A case of pneumonia in a critical patient.

The case of a patient who had recently undergone renal transplantation, and showed symptoms referable to pulmonary infection, is discussed. Chest X-ray showed the presence of bilateral diffuse reticulonodular interstitial involvement. For better characterization HRCT was performed. It detected ground glass interstitial involvement associated with nodules predominant in posterior segments of bilateral lower lobes. The case history associated with the findings of diagnostic imaging are strongly suggestive for pulmonary infection. The diagnosis was confirmed by bronchoalveolar lavage positive for the presence of alveolar cells and intranuclear and intracytoplasmic inclusions typical of Cytomegalovirus infection.

Diagnostic imaging in a case of choledocholithiasis.

A case of a patient with the diagnosis of a neoformation of the blind intestine is discussed. On CT for staging an image at the level of the intrapancreatic tract of main bile duct of not certain interpretation was visualized. On US choledocholithiasis shown by the typical appearance of a hyperechoic image with posterior shadowing was diagnosed. In the study case US was shown to be the procedure of first choice.

Information systems in the management of the radiology department.

Clinical, organizational and administrative service improvement has always been the primary aim of a radiology information system. Studies carried out at Massachusets General Hospital in the late sixties identified two "bottlenecks" in the Departments of Diagnostic Imaging: the planning of examinations and the management of picture archiving. Therefore, the information system started to be viewed as a potential tool for the solution of these problems. In time, the concept of Radiology Information System (RIS) was conceived. With its developments it is now considered an effective support for the daily activity of the Radiology department, to tackle and solve the operational problems posed by the various healthcare professionals. A radiology information system essentially concerns three functional areas: the patient management, the procedure management, the department management. Another major task of RIS is represented by its integration with the other information systems of Radiology and hospital to enable to share information in real time with the hospital information system (HIS) and the other information systems (system of first-aid management, intensive therapy units etc). A modern RIS must be in conformance with DICOM 3 for the service class of the working list to be able to transmit to the diagnostic imaging equipment the patient correct names and demographics and the type of procedure to be performed.

Diagnostic imaging in a case of a cystic lesion of the pancreas.

The case of a patient admitted to hospital for symptoms characterized by upper abdominal pain of pancreatic type associated with vomiting, is discussed. MRI was performed. It documented a focal fluid lesion apparently in communication with the dilated main pancreatic duct showing filling defects. Based on previous radiologic examinations performed elsewhere and MRI findings the diagnostic suspicion was of a cystic lesion. MRI was performed again for re-evaluation and lithotripsy was done; the patient was discharged with the diagnosis of chronic pancreatitis from alcohol abuse.

Combined diagnostic imaging of a non-traumatic swelling of the popliteal cavity.

A case of a 13-year-old female patient with a non-traumatic hard-elastic swelling in the right popliteal cavity, associated with functional impairment in maximal knee flexion and mild pain, is presented. The combination of clinical and radiologic findings (radiography, CT and MRI) suggested a number of differential diagnoses within bone and soft tissue tumors. The collected diagnostic information did not allow a definitive diagnosis that was established only after biopsy.

The neurogenic bladder: anatomy and neurophysiology.

Micturition disorders secondary to alterations of complex neural controls do not represent a separate, typified condition but frequently they are symptoms of more complex diseases. Unfortunately, they are often misunderstood leading to severe damages to the patient. In diagnostic imaging of neural alterations of micturition, a major role is played by voiding cystourethrography for its contribution to both the morphologic and functional aspects. The dynamics of micturition is documented by voiding cystourethrography and with the integration between radiologic morphofunctional imaging and urodynamic pressure values the type and level of the neural lesion can be better defined. Therefore, subsequent neuroradiologic study can be specifically planned. Modern diagnostic imaging allows ready detection of the frequent complications of neurogenic bladder as diverticula, lithiasis, inflammation, that, especially in some patients, if misunderstood, can be particularly severe.

Diagnostic imaging of neurogenic bladder.

Correct radiologic diagnosis of neurogenic bladder is mainly based on morphofunctional information derived from voiding cystourethrography. This examination allows the evaluation of the bladder morphology, the degree of filling, and the validity of muscular contraction. Indications on the bladder neck, striated sphincter function and urethral morphology are also provided. Presence of ureterovesical reflux is detected with its possible precise classification. Abnormal amount of residual urine is identified and often early diagnosis of most common complications of neurogenic bladder as vesical lithiasis, diverticula and infections, can be established.

Picture archiving and communication in radiology.

After over 80 years of exclusive archiving of radiologic films, at present, in Radiology, digital archiving is increasingly gaining ground. Digital archiving allows a considerable reduction in costs and space saving, but most importantly, immediate or remote consultation of all examinations and reports in the hospital clinical wards, is feasible. The RIS system, in this case, is the starting point of the process of electronic archiving which however is the task of PACS. The latter can be used as radiologic archive in accordance with the law provided that it is in conformance with some specifications as the use of optical long-term storage media or with electronic track of change. PACS archives, in a hierarchical system, all digital images produced by each diagnostic imaging modality. Images and patient data can be retrieved and used for consultation or remote consultation by the reporting radiologist who requires images and reports of previous radiologic examinations or by the referring physician of the ward. Modern PACS owing to the WEB server allow remote access to extremely simplified images and data however ensuring the due regulations and access protections. Since the PACS enables a simpler data communication within the hospital, security and patient privacy should be protected. A secure and reliable PACS should be able to minimize the risk of accidental data destruction, and should prevent non authorized access to the archive with adequate security measures in relation to the acquired knowledge and based on the technological advances. Archiving of data produced by modern digital imaging is a problem now present also in small Radiology services. The technology is able to readily solve problems which were extremely complex up to some years ago as the connection between equipment and archiving system owing also to the universalization of the DICOM 3.0 standard. The evolution of communication networks and the use of standard protocols as TCP/IP can minimize problems of data and image remote transmission within the healthcare enterprise as well as over the territory. However, new problems are appearing as that of digital data security profiles and of the different systems which should ensure it. Among these, algorithms of electronic signature should be mentioned. In Italy they are validated by law and therefore can be used in digital archives in accordance with the law.

Diagnostic approach to a rare case of osteoid osteoma of the astragalus.

A rare case of osteoid osteoma of the ankle of the left foot is discussed. Standard X-ray and MRI were negative. Triphasic bone scintigraphy followed by CT were performed. Combined clinical CT and scintigraphy findings were highly suggestive of osteoid osteoma. This diagnosis was confirmed on histology.