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Medical workstations have developed into the super-assistants of radiologists. The overwhelming production of images, hardware that rapidly became cheaper and powerful 3D visualization and quantitative analysis software have all pushed the developments from simple PACS viewing into a really versatile viewing environment. This chapter gives an overview of these developments, aimed at radiologists' readership. Many references and internet are given which discuss the topics in more depth than is possible in this short paper. This paper is necessarily incomplete. [ABSTRACT FROM AUTHOR]

In 2007, the European Commission has commissioned a group of Experts to undertake the revision of Report RP91 on ˵Criteria for Acceptability of Radiological (including Radiotherapy) and Nuclear Medicine Installations″, which will be published soon. This paper introduces some of the concerns encountered in the diagnostic radiology section of the report and the approach adopted to establishing the criteria. [ABSTRACT FROM AUTHOR]

Circulating tumour markers for breast cancer can be classified in different groups: mucins such as CA 15.3, CA 27.29 and CA 549, carcinoembryonic antigen (CEA), cytokeratins (TPA, TPs, Cyfra 21.1), enzymes (LDH), hormones and their subunits. All of them have been proposed over the years for the diagnosis and monitoring of breast cancer at different stages. It is well known that tumour marker tests lack in sensitivity at the earliest stage of cancer and also in specificity. False-negative results are rare in patients with advanced disease and metastases; on the contrary they are most frequent in the first stages. Besides this, false-positive results can be due to different nonmalignant conditions. At present CA 15.3 is the most widely used tumour marker in breast cancer patients. Its use follows the general concepts everywhere accepted for mucinic markers: the CA 15.3 test is not useful in screening and early diagnosis; it has an established role in the diagnosis of recurrences; it has an established role in therapy monitoring, alone or in association with other diagnostic tools; it is still under study as a predictor of response to therapy. Several international guidelines help physicians in using tumour markers giving practical recommendations for the appropriate interpretation of circulating tumour markers. CEA and cytokeratins markers are so far less specific than mucinic markers; therefore, they are sometimes tested for evaluating breast cancer patients. The association of tumour marker tests with a diagnostic imaging modality such as FDG-PET today is of great interest, because sometimes the patients present with a tumour marker increase and do not show clinical symptoms or signs of cancer, or on the contrary some others subjects present with some doubtful symptoms or signs of cancer, and the association with a biochemical test for malignancy can be helpful to make the final diagnosis. FDG-PET is known as a metabolic imaging modality, that, contrary to radiological techniques, reveals cancer not on the basis of morphology like the radiological methods, but because of the uptake and/or processing of a radioactive tracer in cancer tissue. The visualization of cancer by PET depends on the viability and activity of the tumour, and this requirement is very close to the function of synthesis and secretion of tumour markers as products of cell metabolism. One can say that FDG-PET and tumour marker tests describe cancer activities in different ways, and their diagnostic added value takes advantage of this combination. This chapter overviews the results of the association of FDG-PET with elevated or progressively increasing tumour markers. Tumour-marker-guided PET has demonstrated a diagnostic effectiveness in detecting cancer lesions with variable sensitivity, both at presentation (staging) and during the follow-up (discovery of relapses, metastases and re-staging). It is well known that tumour marker increase is a reliable signal of the presence of occult disease, and this suspicion can be explored by FDG-PET. For this reason some authors have proposed that whole body PET may become the method of choice for the assessment of asymptomatic patients with elevated tumour marker levels. The recent development of hybrid systems, allowing the concomitant examination of the patient by combining PET with CT, has increased the accuracy of diagnostic imaging, and several papers support the evidence that PET/CT is able to add incremental diagnostic confidence to PET and detects more lesions than CT or PET alone. A discussion is still open about the question if FDG-PET or PET/CT can substitute the entire battery of tests routinely used for staging breast cancer or detecting relapse in all breast cancer patients.… [ABSTRACT FROM AUTHOR]

Although the introduction of double-contrast radiographic techniques has reduced the comparative advantage of endoscopy over barium studies, most papers suggest that upper gastrointestinal endoscopy is more accurate, particularly regarding the evaluation of inflammatory mucosal abnormalities, bleeding lesions, (Thoeni and Cello 1980) and the post-operative stomach (Ominsky and Moss 1979). [ABSTRACT FROM AUTHOR]

It is commonly stated that "any radiation dose, no matter how small, can cause cancer." The basis for that statement is the linear no-threshold theory (LNT) of radiation carcinogenesis. According to LNT, if 1 Gy (100 rad) of exposure gives a cancer risk R, the risk from 0.01 Gy (1 rad) of exposure is R/100, the risk from 0.00001 Gy (1 mrad) is R/100,000, and so on. Thus the cancer risk is not zero regardless of how small the exposure. However, in recent years, a strong sentiment has developed in the community of radiation health scientists to regard risk estimates in the low-dose region based on LNT as being grossly exaggerated or completely negligible. For example, the 6000-member Health Physics Society, the principal organization for radiation protection scientists, issued a position paper (Health Physics Society 1996) stating "Below 10 rad ... risks of health effects are either too small to be observed or are non-existent." A similar position statement was issued by American Nuclear Society. [ABSTRACT FROM AUTHOR]

This paper reviews the common spectrum of disorders of the neonatal chest. Emphasis is on radiographic changes that have been produced by the introduction of new therapeutic maneuvers, particularly the use of artificial surfactant in treating hyaline membrane disease and the survival of profoundly premature newborns (less than 650 grams). A discussion of meconium aspiration syndrome, neonatal pneumonia, transient tachypnea of the newborn, congenital lymphangiectasia and congenital heart disease is also included. The effect on the neonatal chest radiograph of extracorporeal membrane oxygenation and high frequency ventilation are also mentioned [1]. A review of' surgical' lesions is also included [2]. [ABSTRACT FROM AUTHOR]

The shoulder is one of the most common applications of musculoskeletal US due to the high incidence of rotator cuff disorders related to increasing aging and sporting activities. Many papers dealing with the US scanning technique of the rotator cuff tendons have already been published in the radiological, rheumatologic and orthopaedic literature and US is now widely recognized as an accurate means to evaluate rotator cuff disease (Ptasznik 2001; Bouffard et al. 2000; Brasseur et al. 2000; Thain and Adler 1999; Bretzke et al. 1985; Collins et al. 1987; Crass et al. 1985; Hall 1986; Middleton et al. 1984; Middleton et al. 1986b; Mack et al. 1988a; Middleton 1989; Seibold et al. 1999; Teefey et al. 2000; Naredo et al. 2002). With appropriate equipment and skilled hands, this technique provides assessment of rotator cuff pathology with high sensitivity and specificity in the diagnosis of both partial and fullthickness tears with some specific advantages over MR imaging, such as higher resolution capabilities and the ability to examine tissues in both static and dynamic states and with the patient in different positions. [ABSTRACT FROM AUTHOR]

Crowe (1928) first introduced the term "whiplash" to describe the manner in which the head is moved suddenly to produce a neck sprain. Gay and Abbot (1953) used it first in a medical journal. Since then, more than 10,000 papers have been published, and still there is a great focus on whiplash in the medical literature as well as in the newspapers. Whiplash presently has a much wider usage than only to describe an injury mechanism. It is used to describe the injury itself — whiplash injury; to describe the clinical manifestations of the injury — whiplash symptoms or syndrome; and even to name patients — whiplash patients. [ABSTRACT FROM AUTHOR]

Frequently, traditional cost effectiveness models based on film savings and other productivity improvements indicate that an investment in PACS is difficult to justify. This paper offers a new evaluation perspective based on Real Option Theory that has been applied successfully in other industries. Other than the traditional savings centric model, it allows to account for managerial flexibility, risk, expansion opportunities, increased market share and other "intangible" key metrics. It is based on the consideration that an initial investment may create opportunities for future investments, e.g. by way of expansion. The additional value associated with such real options uncovers the embedded value of the initial investment and may often favor an investment scenario where the traditional savings based approach falls short. In the following, the valuation of a real option and its application to various PACS investment scenarios (option to wait, option to expand, option to learn) are discussed. [ABSTRACT FROM AUTHOR]

In the radiological department today the majority of all X-ray procedures on chest and skeletal radiography is performed with classical film-screen-systems. Using digital luminescence radiography (DLR or CR, which stands for computed radiography) as a technique has shown a way to replace this 100 year old procedure of doing general radiography work by acquiring the X-rays digitally via phosphor screens. But this approach has faced criticism from lots of radiologists world wide and therefore hasn't been overall implemented except in the intensive care environment. A new technology is rising based on the use of so called flat panel X-ray (FD) detectors. Semi-conducting material detects the X-rays in digital form directly and creates an instantaneous image for display, distribution and diagnosis. This ability combined with a large field of view and — compared to existing methods — excellent detective quantum efficiency represents a revolutionary step for chest and skeletal radiography and will put basic X-ray-work back into the focus of radiological solutions. This paper will explain the basic technology of flat panel detectors, possible system solutions based on this technology, aspects of the user interface influencing the system utilization and versatility as well as the possibility to redefine the patient examination process for chest and skeletal radiography. Furthermore the author discusses limitations of the first systems, upgrades for the installed base and possible scenarios for the future, e.g. fluoroscopy or angiography application. [ABSTRACT FROM AUTHOR]

Radiologists in the United States are voluminous producers and a major contributor to the US $6- to 12-billion transcription industry. The volume and complexity is constantly increasing, as is the number of images for review. In a recent review, Rick Marin at the Mayo Clinic, Jacksonville, FL, USA, tracked the number of computed tomography (CT) images produced in the department and compared this to prior years (Table 7). [ABSTRACT FROM AUTHOR]

A description of the world in images is one of the elements that characterize the era of technical dominion. And yet, the myth of gaining knowledge through images — the idea that knowing is, before all else, being able make an image of something — is an ancient dream, and we might almost say, a necessary destiny. Indeed, Western culture has always been an essentially visual culture. The very word idea, which for Plato was the most appropriate object of knowledge, etymologically derives from orao, a very ancient verb that means to see. [ABSTRACT FROM AUTHOR]