Ziele: Um Prozesse optimieren zu können, sollen diese analysiert und die Arbeitsabläufe in verschiedenen radiologischen Einrichtungen erhoben werden. Dadurch sollen diese Abläufe in einem Benchmarking „best practice“ – Prozesse ermitteln Methode: Es wurden die Arbeitsabläufe in 15 radiologischen Abteilungen in Deutschland erhoben. Die Abteilungen gehörten in 4 Fällen zu Universitätskliniken, in 6 Fällen zu Krankenhäusern der Schwerpunkt- oder Regelversorgung, in 3 Fällen zu Niederlassungen, und in 1 Fall zu einer in einem Krankenhaus integrierten Niederlassung und verfügten über eine RIS/PACS-Lösung. Es wurden für 6 Standardfälle aus dem konventionellen Röntgen, Durchleuchtung, CT und MRT von der Anforderung bis zum Verlassen des Befundes/der Bilder die detailierten Prozessschritte in ihren Durchlaufzeiten erfasst. Zusätzlich wurden die Mitarbeiter bzgl. Ihrer Zufriedenheit befragt. Ergebnis: Durch die Einbeziehung der unterschiedlichsten radiologischen Abteilungen gewinnt man eine Vielzahl von Beispielen besonders effizient ausgestalteter Teilprozesse, die teilweise auch unabhängig vom jeweiligen Radiologie-Typ zu einer Prozessverbesserung beitragen können. Schlussfolgerung: Diese Ergebnisse können auf andere radiologische Abteilungen übertragen werden, um Ansatzpunkte und Erkenntnisse über die Schwachstellen bzw. -Potentiale einer Abteilung zu gewinnen. Sowohl um dem Kostendruck zu begegnen, als auch z.B. um eine Sollwertbestimmung für (geplante) digitale Lösungen vornehmen zu können, kann die Methode Benchmarking Hilfestellung geben bei der Abwägung von Nutzen und Risiken. besser abwägen zu können. Vielleicht gelingt es dadurch für und mit der Industrie, eine Standardisierung der Arbeitsabläufe in der deutschen Radiologie zu erarbeiten, die mit besseren und billigeren Produkten digital abgebildet werden können.

A consortium benchmarking project was conducted with the participation of 15 radiology departments in Germany. The process parameters including cycle time, process time, and process cost for staff, were measured along the process chain, for pre-defined reference workflows. Furthermore, profiles of the radiology departments were acquired, including their technological and organizational specifics. The measured parameters were then correlated with the institutes' profiles. As a result, economical benefits of technological solutions like electronic scheduling or speech recognition software could be assessed.

Zusammenfassung Fragestellung: Die Ursache einer konnatalen Hemiplegie bei reifgeborenen Kindern wurde in einer retrospektiven Studie untersucht. Patienten und Methode: Bei 14 Patienten im Alter von 8 Monaten bis 15 Jahren wurden eine zerebrale MR-Tomographie durchgeführt und die klinischen Daten erfaßt. Ergebnisse: Bei allen Patienten fand sich ein morphologisches Korrelat der Bewegungsstörung. Die Läsionen wurden nach pathophysiologischen Gesichtspunkten eingeteilt: zerebrale Entwicklungsstörungen ( n =3), periventrikuläre Leukomalazie ( n =2), periventrikuläre Substanzdefekte ( n =2), subkortikale Leukomalazie ( n =1), subkortikal-kortikale Substanzdefekte ( n =6). Bei 13 von 14 Kindern waren die Schwangerschafts- und Geburtsanamnese unauffällig. Diskussion: Aufgrund reifeabhängiger Reaktionsmechanismen des Gehirns kann von der Morphologie der Läsionen auf den Schädigungszeitpunkt geschlossen werden. Dieser lag bei der Mehrzahl unserer Patienten pränatal.

磁共振的三维技术使大体积的高分辨率检查成为可能。与二维序列相比,这种技术的发展保证了飞速发展的磁共振成像的不断进步。

Using a combination of T1 weighted snap-shot-flash sequences and intravenous contrast bolus it was possible to demonstrate intraluminal signal differences in a period of seconds. 5 confirmed aortic lesions were studied; 2 old aortic dissections (with differentiation between the true and false lumen), 1 acute aortic dissection and a partially thrombosed thoracic aortic aneurysm were demonstrated. The advantage of this technique lies in its simplicity and reproducibility. Difficulties in interpreting the intraluminal phases arising from spin echo and flash techniques are made easier by interpreting the available signals from this method.

The influence of radiotherapy on vascularization [1, 6–8] has to be established. It was the objective of our study to identify changes in the vascular bed of neoplasms [4, 5, 10–12] during the 1st min after intravenous injection of 20 ml Gd-DTPA to obtain prognostic information about tumor response to therapy. This requires very short acquisition times.

Despite 3D gradient echo technique has a better spacial resolution than spin echo sequences, 3D imaging is not well accepted for clinical routine. Because of the large amount of data evaluation cannot be done by single photo-documented slices. Postprocessing of the 3D data sets with an image analysis system is indispensable. A maximum of two different gradient echo sequences (FLASH, FISP) are necessary for imaging of the whole interesting volume with continuous slices. Time of examination is shorter (16 resp. 32 minutes) compared with conventional spin echo sequences. In our opinion 3D gradient echo-sequences are a reliable noninvasive technique for the evaluation of pathological changes of the knee joint which could replace diagnostic arthroscopy in the future.

We examined 36 patients with carcinomas of the tongue and the floor of the mouth. In 11 cases, a clear definition of the tumor extent was not possible using T2 w. spin echo sequences and T1 w. spin echo and gradient echo sequences after injection of contrast material. This delineation was attained with Turbo-FLASH intensity-vs-time studies (Gad-DTPA). The time of acquisition of each measurement was about 1 sec. At the end of injection of Gad-DTPA, 30 measurements with a delay of 1 sec between two measurements were performed. Using this technique, a marginal zone at the boundary of the tumor of very high signal intensity was visible within first minute after Gadolinium injection. This method is not required in the case of clearly hypointense (majority of the tumors) or hyperintense (minority) lesions on T1 w. Gadolinium-enhanced SE or GE images.

The use of 3D-gradient-echo sequences improved the diagnosis of malignant tumors of the skull base, the nasopharynx, the nasal cavities, the paranasal sinuses and the upper parts of the parapharyngeal space with relation to the skull base. Therefore the tumor extent and infiltration may be better appreciated than in conventional 2D-spin-echo or gradient echo sequences. Using this method, the examinations of 22 patients with carcinomas could be compared. Precise tumor delineation was achieved in six of these patients when compared with surgical and histological findings. The 3D sequences most frequently used were FLASH 40 degrees with TR of 40 ms and the shortest TE (5 to 6 ms). 3D turbo-FLASH (MPRage) with Gad-DTPA was applied in order to shorten the acquisition time by half and especially to reduce motion artefacts.

We report on a newborn baby with thrombocytopenia who developed neonatal seizures caused by a temporal lobe hemorrhage as shown by cerebral ultrasonography. This hemorrhage was followed by a cyst isodense to intracerebral fluid. Differentialdiagnostic aspects concerning the etiology of arachnoideal cysts will be discussed in relation to the post-hemorrhagic course and the sonographic or the magnetic resonance tomography findings respectively.

We report on a newborn baby with thrombocytopenia who developed neonatal seizures caused by a temporal lobe hemorrhage as shown by cerebral ultrasonography. This hemorrhage was followed by a cyst isodense to intracerebral fluid. Differential diagnostic aspects concerning the etiology of arachnoideal cysts will be discussed in relation to the post-hemorrhagic course and the sonographic or the magnetic resonance tomography findings respectively.

A retrospective comparative study of CT and MRI was carried out involving 38 vertebral haemangiomas; this revealed a typical signal pattern on MRI from benign lesions. It consists of a hyper-intense signal from the bone marrow affecting the T1/T2 sequences; this may be focal or involve the entire vertebral body. These characteristic signals were compared with CT images of the spine. The areas of bone that produce the high intensity signals on MRI appear on CT as spongy patterns with hypertrophic trabeculae surrounding mostly areas with negative absorption values. An analysis of the changes in the spongiosa has revealed three clearly defined types. The signals derived from haemangiomas extending beyond the bone have an intensity of normal spongiosa; this corresponds with an absence of fat, as demonstrated by CT. Extra-osseous components have low intensity T1 signals that increase in T2 sequences.