The CT vs MR debate, advice for residents

An interview with Dr. Semelka on the relative merits & demerits of CTVersus MRI-- one of the top articles of 2006. Check it out at http://www.medscape.com/viewarticle/530585?sssdmh=dm1.235597&src=top10#

Some interesting ultrasound cases

For those with an interst in fetal diagnostic ultrasound here's a site with some interesting cases posted by many Indian Radiologists. http://drjoea.googlepages.com/obstetric-2

Fast ripples as epilepsy biomarker

Read about this novel diagnostic technique-- a combination of fMRI and MEG that promises to be an accurate biomarker for epilepsy patients. Read about it on http://www.medscape.com/viewarticle/549299?src=mp

MR mammography in tumor recurrence

MR mammography is being developed as a technique for evaluation of breast tumor recurrence. Read the latest about the technique on http://www.medscape.com/viewarticle/548273_print

CCTA unplugged

A few words of caution for those who use advanced 3D and volume rendered images to report CT coronary angiogram images. You are advised to see the raw data to get the whole picture. Check it out on http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=74027&wf=1533&d=1

256 slice Coronary CT angiography

So you thought R & D slept after development of the 5 beat 64 slice CT scanner. Wrong. The images from a 256 slice CT scanner are now being evaluated at Japan. The scanner acquires in a single heartbeat and does not require ECG gating. Take a look at the new revolution in CCTA at http://www.auntminnie.com/index.asp?Sec=sup&Sub=cto&Pag=dis&ItemId=73904&wf=1513

fMRI in conversion disorder

fMRI was performed in women with hysteria (conversion disorder) with sensory impairment in a limb. fMRI showed absence of activity in sensory cortex area and high-lighting of the functional area controlling emotions. http://www.auntminnie.com/index.asp?Sec=sup&Sub=mri&Pag=dis&ItemId=73950&wf=1520

Over-diagnosis of Lung Ca

An introspective study which shows that 27% of lung tumours reported on screening CT's are over-diagnosed especially in women and the inter-observer variability in interpretation of these scans. Read all about it on http://www.medscape.com/viewarticle/548682

Call to serve where required

This is a very poignant appeal to physicians to serve at least short term assignments in under-priviledged areas. This should be a wake-up call for our fraternity in India who should also be encouraged to serve in Rural areas where their services are required and much in need. Read this appeal at http://www.medscape.com/viewarticle/547955?src=mp

MRSI of Prostate

Disappointing news for companies promoting MR spectroscopy of the prostate. In the largest multi-center trial on this topic presented at the RSNA 2006, results have shown no incremental benefit from MR Spectroscopy in detection or management of peripheral zone prostatic Ca. Tough luck for all those chaps who shelled out mega-bucks to purchase the endorectal coil and MRSI software for prostatic imaging. Read all about it at http://www.medscape.com/viewarticle/548599

The last hours of life

Medscape brings us a much acclaimed CME for clinicians on how to tackle the terminally ill patient. It is the best training for clinicians and should give our Radiology colleagues also an insight into how complicated the management of the terminally ill patient can be. If you are looking after your terminally ill parents or significant other this article is a must-read: http://www.medscape.com/viewprogram/5808_pnt

MR safety

Another great safety article on the MRI suite and how to provide centralised source of medical gases in order to prevent anesthesis related complications. Read all about it on: http://www.auntminnie.com/index.asp?Sec=sup&Sub=imc&Pag=dis&ItemId=73984&wf=1527

MRS after brain training

Irish researchers used MR spectroscopy to document the effects of a memory enhancement exercise in a population of senior citizens ... with some surprising results. Catch the excitement on Aunt Minnie TV at http://www.auntminnie.com/index.asp?sec=amtv&sub=29&ItemID=74014&wf=1531&d=1

MRI in Multiple sclerosis

The most comprehensive article to date on the role of MRI in multiple sclerosis is available at medscape. Catch the latest on http://www.medscape.com/viewprogram/6184_pnt

Meet the Robot Doctor

Dr. Aleksandr Kavokin is a moctor from Russia who has developed a computer programme using artificaial intelligence techniques to help diagnose disease from a remote location. He is also into blogging and runs some interesting sites. Meet him at http://www.medscape.com/viewarticle/545042?src=mp

MDCT-timing is vital

Read this study by Stanford University on how to achieve optimal contrast visualization by slowing down speed of acquisition of MDCT scans so that we don't out pace the contrast bolus on 16/64 slice CT scanners. Read all about it on http://www.auntminnie.com/index.asp?Sec=sup&Sub=cto&Pag=dis&ItemId=72560&wf=1284

Eggplant as a low cost breast phantom

So you thought you could only eat eggplant. Here's a group that has turned it into a low cost breast phantom to train residents for breast biopsy. I don't know if this will whet the residents' appetite for eggplant in the future. Check this out at http://www.auntminnie.com/index.asp?Sec=sup&Sub=res&Pag=dis&ItemId=72435&wf=1243

Knee MRI

The definitive guide to knee MRI, check it out at http://www.auntminnie.com/index.asp?Sec=sup&Sub=mri&Pag=dis&ItemId=72269&wf=1218

Alzheimer's disease

Read the latest on Alzheimer's disease, including imaging using a PET radio-ligand (PIB) and CSF bio-markers. Check this out on http://www.medscape.com/viewarticle/543817_1

Pancreatic imaging-recent advances

Read this detailed article on the use of advanced imaging technology for pancreatic disease. This includes the use of optical coherence tomography (OCT), contrast enhanced ultrasound, MDCT and MR spectroscopy in advanced evaluation of pancreatic disease. Check it out on http://www.medscape.com/viewarticle/543067?src=mp

Stem Cell Research

The latest in stem cell research talks about removing the blastomere, 2 days after IVF, so that killing of embryo does not take place. Read the New York Times article on http://www.nytimes.com/2006/08/24/science/24stem.html?th&emc=th

Brain tumors and difusion tensor imaging

Check out the latest concepts in delineation of spread of gliomas in the article : "Gliomas: Histopathologic Evaluation of Changes in Directionality and Magnitude of Water Diffusion at Diffusion-Tensor MR Imaging" by Andreas Stadlbauer et al in the latest edition of Radiology 2006;240 803-810, also available online at

http://radiology.rsnajnls.org/cgi/content/abstract/240/3/803?etoc

The article describes how fractional anisotropy is better than mean diffusivity for assessment and delineation of different degrees of pathologic changes (ie, tumor infiltration) in glioma.

Hepatic chemoembolizaton

read the latest on "Intraarterial Gene Delivery in Rabbit Hepatic Tumors: Transfection with Nonviral Vector by Using Iodized Oil Emulsion" byYoung Il Kim, et al in Radiology 2006;240 771-777 also available online at:

http://radiology.rsnajnls.org/cgi/content/abstract/240/3/771?etoc

The article describes how the authors developed DNA carrier complexes, by using iodized oil and iopamidol, that may be used as modifiers for intraarterial gene delivery. Absolutely cutting edge and exciting stuff. Full article can be accessed at IRIA HQ.

MR safety after coronary revascularization

Check out this article: "Acute Myocardial Infarction: Safety of Cardiac MR Imaging after Percutaneous Revascularization with Stents" by Manesh R. Patel, MD, et al ; reassuring as it tells us that MR imaging is safe in immediate post-stenting cases. read all about it in Radiology 2006;240 674-680 and access online at

http://radiology.rsnajnls.org/cgi/content/abstract/240/3/674?etoc

Diagnostic XRays causing cancer

This is the latest in the debate over whether diagnostic X-Rays or Ct cause cancer-- a very lucid review by Dr. Brant-Zawadski who finds it improbable to believe that a cancer could be caused by patients undergoing diagnostic CT or X-Ray. Check it out at http://www.medscape.com/viewarticle/542277?src=mp

Also read the latest editorial of Radiology "The ALARA (As Low As Reasonably Achievable) Concept in Pediatric Interventional and Fluoroscopic Imaging: Striving to Keep Radiation Doses as Low as Possible during Fluoroscopy of Pediatric Patients—A White Paper Executive Summary" byKeith J. Strauss and Sue C. Kaste inRadiology 2006;240 621-622. Check it out online at

http://radiology.rsnajnls.org/cgi/content/full/240/3/621?etoc

Full copy of this article is available at IRIA HQ.

A must read dialogue between Dr. Ronai & Dr. Semelka on radiation risk form diagnostic X-rays and CT discusses whether a risk of 1 in 1000 of developing cancer after a CT scan is realistic or alarmist. Read all about it on http://www.medscape.com/viewarticle/542696?src=mp

The latest in the debate on radiation risk from MDCT, a radio-biologist gives his scientific analysis of the problem and virtually shrugs off the problem as causing insignificant risk of future cancer. Read all about it on http://www.medscape.com/viewarticle/543008?src=sr

The doomsayer strikes back. Dr. Semelka counters the criticism from his peers and advises caution in CT studies. Read about it on http://www.medscape.com/viewarticle/542555?src=sr

BZ replies again saying radiation is Godlike. Read about it on http://www.medscape.com/viewarticle/542317?src=sr

GBM therapy

Cellular Signaling Molecules as Therapeutic Targets in Glioblastoma Multiforme.
Jay Jagannathan, M.D et al.
Another cutting edge article on latest state-of-the-art nanotechnology for treatment of GBM at the cellular level-- very exciting stuff-- catch all the action on medscape at http://www.medscape.com/viewarticle/540153_print

Overweight doctors

Read this wonderful article on how and why doctors should control their weight through community policing, because it sets a bad example for the pathents whom we are counselling to reduce weight. Catch this article at medscape on: http://www.medscape.com/viewarticle/541443?src=mp

Thoracic Imaging

Pulmonary Circulation: Contrast-enhanced 3.0-T MR Angiography—Initial Results1 Kambiz Nael, MD et al.
An article that describes preliminary results using CEMRA for evaluation of pulmonary circulation. read more about it at http://radiology.rsnajnls.org/cgi/content/abstract/2403051076v1?papetoc

All full text articles on Radiology can be accessed at IRIA HQ at New Delhi for your reference needs.

History of Radiology

A new editorial on Medscape showcases an essay by a 1st year medical student giving her take on the history of radiology and the dangers of radiation, which are coming back to haunt us in the current era of MSCT as well. Absolutely gripping stuff. Read it at: http://www.medscape.com/viewarticle/536109?src=mp

Don't worry, be happy

Read it to the very end .
A great note for all to read it will take just 37 seconds to read this and change your thinking

Two men, both seriously ill, occupied the same hospital room. One man was allowed to sit up in his bed for an hour each afternoon to help drain the fluid from his lungs. His bed was next to the room's only window. The other man had to spend all his time flat on his back.

The men talked for hours on end. They spoke of their wives and families, their homes, their jobs, their involvement in the military service, where they had been on vacation. Every afternoon when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window. The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and color of the world outside.

The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every color and a fine view of the city skyline could be seen in the distance. As the man by the window described all this in exquisite detail, the man on the other side of the room would close his eyes and imagine the picturesque scene. One warm afternoon the man by the window described a parade passing by. Although the other man couldn't hear the band - he could see it. In his mind's eye as the gentleman by the window portrayed it with descriptive words.

Days and weeks passed. One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away.

As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone. Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside. He strained to slowly turn to look out the window beside the bed. It faced a blank wall. The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window.

The nurse responded that the man was blind and could not even see the wall. She said, "Perhaps he just wanted to encourage you."

Epilogue:
There is tremendous happiness in making others happy, despite our own situations.
Shared grief is half the sorrow, but happiness when shared , is doubled.
If you want to feel rich, just count all the things you have that money can't buy.
"Today is a gift, that's why it is called the present."

Someone sent me this by email, so I can't acknowledge the author.

Neck pain: an unusual presentation of a common disease

by A C Pankhania, MBChB, MRCS et al

Check out this article in the British journal of radiology, using the high wire press journal link on www.iria.in to get complete access. The complete article is at http://bjr.birjournals.org/cgi/content/full/79/942/537 I hope you won't miss the suspense if I tell you that this article describes the findings in Spinal Gout.

CCTA radiation dose

A fresh look by Aunt Minnie on how to reduce the radiation dose in Coronary CT angiography performed on MSCT scanners. Good control of heart rate and use of ALARA (as low as reasonably achievable) radiation parameters is the key. Read all about it at http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=71608&wf=1062

Screening for coronary/ carotid artery disease
Also read this article recommending mass screening of asymptomatic persons from 45-75 years age for CAD/ Carotid calcific plaques developed by the SHAPE (Screening for Heart Attack Prevention and Education) Task Force, a group of cardiologists and researchers organized by the Association for Eradication of Heart Attack. The article is available at http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=71684&wf=1071&d=1

Radiology outsourcing

The average American may adopt a "What me worry" attitude about Radiology outsourcing to India, but at heart they are a wirried lot, despite the fact that strict licencing requirements necessarily restrict the amount of work outsourced. Read about it in the New York Times on http://econblog.aplia.com/2006/04/why-dont-we-outsource-more-radiology.html

Original research

Absolute cutting edge research in the latest (July 2006) edition of Radiology journal--M. Beth McCarville et al write about "Angiogenesis Inhibitors in a Murine Neuroblastoma Model: Quantitative Assessment of Intratumoral Blood Flow with Contrast-enhanced Gray-Scale US "

Their results support the hypothesis that gray-scale US measurements of microbubble contrast agent flow can be used to measure the functional consequences of antiangiogenic therapy in orthotopic tumors, and, at least to some degree, they reflect histologic changes in tumor vascularity. Radiology 2006 240: 73-81 (DOI: 10.1148/radiol.2401050709). Contrary to the previous use of US contrast with doppler/ power doppler images the authors have used grey scale US to assess tumors. Read about this at http://radiology.rsnajnls.org/cgi/content/abstract/240/1/73
The full text article is available at IRIA HQ and can be viewed only at IRIA house.

There is also an editorial about this research in the same issue: "Will Improved Assessment of Response to Antiangiogenic Therapies Be Achieved with Contrast-enhanced Gray-Scale US?" authored by Jonathan B. Kruskal

Evidence based imaging

Check out this fantastic CME on medscape on the appropriateness of imaging modalities at http://www.medscape.com/viewprogram/4462?src=sr

Also see this great CME on Imaging Screening and Wellness: What to Tell Patients and Referring Clinicians by Bruce J. Hillman, MD . The article talks about various screening strategies for patients in times of wellness and finds most of them to be cost-ineffective except for Calcium scoring for coronary artery disease, CT virtual colonoscopy for colon cancer and CT Chest for Lung Ca. Whole body CT screening is an absolute no-no. Read more about this on http://www.medscape.com/viewprogram/5499_pnt

MR in spondylolisthesis

Dynamic Degenerative Lumbar Spondylolisthesis: Diagnosis With Axial Loaded Magnetic Resonance Imaging
Posted 05/30/2006
Prakash Jayakumar, MBBS, BSc (Hons); Colin Nnadi, FRCS (Eng); Asif Saifuddin, MRCP, FRCR; Emer MacSweeney, FRCR; Adrian Casey, FRCS
Check out this article on a brand new technique of axial loaded MR to detect degenerative spondylolisthesis which can otherwise be detected on erect XRays but may get missed on a routine MRI without axial loading. Read about it on:
http://www.medscape.com/viewarticle/532037?src=mp

Percutaneous Vertebroplasty

From Spine
Percutaneous Vertebroplasty: Functional Improvement in Patients With Osteoporotic Compression Fractures
Posted 05/30/2006
Luis Álvarez, MD; María Alcaraz, MD; Antonio Pérez-Higueras, MD; Juan J. Granizo, MD; Ignacio de Miguel, MD; Roberto Rossi, E.; Diana Quiñones, MD

Check out this article at http://www.medscape.com/viewarticle/532038?src=mp

The article talks about how percutaneous vertebroplasty significantly improves functional quality of life in patients with osteoporotic compression fractures.

Cardiac CT us Vs. them

Check out a new artice on Medscape regarding cardiac CT using the link http://www.medscape.com/viewarticle/533036?src=mp
It's interesting to see that physicians world-over are reluctant to prescribe CCTA because the patient may require a conventional catheter angio later and this may just add to his lifetime radiation exposure.

Also see an an interview on Cardiac MR--use it or lose it, on turf battles between cardiologists and radiologists on the use of Cardiac MR. Check it out at http://www.medscape.com/viewarticle/528832?src=sr

Another article on relative and absolute contraindications for CCTA is an absolute must-read for those who are interested in or performing CCTA. Read it at aunt minnie http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=71696&wf=1073&d=1

A comparison between MR and CT for assessment of coronary arteries gives CT a definitive edge. Check this out at http://www.auntminnie.com/index.asp?Sec=sup&Sub=cto&Pag=dis&ItemId=72438&wf=1243

aunt minnie

Read further about this on auntminnie.com


When MRI throughput means more than revenue 4/11/2006 Tobias Gilk writes that centers in Canada are overloaded with patients and have huge back-logs. His contention is that proper management of patient appointments and the MRI protocols could drastically reduce this back-log.

CT Radiation Update

CCTA radiation dose
A fresh look by Aunt Minnie on how to reduce the radiation dose in Coronary CT angiography performed on MSCT scanners. Good control of heart rate and use of ALARA (as low as reasonably achievable) radiation parameters is the key. Read all about it at http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=71608&wf=1062

Radiation reference levels
A new article on dose reduction for routine CT scanning is a multicenter study that proposes reference levels of radiation dose and methods of dose reduction, albeit maintaining diagnostic confidence. See it before print in Radiology at http://radiology.rsnajnls.org/cgi/content/abstract/2403050993v1?papetoc

Radiology outsourcing

Radiology outsourcing
The average American may adopt a "What me worry" attitude about Radiology outsourcing to India, but at heart they are a wirried lot, despite the fact that strict licencing requirements necessarily restrict the amount of work outsourced. Read about it in the New York Times on http://econblog.aplia.com/2006/04/why-dont-we-outsource-more-radiology.html

BJR abstract

British Journal of Radiology (2006) 79, 285-294
Review article
What are the risks from medical X-rays and other low dose radiation? B F Wall, BSc, G M Kendall, PhD, A A Edwards, MSc, S Bouffler, PhD, C R Muirhead, PhD and J R Meara, FFPH
Health Protection Agency, Radiation Protection Division, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon. OX11 0RQ, UK
This article outlines the risks of long-term low dosage radiation. Check it out....
Full text on http://www.iria.in/ using High Wire Press Journals link-- free all over India

Journal Updates

radiologist india
Check out this full article on http://www.iria.in/ using the High Wire Press Journals link

British Journal of Radiology (2006) 79, 368-371© 2006

Acute adverse reactions to magnetic resonance contrast media – gadolinium chelates A Li, MBChB, FRCR et al

This article reviews the adverse reactions to MR contrast media and finds them just as safe as previous studies have documented

Neck pain: an unusual presentation of a common disease
by A C Pankhania, MBChB, MRCS et al Check out this article in the British journal of radiology, using the high wire press journal link on http://www.iria.in/ to get complete access.
The complete article is at http://bjr.birjournals.org/cgi/content/full/79/942/537 I hope you won't miss the suspense if I tell you that this article describes the findings in Spinal Gout.

Indian Radiologist

The Indian Radiological and Imaging Association is a National association of radiology and imaging professionals and has a membership of about 6000 members nation-wide.
We have created our web-site www.iria.in for the benefit of the Indian radiologist practicing or studying Radiology in India.
The site has been designed as a complete information portal with the History and Constitution of the Indian Radiological and Imaging Association and links to various Radiology and Imaging sites for Radiology Education.
All the latest Radiology news and controversies are published in an online Newsmagazine. An interactive radiology quiz and CME are also published on this site.
There are links to the Indian Journal of Radiology & Imaging web-site and the web-site of Indian College of Radiology and Imaging is incorporated in the IRIA web-site.

For more details pls visit www.iria.in