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Biomedical subjects

R L Arenson

Publications and source records attributed to R L Arenson.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1987

Digital chest imaging: comparison of two film image digitizers with a classification task.

A classification test was used to compare the results of digitizing chest radiographs with a linear diode array camera and a laser scanner. The ability of B readers to classify a pneumoconiosis test set from original radiographs and the digitized images was compared. The classification of profusion was impaired when images were digitized with the diode array camera but not when they were digitized with the laser scanner. The impairment found with images digitized with the linear diode array camera was overcome with use of a zoom function at the display station. The size of areas of opacification was overestimated on images from both scanners. Variation between and within observers (kappa approximately equal to 0.6) was consistent over observers and over modalities.

Evaluation Studies as Topic↗
PubMed1986

Cystic renal mass evaluation: real-time versus static imaging.

Fifty consecutive cystic renal masses in 43 patients were evaluated by both static scanning and real-time scanning techniques. Various parameters were evaluated and compared to ascertain whether the strict static scan cystic criteria were always present in comparable real-time evaluations. Four (8%) of the 50 masses were not classic cysts on real-time examinations, although the criteria were present on the static scans. Two had minimal acoustic enhancement and two had low-intensity internal echoes. Possible reasons for this difference were detailed and discussed. The potential problems in this observation were enumerated. Based on these observations, in certain cases when a cystic renal mass demonstrates poor acoustic enhancement or low-level internal echoes in real-time examination, static scanning may be helpful and may obviate the need for further studies.

Diagnosis, Differential↗
PubMed1986

Teaching with computers.

Various methods of using computers in education have been presented. Although the interesting file, interactive video, and bibliographic searches stand on their own, a far better approach is to integrate them, so that the radiologist learning new techniques in interventional procedures, for instance, could search the current literature quickly and easily for new articles using the bibliographic search facility and could review interesting cases from the teaching file that pertained to the lesson at hand. One very important attempt to integrate some of these teaching functions in conjunction with other aspects of medical school administration and research has been the Integrated Academic Information Management Systems (IAIMS) Program of the National Library of Medicine. This program stems from a report created by the Association of American Medical Colleges (AAMC), which was funded originally by the National Library of Medicine. This program has funded several teaching institutions to first plan for an integrated approach to medical information (Fig. 7) and then implement prototype systems. As medical image management systems become available (see the article entitled "Digital Image Management: Networking, Display, and Archiving"), they will be a major component of these information networks and will be most important for teaching purposes. Integrating the teaching components described earlier with the medical image management system will be most important.

Computer-Assisted Instruction↗
PubMed1986

Office automation.

By now, the term "office automation" should have more meaning for those readers who are not intimately familiar with the subject. Not all of the preceding material pertains to every department or practice, but certainly, word processing and simple telephone management are key items. The size and complexity of the organization will dictate the usefulness of electronic mail and calendar management, and the individual radiologist's personal needs and habits will determine the usefulness of the home computer. Perhaps the most important ingredient for success in the office automation arena relates to the ability to integrate information from various systems in a simple and flexible manner. Unfortunately, this is perhaps the one area that most office automation systems have ignored or handled poorly. In the personal computer world, there has been much emphasis recently on integration of packages such as spreadsheet, database management, word processing, graphics, time management, and communications. This same philosophy of integration has been applied to a few office automation systems, but these are generally vendor-specific and do not allow for a mixture of foreign subsystems. During the next few years, it is likely that a few vendors will emerge as dominant in this integrated office automation field and will stress simplicity and flexibility as major components.

Computers↗
PubMed1985

Ectopic embryo detection using real-time sonography.

An analysis of the sonograms of 60 patients with a surgically confirmed diagnosis of ectopic pregnancy was performed. In 36 examinations, both real-time and static images were compared, and real-time was judged superior in 22 based on a correlation between the original report and surgical pathology. The appearance of the endometrial canal and the adnexa was characterized in a total of 65 scans. The endometrial canal appearance was variable, with the most common finding being a linear echo (39%). The adnexal changes were less diverse, with an adnexal ring suggestive of an extrauterine gestational sac identified in 60%. In 10 cases, the adnexal ring contained a distinct fetus with a measurable crown-rump length, and cardiac activity was evident in six. Our results indicate that real-time ultrasound coupled with serum beta-hCG RIA should be the procedure of choice when ectopic pregnancy is suspected.

Adnexa Uteri↗
PubMed1985

Routine fetal genitourinary tract screening.

To evaluate routine fetal genitourinary tract obstetrical ultrasound screening, and to determine what size renal pelvis is indicative of significant renal disease, we reviewed 4,832 examinations, which had been performed over 2 years, of 3,530 consecutive obstetrical patients. Any fetus that had a renal pelvis greater than 5 mm or a definable cystic area was identified for follow-up. The fetuses of 39 patients (1.1%) who underwent 112 examinations fulfilled these criteria and constitute the basis of this report. A variety of examination criteria were recorded and analyzed in relationship to the follow-up, which ranged from 2-3 days to 21 months. The fetuses of the 39 patients were grouped into three categories: those with renal pelves between 5 and 9 mm in size; those with renal pelves larger than 10 mm; and those with cystic abnormalities. Those with renal pelves larger than 10 mm had either an obstructing lesion or exceptional extrarenal pelves. The clinical and pathologic aspects of these three groups are detailed, discussed, and analyzed. Criteria for significant fetal renal hydronephrosis and aspects of a loculated appearance are given.

Dilatation, Pathologic↗
PubMed1984

Thyroid imaging: comparison of high-resolution real-time ultrasound and computed tomography.

High-resolution real-time ultrasound (US) and computed tomography (CT) were compared in 48 patients with a clinical diagnosis of thyroid abnormality and also correlated with biopsy or surgery. The modalities were considered comparable in 38 cases (79%), while CT was superior in 5 and US in 5. CT illustrated substernal extension of a goiter, demonstrated a 5-mm nodule not seen in US, showed 2 cases of thyroiditis better than US, and diagnosed a suspected thyroid mass as a lipoma anterior to the thyroid. US detected 4 nodules not seen on CT and resolved contiguous nodules that appeared to be a single nodule on CT. Both techniques lacked histopathological specificity. CT appears to be advantageous in detecting substernal thyroid extension and confirming thyroiditis, while the ability of US to detect small nodules makes it the procedure of choice in evaluating suspected intrinsic thyroid abnormalities.

Adolescent↗
PubMed1984

Automation of the radiology management function.

The functions that are necessary in a radiology computer system are described. These functions include registration, scheduling, patient tracking, film library management, consultation reporting, management reporting, billing, keeping a teaching file, and providing an imaging system interface. Consideration of these points may help in choosing a radiology management system.

Computers↗