mean, 52 years]) were identified in a review of liver MR studies. This represented 13% of all patients with HCC imaged during this time period. Diffuse HCC showed a permeative, infiltrative pattern with ill-defined borders and no evidence of convex margination in all cases. At least 50% of the liver volume was involved with tumor. Diffuse-type HCC showed hypointensity in 15 patients, mixed intensity in three, and isointensity in four on T1-weighted images; heterogeneous hyperintensity in 16 patients; and homogeneous hyperintensity in six on T2-weighted MR images. Diffuse-type HCC showed patchy enhancement in 12 patients, miliary enhancement in nine, and minimal enhancement in one on postcontrast early-phase images, and showed heterogeneous wash-out in all patients on postcontrast late-phase images. Proximal portal venous tumor thrombosis was seen in all patients. Serum alpha-fetoprotein (AFP) value was elevated (>10 ng/mL) in 14 of 18 patients, and 13 showed a value greater than 500 ng/mL. The four patients who did not have elevated AFP had tumors which were indistinguishable from those in patients with elevated AFP; they also did not have a distinctive clinical history. CONCLUSION: Diffuse-type HCC was typically seen as an extensive, heterogeneous permeative hepatic tumor, with portal venous tumor thrombosis on MR images in all cases. Early enhancement, observed as patchy in 12 and miliary in nine of 22 patients, was a distinctive imaging feature. Elevated serum AFP value was a common finding; however, 22% had normal values.

Management of the clinically inapparent adrenal mass ("incidentaloma").

The National Institutes of Health Consensus Development Program convened surgeons, endocrinologists, pathologists, biostatisticians, radiologists, oncologists, and other health care professionals, as well as members of the general public, to address the causes, prevalence, and natural history of clinically inapparent adrenal masses, or "incidentalomas"; the appropriate evaluation and treatment of such masses; and directions for future research. Improvements in abdominal imaging techniques have increased detection of adrenal incidentalomas, and because the prevalence of these masses increases with age, appropriate management of adrenal tumors will be a growing challenge in our aging society. To address six predetermined questions, the 12-member nonfederal, nonadvocate state-of-the-science panel heard presentations from 21 experts in adrenal incidentalomas and consulted a systematic review of medical literature on the topic provided by the Agency for Healthcare Research and Quality and an extensive bibliography developed by the National Library of Medicine. The panel recommended a 1-mg dexamethasone suppression test and measurement of plasma-free metanephrines for all patients with an adrenal incidentaloma; additional measurement of serum potassium and plasma aldosterone concentration-plasma renin activity ratio for patients with hypertension; and surgery for patients with biochemical evidence of pheochromocytoma, patients with tumors greater than 6 cm, and patients with tumors greater than 4 cm who also meet other criteria. The panel also advocated a multidisciplinary approach to managing adrenal incidentalomas. The statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the federal government.