Search PubMed⌕ Search

Biomedical subjects

R L Arenson

Publications and source records attributed to R L Arenson.

At least 19 recordsLinked to original sources
PubMed1992

The impact of PACS on research and education.

Picture Archiving and Communication Systems (PACS) are rapidly evolving and the total digital radiology department may be a reality within the next decade. PACS can have a major impact on the educational and research responsibilities of a medical institution. The possibility of correlating real patient data with existing radiological teaching files opens up numerous possibilities. Multi-institutional research can be strengthened by employing the PACS as the means to the end. This paper discusses the representative examples of how teaching and research can be enhanced with PACS and the technical requirements to achieve the inter-connectivity.

Education, Medical↗
PubMed1992

Software suite for image archiving and retrieval.

The efficient operation of a clinical picture archiving and communication system (PACS) requires a fully functional image archive. The archive should not only be able to store and retrieve images reliably but should also work in concert with software that optimizes the flow of image-related information throughout the PACS. The authors devised a software suite that serves to improve the flow and content of information and the integrity of the data. The software was developed by translating the functions performed by a conventional film library. Types of transactions possible with this system include scheduling, canceling, rescheduling, and prestaging examinations; changing demographic information; merging patient information; and generating reports. The authors believe such a software suite is essential for a clinically useful PACS.

Data Display↗
PubMed1992

Picture archiving and communication systems in the United States.

Picture archiving and communication systems (PACS) are expected to replace film in the years to come. PACS acquire, store, transmit, and display medical images. Although there are several clinical PACS in operation today, there are significant problems slowing their introduction. PACS are limited in spatial and contrast resolution and the workstation's displays present difficulties due to low light levels, slow image presentation, and poorly designed software. Standard interfaces are still lacking for most of the imaging equipment currently in use, making connections to these devices nearly impossible. Cost is a major issue as well. Yet limited implementations, often called mini-PACS, offer advantages such as faster image presentation to radiologists and referring physicians, reduced portable retake rates, the capability for viewing images at home off-hours, and transmission from remote sites. More development is needed for interfaces with the radiology information system and for sophisticated network and image management.

Radiology Information Systems↗
PubMed1990

The digital imaging workstation.

Picture archiving and communication systems (PACS) are expected to convert film-based radiology into a computer-based digital environment, with associated cost savings and improved physician communication. The digital workstation will be used by physicians to display these "soft-copy" images; however, difficult technical challenges must be met for the workstation to compete successfully with the familiar viewbox. Issues relating to image perception and the impact on physicians' practice must be carefully considered. The spatial and contrast resolutions required vary according to imaging modality, type of procedure, and class of user. Rule-based software allows simple physician interaction and speeds image display. A consensus appears to be emerging concerning the requirements for the PACS workstation. Standards such as the American College of Radiology/National Electrical Manufacturers' Association Digital Imaging and Communication Standard are facilitating commercial applications. Yet much careful study is needed before PACS workstations will be fully integrated into radiology departments.

Computer Systems↗
PubMed1989

The impact of sonography on the management of extratesticular abnormalities of the scrotum.

The results of scrotal sonography performed in a recent one-year period (1987) were retrospectively reviewed to assess the role of sonography in the management of patients with extratesticular abnormalities. The study included 226 examinations performed in 204 men. In extratesticular abnormalities, scrotal sonography confirms the clinical impression of the referring physicians, monitors the progress of conservative treatment, and guides the surgical approach. Patients with sonographically classic cystic extratesticular abnormalities rarely come to surgery. Those with complicated cystic abnormalities are usually followed clinically but have a higher incidence of surgery. Those with solid-appearing echogenic abnormalities usually have surgical removal.

Adolescent↗
PubMed1989

The diagnosis of pulmonary nodules: comparison between standard and inverse digitized images and conventional chest radiographs.

We compared plain chest radiographs, standard (bones white) digitized images, and inverse-intensity (bones black) images to determine their ability to identify pathologically confirmed malignant pulmonary nodules. The images were digitized by using a photo-optical laser scanner and were displayed on a 1024 x 1024 x 8 bit system capable of operator-controlled magnification (2x or 4x) and nonlinear (logarithmic/exponential) contrast transformation in both standard and inverse-intensity modes. Receiver-operator curve analysis was used to study the detection performance of six observers who viewed 40 images obtained in 15 normal subjects and 25 abnormal subjects. There was no statistically significant difference in the area under the ROC curve between the standard digital images and the plain chest radiographs. However, ROC areas were significantly greater (p less than or equal to .05) for inverse-intensity digital images when compared with either standard-intensity digital images or plain chest radiographs. These results suggest that inverse-intensity images may have some advantages in the detection of pulmonary nodules.

Humans↗
PubMed1989

A prospective trial of ionic vs nonionic contrast agents in routine clinical practice: comparison of adverse effects.

A multicenter study of adverse effects of ionic and nonionic contrast agents was conducted in three similar time periods. In 1985, before approval of the nonionic contrast agents by the Food and Drug Administration, 6006 consecutive patients received iv ionic agents for urography or CT. After approval of the nonionic agents, 7170 consecutive patients referred for the same examinations were studied. The two groups of patients were significantly different, but the differences were small and did not uniformly favor either group. The incidence of adverse effects in the patients given ionic contrast material was significantly higher than that of the nonionic group (4.17% vs 0.69%, p less than .001). The reactions were also more severe in the ionic group than in the nonionic group (p less than .005). A patient questionnaire disclosed that many patients did not feel well for hours to days after the procedure and also did not immediately resume normal activities of daily living. The nonionic agent was significantly less distressful than the ionic agent. We conclude that nonionic agents cause fewer and less severe adverse effects. Reducing adverse effects can save the patient or the examining site either time or money. However, this study does not show that nonionic agents are more cost-effective than ionic agents.

Contrast Media↗
PubMed1989

Hepatic and biliary tract abnormalities in patients with AIDS. Sonographic-pathologic correlation.

A retrospective evaluation of hepatobiliary sonograms in 22 patients with AIDS was performed and the sonographic abnormalities were correlated with pathologic findings in 10 patients. Hepatic parenchymal abnormalities noted on ultrasound include a hyperechoic parenchymal echo pattern in 45.5%, hepatomegaly in 41%, and focal masses in 9% of patients. Etiologies for the diffuse hyperechoic pattern based on pathologic correlation in eight cases were hepatic steatosis and granulomatous hepatitis. Biliary tract abnormalities identified included gallbladder wall thickening in 55% of patients, dilated gallbladder in 18%, biliary sludge in 23%, and gallstones in 5% of patients. Extrahepatic ductal dilation was seen in 23% of patients, but the intrahepatic ducts were dilated in only 5% of patients. Possible etiologies for biliary tract abnormalities suggested by pathologic correlation in five patients and literature review were cytomegalovirus and cryptosporidial infection, although constitutional factors may have played a role. Hepatobiliary ultrasound is, therefore, an effective screening tool for directing further diagnostic and therapeutic procedures in AIDS patients presenting with clinical evidence of hepatobiliary dysfunction.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Improved financial management of the radiology department with a microcosting system.

The basic unit of service in radiology is the examination or procedure and its associated costs such as film, medical and surgical supplies, personnel, equipment depreciation, and overhead. The appropriate allocation of all operating costs to the specific examination types is the purpose of the microcosting system. Microcosting programs use data from hospital expense and payroll systems and data from a radiology information management system. These data are loaded into a computer spread sheet program for the microcosting computations. The results from using this system include better understanding of costs, accurate budget projections, confidence in negotiating discounts, and improved efficiency and reduced costs.

Accounting↗
PubMed1988

Transvaginal and transabdominal sonography: prospective comparison.

Transvaginal (TV) and transabdominal (TA) sonography were compared in a prospective study. A total of 230 examinations (126 pelvic, 104 pregnancy) were performed on 215 patients, ranging in age from 14 to 80 years. The improved anatomic detail on TV scans yielded new information in 138 (60%) examinations and better visualization of pelvic structures in 51 (22%) examinations. There was no important difference in diagnostic information provided by the two imaging modalities in 36 (16%) cases, and TV images were worse in five (2%). The clinical diagnosis was altered on the basis of TV sonographic findings in 54 (24%) cases and confirmed with certainty in 166 (72%). Diagnostic problems posed by TA scanning were not resolved by TV scanning in ten (4%) instances. Statistical analysis indicated that TV scanning was significantly better than TA scanning in the visualization of gestational sac contents (P less than .005), detection of fetal heart motion (P less than .001), and evaluation of the endometrial canal in the retroverted or retroflexed uterus (P less than .001). TV scanning was significantly better than TA scanning in visualization of the ovaries in patients with uterine leiomyomas (P less than .005) but not significantly better in peri- and postmenopausal patients (P greater than .05).

Adult↗
PubMed1988

Opportunity ahead.

Explore the source record for details and available documents.

Computer Communication Networks↗
PubMed1988

Effect of a digital imaging network on physician behavior in an intensive care unit.

This study examined the effect of a medical image management network on the behavior of physicians working in a medial intensive care unit (MICU). For 1 year, 8-week periods during which chest radiographs were digitized and made available to MICU physicians on a digital display console were alternated with 8-week periods during which only film images were available. Clinical efficacy during the periods was compared by measuring the time between completion of imaging examinations and initiation of specific clinical actions such as placement and positioning of tubes. Results indicate that the time required to take some clinical actions decreased with the immediate availability of images on the digital display console. Established procedures for obtaining radiologic information were altered by the digital imaging network. The time at which physicians viewed images changed, and consultations between MICU staff and radiologists decreased. These results indicate that behavior patterns are altered when a new technology replaces an existing one. Optimal use of this technology may require changes in the logistics of clinical practice.

Behavior↗
PubMed1988

Clinical evaluation of a medical image management system for chest images.

The clinical efficacy and physicians' assessment of a medical image management system (MIMS) for chest images that involved the medical intensive care unit (MICU) and the radiology department were evaluated. A token-passing fiber-optic network was implemented to connect display stations in the MICU and in the chest reading area in the radiology department with a laser film digitizer and an archiving system. To study the clinical efficacy of this system, blocks of 8 weeks during which portable chest images were digitized and immediately made available in the MICU were alternated with blocks of 8 weeks during which film images only were available. Approximately 3000 portable chest examinations were tracked; patients were entered into the study at a rate of 65 per month. Data on time intervals associated with the examination process were collected from MICU physicians, radiologists, radiographers, and film librarians. The time from the completion of an examination to the time an action was taken that was based on radiographic findings showed significant reductions during the digital periods for certain actions. For example, the time to begin drug therapy decreased from a mean of 4.7 hr when films were viewed to a mean of 3.3 hr when digital images were viewed. In conclusion, if prompt action by the MICU physician improves a patient's outcome, a positive effect on patient care will result from the immediate availability of radiographic images.

Computer Systems↗
PubMed1987

Leiomyomas in pregnancy: sonographic study.

With ultrasound monitoring, analysis of the behavior of uterine leiomyomas (fibroids) and their impact on the course of pregnancy was undertaken in a group of 113 patients. Fibroid size changes were analyzed on the basis of trimesters. In the second trimester, smaller fibroids increased in size, whereas larger fibroids decreased in size. In the third trimester, a decrease in size was documented regardless of initial size. The most common patterns of echotexture were hypoechoic, heterogeneous, and echogenic rim. The development of a heterogeneous pattern or anechoic/cystic spaces on a follow-up study was accompanied in seven of ten patients by severe abdominal pain, compared with 12 cases of abdominal pain in 103 patients without such echotexture changes. Although the number of patients was small, the development of these patterns apparently indicates significant degeneration of the fibroid. Fibroids located in the lower uterine segment were accompanied by a higher frequency of cesarean section and retained placenta. Fibroids located in the uterine corpus were more frequently associated with early abortions. Multiple fibroids were accompanied by a higher frequency of malpresentation and premature contractions compared with cases with one or two fibroids.

Adult↗
PubMed1987

Twin gestations: monitoring of complications and anomalies with US.

An evaluation of 227 consecutive twin gestations was undertaken to assess the role of ultrasound (US) in the diagnosis of major obstetric complications and congenital anomalies. US accurately depicted the growth and development of fetuses in 65 patients with underlying maternal disorders that produced additional risks to the pregnancy. Complications such as malpresentations (104 cases), polyhydramnios (15 cases), oligohydramnios (five cases), and uterine myomas (seven of 11 cases) were demonstrated prenatally with US. Fetal anomalies included anencephaly (two cases), hydrocephalus (two cases), conjoined twins (three cases), twin-twin transfusion syndrome (five cases), and acardiac monsters (two cases). Demise of one twin in 20 gestations and demise of both twins in 18 gestations (overall mortality of 17%) were correctly identified with US. These 38 gestations included intrauterine demise in 12, spontaneous abortion in 13, and neonatal deaths in 13. Therefore, when multiple gestations are suspected clinically, serial real-time US scans should be obtained beginning in the first trimester.

Adolescent↗