A gradient head coil has been developed, incorporating two independent gradients within the conventional body coil of the magnetic resonance (MR) system, with reduced rise times (200 microseconds) and maximum amplitudes of 37 and 18 mT/m in the z and y directions, respectively. This gradient coil was systematically evaluated by testing two-dimensional (2D) and three-dimensional (3D) time-of-flight (TOF) MR angiography sequences applied to a pulsatile flow phantom simulating a carotid stenosis and the intracranial vasculature. When standard 2D and 3D TOF MR angiography techniques were used to image the carotid stenosis model, dramatic signal loss in the stenotic segment and a large flow void distal to the stenosis were seen. The shorter (3.8 msec) absolute echo times (TEs) achievable with the gradient coil in 3D sequences substantially reduced the phase dispersion and associated signal loss in the region of stenosis. Shorter TEs alone (3.2 msec) did not minimize signal loss, and first-order flow compensation in the read and section-select directions provided further improvements (despite slightly longer TEs). Reduction of TEs in 2D sequences yielded relatively poor results regardless of the refocusing scheme or TE. This study confirms the predicted benefits of a dedicated coil with improved gradient capabilities for 3D MR angiography. The study suggests the limitations of 2D TOF MR angiography in the evaluation of severe stenoses.

Carotid Arteries↗

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Prenatal detection of anencephaly.

Fetal anomalies were suspected clinically in 3 patients, during the second trimester of pregnancy, due to advanced maternal age, hydramnios and abnormal vaginal bleeding respectively. Sonography revealed anencephaly in all of them, confirmed by roentgenograms and also by high amniotic fluid leveal alpha-fetoprotein in 1 of them. The antenatal diagnosis was confirmed in the 3 abortuses. Early screening of all pregnancies at risk for neural tube malformations is strongly recommended.

Adult↗

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Code blue: what's new?

In October 1992, lengthy new guidelines for cardiopulmonary resuscitation and emergency cardiac care were published by the Emergency Cardiac Care Committee and Subcommittees of the American Heart Association. These guidelines represent the efforts of the world's experts in emergency cardiac care. Yet they may be difficult for the busy clinician to digest in a timely fashion. In this article we summarize the changes in the guidelines from the 1986 version. It is not intended as a substitute for the original document but rather as an adjunct to help the clinician assimilate this new information.

Adult↗

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Cutting to the chase: what physician executives need to know about HIPAA.

All health care providers, plans, and clearinghouses will be affected by the federally mandated uniform standards for administrative transactions. This article presents distilled core information about the Health Insurance Portability and Accountability Act (HIPAA) legislation--the standards, penalties for violations, and status of final rules. It also raises several key unsolved issues of which clinicians, executives, and health care providers must be aware so they can prepare and plan for the upcoming changes. HIPAA is intended to improve the efficiency and effectiveness of the health care system, as well as to increase the protection and confidentiality of individually identifiable health information. The costs of making the transition to the legislated standards and processes remain a worrisome factor. Although there are two years before these standards must be implemented, and cost and compliance issues resolved, work has already begun in many health institutions to identify and address them.

Computer Security↗

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'Second generation' Internet e-health: the gladiator for HIPAA compliance?

The Health Insurance Portability and Accountability Act (HIPAA) is intended to simplify administrative processes and improve health information security. There are a number of traditional ways to address the expense and complexities of simplification, but none of them are bargains or beauties to behold: (1) Do-it-yourself encryption; (2) new back-end system purchases; (3) legacy system re-programming; or (4) onerous paper documentation. The good news is that 'second generation' e-health solutions are emerging that act as internal "wrappers" for health plan or provider data systems. They provide both an interface for end-users and a layer of security for organizational information and allow detailed patient-related data to remain at the system owner's physical location. These second generation solutions don't just 'connect,' data, they actually 'understand' the information, and can use data elements to invoke necessary rules, processing pathways, or personalization for specific stakeholders as required by HIPAA.

Computer Security↗

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Lessons from life. The biology of business transformation.

Biology and business face similar challenges when it comes to change. Living organisms experience constant change. And successful health care organizations must be ready and willing to embrace transition if they are to survive. Take an in-depth look at the biology-to-business metaphor and see how to better manage information technology changes in your organization.

Biology↗

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