New Guidelines: Urinary Tract Infection in Children

The National Institute for Clinical Excellence (NICE) have issued new guidelines for UTI in children (Ref CG54).
There is a handy quick reference guide (Imaging is covered in pages 12 - 13).
Other relevant NICE documents, including the full guidance, can be found here.

A few months ago my paediatrician colleague Dr Job Cyriac gave a nice lecture on this topic. You can view his slides here.

A significant change in radiological practice has been the reduction in the number of micturating cystourethrograms, which is great for everyone.

CAD for detecting bone metastases on CT

There was some discussion at work the other day about how detection of bone mets on CT could be quite tricky. The authors of this article, which describes a computer aided detection (CAD) system for detecting lytic lesions in the spine, put it rather diplomatically

"It has been postulated that bone metastases are missed at CT ... there is a perception that these [bone] windows are underused by radiologists and oncologists."

CAD has been developed for lung and breast lesions. This might be another useful application.

O'Connor SD, Yao J, Summers RM.
Lytic metastases in thoracolumbar spine: computer-aided detection at CT-preliminary study.
Radiology. 2007 Mar;242(3):811-6

Open source PACS solution for private clinics

I installed Osirix , a free (Open Source) imaging workstation program, on a stand-alone iMac at our local private hospital almost two years ago (described here), and it has been used very successfully for reading CT and MRI exams loaded from CDs.

The iMac cost about £2000. (You can check current prices at www.apple.com) . A proprietary workstation would have cost 10 times that amount, at least. Also, each time there is a software update, the upgrade is free, and there has been fantastic free support from the online community of users and developers. Much better than from some commercial products I have used.

At Chesapeake Medical Imaging, they used Macs and Open Source software, including Osirix, to view and archive images from at least half a dozen CT and MRI scanners (Siemens, Toshiba, and Philips), in four clinics, doing 80 multi-scan patient studies every day, (about 3GB of data per day and a terabyte per year), and solved a quarter-million-dollar problem for about $12,000.
http://www.apple.com/science/profiles/cmi/

What's missing from the the Open-Source Osirix PACS solution is integration with the Radiology Information System (RIS), so it's not quite ready for big public hospitals, but it does seem like an excellent idea for smaller private facilities.

I suspect that one of the stumbling blocks may be that in many organisations, IT departments lack the ability, skills or inclination to do anything not covered by the Microsoft service manuals, while corporate management do not know any better and do not challenge the IT guys. It's a pity, because there are enormous potential benefits in cost savings and quality of care.

By the way, there's an online tutorial on how to use Osirix. I've not had to use it but you can check it out here.

ACR Guidance Document for Safe MR Practices

A very long and comprehensive artcle was published recently in the AJR
ACR Guidance Document for Safe MR Practices: 2007
AJR 2007; 188:1447-1474

Meanwhile, here's a low-cost device that might be ueful for screening people visiting your MRI facility

FREE online software for designing your reporting room (or ward, or bedroom, or kitchen)

Floorplanner is an internet-based program that allows you to draw floor plans and lay out your room. There's a free version which should be adequate for small projects, and it's very easy to use. The illustration above shows a plan of our reporting room which I've done from memory, and is not exactly to scale. (I'll publish a more accurate version later).
I found this via Dumb Little Man.

PACS Display Quality Assurance Check : FREE!

Can you read the text in all three boxes?
If not, your monitor may not be suitable for interpreting x-rays.

The PACS Display Quality Assurance Check is a free tool designed to assist with a QA programme for PACS web display devices.
We're currently looking into implementing it.

Read more about it here.

CT of Lefort fractures

Here's an article I've referred to from time to time when someone comes into the CT scanner with an unpleasant facial injury.

Rhea JT, Novelline RA.
How to simplify the CT diagnosis of Le Fort fractures.
AJR Am J Roentgenol. 2005 May;184(5):1700-5.
Free full text

Digital dictation part 2...

Our old PACS, a low-cost affair based on web browsers, and with no RIS-PACS integration, has been replaced by an Agfa Impax PACS, and we now have one-way RIS-PACS integration, so that when an examination is opened on the RIS, the images automatically load up on PACS.

It still needs a bit of tweaking, but it has made a world of difference, and reporting is much easier. I have now stopped using casette tapes.

Some time ago I published a post expressing reservations about digital dictation systems, but, as one correspondent suggested, it was because our system was not properly set up. He was right and I was wrong. We do not have speech recognition at present, but I'm investigating this actively.