Arjun K.

How artificial intelligence and teleradiology can be used for early stroke diagnosis?

The word stroke, similar to the term heart attack, has a forbidding connotation in our minds. It delivers up the image of a life threatening event, with dismal consequences that include disability, paralysis or even death. Magnify this with the national statistics on stroke and the concerns can only intensify – given that stroke is one of the leading causes of death and disability in India. And that the incidence (new cases per year) and prevalence (total number of cases in the community) of stroke in India actually exceed those in developed, high-income countries. To learn more, click the below link.

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Incidence and Implications of a Left Inferior Vena Cava on IVC filter placement

Indian Journal of Radiology and Imaging (2005)

To assess the prevalence and ability to detect a left inferior vena cava (IVC) during venography prior to filter placement and its implications for device implantation. Materials and Methods : Over 58 months, patients referred for an IVC filter were prospectively evaluated for a left IVC by performing cavography injecting into the left iliac vein, left renal venography, or CT scan correlation. Additionally, cavograms of patients receiving filters over the four previous years were reviewed to assess the adequacy of detecting these anomalies based on the degree of opacification of the left iliac vein in relation to the position of the catheter tip. Results: Prospective evaluation for a left IVC was adequate in 477 of 503 patients. Retrospective evaluation using CT scans was possible in another 14. Left IVCs were detected in 5 patients (1%). Three patients with duplications were managed with either 2 filters, a suprarenal filter, or a bird’s nest filter straddling both cavas. Two patients with isolated left IVCs received a single filter. Of 62 retrospectively reviewed cavograms, the left iliac vein was inadequately opacified in 69% when the catheter was in the low IVC (53 patients) and 71% when it was in the right iliac vein (7 patients). Conclusions: Low caval or right iliac vein injections infrequently provide sufficient reflux into the left iliac vein to assess for a left IVC. Left iliac vein catheterization is easy and will readily provide this information. Modifications in filter placement technique may be necessary when caval anomalies are present. To read more, click on below link…

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Total Anomalous Pulmonary Venous Connection: Helical Computed Tomography as an Alternative to Angiography

Indian Heart Journal (2004)

Echocardiographic evaluation of the pulmonary veins is inadequate at times. Cardiac catheterization, especially in sick neonates, may be a high-risk procedure. Helical computed tomography with three-dimensional reconstruction is noninvasive but remains an underutilized modality. Between January 2002 and February 2003, 7 computed tomography scans of children 3 weeks to 5 years of age were performed to evaluate the drainage of the pulmonary veins in suspected total anomalous venous drainage. Helical computed tomography (GE High speed Advantage) was performed using 2 mm sections, and rapid bolus hand injections of 2 ml/kg body-weight of nonionic intravenous contrast. Sagittal and coronal reformats, and three-dimensional reconstructions were performed, and reviewed by the radiologist. The findings were discussed with the pediatric cardiologist and surgeon involved in the case. The diagnoses included complex congenital heart disease (n = 5), isolated infradiaphragmatic total anomalous pulmonary venous connections (n = 1), and transposition of the great arteries with total anomalous pulmonary venous connections (n = 1). Cardiac computed tomography accurately demonstrated infradiaphragmatic total anomalous pulmonary venous connections in 4, and supracardiac drainage in 3 patients, in addition to the other cardiac findings. The findings on computed tomography scan correlated with surgical (n = 5) and/or angiographic findings (n = 2) in 7 patients. In sick, high-risk patients, cardiac computed tomography can be considered as an alternative to cardiac catheterization for the evaluation of pulmonary venous drainage.To learn more, click the below link.

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Implementation of an International Teleradiology Staffing Model

Radiology (2004)

Although teleradiology is presently being used extensively in the United States-for both overseas subspecialty consultations and overnight coverage of imaging services at domestic medical centers-there has been limited investigation of its potential to help provide staffing support to U.S. medical centers from offshore locations. In this review, the authors describe an empirical assessment of the clinical feasibility and applicability of body computed tomographic (CT) image cases that originated at a U.S. university hospital being interpreted nearly contemporaneously by a staff radiologist in India. During a 3-month period, nonemergent CT cases obtained at a tertiary care institution (Yale-New Haven Hospital) were transmitted daily to a satellite reading facility in Bangalore, India. The cases were interpreted at the satellite reading facility by a faculty member radiologist who maintained hospital privileges and academic appointment at the parent institution in the United States. CT imaging reports were transcribed and uploaded directly to the parent institution’s radiology information system. Technical problems temporarily prevented the transfer of image cases twice during the study period. Overall, the project results demonstrated the feasibility and reliability of an international teleradiology staffing model. To read more, click on below link…

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Emergency Radiology Coverage: Technical and Clinical Feasibility of an International Teleradiology Model

Emergency Radiology (2003)

The purpose of the study was to determine the feasibility of international teleradiology, utilizing day-night time differences, for online interpretation of overnight computed tomography (CT) studies. One hundred and two consecutive Emergency Room patients who underwent CT examinations between the hours of 11 pm and 7 am were enrolled. All age groups and study types were included. CT studies were transmitted from the in-hospital PACS system (Kodak, Fremont, Calif.) to a web-based server (Medweb, San Francisco, Calif.). A radiologist in Bangalore, India, working an 8 am to 4 pm day shift, downloaded and reviewed the studies on a desktop PC using a 128-kbps internet connection at 10-20:1 wavelet compression and generated a report. The report was then uploaded to the server, noting the time at upload. Each study report was compared with the official in-house diagnostic report and concordance assessed on a three-point scale. Mean download time was 8.14 s per image. For head CT reports ( n=47), the mean turnaround time for a final transcribed report was 39.5 min. For abdomen/pelvis CT reports ( n=48) the mean turnaround time was 84.4 min. Out of 106 cases, there was discordance between the clinical diagnostic report and the study report in 20 (19%); however, on subsequent review the teleradiology report was found to be correct in 13 of these. Day-night time differences across the globe can be utilized to provide overnight emergency radiology coverage using web-based teleradiology. Scan download and report upload times are within acceptable limits. To read more, click on below link…

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Renal Medulla Carcinoma in a White Adolescent

American journal of Roentgenology (1997)

Renal medullary carcinoma (RMC) is a rare neoplasm of the kidney that has been recently described. It is almost exclusive to young patients of African descent and associated with sickle cell hemoglobinopathy, mainly sickle cell trait and hemoglobin sickle cell disease. The prognosis of RMC is very poor because of the highly aggressive behavior of this neoplasm and its resistance to conventional chemotherapy. Metastatic disease is almost universal at the time of presentation, and the malignancy is minimally responsive to a variety of regimens and/or modalities, including surgery, radiotherapy, chemotherapy, and biological immune-modulation therapy. We report the seventh case of a left RMC occurring in a white child with sickle cell trait, but with a localization of the tumor in the left kidney, considered a non-predominant side for this type of tumor. To learn more, click the below link.

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Dental Implants and Dental CT Software Programs

Seminars in Ultrasound, CT and MRI (1995)

Dental implants are titanium cylinders that are surgically implanted into the jaw to allow fixation of a permanent dental prosthesis. These have provided an attractive alternative to standard removable dentures and have become quite popular. To assess these patients preoperatively, CT software programs were developed that display multiple axial, cross-sectional, and panoramic images of the jaw. As a result, new dialogues and interactions were created between radiologists and dentists, and this in turn brought new territories and unfamiliar diseases to the radiologists’ view. The purpose of this article is to familiarize the radiologist with dental implants, the surgical procedure, dental CT software programs, and related dental pathology. To know more, do read.

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“Small bowel feces sign” – A Ct sign in small bowel obstruction

Introduction Small bowel obstruction is a common cause of abdominal emergency. Diagnosis helps effective management and prevents complications. CT is an effective tool in evaluation of small bowel obstruction. The small bowel feces sign is a finding observed in small bowel obstruction on Helical CT (6). It is defined as presence of feces like material

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Inter-Organizational E-Commerce in Healthcare Services: The Case of Global Teleradiology.

Abstract Advances in healthcare information technology have enabled new models for electronic delivery of healthcare services. In this paper, we present the case of electronic delivery of radiological services and describe the market-based and technological factors that have led to the development of internet-based service models for flexible delivery of radiological services. Specifically, we describe

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