Despite its widespread use, liver US has several important limitations that healthcare providers should recognize, particularly because of its low sensitivity. Using a combination of echographic parameters, liver US showed a significant improvement in its diagnostic performance, but still was of limited value for monitoring treatment over time.

The recent proliferation of multi-detector row computed tomography (CT) has led to an increase in the creation and interpretation of images in planes other than the traditional axial plane. Powerful three-dimensional (3D) applications improve the utility of detailed CT data but also create confusion among radiologists, technologists, and referring clinicians when trying to describe a particular method or type of image. Designing examination protocols that optimize data quality and radiation dose to the patient requires familiarity with the concepts of beam collimation and section collimation as they apply to multi-detector row CT. A basic understanding of the time-limited nature of projection data and the need for thin-section axial reconstruction for 3D applications is necessary to use the available data effectively in clinical practice. The axial reconstruction data can be used to create nonaxial two-dimensional images by means of multiplanar reformation. Multiplanar images can be thickened into slabs with projectional techniques such as average, maximum, and minimum intensity projection; ray sum; and volume rendering. By assigning a full spectrum of opacity values and applying color to the tissue classification system, volume rendering provides a robust and versatile data set for advanced imaging applications.

Of 29 patients who had ablation of hepatic tumors adjacent to the diaphragm, five (17%) had diaphragmatic injury, which was clinically apparent with right shoulder pain.

The transition to filmless radiology is a much more formidable task than making the request for proposal to purchase a (Picture Archiving and Communications Systeml PACS. The Department of Defense and the Veterans Administration have been pioneers in the transformation of medical diagnostic imaging to the electronic environment. Many civilian sites are expected to implement large-scale PACS in the next five to ten years. This presentation will relate the empirical insights gleaned at our institution from a large-scale PACS implementation. Our PACS integration was introduced into a fully operational department (not a new hospital) in which work flow had to continue with minimal impact. Impediments to user acceptance will be addressed. The critical components of this enormous task will be discussed. The topics covered during this session will include issues such as phased implementation, DICOM (digital imaging and communications in medicine) standard-based interaction of devices, hospital information system (HISl/radiology information system (RIS) interface, user approval, networking, workstation deployment and backup procedures. The presentation will make specific suggestions regarding the implementation team, operating instructions, quality control (QC), training and education. The concept of identifying key functional areas is relevant to transitioning the facility to be entirely on line. Special attention must be paid to specific functional areas such as the operating rooms and trauma rooms where the clinical requirements may not match the PACS capabilities. The printing of films may be necessary for certain circumstances. The integration of teleradiology and remote clinics into a PACS is a salient topic with respect to the overall role of the radiologists providing rapid consultation. A Webbased server allows a clinician to review images and reports on a desk-top (personal) computer and thus reduce the number of dedicated PACS review workstations. This session will focus on effective strategies for a seamless transition. Critical issues involve maintaining a good working relationship with the vendor, cultivating personnel readiness and instituting welldefined support systems. Success depends on the ability to integrate the institutional directives, user expectations and available technologies. A team approach is mandatory for success. Copyright © 1998 by~B. Saunders Company T HE GOAL OF THIS PRESENTATION is toprovide a framework for a seamless transition from a traditional radiology department and fileroom to a PACS for a large institution without substantially diminishing services during this period. This opinion is derived from experience implementing one of the largest PACS in the world. Analogous to a HIS and a RIS, a PACS is a hospital system and should be viewed as such by the hospital administration, medical information systems (MIS) personnel, referring health care providers (HCP), nurses, technologists and radiologists.The methodology for transition to a PACS will be considered in a strategical and t...

The US military has been investigating methods for improving radiographic support for field medical operations. The purpose of this project was to develop and test a portable digital radiography (DR) system to determine its feasibility for field operations. A prototype portable digital radiography device was designed and assembled using a commercially available DR sensor. The sensor and necessary hardware were mounted into a ruggedized aluminum case. The device underwent testing in the hospital and field environments. The prototype rapidly provided digital radiographs in a variety of settings. Shortcomings of the device affecting usability and reliable operation were identified. The successful construction and operation of a portable digital radiography prototype shows that such a device is feasible for field applications. The prototype requires further modification and testing to improve its usability and reliability, and to explore other potential applications, both military and civilian.