Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction: assessment with CT, US, and US-guided fine-needle aspiration biopsy.

The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and palpation were compared, and US-guided fine-needle aspiration biopsy of nodes with a small axis of 5 mm or greater was performed. Supraclavicular metastases were detected on CT scans in 11 of 13 patients (85%) and on US scans in 14 of 16 patients (88%) but were palpable in only three of the 16 patients (19%). The predictive value of a supraclavicular node indicating metastases was .74 at US and .85 at CT. Metastases were diagnosed in 10 of 46 patients with squamous cell carcinoma (22%) and five of 50 patients (10%) with adenocarcinoma. Nodes with metastases had a round configuration, with a statistically significant greater short-axis to long-axis ratio than that of benign nodes (0.89 vs 0.54; P = .05). In four of 16 patients (25%) with supraclavicular metastases proved with cytologic examination, neither CT nor US of the mediastinum and abdomen showed enlarged nodes.

Evaluation of abdominal lymph nodes by ultrasound.

To evaluate the significance of sonographically detected abdominal lymph nodes, the medical records of 100 consecutive patients with abdominal lymphadenopathy were reviewed. The number of lymph nodes, their localizations, dimensions, shape, and architecture were recorded. One hundred ninety-four lymph nodes were found in 63 patients known to have a malignancy; 68 lymph nodes were found in 37 patients with benign diseases. The localization, size, shape, and architecture of all lymph nodes were evaluated. Of the different variables we studied in the evaluation of the abdominal lymph nodes, echogenicity, shape, age of the patient, and a periaortic localization are helpful in the differentiation between benign and malignant involvement. There remains a considerable overlap; in these cases fine-needle aspiration biopsy is the method of choice to establish the diagnosis.

Clinical evaluation of a medical image management system for chest images.

The clinical efficacy and physicians' assessment of a medical image management system (MIMS) for chest images that involved the medical intensive care unit (MICU) and the radiology department were evaluated. A token-passing fiber-optic network was implemented to connect display stations in the MICU and in the chest reading area in the radiology department with a laser film digitizer and an archiving system. To study the clinical efficacy of this system, blocks of 8 weeks during which portable chest images were digitized and immediately made available in the MICU were alternated with blocks of 8 weeks during which film images only were available. Approximately 3000 portable chest examinations were tracked; patients were entered into the study at a rate of 65 per month. Data on time intervals associated with the examination process were collected from MICU physicians, radiologists, radiographers, and film librarians. The time from the completion of an examination to the time an action was taken that was based on radiographic findings showed significant reductions during the digital periods for certain actions. For example, the time to begin drug therapy decreased from a mean of 4.7 hr when films were viewed to a mean of 3.3 hr when digital images were viewed. In conclusion, if prompt action by the MICU physician improves a patient's outcome, a positive effect on patient care will result from the immediate availability of radiographic images.

Improved financial management of the radiology department with a microcosting system.

The basic unit of service in radiology is the examination or procedure and its associated costs such as film, medical and surgical supplies, personnel, equipment depreciation, and overhead. The appropriate allocation of all operating costs to the specific examination types is the purpose of the microcosting system. Microcosting programs use data from hospital expense and payroll systems and data from a radiology information management system. These data are loaded into a computer spread sheet program for the microcosting computations. The results from using this system include better understanding of costs, accurate budget projections, confidence in negotiating discounts, and improved efficiency and reduced costs.

Design of a medical image management system: a practical cost-effective approach.

The impact of technology and economics is driving radiology departments into a digital era. There have been significant developments in the design of Medical Image Management System components. However, many important design criteria have been neglected, leading to an ineffective end product. This paper will discuss the more important design criteria. The design will be considered from the user's point of view. The implementation of a prototype Medical Image Management System (MIMS) serving a Medical Intensive Care Unit in our Institution will be presented. The structure and very preliminary results of a clinical evaluation will be discussed. Plans to expand the MIMS beyond the Department and the Hospital will also be briefly discussed. The role of the personal computer in the design of a MIMS will be reviewed.

Value of CT in the preoperative assessment of lung cancer: a survey of thoracic surgeons.

Practicing thoracic surgeons were randomly surveyed to evaluate how computed tomography (CT) has influenced the preoperative evaluation of bronchogenic carcinoma. Thirty-six percent of the 529 respondents routinely requested CT and 62% did so selectively. Approximately 40% indicated that CT provided useful information in most cases. Nearly all surgeons (98.7%) do not rely on the identification of enlarged lymph nodes with CT to spare the patient surgical staging; however, 77.5% are influenced by CT results in their staging procedures. Fifty-seven percent reported that a negative CT study eliminates surgical staging entirely unless the patient has a "coin lesion," in which case 75% are willing to proceed directly to thoracotomy. For surgeons who use CT selectively, an abnormal mediastinal contour on the radiograph was the most frequent radiologic abnormality to prompt CT (85%). Thirty-seven percent are influenced by tumor histology in their decision to request CT. There was little difference in the pattern of CT use between university and community hospital surgeons.

The Unibed patient monitoring system: a new approach for a new technology.

The Unibed patient monitoring system represents a new approach to the design of medical instrumentation based upon recent advances in microcomputer and related large-scale integration technology. This system is intended to replace an entire range of traditional monitoring devices with a single general-purpose unit capable of recognizing the nature of the signal source and performing appropriately. All of the usual switches, knobs, dials, and meters have been replaced by a touch-sensitive character display. The hardware responsible for physiological signal analysis, information display, and user interaction is actually a set of firmware modules implemented in terms of microcomputer programs. This firmware gives the system its functional personality and transforms it from a compact process-control system into a useful medical instrument. Prototypes are now being clinically tested and evaluated at the Dijkzigt Academic Hospital, Rotterdam, Netherlands.