Guest: Dushyant Sahani, MD Host: Jason Birnholz, MD More often, the diagnosis of causes of upper abdominal pain and specialty triage of patients as necessary has become the province of the radiologist. How do radiologists best approach diagnosis and management for these patients, and what factors underlie positive interactions between referring physician and radiologist for this common clinical problem? Host Dr. Jason Birnholz is joined by Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to examine the radiology of upper abdominal pain and the expanding role of the radiologist.

Advances in Medical Imaging

The Radiology of Upper Abdominal Pain

Host: Jason Birnholz, MD Guest: Dushyant Sahani, MD Autoimmunity has been identified in over 100 separate diseases. Depending on the target tissues, these disorders may be systemic, localized, or perhaps somewhere in between. The characteristics of autoimmune pancreatitis represent one such example of diffuse-to-localized disorders, and is the subject of this discussion. New forms of imaging enable us to map the inflammatory components of this and other diseases, often identifying conditions that were not part of the original differential diagnosis. How does this both aid and complicate management strategies for patients? Host Dr. Jason Birnholz welcomes Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to share insights and expertise on imaging autoimmune pancreatitis.

CT Imaging for Autoimmune Pancreatitis

Guest: Andrea Doria, MD, PhD, MSc Host: Jason Birnholz, MD In 1888, William Osler wrote in the Lancet the following: "In patients with suspected acute appendicitis, one should urge towards laparotomy. The indications for surgical interference are not always clear, but in my experience I have been taught that the abdomen is much more frequently left untouched than it should be, and that an operation is too often deferred until practically useless." Clearly, diagnosis of acute appendicitis has come a long way since then. But challenges remain in selecting the safest, most timely, and cost-effective diagnostic modalities for this condition. Dr. Andrea Doria, associate professor in the department of medical imaging at the University of Toronto School of Medicine, clarifies the use of ultrasound versus CT for evaluation of acute appendicitis in children. Dr. Jason Birnholz hosts.

Cost and Risk Analysis for Imaging of Acute Appendicitis in Children

Guest: Scott Holland, PhD Host: Jason Birnholz, MD Guest: Daniel Choo, MD Successful cochlear implantation has remarkable impact on quality of life for children with congenital and early onset hearing loss. How do clinicians best evaluate these children for likelihood of success with implants, and what are the imaging challenges when following up with these patients later on? Drs. Scott Holland and Daniel Choo from the University of Cincinnati examine new technologies on the horizon, from fMRI to near-infrared spectrophotometry, for screening and following candidates of cochlear implantation. In the process, they outline salient features of sensorineural hearing deficits and share the state-of-the-art in operative methods for implantation. Dr. Jason Birnholz hosts.

State of the Art in Cochlear Implantation Imaging

Guest: Stephanie Wilson, MD, FRCPC Host: Jason Birnholz, MD Many clinicians are well familiarized with standard contrast agents such as barium and iodinated compounds to enhance angiographic imaging. Ultrasound, capable of visualizing bloodflow with the use of doppler alone, is yet insufficiently sensitive to capture perfusion of organs and/or tumors at the capillary level. What special kinds of contrast enhancements are needed for ultrasound in this case? Dr. Stephanie Wilson, professor of medical imaging and obstetrics and gynecology at the University of Calgary in Alberta, Canada, discusses the science and art of using micro-bubble contrast agents, and the emergence of contrast-enhanced ultrasound (CEUS) as a safer alternative to traditional angiography. Dr. Jason Birnholz hosts.

The Science and Art of Micro-Bubble Contrast Agents

Guest: James B. Spies, MD Host: Jason Birnholz, MD It's not uncommon for women to report experiencing menstrual changes after having given birth two or more times. These changes include shorter cycles, increased cramping, and heavier bleeding, at times with clots. Such changes are hallmark signs of adenomyosis. Definitive diagnosis of adenomyosis can be made easily with MRI or ultrasound, but are there therapeutic options from interventional radiology as well? If so, can these methods replace hysterectomy? Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, joins host Dr. Jason Birnholz to resolve these questions.

Treating Adenomyosis: Alternatives to Hysterectomy

Host: Jason Birnholz, MD Guest: James B. Spies, MD Host Dr. Jason Birnholz and Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, look at fibroid tumors- their incidence and treatment. They discuss the populations in which there is a high prevalence, as well as genetic factors and the basics of interventional radiology protocol.

Rationales for Uterine Artery Embolization for Fibroids

Guest: J. Herman Kan, MD, FACR Host: Jason Birnholz, MD Pre-treatment MRI can eliminate unnecessary diagnostic or surgical procedures for children with suspected musculoskeletal infections. Host Dr. Jason Birnholz and Dr. J. Herman Kan, assistant professor of radiology at Vanderbilt University Medical Center, specializing in pediatric and adolescent radiology, discuss the application of MRIs and the results of his recent study which showed that a significant number of surgeries could be avoided with early MRI evaluation. Tune in to hear the valuable role MRI plays in the evaluation of musculoskeletal infection. 

Pediatric Musculoskeletal Infections: The Role of MRI

Guest: Sharlene Teefey, MD Host: Beverly Hashimoto, MD Dr. Sherry Teefey, professor of radiology at Washington University School of Medicine in St. Louis, discusses with host Dr. Beverly Hashimoto her experience in Bhutan and Uganda, teaching medical professionals how to use ultrasound and computed tomography and enhancing current techniques. Tune in to hear the challenges to providing imaging services in these countries and the future goals to introduce new modalities and improve radiological services in third world countries.

Radiological Services in the Third World

Guest: Sharlene Teefey, MD Host: Beverly Hashimoto, MD Ultrasound images of the musculoskeletal system provides pictures of muscles, tendons, ligaments, joints and soft tissue throughout the body. Dr. Sherry Teefey, associate professor of radiology at Washington University School of Medicine in St. Louis, discusses with host Dr. Beverly Hashimoto some of the common uses for this procedure. Dr. Teefey also discusses the application of musculoskeletal ultrasound in conjunction with aspiration or injection. Tune in to hear the benefits and limitations of diagnostic musculoskeletal ultrasound.

Musculoskeletal Ultrasound Applications

Guest: Fiona Gilbert, MD, MBChB, DMRD Host: Jason Birnholz, MD Dr. Fiona Gilbert, Roland Sutton Chair of Radiology at University of Aberdeen Institute of Medical Sciences, discusses her research findings that showed that the rate of breast cancer detection by two experts reading a mammogram was the same as one expert aided by a computer. Dr. Gilbert explains to host Dr. Jason Birnholz that, unlike in the United States, it is normal practice in the United Kingdom for two trained readers to examine mammograms. Tune in to hear how computer-aided detection is likely to improve breast cancer detection in those countries where a single reader is used, as well as improve efficiencies in countries that require two readers. 

Breast Cancer Screening: Improved Readings With Computers

Host: Beverly Hashimoto, MD Guest: Jonn Cronan, MD, FACR Thanks to extremely sensitive ultrasound technology, thyroid nodules are being detected and treated at unprecedented rates. Host Dr. Beverly Hashimoto welcomes Dr. John Cronan, professor of diagnostic imaging at the Brown University School of Medicine and chairman of the diagnostic imaging department at Rhode Island Hospital, to discuss the phenomenon of over-treatment of thyroid nodules. Is this pattern of care helping or harming our patients? 

A Closer Look at Thyroid Ultrasound

Guest: Roee Lazebnik, MD, PhD Host: Jason Birnholz, MD Developments in ultrasound technologies yield superior image quality.  But these new technologies are also designed to maximize information density– minimizing acquisition time, decreasing analysis time, and simplifying reporting. Dr. Roee Lazebnik, a radiologist with a PhD in biomedical engineering, employed by Siemens Healthcare, explains to host Dr. Jason Birnholz how the new ultrasound imaging equipment gives greater information density by increasing the amount of clinical information derived from an image.  

Ultrasound: Medical Efficiency for the 21st Century

Guest: Vicki Noble, MD Host: Beverly Hashimoto, MD Dr. Vicki Noble, director of the Division of Emergency Ultrasound at Massachusetts General Hospital in Boston, discusses with host Dr. Beverly Hashimoto the importance of ultrasound in the critical care setting.  In the emergency department, ultrasound can improve the physican's ability to administer appropriate treatment during the crucial "golden hour" of trauma.  Dr. Noble also discusses six additional applications for ultrasound in the emergency department.

Ultrasound in Emergency Medicine

Host: Beverly Hashimoto, MD Guest: Beryl Benacerraf, MD More than amazing images, the utility of three dimensional ultrasound images in obstetrics is expansive, according to guest Dr. Beryl Benacerraf, director of obstetrical ultrasound at Massachusetts General Hospital. Dr. Benacerraf and host Dr. Beverly Hashimoto talk about the ability of volume imaging to capture an image of the uterus from a coronal view, a view that is critical for assessment but could not be obtained through traditional portals of entry prior to 3-D imaging. Dr. Benacerraf also illuminates the diagnostic benefits of other display modalities permitted by volume imaging, such as surface renderings and tomographic cuts. 

Utility of 3-D Ultrasound Volume Imaging in Obstetrics and Gynecology

Medical imaging is an important healthcare topic that impacts physicians in all specialties. Understanding the recent dramatic advances in imaging technology, and their impact on clinical practice is essential for healthcare providers. Advances in Medical Imaging will provide the latest information on imaging topics from renowned experts in the field.

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Advances in Medical Imaging

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