One of the biggest challenges in dose monitoring is customization of CT dose estimates to the patient. Patient size remains a highly significant variable. One metric that has previously been used for patient size is patient weight, though this is often criticized as inaccurate. In this work, we compare patients’ weight to their effective diameters obtained from a CT scan of the chest or the abdomen. CT exams of the chest (N=163) and abdomen/pelvis (N=168) performed on adult patients in July 2012 were randomly selected for analysis. The effective diameter of the patient for each exam was determined using the central slice of the scan region for each exam using eXposure™ (Radimetrics, Inc., Toronto, Canada). In some cases, the same patient had both a chest and abdominopelvic CT, so effective diameters from both regions were analyzed. In this small sample size, there appears to be a linear relationship between patient weight and effective diameter when measured in the mid-chest and mid-abdomen of adult patients. However, for each weight, patient effective diameter can vary by 5 cm from the regression line in both the chest and the abdomen. A 5-cm difference corresponds to a difference of approximately 0.2 in the chest and 0.3 in the abdomen/pelvis for the correction factors recommended for size-specific dose estimation by the AAPM. This preliminary data suggests that weight-based CT protocoling may in fact be appropriate for some adults. However, more work is needed to identify those patients in whom weight-based protocoling is not appropriate.
RADIANCE extracts CT dose parameters from dose sheets using optical character recognition and stores the data in a
relational database. To facilitate validation of RADIANCE's performance, a simple user interface was initially
implemented and about 300 records were evaluated. Here, we extend this interface to achieve a wider variety of
functions and perform a larger-scale validation. The validator uses some data from the RADIANCE database to prepopulate
quality-testing fields, such as correspondence between calculated and reported total dose-length product. The
interface also displays relevant parameters from the DICOM headers. A total of 5,098 dose sheets were used to test the
performance accuracy of RADIANCE in dose data extraction. Several search criteria were implemented. All records
were searchable by accession number, study date, or dose parameters beyond chosen thresholds. Validated records were
searchable according to additional criteria from validation inputs. An error rate of 0.303% was demonstrated in the
validation. Dose monitoring is increasingly important and RADIANCE provides an open-source solution with a high
level of accuracy. The RADIANCE validator has been updated to enable users to test the integrity of their installation
and verify that their dose monitoring is accurate and effective.
The role of computers in medical image display and analysis continues to be one of the most computationally demanding
tasks facing modern computers. Recent advances in GPU architecture have allowed for a new programming paradigm
which utilized the massively parallel computational capacity of GPUs for general purpose computing. These parallel
processors provide substantial performance benefits in image analysis and manipulation. Automated segmentation
algorithms gain the most benefit from incorporation of GPU computing into the image processing workflow. There are
also new visualization paradigms, such as stereoscopic 3D, which have been made possible by the continued increase in
computational capacity of GPUs. These two key functions of modern GPUs will enable medical imagers to keep pace
with the increasing size of scan data sets while allowing for new and innovative analysis and interaction paradigms.
With the current emphasis on healthcare reform and cost effectiveness, methods to increase healthcare efficiency while
improving outcomes are paramount. With reference to breast cancer, delay in diagnosis can cause significant morbidity
and mortality, as well as increased long term health care costs. Assessment with short interval mammographic follow-up
of BI-RADS category 3 lesions has been shown to increase detection of a small number of breast cancers at an early
stage. Because of the importance of timely follow-up for these patients, we propose a novel computer application that
identifies patients due for short-term mammographic follow-up, thus reducing costly hours spent by personnel, reducing
human error, and improving patient compliance.
Our web-based application mines radiology reports and scheduling information to generate lists of patients due for short-term
mammographic follow-up of BI-RADS category 3 results. The results can be placed in a worklist that can be used
by a staff member to contact patients to schedule follow-up appointments. Additional analytic features of the application
can identify referral characteristics that may serve as potential sources for improvement of patient follow-up.
We believe that an automated system can be designed to improve patient care and compliance with follow-up of BI-RADS
category 3 results.
Indeterminate incidental findings pose a challenge to both the radiologist and the ordering physician as their imaging
appearance is potentially harmful but their clinical significance and optimal management is unknown. We seek to
determine if it is possible to automate detection of adrenal nodules, an indeterminate incidental finding, on imaging
examinations at our institution. Using PRESTO (Pathology-Radiology Enterprise Search tool), a newly developed
search engine at our institution that mines dictated radiology reports, we searched for phrases used by attendings to
describe incidental adrenal findings. Using these phrases as a guide, we designed a query that can be used with the
PRESTO index. The results were refined using a modified version of NegEx to eliminate query terms that have
been negated within the report text. In order to validate these findings we used an online random date generator to
select two random weeks. We queried our RIS database for all reports created on those dates and manually
reviewed each report to check for adrenal incidental findings. This survey produced a ground- truth dataset of
reports citing adrenal incidental findings against which to compare query performance. We further reviewed the
false positives and negatives identified by our validation study, in an attempt to improve the performance query.
This algorithm is an important step towards automating the detection of incidental adrenal nodules on cross sectional
imaging at our institution. Subsequently, this query can be combined with electronic medical record data searches to
determine the clinical significance of these findings through resultant follow-up.
When the first quarter of 2010 Department of Radiology statistics were provided to the Section Chiefs, the authors
(SH, BC) were alarmed to discover that Ultrasound showed a decrease of 2.5 percent in billed examinations. This
seemed to be in direct contradistinction to the experience of the ultrasound faculty members and sonographers. Their
experience was that they were far busier than during the same quarter of 2009. The one exception that all
acknowledged was the month of February, 2010 when several major winter storms resulted in a much decreased
Hospital admission and Emergency Department visit rate. Since these statistics in part help establish priorities for
capital budget items, professional and technical staffing levels, and levels of incentive salary, they are taken very
seriously.
The availability of a desktop, Web-based RIS database search tool developed by two of the authors (WK, WB) and
built-in database functions of the ultrasound miniPACS, made it possible for us very rapidly to develop and test
hypotheses for why the number of billable examinations was declining in the face of what experience told the authors
was an increasing number of examinations being performed. Within a short time, we identified the major cause as
errors on the part of the company retained to verify billable Current Procedural Terminology (CPT) codes against
ultrasound reports. This information is being used going forward to recover unbilled examinations and take measures to
reduce or eliminate the types of coding errors that resulted in the problem.
Imaging centers nationwide are seeking innovative means to record and monitor CT-related radiation dose in
light of multiple instances of patient over-exposure to medical radiation. As a solution, we have developed RADIANCE,
an automated pipeline for extraction, archival and reporting of CT-related dose parameters. Estimation
of whole-body effective dose from CT dose-length product (DLP)-an indirect estimate of radiation dose-requires
anatomy-specific conversion factors that cannot be applied to total DLP, but instead necessitate individual
anatomy-based DLPs. A challenge exists because the total DLP reported on a dose sheet often includes multiple
separate examinations (e.g., chest CT followed by abdominopelvic CT). Furthermore, the individual reported
series DLPs may not be clearly or consistently labeled. For example, Arterial could refer to the arterial phase
of the triple liver CT or the arterial phase of a CT angiogram. To address this problem, we have designed an
intelligent algorithm to parse dose sheets for multi-series CT examinations and correctly separate the total DLP
into its anatomic components. The algorithm uses information from the departmental PACS to determine how
many distinct CT examinations were concurrently performed. Then, it matches the number of distinct accession
numbers to the series that were acquired, and anatomically matches individual series DLPs to their appropriate
CT examinations. This algorithm allows for more accurate dose analytics, but there remain instances where automatic
sorting is not feasible. To ultimately improve radiology patient care, we must standardize series names
and exam names to unequivocally sort exams by anatomy and correctly estimate whole-body effective dose.
Radiologists often recommend further imaging, laboratory or clinical follow-up as part of a study interpretation, but rarely receive feedback as to the results of these additional tests. In most cases, the radiologist has to actively pursue this information by searching through the multiple electronic medical records at our institution. In this work, we seek to determine if it would be possible to automate the feedback process by analyzing how radiologists phrase recommendations for clinical, laboratory or radiologic follow-up. We surveyed a dozen attending radiologists to create a set of phrases conventionally used to indicate the need for follow-up. Next, we mined dictated reports over a 1-year period to quantify the appearance of each of these phrases. We are able to isolate 5 phrases that appear in over 21,000 studies performed during the 1-year period, and classify them by modality. We also validated the query by evaluating one day's worth of reports for follow-up recommendations and assessing the comparative performance of the follow-up query. By automatically mining imaging reports for these key phrases and tracking these patients' electronic medical records for additional imaging or pathology, we can begin to provide radiologists with automated feedback regarding studies they have interpreted. Furthermore, we can analyze how often these recommendations lead to a definitive diagnosis and enable radiologists to adjust their practice and decision-making accordingly and ultimately improve patient care.
Data mining of existing radiology and pathology reports within an enterprise health system can be used for clinical
decision support, research, education, as well as operational analyses. In our health system, the database of radiology
and pathology reports exceeds 13 million entries combined. We are building a web-based tool to allow search and data
analysis of these combined databases using freely available and open source tools. This presentation will compare
performance of an open source full-text indexing tool to MySQL's full-text indexing and searching and describe
implementation procedures to incorporate these capabilities into a radiology-pathology search engine.
Over the past decade, several computerized tools have been developed for detection of lung nodules and for providing
volumetric analysis. Incidentally detected lung nodules have traditionally been followed over time by measurements of
their axial dimensions on CT scans to ensure stability or document progression. A recently published article by the
Fleischner Society offers guidelines on the management of incidentally detected nodules based on size criteria. For this
reason, differences in measurements obtained by automated tools from various vendors may have significant
implications on management, yet the degree of variability in these measurements is not well understood. The goal of this
study is to quantify the differences in nodule maximum diameter and volume among different automated analysis
software. Using a dataset of lung scans obtained with both "ultra-low" and conventional doses, we identified a subset of
nodules in each of five size-based categories. Using automated analysis tools provided by three different vendors, we
obtained size and volumetric measurements on these nodules, and compared these data using descriptive as well as
ANOVA and t-test analysis. Results showed significant differences in nodule maximum diameter measurements among
the various automated lung nodule analysis tools but no significant differences in nodule volume measurements. These
data suggest that when using automated commercial software, volume measurements may be a more reliable marker of
tumor progression than maximum diameter. The data also suggest that volumetric nodule measurements may be
relatively reproducible among various commercial workstations, in contrast to the variability documented when
performing human mark-ups, as is seen in the LIDC (lung imaging database consortium) study.
KEYWORDS: Ultrasonography, Picture Archiving and Communication System, Doppler effect, Radiology, Diagnostics, Data storage, Surgery, 3D image processing, Color imaging, Databases
The purpose of this study was to determine if the size of ultrasound examinations was increasing over time.
The primary reasons for this are believed to be an increased number of images per study, the incorporation of "cine
loops", and increased use of color flow Doppler. The result of this study, if it supports the hypothesis that ultrasound
study size is increasing, would be directly applicable to planning for future expansion of storage in the Ultrasound
PACS. Data were obtained from the ultrasound PACS server for number of studies, number of images, and total
stored volume for sampled months (January and July of 2003 - 2006). The investigators believed that these months
would provide a reasonable sample of study size as examination types did not vary significantly from month to month
(based on Departmental statistics). The Radiology Department's information system (RIS) was used to determine total
yearly ultrasound examination volume to determine the trend over time. Because no protected health information (PHI)
was to be used in this study, the investigators believed that no IRB approval was necessary. The number of studies done per month was more variable than the investigators had believed. One month in
particular (July, 2003) had an anomalously large number of studies. However, despite this, computations of the number
of images per study, the total data volume per study, and the average amount of data per image did show an increasing
trend as expected. Also, the total volume of data stored showed an increasing trend over the study time period. The
investigators' hypothesis that examination size is increasing has been demonstrated to be true for the months sampled. From Departmental data, the investigators know that the most recent ultrasound yearly volume
increased approximately ten percent over the previous year, and that trend was also seen for the study period (from 7-10
percent per year increase in volume). With the information that the examination size is also increasing, the Department
can make better plans for future expansion of the Ultrasound PACS storage system. Ultrasound examination size is increasing, largely because of the increased use of cine loops. A change to
using more of these to replace single static images will further increase examination size.
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