Purpose: This retrospective study examined the performance of general radiologists in a community-based hospital in detecting colorectal cancer (CRC) with computed tomography (CT) in the unprepared large bowel. Methods: The pathology database at a community hospital over the past 7 years (2009-2015) was retrospectively analysed for pathologically proven CRC (924 cases). The provincial hospital information profile for these patients was reviewed to determine if they had an abdominal CT for any reason in the year prior to biopsy. Metrics such as age, sex, time between the CT and biopsy or surgery, whether CRC was initially detected by the radiologist, and if this was an emergency presentation was evaluated. In the cases where CRC was not identified, the CT scans were reanalysed to determine if the CRC was identifiable in retrospect. The sensitivity of detecting CRC by CT scan in the unprepared large bowel was calculated. Results: Of the 924 biopsy proven CRC cases, 22% (207 of 924) of the patients had a CT prior to biopsy. Of these cases, 47% (97 of 207) presented on an emergency basis. Of the cases with imaging in the year prior, about 60% (125 of 207) had cancer prospectively detected by the radiologist. Upon re-examination of the cases in which CRC was not initially detected, 59% were visualized in retrospect. Conclusions: Community general radiologists can successfully detect CRC with a high degree of accuracy. Reformatted images, bowel wall thickening when regional nodes are prominent, and minimizing oral contrast were helpful in improving detection. (C) 2017 Canadian Association of Radiologists. All rights reserved.

Purpose: The purpose of this study was to determine whether low-kilovoltage (80 or 100 kV) computed tomography (CT)-guided interventions performed in a community-based hospital are feasible and to compare radiation exposure incurred with conventional 120 kV potential.Materials and Methods: Effective doses (ED) received by patients who underwent CT-guided intervention were analysed before and after a low-dose kilovoltage protocol was instituted in our department. We performed CT-guided procedures of 93 consecutive patients by using conventional 120-kV tube voltage (50 patients) and a low voltage of 80 or 100 kV for the remainder of this cohort. Automatic tube current modulation was enabled to obtain the best image quality. Procedure details were prospectively recorded and included examination site and type, slice width, tube voltage and current, dose length product, volume CT dose index, and size-specific dose estimate. Dose length product was converted to ED to account for radiosensitivity of specific organs. Statistical comparisons with test differences in the ED, volume CT dose index, size-specific dose estimate, and effective diameter (patient size) were made by using the Student t test.Results: All but 6 of the procedures performed at 80 kV were successful, for a success rate of 86%. At lower voltages, the ED was significantly (P < .01) reduced, on average, by 57%, 73%, and 65% for the pelvic, chest, and abdomen procedures, respectively.Conclusion: A low-dose radiation technique by using 80 or 100 kV results in a high technical success rate for pelvic, chest, and abdomen CT-guided interventional procedures, although dramatically decreasing radiation exposure. There was no significant difference in effective diameter (patient size) between the conventional and the low-dose groups, which would suggest that dose reduction was indeed a result of kVp change and not patient size.

Purpose The purpose of this study was to evaluate whether 3-dimensional (3D) volumetric acquisition of shoulder ultrasound (US) data for supraspinatus rotator cuff tears is as sensitive when compared with conventional 2-dimensional (2D) US and routine magnetic resonance imaging (MRI), and whether there is improved workroom time efficiency when using the 3D technique compared with the 2D technique. Methods In this prospective study, 39 shoulders underwent US and MRI examination of their rotator cuff to confirm the accuracy of both the 2D and 3D techniques. The difference in sensitivities was compared by using confidence interval analysis. The mean times required to obtain the 2D and 3D US data and to review the scans were compared by using a 1-tailed Wilcoxon test. Results Sensitivity and specificity of 2D US in detecting supraspinatus full- and partial-thickness tears was 100% and 96%, and 80% and 100%, respectively, and similar values were obtained with 3D US at 100% and 100%, and 90% and 96.6%, respectively. Analysis of the confidence limits of the sensitivities showed no significant difference. The mean time (± SD) of the overall 2D examination of the shoulder, including interpretation was 10.02 ± 3.28 minutes, whereas, for the 3D examination, it was 7.08 ± 0.35 minutes. Comparison between the 2 cohorts when using a 1-tailed Wilcoxon test showed a statistically significant difference ( P < .05). Conclusion 3D US of the shoulder is as accurate as 2D US when compared with MRI for the diagnosis of full- and partial-thickness supraspinatus rotator cuff tears, and 3D US examination significantly reduced the time between the initial scan and the radiologist interpretation, ultimately improving workplace efficiency.

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Objectives The purpose of this study was to determine whether the addition of disposable enemas and a 24-hour diet of clear fluids to the bowel preparation protocol before transrectal ultrasound-guided prostate biopsy decreases the rate of postbiopsy sepsis. Methods Sepsis rates of patients who underwent transrectal ultrasound-guided prostate biopsies at a community hospital were analyzed before and after a new bowel preparation protocol was introduced in our department. All patients received the antibiotic ciprofloxacin both before and after the biopsy. The first group (190 patients) had a preparation protocol that only asked the patients to stop eating by midnight (clear fluids only) on the day before the biopsy. The second group involved 217 patients and followed a bowel-cleansing biopsy preparation protocol. This protocol included the use of 2 disposable enemas and a diet of clear fluids for 24 hours preceding the biopsy. A systematic chart review was then performed to determine which patients had required treatment for postbiopsy sepsis. Results Sepsis occurred in 4 patients (2.11%) in group 1 and 1 patient (0.46%) in group 2. After performing a 2-sided Fisher exact test, it was found that there was no significant difference between the groups at a 95% confidence level (P = .189). Conclusions The 24-hour clear-fluid diet and the use of disposable enemas combined with a regimen of ciprofloxacin decreased the rate of postbiopsy sepsis in patients who underwent transrectal ultrasound-guided prostate biopsy, but the results were not significantly different.

OBJECTIVE:The purpose of this study was to determine the effect on workroom time efficiency of the 3D sonographic technique compared with the 2D technique in examinations of the kidney, shoulder, small parts (thyroid, testes, Achilles tendon, other superficial structures), and female pelvic organs in a community hospital.SUBJECTS AND METHODS:A random sample of 23 patients underwent consecutive 3D sonographic examinations on a single day. Another random sample of 40 patients underwent consecutive traditional 2D sonographic examinations the next day. Both cohorts included a mixture of patients who underwent shoulder, renal, small-parts, and pelvic scans. The 3D shoulder examinations were followed by direct examination by a radiologist using the traditional 2D technique to confirm the diagnostic accuracy of the 3D technique. The mean times that patients were in the sonography room for 2D and for 3D sonography were recorded and compared by use of a two-sample Student's t test.RESULTS:The mean time per examination for the 3D cohort was 11.48 +/- 3.55 minutes (SD). The mean time per examination for the 2D cohort was 25.30 +/- 11.64 minutes. Results of a two-sample Student's t test showed the times for the two groups were statistically different (p < 0.001). No diagnoses made with 3D shoulder sonographic findings were changed when the shoulders were reevaluated directly by radiologists using conventional 2D sonography.CONCLUSION:This study showed significantly better workroom time efficiency with use of 3D sonography than with traditional 2D sonography in pelvic, renal, small-parts, and shoulder examinations in a community hospital. These findings suggest that in the correct clinical setting, adopting 3D scanning protocols may greatly improve patient throughput.

A woman, aged 84 years, presented to our emergency department with posteriorly radiating chest pain that began following dinner. She reported no change in bowel habits, hematochezia, or melena. She had previous peptic ulcer disease and a long-standing history of gastroesophageal reflux disease. Her medications included acetylsalicylic acid and rabeprazole. Electrocardiogram and troponin analyses were negative for ischemic heart disease. The emergency physician suspected an aortic dissection, and computed tomography (CT) chest and abdomen scans were performed with and without IV and oral contrast. The aorta was normal and the noncontrast images demonstrated a hyperdense mass (not shown) that did not enhance consistent with a large intramural hematoma extending from the upper esophagus (level of T2 vertebral body) to the fundus of the stomach (Figures 1A and B).

OBJECTIVEThe purpose of this study was to determine the utility and accuracy of sonography in diagnosing acute appendicitis in patients with suspected acute appendicitis in a general community hospital.MATERIALS AND METHODSAll reports relating to appendicitis were retrospectively obtained from archived transcription reports of nine radiologists from a geographically constrained hospital between December 1999 and December 2003 by a search on the keyword "appendicitis." These files were correlated with the histopathology reports from surgical appendectomy or findings from clinical follow-up during the same period. A survey eliciting the views of five local surgeons on the utility of sonography for the detection of acute appendicitis was also collected.RESULTSSonography reports for 667 patients (mean age, 34 years; range, 6-93 years) were obtained. Of these, a total of 174 had pathologically proven appendicitis and 145 had positive findings for appendicitis on sonography. The accuracy was 92%; sensitivity, 83%; and specificity, 95%. The positive predictive value was 86%, and the negative predictive value was 94%. Three of the five surveyed surgeons indicated they used sonography less than 25% of the time, with none using it more than 75%.CONCLUSIONThe sensitivity, specificity, accuracy, and positive and negative predicative values of sonography performed by general radiologists in a community hospital are comparable to statistics quoted in the literature for academic institutions. The most common error was the tendency to misclassify appendixes under 6 mm. Most surgeons surveyed stated their use of sonography would increase if sonography yielded a sensitivity and specificity of 85% or greater.

OBJECTIVE:To determine if ambulatory patients who have undergone image-guided core liver biopsy with an 18-gauge needle and spring-loaded biopsy gun can be safely discharged after 1 hour of observation in the radiology department.METHODS:Fifty-four consecutive patients underwent ultrasound-guided core liver biopsy for a variety of suspected diffuse liver diseases. Post-biopsy, they were asked to grade their pain on a scale of 1-10 after 1 hour of recumbency on a hospital gurney in the department. At 2 weeks, all patients were contacted and asked about their level of pain and when they returned to normal activities.RESULTS:Of the 54 patients enrolled, 4 were lost to follow-up. Pain was the most common minor complication, occurring in 31 (62%) of patients. The average level of pain after 1 hour was 2.1 (1 = no pain) and after 24 hours, 1.5. Seven patients were admitted to a medical daycare bed for a total of 4 hours and were then discharged. The remainder were discharged after 1 hour. Forty (80%) patients were pain-free after 24 hours, 36 (90%) of the 40 patients who were working returned to work the following day, and within a week, all patients had returned to all normal activities. No patients required an inpatient hospital stay or sought assistance at an emergency department.CONCLUSION:These preliminary results demonstrate that ultrasound-guided 18-gauge liver core biopsy is a safe procedure, and, provided larger series confirm these findings, patients showing no complications can be discharged from the department after 1 hour with notable cost savings.

Nonsteroidal anti-inflammatory drug–induced colonic strictures are uncommon and usually occur in the proximal ascending colon. We describe the progressive findings of nonsteroidal anti-inflammatory drug–induced strictures in the ascending colon and at the ileocecal valve with subsequent bowel obstruction secondary to intussusception.