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DNA extraction and amplification of leishmania from archived, Giemsa-stained slides, for the diagnosis of cutaneous Leishmaniasis by PCR.

DNA was isolated from 92 Giemsa-stained smears of lesions from suspected cases of cutaneous leishmaniasis and used for PCR-based diagnosis of Leishmania infection. Each smear had been examined under a light microscope at x 1,000 and scored for amastigote numbers. Although the smears had been stored for up to 4 years, all the microscopy-positive slides were also positive by PCR and four of the 14 smears that were negative by microscopy (although of lesions that were clinically consistent with leishmaniasis) were also PCR-positive. PCR-based investigations therefore appear to offer an effective method to confirm suspected cases of cutaneous leishmaniasis using (even archived) samples that have been collected, from humans (and reservoir hosts) in the field, by simple methods.

Animals↗

Expression of glucocorticoid and progesterone nuclear receptor genes in archival breast cancer tissue.

BACKGROUND: Previous studies in our laboratory have shown associations of specific nuclear receptor gene variants with sporadic breast cancer. In order to investigate these findings further, we conducted the present study to determine whether expression levels of the progesterone and glucocorticoid nuclear receptor genes vary in different breast cancer grades. METHODS: RNA was extracted from paraffin-embedded archival breast tumour tissue and converted into cDNA. Sample cDNA underwent PCR using labelled primers to enable quantitation of mRNA expression. Expression data were normalized against the 18S ribosomal gene multiplex and analyzed using analysis of variance. RESULTS: Analysis of variance indicated a variable level of expression of both genes with regard to breast cancer grade (P = 0.00033 for glucocorticoid receptor and P = 0.023 for progesterone receptor). CONCLUSION: Statistical analysis indicated that expression of the progesterone nuclear receptor is elevated in late grade breast cancer tissue.

Breast Neoplasms↗

The effect of Picture Archiving and Communications Systems on the accuracy of diagnostic interpretation of pediatric emergency physicians.

OBJECTIVES: To compare the accuracy of diagnostic interpretation of radiographs by pediatric emergency physicians (EPs) before and after the introduction of a Picture Archiving and Communications System (PACS). METHODS: The pre-PACS study period included results from September 2001, when patients were evaluated by using only conventional radiographs. The post-PACS study period consisted of results from September 2002, when patients were evaluated by using only digital radiographic studies. During these periods, consecutive medical records of all patients who underwent radiological studies when attending the pediatric emergency department (ED) were reviewed. The radiographic interpretation by the pediatric EP, documented at the time of the ED visit, was compared with that made by the pediatric radiologist. RESULTS: Data were available from 1,644/1,651 sets of conventional radiographs ordered for the pre-PACS study period and from 1,430/1,431 sets of digital radiographic studies for the post-PACS study period. The prevalence of positive radiological studies as per the radiologists was 32.2% (pre-PACS study period) vs. 28.7% (post-PACS study period). Diagnostic performance of the pediatric EPs for the two time periods was as follows: overall accuracy, 98.1% (95% confidence interval [CI] = 94.5% to 100%) vs. 98.5% (95% CI = 87.5% to 100%); sensitivity, 96.4% (95% CI = 94.5% to 97.8%) vs. 98.1% (95% CI = 96.2% to 99.2%); specificity, 98.9% (95% CI = 98.1% to 99.4%) vs. 98.6% (95% CI = 97.7% to 99.3%); negative predictive value, 98.3% (95% CI = 97.4% to 99.0%) vs. 99.2% (95% CI = 98.5% to 99.7%); and positive predictive value, 97.7% (95% CI = 96.0% to 98.8%) vs. 96.6% (95% CI = 94.4% to 98.2%). The proportion of false negatives (FN) was 1.2% (19/1,644) vs. 0.6% (8/1,430). Only one FN patient for each time period required immediate follow-up for a missed diagnosis. CONCLUSIONS: Radiograph interpretations by pediatric EPs with digital studies remain as accurate in comparison with assessments performed by using conventional radiographs.

Child↗

Her-2/neu analysis in archival tissue samples of human breast cancer: comparison of immunohistochemistry and fluorescence in situ hybridization.

PURPOSE: The objective of our study was to compare the methods used in the literature to analyze HER-2/neu status on archival breast cancer tissue. Therefore, a series of antibodies was evaluated to assess their immunohistochemical (IHC) sensitivity in correlation to gene amplification determined by fluorescence in situ hybridization (FISH). MATERIALS AND METHODS: HER-2/neu overexpression was studied on paraffin sections of 85 invasive breast cancers using a panel of five monoclonal (9G6, 3B5, CB11, TAB250, GSF-HER2) and two polyclonal antibodies (A8010, A0485) in addition to the HercepTest (DAKO, Glostrup, Denmark). HER-2/neu gene amplification was determined by FISH using a dual-color probe (PathVysion; Vysis, Stuttgart-Fasanenhof, Germany). RESULTS: HER-2/neu overexpression was demonstrated in 26% (9G6, TAB250, GSF-HER2), 27% (3B5, CB11), 33% (A8010) and 42% (A0485, HercepTest) of the tumors. FISH on paraffin sections identified gene amplification in 28% of the tumors. Strongly positive IHC results (3+) were always associated with gene amplification. Among the 16 tumors presented with weakly positive IHC results (2+) using the HercepTest, 12 (75%) lacked gene amplification. CONCLUSION: The comparison of IHC and FISH demonstrated an excellent correlation of high-level HER-2/neu overexpression (3+) with gene amplification; ie, FISH does not provide further information in these tumors. However, weakly positive IHC results (2+) obtained with the HercepTest share only a minor association with gene amplification.

Antibodies, Monoclonal↗

Development of a web-based picture archiving and communication system using satellite data communication.

Using the JAVA language we have developed a Web-based picture archiving and communication system (PACS) which allows a remote hospital to access medical images. An asymmetric satellite data communication system (ASDCS) provided a receive-only link for data delivery and a conventional terrestrial link (which could be the conventional telephone network) allowed data transmission. The satellite communication link was 10-30 times faster than the conventional terrestrial link. To increase image transmission speeds over the Internet connection, JPEG and wavelet compression methods were used. The resulting images were evaluated quantitatively by measuring the peak signal:noise ratio and qualitatively by radiologists. Compression ratios of 10:1 or less were deemed acceptable for diagnostic purposes. The system appears to be suitable for teleradiology and telemedicine.

Computer Communication Networks↗

Cardiac picture archiving and communication systems and telecardiology - technologies awaiting adoption.

Diagnostic and therapeutic procedures associated with cardiology are heavily supported by diagnostic imaging technology. The management of such images, including radiographs, echocardiography examinations and cardiac angiography studies, requires a suitable means of handling the data. A number of manufacturers are now offering picture archiving and communication systems (PACS) and telecardiology options. These could greatly improve the efficiency of data management for cardiac examinations, including linkage to radiology and hospital information systems and electronic patient records. A barrier to the implementation of cardiac PACS has been the relatively high capital cost. There have also been technical difficulties in implementing a suitable interface. Historical problems have included 'turf wars' between different specialist groups and a reluctance to shift from well established practice patterns. Early cooperative work between radiologists and cardiologists in the development of coronary arteriography has been replaced by contention between cardiologists, radiologists and vascular surgeons, often driven by economic considerations rather than the needs of the patient. At this stage, cardiac PACS and telecardiology have great potential for improving the coordinated care of cardiac patients in Australia.

Journal Article↗

Choosing networks for picture archiving and communication systems and teleradiology.

Qualitative interviews were performed with 26 resource persons with experience of picture archiving and communication systems and teleradiology. The results reported here concern the different types of networks there was interest in establishing. Eight types of networks were considered to be of interest. The two main reasons for wanting the networks were related to clinical communication and improved exploitation of resources. Use of such networks means cooperation across organizational boundaries. Networks can play an organizational role and this raises questions concerning the future organization of radiology services.

Computer Communication Networks↗

Implementation of a radiology information system/picture archiving and communication system and an image transfer system at a large public teaching hospital--assessment of success of adoption by clinicians.

In 2001 a radiology information system/picture archiving and communication system (RIS/PACS) was installed at the Princess Alexandra Hospital (PAH) in Brisbane, with electronic image transfer links to other major hospitals in Queensland. An assessment study is being performed of the effect of the ready availability of radiology results on clinicians, clinical decision making and the time taken to treat patients. A series of structured interviews with senior clinicians at the PAH began in July 2002. Administrative data are being collected from the PAH computer system. Preliminary results from the first six months of the study suggest that the introduction of the RIS/PACS at the PAH has been well received by senior clinicians and has been helpful in clinical decision making. Patient management has been improved and the time taken to arrive at clinical decisions has been reduced, particularly in neurosurgery. The RIS/PACS has significantly improved access to imaging resources for teaching, owing to the ability to retrieve reference images and to project high-quality images during teaching sessions. However, the introduction of the RIS/PACS has not reduced patient length of stay.

Attitude of Health Personnel↗

Teleradiology and picture archiving and communications systems: changed pattern of communication between clinicians and radiologists.

In a few years all radiology departments in Norwegian hospitals will have a picture archiving and communications system (PACS). This depends on telecommunications with great capacity for transmitting radiology images. The new technology questions the need for daily meetings between radiologists and clinicians, 'clinico-radiological conferences'. Qualitative interviews were performed with 23 resource persons experienced with problems related to PACS and teleradiology. The response rate was 91%. In all, 29% answered that the clinico-radiological conferences could be abolished, 52% replied no and 19% replied both yes and no. The clinico-radiological conferences could be abolished for some clinical departments, but only after consultation between radiology and clinical departments. If the conferences are abolished, clinicians and radiologists may spend more time on treatment and interpretation, with a probable productivity gain.

Attitude of Health Personnel↗

Work practice changes caused by the introduction of a picture archiving and communication system.

We studied the acceptance of work practice changes six months after the introduction of a picture archiving and communication system (PACS) in New South Wales. A one-page questionnaire was developed to assess doctors' and nurses' acceptance of work practice changes. Over 100 subjects were surveyed and 76 responded. In all, 92% of participants worked in the intensive-care unit (ICU) or the emergency department (ED). The results showed that the PACS had received a high level of acceptance. The respondents would not like to return to a film-based practice. They were happy with the accessibility of images, especially when patients returned from an X-ray examination. At the time of survey, the doctors still had difficulty in remembering their user name and password. The users rarely or only sometimes used their own user names and passwords to log on the system. They were sometimes annoyed by the automatic time-out function. Nurses were happy that the PACS relieved their burden of searching for X-ray images for doctors. However, they distanced themselves from accessing the PACS, which they regarded as a doctors' tool.

Attitude of Health Personnel↗

The benefits of hospital-wide picture archiving and communication systems: a survey of clinical users of radiology services.

This paper describes one element of a broad evaluation of a hospital-wide picture archiving and communication system (PACS): an assessment of the views of users of the radiology service, their major causes of dissatisfaction with the service, the incidence of image unavailability, and the consequences of images being unavailable. The principal research design was a "before and after" comparison at Hammersmith Hospital, as the hospital site introducing PACS. Several other hospitals were included in this survey, for comparison. Questionnaires were distributed several times before PACS was operational at Hammersmith, and on one occasion after. The overall response rate was 54%. The main pre-PACS radiology-related problem areas were: the non-availability of images, the non-availability of written reports when clinically required, and the time devoted by junior staff to image searching. PACS greatly reduced the perceived problem of image non-availability. But Hammersmith's problems with the availability of radiological reports still remained when PACS was operational. The time junior doctors spent in image-searching was dramatically reduced by the introduction of PACS.

Attitude of Health Personnel↗

The effect of a picture archiving and communication system (PACS) on patient radiation doses for examination of the lateral lumbar spine.

This study was conducted to determine whether the doses for the radiographic examination of the lateral lumbar spine changed as a result of the introduction of a hospital-wide picture archiving and communication system (PACS). Doses were measured by thermoluminescent dosimeters (TLD) and dose-area product (DAP) meter readings for 100 patient examinations using a 300-speed conventional film/screen system and for 96 patient examinations when PACS was fully operational. Radiographic technique, exposure factors and patient characteristics were noted and effective doses were calculated, and a comparison was made of all variables. No significant differences between conventional and PACS working were found in surface entry and effective doses for single views of the lateral lumbar spine, but there was a 20% reduction in DAP readings with PACS. However, when summed doses for all images, including rejects, required to demonstrate the lateral lumbar spine for each patient were compared, PACS was found to be associated with significantly lower surface entry (TLD) dose, DAP reading and effective dose (28%, 36% and 16%, respectively) than conventional film. For single images of L1-5, when PACS was in use, there was a significant reduction in the DAP readings and increases in the area of the film/plate irradiated, the focus-to-skin distance and the focus-to-film distance. In addition, significantly fewer lumbosacral junction views were undertaken when PACS was in use. Since many confounding factors may have influenced the results over the period of dose measurement, regression models were used to determine the significance of PACS. These models showed that the use of PACS was not significant in causing any differences in the dose for single images as compared with when film was used, but was significant in the resulting total dose reductions for the examinations.

Adult↗

Comparison of film, hard copy computed radiography (CR) and soft copy picture archiving and communication (PACS) systems using a contrast detail test object.

This paper describes two experiments where a widely available test object (FAXIL TO20) was used to compare film, hard copy computed radiography (CR) and soft copy picture archiving and communication systems (PACS) images. Baseline images were produced with a fixed mAs. All images were scored by four experienced medical physicists. Contrast detail curves for the three types of images were almost identical. A second series of images was produced with the mAs varying from 1 mAs to 250 mAs. The contrast detail curves were plotted for each mAs value and the wider exposure latitude of CR compared with film was demonstrated. Use of PACS provided no further increase in exposure latitude. The density of the film images increased with mAs but the density of the CR hard copy images remained constant. It is of concern that the wider latitude of the CR images extends to exposures that are much higher than those used for film with no noticeable change in CR image density but with better images at higher exposures, because the potential exists for patient doses to increase. Hard copy CR images provide information about the exposure index which relates to the input dose to the plate and hence approximately to the dose to the patient. However, since such information is currently not available on default soft copy images, the authors suggest that all manufacturers of PACS should provide an indication of dose as a mandatory default setting.

Evaluation Studies as Topic↗

Picture archiving and communication systems: the users' view.

A study was undertaken to assess the acceptability to users of a Picture Archiving and Communication System (PACS). A questionnaire was issued to 208 users. Some questions required a graduated score in response and others a free text response. 101 responses were received from a cross section of hospital staff. The majority of users judged PACS to be a major advance for the hospital, with high quality images, less frustration than using film and an improvement in their working lives. They judged that it had made a positive change in their working practices and had met their expectations. They welcomed the access it gave them to Radiology reports. There was more ambivalence about the impact it had made to the efficiency of clinic consultations and the conduct of ward rounds. Free text responses were made concerning the benefits and disadvantages of PACS. Analysis of these demonstrated many more benefits than disadvantages. The Radiology department has been enabled to address the concerns of staff raised through the questionnaire, and has been encouraged by the positive responses. PACS has been accepted well by a wide cross section of hospital staff. It has improved their working lives and made a major contribution to the working of the hospital as a whole.

Attitude of Health Personnel↗

Integration of multiple direct digital imaging sources in a picture archiving and communication system (PACS).

OBJECTIVES: The aim of this report was to describe a flexible picture archiving and communication system (PACS) able to handle and communicate digital image data from various radiography systems and other sources. METHODS: The radiographic image is acquired using the vendor's own software. Following image capture, a "request for update" message (appending a record to an Access database) activates our PACS engine, "DigiMerge". Images from sources with no patient-related organizing software, e.g. TWAIN-compatible scanners and digital cameras, are handled by a self-developed program, "MedCom-T". DigiMerge generates and maintains one database based on all manufacturers' databases (software: VixWin 2000, Digora for Windows, Dimaxis Pro, Sidexis, CDR DICOM for Windows, Trophy for Windows). This database contains patient information, image information and image path. The program "DigiView" searches a patient and displays patient and image data from the database generated by DigiMerge. With DigiView, images can be viewed at any workstation in the dental school, but only temporary changes can be made (contrast, brightness, etc.) and no image can be deleted. RESULTS: The PACS is currently installed on 86 workstations. Statistics collected by DigiMerge reveal that approximately 2000 new digital images are recorded each month, half of which are radiographs and the other half are clinical photographs. Statistics collected by DigiView reveal that 500-800 digital images are opened per week. CONCLUSIONS: The self-developed PACS is able to manage images from a range of digital modalities each providing its own image data format.

Computer Systems↗

Polymerase chain reaction amplification of DNA from archival celloidin-embedded human temporal bone sections.

A method was developed for fast and efficient isolation of DNA from formalin-fixed, decalcified, celloidin-embedded human temporal bone sections for subsequent use in polymerase chain reaction (PCR) DNA amplification. The method relies on the use of an enzymatic digestion with proteinase K to release and solubilize the patient's DNA from an individual 20- to 25-microns temporal bone section. The method described should be of great value to those investigators extracting DNA from archival individual human temporal bone sections for polymerase chain reaction assays of specific genetic alterations associated with temporal bone pathologies. The molecular characterization of viral infections, oncogenes, or other etiological agents of disease using PCR could provide important information regarding the etiopathogenesis of many auditory, vestibular, and facial nerve disorders, such as autoimmune hearing loss, congenital hearing losses, Meniere's disease, otosclerosis, or Bell's palsy.

Collodion↗

Amplification of mitochondrial DNA from archival temporal bone specimens.

Archival temporal bone collections are an invaluable resource for studying the molecular genetics of many types of otopathology. The irreplaceable nature of temporal bone sections makes efficiency of DNA extraction of paramount importance. Several protocols are available for extracting DNA from fresh and preserved tissue. To establish the best protocol for reliably extracting DNA from celloidin-embedded temporal bone sections, a variety of DNA extraction techniques were tested. Using the optimum protocol, mitochondrial DNA fragments ranging in size from less than 100 base pairs to more than 400 base pairs were amplified, and the authenticity of polymerase chain reaction (PCR) products was confirmed through comparative sequence analysis.

Acetates↗

Toxicologic and epidemiologic clues from the characterization of the 1952 London smog fine particulate matter in archival autopsy lung tissues.

Exposure to atmospheric fine particulate matter (PM), even at low ambient concentrations, has clearly been linked to increases in mortality and morbidity. A 10- micro g m(-3) increase in PM10 (PM < 10 micro m) has been found to produce a 0.5% increase in daily mortality. The mechanism of action is a source of debate, although recent attention has focused on the cardiac effects of PM exposures. Likewise, several possible etiologic agents have been implicated, including ultrafine PM (PM <or= 100 nm), metals, and the acid components, yet the responsible constituent remains undetermined. During the catastrophic PM exposure episode in London in December 1952, some 4,000 excess deaths occurred at the height of the event. The extreme mortality during that episode and the preservation of archival autopsy tissues allow us the unique opportunity to report on the form and composition of December 1952 London PM in situ in tissues from persons known to have died from the smog exposure. Because absolute increases in mortality with current levels of PM in Western Europe and North America are low, analogous tissues are unlikely to be contemporaneously available. Taking a lung compartment (airway, airspace, interstitium, and lymph node) approach, we differentiated exposures contemporary with death from those of earlier origin. Electron microscopic analyses revealed the dominance of retained soot and a surfeit of other particle types. A variety of metal-bearing particle types were found in all compartments, but Pb, Zn, and SnZn types appeared the least biopersistent. The results support the acute toxicologic importance of ultrafine carbonaceous and metal PM.

Adult↗