The effects of changes in utilization and technological advancements of cross-sectional imaging on radiologist workload.

RATIONALE AND OBJECTIVES: To examine the effect of changes in utilization and advances in cross-sectional imaging on radiologists' workload. MATERIALS AND METHODS: All computed tomography (CT) and magnetic resonance imaging (MRI) examinations performed at a single institution between 1999 and 2010 were identified and associated with the total number of images for each examination. Annual trends in institutional numbers of interpreted examinations and images were translated to changes in daily workload for the individual radiologist by normalizing to the number of dedicated daily CT and MRI work assignments, assuming a 255-day/8-hour work day schedule. Temporal changes in institutional and individual workload were assessed by Sen's slope analysis (Q = median slope) and Mann-Kendall test (Z = Z statistic). RESULTS: From 1999 to 2010, a total of 1,517,149 cross-sectional imaging studies (CT = 994,471; MRI = 522,678) comprising 539,210,581 images (CT = 339,830,947; MRI = 199,379,634) were evaluated at our institution. Total annual cross-sectional studies steadily increased from 84,409 in 1999 to 147,336 in 2010, representing a twofold increase in workload (Q = 6465/year, Z = 4.2, P < .0001). Concomitantly, the number of annual departmental cross-sectional images interpreted increased from 9,294,140 in 1990 to 94,271,551 in 2010, representing a 10-fold increase (Q = 8707876/year, Z = 4.5, P < .0001). Adjusting for staffing changes, the number of images requiring interpretation per minute of every workday per staff radiologist increased from 2.9 in 1999 to 16.1 in 2010 (Q = 1.7/year, Z = 4.3, P < .0001). CONCLUSIONS: Imaging volumes have grown at a disproportionate rate to imaging utilization increases at our institution. The average radiologist interpreting CT or MRI examinations must now interpret one image every 3-4 seconds in an 8-hour workday to meet workload demands.

[Cross-sectional imaging evaluation of renal masses]. / Schnittbildgebung der Nierentumoren.

Cross-sectional imaging modalities including multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are the diagnostic standard in detection, characterization, and staging of renal masses due to their high sensitivity and specificity. Currently, most renal masses are incidentally diagnosed by imaging for other medical reasons. Recent developments have improved image acquisition with high resolution, while simultaneously reducing radiation dose. CT imaging is the most accessible cross-sectional imaging method and is, therefore, the standard technique. MRI is indicated in patients who are allergic to intravenous CT contrast medium, in patients with renal insufficiency, or in younger patients. Further characterization of renal masses is possible with functional imaging including dual energy CT, perfusion CT, or diffusion-weighted MRI. Contrast-enhanced ultrasound allows detection of even subtle enhancement in hypovascular lesions with high sensitivity and can add valuable information to CT and MRI studies.

Importance of transverse pedicle angle & chord length of lumbar pedicle in screw placement: a CT scan study on North West Indian population

The aim of this study was to measure the lumbar pedicle dimensions and its angulations for the development of techniques and devices for spinal instrumentation on computed tomography (CT) scan. Fifty CT scans of lumbar vertebral column of patients belonging to North West Indian population was randomly selected. Various morphometric parameters were recorded using software. The transverse pedicle angle increased from L1 to L5 in both males and females. In males it was maximum at L5 (25.7°) and minimum at L1 (7.5°). In females it was maximum at L5 (24.0°) and minimum at L1 (7.4°). The chord length in males was maximum at L5 (51.3 mm) and minimum at L1 (48.1 mm). In female chord length was maximum at L2 (51.1 mm) and minimum at L4 (47.6) on right side and on left side it was maximum at L3 (50.9 mm) and minimum at L1 (46.7 mm). A screw of 40 mm length appeared to be safe at all lumbar levels as all the vertebrae studied had a chord length well in excess of 40 mm. The length of the pedicular screw needs to be substantially smaller for Indian population than those mentioned in Western literature. At the lower lumber levels, greater lateral inclination of the pedicle should be kept in mind. Otherwise it may lead to the breach of the medial cortex of the pedicle with resultant risk to the neural tissues (AU)

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[Modern cross-sectional imaging of head and neck vessels]. / Moderne Schnittbildgebung der Kopf-Hals-Gefässe.

Although digital subtraction angiography (DAS) remains the gold standard for neurovascular imaging, the number of diagnoses made on the basis of less invasive cross-sectional imaging techniques (CT and MR angiography) is increasing. The present article provides important technical principles of CT and MR angiography, followed by an analysis of the diagnostic possibilities and limitations of vascular cross-sectional imaging. The particular importance of post-processing of vascular cross-sectional datasets is also discussed. Using the typical clinical diagnostic work-up of extra- and intracranial vascular diseases as a basis, the article explains how a suitable examination technique and protocol is chosen and which limitations need to be borne in mind. After taking at look at the technical advances expected in the future (3-Tesla MRA, dual-energy CTA, post-processing workflow in PACS), the remaining indications for diagnostic DSA will be presented and explained.

Sella turcica morphometry using computed tomography

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From data to knowledge--the Visible Human Project continues.

The U. S. National Library of Medicine (NLM) has long been a world leader in the archiving and distribution of the print-based images of biology and medicine. NLM has also been a pioneer in the use of computer systems to encode and distribute textual knowledge of the life sciences. NLM's Long Range Planning effort of 1985-86 foresaw a coming era where NLM's Bibliographic and factual database services would be complemented by libraries of digital images, distributed over high speed computer networks. The NLM Planning Panel on Electronic Imaging recommended that NLM should undertake the building a digital image library consisting of computerized tomography (CT) and magnetic resonance (MR) images, and cryosection images of a representative, carefully selected and prepared male and female cadaver--the "Visible Human Project ." The male and female Visible Human data sets are now being made available through a license agreement with the NLM. The data sets are supporting a wide range of educational, diagnostic, treatment planning, and commercial uses. The NLM, in partnership with other U.S. government research agencies has begun a three prong effort within the Visible Human Project to address: the creation of a new online, interactive, digital head-and-neck atlas; the development of a tool kit of computational programs capable of automatically performing many of the basic data handling functions required for using Visible Human data in applications; and the improved resolution of future Visible Human data sets through the reduction of the anatomical artifacts introduced by the methods used to stabilize and section the anatomical materials and the development of staining and wide-spectrum methods for increasing tissue contrast.

The Visible Human Project: a resource for education.

Throughout recorded history, the relationships between biological structure and function have been central to the understanding of health and disease. For many centuries, the anatomy illustrations originally created during the medieval period formed the basis for the study of medicine. But learning and understanding anatomic structures is limited by the fundamentally two-dimensional images traditionally used to teach them. The digital computer now allows scientists to acquire, store, manipulate, and display complex images. In 1989, the National Library of Medicine (NLM) began a project to use computer technologies to build a prototype digital image library of data representing a complete normal adult human male and female. In this paper, the author describes the beginnings of this project, the Visible Human Project (VHP), the digital images currently available in the VHP database, ongoing research and development, and plans for the future of the VHP.