Imaging

The American College of Rheumatology is billing its new online image bank as the “most comprehensive online collection of rheumatology-related images,” running the alphabet from avascular necrosis to vasculitis.

The collection includes more than 1,500 clinical, pathological, and radiologic images of both common and rare rheumatic disorders. The primary purpose of the image bank is as a teaching tool. “It's a great teaching tool for people training in rheumatology,” said Dr. Alan Baer, chair of the ACR's Audiovisual Aids Subcommittee, which is the arm of ACR that oversaw the development of the image bank.

In addition to their usefulness in training the next generation of rheumatologists, the images can also be used when rheumatologists “go out into the community to give talks to their colleagues or laypeople.”

The images are arranged in sections by type of disorder—soft-tissue rheumatic syndromes, for example. Within a section, images are presented alphabetically by condition.

The image bank is the descendant of the college's slide collection, which got its start in 1958 with a collection of pathology slides. The collection has been revised and supplemented several times since then. “For many years, it was a 35-mm collection. But within the past decade, it became a CD-ROM collection,” said Dr. Baer, who is both chief of rheumatology and director of the Johns Hopkins University Clinical Practice, both at Good Samaritan Hospital, Baltimore. “For a number of years, we have recognized the need to put the image bank online and make it Internet accessible. That's what we've accomplished in the last year.”

Certainly it's easy enough to find rheumatology images through search engines, such as Google. However, the committee makes “a very concerted effort to ensure that these are top-quality images that are carefully annotated.” In fact, the images and any accompanying material are carefully scrutinized for accuracy, and additional information may be requested.

“It's a very reliable source of images,” said Dr. Baer.

Over the years, the collection has grown from pathology, histology, clinical photos, and x-rays to include newer imaging modalities such as MRI, CT, and sonography.

Dr. Baer hopes to expand the online collection to include video in the future. “We want to move to some of the new imaging formats.”

Video “opens up a whole new arena for us.” For example, “you could watch someone examine a certain joint or watch procedures being performed.”

Video would be particularly useful for including ultrasound imaging in the collection.

Ultrasound is dynamic by nature and it's hard to capture the diagnostic process with a static image, he noted.

“This is a great opportunity to create a whole new type of educational tool,” said Dr. Baer.

The image bank can be found at www.rheumatology.org

These images from a patient with Wegener's granulomatosis illustrate what the ACR has on offer.

Source American College of Rheumatology Image Bank

The American College of Rheumatology is billing its new online image bank as the “most comprehensive online collection of rheumatology-related images,” running the alphabet from avascular necrosis to vasculitis.

The collection includes more than 1,500 clinical, pathological, and radiologic images of both common and rare rheumatic disorders. The primary purpose of the image bank is as a teaching tool. “It's a great teaching tool for people training in rheumatology,” said Dr. Alan Baer, chair of the ACR's Audiovisual Aids Subcommittee, which is the arm of ACR that oversaw the development of the image bank.

In addition to their usefulness in training the next generation of rheumatologists, the images can also be used when rheumatologists “go out into the community to give talks to their colleagues or laypeople.”

The images are arranged in sections by type of disorder—soft-tissue rheumatic syndromes, for example. Within a section, images are presented alphabetically by condition.

The image bank is the descendant of the college's slide collection, which got its start in 1958 with a collection of pathology slides. The collection has been revised and supplemented several times since then. “For many years, it was a 35-mm collection. But within the past decade, it became a CD-ROM collection,” said Dr. Baer, who is both chief of rheumatology and director of the Johns Hopkins University Clinical Practice, both at Good Samaritan Hospital, Baltimore. “For a number of years, we have recognized the need to put the image bank online and make it Internet accessible. That's what we've accomplished in the last year.”

Certainly it's easy enough to find rheumatology images through search engines, such as Google. However, the committee makes “a very concerted effort to ensure that these are top-quality images that are carefully annotated.” In fact, the images and any accompanying material are carefully scrutinized for accuracy, and additional information may be requested.

“It's a very reliable source of images,” said Dr. Baer.

Over the years, the collection has grown from pathology, histology, clinical photos, and x-rays to include newer imaging modalities such as MRI, CT, and sonography.

Dr. Baer hopes to expand the online collection to include video in the future. “We want to move to some of the new imaging formats.”

Video “opens up a whole new arena for us.” For example, “you could watch someone examine a certain joint or watch procedures being performed.”

Video would be particularly useful for including ultrasound imaging in the collection.

Ultrasound is dynamic by nature and it's hard to capture the diagnostic process with a static image, he noted.

“This is a great opportunity to create a whole new type of educational tool,” said Dr. Baer.

The image bank can be found at www.rheumatology.org

These images from a patient with Wegener's granulomatosis illustrate what the ACR has on offer.

Source American College of Rheumatology Image Bank

The American College of Rheumatology is billing its new online image bank as the “most comprehensive online collection of rheumatology-related images,” running the alphabet from avascular necrosis to vasculitis.

The collection includes more than 1,500 clinical, pathological, and radiologic images of both common and rare rheumatic disorders. The primary purpose of the image bank is as a teaching tool. “It's a great teaching tool for people training in rheumatology,” said Dr. Alan Baer, chair of the ACR's Audiovisual Aids Subcommittee, which is the arm of ACR that oversaw the development of the image bank.

In addition to their usefulness in training the next generation of rheumatologists, the images can also be used when rheumatologists “go out into the community to give talks to their colleagues or laypeople.”

The images are arranged in sections by type of disorder—soft-tissue rheumatic syndromes, for example. Within a section, images are presented alphabetically by condition.

The image bank is the descendant of the college's slide collection, which got its start in 1958 with a collection of pathology slides. The collection has been revised and supplemented several times since then. “For many years, it was a 35-mm collection. But within the past decade, it became a CD-ROM collection,” said Dr. Baer, who is both chief of rheumatology and director of the Johns Hopkins University Clinical Practice, both at Good Samaritan Hospital, Baltimore. “For a number of years, we have recognized the need to put the image bank online and make it Internet accessible. That's what we've accomplished in the last year.”

Certainly it's easy enough to find rheumatology images through search engines, such as Google. However, the committee makes “a very concerted effort to ensure that these are top-quality images that are carefully annotated.” In fact, the images and any accompanying material are carefully scrutinized for accuracy, and additional information may be requested.

“It's a very reliable source of images,” said Dr. Baer.

Over the years, the collection has grown from pathology, histology, clinical photos, and x-rays to include newer imaging modalities such as MRI, CT, and sonography.

Dr. Baer hopes to expand the online collection to include video in the future. “We want to move to some of the new imaging formats.”

Video “opens up a whole new arena for us.” For example, “you could watch someone examine a certain joint or watch procedures being performed.”

Video would be particularly useful for including ultrasound imaging in the collection.

Ultrasound is dynamic by nature and it's hard to capture the diagnostic process with a static image, he noted.

“This is a great opportunity to create a whole new type of educational tool,” said Dr. Baer.

The image bank can be found at www.rheumatology.org

These images from a patient with Wegener's granulomatosis illustrate what the ACR has on offer.

Source American College of Rheumatology Image Bank

NEW ORLEANS — Abdominal computed tomography limited to the region of tenderness accurately delineates acute pathology while reducing radiation exposure, according to a double-blind study.

A standard abdominal CT scan covers an area from above the diaphragm to the mid-thigh. But in the study, limiting the scan to the tender area cut radiation exposure by a mean of 69% while preserving 96% sensitivity, Dr. Joshua Broder said at the annual meeting of the Society for Academic Emergency Medicine.

The 93 patients in the single-center study underwent standard abdominal CT after presenting to the emergency department with nontraumatic abdominal tenderness. Before imaging, emergency physicians placed skin markers to delineate the cephalocaudad extent of tenderness. Then they added coded meaningless markers so radiologists would remain blinded to the region of tenderness, said Dr. Broder of Duke University Medical Center, Durham, N.C.

Of the 93 patients, 51 ultimately were found to have abdominal pathology, most commonly acute appendicitis. In one-third of cases, the pathology identified by radiologists was completely contained in the area highlighted by the skin markers of abdominal tenderness; in another 51%, the pathology was partially located in the marked zone and would have been readily detected by a scan limited to the region of abdominal tenderness.

Although in 16% of cases, the pathology wasn't even partially in the skin marker zone, in most of those instances it was doubtful that the pathology actually caused the abdominal pain. The rate of clinically relevant false-negative abdominal CT scans limited to the area of pain and tenderness was only 4%.

Dr. Broder and his associates also tested intermediately restricted CT, in which the entire abdomen and pelvis below the most cephalad skin marker of tenderness was scanned. This reduced radiation exposure by 38% and increased test sensitivity to 98%.

Based on the encouraging results in a nonconsecutive series, Dr. Broder plans to perform a larger, double-blind study in a consecutive series of similar patients.

NEW ORLEANS — Abdominal computed tomography limited to the region of tenderness accurately delineates acute pathology while reducing radiation exposure, according to a double-blind study.

A standard abdominal CT scan covers an area from above the diaphragm to the mid-thigh. But in the study, limiting the scan to the tender area cut radiation exposure by a mean of 69% while preserving 96% sensitivity, Dr. Joshua Broder said at the annual meeting of the Society for Academic Emergency Medicine.

The 93 patients in the single-center study underwent standard abdominal CT after presenting to the emergency department with nontraumatic abdominal tenderness. Before imaging, emergency physicians placed skin markers to delineate the cephalocaudad extent of tenderness. Then they added coded meaningless markers so radiologists would remain blinded to the region of tenderness, said Dr. Broder of Duke University Medical Center, Durham, N.C.

Of the 93 patients, 51 ultimately were found to have abdominal pathology, most commonly acute appendicitis. In one-third of cases, the pathology identified by radiologists was completely contained in the area highlighted by the skin markers of abdominal tenderness; in another 51%, the pathology was partially located in the marked zone and would have been readily detected by a scan limited to the region of abdominal tenderness.

Although in 16% of cases, the pathology wasn't even partially in the skin marker zone, in most of those instances it was doubtful that the pathology actually caused the abdominal pain. The rate of clinically relevant false-negative abdominal CT scans limited to the area of pain and tenderness was only 4%.

Dr. Broder and his associates also tested intermediately restricted CT, in which the entire abdomen and pelvis below the most cephalad skin marker of tenderness was scanned. This reduced radiation exposure by 38% and increased test sensitivity to 98%.

Based on the encouraging results in a nonconsecutive series, Dr. Broder plans to perform a larger, double-blind study in a consecutive series of similar patients.

NEW ORLEANS — Abdominal computed tomography limited to the region of tenderness accurately delineates acute pathology while reducing radiation exposure, according to a double-blind study.

A standard abdominal CT scan covers an area from above the diaphragm to the mid-thigh. But in the study, limiting the scan to the tender area cut radiation exposure by a mean of 69% while preserving 96% sensitivity, Dr. Joshua Broder said at the annual meeting of the Society for Academic Emergency Medicine.

The 93 patients in the single-center study underwent standard abdominal CT after presenting to the emergency department with nontraumatic abdominal tenderness. Before imaging, emergency physicians placed skin markers to delineate the cephalocaudad extent of tenderness. Then they added coded meaningless markers so radiologists would remain blinded to the region of tenderness, said Dr. Broder of Duke University Medical Center, Durham, N.C.

Of the 93 patients, 51 ultimately were found to have abdominal pathology, most commonly acute appendicitis. In one-third of cases, the pathology identified by radiologists was completely contained in the area highlighted by the skin markers of abdominal tenderness; in another 51%, the pathology was partially located in the marked zone and would have been readily detected by a scan limited to the region of abdominal tenderness.

Although in 16% of cases, the pathology wasn't even partially in the skin marker zone, in most of those instances it was doubtful that the pathology actually caused the abdominal pain. The rate of clinically relevant false-negative abdominal CT scans limited to the area of pain and tenderness was only 4%.

Dr. Broder and his associates also tested intermediately restricted CT, in which the entire abdomen and pelvis below the most cephalad skin marker of tenderness was scanned. This reduced radiation exposure by 38% and increased test sensitivity to 98%.

Based on the encouraging results in a nonconsecutive series, Dr. Broder plans to perform a larger, double-blind study in a consecutive series of similar patients.

CHICAGO — Patients undergoing abdominal/pelvic computed tomography frequently receive unindicated additional scans, resulting in excess radiation exposure, a review of 978 CT scans suggests.

The review, which included exams done in 500 patients, revealed that 263 exams (52.6% of the total) were not indicated based on American College of Radiology Appropriateness Criteria. The exams, performed at institutions in Illinois, Michigan, Minnesota, and Wisconsin, involved patients aged 9 months to 91 years.

One in five patients received at least 50 millisieverts (mSv) of radiation in a single examination. Seven (1.4%) of the 500 patients received greater than 100 mSv—a dose that is associated with an increased cancer risk. The mean radiation dose per patient was 32.9 mSv, which is equivalent to the dose from about 1,000 chest X-rays. The 308 exams that consisted of multiple phases exposed patients to a mean dose of 43 mSv, Dr. Kristie Guite reported at the annual meeting of the Radiological Society of North America.

Radiologists are encouraged to follow the standard of “As Low as Reasonably Achievable” or ALARA, noted Dr. Guite, a resident at the University of Wisconsin, Madison. “The most important finding in this study is that adherence to ALARA is not widespread at this time,” she said at a press briefing during the meeting.

“At the doses seen in our study, 1 in 1,000 patients could get a radiation-induced cancer,” she said. If the data are extrapolated to all CT scans of the abdomen/pelvis performed in the United States, “this would lead to 23,000 radiation-induced cancer cases per year.”

As for why radiologists may order extra scans, coauthor Dr. J. Louis Hinshaw, also with the UW-Madison, said it may be that radiologists simply have the ability and tools available to perform the tests. Also, protocols are set up on CT scanners beforehand and are often designed to answer “what if” scenarios, in which additional views may be needed. “There is some risk-aversion that comes into play,” he said at the briefing.

Of the 500 patients, 7% had findings that would not have been identified without the extra scans, but most of these were not clinically relevant, Dr. Hinshaw said.

The Radiological Society of North America has partnered with the American College of Radiology to create a task force on adult radiation protection to increase awareness of cumulative dose and radiation risks.

Both researchers stressed that CT is a valuable diagnostic tool and that the study findings should not impede use of the technology.

Press briefing moderator Dr. Robert Zimmerman, professor of radiology at Weill Cornell Medical College in New York, concurred. He suggested that patients investigate the radiation protocol at their institution and ask their physicians what steps are being taken to minimize radiation dose.

“We don't want to damage patients, but we know we have the technology that is very useful in saving people's lives,” Dr. Zimmerman said. “We are trying to balance the two.”

In the current study, patients with a malignancy were 22% more likely to receive excess radiation, Dr. Guite said.

Delayed-phase imaging, performed after a contrast agent has accumulated in the kidneys/bladder, accounted for 77% of the unnecessary scans.

There was no study sponsorship, but one coauthor disclosed being a stock holder with NeuWave Medical Inc. and a patent holder with Covidien AG.

'At the doses seen in our study, 1 in 1,000 patients could get a radiation-induced cancer.'

Source DR. GUITE

CHICAGO — Patients undergoing abdominal/pelvic computed tomography frequently receive unindicated additional scans, resulting in excess radiation exposure, a review of 978 CT scans suggests.

The review, which included exams done in 500 patients, revealed that 263 exams (52.6% of the total) were not indicated based on American College of Radiology Appropriateness Criteria. The exams, performed at institutions in Illinois, Michigan, Minnesota, and Wisconsin, involved patients aged 9 months to 91 years.

One in five patients received at least 50 millisieverts (mSv) of radiation in a single examination. Seven (1.4%) of the 500 patients received greater than 100 mSv—a dose that is associated with an increased cancer risk. The mean radiation dose per patient was 32.9 mSv, which is equivalent to the dose from about 1,000 chest X-rays. The 308 exams that consisted of multiple phases exposed patients to a mean dose of 43 mSv, Dr. Kristie Guite reported at the annual meeting of the Radiological Society of North America.

Radiologists are encouraged to follow the standard of “As Low as Reasonably Achievable” or ALARA, noted Dr. Guite, a resident at the University of Wisconsin, Madison. “The most important finding in this study is that adherence to ALARA is not widespread at this time,” she said at a press briefing during the meeting.

“At the doses seen in our study, 1 in 1,000 patients could get a radiation-induced cancer,” she said. If the data are extrapolated to all CT scans of the abdomen/pelvis performed in the United States, “this would lead to 23,000 radiation-induced cancer cases per year.”

As for why radiologists may order extra scans, coauthor Dr. J. Louis Hinshaw, also with the UW-Madison, said it may be that radiologists simply have the ability and tools available to perform the tests. Also, protocols are set up on CT scanners beforehand and are often designed to answer “what if” scenarios, in which additional views may be needed. “There is some risk-aversion that comes into play,” he said at the briefing.

Of the 500 patients, 7% had findings that would not have been identified without the extra scans, but most of these were not clinically relevant, Dr. Hinshaw said.

The Radiological Society of North America has partnered with the American College of Radiology to create a task force on adult radiation protection to increase awareness of cumulative dose and radiation risks.

Both researchers stressed that CT is a valuable diagnostic tool and that the study findings should not impede use of the technology.

Press briefing moderator Dr. Robert Zimmerman, professor of radiology at Weill Cornell Medical College in New York, concurred. He suggested that patients investigate the radiation protocol at their institution and ask their physicians what steps are being taken to minimize radiation dose.

“We don't want to damage patients, but we know we have the technology that is very useful in saving people's lives,” Dr. Zimmerman said. “We are trying to balance the two.”

In the current study, patients with a malignancy were 22% more likely to receive excess radiation, Dr. Guite said.

Delayed-phase imaging, performed after a contrast agent has accumulated in the kidneys/bladder, accounted for 77% of the unnecessary scans.

There was no study sponsorship, but one coauthor disclosed being a stock holder with NeuWave Medical Inc. and a patent holder with Covidien AG.

'At the doses seen in our study, 1 in 1,000 patients could get a radiation-induced cancer.'

Source DR. GUITE

CHICAGO — Patients undergoing abdominal/pelvic computed tomography frequently receive unindicated additional scans, resulting in excess radiation exposure, a review of 978 CT scans suggests.

The review, which included exams done in 500 patients, revealed that 263 exams (52.6% of the total) were not indicated based on American College of Radiology Appropriateness Criteria. The exams, performed at institutions in Illinois, Michigan, Minnesota, and Wisconsin, involved patients aged 9 months to 91 years.

One in five patients received at least 50 millisieverts (mSv) of radiation in a single examination. Seven (1.4%) of the 500 patients received greater than 100 mSv—a dose that is associated with an increased cancer risk. The mean radiation dose per patient was 32.9 mSv, which is equivalent to the dose from about 1,000 chest X-rays. The 308 exams that consisted of multiple phases exposed patients to a mean dose of 43 mSv, Dr. Kristie Guite reported at the annual meeting of the Radiological Society of North America.

Radiologists are encouraged to follow the standard of “As Low as Reasonably Achievable” or ALARA, noted Dr. Guite, a resident at the University of Wisconsin, Madison. “The most important finding in this study is that adherence to ALARA is not widespread at this time,” she said at a press briefing during the meeting.

“At the doses seen in our study, 1 in 1,000 patients could get a radiation-induced cancer,” she said. If the data are extrapolated to all CT scans of the abdomen/pelvis performed in the United States, “this would lead to 23,000 radiation-induced cancer cases per year.”

As for why radiologists may order extra scans, coauthor Dr. J. Louis Hinshaw, also with the UW-Madison, said it may be that radiologists simply have the ability and tools available to perform the tests. Also, protocols are set up on CT scanners beforehand and are often designed to answer “what if” scenarios, in which additional views may be needed. “There is some risk-aversion that comes into play,” he said at the briefing.

Of the 500 patients, 7% had findings that would not have been identified without the extra scans, but most of these were not clinically relevant, Dr. Hinshaw said.

The Radiological Society of North America has partnered with the American College of Radiology to create a task force on adult radiation protection to increase awareness of cumulative dose and radiation risks.

Both researchers stressed that CT is a valuable diagnostic tool and that the study findings should not impede use of the technology.

Press briefing moderator Dr. Robert Zimmerman, professor of radiology at Weill Cornell Medical College in New York, concurred. He suggested that patients investigate the radiation protocol at their institution and ask their physicians what steps are being taken to minimize radiation dose.

“We don't want to damage patients, but we know we have the technology that is very useful in saving people's lives,” Dr. Zimmerman said. “We are trying to balance the two.”

In the current study, patients with a malignancy were 22% more likely to receive excess radiation, Dr. Guite said.

Delayed-phase imaging, performed after a contrast agent has accumulated in the kidneys/bladder, accounted for 77% of the unnecessary scans.

There was no study sponsorship, but one coauthor disclosed being a stock holder with NeuWave Medical Inc. and a patent holder with Covidien AG.

'At the doses seen in our study, 1 in 1,000 patients could get a radiation-induced cancer.'

Source DR. GUITE