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Everything you need to know about Computed Tomography (CT) & CT Scanning

October 2017 Imaging Pearls - Learning Modules | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ October 2017

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3D and Workflow

    • “ Cinematic rendering (CR) is a new rendering algorithm that incorporates a more advanced lighting model than that used for VR, to create photorealistic 3D CT images. The post-processing tool is not yet widely available and its ultimate clinical utility has yet to be assessed in well-designed studies. Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care.”


      Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
    • “Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care. In this pictorial essay, a series of complex cardiovascular cases are presented to demonstrate the enhanced display capabilities associated with cinematic rendering and the utility to guide patient management and understanding are discussed.”

      
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
    • “Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care. In this pictorial essay, a series of complex cardiovascular cases are presented to demonstrate the enhanced display capabilities associated with cinematic rendering and the utility to guide patient management and understanding are discussed.”


      Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
    • “Imaging of thoracic vasculature presents a unique set of challenges owing to the complex relationships between systemic and pulmonary arteries, in addition to artifacts that result from cardiac and respiratory motion. Retrospective and prospective gating can be used to address the motion artifact. For interpretation and display, this anatomic region is best evaluated with rendering algorithms that preserve the 3D relationships of these intertwined arteries. Accordingly, volume rendering and cinematic rendering are the optimal post-processing tools for pulmonary and aortic imaging.”

      
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
Adrenal

    • “Secondary involvement of the adrenal glands with non-Hodgkin lymphoma has been reported to occur in up to 25% of patients during the course of their disease. However, primary adrenal lymphoma is extremely rare and accounts for just 1% of all non- Hodgkin’s lymphoma cases.” 


      Primary adrenal lymphoma: Radiological; pathological, clinical correlation 
Zhou L et al.
Eur J Radiol. 2012 Mar;8(3):401-5

    • “Primary adrenal lymphoma generally manifests as large, soft- tissue masses, replacing the adrenal glands with the maximal diameters often exceeding 6 cm. In this study, most (7/9) of adrenal lymphomas are round or oval and smooth with well- defined margins, even in the largest lesions as seen in our experience. Despite their large size, imaging often reflects preservation of the native triangular appearance of the normal adrenal gland.” 


      Primary adrenal lymphoma: Radiological; pathological, clinical correlation 
Zhou L et al.
Eur J Radiol. 2012 Mar;8(3):401-5

    • “some primary adrenal lymphomas may manifest as masses with necrotic or cystic components and heterogeneous, moderate enhancement, as occurred in one of our cases, making it impossible to differentiate from primary adrenal cortical carcinoma, pheochromocytomas, or metastatic disease.”

      
Primary adrenal lymphoma: Radiological; pathological, clinical correlation 
Zhou L et al.
Eur J Radiol. 2012 Mar;8(3):401-5

    • Primary Adrenal Lymphoma: Facts
      • Primary adrenal lymphoma commonly affects elderly men; with a median age of 65 years old
      • Bilateral involvement occurred in 73% of the cases in one study
      • Approximately 50% of patients actually develop symptoms of adrenal insufficiency, such as pigmented skin and mucous membrane, fatigue, anorexia, and constipation 

    • Primary Adrenal Lymphoma: CT Appearance
      • It is characterized by large tumors, exceeding 10 cm in diameter, with a growth pattern of infiltration.
      • Masses generally expand and infiltrate the glands, maintaining their triangular appearances.
      • some primary adrenal lymphomas may manifest as masses with necrotic or cystic components and heterogeneous, moderate enhancement , as occurred in one of our cases making it impossible to differentiate from primary adrenal cortical carcinoma, pheochromocytomas, or metastatic disease.

    • “Although it is a rare entity, primary lymphoma of the adrenal gland should be considered in the differential diagnosis of bilateral nodular adrenal lesions, particularly when there is evidence of associated adrenal insufficiency. We describe the case of an 83-year-old woman admitted to the emergency department due to a month's history of asthenia, weight loss, anorexia and nausea. Abdominopelvic CT showed bilateral nodular lesions of adrenal glands and a stimulation test with tetracosactide was compatible with primary adrenal insufficiency.”

      
Diffuse large B-cell lymphoma of the adrenal gland: a rare cause of primary adrenal insufficiency.
de Sousa Lages A et al.
BMJ Case Rep. 2016 Mar 18;2016

    • “Lymphomatous involvement of an adrenal gland during the course of a lymphoma is common, but a primary presentation of adrenal insufficiency in a patient with lymphoma involving both adrenal glands is rare. We describe a 36-year-old man with non-Hodgkin lymphoma (NHL) who presented with adrenal insufficiency. His evaluation consisted of several imaging modalities, including positron emission tomography-computed tomography (PET-CT) scans, which were helpful in defining the extent of disease prior to treatment and in monitoring the patient's response to treatment. Our case illustrates the importance of preoperative evaluation to exclude a lymphoma, particularly in patients with bilateral renal and/or adrenal masses.”


      Adrenal insufficiency as presenting feature of non-Hodgkin lymphoma.
Jacobs BL et al.
Can J Urol. 2010 Oct;17(5):5411-4.

Chest

    • “Cinematic rendering (CR) is a new rendering algorithm that incorporates a more advanced lighting model than that used for VR, to create photorealistic 3D CT images. The post-processing tool is not yet widely available and its ultimate clinical utility has yet to be assessed in well-designed studies. Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care.”

      
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
    • “Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care. In this pictorial essay, a series of complex cardiovascular cases are presented to demonstrate the enhanced display capabilities associated with cinematic rendering and the utility to guide patient management and understanding are discussed.”

      
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
    • “Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care. In this pictorial essay, a series of complex cardiovascular cases are presented to demonstrate the enhanced display capabilities associated with cinematic rendering and the utility to guide patient management and understanding are discussed.”


      Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
    • “Imaging of thoracic vasculature presents a unique set of challenges owing to the complex relationships between systemic and pulmonary arteries, in addition to artifacts that result from cardiac and respiratory motion. Retrospective and prospective gating can be used to address the motion artifact. For interpretation and display, this anatomic region is best evaluated with rendering algorithms that preserve the 3D relationships of these intertwined arteries. Accordingly, volume rendering and cinematic rendering are the optimal post-processing tools for pulmonary and aortic imaging.”

      
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging
Rowe SK, Johnson PT, Fishman EK
Br J Radiol. 2017 Sep 22:20170558.
Kidney

    • “Patients with lymphangioleiomyomatosis (LAM) have a frequency of angiomyolipoma (AML) that varies from 20% to 54% depend- 
ing on the method of patient or case collec- tion, imaging modality used, diagnostic criteria, and statistics of sampling variation. This frequency of AML is much higher than the reported frequency of 1–3% in the general population.”


      Active Surveillance of Nonfatty Renal Masses in Patients With Lymphangioleiomyomatosis: Use of CT Features and Patterns of Growth to Differentiate Angiomyolipoma From Renal Cancer 
Nilo A. Avila et al.
AJR 2017; 209:611–619
    • “AMLs with no visible fat that are hyperattenuating relative to the normal renal parenchyma on unenhanced CT have been called “AML with minimal fat,” and AMLs that are hypoattenuating relative to the normal renal parenchyma but with attenuation values not in the range of fatty tissue on unenhanced CT have been termed “AML with diffusely scattered fat”. In this article, we use the term “nonfatty renal mass” to denote any renal mass with no visible fat on CT and the term “nonfatty AML” to denote an AML with no visible fat on CT.”


      Active Surveillance of Nonfatty Renal Masses in Patients With Lymphangioleiomyomatosis: Use of CT Features and Patterns of Growth to Differentiate Angiomyolipoma From Renal Cancer 
Nilo A. Avila et al.
AJR 2017; 209:611–619
    • “Renal AML can be classified according to amount of fat as fat rich, fat poor, or fat invisible. To detect fat, one needs to thoroughly evaluate the entire AML by controlling the size and shape of the ROI. Fat-invisible AML should be biopsied, and fat-poor AML requires further investigation to determine whether biopsy is necessary to differentiate it from renal cell carcinoma. If differentiation between AML and renal cell carcinoma is not clear with CT and MRI, percutaneous biopsy may be performed.”


      Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat 
Byung Kwan Park 
AJR 2017; 209:826–835
    • “Angiomyolipoma (AML) is the most common benign solid renal tumor. Most AMLs contain fat that is clearly visible on CT and MR images, so these tumors can be easily diagnosed without biopsy or surgery. Approximately 5% of renal AMLs, however, have too little fat to be identified in a CT or MRI examination. Preoperatively, these AMLs are difficult to differentiate from renal cell carcinoma (RCC) with radiologic examinations, and they frequently are diagnosed after surgery.”

      
Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat 
Byung Kwan Park 
AJR 2017; 209:826–835


    • Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat 
Byung Kwan Park 
AJR 2017; 209:826–835
    • 
“Unenhanced CT clearly depicts a hypoattenuating area (≤ –10 HU) suggesting fat in fat-rich AML. There- fore, detecting fat is not a problem in most fat-rich AMLs. However, some fat-rich AMLs have very small foci of fat measuring less than –10 HU, so these hypoattenuating areas may not be recognized at preoperative CT. Therefore, meticulous care should be taken not to miss a small focus of fat. Thin (< 5 mm) slice thickness (1.5–3 mm) should be used because thick (≥ 5 mm) slice thickness may not depict fat attenuation.”


      Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat 
Byung Kwan Park 
AJR 2017; 209:826–835
    • 
“Unenhanced CT cannot show fat attenuation in fat-invisible AMLs . These lesions appear homogeneously hyperattenuating because they have too little fat . The attenuation of fat-invisible AML is higher than that of fat-poor AML because the amount of fat in the former is lower than that in the latter. For this reason, the attenuation values of fat-invisible AML are fairly constant compared with those of fat- poor AML wherever an ROI is placed.”

      
Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat 
Byung Kwan Park 
AJR 2017; 209:826–835
    • “Contrast-enhanced CT is not necessary for diagnosing fat-rich AML but should be performed when there is potential for tumor bleeding. Frequently, large fat-rich AMLs contain a lot of tortuous or dilated vessels, which are susceptible to bleeding. Contrast-enhanced CT is essential to identify these abnormal vessels before embolization.”


      Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat 
Byung Kwan Park 
AJR 2017; 209:826–835
    • 
“Contrast-enhanced CT frequently shows heterogeneous enhancement within fat-poor AMLs because a small amount of fat is localized or scattered. Therefore, this type of AML may be misdiagnosed as clear cell RCC, which is heterogeneously enhancing on contrast-enhanced CT images. Still, it is unclear that fat-poor AML requires MRI or percutaneous biopsy. By definition, MRI is necessary to identify fat-poor AML. However, clear cell RCCs may have similar MRI features to those of these AML.”


      Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat 
Byung Kwan Park 
AJR 2017; 209:826–835
Pancreas

    • “Groove pancreatitis is a rare focal form of chronic pancreatitis that occurs in the pancreaticoduodenal groove between the major and minor papillae, duodenum and pancreatic head. Radiologic appearance and clinical presentation can result in suspicion of malignancy rendering pancreaticoduodenectomy inevitable.” 

      
Dual-phase CT findings of groove pancreatitis
Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman
Eur J Radiol. 2014 Aug; 83(8): 1337–1343.
    • “Soft tissue thickening in the groove was seen in all patients. Pancreatic head, groove and duodenum were all involved in 75% patients. A discrete lesion in the pancreatic head was seen in half of the patients, most of which appeared hypodense on both arterial and venous phases. Cystic changes in pancreatic head were seen in 75% patients. Duodenal involvement was seen in 92% patients including wall thickening and cyst formation. The main pancreatic duct was dilated in 7 patients, with an abrupt cut off in 3 and a smooth tapering stricture in 4. Five patients had evidence of chronic pancreatitis with parenchymal calcifications.” 


      Dual-phase CT findings of groove pancreatitis
Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman
Eur J Radiol. 2014 Aug; 83(8): 1337–1343.
    • “Soft tissue thickening in the groove was seen in all patients. Pancreatic head, groove and duodenum were all involved in 75% patients. A discrete lesion in the pancreatic head was seen in half of the patients, most of which appeared hypodense on both arterial and venous phases. Cystic changes in pancreatic head were seen in 75% patients. Duodenal involvement was seen in 92% patients including wall thickening and cyst formation.” 

      
Dual-phase CT findings of groove pancreatitis
Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman
Eur J Radiol. 2014 Aug; 83(8): 1337–1343.
    • “In conclusion, the diagnosis of GP may be difficult on MDCT and exclusion of malignancy such as pancreatic adenocarcinoma, ampullary and duodenal carcinomas is important. However, certain features seen on MDCT such as sheet like hypodensity in the PD groove, medial duodenal wall thickening and cystic changes in the duodenal wall along with evidence of chronic pancreatitis in the pancreatic head are highly suggestive of GP.” 


      Dual-phase CT findings of groove pancreatitis
Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman
Eur J Radiol. 2014 Aug; 83(8): 1337–1343.
    • “Presence of mass or soft tissue thickening in the groove with cystic duodenal thickening is highly suggestive of groove pancreatitis. Recognizing common radiological features may help in diagnosis and reduce suspicion of malignancy.” 


      Dual-phase CT findings of groove pancreatitis
Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman
Eur J Radiol. 2014 Aug; 83(8): 1337–1343.
Practice Management

    • “1. Do work that matters, that is hard, and that we are uniquely able to do: Make sure that the problem you are working on matters to other people and is thus commercially viable work that can be funded. Remember, however, that unless you swing for the fences your company will almost certainly lose. If you don’t take risks in business, how can you hope to beat all those other incredible companies in the marketplace? The conservative move is the one that will put you out of business!”


      “From Gaming Machines to Thinking Machines . . . ”
 Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.
    • “2. Do work that brings us incredible joy: Realize that profits may not be there when you start. Use the pride and satisfaction in the work itself as a way to overcome those inevitable initial setbacks and obstacles.”


      “From Gaming Machines to Thinking Machines . . . ”
 Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.
    • “3. Believe in your vision knowing that the best customers may not, at first: It is a truism that several of our most successful innovations were products that consumers claimed to have no interest in prior to our developing them! Success as an innovator sometimes requires the foresight to see ahead of the customer’s current wants and desires.”


      “From Gaming Machines to Thinking Machines . . . ”
 Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.

    • “4. Although Jen-Hsun Huang’s development of a multibillion-dollar company may seem light-years away from the demands of running a local radiology practice, his advice to take “joy in your work” and “care about craftsmanship” is valid for any industry. Though it is easy to simply “mail it in” and provide a mediocre product, maintaining your long-term viability in a competitive industry requires caring a great deal about the quality of your product or service. Certainly, as in Silicon Valley, many radiology practices have encountered failure because they failed to realize that it is quality work that underpins financial success.”

      
“From Gaming Machines to Thinking Machines . . . ”
 Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.
    • OBJECTIVE: The purpose of this study is to assess features of patient satisfaction scores for U.S. radiologists using a popular physician rating website.


      CONCLUSION: 
      Overall, most radiologists rated online by their patients score well, but reviews tended to be either strongly positive or negative. Scores across various categories are highly correlated, suggesting that there is a halo effect. Radiologists should recognize the effect of both facility- and radiologist-related factors in influencing patients' overall perceptions.


      How Satisfied Are Patients With Their Radiologists? Assessment Using a National Patient Ratings Website.
Ginocchio LA, Duszak R Jr, Rosenkrantz AB
AJR Am J Roentgenol. 2017 May;208(5):W178-W183
    • “Nearly 60% of radiologist respondents use social networking for professional purposes. Radiology is likely to see growth in the role of social networking in the coming years as nearly half of professional users are radiology trainees. Twitter use for professional purposes among radiologists was disproportionately male. It is important to be cognizant of gender imbalance and to improve visibility of female leaders on social networking.”


      Professional Social Networking in Radiology: Who Is There and What Are They Doing?
Patel SS, Hawkins CM, Rawson JV, Hoang JK
Acad Radiol. 2017 May;24(5):574-579
    • “RadiologyInfo provides a tangible demonstration of how radiologists can engage directly with the global public to educate them on the value of radiology in their health care and to allay concerns and dispel misconceptions. Regular self-assessment and responsive planning will ensure its continued growth and relevance.”


      Enhancing Public Access to Relevant and Valued Medical Information: Fresh Directions for RadiologyInfo.org.
Rubin GD, Krishnaraj A ,Mahesh M, Rajendran RR, Fishman EK
J Am Coll Radiol. 2017 May;14(5):697-702.

    • “RadiologyInfo.org is a public information portal designed to support patient care and broaden public awareness of the essential role radiology plays in overall patient health care. Over the past 14 years, RadiologyInfo.org has evolved considerably to provide access to more than 220 mixed-media descriptions of tests, treatments, and diseases through a spectrum of mobile and desktop platforms, social media, and downloadable documents in both English and Spanish..”


      Enhancing Public Access to Relevant and Valued Medical Information: Fresh Directions for RadiologyInfo.org.
Rubin GD, Krishnaraj A ,Mahesh M, Rajendran RR, Fishman EK
J Am Coll Radiol. 2017 May;14(5):697-702.

    • “As patients continue to turn to online resources for health care information to guide their care decisions, it is becoming increasingly important for radiologists to engage with patients online via social media platforms. There are many ways physicians can use social media to provide patients with valuable information and improve the overall patient experience. By optimizing online discoverability, curating radiology content, engaging with patient communities, and producing mineable social media content, radiologists can emerge as thought leaders in this new form of patient-centered communication and information exchange.”

      
Social Media and the Patient Experience.
Hawkins CM1, DeLaO AJ2, Hung C3
J Am Coll Radiol. 2016 Dec;13:1615-1621
    • PURPOSE: To assess the content of currently available YouTube videos seeking to educate patients regarding commonly performed imaging examinations.

      
CONCLUSIONS: Educational patient videos on YouTube regarding common imaging examinations received high public interest and may provide a valuable patient resource. Videos most consistently provided information detailing the examination experience and less consistently provided safety information or described the presence and role of the radiologist.


      Assessing the Content of YouTube Videos in Educating Patients Regarding Common Imaging Examinations.
Rosenkrantz AB1, Won E2, Doshi AM2
J Am Coll Radiol. 2016 Dec;13(12 Pt A):1509-1513

    • “Developing a consistent brand and presence in the work setting, on social media accounts, and in professional organizations at the local, national, and international levels is the ultimate goal. At present, very little, if any, formal training is provided on personal branding skills such as these in current residency curricula, and it is critical for radiologists to fill their gaps in knowledge through additional means.”


      Personal Branding: A Primer for Radiology Trainees and Radiologists.
Kalia V1, Patel AK2, Moriarity AK3, Canon CL4.
J Am Coll Radiol. 2017 Jul;14(7):971-975
    • Social Media in Medicine
      Social Media
    • Social Media in Radiology
      Social Media
    • Facebook Live
      Facebook Live
    • Instagram
      Instagram
    • “For each enterprise or institution, the name is inextricably attached to the value of the brand. It is the responsibility of the enterprise or institution to make sure the attributes and values attached to the brand are upheld, ensuring that the brand equity is maintained or improved. Why? Because the brand helps attract customers and attract the best staff and allows a company to charge a premium for its products and services.”


      The Importance of Brand Name.
Freeman M, Fishman EK, Horton KM, Sheth S
 J Am Coll Radiol. 2017 Jun 14. pii: [Epub ahead of print]
    • “Once your brand experience is established and equity is accrued, it is paramount to protect that eq- uity. If your institution were a chain of fine hotels, say the Four Seasons, what would happen to the brand equity if one of the properties did not provide the same level of service as the others? Or if the hotel you always stayed in suddenly began to erode in quality? Would your opinion of the whole chain change? Would you still recommend it as your favorite place to stay? Probably not. Consistency is key, and it’s something the entire organization has to believe in and convey.”


      The Importance of Brand Name.
Freeman M, Fishman EK, Horton KM, Sheth S
 J Am Coll Radiol. 2017 Jun 14. pii: [Epub ahead of print]
    • “Perception is crucial. Health care facilities can positively affect patients’ perceptions by ameliorating the experience surrounding the delivery of health care itself. A relative of mine recounts the experience of undergoing a thyroidectomy at Memorial Sloan Kettering Hospital. The family waited in a beautifully appointed waiting room, could be easily contacted using a sensor device loaned to them by the hospital, and were able to follow the journey of their loved one on a monitor, also via sensor. This was not only comforting for the family but, just as importantly, gave them a sense that the facility was indeed state of the art.”


      The Importance of Brand Name.
Freeman M, Fishman EK, Horton KM, Sheth S
 J Am Coll Radiol. 2017 Jun 14. pii: [Epub ahead of print]
    • “The kinds of people who work in your company matter: When you consider a candidate, include a personality test, strive to hire happy, empathetic people, and then keep them that way. 
Create an environment that fosters that type of personality and ensure that peer employees partici- pate in the process. Have potential hires interviewed by their peers so that the entire team is invested in the new employee’s success.”


      The Importance of Brand Name.
Freeman M, Fishman EK, Horton KM, Sheth S
 J Am Coll Radiol. 2017 Jun 14. pii: [Epub ahead of print]
    • “Employees should understand that they are all ambassadors of the brand. In your institution, your patients are bound to have many interactions with various employees before they meet you. Some patients will share their experiences on social media. Alongside many excellent reviews celebrating the superb care offered by your institution, one can read other comments lamenting the long wait times, dirty chairs in the waiting room of the emergency department, and perceived rudeness of some of the staff members. Through social media, negative per- ceptions can be spread to large audiences, adversely affecting your brand.”

      
The Importance of Brand Name.
Freeman M, Fishman EK, Horton KM, Sheth S
 J Am Coll Radiol. 2017 Jun 14. pii: [Epub ahead of print]
    • “A brand does not live inside the walls of a company. It lives in the hearts and minds of your patients, your employees, and your community. And your brand is even more emotionally charged than almost all others. For your patients, your brand is in their hands because their life is in your hands.”


      The Importance of Brand Name.
Freeman M, Fishman EK, Horton KM, Sheth S
 J Am Coll Radiol. 2017 Jun 14. pii: [Epub ahead of print]
    • Radiology personnel: Receptionists and technologists are the face of a practice. We have to invest in them and promote a patient-friendly and efficiency culture. 
Physical layout: Although radiologists justifiably focus on acquiring state-of-the-art equipment, well-designed facilities project an image of competence and efficiency. 
Communication: Radiologists need to embrace opportunities to reach out to patients, for example, by making themselves available to answer potential questions through a phone number or e-mail address included in the report.”


      The Importance of Brand Name.
Freeman M, Fishman EK, Horton KM, Sheth S
 J Am Coll Radiol. 2017 Jun 14. pii: [Epub ahead of print]
Small Bowel

    • “Small bowel cancers are very rare despite the length and large mucosal surface of the small bowel and account for 3% to 6% of all gastroin- testinal (GI) tract malignancies. Adenocarcinoma, neuroendocrine neoplasms, lymphoma, and GI stromal tumors (GISTs) are the most prevalent primary small bowel cancers, with adenocarcinoma and neuroendocrine neoplasms accounting for nearly two-thirds of small bowel cancers.”

      
Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
    • “Capsule endoscopy is a safe and minimally invasive modality for visualizing the entire small bowel. It is typically well tolerated by patients. The limitations of the procedure include diagnostic procedure (no therapeutic ability), potential of missing a lesion, decreased visualization if fluid or bubbles are retained in the lumen, false- positive findings, and capsule retention if stricture or significant inflammation present.”

      
Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
    • “There are mixed results for capsule endoscopy in the detection of small bowel tumors. In small retrospective and prospective single-center studies, CT enterography was shown to be superior to capsule endoscopy in the detection of small bowel tumors.”


      Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
    • “Several hereditary conditions, including familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer (also known as Lynch syndrome), Peutz- Jeghers syndrome, MUTYH-associated polyposis, and cystic fibrosis, are well known to be associated with increased risk for small bowel adenocarcinoma. .”

      
Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
    • “The most typical appearance of small bowel adenocarcinoma is an annular, constricting mass (apple-core lesion) that causes luminal narrowing that is often associated with upstream bowel dilatation. Even a small encircling adenocarcinoma can cause small bowel obstruction due to prominent intratumoral desmoplasia, and a small obstructing cancer should not 
 be neglected.”

      
Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
    • “A variety of conditions increase the risk of small bowel GISTs. Familial GIST is autosomal dominant and often leads to the development of a single or multiple GISTs in middle age. Additionally, about 5% of patients with neurofibromatosis type 1 (NF-1) will present with a small bowel GIST; GISTs can be seen in young females as part of the Carney triad (gastric or small bowel GIST, pulmonary chondroma, and extra-adrenal pheochromocytoma) or in males or females as part of the Carney-Stratakis syndrome (GIST and paraganglioma).”

      
Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
    • “Neuro- endocrine neoplasms typically occur in distal/terminal ileum, with the small bowel primary presenting as a small enhancing polyp or more 
characteristically as a plaquelike mass, often with serosal retraction. Tumor can be singular or multifocal along a bowel segment. Nodal metastases typically cluster around mesenteric vessels (with potential to narrow or occlude them), with advanced mesenteric metastases presenting with a characteristic pattern of rounded soft tissue, punctate calcification, and radiating strands of desmoplasia.”


      Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
    • “Crohn disease can mimic small bowel tumors; patients with long-standing Crohn disease are at increased risk for these tumors, particularly lymphoma and adenocarcinoma, which can be discovered incidentally. Radiological diagnosis of small bowel tumors developing in Crohn disease is very difficult because the imaging findings are similar to the findings of long- standing Crohn disease, and biopsy should be used when required to distinguish between them.”


      Imaging and Screening of Cancer of the Small Bowel 
Jin Sil Kim et al.
 Radiol Clin N Am (2017) (in press)
© 1999-2017 Elliot K. Fishman, MD, FACR. All rights reserved.