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MR imaging versus alternative imaging techniques.

MR imaging is the method of choice in evaluating a large number of soft-tissue abnormalities; however, it has certain draw-backs, some of which may make other imaging methods more suitable. MR imaging is more expensive than alternative imaging methods; it may not be affordable for screening purposes and for diagnoses obtainable by less expensive imaging methods. In addition, immediate scheduling is not always possible for MR imaging, and an MR scanner may not be available close to the patient's home, which may be important for imaging follow-up. These factors support the use of other imaging modalities, with sonography frequently being the appropriate choice. In some situations, mainly in the presence of certain biomedical implants and devices, MR imaging is contraindicated. Additionally, under some circumstances patient access may be difficult during MR imaging; sonography and CT therefore are preferable (as for imaging guided biopsy). Moreover, some artifacts, such as motion artifacts, may have less relevance in other imaging methods (such as sonography), which may be important in noncooperative patients and children. MR imaging may not be specific in tumors and infection; this deficiency is shared with most alternative imaging methods, with the exception of scintigraphy in selected indications. Lastly, standard radiography and CT commonly are superior to MR imaging in diagnosing calcification and abnormalities of cortical bone. Consequently, in selected cases and for screening purposes, methods other than MR imaging should be considered for depicting soft-tissue structures.

Artifacts↗

Prospective comparative study of ability of MR imaging and other imaging modalities to localize tumors in patients with Zollinger-Ellison syndrome.

The role of magnetic resonance (MR) imaging in patients with pancreatic endocrine tumors such as Zollinger-Ellison syndrome (ZES) is controversial. In the present study we have examined the ability of current MR imaging compared with other imaging modalities, to localize gastrinomas in 43 patients with ZES. All results were subsequently assessed at exploratory laparotomy (N = 34) or by liver biopsy (N = 9). For the 18 patients with metastatic gastrinoma in the liver, MR imaging had a sensitivity of 83%, ultrasound 50%, CT 56%, and angiography 61%. The combination of MR imaging, ultrasound, and CT were the same as MR imaging alone. For MR imaging, both T1 and STIR sequences had equal sensitivity, although tumors were more easily seen with STIR sequences. Specificity of MR imaging was slightly lower (88%) than the other modalities (96-100%) because MR imaging incorrectly identified small hemangiomas as possible tumors in four patients. MR imaging was better than CT in identifying metastatic lesions in the liver. For the localization of primary gastrinoma, assessed in 32 patients, MR imaging had a sensitivity of 25%, ultrasound 19%, CT 28%, all three together 38%, and angiography 59%. Localization of metastatic gastrinoma in the liver or primary gastrinomas in 16 patients was assessed before and after gadolinium-DTPA (0.1 mmol/kg). The sensitivity and specificity of MR imaging was unchanged but bolus injection and rapid MR acquisition techniques were not used. These results indicate that recent advances in MR imaging have greatly improved its sensitivity for the detection and assessment of the extent of metastatic gastrinoma. MR imaging is now the imaging study of choice to assess metastatic pancreatic endocrine tumors in the liver. In contrast, the detection of primary tumors by MR imaging has not improved; therefore, angiography remains the study of choice.

Adult↗

Thallium-201 for assessment of myocardial viability: quantitative comparison of 24-hour redistribution imaging with imaging after reinjection at rest.

Redistribution thallium-201 imaging 2 to 4 h after exercise may be incomplete and therefore may be inadequate to fully assess myocardial variability. Late redistribution imaging 24 h after exercise has been proposed to overcome this limitation of thallium stress imaging. However, because of poor count density the image quality on these studies is often suboptimal. In the present study the diagnostic information on 24-h planar thallium redistribution images was compared with that on images obtained after a reinjection of thallium at rest. Eighty-four patients with a stress thallium-201 defect had delayed redistribution imaging after 2 to 4 h and 24 h later, and again after an injection of thallium at rest. Defect reversibility on 24-h redistribution images was compared quantitatively with that on images after injection of thallium at rest. The quality of thallium images at rest was consistently better than that of 24-h redistribution images. Poor quality studies occurred in 13% of 24-h redistribution images compared with 0.4% of the studies at rest. Significantly more defect reversibility was detected on images after the reinjection at rest. Of 41 patients who appeared to have a fixed defect at 2- to 4-h redistribution imaging, 11 (27%) had a reversible defect by 24-h redistribution imaging compared with 29 (71%) after thallium-201 reinjection. No clinical variables at the time of stress testing were predictive of late defect reversibility. It is concluded that in patients with fixed a thallium defect at 2 to 4 h after exercise, reimaging after a reinjection at rest provides better diagnostic information than does 24-h late redistribution imaging.

Adult↗

Cephalometric analysis with digital storage phosphor images: extreme low-exposure images with and without postprocessing noise reduction.

This study evaluated extreme exposure reduction in cephalography with monitor-displayed DICOM (Digital Imaging and Communication in Medicine, Rosslyn, Va) images. The purposes were to investigate to what extent exposure can be reduced without losing diagnostic information for tracing analysis, whether postprocessing noise reduction could benefit localization of anatomic landmarks in extreme low-exposure images, and the quality of the images. Three images (optimal, extreme low exposure, and noise-reduced extreme low exposure) were obtained from 24 volunteers. Three orthodontists traced 18 landmarks and subjectively judged the quality of the images. Sixteen of the landmarks were well identified on the extreme low-exposure images when they were compared with the optimal images. Apex inferius and apex superius were not well identified. The evaluation of image quality on a visual analogue scale showed that the optimal images were given the highest scores, extreme low-exposure images with postprocessing noise reduction the second highest scores, and extreme low-exposure images the lowest scores. Monitor-based tracing analysis on storage phosphor cephalographic images with a 94% exposure reduction, compared with conventional exposure, can be performed with only 2 of 18 landmarks not well identified. The landmarks were better identified on the low-exposure images with standard postprocessing than on the images with post-processing noise reduction, although the subjective evaluation of the image quality indicated the opposite.

Adult↗

Medical imaging of intervertebral disc degeneration: current status of imaging.

STUDY DESIGN: The author reviewed literature and reports on spine imaging, selected key articles in which novel imaging strategies were described, and prepared a review of currently developing imaging strategies in intervertebral disc degeneration. OBJECTIVES: To provide a review of imaging in intervertebral disc degeneration that covers the current methodology briefly and describes developing techniques in detail. SUMMARY OF BACKGROUND DATA: Computed tomography and magnetic resonance imaging provide excellent anatomic images of the spine. However, anatomic imaging of the spine does not reliably identify the source of pain in patients with intervertebral disc degeneration. Many functional imaging techniques are suited to the study of the spine. Some of these techniques will improve our understanding of intervertebral disc degeneration and clinical symptomatology. METHODS: The author selected reports in the current literature for further review and attempted to describe succinctly the material in the reports that are most relevant to spine imaging. RESULTS: New and potentially useful imaging strategies for spine imaging include dynamic computed tomography, dynamic magnetic resonance imaging, functional magnetic resonance imaging, diffusion imaging, and magnetic resonance spectroscopy. CONCLUSIONS: Technological advances in magnetic resonance imaging and computed tomography imaging continue to offer more opportunities to investigate and diagnose back pain and intervertebral disc degeneration.

Back Pain↗

Comparison of transcranial brain tissue perfusion images between ultraharmonic, second harmonic, and power harmonic imaging.

BACKGROUND AND PURPOSE: To clarify optimal brain tissue perfusion images visualized by transcranial ultrasound harmonic imaging, we compared gray-scale integrated backscatter (IBS) images of new ultraharmonic imaging (UHI) and conventional second harmonic imaging (SHI) with power harmonic imaging (PHI) (harmonic B-mode with harmonic power Doppler images) in 10 patients with and 4 without a temporal skull. METHODS: Using a SONOS 5500 (Philips), we evaluated transient response images taken after a bolus Levovist injection at a horizontal diencephalic plane via temporal windows. Based on transmitting/receiving frequencies (MHz), 4 imaging procedures using an S3 transducer (SHI2.6 [1.3/2.6], UHI [1.3/3.6], PHI2.6 [1.3/2.6], and PHI3.2 [1.6/3.2]) and 2 imaging procedures using an S4 transducer (SHI3.6 [1.8/3.6] and PHI3.6 [1.8/3.6]) were compared in terms of size and location, peak intensity (PI), contrast area demarcation, and background image quality. RESULTS: In intact skull cases, gray-scale imaging tended to show larger contrast areas than PHI. A large contrast area was most frequently observed in SHI2.6 images, despite there being more high-PI cases in UHI. No contrast area with unclear background was observed in a few cases. In craniectomized cases, all contrast images tended to have large and high PI compared with the intact skull cases. PHI, particularly PHI3.6, demonstrated sharper demarcation and a clearer background than gray-scale imaging. CONCLUSIONS: Transcranial gray-scale SHI using a low receiving frequency of 2.6 MHz is the superior method. PHI identifies contrast area localization better than gray-scale imaging and is particularly suitable for intraoperative and postoperative cases.

Adult↗

[Observations on three dimensional images for cracks of doweled teeth--comparison of images from specimen sections and dental tomograms from small three dimensional X-ray CT].

PURPOSE: Intraoral views of teeth with dowel and post hole taken by small three-dimensional X-ray CT (3DX) were compared with three-dimensional images from specimen sections of the same extracted teeth. This comparison shows the usefulness of 3DX for examination of cracked teeth in the oral cavity. MATERIALS AND METHODS: After taking dental tomographic images using 3DX for fractured teeth in the oral cavity, the fractured teeth were extracted and three-dimensional images for them and their cracks were obtained from a set of photographed sections. Then both sets of three-dimensional images for the fractured teeth were compared in terms of the form and region of the cracks. DISCUSSION: The tooth cracks were observed at the root face region in the intraoral view. Also, in the extracted teeth, fracture lines were recognized from the three-dimensional images. Moreover, a discontinuous image was obtained in teeth from the dental tomographic image using 3DX. This discontinuous image in teeth was observed in the same region and direction as the cracks of the three dimensional image from specimen sections of the extracted teeth. CONCLUSIONS: The discontinuous images of teeth in the dental tomographic images from 3DX were observed in the same region and direction as the cracks of teeth in the three-dimensional images from specimen sections of the extracted teeth. It was confirmed that dental tomographic images from 3DX are useful for finding cracks in living teeth. However, dental tomographic images from small three-dimensional X-ray CT are not perfectly reliable because the discontinuous image is not found in some teeth where the cracks are recognized by images from specimen sections after extraction.

Humans↗

MR imaging of bone marrow lesions: relative conspicuousness on T1-weighted, fat-suppressed T2-weighted, and STIR images.

OBJECTIVE: Fat-saturation pulse sequences offer important potential advantages for depiction of bone marrow lesions on MR images. The objectives of this study were to evaluate the relative conspicuousness of bone marrow lesions on images obtained by using two of the most widely available fat-suppression techniques, short-TI inversion recovery (STIR) and fat-saturation T2-weighted imaging, and to analyze the effect of these methods on image quality. In addition, we sought to determine if either or both of these sequences provide significant advantages relative to conventional T1-weighted spin-echo images for the evaluation of bone marrow lesions. SUBJECTS AND METHODS: T1-weighted (600/15 [TR/TE]), STIR (2500/20/160 [TR/TE/TI]), and fat-saturation T2-weighted (2500/20-70) MR images were obtained with a 1.5-T system in 34 consecutive patients with suspected bone marrow lesions. The conspicuousness of 36 lesions was evaluated subjectively by three radiologists, who also evaluated the MR images for how well they showed margination and extent of the lesion, image uniformity, motion artifacts, and overall image quality. In addition, lesion contrast on these sequences was compared quantitatively by using percentage contrast measurements. RESULTS: Lesions were qualitatively equally conspicuous with all four pulse sequences. Quantitative measurements indicated that lesions were more conspicuous on fat-saturation T2-weighted and STIR images than on T1-weighted images (p < .001). Differences between the first two sequences were not significant. Factors related to image quality, including reduction in motion artifacts and image uniformity, were generally superior on T1-weighted images. CONCLUSION: T1-weighted, fat-saturation T2-weighted, and STIR sequences all provide a high degree of sensitivity for depiction of most types of bone marrow abnormalities. Although the conspicuousness of lesions is similar on fat-saturation T2-weighted and STIR images, the former sequence has several practical advantages, including acquisition of more slices per unit time and improved tissue specificity. The combination of T1-weighted and either fat-saturation T2-weighted or STIR images is highly effective for the evaluation of bone marrow lesions.

Adolescent↗

MR imaging and sonography of early prostatic cancer: pathologic and imaging features that influence identification and diagnosis.

OBJECTIVE: The purpose of this study was to correlate findings at MR imaging and transrectal sonography with histopathologic findings after surgery in patients with prostatic cancer, to identify the pathologic characteristics of prostatic cancer that improved detection with MR imaging and transrectal sonography, and to identify the imaging characteristics that correlated with detection of true cancers. MATERIALS AND METHODS: Data from MR imaging in 320 patients and from transrectal sonography in 343 patients who were enrolled in the Radiological Diagnostic Oncology Group multiinstitutional study of imaging in prostatic cancer were correlated with results of radical prostatectomy. Only cancers 5 mm or greater in at least one dimension were evaluated pathologically. The locations of lesions and the linear dimensions and volumes of individual lesions and the prostate gland were evaluated pathologically and with imaging studies. The appearance of lesion margins on images and the degree of differentiation of lesions seen on pathologic examination were also studied. Univariate and multivariate analysis were performed to determine the pathologic findings associated with imaging detection and the imaging characteristics associated with prostatic cancer. RESULTS: MR imaging and transrectal sonography showed 62% and 64% of cancers, respectively, each with a positive predictive value of 68%. Cancers that were larger, moderately or poorly differentiated, or located in the posterior half of the outer gland were easier to detect (p < .0001). The overall size of the prostate did not effect lesion detection. However, abnormalities identified in the posterior half of the outer gland were more likely to be cancers. On transrectal sonograms, larger abnormalities also were more likely to be malignant tumors. The sharpness of the margins of the imaged abnormalities did not predict pathologic status. CONCLUSION: Detection of prostatic cancer with MR imaging or transrectal sonography is affected by cancer size, differentiation, and location; the odds of an imaged lesion's being malignant are related to location and, for transrectal sonography, size. Knowledge of anatomic/pathologic features that enhance lesion detection may help when using imaging tests to detect prostatic carcinoma. That certain imaging characteristics of lesions are associated with true cancers may assist in the interpretation of MR images and transrectal sonograms of the prostate.

Algorithms↗

Evaluation of the tumor-brain interface of intracranial meningiomas on MR imaging including FLAIR images.

PURPOSE: The usefulness of fluid-attenuated inversion recovery (FLAIR) imaging for the evaluation of brain diseases has been reported. The purpose of this study was to evaluate the brain-meningioma interface with MRI including FLAIR imaging. MATERIALS AND METHODS: This study involved 48 patients with 50 intracranial meningiomas. We retrospectively evaluated the brain-meningioma interface by various imaging method including FLAIR. If a thin layer with a signal intensity different from that of the tumor and brain was observed in the areas of the tumor-brain interface in T(1)-weighted IR (T(1)WIR) and T(2)-weighted turbo SE (T(2)WTSE) images, we defined this structure as the rim. The presence or absence of the rim and the signal intensity were evaluated, and the length and the signal intensity of the rim observed with FLAIR and contrast-enhanced T(1)WIR (CE-T(1)WIR) images were evaluated. RESULTS: In 35 of the 50 lesions (70.0%), the rim was observed in the tumor-brain interface as a layer of low signal intensity in T(1)WIR images and high signal intensity in T(2)WTSE images. In 13 lesions (26.0%), no rim was detected. Flow voids were observed at the tumor-brain interface in 20 of the 50 lesions (40.0%). No rim showed a low signal intensity of the tumor-brain interface in both T(1)WIR and T(2)WTSE images. The rim exhibited an iso-to-high signal intensity compared to the tumor parenchyma in FLAIR images and an enhanced signal intensity in CE-T(1)WIR images. In contrast to T(1)WIR images, the rim in FLAIR images tended to be identified across the entire circumference. CONCLUSION: The rim at the brain-meningioma interface revealed as low signal intensity in T(1)WIR images and high signal intensity in T(2)WTSE images, which was conventionally considered to be the CSF cleft, was often revealed in FLAIR images as high signal intensity compared to the tumor parenchyma, and an enhanced signal intensity in CE-T(1)WIR images. Therefore, the presence of CSF in such rims is unlikely, and the rims might reflect the capsule structure of the tumor surface.

Adult↗

Image-based cardiac gating for three-dimensional intravascular ultrasound imaging.

Three-dimensional (3-D) intravascular ultrasound (US), or IVUS, provides valuable insight into the tissue characteristics of the coronary wall and plaque composition. However, artefacts due to cardiac motion and vessel wall pulsation limit the accuracy and variability of coronary lumen and plaque volume measurement in 3-D IVUS images. ECG-gated image acquisition can reduce these artefacts but it requires recording the ECG signal and may increase image acquisition time. The goal of our study was to reconstruct a 3-D IVUS image with negligible cardiac motion and vessel pulsation artefacts, by developing an image-based gating method to track 2-D IVUS images over the cardiac cycle. Our approach involved selecting 2-D IVUS images belonging to the same cardiac phase from an asynchronously-acquired series, by tracking the changing lumen contour over the cardiac cycle. The algorithm was tested with IVUS images of a custom-built coronary vessel phantom and with patient images. The artefact reduction achieved using the image-gating approach was > 86% in the in vitro images and > 80% in the in vivo images in our study. Our study shows that image-based gating of IVUS images provides a useful method for accurate reconstruction of 3-D IVUS images with reduced cardiac motion artefact.

Algorithms↗

An automated PACS image acquisition and recovery scheme for image integrity based on the DICOM standard.

The data quality and completeness of acquired images, which we refer to as integrity, is considered as the most important requirement in the image acquisition design of the Picture Archiving and Communication System (PACS). The Digital Imaging and Communications in Medicine (DICOM) standard significantly simplifies the task of acquiring radiological images from a DICOM compliant imaging system into the PACS. However, human interaction with the imaging system by changing the DICOM communication settings can result in missing images during the PACS image acquisition. A scheme based on the DICOM Query and Retrieve (Q/R) service class was developed to automatically identify and recover missing images. In addition, grouping sequential scanned images such as a CT and MR image series is another potential process that can miss images because of no indication of the end of series. Two methods are presented for determining the end of series and the pros and cons of each method are discussed in detail. Two experiments in a real clinical environment were conducted; one with and one without the Q/R implementation. The statistical results indicate two highlights from this work. First, the Q/R scheme faithfully recovered all missing images caused by human interaction with the DICOM compliant imaging system. Second, there was no single image slice missed when grouping slices into a series using the presented grouping algorithm in the two experimental periods.

Algorithms↗

Magnetic resonance imaging of the temporomandibular joint: value of pseudodynamic images.

Magnetic resonance fast scanning technique (gradient recalled acquisition at steady state) has been reported to be useful when evaluating the dynamics of the temporomandibular joint and also to be accurate for determining the disk position. Yet in our clinical experience gradient recalled acquisition at steady state images have frequently been inferior to proton density images for diagnosis of temporomandibular joint internal derangement. The first aim of this study was to compare gradient recalled acquisition at steady state images with proton density images for diagnosis of disk position. The second aim was to identify what additional information could be gathered from gradient recalled acquisition at steady state images when compared with static proton density images. We obtained unilateral images from 20 patients with signs and symptoms of temporomandibular joint internal derangement and from 20 asymptomatic volunteers. Multiple gradient recalled acquisition at steady state images were obtained during mouth opening and closing and proton density images were obtained at the closed and open mouth positions. The results showed that the gradient recalled acquisition at steady state images were in accordance with the proton density images in 32 joints (80%) and were false negative in 8 joints (20%). Six of the joints with false-negative gradient recalled acquisition at steady state images showed sideways disk displacement, and two showed partial anterior disk displacement. Gradient recalled acquisition at steady state images, on the other hand, provided information about movement pattern and also demonstrated impingement of the joint structures on the muscles anterior to the joint at maximal mouth opening. It was concluded that gradient recalled acquisition at steady state images cannot replace proton density images for diagnosis of disk position but they can provide supplementary information for evaluation of joint function.

Adolescent↗

Improved image quality in digital mammography with image processing.

PURPOSE: The effect of image processing, specifically Bayesian image estimation (BIE), on digital mammographic images is studied. BIE is an iterative, nonlinear statistical estimation technique that has previously been used in chest radiography to reduce image scatter content and improve the contrast-to-noise ratio (CNR). We adapt this technique to digital mammography and examine its effect. METHODS/MATERIALS: Images of the American College of Radiologists (ACR) breast phantom were acquired on a calibrated digital mammography system at a normal mammographic exposure both with and without a grid. An iterative Bayesian estimation algorithm was formulated and used to process the images acquired without a grid. Quantitative scatter fractions were measured and compared for the image acquired with the grid, the image acquired without the grid, and the image acquired without the grid and processed by the Bayesian algorithm. CNR values were also computed for the four visible masses in the ACR phantom before and after processing and compared to a grid. RESULTS: Initial images acquired without an antiscatter grid had scatter fractions of 0.46. Processing this image with BIE reduced the scatter content to under 0.04. In comparison, the image acquired with a grid had scatter of 0.19. BIE processing accounted for CNR improvements from 29% to 219% for the masses seen in the ACR phantom as compared to the unprocessed image. Visibility of the four masses in the phantom was improved. CONCLUSIONS: Bayesian image estimation can be used with digital mammography to reduce scatter fractions. This technique is very useful as it can reduce scatter content effectively without introducing any adverse effects, such as grid line aliasing. Bayesian processing can also increase image CNR, which may potentially increase the visualization of subtle masses. Preliminary work shows an improvement in CNR to values greater than that provided by a standard grid.

Algorithms↗

[Assessment of image display of contrast enhanced T1W images with fat suppression].

UNLABELLED: The effects of imaging conditions and measures for their improvement were examined with regard to recognition of the effects of contrast on images when T1-weighted imaging with selective fat suppression was applied. METHOD: Luminance at the target region was examined before and after contrast imaging using phantoms assuming pre- and post-imaging conditions. A clinical examination was performed on tumors revealed by breast examination, including those surrounded by mammary gland and by fat tissue. RESULTS: When fat suppression was used and imaging contrast was enhanced, the luminance level of fat tumors with the same structure as the prepared phantoms appeared to be high both before and after contrast imaging, and the effects of contrast were not distinguishable. This observation is attributable to the fact that the imaging conditions before and after contrast imaging were substantially different. To make a comparison between pre- and post-contrast images, it is considered necessary to perform imaging with fixed receiver gain and to apply the same imaging method for pre- and post-contrast images by adjusting post-contrast imaging conditions to those of pre-contrast imaging.

Adipose Tissue↗

Megavoltage imaging with a large-area, flat-panel, amorphous silicon imager.

PURPOSE: The creation of the first large-area, amorphous silicon megavoltage imager is reported. The imager is an engineering prototype built to serve as a stepping stone toward the creation of a future clinical prototype. The engineering prototype is described and various images demonstrating its properties are shown including the first reported patient image acquired with such an amorphous silicon imaging device. Specific limitations in the engineering prototype are reviewed and potential advantages of future, more optimized imagers of this type are presented. METHODS AND MATERIALS: The imager is based on a two-dimensional, pixelated array containing amorphous silicon field-effect transistors and photodiode sensors which are deposited on a thin glass substrate. The array has a 512 x 560-pixel format and a pixel pitch of 450 microns giving an imaging area of approximately 23 x 25 cm2. The array is used in conjunction with an overlying metal plate/phosphor screen converter as well as an electronic acquisition system. Images were acquired fluoroscopically using a megavoltage treatment machine. RESULTS: Array and digitized film images of a variety of anthropomorphic phantoms and of a human subject are presented and compared. The information content of the array images generally appears to be at least as great as that of the digitized film images. CONCLUSION: Despite a variety of severe limitations in the engineering prototype, including many array defects, a relatively slow and noisy acquisition system, and the lack of a means to generate images in a radiographic manner, the prototype nevertheless generated clinically useful information. The general properties of these amorphous silicon arrays, along with the quality of the images provided by the engineering prototype, strongly suggest that such arrays could eventually form the basis of a new imaging technology for radiotherapy localization and verification. The development of a clinically useful prototype offering high-quality images, ultimately with an approximately 52 x 52-cm2 detection surface, is anticipated.

Equipment Design↗

27. PET Image Interpretation. Attenuation-Corrected (ATN) Vs Non-Attenuation Corrected (NATN) Images.

Purpose: The purpose of this study was to evaluate the difference, if any, in lesion detection in ATN and NATN images.Methods: Sixty-one consecutive patients having clinical whole body FDG PET scans for oncologic indications were included. The patients were administered 10-20 mCi FDG intravenously, and imaging on the Advance (GE Medical Systems) was started 45 min-1 h after injection. The emission images were acquired for 4 min and the transmission images for 3 min per bed position. The images were reviewed on the vendor-provided workstation. Four of the interpreting physicians read the ATN images first, and the other read the NATN images first. The interpreting physicians were asked to determine if any lesions were seen on only the ATN or NATN images (discordant findings) and to describe differences in the images not affecting overall interpretation.Results: In the 61 patients, 3 discordant findings with abnormalities on the ATN images but not on the NATN images included the following: lung nodule, AP window node, and small para-aortic node. Observations that did not affect overall interpretation include the following: transmission scan helped localize lesion to be below instead of above the diaphragm; AT-N image better demonstrated liver metastasis; benign lung lesion seen only on ATN image (3 cases); pretracheal node seen better on NATN images; and low grade hilar activity on NATN not seen on ATN images.Conclusion: These results demonstrate that the ATN images detect more lesions than the NATN images, and that reviewing NATN images may not be necessary. A different method for performing this evaluation is now being undertaken.

Journal Article↗

Photographic images, digital imaging, dermatology, and the law.

BACKGROUND: Patient photographic images play an important role in dermatological record keeping and training. An assessment of the legal implications of image taking is necessary to use images properly. OBSERVATIONS: Images are parts of the medical record and must be treated with the same care as written medical records. Because multiple digital images are sometimes taken and digital images can be easily manipulated, they present novel issues in this regard. Images can be used as evidence in court. Issues regarding digital images include (1). authentication, (2). manipulation, (3). audit trail verification, and (4). data compression. The Health Information Portability and Accountability Act requires that health care providers control and track those who have access to identifiable digital medical information. This should facilitate the use of digital images as evidence because the provenance of digital images can be established. The Health Information Portability and Accountability Act covers the use and disclosure of protected health information, such as "full-face photographic images and any comparable images." To publish identifiable digital images (images of the face), it seems prudent for patients to waive in writing their rights to this protected health information. Conclusion Images will continue to enhance dermatological care, and understanding and accounting for the legal underpinnings of their use is prudent.

Confidentiality↗