[Status of telemedicine in Austria]. / Stand der Telemedizin in Osterreich.

In an overview the situation of telemedicine in Austria is presented regarding the Austrian health service with the focus on patients. First the term "telemedicine" is defined according to the present definition of the European Union and the situation of the Austrian health service. Afterwards individual success components for the planning of telemedicine projects are presented. These are briefly shown by the "five-column concept" of the Tyrolean Government, which includes the medical, legal, economic, technical and quality management-oriented aspects during the planning and evaluation period of telemedicine projects. The conclusion gives an overview of individual committees and activities of the Austrian medical universities, the federation and states as well as individual Austrian telemedical societies.

[Ultrasound contrast agents and prostate cancer]. / Ultraschallkontrastmittel und Prostatakarzinom.

Prostatic carcinoma is the most frequent malignant disease in men and associated with very high mortality. The diagnostic work-up of prostatic carcinoma is based on tests to determine the level of prostate-specific antigen (PSA), digital rectal examination, and transrectal sonography. Due to diagnostic limitations, ultrasound-guided prostate biopsy is the method of choice for diagnosis of prostatic carcinoma. New imaging technologies allow detection of prostatic carcinoma, thus facilitating removal of specific biopsy specimens from these regions. Introduction of ultrasound contrast agents ("echo signal enhancers") significantly increased the diagnostic potential of this method, making it possible to visualize tumor vascularization.

Guidelines for teleradiology practice: results of the Tyrolean teleradiology pilot project.

The Tyrolean telemedicine pilot project linked the University Clinic of Innsbruck and the district hospital in Reutte. Five medical specialties were investigated: teleradiology, telepathology, teledermatology, tele-ophthalmology and tele-oncology. A Tyrolean 'four-column model of quality management in telemedicine' was introduced to ensure a global view of the project and to avoid mistakes. In teleradiology, a 12-step workflow was developed, which described the medical responsibilities at each stage. We found that the defined teleradiology workflow and the technical equipment for data security and data exchange worked without problems in over 79% of a total of 424 cases. To ensure continuous quality assurance, the whole teleradiology workflow was ISO 9001:2000 certified.

[The value of ultrasound (US) in the diagnosis of prostate cancer]. / Sonographie des Prostatakarzinoms. Derzeitiger Stand und Zukunftsperspektiven.

The value of ultrasound (US) in the diagnosis of prostate cancer has increased in importance in the past decade, which is mainly related due to the increasing incidence of prostate cancer, the most common malignancy in men. The value of conventional gray-scale US for prostate cancer detection has been extensively investigated. The introduction of US contrast agents has dramatically changed the role of US for prostate cancer detection. Advances in US techniques were introduced to further increase the role of US contrast agents. Although most of these advances in US techniques, which use the interaction of the contrast agent with the transmitted US waves are very sensitive for the detection of microbubbles, are mostly unexplored, in particular for prostate applications. First reports of contrast-enhanced US investigations of blood flow of the prostate have shown that contrast-enhanced US adds important information to the conventional US technique. We present a critical evaluation of the current status of transrectal US imaging for prostate cancer detection. Furthermore, we give background information on US contrast agents and imaging modalities. Early results of contrast-enhanced US suggest the feasibility of the use of US contrast agents to enhance US imaging of the prostate. The application of US contrast agents for the detection and clinical staging of prostate cancer is promising. However, future clinical trials will be needed to determine the promise of contrast-enhanced US of the prostate evolves into clinical application.

Benefit for the patient of a teleradiology process certified to meet an international standard.

To guarantee the quality of teleradiology services in Austria we have developed an easy-to-use and continuously re-evaluated teleradiology workflow model. This is based on the quality management model (ISO 9001:2000) of the International Standardization Organization (ISO) and guarantees the quality of the process. From January 2002 to January 2003 we examined 544 emergency teleradiology computerized tomography studies transmitted to the Department of Radiology 2 in Innsbruck. The patients were from the rural hospital of Reutte. In 450 cases (83%) the sending of the written legal final report took less than 1 h. The numbers of mistakes (mostly minor workflow errors) were reduced from 23 errors per month in January 2002 to 9 errors per month in January 2003. The continuous cross-checking of the workflow and the training of the employees involved guaranteed a better standard of teleradiology in our department. Since December 2002, the whole Tyrolean teleradiology process has been ISO 9001:2000 certified.

[Diagnosis of climbing related overuse injuries]. / Diagnostik von Uberlastungsschäden bei Sportkletterern.

Sport climbing shows an enormous increase in participation, evolving to more popularity, including even school sport activity on high standards. Therefore the number of climbing related injuries is increasing and becomes a more frequently encountered medical problem. Typical climbing associated injuries involve predominantly the upper limb. Overuse injuries are the most common climbing related injuries. The clinical examination is the first line investigation, which is often limited especially in the acute phase. However, an exact diagnosis is desirable for therapeutic management. Imaging modalities have shown to be capable for detection of climbing related injuries. An overview about the current use of x-ray, ultrasound and magnetic resonance imaging in different climbing related overuse injuries is presented.

Endocranial capacity of the bodo cranium determined from three-dimensional computed tomography.

The 600,000-year-old cranium from Bodo, Ethiopia, is the oldest and most complete early Middle Pleistocene hominid skull from Africa. "Virtual endocast" models created by three-dimensional computed tomography (CT) techniques indicate an endocranial capacity of about 1,250 cc for this cranium (with a reasonable range between approximately 1,200-1,325 cc, depending on how missing portions of the basicranial region are reconstructed). From these determinations, several important implications emerge concerning current interpretations of "tempo and mode" in early hominid brain evolution: 1) already by the early Middle Pleistocene, at least one African hominid species, Homo heidelbergensis, had reached an endocranial capacity within the normal range of modern humans; 2) in spite of its large endocranial capacity, estimates of Bodo's encephalization quotient fall below those found in a large sample of Homo sapiens (both fossil and recent) and Neandertals; and 3) the greatest burst of brain expansion in the Homo lineage may not have been in the last several hundred thousand years, but rather much earlier in the Lower to early Middle Pleistocene.

Comparison of standard and individually planned infradiaphragmatic fields in irradiation of retroperitoneal lymph nodes.

PURPOSE: In prophylactic irradiation of infradiaphragmatic lymphatic nodes (LN), the width of the paraaortic and pelvic field is given by a line joining the tips of the transverse processes of the 11th thoracic to the 4th lumbar vertebrae. Then the field boundary follows a straight line to the most lateral point of the acetabulum seen on the simulation film. Another method of setting the field border is to project the lateral contours of the large abdominal vessels from T(1)-weighted coronal MR images of the abdomen onto the simulator radiographs and add a 2-cm margin along the so delineated vessels. In our study, we compared both methods as to full enclosure of paraaortic and pelvic lymphatics or nodal miss. MATERIAL AND METHODS: Abdominal CT scans of 81 patients with involvement of paraaortic lymph node regions with LN sizes not exceeding 2.5 cm were examined. The distance from the center of the appropriate vertebra to the center of the most lateral lymph node was referred to the transverse process as well as to the outside contour of the aorta on the left and the vena cava on the right side. Respectively, the LN were measured referenced to the iliac vessels from the 5th lumbar through to the 2nd sacral vertebra. At the level of the hip joint the distance was measured from the midline as determined by a line through the center of the sacrum, perpendicular to a line connecting center of both femoral heads. RESULTS: Our measurements showed that lymph nodes do occur (1) lateral to the transverse processes of the thoracic and lumbar vertebrae as well as (2) outside the 2-cm safety margin from the lateral contour of the large abdominal vessels. CONCLUSION: These data clearly show that the traditional fields for radiation of infradiaphragmatic lymphatic nodes have not been large enough to enclose almost all retroperitoneal and pelvic lymph nodes with certainty. We recommend an expansion of the fields.

[Value of high-resolution ultrasound in the evaluation of finger injuries in extreme sport climbers]. / Stellenwert der hochauflösenden Sonographie in der Abklärung von Fingerbeschwerden bei Extremsportkletterern.

AIM: To determine the value of high-resolution ultrasound in the evaluation of finger injuries and changes due to strain in the fingers of extreme rock climbers. METHODS: High-frequency ultrasound was performed on 208 fingers of 52 extreme rock climbers (mean age: 29.7 yrs) and on 80 fingers of 20 healthy volunteers (mean age: 28.5 yrs). The following parameters were sonographically assessed: thickness of the pulley-system A2, distance between phalanx and tendon (PS distance), gliding ability of the flexor tendons, and the periarticular and peri-tendinous space. The examination was performed on the handling in a supinated position with extended fingers, followed by active and passive flexion of about 40 degrees. All climbers also underwent clinical examination. RESULTS: The pulley-system of climbers showed a significantly increased thickness of 0.17 (+/- 0.09) cm compared with the healthy volunteers (p < 0.001). PS-distances of up to 0.51 (+/- 0.15) cm were found only in symptomatic climbers and proved to be a sign of tendon bow-stringing. No impairment of gliding ability was seen in both groups. Tendon sheath cysts were detected in 76% (62) of symptomatic fingers of the climbers. CONCLUSIONS: Non-invasive high-resolution ultrasound examination of fingers proved to be a very helpful method for diagnosing changes due to strain as well as finger injuries in rock climbers, especially in cases where the clinical examination was difficult to perform.

Security aspects of teleradiology between the university centre and outlying hospitals in Tyrol.

We assessed a data security system using biometric fingerprint techniques and smartcards to control access to a teleradiology system. Clinical cases were initially discussed between the referring physician and radiologist in Tyrol using a video-phone. Subsequent correspondence, including the transmission of images between the referring physician and the radiologist, was carried out by e-mail using the security system to prevent unauthorized access to patient information. Seventy-eight teleradiology sessions were conducted using this data security system. Speed and stability of data exchange were unaffected by the additional security feature. The average log-on time to the system was 7.8 s. The average training time on how to use the system was 15 min. The radiologist was able to issue a final patient report using the system within 1.5 of the initial contact. The data security feature was user-friendly and did not hinder the normal teleradiology consultation.

The value of the World Wide Web for tele-education in radiology.

We assessed Websites for radiological education. Of several hundred sites identified, 30 were randomly selected for evaluation by two groups of observers. All Web pages were rated with respect to time required to access the information; structure and organization of the site; image quality; and information content and relevancy. Rapid access was gained to many educational radiology Websites, which contained large numbers of interesting radiological images of good quality. A weak point was the structure and organization of the sites. The greatest variability in ratings was found in the information content and relevancy of the Websites.

Virtual computed tomography colonoscopy: artifacts, image quality and radiation dose load in a cadaver study.

The purpose of our study was to evaluate the interdependency of spatial resolution, image reconstruction artifacts, and radiation doses in virtual CT colonoscopy by comparing various CT scanning protocols. A pig's colon with several artificial polypoid lesions was imaged after air insufflation with helical CT scanning using 1-, 3-, and 5-mm collimation, and pitch values varying from 1.0 to 3.0. Virtual endoscopic images and "fly through" sequences were calculated on a Sun Sparc 20 workstation (Navigator Software, GE Medical Systems, Milwaukee, Wis.). Several reconstruction artifacts as well as overall image quality were evaluated by three independent reviewers. In addition, radiation doses for the different CT protocols were measured as multiple-scan average dose using a 10-cm ion chamber and a standard Plexiglass body phantom. Generally, image quality and reconstruction artifacts were less affected by pitch values than by beam collimation. Thus, narrow beam collimation at higher pitch values (e. g. 3 mm/2.0) seems to be a reasonable compromise between quality of virtual endoscopic images and radiation dose load.

Finger injuries in extreme rock climbers. Assessment of high-resolution ultrasonography.

Dynamic high-resolution ultrasonography findings obtained in 34 extreme rock climbers with finger injuries were compared with those in 20 healthy volunteers. Thicknesses of the flexor tendon and A-2 flexor tendon pulley system were measured at the base of the proximal phalanx. The distance between the tendon and phalanx was evaluated with the finger in extension and in forced flexion as a measure of bowstringing. Gliding ability of the flexor tendons was assessed during active and passive motion. Compared with healthy volunteers, climbers showed a significantly increased thickness of the flexor tendons and the flexor tendon pulley system but no impairment of the gliding mechanism. Only in climbers did the distance between tendon and phalanx increase from 0.14 cm (+/-0.07) during extension to 0.30 cm (+/-0.09) during forced flexion. In three climbers with complete A-2 pulley ruptures this distance was up to 0.51 cm (+/-0.15) during forced flexion. Clinically unsuspected synovial cysts, thickened joint capsules, fibrous tissue, or fluid collection were found only in climbers. We concluded that dynamic ultrasonography is a valuable tool for accurate assessment of early changes in "climber's finger." It provides useful information, especially in cases where clinical evaluation is difficult, and should be performed to select appropriate therapeutic management.

Virtual reality and anthropology.

Since the discovery of the Tyrolean Iceman in 1991 advanced imaging and post processing techniques were successfully applied in anthropology. Specific techniques include spiral computed tomography and 3-dimensional reconstructions including stereolithographic and fused deposition modeling of volume data sets. The Iceman's skull was the first to be reproduced using stereolithography, before this method was successfully applied in preoperative planning. With the advent of high-end graphics workstations and biomedical image processing software packages, 3-dimensional reconstructions were established as a routine tool for analyzing volume data sets. These techniques opened totally new insights in the field of physical anthropology. Computed tomography became the ideal research tool to access the internal structures of various precious fossils without damaging or even touching them. Many of the most precious specimens from the species Autralopithecus (1.8-3.5 Myears), Homo heidelbergensis (200-600 kyears) or Homo neanderthalensis (40-100 kyears) were scanned during the last 5 years. Often the fossils are filled with a stone matrix or other materials. During the postprocessing routines highly advanced algorithms were used to remove virtually these incrustations. Thus it was possible to visualize the morphological structures that lie beneath the matrix. Some specimen were partially destroyed, so the missing parts were reconstructed on computer screen in order to get estimations of the brain volume and endocranial morphology, both major fields of interest in physical anthropology. Moreover the computerized form of the data allows new descriptions of morphologic structures by the means of 'geometric morphometrics'. Some of the results may change aspects and interpretations in human evolution. The introduction of new imaging and post processing techniques created a new field of research: Virtual Anthropology.

[Assessment of renal resistance index in children with vesico-ureteral reflux]. / Wertigkeit des renalen Resistenz-Index bei Kindern mit vesikoureteralem Reflux.

AIM: To assess the value of the renal resistive index (RI) in evaluating renal perfusion in children with vesicoureteral reflux (VUR). METHOD: We investigated 92 kidneys in 46 children with VUR with a mean age of 6 +/- 4 years. The RI was measured at the level of the interlobar-/arcuate-arteries using a color Doppler unit Acuson 128 XP/10 (Mountain View, Cal.). The results of the RI-measurement were correlated to the findings in renal scintigraphy. RESULTS: Children with VUR grade I-III showed RI-values less than the normal physiological upper limit of 0.7. Patients with VUR grade IV-V demonstrated a significant increased RI-value of 0.77 +/- 0.07 (p < 0.0001). The correlation of the RI-measurements with the scintigraphic findings revealed a correlation-coefficient of r2 = 0.61. CONCLUSION: Changes of renal perfusion were only found in high-grade VUR, demonstrating a good correlation with the scintigraphic findings. Therefore color Doppler ultrasound seems to be helpful in the follow-up of patients with high-grade reflux.

Crossing vessels at the ureteropelvic junction: detection with contrast-enhanced color Doppler imaging.

PURPOSE: To investigate the feasibility of imaging crossing vessels at the ureteropelvic junction (UPJ) preoperatively by means of contrast agent-enhanced color Doppler imaging (CDI). MATERIALS AND METHODS: Twenty-nine patients (13 female patients, 16 male patients; age range, 17-76 years; mean age, 45 years) with symptomatic UPJ obstruction were examined with CDI before and after intravenous infusion of the contrast agent. The type (i.e., arterial or venous) and position of the vessel relative to the UPJ (i.e., anterior or posterior) were assessed. The CDI findings were correlated with the surgical findings at laparoscopic pyeloplasty. RESULTS: Among the 29 patients, crossing vessels were detected with nonenhanced CDI in 15 patients, with enhanced CDI in 22 patients, and with laparoscopy in 23 patients. Enhanced CDI depicted crossing vessels in 22 (96%) of the 23 laparoscopically confirmed cases compared with nonenhanced CDI, which depicted 15 (65%) of the 23 cases. The rate of detecting crossing vessels increased significantly with use of the contrast agent (P < .016, McNemar test). CONCLUSION: Compared with nonenhanced CDI, contrast-enhanced CDI significantly improves the detection of crossing vessels at the UPJ and is useful in the presurgical evaluation of UPJ obstruction.

Re-evaluation of the endocranial volume of the Guattari 1 Neandertal specimen (Monte Circeo).

The endocranial capacity of Guattari 1 originally was estimated by Sergi as approximately 1.550 cm3. Using three different approaches, a physical endocast, a stereolithographic model, and a virtual endocast, we have estimated the endocranial capacity of Guattari 1 as approximately 1.350 cm3. This paper explains our revision of the estimated endocranial volume of Guattari 1, provides a cautionary case concerning other estimates of endocranial volume, and demonstrates and encourages the use of recent advances in imaging, modeling, and analysis of endocranial volume.

Respirator triggering of electron beam computed tomography (EBCT): research on vital capacities.

In this project we evaluate the dynamic changes during expiration at different levels of positive-end-expiratory pressure (PEEP) in ventilated patients. We wanted to discriminate between normal lung function and acute respiratory distress syndrome (ARDS). After approval by the local Ethic Committee we studied two ventilated patients: (one with normal lung function and one with ARDS) We used the 50 ms scan mode of the EBCT. The beam was positioned 1 cm above the diaphragm while the table position remained unchanged. We developed an electronic trigger that utilizes the respirator's synchronizing signal to start the EBCT at the onset of expiration. During controlled mechanical expiration at two levels of PEEP (0 and 15 cm H2O), pulmonary aeration was rated as: well-aerated (-900HU to -500HU), poorly aerated (-500HU to -100HU) and non-aerated (-100HU to +100HU). Pathological and normal lung functions showed different dynamic changes. The different PEEP levels resulted in a significant change of pulmonary aeration in the same patient. Although we studied only two patients, respiratory triggered EBCT may be accurate in discriminating pathological changes due to the abnormal lung function in a mechanically ventilated patient.