Development of an IHE MRRT-compliant open-source web-based reporting platform.

OBJECTIVES: To develop a platform that uses structured reporting templates according to the IHE Management of Radiology Report Templates (MRRT) profile, and to implement this platform into clinical routine. METHODS: The reporting platform uses standard web technologies (HTML / JavaScript and PHP / MySQL) only. Several freely available external libraries were used to simplify the programming. The platform runs on a standard web server, connects with the radiology information system (RIS) and PACS, and is easily accessible via a standard web browser. RESULTS: A prototype platform that allows structured reporting to be easily incorporated into the clinical routine was developed and successfully tested. To date, 797 reports were generated using IHE MRRT-compliant templates (many of them downloaded from the RSNA's radreport.org website). Reports are stored in a MySQL database and are easily accessible for further analyses. CONCLUSION: Development of an IHE MRRT-compliant platform for structured reporting is feasible using only standard web technologies. All source code will be made available upon request under a free license, and the participation of other institutions in further development is welcome. KEY POINTS: • A platform for structured reporting using IHE MRRT-compliant templates is presented. • Incorporating structured reporting into clinical routine is feasible. • Full source code will be provided upon request under a free license.

Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries.

OBJECTIVE: To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. METHODS: This study included a total of 125 patients treated in the chest pain unit during a 39-month period. Each included patient underwent MRI within a median of 3 days after cardiac catheterization. The MRI protocol comprised cine, oedema-sensitive and late gadolinium-enhancement imaging. The standard of reference was a consensus diagnosis based on clinical follow-up and the synopsis of all clinical, laboratory and imaging data. RESULTS: MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hypertensive heart disease, hypertrophic CM, cardiac amyloidosis and non-compaction CM. MRI-based diagnoses were the same as the final reference diagnoses in 113/125 patients (90%), with the two diagnoses differing in only 12/125 patients. In two patients, no final diagnosis could be established. CONCLUSION: CMR performed early after the onset of symptoms revealed a broad spectrum of diseases. CMR delivered a correct final diagnosis in 90% of patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. ADVANCES IN KNOWLEDGE: Diagnosing patients with acute coronary syndrome but unobstructed coronary arteries remains a challenge for cardiologists. CMR performed early after catheterization reveals a broad spectrum of diseases with only a simple and quick examination protocol, and there is a high concordance between MRI-based diagnoses and final reference diagnoses.

[Reporting initiatives. An update on treatment in radiology]. / Reporting Initiatives. Ein Update zur Befundung in der Radiologie.

The written radiological report is the most important means of communication between the radiologist and the referring medical doctor. There is no universal definition of a radiological report concerning its structure and content. The majority of clinicians and radiologists prefer structured reporting rather than free text reports of findings. Structured reporting does not increase the quality of a radiological report but has many advantages in research, teaching and quality management. Using standard RadLex terms facilitates translation and ontological assignment of a report. The Reporting Initiative of the Radiological Society of North America (RSNA) offers free and freely available extensively validated best practices radiology report templates in the new management of radiology report templates (MRRT) format according to the guidelines of the Integrating the Healthcare Enterprise (IHE).

Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula.

OBJECTIVE: Herein we report our experience in placement of endovascular stentgrafts in the descending aorta in patients with acute bleeding complications due to traumatic rupture or aortobronchial fistula. METHODS: Six patients (one woman, five men, mean age 47+/-19 years) were treated from September 1995 to February 2000 by implantation of endovascular stentgrafts in the descending aorta. Indications included traumatic ruptures of the aortic isthmus (n=3) and aortobronchial fistulas (n=3). All procedures were performed under general anaesthesia. The implants were introduced under fluoroscopic guidance via the aorta (n=1), the iliac (n=4) or femoral (n=2) artery, respectively. RESULTS: All aortobronchial fistulas and ruptures were sealed up successfully. There was no perioperative morbidity and no procedure-related morbidity except one patient who received aortofemoral reconstruction because of iliac occlusive disease. All patients are alive and well after a mean follow-up of 31 months (range 6-60). Two patients had recurrent hemoptysis, in one case, the patient received a second implant (distal extension), the other patient was managed conservatively. CONCLUSION: Endovascular treatment by a stentgraft is a safe and reliable procedure in the management of acute bleeding complications in patients with aortic rupture or aortobronchial fistulas.

Subcutaneous implantation metastasis of a cholangiocarcinoma of the bile duct after percutaneous transhepatic biliary drainage (PTBD).

Percutaneous transhepatic biliary drainage (PTBD) is the basis for most biliary interventional procedures. We recently observed the occurrence of a subcutaneous implantation metastasis after PTBD in a patient with incurable cholangiocarcinoma. Although tumor cell seeding along the catheter tract is a very rare complication, we think that PTBD should be avoided when curative resection is planned.

Aneurysms complicating inflammatory diseases in immunocompromised hosts: value of contrast-enhanced CT.

We studied the value of contrast-enhanced CT in the detection of aneurysms in immunocompromised patients suffering from inflammatory diseases eventually complicated by hemorrhage. Contrast-enhanced spiral CT was applied in three patients with immunocompromise due to chemotherapy, alcohol abuse or HIV. They suffered from invasive aspergillosis, chronic pancreatitis with pseudocyst formation, and acute pancreatitis together with HIV-associated lymphadenopathy. Complicating hemorrhage was present in two cases. Contrast-enhanced CT showed aneurysms complicating the underlying inflammatory disease in all three cases. The feeding vessels were identified and the patients with signs of bleeding were subsequently referred for angiography and embolization. Contrast-enhanced spiral CT is suited to detect aneurysms in immunocompromised patients suffering from inflammatory disease. It is recommended in these patients prior to angiography and intervention.