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Computers in Radiology

1 What is PACS? PACS stands for Picture Archiving and Communication System. On the most basic level, PACS integrates image acquisition modalities, workstation displays, the image archiving system, and the underlying network. 2 How are PACS images stored? The PACS archive traditionally has been composed of short-term and long-term storage. Short-term storage is usually composed of redundant arrays of inexpensive (or independent) discs (RAID) arrays that…

Introduction to Image Processing, Visualization, and Analysis

1 What is a digital image? A digital image is an image discretized in spatial coordinates and in brightness. It can be represented by a multidimensional array of integers. 2 What is the difference between a pixel and a voxel? A pixel, or picture element, is the smallest element of a 2D digital image that can be individually processed, whereas a voxel, or volume element, is…

Introduction to Nuclear Medicine and Molecular Imaging

1 What is molecular imaging? Molecular imaging is the visualization, characterization, and measurement of biologic processes at the molecular and cellular levels in humans and other living systems. It is essentially a noninvasive means to study in vivo biochemistry and cell biology and is useful to optimize diagnosis and therapy of disease in individualized patients. Nuclear medicine techniques and optical imaging techniques are most commonly used…

Introduction to Ultrasonography, CT, and MRI

Ultrasonography (US) 1 What is ultrasonography (US), and how does it work? US is a structural imaging technique that uses high-frequency mechanical ultrasound waves (with frequencies greater than audible sound waves) to create real-time tomographic (cross-sectional) images. A hand-held transducer is applied to a part of the body to transmit ultrasound waves into the patient. Reflected ultrasound waves (echoes) are then detected by the transducer and…

Introduction to Radiography, Fluoroscopy, and Tomosynthesis

Radiography 1 What is radiography? Radiography is an imaging technique that uses x-rays to create projectional (2D) images of a region of interest in the body. It is performed by shining x-rays on a film or other image detector with a patient placed in front of it in a certain orientation. Different types of tissues in the patient attenuate x-rays to different degrees, leading to formation…

Internet, Social Media, and Applications

Introduction The Digital Revolution began in the latter half of the 20th century with the first uses of digital computers and data storage. The 1970s saw the development of the first microprocessor, Intel’s 4004, which marked the advent of the rapidly doubling processor speeds predicted by Moore’s Law. These exponential increases in computing power have since drastically changed how businesses and individuals interact by leading to…

Leadership: A Manifesto for the Nonclinical Education of Radiologists Looking to Succeed in Difficult Times

Introduction Historically, to be successful in their professional careers, radiologists must train intensively for years. They must master a daunting amount of clinical material, pass comprehensive tests, and meet a wide array of challenges in their training. That has not changed during my own career (now around a quarter-century in length) and, if anything, the amount of material that radiologists are expected to master keeps increasing…

Malpractice and Radiology: A Hapless Relationship

Prologue To gain a more meaningful understanding of the current state of affairs with regard to medical malpractice litigation in the United States, we begin by looking back at certain events that have brought us to the present. England, 1765 British legal scholar Sir William Blackstone published Commentaries on the Laws of England, in which “neglect or unskillful management of a physician or surgeon” was referred…

Emergency Radiology

Communication in Emergency Radiology Physician-to-Patient Communication Physician-to-patient communication is a unique challenge for radiologists. Radiologists and patients often have isolated encounters, without any prior patient-physician relationship established. Most radiology services, including an emergency radiology service, do not schedule dedicated clinic time, and therefore meeting with patients may not be a set priority in the daily workflow. Additionally, radiologists often do not have enough information from the…

Quality Considerations in Children

Although many of the quality and safety discussions throughout this volume are applicable to all aspects of radiology including the imaging of children, there are several topics that are especially critical or unique to pediatric patients including radiation reduction, sedation, and selection of the optimal study. Radiation Reduction In recent years, medical imaging has become a major source of ionizing radiation exposure, with the most significant…

Interventional Radiology

Safety Culture and Teamwork in Interventional Radiology The practice of interventional radiology (IR) is distinct from that of diagnostic radiology (DR) in that IR is able to treat patients with a wide variety of vascular and nonvascular disorders. Inherent in these abilities is the responsibility to provide safe, evidence-based, and patient-centered care. One method of working toward this goal is creating a safety culture within the…

Optimizing Radiation Dose for Computed Tomography

Evolution of Computed Tomography Technology Computed tomography (CT) plays a major role in the practice of medicine. CT was invented by the British scientist Sir Godfrey Hounsfield in 1972 at Electric and Musical Industries research laboratories. Since its invention, CT has evolved rapidly and transformed the field of medicine. The first CT scanners were dedicated to acquiring head images. With development of subsequent scanners, it became…

Noninterpretive Skills in Magnetic Resonance Imaging

Introduction Magnetic resonance imaging (MRI) is used in the diagnosis of patients with many conditions, and while the interpretive skills necessary to appropriately interpret the MRI images are complex, so too are the noninterpretive skills. Many of these issues come to the radiologist’s attention on a daily basis—for example, issues concerning magnetic resonance (MR) safety, whether a patient will be safe in the MRI environment, and…

Noninterpretive Skills in Ultrasound

Bioeffects of Ultrasound The benefit of diagnostic ultrasound as an imaging modality in clinical practice cannot be overstated. Avoiding the radiation of radiography and computed tomography and the restrictive nature of magnetic resonance imaging coupled with the portability of ultrasound machines make ultrasound an attractive diagnostic tool. Although there are no known deleterious effects in humans when used within normal ranges, knowledge of potential bioeffects of…

Safe Use of Contrast Media

Introduction Widespread use of medical imaging has led to a significant increase in the use of radiologic contrast media (CM). Half of the estimated 78 million computed tomography (CT) examinations and 37 million magnetic resonance imaging (MRI) examinations performed annually in the United States include the use of CM. Radiographic CM are used in imaging examinations to aid in the characterization, detection, and staging of disease.…

Imaging of Pregnant and Lactating Women

Introduction Radiation risks are of concern in pregnant patients due to the potential of harmful effects on the fetus. However, due to referring physician concerns about maternal health, some exams using ionizing radiation have to be performed in pregnant patients. A balance between appropriateness and overutilization of imaging techniques needs to be maintained to provide the best care to the patient. Any imaging technique performed should…

Statistical Tools and Quantitative Reasoning

Introduction The practice of medicine frequently requires that physicians make critical diagnostic and treatment decisions with incomplete information, working in a background of high uncertainty. The specialty of diagnostic radiology is not exempt from this reality. Although people in other walks of life might view such a high-uncertainty/high-stakes situation to be paralyzing, inaction is rarely an option in the practice of medicine. Many doctors consider this…

Radiology Informatics

Informatics is the science and practice of computer information systems. Imaging informatics encompasses the use of information technology to deliver efficient, accurate, and reliable medical imaging services within a healthcare network. Its imprint is felt in every step of the process of patient imaging, from order entry to results communication. Radiologists have key roles as leaders in imaging informatics and are the liaisons between the clinical…

Accounting in Radiology

Dominant Payers in American Healthcare Most healthcare costs, roughly 72% by current estimates, are paid by third-party payers. Insured patients still have out-of-pocket expenses, for example, to meet copayments and deductibles, depending on the actuarial value of their plan. Approximately 12% of the US population is uninsured, or self-pay ( Fig. 16.1 ). Third-party payers include private insurance, Medicare, and Medicaid. The majority of the funds,…