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Mary Gospodarowicz - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance imaging mri for localization of the prostatic apex comparison to computed tomography ct and urethrography
Radiotherapy and Oncology, 1998Co-Authors: Michael Milosevic, S Voruganti, Ralph Blend, H Alasti, Padraig Warde, M Mclean, Pamela Catton, C Catton, Mary GospodarowiczAbstract:Abstract Background and purpose : It is necessary to include the entire prostate in the high dose treatment volume when planning radical radiation for patients with prostate cancer. We prospectively compared magnetic resonance imaging (MRI) to computed tomography (CT) and urethrography as means of localizing the prostatic apex. Materials and methods : Thirty patients with clinically localized prostate cancer had a sagittal T2-weighted MRI scan and a conventional axial CT scan performed in the treatment position prior to the start of radiotherapy. Twenty of these patients had a static retrograde urethrogram performed at simulation. The position of the MRI and CT apices were localized independently by two radiation oncologists. In addition, the MRI apex was localized independently by a Diagnostic Radiologist. The urethrogram apex, defined as the tip of the urethral contrast cone, was easily identified and was therefore localized by only one observer. Results : There was good interobserver agreement in the position of the MRI apex. Interobserver agreement was significantly better with MRI than with CT. There were no systematic differences in the position of the MRI and CT apices. However, the MRI apex was located significantly above and behind the urethrogram apex. There was poor correlation between MRI and CT and between MRI and urethrogram in the height of the apex above the ischial tuberosities. There was 83% agreement between MRI and CT and 80% agreement between MRI and urethrogram in the identification of patients with a low-lying apex. The apex, as determined by MRI, was Conclusions : MRI is superior to CT and urethrography for localization of the prostatic apex. All patients undergoing radiotherapy for prostate cancer should have localization of the apex using MRI or a technique of equal precision to assure adequate dose delivery to the entire prostate and to minimize the unnecessary irradiation of normal tissues.
Vincent M. Mellnick - One of the best experts on this subject based on the ideXlab platform.
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Traumatic abdominal aortic injury: clinical considerations for the Diagnostic Radiologist
Abdominal Radiology, 2018Co-Authors: Richard Tsai, Demetrios Raptis, Constantine Raptis, Vincent M. MellnickAbstract:Traumatic abdominal aortic injury (TAAI) is a severe complication of penetrating and blunt trauma with significant morbidity and mortality, particularly if diagnosis is delayed. In patients with life-threatening injuries, accurate and prompt diagnosis of TAAI can be made with computed tomography (CT). Once the diagnosis of TAAI is made, the Radiologist should provide an accurate description of the aortic lesion and the extent of injury in order to guide management whether it be non-operative, open aortic repair, or endoluminal stent repair. The purpose of this article is to review the key imaging aspects of TAAI and to discuss how the key CT imaging findings affect clinical management.
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acute traumatic aortic injury practical considerations for the Diagnostic Radiologist
Journal of Thoracic Imaging, 2015Co-Authors: Constantine A Raptis, Vincent M. Mellnick, Mark M Hammer, Kathleen G Raman, Sanjeev BhallaAbstract:The diagnosis of acute traumatic aortic injury (ATAI) relies heavily on accurate and efficient imaging interpretation, thereby making the Radiologist integral to the care of patients in whom these life-threatening lesions are suspected. Typically, this evaluation begins with the initial trauma radiograph, in which findings suggestive of mediastinal hematoma or ATAI can be detected. Definitive diagnosis of ATAI is made with the current gold standard, computed tomography, wherein indirect and direct signs of ATAI provide the means for sensitive and specific diagnosis. Although the diagnosis of ATAI on computed tomography can be straightforward, technical and anatomic pitfalls can complicate interpretation and must be understood. Once the diagnosis is made, the Radiologist needs to provide a meaningful report that includes an appropriate description of the lesion location and characteristics. The purpose of this article is to review the key aspects of the imaging evaluation of ATAI with a focus on factors that affect the management of these patients.
Joel Rubenstein - One of the best experts on this subject based on the ideXlab platform.
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impact of magnetic resonance imaging on gross tumor volume delineation in non spine bony metastasis treated with stereotactic body radiation therapy
International Journal of Radiation Oncology Biology Physics, 2018Co-Authors: Srinivas Raman, Lee Chin, Darby Erler, Eshetu G Atenafu, Patrick Cheung, William Chu, Hans Chung, Andrew Loblaw, Ian Poon, Joel RubensteinAbstract:PURPOSE This study investigates the inter-observer variability of contouring non-spine bone metastases using the planning CT alone vs. the addition of MRI T1 and T2 imaging sequences. METHODS AND MATERIALS 10 cases of non-spine bone metastases treated with SBRT at our institution were selected. The gross tumor volume (GTV) for each case was delineated by six SBRT radiation oncologists (RO) and one Diagnostic Radiologist (DR) on the treatment planning CT. After a minimum of three months, each case was re-contoured on the CT fused with a MRI T1 sequence followed by a MRI T2 sequence. STAPLE consensus contours were created from the RO volumes and inter-observer variability was measured using both κ agreement and the Dice coefficient (DSC). RESULTS In total, 180 RO contours were analyzed within three datasets (CT, CT + MRI T1 and CT + MRI T1 + MRI T2). The mean GTV was 16.95 cm3 (range, 0.12-269.6 cm3). The RO κ agreement was 0.6129 based on CT alone, and significantly increased to 0.7045 in the CT + MRI T1 (P = .042) dataset and 0.7017 in the CT + MRI T1 + MRI T2 dataset (P = .048). The mean DSC in the CT alone dataset was 0.7047, and significantly increased to 0.7628 in the CT + MRI T1 dataset (P < .001) and 0.7544 in the CT + MRI T1 + MRI T2 dataset (P = .001). There were no statistical differences in RO κ agreement (P = .948) or mean DSC (P = .573) when comparing the CT + MRI T1 and CT + MRI T1 + MRI T2 datasets. The DSC agreement between DR and RO volumes was lowest (0.6887) in the CT alone dataset and significantly increased to 0.7398 in the CT + MRI T1 dataset (P = .003) and 0.7342 in the CT + MRI T1 + MRI T2 dataset (P = .008). CONCLUSIONS The fusion of MRI T1 images to CT significantly reduced inter-observer variability amongst RO's in delineating non-spine bone metastases, and improved agreement between GTVs delineated by the RO to the DR.
Karen Andrews - One of the best experts on this subject based on the ideXlab platform.
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awareness of interventional radiology among patients referred to the interventional radiology department a survey of patients in a large canadian community hospital
Journal of Vascular and Interventional Radiology, 2007Co-Authors: Mark O Baerlocher, Murray R Asch, Gaurav Puri, Andrew Vellahottam, Andy Myers, Karen AndrewsAbstract:Purpose To quantify the level of knowledge about interventional radiology (IR) among patients referred for an IR procedure and to develop recommendations on how to increase public awareness of IR. Materials and Methods Paper surveys were prospectively administered to consecutive patients scheduled to undergo an IR procedure at a community hospital. The study was terminated at the accrual of 100 completed surveys. Results Totals of 28% and 6% knew generally the job of a Diagnostic Radiologist and interventional Radiologist, respectively, and 6% had heard of the field of IR before their referral (despite 21% having undergone a procedure previously). Before their arrival in the IR department, 87% had not received any information about IR. Three percent, 0%, 4%, 82%, and 82% had heard about uterine artery embolization, radiofrequency ablation, vertebroplasty, biopsy (any type), and angioplasty, respectively. After the procedures, 84% had a clearer view of what interventional Radiologists do, but 98% believed that most others did not know what IR was. When asked how best to educate the public about IR, the responses were: unsure (39%), other (19%), pamphlets (12%), information from physicians (9%), television (8%), and Internet (7%). Overall, the mean satisfaction rate was 8.8 (with 0 representing the minimum and 10 representing the maximum), and 97% would choose IR over surgery for future treatments. Conclusions These data quantify and strongly support the views that (1) even among patients specifically referred to IR for a procedure, the majority of people are unaware of what the field is or may offer; and (2) most patients were satisfied with their IR experience. Six results-based recommendations are made to increase public awareness about IR.
Mark D Mamlouk - One of the best experts on this subject based on the ideXlab platform.
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becoming a clinical Diagnostic Radiologist the answer is not clinically correlate
Journal of The American College of Radiology, 2012Co-Authors: Mark D MamloukAbstract:One would be hard pressed to dispute radiology’s dynamic role in health care, which has launched it to the forefront of medicine. However, in all of this, Radiologists have seemed to be growingly passive. Before PACS, clinicians were more dependent on Radiologists for image interpretation; there was an established Radiologist-clinician relationship. In the present era, clinicians more readily interpret their own studies [1]. This has led to less ommunication between the 2 paries, decreased education of cliniians on interpretations and protools, and the failure of Radiologists o act as image consultants [1]. These sobering facts emphasize the need for the emergence of a more refined Radiologist.