Matthew Albucher

If you want to diagnose appendicitis, there's an app for that.

Radiologists may soon be able to use an Apple iPhone application to view CT images wherever there's a wireless connection.

The study, performed at the University of Virginia in Charlottesville and presented at RSNA 2009, found that 15 of 25 patients referred to CT scanning for right lower quadrant abdominal pain were correctly diagnosed with acute appendicitis on 74 of 75 interpretations, with only one false negative and no false positives. In eight of the 15 patients who had appendicitis, 88% of interpretations correctly identified calcified deposits in the appendix.

“The iPhone interpretations of the CT scans were as accurate as the interpretations viewed on dedicated PACS workstations,” said Dr. Asim F. Choudhri, a neuroradiology fellow at Johns Hopkins University, during an RSNA news conference.

The iPhone application may be most useful to residents or trainees who need immediate faculty feedback on complicated cases.

While e-mail messages of single images have been used in the past, OsiriX Mobile allows imagers to scroll through a full data set, he said.

On new iPhones, which utilize the 3G network, data streaming can be as fast as three seconds per image-or only one second per image when logged into a wireless broadband network. But patient privacy issues still need to be addressed before such applications can achieve widespread use in clinical practice, Choudhri said. The iPhones utilized in the study were kept in a locked location, but password, virtual private network, or firewall protection may also be employed to protect patient privacy.

Since the general public can also download OsiriX Mobile, the application may enable patients to more easily access their own images.

“This can allow patients to be a part of their healthcare process,” Dr. Choudhri said.

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iPhone enables fast diagnosis of appendicitis

Ultrasound elastography could be an effective means of reducing unnecessary breast biopsy, according to an ongoing study presented Monday at the 2009 RSNA meeting. 

 About eight of every 10 breast biopsies turn out to be benign. Elastography can better distinguish between benign abnormalities and cancerous breast lesions and keep unnecessary needle biopsies from ever taking place, said Dr. Stamatia V. Destounis, a diagnostic radiologist at Elizabeth Wende Breast Care in Rochester, NY.

Cancerous tumors tend to be stiffer than benign cysts or healthy tissue. Though useful for imaging breast tissue, standard B-mode ultrasound may underestimate some lesions as it visualizes only the actual mass and not its surroundings. Elastography, on the other hand, can measure the stiffness of a lesion and more easily distinguish between a fluid-filled abnormality and a malignant cancer, Destounis said. 

 Elastography software, which allows testing of tissue elasticity with little transducer pressure, can be added to existing standard ultrasound equipment, she said. 

 “You can perform elastography at the same time as handheld ultrasound and view the images on a split screen, with the two-dimensional ultrasound image on the left and the elastography on the right,” she said. 

 The ongoing study of 179 patients, conducted at the Charles Cross Hospital Unit in London, U.K., found that ultrasound elastography correctly identified 98% of malignant lesions and 82% of benign lesions. Elastography also enabled researchers to accurately measure lesion size. 

 According to the American Cancer Society, there will be an estimated 192,370 new cases of invasive breast cancer and 62,280 new cases of ductal carcinoma in situ in the U.S. in 2009. Elastography could help differentiate these from benign cases, Destounis said.

Ultrasound elastography could be an effective means of reducing unnecessary breast biopsy, according to an ongoing study presented Monday at the 2009 RSNA meeting.

Ultrasound elastography slashes needless breast biopsies

Evidence from x-ray exams suggests that tabs used to open aluminum beverage cans pose a swallowing risk to children, according to a study presented Monday at the 2009 RSNA meeting. 

 Cans were redesigned in the mid-1970s to reduce the risk of accidental swallowing of the tabs. However, the study found 19 children had ingested tabs between 1993 and 2009. The finding is particularly troubling to radiologists because aluminum is extremely hard to see on x-rays compared with other metals, said lead investigator Dr. Lane F. Donnelly, chief of radiology at Cincinnati Children's Hospital Medical Center. 



Prior to the 1980s, beverage cans were opened via removable pull-tabs. However a 1975 study in the 

Journal of the American Medical Association

 examined two cases of accidental swallowing and one case of aspiration of pull-tabs that had been dropped back into the can. Since then, beverage manufacturers have constructed pull-tabs that remain attached, albeit loosely, to the original can. 

 "If you fiddle with these stay-tabs, you can easily pull them off," Donnelly said. 

 Of the 19 accidental ingestions identified in the study, only four (21%) were visible on x-rays. In these four cases, the tab was located in the stomach. Radiologists can easily spot swallowed foreign bodies like pennies because they are made of copper and zinc. But aluminum, a much lighter metal, can be nearly invisible on x-rays, Donnelly said. 

 "Not seeing the tab on the x-ray does not mean it was not swallowed," he said. 

 None of the 19 cases required surgery. However, tabs have jagged edges that can lacerate or embed themselves in the bowel or small intestine. Interestingly, only four of the subjects were children younger than five years old. 

 "It is unusual that the majority [of] cases occurred among teenagers, since foreign-body ingestion typically occurs in infants and toddlers," Donnelly said. 

 Study findings might demonstrate an overall safety hazard with stay-tabs. Therefore, beverage cans should be redesigned to make tabs less easy to remove by children, Donnelly said.

Evidence from x-ray exams suggests that tabs used to open aluminum beverage cans pose a swallowing risk to children, according to a study presented Monday at the 2009 RSNA meeting.

Aluminum can stay-tabs still pose swallowing risk for children

Using 3T MR imaging, California researchers have found that high levels of physical activity may be linked to knee abnormalities in middle-aged men and women. People between the ages of 45 and 55 who engage in several hours of walking, sports, or other types of exercise per week may be at greater risk of developing osteoarthritis than less active adults, according to a study presented Monday at the 2009 RSNA meeting.

The investigation highlighted the need for further studies to evaluate the types of exercise that are most associated with knee abnormalities, according to lead researcher Dr. Christoph Stehling, a research fellow in the radiology and biomedical imaging department at the University of California, San Francisco.

Two hundred thirty-six asymptomatic participants with normal body mass indexes were separated into low-, middle- and high-activity groups based on their responses to a physical activity questionnaire. The subjects underwent 3T MRI to test for knee abnormalities.

The study found that those in the high-activity group were more likely to suffer from meniscal lesions, cartilage lesions, ligament lesions, and bone marrow edema. Seventy-five percent of subjects in the medium-activity group suffered from cartilage lesions compared with more than 90% of those in the high-activity group.

“We have to interpret the findings cautiously,” said Dr. Thomas M. Link, a coauthor of the study. “What I see in my daily practice is that all extremes in activity are really bad.”

The association between physical activity and knee abnormality is not completely understood and researchers still ignore the cause of these abnormalities. Results were nonetheless surprising and indicate there is a relationship, Stehling said.

Some activities were inherently riskier than others, however. Previous studies by Stehling’s group suggest that high-impact, weight-bearing physical activity, such as running and jumping, may be worse for cartilage health.

“Conversely, low-impact activities, such as swimming and cycling, may protect diseased cartilage and prevent healthy cartilage from developing disease,” he said.

Using 3T MR imaging, California researchers have found that high levels of physical activity may be linked to knee abnormalities in middle-aged men and women. People between the ages of 45 and 55 who engage in several hours of walking, sports, or other types of exercise per week may be at greater risk of developing osteoarthritis than less active adults, according to a study presented Monday at the 2009 RSNA meeting.

Author | Matthew Albucher

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