Continuous Publishing articles

[Quality Initiatives] Radiation Risk: What You Should Know to Tell Your Patient

Verdun, F. R., Bochud, F., Gudinchet, F., Aroua, A., Schnyder, P., Meuli, R. — 2008-09-24

The steady increase in the number of radiologic procedures being performed is undeniably having a beneficial impact on healthcare. However, it is also becoming common practice to quantify the health detriment from radiation exposure by calculating the number of cancer-related deaths inferred from the effective dose delivered to a given patient population. The inference of a certain number of expected deaths from the effective dose is to be discouraged, but it remains important as a means of raising professional awareness of the danger associated with ionizing radiation. The risk associated with a radiologic examination appears to be rather low compared with the natural risk. However, any added risk, no matter how small, is unacceptable if it does not benefit the patient. The concept of diagnostic reference levels should be used to reduce variations in practice among institutions and to promote optimal dose indicator ranges for specific imaging protocols. In general, the basic principles of radiation protection (eg, justification and optimization of a procedure) need to be respected to help counteract the unjustified explosion in the number of procedures being performed.

[Online Only] Pictorial Review of Tuberous Sclerosis in Various Organs

Umeoka, S., Koyama, T., Miki, Y., Akai, M., Tsutsui, K., Togashi, K. — 2008-09-04

Tuberous sclerosis is a rare autosomal dominant neurocutaneous syndrome characterized by the presence of benign congenital tumors in multiple organs. The diagnosis is usually established on the basis of diagnostic criteria applied to physical or radiologic findings. Because the classical triad of epilepsy, mental retardation, and adenoma sebaceum is uncommonly seen at clinical examination, radiologic examinations can play an important role in the diagnosis of tuberous sclerosis and in treatment. Cardiac rhabdomyoma, renal angiomyolipoma, and neurologic involvement encompassing cortical or subependymal tubers and white matter abnormalities are the common radiologic findings. Detection of these entities can be strong evidence for suspecting tuberous sclerosis. The presence of pulmonary lymphangioleiomyomatosis, multifocal micronodular pneumocyte hyperplasia, or multiple renal cysts also raises suspicion of tuberous sclerosis. Moreover, tuberous sclerosis can involve bone, liver, and the alimentary tract. The clinical course and patient prognosis depend on the sites of manifestations. Familiarity with the clinical and radiologic findings in various organs is crucial in diagnosis and treatment.

[Informatics] Informatics in Radiology: Image Exchange: IHE and the Evolution of Image Sharing

Mendelson, D. S., Bak, P. R. G., Menschik, E., Siegel, E. — 2008-09-04

The sharing of radiologic images has become a fundamental part of radiology services and is essential for delivering high-quality care. Film is quickly becoming obsolete as a means of transporting and sharing large volumes of imaging data. Image sharing has evolved from film to transportable media (eg, compact disks) to direct electronic exchange over the Internet. The latter two means of image sharing have associated work flow–related and technical challenges for which solutions are being developed. Integrating the Healthcare Enterprise (IHE^®) provides a standards-based approach to the development of robust, universally accepted solutions. Several IHE profiles have been developed to provide a framework for current image sharing efforts. The Philadelphia and New Jersey Health Information Exchanges and the Canada Health Infoway represent efforts to apply IHE technical profiles to facilitate the secure and confidential exchange of electronic images over the Internet. The research community is concomitantly developing solutions that solve image exchange issues that are specific to research (eg, the sharing of deidentified data) but that might also be encountered in the general population. The personal health record is a more recent development that may provide consumers with direct control over the process of sharing images electronically with their healthcare providers.