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Interested in the latest news in the field of Obstetric Ultrasound?

If you are, we have good news!

A new free Special Report is now available:

Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma

Get the Special Report Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma absolutely FREE when you sign up for Radiology Daily alerts.

Dear concerned radiology professional,

If you’re a practising radiologist, radiology resident or internist, you know how far Obstetric Ultrasound has advanced in recent years—even in the past few months, with newer and better imaging and more effective techniques emerging all the time.

So, what’s a busy radiologist to do?

First and foremost, stay on top of the latest research, and your CME requirements, particularly those Obstetric Ultrasound courses that address the latest technology and how to use it correctly and safely, as well as how to interpret your findings to aid in treatment decisions in the hope of the best patient outcome.

Radiology Daily was launched to help you stay on top of your CME requirements, bringing you the latest news on Obstetric Ultrasound. This is news you can use in your practice to stay on the cutting edge, or even ahead of the curve.

Radiology Daily, from Oakstone Medical Publishing, which produces the landmark Practical Reviews in Radiology, brings you the latest news in the world of radiology from over 40 journals around the globe.

Practical Reviews in Radiology brings you peer-reviewed article abstracts–essential reading for anyone in the field of radiology who wants to keep current with the latest research and findings, and meet their CME requirements at the same time.

Now you can get this invaluable free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, completely free.

When you download your copy of your free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, you’ll also be registered for your free Radiology Daily email alerts.

Each time we publish a new article on Obstetric Ultrasound at the Radiology Daily website, it will be sent to your inbox, to help keep you up to date on the news you need to know in the world of obstetric ultrasound.

To get your free copy of Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, simply enter your email address in the box, and click on the button below.

We will send you a confirmation email with your download link to get your PDF copy of this free report to read and use right away.

Then, each time we publish a new article at the site, about once every month, you will receive the new article via email–completely free!

To get your FREE Special Report Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma and register for your free Radiology Daily email newsletters, just fill in the box below.

[rclp_ofie title="Oakstone Medical Publishing is your reliable source for obstetric ultrasound CME" subtitle="Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now! " instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about obstetric ultrasound research and obstetric ultrasound courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report.
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Every professional caregiver has dedicated themselves to a lifetime of learning.

You hunger for knowledge…for advanced skills…for tools that promote patient health…

Your goal is always the same:

You want to detect and diagnose disease more quickly and efficiently, in its earliest stages, when treatment is likely to be less difficult and cure is more probable.

This invaluable Special Report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, brings you invaluable advice on how to detect and diagnose these three main women’s health concerns.

In this special report, you will learn:

• How to Identify Ectopic Pregnancy:
• Who is at risk;
• The main reasons for ectopic pregnancies;
• The 4 key observations to detect normal pregnancy on ultrasound and rule out ectopic pregnancy;
• Evaluating ovarian masses on ultrasound;
• Why size matters when it comes to ovarian masses;
• How to approach ovarian masses in pre-menopausal women;
• How to approach ovarian masses in post-menopausal women;
• The main ovarian masses you will encounter on ultrasound;
• The main types of ovarian cysts;
• The characteristic appearance on a sonograph of the main types of ovarian cysts;
• How to approach ovarian masses if you locate them on ultrasound;
• Which types of ovarian cysts can be ruled benign upon ultrasound;
• Why practice is key when it comes to evaluating ovarian masses on ultrasound;
• Evaluating endometrial thickness with ultrasound;
• What is considered normal endometrial thickness in pre-menopausal women;
• Evaluating endometrial thickness in postmenopausal women;
• How your evaluation should differ if bleeding is present;
• Why it is important to identify atrophic endometrium with ultrasound;
• The appearance of endometrial carcinoma on ultrasound;
• Why focal thickenings of the endometrium are also important;
• The difference in appearance on ultrasound between endometrial polyps and submucous myomas.
• Further resources and suggested reading;
• And more…

Oakstone Medical Publishing is your reliable source for Obstetric Ultrasound CME.

Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma now, and download in minutes.

Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about Obstetric Ultrasound and Obstetric Ultrasound CME courses to the Radiology Daily website.

[rclp_ofie title="Oakstone Medical Publishing is your reliable source for obstetric ultrasound CME" subtitle="Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now! " instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about obstetric ultrasound research and obstetric ultrasound courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report.
" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

Your time is very valuable.

Keeping current on new medical technology and procedures is time-consuming, but essential to your professional career.

So we’ve distilled the most important facts about Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma into a fast-reading report of only about 2,500 words.

Why not invest the next 10 minutes in gaining a deeper understanding of the latest techniques for MRI imaging of the knee?

Best of all, you’ll also get a free subscription to Radiology Daily‘s email service, to keep you abreast of every new article we post at the site on the topics of the most interest to you.

There are 13 Radiology Daily topics in all, news you can use to add to your knowledge of the rapidly changing world of radiology and stay on top of your CME requirements. You can easily unsubscribe from Radiology Daily at any time with a couple of mouse clicks. It couldn’t be easier.

To get your copy of the free Special Report Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now, plus register for your free copy of the Radiology Daily newsletter, simply fill in your details below.

With kind regards,

Don Deye, M.D.
Medical Director

[rclp_ofie title="Oakstone Medical Publishing is your reliable source for obstetric ultrasound CME" subtitle="Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now! " instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about obstetric ultrasound research and obstetric ultrasound courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report.
" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

P.S. As any radiologist knows, when it comes to Obstetric Ultrasound, experience is key in detecting and treating disease. So is keeping up to date with the latest technologies, techniques, and procedures, in the hopes of gaining the best patient outcomes.

If you agree, I’m sure you’ll want to read Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma. Just enter your email address, download your free report, and start reading in minutes.

[rclp_ofie title="Oakstone Medical Publishing is your reliable source for obstetric ultrasound CME" subtitle="Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now! " instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about obstetric ultrasound research and obstetric ultrasound courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report.
" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

Free Special Reports on leading Radiology topics for you to download now. Plus, get free email newsletters.

A recent study was conducted to assess the effect of weight-based automatic tube current modulation in children with congenital thoracic cardiovascular disease using conventional angiography, sonography, or surgery as reference standards.

The findings show that automatic tube current modulation combined with low tube voltage settings markedly reduces radiation exposure without significant reduction in image quality.

The Study
68 patients referred to the pediatric radiology department for known or suspected cardiovascular abnormalities over a 2-year period were identified.

Methodology

Overall, 38 patients underwent 64-MDCT and 30 underwent 16-MDCT.

Patients were divided into 3 groups based on tube voltages used corresponding to 80, 100, and 120 kVp. A normality distribution test was used based on age, height, and body weight.

Of those who underwent surgery, postoperative scanning was identified.

Tube voltage was individually adjusted to patient weight.

For those undergoing 64-MDCT, commercially available tube current modulation software was used which obtains monitoring of tissue attenuation and results in real-time adjustment of the base tube current.

Image evaluation was performed on a 3D-enabled workstation. Each data set was assessed for image noise and graded for quality.

To assess diagnostic quality, 2 readers were asked to independently assess the display of relevant vascular structures and to identify cardiovascular defects.

Image quality was graded using multiple previously published criteria, and structures were assessed on a 5-point scale, with 1 corresponding to qualitative unacceptability and 5 to excellent diagnostic quality.

All defects that had been documented on MDCT were correlated to cardiac sonography, conventional angiography, or surgery.

Radiation dose was calculated using CT dose calculation software with variables such as CT dose index (CTDI), dose-length product (DLP), and effective radiation dose equivalent being reported.

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Results
Compared with scanning without automated tube current modulation, the tube current-time product was statistically significantly reduced by 57.8%. CTDI was reduced by 56.3% and DLP by 54.9%. The radiation dose equivalent was reduced by 60.3%.

In comparison with 16-MDCT, 64-MDCT with tube current modulation resulted in a significant reduction in all these variables as well.

Image quality scores and image noise levels were comparable for both CT scanning techniques.

All cardiovascular defects documented on MDCT scans were correlated at cardiac sonography with agreement calculated to be 94.9% and 91.5% for the 2 reviewers.

Using catheter angiography and surgery, agreement was 100%.

Conclusions
Automated tube current modulation combined with low tube voltage resulted in significantly decreased radiation dose while maintaining image quality and diagnostic accuracy.

Reviewer’s Comments
When presented with data from studies such as this, it is surprising that the standard of practice has been to wantonly expose children to unnecessary ionizing radiation without establishing a threshold where study quality would not suffer.

For the time being, the data from a significant cohort such as this should be put into practice at any institution with the same scanning equipment.

Author: Basil Hubbi, MD

Reference:
Herzog C, Mulvihill DM, et al. Pediatric Cardiovascular CT Angiography: Radiation Dose Reduction Using Automatic Anatomic Tube Current Modulation. AJR; 2008; 190 (May): 1232-1240

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Minkowski Functionals: Quantitative Classification of Breast Parenchymal Density

A recent study was conducted to test the hypothesis that spatial distribution of x-ray attenuation values in digital mammograms can be analyzed quantitatively by using topologic techniques based on Minkowski functionals.

Minkowski functionals are described as a set of topographic descriptors used in an algorithm for quantitative imaging processors.

The study concluded that Minkowski functionals are a novel reproducible approach to quantitatively classify breast parenchymal density.

The Study

Digital mammograms of 100 women performed over a 1-year period at a single institution were randomly chosen. Those that had prior breast surgery, known malignant disease, or breast implants were excluded.

Methodology
A 512- x 512-pixel region of interest was drawn on each of the mammograms in an area of the breast where the density pattern was homogeneous.

Subsequently, 2 experienced radiologists classified the parenchymal pattern within these regions of interest as normal, involution atrophy, or fibrosis based on predetermined qualitative definitions for each category.

Subsequently, quantitative density measurements were performed by first using mean, median, and 20th percentile values of gray-level intensity.

Subsequently, mathematic topology using Minkowski functional spectra analysis as described in a prior publication by Michielsen et al was used. Both quantitative methods were compared with the predetermined radiologist classifications as the standard.

Results
Minkowski functionals are a novel reproducible approach to quantitatively classify breast parenchymal density.

Mean, median, and 20th percentile gray-level intensity for normal breast tissue was 90 ± 9, 91 ± 8, and 68 ± 18, respectively. The mean, median, and 20th percentile gray-level intensity for involution was 84±7, 83 ± 7, and 75 ± 6, respectively, and for fibrosis, the mean, median, and 20th percentile gray-level intensity was 90 ± 8, 89 ± 9, and 73 ± 10, respectively.

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Using the qualitative classification as a standard, with the parameters obtained from gray-level histograms, only 37% to 66% of cases were classified correctly.

Comparatively, discriminant models of the spectral information of the Minkowski functionals exhibited a rate of correct classification of 76% to 83%.

Reviewer’s Comments
The heavy use of statistical analysis and technical descriptors in this study belie the potential this may have on the future of breast imaging by way of computer-aided detection.

We may see this kind of information resurface at a later date, when this approach to categorizing the density of breast tissue trickles down the industry path.

Author: Basil Hubbi, MD

Reference:

Boehm HF, Schneider T, et al. Automated Classification of Breast Parenchymal Density: Topologic Analysis of X-Ray Attenuation Patterns Depicted With Digital Mammography. AJR; 2008;191 (December): W275-W282

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Does BMI Affect Accuracy of MRI for Knee Dislocation?

A recent study in AJR examined the incidence and cause of knee dislocation in normal and obese patients with evaluation of MRI findings. It also sought to determine if specific injury patterns are associated with an increased body mass index (BMI).

The result have show that although diagnostic accuracy of MRI does not suffer as a result of a high BMI, there is an increased prevalence of popliteal tendon ruptures in obese patients with knee dislocation.

Methodology
Over a 7-year period, patients who were given the diagnosis of knee dislocation at a level 1 trauma center were identified. Two radiologists independently reviewed the MRI results.

Findings were noted, including injury to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament, popliteus tendon, quadriceps tendon, patellar ligament, and medial retinaculum.

Injuries to the bone, cartilage, menisci, nerves, and arteries were also recorded.

Equivocal cases were resolved by consensus.

Images were classified subjectively as diagnostic or nondiagnostic.

BMI and mechanism of injury were obtained from the patients’ files. MRI findings of those with a BMI >25 were compared with those with a BMI <25, and statistical analysis was performed.

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Results
24 patients were identified as having knee dislocation over the 7-year period. The incidence based on the local population was determined to be 2.3 knee dislocations per million.

Of the 24 patients, 19 had an MRI of diagnostic quality. The mechanism of injury was determined as follows:

• 7 cases secondary to high-energy trauma
• 7 cases secondary to athletic injury
• 10 cases secondary to a simple fall.

When comparing those with a BMI >25 to those with a BMI <25, no statistical significance was found in image quality and subjective diagnostic quality of the MRI study.

The only statistically significant injury pattern identified between both groups was complete rupture of the popliteal tendon, a finding seen only in the overweight group.

In total, 46% of patients in this study with knee dislocation were overweight and underwent low-incidence trauma.

Conclusions
Although diagnostic accuracy of MRI does not suffer due to a high body mass index, there is an increased prevalence of popliteal tendon ruptures in obese patients with knee dislocation.

The annual incidence of low-energy trauma-induced knee dislocations in overweight patients is not insignificant at a level 1 trauma center.

Reviewer’s Comments
These findings can be practically utilized to determine whether knee dislocation occurred in patients with a BMI >25 after spontaneous reduction.

The presence of popliteal tendon rupture in the setting of low-energy trauma in this patient population subset can be reliably used to diagnose those who may have had a recent knee dislocation.

Author: Basil Hubbi, MD

Reference:
Peltola EK, Lindahl J, et al. Knee Dislocation in Overweight Patients. AJR; 2009;192 (January): 101-106

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In a recent study reported in Pediatric Radiology, the safety and results of MR cholangiopancreatography (MRCP) on pediatric patients were examined, including the effects of secretin and a negative oral contrast agent. Additionally, the findings on MRCP were compared with those of endoscopic retrograde CP (ERCP) in patients who underwent both studies.

The Study

Over a 3-year period, any patient age 18 years younger who underwent an MRCP at the author’s institution were identified in this retrospective study.

The most frequent clinical indications for MRCP were pancreatitis and elevated liver function tests. They found that secretin allowed better delineation of the pancreatic duct as well as qualitative evaluation of the exocrine function of the pancreas. The MRCP and ERCP diagnoses were concordant in 13 of 16 patients evaluated as abnormal on MRCP.

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As they discussed, MRCP is technically feasible and safe in children, and the use of both secretin enhancement and a negative oral contrast agent appears to improve both image quality and the diagnostic confidence of the radiologist.

MRCP gives additional information, compared to ERCP alone, on a variety of pathologies in the pancreaticobiliary systems. This comprehensive article summarizes the main usages of MRCP in general, and particularly in children. Besides addressing the feasibility and safety, the article comments on the use of secreting and negative oral contrast as useful adjuncts in those patients who are amenable.

Author: Basil Hubbi, MD

Reference:

Delaney L, Applegate KE,et al. MR Cholangiopancreatography in Children: Feasibility, Safety, and Initial Experience. Pediatr Radiol 2007;38 (December):64-75.

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Welcome to the Pediatric Radiology Section of Radiology Daily.

In the Pediatric Radiology section, we will be keeping you up to date on the latest information in the field of Pediatric Radiology. We include news on the current clinical challenges in Pediatric Radiology, interpreting imaging studies, and how to use the various imaging technologies in the hope of better patient outcomes.
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Welcome to the Neuroradiology Section of Radiology Daily.

In the Neuroradiology section, we will be keeping you up to date on the latest information in the field of Neuroradiology, including x-ray, MRI, Bone Scintigraphy, PET, PET/CT, and SPECT/CT.

We will also include news on the current clinical challenges in Neuroradiology, interpreting imaging studies, and how to use the various imaging technologies in the hope of better patient outcomes.
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Welcome to the Diagnostic Imaging Section of Radiology Daily.

In the Diagnostic Imaging section, we will be keeping you up to date on the latest technology  in the field of Diagnostic Imaging, including x-ray, ultrasound, mammography, CT, CT/MR angiography, MRI, PET and more.

We will also include information on current clinical challenges, as well as case studies and how to interpret them, for better diagnosis in the hope of better patient outcomes.

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Welcome to the Chest Radiology Section of Radiology Daily.

In the Chest Radiology section, we will be keeping you up to date on the latest information in the field of Chest Radiology, including cardiac imaging, multidetector CT, CT/MR angiography, MRI and more.

We will also include news on the current clinical challenges in Chest Radiology, interpreting imaging studies, and how to use the various imaging technologies in the hope of better patient outcomes.
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