Personal computer needs for the radiologist.

This article reviews the computer system hardware and software, applications programs, and computer network services that are available on microcomputers for use by the radiologist. The American College of Radiology Institute computer network is described, which is specifically designed to help the practicing radiologist.

What happens to patients after upper and lower gastrointestinal tract barium studies?

We investigated the occurrence of new constipation, diarrhea, nausea, vomiting, visible blood in stool, abdominal pain, black stools, belching, and flatus in 324 outpatients following upper or lower gastrointestinal tract barium procedures. We also evaluated the roles of age, sex, patient mobility, and types of barium enema (single- or double-contrast). At least one new symptom was reported after 51% of all examinations. Constipation was the most frequently reported single symptom after barium meal or small bowel examinations. Fifty percent of all constipation occurred following upper gastrointestinal examinations. Abdominal pain was common in patients of the seventh decade, especially following barium enema. Nausea typically followed barium swallow or upper gastrointestinal series. Belching and passage of flatus were the most frequently reported symptoms after barium enema, both single- and double-contrast. No significant relationship between the frequency of symptoms and patient age, sex, or the type of barium enema was established.

Computer use and education in radiology residency programs.

Computers play an increasingly important role in radiology education and research. We surveyed all U.S. residency programs to assess computer availability, education, and use by residents. Out of 210 questionnaires sent, 132 were returned (63% response). Areas of inquiry included computer equipment and software as well as resident use of facilities. Opinions were also solicited concerning the importance of computer literacy and education. Sixty-nine percent of the respondents have computer facilities (61% within the department). Predominant uses include scientific papers, slides/audiovisual presentations and resume preparation. Popular software includes word processing, spreadsheets, databases and graphics. Of those training programs with computers, 85% provided computer education, and most (70%) felt computer training was very important. Forty-seven percent expected their residents to have at least passing acquaintance with computers. However, in 60% of programs with computers, the computers are used by less than half the residents. Of those programs without a computer, 61% provided no computer training, and only 44% felt computer education was very important. A sizable minority of radiology residency programs are still without computer facilities. Those programs that have computers tend to place a greater emphasis on computer education and literacy for radiology residents. However, even in programs that have computers, it seems they are often underutilized by residents.

Radiologists' perception of professional journals.

RATIONALE AND OBJECTIVES: We assessed radiologists' perceptions of radiologic and general medical journals. METHODS: Five thousand randomly chosen radiologists (4,200 American College of Radiology (ACR) members and 800 members in training) were surveyed by mail concerning their opinion of selected radiology and major medical journals. The mail survey was followed up by a phone survey of 45 previously unsurveyed radiologists from a smaller list of a similar ACR population. RESULTS AND CONCLUSIONS: Of the 5,000 surveys mailed out, 987 (20%) were completed and returned. There were no systematic differences in the questionnaire results between those surveyed by phone and those surveyed by mail. In general, academic radiologists, private practice radiologists, and radiologists in training did not differ in their assessment of professional journals. The respondents picked Radiology as their first choice if they were allowed to read only one journal. The respondents believed that Radiology published the best clinical research and Investigative Radiology the best basic science research. American Journal of Roentgenology (AJR), Radiology, and Journal of Computer Assisted Tomography ranked highest for sureness and rapidity of manuscript acceptance and publication, while Radiology, New England Journal of Medicine, and the Journal of the American Medical Association ranked highest in terms of exposure and prestige.

AUR memorial award--1987. The impact of focused instruction on learning mammography.

Recent promotion of breast cancer screening has increased the demand for mammography services and well-trained mammographers. To determine whether focused instruction, which may occur in continuing medical education courses, is effective in imparting mammography skills and knowledge, an instructional program was developed and evaluated. Seventeen physicians were tested before and after six 1-hour instructional sessions about breast disease and cancer screening, mammogram interpretation, and determining appropriate patient disposition. Twelve weeks after instruction, subjects demonstrated significant improvement in factual knowledge, in decision-making ability regarding patient disposition, and in recognition of benign disease on mammograms. There also was significant improvement in specificity, but no improvement in cancer detection. Further, no correlation between participants' subjective self-assessment of improvement and their actual performance on the postinstruction evaluation was found. Evaluation of instructional programs is necessary to determine their effectiveness, and promotes improvement in instructional offerings.

Comparison of breast consistency at palpation with breast density at mammography.

Palpable breast consistency on physical examination was compared with the breast density on mammography for 909 consecutive patients. One of two experienced nurse practitioners palpated each patient's breasts and assigned a consistency value of 1 (little palpable breast consistency) to 4 (maximal palpable breast consistency). Seven mammographers rated the breast density on mammography as either fatty, mild, moderate, or marked parenchymal density for each breast. A low statistical correlation between the two parameters was shown. Thirty-seven percent of markedly dense breasts on mammography was rated only 1 or 2 on palpation. Thus, breast consistency judged by palpation cannot be directly correlated with the density shown on mammography and cannot be used to predict optimal radiographic technique.

Sonographic image degradation after barium enema.

RATIONALE AND OBJECTIVES: The authors previously showed that barium does not interfere with abdominal sonography performed after a biphasic upper gastrointestinal tract examination. This study was designed to assess the impact of a barium enema (BE) examination on the quality of abdominal sonography performed immediately after the barium enema. METHODS: Forty patients scheduled for routine barium enemas (22 air contrast and 18 solid column) were prospectively examined with abdominal sonography before and after their BEs. The resulting 80 sonograms were randomized; three radiologists blindly assessed the quality of images of each of six anatomic areas (aorta, pancreas, porta hepatis, gallbladder, and the right and left lobes of the liver). RESULTS: There was no statistically significant degradation of the images for the right and left lobes of the liver and the pancreas. However, the images for the gallbladder, porta hepatis, and aorta had a statistically significant (P < .05) degradation of their ultrasound quality following barium enema. CONCLUSIONS: Unlike upper gastrointestinal tract examination, BE examination does interfere with the quality of a subsequent abdominal ultrasonography. Thus, when both studies are required, sonography should be performed first.

Detection of breast abnormalities on teleradiology transmitted mammograms.

The authors conducted an observer performance study to compare breast lesion detection of conventional mammography (CM) with teleradiology (TE) transmitted mammograms. One hundred four abnormal, single-projection mammographic images were transmitted by teleradiology. Abnormalities included 11 cases with skin thickening or retraction, 48 cases with microcalcifications, and 52 with parenchymal masses. The CM and TE images were reviewed by four mammographers who indicated the type and location of abnormalities and a level of confidence for their diagnostic decisions. For each of three detection tasks--skin and nipple abnormalities, microcalcifications, and masses--receiver operating characteristic curve analysis was performed for individual readers and all readers as a group. For detecting skin and nipple abnormalities, readers performed significantly better with CM than with TE (z = 2.05, P = less than 0.04). However, no significant differences were found among readers for detection of either microcalcifications or masses. Further improvements in hardware and imaging parameters may improve detection of soft tissue abnormalities. Further evaluation is necessary to determine whether teleradiology might be applicable to breast cancer screening.

Occurrence of fibroadenomas in postmenopausal women referred for breast biopsy.

OBJECTIVE: To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy. DESIGN: A retrospective review of breast biopsy outcome and of patient demographics, including menstrual and hormonal status. SETTING: The Tucson Breast Center, a large outpatient breast cancer detection clinic affiliated with the University of Arizona Health Sciences Center in Tucson, Arizona. PARTICIPANTS: All women seen at the Tucson Breast Center between 1985 and 1990 who were referred for breast biopsy. RESULTS: A total of 100 fibroadenomas were found in 709 breast biopsies whose results were known. Fifty-two of these were in premenopausal women and 44 in postmenopausal women; the menopausal status of four women was unknown. In postmenopausal women, 11 of the 44 patients reported hormone use. Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women. Fibroadenomas constituted 10% (44 of 447) of all biopsies in postmenopausal women, including those with breast masses, abnormal calcifications, or other lesions. CONCLUSION: Noncalcified fibroadenomas of the breast are not confined to young women and may constitute a small but noteworthy proportion of lesions coming to breast biopsy in postmenopausal women.

Patient perceptions of stereotaxic large-core breast biopsy.

RATIONALE AND OBJECTIVES: The authors evaluated the perceptions of patients who underwent stereotaxic core breast biopsy before and after the procedure. METHODS: By using a standard questionnaire, 58 patients undergoing stereotaxic core breast biopsy with a 14-gauge needle were interviewed immediately before, immediately after, and 24 hours and 5 days after the procedure. RESULTS: Discomfort recorded by patients 24 hours after core biopsy correlated with the amount of time needed before normal activities were resumed (P = .001). Only five patients (9%) indicated severe discomfort during the procedure. Patient age, number of core biopsy samples taken, and lesion depth did not correlate with level of discomfort. Fifty-five patients (95%) resumed normal activities within 24 hours. However, 41 patients (71%) had some breast bruising as many as 5 days after the procedure. Overall, patient satisfaction with care was high; 56 patients (97%) stated they would return for another biopsy in the future. CONCLUSION: The morbidity associated with stereotaxic core breast biopsy is low, although the majority of patients in this series experienced bruising lasting as long as 5 days after the procedure. Despite this, almost all patients would return for a core breast biopsy in the future, if indicated.

Follow-up of benign results of stereotactic core breast biopsy.

RATIONALE AND OBJECTIVES: The purpose of this study was to obtain long-term follow-up data on women with benign histologic results of a breast stereotactic core needle biopsy (CNB). MATERIALS AND METHODS: Mammography charts of 300 consecutive women who underwent prone stereotactic CNB with digital radiography were reviewed. Women with frankly malignant or suspicious histologic findings (51 patients) or a technically unsuccessful stereotactic CNB (one patient) were excluded. The remaining 248 benign core biopsies in 229 women were included in the study. RESULTS: Follow-up mammograms were obtained for 152 lesions with benign histologic results following stereotactic CNB. The mean length of follow-up after stereotactic CNB was 34.6 months. Cancer was diagnosed in six women who underwent surgical biopsies 1/2 to 30 months after benign stereotactic CNB. An initial chart review demonstrated that no follow-up data were available for 64 lesions, and information was missing for an additional seven. CONCLUSION: SCNB remains a sampling procedure that can result in false-negative histologic results. Intrinsic procedural issues were identified that could minimize the potential for missing a malignancy. Goals for patient compliance with follow-up recommendations fell short of expectations.

Emergency department coverage by academic departments of radiology.

RATIONALE AND OBJECTIVES: The purpose of this study was to survey academic radiology departments to determine how emergency radiology coverage is handled and whether there are any prerequisites for those individuals providing this coverage. MATERIALS AND METHODS: The authors developed a simple two-page survey and sent it to a total of 608 program directors, chiefs of diagnostic radiology, chairpersons, and chief residents at academic departments of radiology. RESULTS: Of the 608 surveys sent, 278 (46%) were returned. More than half of the departments have an emergency radiology section that provides "wet read" coverage during the day, and most academic departments cover the emergency department during the night and on weekends. Nighttime and weekend coverage is handled mostly by residents. Most departments give time off for lunch, with few other prerequisites for faculty who provide emergency coverage. Sixty percent of the departments have teleradiology capability, and many use it for emergency department coverage. CONCLUSION: These results can serve as the basis for discussion and comparison with other institutions regarding a variety of aspects of emergency department coverage.

Radiologic total lung capacity measurement. Development and evaluation of a computer-based system.

The development of a computer-based radiologic total lung capacity (TLC) measurement system designed to be used by non-physician personnel is detailed. Four operators tested the reliability and validity of the system by measuring inspiratory PA and lateral pediatric chest radiographs with a Graf spark pen interfaced to a DEC VAX 11/780 computer. First results suggest that the ultimate goal of developing an accurate and easy to use TLC measurement system for non-physician personnel is attainable.

Non-lymphoreticular cancer of the gastrointestinal tract in the young adult: general hospital experience.

A review of 39 cases of non-lymphoreticular cancer of the gastrointestinal (GI) tract in young adults (ages 18-40 years) compiled from the tumor registries of three general teaching hospitals during the years 1966-1976 is presented. Several aspects of their clinical presentation, diagnostic evaluation, and treatment are assessed. Several features are worthy of comment regarding this subgroup of cancer patients: unexplained anemia, evidence of GI tract blood loss, and weight loss are frequent findings, singly or in combination; delay in diagnosis of gastric malignancy may be occasioned due to response of abdominal complaints to nonspecific therapy such as antacids; and an unexpectedly high number of women were among the cancer group, especially among those with stomach and colorectal cancer.

Tubes, lines, catheters, and other interesting devices.

Medical devices (tubes, catheters, lines, prostheses, etc.) are a common finding on radiologic studies. Sometimes they may be misdiagnosed as a pathologic process, or an important observation concerning a medical device may be overlooked because of lack of familiarity with a particular device. This review discusses a variety of tubes, lines, catheters, and other interesting and important medical devices found on everyday radiologic studies. Whenever an unusual radiologic finding is encountered, the first question to be asked is, "Is the finding a film artifact or an artifact of the imaging modality itself (computed radiography, computed tomography [CT], ultrasound, magnetic resonance imaging [MRI], nuclear medicine)? If not, does it represent a medical device or foreign material in or on the patient?" All those who interpret radiologic studies should develop the good habits of obtaining and reviewing the patient's prior studies and should, in addition, read the prior radiology reports. Good reading habits, combined with a knowledge of imaging artifacts, medical devices, foreign bodies, and normal anatomic variants, provide a solid starting point for the interpretation of radiologic studies. One very important factor often not appreciated by radiologists and referring physicians is that, in many instances, the radiologic visibility of a medical device has been given no thought, and the device has been designed with no input from the radiologic community. To compound this problem further, devices are often purchased by a hospital or medical center for the lowest price. Those purchasing devices frequently fail to seek advice from radiologists and other physicians concerning the radiologic detectability of the devices they purchase. Medical devices are manufactured from a variety of substances known as biomaterials. These include various types of metals, polymers, rubbers, ceramics, and composites. Biomaterials are substances brought into contact with living tissue for the purpose of treating a medical or dental problem. They must be compatible with human tissues chemically, mechanically, and pharmacologically. There are many ways to classify biomaterials, such as synthetic versus "natural," permanent versus transient, liquid versus solid, hard versus soft, and so forth. Although most life-support devices are within the patient's heart, blood vessels, lungs, or pleura, miscellaneous tubing, clamps, syringes, electrocardiograph (ECG) leads, and other apparatus often lie on or under the patient and appear on radiographs, especially chest studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Gallery of medical devices.

This article provides an overview of the multitude of medical devices used in patients from head to toe. Simple line drawings show a wide assortment of medical devices. These drawings and the accompanying short descriptions are to be used for quick reference to identify some of the more common medical devices that are certain to appear on everyday radiographs. There is an extensive bibliography for the reader to obtain more detailed information about a particular device or medical apparatus. Knowing the specific name of a device is nearly impossible and is really not necessary, in particular, the eponyms attached to all manner of orthopedic apparatus. Many device names have evolved from their original meaning. What is important is the device's function and the recognition of its presence, as well as an understanding of its use and potential complications.

Common surgical procedures.

This article illustrates some common surgical procedures. Radiologists and other physicians frequently see patients who have had one or more of these operations. We hope to illustrate with drawings and radiographs the basic purpose of the procedures and the relevant anatomy. This is not intended to illustrate or discuss the actual surgical techniques. Our intention is to illustrate one generally accepted way of performing a given type of surgical procedure. For many of these operations, there may be multiple other techniques to accomplish the same result for the patient. Some of the illustrations and text in this monograph were originally published in Radiologic Guide to Medical Devices and Foreign Bodies, edited by T.B. Hunter and D.G. Bragg, St. Louis: Mosby-Year Book, 1994.