Abdominal radiograph usage trends in the setting of constipation: a 10-year experience.

PURPOSE: Limited data are available to guide the use of abdominal radiographs in the setting of constipation, especially in adults. Anecdotally, there has been a recent increase in such examinations. We sought to determine ordering trends for abdominal radiographs ordered to assess constipation, as well as to better understand referring clinician and radiologist opinion on such examinations. METHODS: We conducted a retrospective review of all abdominal radiographs performed between 2004 and 2014 at our institution with a primary indication of constipation. We also surveyed clinicians and radiologists regarding their opinions and practices involving such examinations. RESULTS: Constipation radiograph volume increased by approximately 56% over the 10-year period, while volume of all other abdominal radiographs decreased. Growth was greatest in adult females. Both radiologists and clinicians agree that constipation is a clinical diagnosis and are neutral as to whether radiographs help make the diagnosis. Clinicians somewhat agree that radiographs are helpful in determining management and find quantitation of stool burden within the radiology report helpful. Radiologists tend to find radiographs inaccurate at quantifying stool burden. Clinicians tend to agree that the increasing use of radiographs for constipation is appropriate while radiologists disagree. Education on these trends did not affect the intended future ordering practice of referring clinicians. CONCLUSIONS: Constipation abdominal radiograph volume has disproportionately increased, especially in adult women. Clinicians and radiologists agree that constipation is a clinical diagnosis. Otherwise, the groups tend to have differing opinions on the utility of such examinations. Clinicians indicated no intention to change their ordering practices. Further investigation is needed to better define the role of imaging for this indication, including how the radiologist may best interpret and report such examinations.

Imaging Advances in Urolithiasis.

The prevalence of urinary stones in the United States has been described as 1 in 11 persons reporting a history of stones. Imaging plays a crucial role in diagnosis, management, and follow-up for these patients and imaging technology over the last 100 years has advanced as the disease prevalence has increased. CT remains the gold standard for imaging urolithiasis and changes in this technology, with the addition of multidetector CT and dual-energy CT, as well as the changes in utilization of CT, have decreased the radiation dose encountered by patients and allowed for improved stone detection. The use of digital tomography has been introduced for follow-up of recurrent stone formers offering the potential to lower radiation exposure over the course of a patient's lifelong treatment. However, there is still a demand for improved imaging techniques to detect smaller stones and stones in larger patients at lower radiation doses as well as the continued need for the judicious use of all imaging modalities for healthcare cost containment and patient safety.

Radiology research in mainland China in the past 10 years: a survey of original articles published in Radiology and European Radiology.

PURPOSE: To evaluate the features and trends of Radiology research in Mainland China through bibliometric analysis of the original articles published in Radiology and European Radiology (ER) between 2006 and 2015. MATERIALS AND METHODS: We reviewed the original articles published in Radiology and ER between 2006 and 2015. The following information was abstracted: imaging subspecialty, imaging technique(s) used, research type, sample size, study design, statistical analysis, study results, funding declarations, international collaborations, number of authors, department and province of the first author. All variables were examined longitudinally over time. RESULTS: Radiology research in Mainland China saw a substantial increase in original research articles published, especially in the last 5 years (P < 0.001). Within Mainland China's Radiology research, neuroradiology, vascular/interventional Radiology, and abdominal Radiology were the most productive fields; MR imaging was the most used modality, and a distinct geographic provenience was observed for articles published in Radiology and ER. CONCLUSION: Radiology research in Mainland China has seen substantial growth in the past 5 years with neuroradiology, vascular/interventional Radiology, and abdominal Radiology as the most productive fields. MR imaging is the most used modality. Article provenience shows a distinct geographical pattern. KEY POINTS: • Radiology research in Mainland China saw a substantial increase. • Neuroradiology, vascular/interventional Radiology, and abdominal Radiology are the most productive fields. • MRI is the most used modality in Mainland China's Radiology research. • Guangdong, Shanghai, and Beijing are the most productive provinces.

El carbonato de lantano tiene una apariencia radiopaca en la radiografía de abdomen / Lanthanum carbonate has a radiopaque appearance on the plain abdominal radiography

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Changing Abdominal Imaging Utilization Patterns: Perspectives From Medicare Beneficiaries Over Two Decades.

PURPOSE: To assess changing utilization patterns of abdominal imaging in the Medicare fee-for-service population over the past two decades. METHODS: Medicare Physician Supplier Procedure Summary master files from 1994 through 2012 were used to study changes in the frequency and utilization rates (per 1,000 Medicare beneficiaries per year) of abdominal CT, MRI, ultrasound, and radiography. RESULTS: In Medicare beneficiaries, the most frequently performed abdominal imaging modality changed from radiography in 1994 (207.4 per 1,000 beneficiaries) to CT in 2012 (169.0 per 1,000). Utilization rates of abdominal MR (1037.5%), CT (197.0%), and ultrasound (38.0%) all increased from 1994-2012 (but declined briefly from 2007 to 2009). A dramatic 20-year utilization rate decline occurred for gastrointestinal fluoroscopic examinations (-91.9% barium enema, -80.0% upper gastrointestinal series) and urologic radiographic examinations (-95.3%). Radiologists were the dominant providers of all modalities, accounting for >90% of CT and MR studies, and >75% of most ultrasound examination types. CONCLUSIONS: Medicare utilization of abdominal imaging has markedly changed over the past two decades, with overall dramatic increases in CT and MRI and dramatic decreases in gastrointestinal fluoroscopic and urologic radiographic imaging. Despite these changes, radiologists remain the dominant providers in all abdominal imaging modalities.

Gastritis enfisematosa con gas venoso portal: tratamiento conservador en abdomen agudo de causa infrecuente / Emphysematous gastritis associated with portal venous gas: Medical management to an infrequent acute abdominal pain

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Endometriosis como causa de obstrucción intestinal tratada por vía laparoscópica / Endometriosis as a cause of bowel obstruction treated with laparoscopy

La endometriosis intestinal es una causa poco frecuente de abdomen agudo que debe incluirse en el diagnóstico diferencial de la obstrucción intestinal en mujeres fértiles con antecedentes de episodios repetidos de dolor abdominal. Presentamos un caso clínico de dicha patología, diagnosticada mediante laparoscopia exploradora ante un cuadro de obstrucción intestinal sin respuesta al tratamiento conservador (AU)

Intestinal endometriosis is a very uncommon cause of acute abdomen that must be included in the differential diagnosis of small bowel obstruction in young fertile women with a history of recurrent abdominal pain. We present a case of this disease diagnosed by exploratory laparoscopy in a patient with bowel obstruction and no response to conservative treatment (AU)

Emerging techniques for dose optimization in abdominal CT.

Recent advances in computed tomographic (CT) scanning technique such as automated tube current modulation (ATCM), optimized x-ray tube voltage, and better use of iterative image reconstruction have allowed maintenance of good CT image quality with reduced radiation dose. ATCM varies the tube current during scanning to account for differences in patient attenuation, ensuring a more homogeneous image quality, although selection of the appropriate image quality parameter is essential for achieving optimal dose reduction. Reducing the x-ray tube voltage is best suited for evaluating iodinated structures, since the effective energy of the x-ray beam will be closer to the k-edge of iodine, resulting in a higher attenuation for the iodine. The optimal kilovoltage for a CT study should be chosen on the basis of imaging task and patient habitus. The aim of iterative image reconstruction is to identify factors that contribute to noise on CT images with use of statistical models of noise (statistical iterative reconstruction) and selective removal of noise to improve image quality. The degree of noise suppression achieved with statistical iterative reconstruction can be customized to minimize the effect of altered image quality on CT images. Unlike with statistical iterative reconstruction, model-based iterative reconstruction algorithms model both the statistical noise and the physical acquisition process, allowing CT to be performed with further reduction in radiation dose without an increase in image noise or loss of spatial resolution. Understanding these recently developed scanning techniques is essential for optimization of imaging protocols designed to achieve the desired image quality with a reduced dose.

CT angiography in the abdomen: a pictorial review and update.

The development of multidetector CT technology and helical scanning techniques has revolutionized the use of CT for primary diagnostic evaluation of the abdominal vasculature, particularly the arterial system. CT angiography has numerous benefits relative to conventional catheter angiography, and has largely replaced catheter-based techniques in many clinical algorithms. This pictorial review and update will cover important technical principles related to modern CT angiography (including contrast delivery and dose considerations), discuss relevant anatomy and variants, and illustrate numerous arterial conditions related to the abdominal aorta and branch vessels.

Perspectives on radiation dose in abdominal imaging.

Reported instances of patients' overexposure to imaging-related radiation have spurred the radiology and medical physics communities to identify and develop methods for decreasing the amount of radiation used to achieve diagnostic-quality images. These initiatives include examining and optimizing conventional CT scanning parameters, introducing innovative scan protocols, and incorporating novel dose reduction technologies. The greatest challenge to effective dose reduction in the abdomen and pelvis remains patient size. Here, we review the state of the art in abdominopelvic CT in both adult and pediatric patients and describe some of our own efforts in dose reduction for these types of examinations.

Exploración laparoscópica de la vía biliar y coledocorrafia sobre prótesis biliar: dejando atrás el tubo de Kehr / Laparoscopic common bile duct exploration and antegrade biliary stenting: leaving behind the Kehr tube

Introducción: el tratamiento de la colecisto-coledocolitiasis por vía laparoscópica en un tiempo ha demostrado resultados comparables a la colecistectomía laparoscópica asociada a CPRE. Clásicamente, la coledocorrafia se ha realizado sobre un tubo en T para permitir la derivación externa del flujo biliar. Sin embargo, su retirada está asociada a una significativa tasa de complicaciones. El uso de prótesis biliares anterógradas, evita toda la morbilidad asociada a la retirada del tubo en T. En este estudio, comparamos los resultados entre la coledocorrafia sobre Kehr vs. prótesis biliar en nuestra serie de colédoco-litotomía laparoscópica. Material y métodos: entre 2004 y 2011, hemos intervenido 75 pacientes de colecisto-coledocolitiasis por vía laparoscópica, realizando en 47 casos la coledocorrafia sobre un tubo de Kehr y sobre prótesis biliar transpapilar en los 28 restantes. Resultados: la estancia postoperatoria fue menor en el grupo prótesis (5 ± 10,26 días) que en el grupo Kehr (12 ± 10,6 días), siendo estadísticamente significativa. Se observó una mayor tendencia a las complicaciones grado B en el grupo prótesis (10,7 vs. 4,3 %) y complicaciones grado C en el grupo Kehr (6,4 vs. 3,6 %). La tasa de coledocolitiasis residual fue de 3 casos en el grupo Kehr (6,4 %) y ninguno en el grupo prótesis. Conclusiones: la coledocorrafia sobre prótesis biliar transpapilar por vía laparoscópica es una técnica efectiva y segura para el tratamiento de la colecisto-coledocolitiasis en un único tiempo, evitando todas las complicaciones derivadas del manejo y retirada del tubo de Kehr(AU)

Introduction: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS) has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE). Material and methods: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed following Kehr tube placements in 47 cases and transpapillary biliary stenting was conducted in the remaining 28 patients. Results: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days) than in the Kehr group (12 ± 10.6 days), with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 %) and to grade C complications in the Kehr group (6.4 vs. 3.6 %). There were 3 cases of residual common bile duct stones in the Kehr group (6.4 %) and none in the stent group. Conclusions: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity(AU)

The optimal contrast media policy in CT of the liver. Part II: Clinical protocols.

The advent of multidetector computed tomography (MDCT) revolutionized abdominal imaging. In particular, the definitive assessment of CT injection protocols, for the evaluation of the liver parenchyma, is still a critical issue for radiologists. Over the last years, this feature encouraged several authors to address their efforts to find the most accurate delay between the contrast medium injection and the effective scan-start, for the identification and characterization of liver lesions. Technological developments of the present century such as number of slices, submillimetric collimation, and the use of multiple dynamic post-contrast phases per single examination, may all contribute to increase the radiation exposure of single patients. The aim of this review is to propose liver imaging protocols, taking into consideration different clinical needs such as patients with chronic liver disease, healthy patients with focal liver lesion, and oncological patients to minimize radiation exposure. Finally, two recent innovations in MDCT which illustrate the potential application of multi-energy computed tomography (MECT) and perfusion computed tomography (CTp) when evaluating liver parenchyma will be discussed in a short closing paragraph.

Nationwide surveys of chest, abdomen, lumbosacral spine radiography, and upper gastrointestinal fluoroscopy: a summary of findings.

This paper reports findings from Nationwide Evaluation of X-ray Trends surveys conducted in 2001, 2002, and 2003 of clinical facilities that perform routine radiographic examinations of the adult chest, abdomen, lumbosacral spine, and upper gastrointestinal fluoroscopic examinations. Randomly identified clinical facilities were surveyed in approximately 40 participating states. For the surveyed radiographic exams, additional facilities that use computed radiography or digital radiography were surveyed to ensure adequate sample sizes for determining comparative statistics. State radiation control personnel performed site visits and collected data on patient exposure, radiographic/fluoroscopic technique factors, image quality, and quality-control and quality-assurance practices. Results of the NEXT surveys are compared with those of previous surveys conducted in 1964 and 1970 by the U.S. Public Health Service and the Food and Drug Administration. An estimated 155 million routine adult chest exams were performed in 2001. Average patient entrance skin air kerma from chest radiography at facilities using digital-based imaging modalities was found to be significantly higher (p < 0.001), but not so for routine abdomen or lumbosacral spine radiography. Digital-based imaging showed a substantial reduction in patient exposure for the radiographic portion of the routine upper gastrointestinal fluoroscopy exam. Long-term trends in surveyed diagnostic examinations show that average patient exposures are at their lowest levels. Of concern is the observation that a substantial fraction of surveyed non-hospital sites indicated they do not regularly have a medical physics survey conducted on their radiographic equipment. These facilities are likely unaware of the radiation doses they administer to their patients.

Noncardiac findings on cardiac CT part I: Pros and cons.

Cardiac computed tomography (CT) has evolved into an effective imaging technique for the evaluation of coronary artery disease in selected patients. Two distinct advantages over other noninvasive imaging modalities include its ability to evaluate directly the coronary arteries and to provide an opportunity to evaluate extracardiac structures, such as the lungs and mediastinum. Some centers reconstruct a small field of view (FOV) cropped around the heart, but a full FOV (from skin to skin in the irradiated area) is obtainable in the raw data of every scan so that clinically relevant noncardiac findings are identifiable. Debate in the scientific community has centered on the necessity for this large FOV evaluation. A review of noncardiac structures provides the opportunity to make alternative diagnoses that may account for the patient's presentation or to detect important but clinically silent problems such as lung cancer. Critics argue that the yield of biopsy-proven cancers is low and that the follow-up of incidental noncardiac findings is expensive, resulting in increased radiation exposure and possibly unnecessary further testing. In this two-part review we outline the issues surrounding the concept of the noncardiac read looking for noncardiac findings on cardiac CT. Part I focuses on the pros and cons of the practice of identifying noncardiac findings on cardiac CT.