Movement of the diaphragm can be evaluated with diagnostic ultrasound using B- and M-mode techniques. Ultrasonic scanning is a highly sensitive method of demonstrating generalized or localized abnormalities of diaphragmatic motion and is superior to fluoroscopy in several respects. There is no exposure to ionizing radiations, and a permanent record of the excursion of the diaphragmatic surface is obtained. This method has the additional advantage of providing a two-dimensional display of the upper abdominal quadrant, which may reveal the nature of the underlying disease process.
In a significant number of patients with blunt abdominal trauma, the diagnosis of ruptured spleen is not readily apparent. Is is in these cases that echographic evaluation appears to aid significantly in diagnosis. Seventy patients with blunt abdominal trauma were studied by echography. Results indicated 61 true negative cases, 1 false negative, 4 true positives, and 4 false positives. Criteria for splenic rutures are set forth. Ultrasound is considered to be an excellent screening procedure for suspected splenic rupture.
In 1998 we surveyed our radiologists on teleradiology satisfaction. Results were generally positive. In 2002 we experienced a sevenfold case increase in teleradiology volume. The present study surveyed the radiologists again. The hypothesis was that, with increased case volume and radiologist experience with the system, ratings would increase. Image quality was excellent/good, although plain film and ultra sound (US) had more fair/poor ratings. Monitors, navigation, image processing, and Web-based reporting were rated as excellent/good. The voice-recognition system was rated poorly. Diagnostic confidence was about the same as for film. Exceptions were magnetic resonance imaging (MRI) US, and plain film. Up to 10% of cases are unreadable because of poor image quality, not enough images, or inadequate patient history. Overall, the radiologists are satisfied, although some improvements can be made.
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