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    31 December 2006


    Recommendations formulated on the basis of the results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II trial have recently been published. Some of our current protocols are at variance with these.

    For instance, we currently image patients with a moderate clinical probability of PE and a negative d-dimer. The PIOPED II investigators recommend that in such patients no further testing is necessary.

    I won't go into all the other details, but it makes interesting reading, and we'll be reviewing our practice in consultation with the physicians.

    Diagnostic Pathways in Acute Pulmonary Embolism: Recommendations of the PIOPED II Investigators.
    Stein PD,Woodard PK,Weg JG,Wakefield TW,Tapson VF,Sostman HD,Sos TA,Quinn DA,Leeper KV Jr,Hull RD,Hales CA,Gottschalk A,Goodman LR,Fowler SE,Buckley JD.
    Radiology. 2007 Jan;242(1):15-21.
    MEHTRadiology citation
    (A similar version of this editorial was published in the December 2006 issue of the American Journal of Medicine)

    Also by the same authors:
    Multidetector computed tomography for acute pulmonary embolism
    N Engl J Med. 2006 Jun 1;354(22):2317-27.
    CONCLUSIONS: In patients with suspected pulmonary embolism, multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity. The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results.

    16 September 2006

    Digital Dictation and Voice Recognition: Not ready for prime time?

    Our digital dictation system consists of a Philips Speech Mike linked in to our RIS (TC-RAD, McKesson). For plain film reporting, after using it for a year or two, I have switched back to using cassette tapes, and guess what? I estimate that my productivity is up 20%, and fatigue levels reduced by 50%. Other colleagues have reported similar experiences.

    The problem with our digital dictation system is that it involves numerous mouse clicks and aiming a cursor several times during the dictation process, and this increases the total amount of work very substantially if the report is very brief (e.g. "Normal appearances"). Also, transcription of reports by secretaries from digital dictation involves more steps and is inherently less efficient than transcription from tape.

    There are advantages to digital dictation, and it's OK for longer reports like CT and MRI reports. It allows secretaries to retrieve and locate dictated reports more easily. However, at least in our version, there are very serious inadequacies.

    As for voice recognition (VR), I tried that too, for several months, and put enormous effort into training the system, which was created by bolting the Dragon dictation system (which seems to have nothing but outstanding reviews in PC magazines) onto our digital dictation system. I came to the conclusion that I would have been better served by doing a touch typing course.

    Here's an online article that describes in great detail the experiences of many users with radiological voice recognition systems. I concur with the opinions expressed.
    Voice, I mean Speech Recognition, Buggy Whips, and OODA Loops

    If VR makes sense on an accountant's spreadsheet in terms of staffing levels and turnaround times, this may be because the spreadsheet has not recorded all of the variables. I am now extremely sceptical about the practicalities and costs of these systems in their current form.

    From personal experience I am wary of verbal or published recommendations for VR systems and other software products, especially those designed for medical use, where standards and expectations are often extremely low. Someone who has spent vast sums of money on a poor quality product may be reluctant to admit (even to himself, let alone to the outside world) that it was all a big mistake.

    13 September 2006

    Drinking barium to protect the fetus during CT pulmonary angiography

    This phantom study suggests that ingestion of barium will shield the fetus of a woman undergoing CT pulmonary angiography.
    It's cheap, harmless and seems logical, so why not?

    Yousefzadeh DK, Ward MB, Reft C.
    Internal barium shielding to minimize fetal irradiation in spiral chest CT: a phantom simulation experiment.
    Radiology. 2006 Jun;239(3):751-8.

    22 April 2006

    Simpler CT reporting for clnical trials?

    "In the majority of patients with hepatic metastases of colorectal cancer, measuring the maximal diameter of the single largest lesion yielded the same treatment-response classification as measuring up to five target lesions. This result suggests that it may be possible to reduce the number of lesions measured in clinical trials."

    CT of Colon Cancer Metastases to the Liver Using Modified RECIST Criteria: Determining the Ideal Number of Target Lesions to Measure
    Zacharia, Saini, Halpern and Sumner. AJR April 2006; 186:1067-1070

    Now wouldn't that make life so much easier?

    19 April 2006

    Barium enemas on the cover of Radiology!

    Makes a change from virtual colonoscopy :-)

    Unlike other authors, this group found that in their series, technical errors were more common than perceptual errors, and the majority of missed polyps were in the proximal colon.

    Thompson, Foster, Paulson et al
    Causes of Errors in Polyp Detection at Air-Contrast Barium Enema Examination
    Radiology April 2006;239:139-148.

    30 March 2006

    CiteULike: FREE Online reference manager

    I discovered this site through a link on our hospital intranet.
    It's free, online and easy to use.
    You can also set up a "group" for your department or colleagues so you can share references, as we have done.

    20 January 2006

    Free software for CT and MRI cerebral perfusion and breast MRI

    I came across this website offering free software, developed in conjunction with the University of Dusseldorf, for analysng CT and MRI cerebral perfusion studies, (stroketool-CT and stroketool) and contrast enhanced breast MRI studies (mammatool).

    We already have equivalents of stroketool and mammatool in our MRI unit so we would have no real use for this software, but someone might find it fun to play with.

    On the other hand, stroketool-CT might be useful, since we don't have cerebral perfusion software installed on our CT workstation. However I can't think of a way round the ethical and legal issues, i.e. giving iv contrast to stroke patients just to play around with free software that, according to the website "may not be used for diagnosis or patient treatment".

    I found the software via