Utility of the coned-down lateral view of the lumbosacral spine.

Objective: At certain institutions and radiology practices, a routine lumbar radiographic exam may include 3 views: AP, lateral, and coned-down lateral of the lumbosacral junction. The purpose of this study is to determine whether the third coned-down-lateral view adds significant diagnostic information regarding pathology at the L4-L5 and L5-S1 levels.

Materials And Methods: This retrospective study includes patients (n = 74) who had a 3-view radiographic exam of the lumbar spine, as well as a CT or MRI within six months.

Clearing the Congestion: Chest Radiography and BNP to Rule-out Congestive Heart Failure.

Purpose: Ruling out congestive heart failure (CHF) is clinically important in Emergency Department (ED) patients. Normal serum brain natriuretic peptide (BNP) represents an important reference standard for excluding CHF. Results of chest radiographs (CXR) are also considered and, when discordant with BNP levels, may result in a clinical dilemma.

Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department.

Objective: The purpose of our study was to determine whether the radiation exposure to patients with suspected pulmonary embolism (PE) could be decreased by safely increasing the use of ventilation-perfusion (V/Q) scanning and decreasing the use of CT pulmonary angiography (CTPA) through an educational intervention.

Materials And Methods: Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments in December 2006 and January 2007 regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE. To reduce radiation exposure, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography.

The current and continuing important role of ventilation-perfusion scintigraphy in evaluating patients with suspected pulmonary embolism.

After the publication of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study in 1990, there was considerable controversy concerning the ventilation-perfusion (V/Q) study in regard to its low sensitivity and high number of nondiagnostic examinations when used in patients with suspected pulmonary embolism (PE). Many lessons have been learned from the PIOPED database that have greatly improved our interpretive skills in the 2 decades since the study was performed. One of the key problems negatively impacting interpretation was the predominantly inpatient population that was studied.

Radiology residents' on-call interpretation of chest radiographs for pneumonia.

Rationale And Objectives: This study is designed to assess the performance of radiology residents in interpreting emergency department chest radiographs for pneumonia and to characterize chest radiographic findings in patients for which interpretation was amended by an attending radiologist.

Materials And Methods: We retrospectively reviewed all amended reports for chest radiographs performed on emergency department patients July 2002-June 2003. Reports preliminarily interpreted by residents and amended by a board-certified staff radiologist for the presence or absence of pneumonia were identified.

Catheter-induced vasospasm in the treatment of acute lower gastrointestinal bleeding.

Purpose: To demonstrate results in managing lower gastrointestinal (GI) bleeding with the use of superselective catheterization and intentional induction of vasospasm of the bleeding vessel without the use of embolic agents or vasospasm-inducing medications.

Materials And Methods: A retrospective review of 15 episodes of lower GI bleeding treated in the past 6 years by intentional catheter-induced vasospasm (CIV) to achieve thrombosis of a bleeding source was conducted. Nine patients had angiographically proven inferior mesenteric artery bleeding and six had angiographically proven superior mesenteric artery bleeding.

Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas: buttock claudication, a recognized but possibly preventable complication.

Purpose: Hypogastric artery embolization is considered to be necessary to prevent retrograde flow and potential endoleaks when a stent-graft crosses the origin of the hypogastric artery. The authors assess the incidence of buttock claudication, which is the primary complication encountered. The effect of coil location and the presence of antegrade flow at the completion of embolization are evaluated.

Reengineering a radiology department in an academic institution.

Objective: A 1-year program was undertaken in conjunction with an outside consultant to cut nonphysician labor expenses by 15%, cut nonlabor expenses by 10%, and improve all service parameters in an academic radiology department.

Materials And Methods: A steering committee decided on five major goal teams: improve report turnaround time and improve patient throughput, increase the efficiency of performance and improve the quality of radiologic examinations, decrease the cost of each examination, improve charge capture, and improve the perception of the department. The goal teams met at least every 2 weeks, made presentations to the steering committee at midyear, and were then disbanded.

Stent-graft repair of aorto-iliac occlusive disease coexisting with common femoral artery disease.

Purpose: Significant disease or occlusion of the common femoral artery may preclude percutaneous therapy for aorto-iliac occlusive disease. In addition, aorto-iliac angioplasty may not reverse the ischemic symptoms when common femoral artery disease exists. The authors describe the feasibility of endoluminal stent-grafts to treat multilevel aortoiliofemoral occlusive disease.

Infrapopliteal percutaneous transluminal angioplasty: what we know.

We believe that a substantial experience demonstrating the effectiveness and safety of infrapopliteal artery PTA has been accumulated. It is clear that the results of tibial PTA and femoropopliteal PTA are closely associated for most patients undergoing limb salvage procedures. Anatomic selection is most important; patients with focal disease and restorable runoff will generally benefit, and interventional radiologists should concentrate on treating this group of patients.

Venous invasion in renal vein leiomyosarcoma: case report and review of the literature.

Tumors arising from veins are rare, usually present with nonspecific clinical and imaging findings and almost universally show histology of leiomyosarcoma. This twentieth reported case of primary renal vein leiomyosarcoma demonstrates invasion of the renal vein with endoluminal propagation of tumor into the infrahepatic inferior vena cava (IVC), an unreported manifestation. The combination of CT, ultrasound, and angiographic studies allowed differentiation from renal cell carcinoma by suggesting a tumor arising from the renal vein.

Value of preoperative renal artery embolization in reducing blood transfusion requirements during nephrectomy for renal cell carcinoma.

Purpose: The authors evaluated the effectiveness of preoperative ethanol renal artery embolization in reducing transfusion requirements during nephrectomy for renal cell carcinoma.

Patients And Methods: Of 93 consecutive patients who underwent nephrectomy for renal cell carcinoma from 1980 to 1990, 24 patients underwent embolization within 24 hours of nephrectomy. Finding in this group were compared with those in 69 control patients who underwent surgery without preoperative embolization.

Comparison of duplex ultrasonography and ascending contrast venography in the diagnosis of venous thrombosis.

The application of duplex ultrasonography to the diagnosis of venous thrombosis requires validation by comparison of the duplex findings with the results of ascending contrast venography. In this study, 2534 veins were examined by both methods with contrast venography results serving as the standard for comparison. In this setting, duplex ultrasonography proved to be 100% sensitive and 99% specific for venous thrombosis.

Compression of vein graft by hematoma during fibrinolytic therapy simulating intrinsic venous stricture--a case report.

Narrowing of a vein graft at an area of perigraft extravasation was encountered during fibrinolytic therapy for graft thrombosis. With cessation of fibrinolytic therapy, extravasation ceased and the vein lumen widened. Extrinsic compression and/or spasm due to a hematoma should be included as causes of vein graft narrowing in patients undergoing fibrinolytic therapy.

Radiology in intestinal ischemia. Angiographic diagnosis and management.

Angiography is an essential component of the diagnosis and treatment of patients with acute and chronic intestinal ischemia. Aortography and selective angiography permit identification of the cause and precise anatomy of intestinal ischemic syndromes, and also help plan their potential correction. Direct intra-arterial infusion of pharmacologic agents into splanchnic vessels has now become part of the therapy of these conditions.