PACS Workstation Research Articles

A comparative Analysis of glenoid morphology in On- and Off-Track Lesions following anterior shoulder dislocation

BackgroundAnterior shoulder dislocation is a prevalent clinical issue, with high recurrence rates after initial dislocation. Stability of the shoulder joint is maintained by the interplay of static and dynamic stabilizers, including the glenoid and humeral head morphology. Glenoid morphology has been identified as particularly influential in joint stability, and thus the evaluation of glenoid bone loss is crucial in managing shoulder dislocations. This study aimed to investigate the differences in glenoid morphologies between on-track and off-track lesions post-dislocation. MethodsThis retrospective case-control study included patients who presented with shoulder dislocation at a level 1 trauma center from 2011 to 2020. Patients with anterior shoulder dislocation, complete CT imaging, visible bone loss and those aged 18 years or older were included. Radiographic parameters were assessed using a certified PACS workstation. The groups were divided into On- or off-track lesions and their glenoid version, glenoid concavity and the morphometrical based bony shoulder stability ratio (BSSR) were compared. Results212 patients (70% male and mean age of 50 years) were included and no significant difference was found between the on-track and off-track groups in terms of demographics or injury mechanism. Significant differences were noted in the glenoid defect (1.28 mm vs. 4.67mm, p 0.001), glenoid concavity/depth (1.7mm vs. 1.3mm, p 0.001) the BSSR (40% vs 33%, p 0.001) and glenoid retroversion (4.4 vs. 2.9°, p 0.009). ConclusionGlenoid morphology has become an increasing focus in the treatment of anterior shoulder dislocation. Patients with an off-track lesion appear to have not only greater glenoid loss and a larger Hill-Sachs, but also a flatter glenoid with less retroversion. This also appears to lead to a lower BSSR.

MRI 3D SPACE T2WI for Pituitary Adenoma Cavernous Sinus Invasion Diagnosis

ObjectiveThis study aims to assess the utility of MRI 3D SPACE T2WI sequences in evaluating cavernous sinus invasion by pituitary adenomas. Materials and methodsData were collected from patients who underwent continuous pituitary MRI examinations at the Medical Imaging Center of our hospital from October 2019 to February 2021. Eligible cases were evaluated for sagittal and axial T1WI sequences, coronal 3D SPACE T2WI sequences, and sagittal and coronal enhanced T1WI sequences using the INFINITT PACS workstation. The Wilcoxon signed-rank test for paired samples and the Mann–Whitney U test for two independent samples were used to statistically analyze differences in image quality scores among various groups. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each observation index were compared with intraoperative results. Results3D SPACE T2WI showed superior cavernous sinus imaging quality compared with CE T1WI and T2WI plain scans (P<0.05). The sensitivity, specificity, PPV, and NPV were 100%, 90.0%, 55.60%, and 100.0%, respectively. The accuracy for pituitary adenoma invasiveness diagnosis based on cavernous sinus medial wall integrity was 94.40%. ConclusionThe imaging quality of the medial wall of the cavernous sinus on the 3D SPACE T2WI plain scan sequence surpassed that of CE T1WI TSE-enhanced scans and T2WI TSE plain scans. The continuous observation of the medial wall of the cavernous sinus using this sequence holds great diagnostic value for assessing cavernous sinus invasion by pituitary adenomas. This strategy is more reliable than traditional MRI observation indicators.

Virtual reading room for diagnostic radiology

Rationale and ObjectiveTo assess the perceptions of radiology staff regarding the role of virtual reality technology in diagnostic radiology after using a virtual reality (VR) headset MethodsParticipants completed a pre-study questionnaire assessing their familiarity with VR technology and its potential role in radiology. Using a VR headset, participants entered a simulated reading room (SieVRt, Luxsonic Technologies) with three large virtual monitors. They were able to view plain radiographs, ultrasound, CT, and MRI images and pull up and compare multiple images simultaneously. They then completed a post-study questionnaire to re-assess their perception about the role of VR technology for diagnostic radiology. ResultsFifteen participants were enrolled, with 33.3 % attendings, 40 % fellows, and 26.7 % residents. Pre-study, 60 % reported they were “not familiar” with VR technology and 66.7 % had never used it. On a 1 to 5 scale, the median perceived likelihood of VR having a role in radiology significantly increased from 3 (IQR 2–3) pre-study to 4 (IQR 4–4) post-study; p = 0.014. Image contrast and resolution were adequate according to most participants, with 53.3 % strongly agreeing and 33.3 % agreeing. The headset was comfortable for 73.3 % and did not induce nausea in any participant. Confidence in VR technology improved after using the headset for 80 %. According to 80 %, future VR technology could replace a PACS workstation. DiscussionRadiologists’ perception regarding the role of virtual reality in diagnostic interpretation improves after a hands-on trial of the technology, and VR has the potential to replace a traditional workstation in certain situations.

Radiologic blind spots in hip and pelvic radiographs.

The purpose of our study was to identify the locations at which hip and pelvic fractures are commonly missed on radiographs. A retrospective study was performed at four non-Level 1 trauma center emergency departments. IRB approval was obtained. All emergency department hip or pelvic radiographs with subsequent CT performed within 48h were identified from 2017 to 2022. Reports for each radiograph and CT were scored for the presence or the absence of fracture in the following locations: ilium, sacrum, superior pubic ramus, inferior pubic ramus, pubis, acetabulum, subcapital femoral, femoral neck, greater trochanter, lesser trochanter, intertrochanteric, and subtrochanteric. The CT report was used as the gold standard. The false-negative radiography cases were reviewed on a PACS workstation to determine whether the case had an "unexpected miss" of a fracture, a subtle fracture, radiographically occult fracture, or exam was limited by artifact. The percentage of missed fractures at each location was calculated. Nine hundred seventy-five radiography cases with subsequent CT were identified. One hundred forty-six cases did not meet entry criteria; therefore, 829 cases were analyzed further. Seventy-four percent of patients were female with age of 74 ± 16 (mean ± standard deviation) years (range 1-103). Three hundred fifty-two cases had at least one fracture, and many cases had multiple fractures. There were 68 false-negative cases. The most commonly missed fractures by percentage were pubis, ilium, and greater trochanter. The most common unexpectedly missed fractures were greater trochanter and femoral subcapital. A careful systematic evaluation of hip and pelvic radiographs, with particular attention to the pubis, ilium, greater trochanter, and subcapital region, may improve radiographic fracture detection and decrease delays in diagnosis.

Increased Incidence of Acute Pulmonary Embolism in Emergency Department Patients During the COVID‐19 Pandemic

Early detection of acute pulmonary embolism (PE) in patients with SARS-CoV-2 infection is integral to the clinical management of these patients. Many recently published studies have evaluated incidence of PE in hospitalized patients with COVID-191-9 , however there is relatively limited data describing patients with SARS-CoV-2 infection and concomitant diagnosis of acute PE upon initial presentation. Therefore, the purpose of this study is to (i) evaluate the incidence of acute pulmonary embolism (PE) in patients undergoing computed tomography pulmonary angiography (CTPA) in the emergency department (ED) across six hospitals in New York City during the height of the COVID-19 pandemic compared to a non-pandemic period, and (ii) compare the characteristics and early outcomes of patients presenting with PE during the pandemic (n=87) to patients presenting with PE during a non-pandemic period (n=34).

WhatsApp as an Emergency Teleradiology Application for Cranial CT Assessment in Emergency Services

To evaluate the diagnostic agreement of transmitted images of cranial CT due to trauma, through WhatsApp software compared to workstation image-based diagnosis. Observational study. Department of Emergency Medicine, Adiyaman University Training and Research Hospital, from January 2017 to May 2018. A total of 94 cases that presented to the Emergency Department and underwent cranial CT were included in the study. CT images were video-recorded by the emergency physician using an Apple iPhone 7. The images were evaluated by two different radiologists using Samsung Galaxy Edge 7 and Samsung Note 8 mobile phones. Later, the radiological images were reviewed by two different radiologists at the PACS workstation. Then, the WhatsApp-mediated and final diagnoses were compared for various lesions to evaluate the interobserver agreement and diagnostic success of the use of WhatsApp software. In the assessment of the interobserver agreement, the kappa values were found to be 0.89 for normal findings, 0.84 for subdural hematoma, 0.73 for subarachnoid hemorrhage, 0.81 for epidural hematoma, 0.85 for fractures, 1 for parenchymal hematoma, and 0.68 for parenchymal contusion. Although WhatsApp can be used in the evaluation of emergency cranial CT images, it is essential to note that some findings, especially those indicating fractures, subdural hematoma, and parenchymal contusion, can be overlooked. Key Words: Teleradiology, PACS, Medical software, Computed tomography, WhatsApp, Instant Messenger.

Clinical utility of 2-D anatomic measurements in predicting cough-associated headache in Chiari I malformation.

Cough-associated headache (CAH) is the most distinctive symptom of patients with Chiari I malformation (CMI) and indicates clinically significant disease. We determined the clinical utility of simple 2D anatomic measurements performed on a PACS workstation by assessing their diagnostic accuracy in predicting CAH in CMI patients. Seventy-two consecutive CMI patients (cerebellar tonsillar herniation >5mm) with headache seen by neurosurgeons over 6years were included. Sagittal T1 images were used by two readers to measure: extent of tonsillar herniation, lengths of the clivus and supra-occiput, McRae and pB-C2 lines, as well as clivus-canal, odontoid retroversion, and skull base angles. Neurosurgery notes were reviewed to determine presence of CAH. Mann-Whitney test was used to compare measurements between patients with and without CAH. Predictive accuracy was assessed by receiver operating characteristic (ROC) curve. 47/72 (65.3%) CMI patients reported CAH. Tonsillar herniation with CAH (10.2mm, 7-14mm; median, interquartile range) was significantly greater than those without CAH (7.9mm, 6.3-10.9mm; p = 0.02). Tonsillar herniation ≥ 10mm showed sensitivity and specificity of 51% and 68%, and tonsillar herniation > 14mm showed sensitivity and specificity of 30% and 100%, respectively, for predicting CAH. Other 2D measurements showed no statistically significant differences. Among the 2D measurements used, only the extent of tonsillar herniation is different between CMI patients with and without CAH. Although CMI is diagnosed with tonsillar herniation of only 5mm, we found that a much higher extent of herniation is needed to be predictive of CAH.

Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution.

PurposeSoftware solutions such as mRay allow review of radiological images on handheld devices. We investigated if the quality is adequate for evaluating CT scans of patients with suspected stroke.Methods50 patients (Median age 80 years, 28 females) were retrospectively selected. All patients had undergone multidetector CT angiography ± perfusion and presented with clinical signs of acute stroke. Out of the 50 patients, 19 had large-vessel occlusion (LVO), 5 had intracranial hemorrhage (ICH), 10 had severe intracranial stenosis of at least one major vessel, 2 had intracranial tumor and 15 had no or an unrelated pathology. One experienced neuroradiologist and one resident scored the anonymized pictures separately on two handheld devices (iPhone 7 Plus, MED-TAB) equipped with mRay Software and on a PACS workstation. Each case was reviewed on all three devices with a break in-between of at least 12 weeks. The scoring on the traditional workstation was compared with the two handheld devices, regarding detection of early ischemic signs, LVOs, CBV/CBF-mismatch, ICHs and severe stenosis. Both raters were asked to rate the diagnostic quality of both handheld devices regarding detection of LVOs, ICHs, early ischemic signs and overall.ResultsAll LVOs, intracranial tumors and ICHs were detected on both mobile devices. There was no significant difference in the rating of CCT and CBF ASPECTS between all three devices, while the sensitivity for detecting a CBF/CBV-mismatch was above 80% on both devices. Both raters assessed the diagnostic quality to be sufficient on both mobile devices to base treatment decisions on.ConclusionSoftware solutions such as mRay for handheld devices provide adequate diagnostic quality for the review of CT scans of suspected stroke patients.

New trochlea - old patella. Do both fit together?

Aims and Objectives: Trochlear dysplasia has been established as the most common and impactful predisposing factor of lateral patellar dislocation (LPD). In addition, a clear correlation between trochlear dysplasia and the development of cartilage defects and osteoarthritis in the patellofemoral joint has been established. Though current literature increasingly supports trochleoplasty procedures for the treatment of LPD only few data evaluated the actual improvements of the cartilaginous patella-trochlea congruence after deepening trochleoplasty procedure. The aim of this study was therefore to evaluate the patella-trochlea congruence before and after a deepening trochleaplasty and medial patellofemoral ligament (MPFL) reconstruction in severe trochlear dysplasia. The hypothesis was that the deepening trochleoplasty and MPFL reconstruction is able to correct patella-trochlea congruence to physiological parameters. Materials and Methods: The study group comprised 20 patients. All patients suffered recurrent LPD due to severe trochlear dysplasia and underwent a deepening ‘Bereiter’ trochleoplasty and MPFL reconstruction. Pre- and postoperative magnetic resonance imaging (MRI) investigations were used to assess the patella-trochlea contact ratio, the posterior patellar edge - trochlea groove ratio, and the lateral patellar inclination angle (patellar tilt). Measurements were obtained using open-source PACS workstation software (OsiriX v. 5.8.5, Pixmeo SARL, CH1233 Bernex, Switzerland). All parameters were compared to a control group of 20 at random selected patients without any medical history related to the patellofemoral joint. A paired two-tailed t-test was used to test for differences between the pre- and postoperative measurements within the study group. A one-way analysis of variance (ANOVA) with Bonferoni post-test adjustment was used to test for differences between all measurement series. The level of significance was set at 0.05. Results: Preoperatively, all parameters of the study group were significantly different when compared to the control group. This meant a reduced patella-trochlea contact ratio (0.38 ± 0.13 vs. 0.67 ± 0.09; p&lt;0.001), an increased patellar lateralization (0.81 ± 0.10 vs. 0.98 ± 0.03; p&lt;0.001), and increased patellar tilt (27.1° ± 7.7° vs. 9.4° ± 5.7°; p&lt;0.001). Postoperatively, all parameters showed a significant improvement. The patella-trochlea contact ratio increased to a mean of 0.65 ± 0.11 (p&lt;0.0001), patellar lateralization improved to a mean posterior patellar edge - trochlea groove ratio of 0.94 ± 0.06 (&lt;0.0001), and patellar tilt reduced to a mean of 15.05° ± 4.2° (p&lt; 0.0001). All parameters reached normal values when compared to the control group (all p &gt;0.05). Conclusion: Findings of this study indicate that in severe trochlear dysplasia deepening trochleoplasty and MPFL reconstruction is able to correct patellar alignment und patellar-trochlear congruence to normal values.

Main pulmonary artery diameter assessment in a large sample of Indian population: a MDCT based study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The gold standard for pulmonary artery pressure measurement is right heart catheterization but its invasive nature precludes its routine use. Main pulmonary arterial trunk calibre increase is a strong indicator of underlying pulmonary arterial hypertension. MDCT can accurately measure the diameter of main pulmonary artery. The objective of the study was to establish the normative values of main pulmonary artery caliber using contrast enhanced CT and try to ascertain any significant difference in main pulmonary artery calibers between two genders and correlation of age and main pulmonary artery diameter.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Contrast enhanced CT images of 462 subjects were analysed on a PACS workstation monitor and widest diameter perpendicular to long axis of the main pulmonary artery as seen on reformatted axial image was measured with electronic caliper tool at the level of the main pulmonary artery bifurcation. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean main pulmonary artery diameter in females was 22.54±2.19 mm and 23.34±3.06 mm in males. The mean pulmonary artery diameter in males was larger than females with statistically significant difference seen (p&amp;lt;0.05). The correlation coefficient between age of whole sample and their mean main pulmonary artery was found to be 0.1006 with no statistically significant difference.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is a statistically significant difference in the mean main pulmonary artery calibre between males and females with no strong correlation between the age and mean main pulmonary artery calibre. Further studies are warranted to find the complex interaction between main pulmonary artery diameter and sex, age and body mass index.&lt;/p&gt;

Magnetic Resonance Imaging Technologist Breast Subspecialty Program; a Quality Improvement Project Gone Right

We describe a Lean based Quality Improvement Project (QIP) to improve the defect rate of breast magnetic resonance imaging (MRI) studies by developing a MRI Technologist Breast Sub-specialization Program. Key stakeholders (physician and technologist) drove the QIP. Both the overall defect rate and the callback rate (severe defects requiring patients return for repeat imaging) were measured over a 2-month period as 17% and 6%, respectively. Lean visualization tools of Pareto Chart & Fishbone Diagram identified lack of multiple trends, but discerned that most defect causes were within the responsibility of the technologists. Lean Value Stream Map identified technologists' useless work (muda), which was subsequently eliminated. Radiologists collectively defined what made a quality study in a Quality Checklist. Key stakeholders limited the number of technologists based on the study volume (50 studies/technologist/2 years) and reviewed 5 studies recently performed by each technologist. If all 5 studies were defect free per the Quality Checklist, then the technologist was certified to perform breast MRI's by himself/herself. Otherwise, the technologist was on probation. Key stakeholders selected SuperTechs with advanced skill and interest from the certified pool to cover all shifts. Technologists on probation had to complete 5 additional studies defect-free under the supervision of a SuperTech to achieve certification. In addition, SuperTechs were available to backup certified technologists, as needed. Software was implemented at the PACS workstation to flag defective and callback studies. 6 months after the initiation of the QIP, the defect rate decreased from 17% to 2% (p>0.02), and the callback rate decreased from 6% to 0, thus confirming this MRI Breast Program was a QIP gone right.

Accuracy of smartphone-based evaluation of Emergent Large Vessel Occlusion on CTA

ObjectivesMechanical thrombectomy is the standard of care for stroke caused by an emergent large vessel occlusion in the anterior circulation, and the ability to rapidly review CTA is one hurdle in minimizing the time from diagnosis to intervention. We evaluated the diagnostic accuracy and confidence in review of stroke CTA for ELVO via a smartphone-based application as compared to PACS workstation. Patients and MethodsSeventy-six head and neck CTA studies performed for stroke from one comprehensive and seven primary stroke centers were independently reviewed remotely on smartphone by two blinded interventional neuroradiologists in actual-use circumstances. The presence and location of large vessel occlusion(s), diagnostic quality, and confidence in interpretation were recorded. Comparison was made to blinded PACS workstation review performed at a delayed interval. Weighted Kappa and Kendall’s Tau statistics were calculated to evaluate intra- and inter-observer reliability. ResultsOf the 76 studies, 20 (26%) had a large vessel occlusion. 14 M1 segment occlusions (18%); 2 ICA terminus (3%); 2 tandem carotid and M1 (3%); and 2 basilar artery (3%). There was 100% diagnostic accuracy by both PACS workstation and smartphone review (p = .9999) with high inter- and intra-rater reliability for assessments of both image quality and diagnostic confidence. ConclusionIn actual-use circumstances, experienced neuroradiologists can diagnose ELVOs on CTA using a smartphone application as accurately as on PACS workstation without degradation of confidence. These findings support the use of mobile electronic devices by stroke centers to rapidly triage patients for mechanical thrombectomy.

Comparison of Pedal Soft Tissue Thickness Between Those With and Without Diabetes

Ulceration is a serious consequence of diabetes that can lead to disability in patients with diabetes. One of the risk factors for ulceration is high foot pressure. The thickness of the pedal soft tissue is important because it has a cushioning effect. Soft tissue atrophy causes elevation in the plantar pressure, which, in turn, causes ischemia. Therefore, we investigated the severity of pedal soft tissue atrophy caused by diabetes and aging. From February 2009 to February 2016, we examined the feet of 261 patients treated in our hospital using magnetic resonance imaging. We divided the patients enrolled in the study into 2 groups. The first group included 52 patients with diabetes but without peripheral arterial disease and the second group included 47 patients without diabetes. We measured the vertical distances under all patients' metatarsal heads using T1-weighted magnetic resonance imaging and measured the pedal soft tissue thickness using the PACS workstation (m-view). We compared the soft tissue thicknesses of the 2 groups and performed statistical analyses of the relationships between these data and other parameters using 2-way analysis of variance. The soft tissue under the first to fourth metatarsal heads was thinner in the diabetic patients than in the nondiabetic patients (first metatarsal, 6.4 versus 8.69; second metatarsal, 8.85 versus 10.64; third metatarsal, 8.15 versus 9.21; fourth metatarsal, 7.38 versus 8.54; p < .05). Aging had no effect on pedal soft tissue atrophy in either group. In conclusion, our study confirmed that diabetic patients experience more severe plantar soft tissue atrophy than nondiabetic patients. We have developed a standard procedure to enable the prediction of pedal soft tissue atrophy severity in diabetic patients.

Electronic Medical Record Integration for Streamlined DXA Reporting.

Dual-energy X-ray absorptiometry (DXA) is the most frequently performed examination to assess bone mineral density in clinical practice. Aside from images and graphical displays, many numerical values are part of DXA reports. These values are typically manually entered into the formal report through the electronic medical record or PACS workstation. The process takes time and is prone to errors. Exporting the DXA numerical data via HL7 engine to the electronic medical record was proposed to improve reporting efficiency and accuracy. The output from the DXA unit computer was reconfigured to export the report content via the HL7 interface engine into the electronic medical record. Radiology interpretive reporting was subsequently done directly in the electronic medical record. In the evaluation of errors, 100 preliminary DXA reports before the change and 100 after the change were examined. These reports were analyzed for errors that included decimal change, number transposition, negative number issue, other incorrect number error, and failure to include prior exam for comparison. In addition, report turnaround times were evaluated before and after the changes were made. Reporting time evaluations included 1-year volume prior to change (3915 reports) and 1month post-change (206 reports). Of 100 DEXA exams before the change, 15 final reports contained 25 numerical errors. After the change, no numerical errors in the reports were identified. Exam end to final report time decreased from 2159 to 625min on average. Automating data transmittal from the DXA modality for report generation improves accuracy and turnaround time. This approach did not require any third party software, and healthcare information security concerns were negated since we are using our standard workstations. Secondary to the affordability and applicability to the large percentage of the population using electronic medical record systems, this type of automated workflow is recommended.

Abstract WMP14: Accuracy of Smartphone-based Evaluation of Large Vessel Occlusion on CTA

Introduction: Since mechanical thrombectomy was established as the gold standard for treatment of stroke caused by an emergent large vessel occlusion (ELVO), comprehensive stroke centers have worked to streamline their workflow and minimize time-to-intervention; the ability to rapidly review CT angiography (CTA) is one hurdle in that process. To that end, we evaluated the diagnostic accuracy and confidence in review of CTA of the head and neck for ELVO via a smartphone-based application (LifeImage) as compared to review on a PACS workstation. Methods: Seventy-six head and neck CTA studies performed for potential stroke from one comprehensive and seven primary stroke centers were independently reviewed remotely on smartphone by two blinded neurointerventional radiologists in actual-use circumstances. The presence and location of large vessel occlusion(s), diagnostic quality, and confidence in interpretation were recorded. Comparison was made to blinded review of these studies on a PACS workstation performed at a delayed interval. Kappa statistics were calculated to evaluate intra- and inter-observer reliability. Results: Over 76 studies, occlusion of the M1 segment was demonstrated in 14 (18%); carotid artery in 2 (3%); tandem carotid and M1 in 2 (3%); basilar artery in 2 (3%); and no large vessel occlusion in 56 (73%). There was complete agreement between CTA interpretations on smartphone and on PACS with excellent intra- and inter-observer reliability (Table 1). No ELVOs were missed on smartphone review of these studies. Conclusion: In actual-use circumstances, experienced neurointerventional radiologists are able to utilize a smartphone application to diagnose an ELVO on CTA as accurately as on a PACS workstation with similar levels of confidence. These findings support the use of mobile electronic devices by stroke networks to rapidly triage patients for mechanical thrombectomy.

Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections.

To compare the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections with respect to successful intra-articular needle placement, fluoroscopy time, radiation dose, and dose area product (DAP). This retrospective study was IRB-approved and HIPAA-compliant. 498 fluoroscopically guided tibiotalar joint injections were performed or supervised by one of nine staff radiologists from 11/1/2010-12/31/2013. The injection approach was determined by operator preference. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise versus anterior midline) and to confirm intra-articular needle placement. Fluoroscopy time (minutes), radiation dose (mGy), and DAP (μGy-m(2)) were recorded and compared using the student's t-test (fluoroscopy time) or the Wilcoxon rank sum test (radiation dose and DAP). There were 246 lateral mortise injections and 252 anterior midline injections. Two lateral mortise injections were excluded from further analysis because no contrast was administered. Intra-articular location of the needle tip was documented in 242/244 lateral mortise injections and 252/252 anterior midline injections. Mean fluoroscopy time was shorter for the lateral mortise group than the anterior midline group (0.7 ± 0.5 min versus 1.2 ± 0.8 min, P < 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy, P = 0.04; 11.5 ± 15.3 μGy-m(2) versus 13.5 ± 17.3 μGy-m(2), P = 0.006). Both injection approaches resulted in nearly 100% rates of intra-articular needle placement, but the lateral mortise approach used approximately 40% less fluoroscopy time and delivered 15% lower radiation dose and DAP to the patient.

Is there a systematic bias of apparent diffusion coefficient (ADC) measurements of the breast if measured on different workstations? An inter- and intra-reader agreement study.

To evaluate the influence of post-processing systems, intra- and inter-reader agreement on the variability of apparent diffusion coefficient (ADC) measurements in breast lesions. Forty-one patients with 41 biopsy-proven breast lesions gave their informed consent and were included in this prospective IRB-approved study. Magnetic resonance imaging (MRI) examinations were performed at 1.5T using an EPI-DWI sequence, with b-values of 0 and 1000s/mm(2). Two radiologists (R1, R2) reviewed the images in separate sessions and measured the ADC for lesion, using MRI-workstation (S-WS), PACS-workstation (P-WS) and a commercial DICOM viewer (O-SW). Agreement was evaluated using the intraclass correlation coefficient (ICC), Bland-Altman plots and coefficient of variation (CV). Thirty-one malignant, two high-risk and eight benign mass-like lesions were analysed. Intra-reader agreement was almost perfect (ICC-R1 = 0.974; ICC-R2 = 0.990) while inter-reader agreement was substantial (ICC from 0.615 to 0.682). Bland-Altman plots revealed a significant bias in ADC values measured between O-SW and S-WS (P = 0.025), no further systematic differences were identified. CV varied from 6.8% to 7.9%. Post-processing systems may have a significant, although minor, impact on ADC measurements in breast lesions. While intra-reader agreement is high, the main source of ADC variability seems to be caused by inter-reader variation. • ADC provides quantitative information on breast lesions independent from the system used. • ADC measurement using different workstations and software systems is generally reliable. • Systematic, but minor, differences may occur between different post-processing systems. • Inter-reader agreement of ADC measurements exceeded intra-reader agreement.

Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD).

This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain.

WE‐G‐201‐02: Image Quality Characteristics of Handheld Medical Image Viewing Devices

Many health care organizations are adopting mobile applications for patient care. These tools can provide the opportunity for improvements in timely access to patient images. With new possibilities for patient image viewing, it is sensible to take a closer look at what handheld devices might provide and how they are being used.Three speakers: a radiologist, an imaging research scientist, and a clinical medical physicist provide input into different aspects of image viewing on handheld devices.1. Patrick Luetmer, M.D., RadiologistProvides a radiologist's perspective of how mobile technologies best fit into patient care workflows, including how patient image viewing is done differently on a mobile platform compared to a PACS workstation and what types of decisions are being made from handheld devices.2. Aldo Badano, Ph.D., Imaging Research ScientistProvides an overview of technological properties of handheld devices and describes how image viewing with handheld devices impacts the image information that is visible under ideal and clinical conditions.3. Dr. Alisa Walz‐Flannigan, Ph.D., Clinical Medical PhysicistProvides an overview of different strategies for setup and quality control as relevant for handheld devices.This session is related to the ongoing work of Task Group No. 260 “Considerations for the Use of Handheld Devices for Viewing Medical Images”.Learning Objectives: To understand how mobile devices for image viewing are being used to enhance patient care To understand how technological properties of various mobile devices combine with device usage to impact the information visible in a medical image To gain awareness of different options for configuring and testing handheld devices for medical image viewing Dr. Aldo Badano has the following: Cooperative Research and Development Agreement (CRADA #123‐07) with BARCO.

WE‐G‐201‐04: Panel Discussion

Many health care organizations are adopting mobile applications for patient care. These tools can provide the opportunity for improvements in timely access to patient images. With new possibilities for patient image viewing, it is sensible to take a closer look at what handheld devices might provide and how they are being used.Three speakers: a radiologist, an imaging research scientist, and a clinical medical physicist provide input into different aspects of image viewing on handheld devices.1. Patrick Luetmer, M.D., RadiologistProvides a radiologist's perspective of how mobile technologies best fit into patient care workflows, including how patient image viewing is done differently on a mobile platform compared to a PACS workstation and what types of decisions are being made from handheld devices.2. Aldo Badano, Ph.D., Imaging Research ScientistProvides an overview of technological properties of handheld devices and describes how image viewing with handheld devices impacts the image information that is visible under ideal and clinical conditions.3. Dr. Alisa Walz‐Flannigan, Ph.D., Clinical Medical PhysicistProvides an overview of different strategies for setup and quality control as relevant for handheld devices.This session is related to the ongoing work of Task Group No. 260 “Considerations for the Use of Handheld Devices for Viewing Medical Images”.Learning Objectives: To understand how mobile devices for image viewing are being used to enhance patient care To understand how technological properties of various mobile devices combine with device usage to impact the information visible in a medical image To gain awareness of different options for configuring and testing handheld devices for medical image viewing Dr. Aldo Badano has the following: Cooperative Research and Development Agreement (CRADA #123‐07) with BARCO.