Sonographic physical diagnosis 101: teaching senior medical students basic ultrasound scanning skills using a compact ultrasound system.

This project was designed to test the feasibility of introducing ultrasound to senior medical students as a primary diagnostic tool in the evaluation of patients. Specifically, its aim was to determine if it is possible for medical students untrained in sonography to gain basic competence in performing abdominal ultrasound with limited didactic and hands-on instructions. Registered sonographers provided the students with hands-on instructions on the use of a compact ultrasound system. They were likewise shown how to evaluate specific organs and perform measurements. The results of the student measurements and those obtained by the sonographers were compared. There was close correlation between the results obtained by sonographers and students on both normal and abnormal findings. This supports the concept that medical students can be taught basic ultrasound skills with limited didactic and hands-on instructions with the potential of using these skills in the patient clinics as an adjunct to routine physical diagnosis.

Interdepartmental problem-solving as a method for teaching and learning systems-based practice.

RATIONALE AND OBJECTIVES: Systems-based practice (SBP) has been the most difficult competency to implement in radiology residency programs, and methods for teaching and learning SBP concepts are needed. Because systems problems are usually multifactorial, a multidisciplinary approach is required. In our institution, survey data indicated patient dissatisfaction with emergency care. Prolonged wait times for radiology procedures were identified as a systems problem. When hospital administration asked the emergency medicine and radiology departments to work together to improve patient care, residents had a "real-world" opportunity to achieve the SBP competency. MATERIALS AND METHODS: Systems problems were identified and categorized. Data on patient transport were collected. Accurate time logs documenting when studies were ordered, performed, and interpreted were maintained. Data were analyzed at interdepartmental meetings and three improvements were planned and implemented. RESULTS: A direct line of communication was established between radiology and emergency medicine via a dedicated cellular telephone. A joint emergency medicine/radiology teaching conference was established. Additional transport personnel were employed. Residents in both departments increased their understanding of their role in the health care system, demonstrated an ability to identify systems problems and appropriately implement improvements, and enhanced their professional relationships. CONCLUSION: This innovative method integrated educational goals with patient care goals, was grounded in "real-life" experience, and held residents accountable for results. Competence in SBP, patient care, professionalism, and interpersonal and communication skills were demonstrated. We recommend this approach as an efficient and effective way to integrate SBP into everyday clinical practice.

Early detection of bone infection and differentiation from post-surgical inflammation using 2-deoxy-2-[18F]-fluoro-D-glucose positron emission tomography (FDG-PET) in an animal model.

Diagnosing bone infection in the context of post-surgical inflammation is problematic since many of the early signs of infection are similar to normal post-surgical changes. We used a rabbit osteomyelitis model to evaluate the use of 2-deoxy-2-[(18)F]-fluoro-d-glucose positron emission tomography (FDG-PET) as a means of detecting post-operative infection in the context of post-surgical inflammation. Comparisons were made between infected and non-infected rabbits in which infection with Staphylococcus aureus was initiated at the time of surgery. Weekly PET scans were obtained 30 and 60 min after the introduction of FDG and analyzed based on standardized uptake values (SUV) at the surgical site and visual assessment of the presence or absence of infection. Concurrent X-rays were taken immediately prior to scanning. At 4weeks post-operatively, animals were sacrificed for histologic and bacteriologic confirmation of infection. Uptake of FDG was evident in the bone of all rabbits on day 1 post-surgery, however, SUV comparisons from the surgical site could not be used to distinguish between the infected and uninfected groups until day 15. Visual analysis of FDG-PET scans revealed a significant difference (p<0.01) between the infected and uninfected groups as early as day 8. This was due in part to the ability to visualize regional lymph nodes by FDG-PET.

Introduction to PET imaging with emphasis on biomedical research.

Medical imaging is migrating from anatomic imaging to functional imaging and fused anatomic/functional imaging. The technology is being adapted for biomedical research using both clinical and small animal scanners. The ability to externally image real-time physiologic processes in both normal and deranged conditions, including various models to image gene expression, apoptosis, or drug biodistribution, has powerful impact on the exploration of biomedical and fundamental biological research. Positron emission tomography (PET) has a unique ability to not only provide such images but also to do so with high resolution (typically 1-2mm resolution for small animal scanners) and to provide both relative and absolute quantitation. This technology is revolutionizing biomedical and biological research. This article reviews the underlying principles involved in this technology, gives a brief history of its development, and then introduces the interested researcher to some of the important techniques that could be of use.

Does electron beam computer tomography provide added value in the diagnosis of coronary artery disease?

PURPOSE OF REVIEW: Electron beam computer tomography (EBCT) is increasingly being used to diagnose coronary artery disease (CAD) in the asymptomatic patient. The aim of this review is to assess the current findings concerning EBCT in the diagnosis and prognostication of CAD. RECENT FINDINGS: Review of the English language peer-reviewed medical literature for EBCT was done with emphasis on the diagnosis and prognosis of CAD. SUMMARY: The goal of risk stratification is to limit aggressive and costly care to group of high-risk patients. EBCT has been used to track the progression of coronary atherosclerosis periodically. Studies have shown that the calcium score will increase from 18 to 22% per year and depends on the age, sex and renal function. Patients with end-stage renal disease have much higher counts. Because it is cheap and noninvasive, EBCT has been used to assess the effects of medications on velocity of increase in the calcium scores. There is concern about radiation for its use long term to assess the calcium score increase over a long period of time.