The new effective tool for data migration from old PACS (Rogan) to new PACS (Fuji Synapse) with integrated Thai patient names.

OBJECTIVE: To investigate consuming time and amount of data transfer for PACS data migration from the existing system to a new one by using new developed software tools. MATERIAL AND METHOD: The authors have developed a migration tool for PACS data migration and integrated Thai names into a new PACS by the following steps. First, look up the existing database table for hospital number (HN) and image names for each series number. Second, directly retrieve image from storage. Third, get the Thai name by searching HN from the hospital information system (HIS). Then, send the new study to the new PACS via hospital level 7 (HL7) message. Finally, send images to the new PACS. RESULTS: The data were migrated from the existing PACS, integrated Thai name and sent them to the new PACS. The total migrated images of CR, CT and MR were 296,269, 692,860 and 42,941 images respectively. The average migrated images per series for CR, CT and MR were about 1.01, 89.84 and 15.53 images in successive order. The consuming time for data migration of CR, CT and MR were 685.8, 283.4 and 34.8 hours, respectively. CONCLUSION: The authors successfully developed new application tool for PACS migration that used to migrate data from the existing PACS to the new one, which are powerful and highly flexibility tools, and including patient Thai name in patient information during data migration.

Spiral CT in the diagnosis of pulmonary embolism.

Objective: To evaluate the usefulness of spiral computed tomography (CT) in the diagnosis of pulmonary embolism (PE). Methods: A retrospective study was performed on 52 patients who underwent CT angiography (CTA) using spiral CT at our department from May 2000 to August 2003. A thoracic radiologist who was blinded to the database reviewed the radiological findings in all examinations from clinical data. A final diagnosis of PE was made by clinical conclusion from all other investigations, laboratory results and treatment outcome. Results: From 52 cases recruited into the study, 24 cases were suspected of PE before the examinations. Sixteen cases resulted in a final diagnosis of PE with acute PE in 7 cases and chronic PE in nine. The CTA correctly diagnosed PE in eleven cases, two cases were false-negative; CTA was proven to indentify PE that were detected through conventional angiography. Seventeen lesions of intraluminal filling defects were found, two of which were main pulmonary arteries (PA), four lobar and eleven segmental PA. The CT findings of clots consisted of six complete filling defects, two central clots and nine eccentric clots. The other findings, such as intraluminal web, calcification of clots, enlarged vessels and irregular thickening of vessel walls, were also demonstrated. Ancillary findings found in this study were atelectasis, oligemia, mosaic pattern and pleural effusion. Conclusion: Spiral CT is a useful method for the diagnosis of PE.

CT criteria for differentiation between true and false lumen in aortic dissection.

Acute aortic dissection can be an emergency event characterized by the splitting of tunica media of the aortic wall by high pressure arterial blood throught an intimomedial tear: The CT imaging is a currently emerging technique for dianosis and evaluation of aortic dissection and has sensitivity and specificity of nearly 100%. The differentiation between true and false lumens of aortic dissection is important for percutaneous treatment with endovascular grafts or surgical repair: Previous studies described CT criteria to distinguish true from false lumens. The most reliable sings in this study are outer wall calcification, intraluminal thrombus, eccentric flap calcification, a larger area at one-quarter distance, and a larger area at one-half distance.

The cost-effectiveness of chest radiography as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.

Regular screening with chest radiography (CXR) in an annual physical check up of the elderly is most frequently practiced. This study aimed to identify the CXR indices and the cost-effectiveness of CXR as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities of Bangkok around Siriraj Hospital. The gold standard for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated, completed spirometry and a CXR. The selected nine indices from PA and lateral CXR for diagnosing COPD were based on the presence of hyperinflation. The positive criteria of each index were reported. The cut-off point of best average accuracy ie, Z score of the CXR was 0.07 with a sensitivity of 75.9 per cent (95% CI 70.2-81.6%), specificity of 72.4 per cent (95% CI 70.8-74.0%) and the best average accuracy of 74.1 per cent (95% CI 72.5-75.7%) whereas the cost-effective cut-off point of a Z score of CXR as a screening test for COPD was 0.04 at the lowest grand total cost. The cost to detect one case of COPD was 2,008 baht and needed to screen 17 elderly. It is suggested that CXR is probably not a suitable screening test for COPD in the elderly due to the complicated derivation of the CXR indices. However, its efficacy may be of some value in in-office diagnosis of COPD.

Bronchial artery embolization for massive hemoptysis.

Hemoptysis, when massive and untreated, has a mortality rate of more than 50%. Therefore, significant hemoptysis calls for swift detection of the anatomic source of the hemorrhage so that definite therapy can be initiated to stop bleeding. Bronchoscopy, chest roengenography and CT scans may point to the likely source of the hemorrhage. Since the bronchial circulation is the major source of hemoptysis, therapeutic embolization of bronchial arteries can be performed to stop bleeding. Angiographic and clinical data from 30 patients (35 sessions) with hemoptysis who were referred for embolotherapy between 1998-2002 were retrospectively reviewed. The most frequent causes of hemoptysis were tuberculosis (66%), bronchiectasis (11%) and other various conditions resulting in bronchpulmonary anastomoses (11%). The bronchial embolization was attempted in 27/35 sessions with percentage grading successful rate of embolization. Recurrent hemoptysis could be as high as 100% if the initial embolization success rate was less than 50%. Overall, 14/27 patients suffered a bleeding relapse. Note that nine of these patients experienced a bleeding relapse within 30 days, whereas the rest occurred more than 30 days after embolization. Note that, repeat embolization can be performed safely.

Treatment of hepatocellular carcinoma by injection of iodine*131-labelled lipiodol into the hepatic artery.

The therapeutic efficacy iodine*131-labelled Lipiodol was studies in the treatment of hepatocellular carcinoma (HCC). The results of the treatment were evaluated for four aspects: size of the tumour; serum alphafetoprotein level ; the quality of the patient’s life;and the survival rate. The hepatocellular carcinoma was diagnosed by evidence of mass in the liver using either computed tomography or ultrasonography with tissue biopsy and/or a high level of alphafetoprotein of more than 500 U. Twenty patients were randomized into two groups for comparison. The patients in group A were treated by intrahepatic injection of iodine*131-labelled Lipiodol 60 miliCuries(mCi). The patients in group B were treated by intra-hepatic injection of a mixture of Lipiodol and chemotherapeutic agents, mitomicin c 20 mg. and 5-fluoracil 500 mg., followed by selective hepatic artery embolisation of small pieces of gelatin sponge (gelfoam). Both groups were evaluated by computed tomography (CT) and the possible repeat of treatment protocol after two months. There were no serious side-effects or major complications in either group of patients. The patients’ conditions worsened by 40 percent in both groups. The tomours’ sizes remained unchanged by 50 percent in both groups. The serum alphafetoprotein levels had increased by 40 percent in group A, and remained unchanged by 50 percent in group B. The survival rates at one and two years in group A were 20 and 20 percent, and in group B there were 30 and 0 percent, respectively. Satisfactory results were obtained in the treatment of small HCC, size less than 5 cm. with intra-hepatic artery injection of iodine*131-labelled Lipiodol. In large HCC (>10cm) no response by the tumour was seen in either group. This was the first study of this type performed in Thailand.

Evaluation of new ovarian cancer markers, STN, CA 546 and CA 72-4 in Thai patients.

Ovarian cancer is the most fatal gynaecologic malignance. At present, there is no sensitive test to detect early stages of the disease. In our study of 32 ovarian cancer patients admitted in Siriraj Hospital, 3 new tumor makers, STN, CA 546 and CA 72-4 were selected to evaluate for their sensitivity as compared with CA 125 Kit. The best positive rate for non-mucinous type of ovarian cancer was 82% obtained from the CA 125 test while the result for mucinous type was 67% obtained from a combined test of CA 125 and STN. As a requirement for early diagnosis, tests using CA 125 or CA 72-4 showed best sensitivity of 33% in early stages of non-mucinous, while CA 546 test revealed the highest result of 33% for mucinous type. Thus, the combination of new tumor marker assay of STN, CA 546, CA 72-4 together with CA 125 would increase sensitivity in detecting ovarian cancer especially for the mucinous type which is more common in Thailand.