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Diagnostic and evidential static image, video clip, and sound multimedia are captured during routine clinical care in cardiology, dermatology, ophthalmology, pathology, physiatry, radiation oncology, radiology, endoscopic procedural specialties, and other medical disciplines. Providers typically describe the multimedia findings in contemporaneous electronic health record clinical notes or associate a textual interpretative report. Visual communication aids commonly used to connect, synthesize, and supplement multimedia and descriptive text outside medicine remain technically challenging to integrate into patient care. Such beneficial interactive elements may include hyperlinks between text, multimedia elements, alphanumeric and geometric annotations, tables, graphs, timelines, diagrams, anatomic maps, and hyperlinks to external educational references that patients or provider consumers may find valuable. This HIMSS-SIIM Enterprise Imaging Community workgroup white paper outlines the current and desired clinical future state of interactive multimedia reporting (IMR). The workgroup adopted a consensus definition of IMR as “interactive medical documentation that combines clinical images, videos, sound, imaging metadata, and/or image annotations with text, typographic emphases, tables, graphs, event timelines, anatomic maps, hyperlinks, and/or educational resources to optimize communication between medical professionals, and between medical professionals and their patients.” This white paper also serves as a precursor for future efforts toward solving technical issues impeding routine interactive multimedia report creation and ingestion into electronic health records.

Mammography will continue as the breast cancer screening imaging study of choice for the foreseeable future. Ultrasound and magnetic resonance imaging (MRI) are widely available adjunctive studies for women with suspicious mammographic or clinical findings, and MRI is a screening tool for women with specific increased risks for breast cancer. Options for diagnosis will continue to evolve and progress. This article discusses a wide variety of imaging options currently used and in development, their strengths, limitations, and potential future roles in the continuing pursuit of early breast cancer diagnosis, treatment, and follow-up.

To retrospectively analyze radiation dose data for six common venous access procedures.Institutional review board approval was obtained for this HIPAA-compliant study; informed consent was not required. Data review was limited to a quality assurance database. Patient medical records were not reviewed. We retrospectively analyzed radiation dose data from a prospective quality assurance program. Dose data were analyzed for 1010 instances of six different venous access placement procedures performed between February 1998 and July 2004. Radiation dose measurements were generated automatically by the interventional fluoroscopy units and were recorded at the conclusion of each procedure. Descriptive and summary statistical analyses were performed to determine median, minimum, and maximum values of radiation dose for each procedure. A P value of less than .05 indicated a significant difference. Because the data distribution was highly skewed, logarithmic transformation was performed. Dose data for four different venous access procedures (excluding chest port placement and peripherally inserted central catheter placement) were compared with a one-way analysis of variance. Pairwise comparisons with the Tukey honestly significant difference test were subsequently performed for each analogue where analysis of variance demonstrated a significant result.No procedure yielded a cumulative dose of more than 950 mGy or a peak skin dose of more than 760 mGy. The highest mean cumulative dose (ie, 88 mGy), mean dose-area product (ie, 873 cGy . cm(2)), and mean peak skin dose (ie, 43 mGy) were observed for tunneled dialysis catheter placements. Significant differences in dose were observed for tunneled catheter placement versus nontunneled catheter placement (.001 to .027). No significant differences in dose were observed for larger-diameter versus smaller-diameter catheters.Radiation doses from venous access procedures are low. Even extreme outlier cases are unlikely to produce doses high enough to cause skin effects, especially when knowledgeable operators using well-calibrated equipment perform the procedures.

Medical advances will be driven by the enhancement of imaging for diagnosis, refinement of treatment, and evaluation of treatment efficacy. The convergence of technology in materials science, biology, and the computer industry has greatly advanced diagnostic imaging. Precision in control of the spatial and temporal properties of light and its heterogeneous scattering properties have extended our capability for imaging. Refinements in radioimmunoscintigraphy for image acquisition, fusion of images, and outcome data now suggest use for image-guided therapy. Novel MRI agents appear to provide significant imaging capabilities to detect malignant lymph nodes. Future applications of optical coherence tomography, electron paramagnetic resonance imaging, nanotechnology, molecular imaging, and hyperspectral spectroscopy promise further refinements to image tissues for diagnosis.