2008 Reference Manual for Magnetic Resonance Imaging

Cardiotext Price: $70.00Availability: In stock. Usually ships within 24 hours. Rush shipping available.Product Information:
ISBN-13: 9780974641041
ISBN-10: 0974641049
Publisher: BRPG
Format: Paperback, 600 pages
Pub Date: 01/2008

http://www.mrisafetybook.com/

 

http://www.cardiotext.com/full.html?isbn=9780974641041

Microsoft Smater EMR

Microsoft Envisions Smarter EMR Interfaces

Filed under: Informatics

 

Microsoft engineers are working on developing visual interfaces for electronic medical records (EMR), and have setup a website to help with brainstorming and demonstrating different ideas using Microsoft’s Common User Interface platform powered by Silverlight, the company’s high powered version of Adobe Flash.

From Microsoft Health’s Patient Journey Demonstrator:

The Patient Journey Demonstrator conceptualizes an end-to-end journey where a specific clinical scenario is used to illustrate how an integrated, patient-centric care record can transition seamlessly between care settings. It demonstrates how data can be accessed and entered from many of the care sources experienced along the patient journey.In this scenario, a man with suspected heart disease is examined by his family doctor. Using decision support tools, his doctor decides that the best course of action is to refer him for further tests. The scenario then tracks the activities that take place from the initial consultation through secondary care to an Angiogram.

Silverlight 2.0 Beta 1 is required to run the Patient Journey Demonstrator. Please click on “Install Microsoft Silverlight”

Supported Operating Systems and Browsers

• Windows Vista with Internet Explorer 7 and Firefox 1.5+
• Windows XP SP2 with Internet Explorer 6+, and Firefox 1.5+
• Windows Server 2003 (excluding IA-64) with Internet Explorer 6+, and Firefox 1.5+
• Windows 2000 with Internet Explorer 6
• Mac OS 10 4.8+ (Intel-based) with Firefox 1.5+ and Safari

 

Neuroarm does first surgery

I was wondering about this neuroarm after I wrote about it a while back. I am glad to see that they are getting some use out of all that technology. I would hate to see it go to waste. Here is some information about what Doctors in Canada are doing with this Robotic arm.

Surgeons at the Foothills Medical Centre in Canada performed the first procedure using the neuroArm microsurgery device, when they removed a tumor from the brain of a 21 year old woman.

We’ve reported about the neuroArm, a robot, developed at the University of Calgary, capable of operating inside an MRI machine’s magnetic field, in the past (see here, here, and here).

From a University of Calgary press release:

Paige Nickason, 21, is recovering after having a tumour removed from her brain with the assistance of neuroArm, a surgical robotic system developed by a team led by Dr. Garnette Sutherland, a Calgary Health Region neurosurgeon and professor of neurosurgery in the University of Calgary Faculty of Medicine.”I had to have the tumour removed anyway so I was happy to help by being a part of this historical surgery,” says Nickason, from her hospital room less than 24 hours after the surgery.

neuroArm is the world’s first MRI-compatible surgical robot capable of both microsurgery and image guided biopsy. The surgical robotic system is controlled by a surgeon from a computer workstation, working in conjunction with intraoperative MR (magnetic resonance) imaging. Dr. Sutherland developed the intraoperative MRI machine with Winnipeg-based IMRIS Inc. The technology allows a high field MRI scanner to move into the operating room on demand, providing imaging during the surgical procedure without compromising patient safety.

Einstien’s quote of the day

He who can no longer pause to wonder and stand rapt in awe, is as good as dead; his eyes are closed.

 

picture credit(http://www.flickr.com/photos/jogorman/)

Aquilion one 3rd install Beth Israel Boston

“The Aquilion ONE has the potential to provide a single, comprehensive exam that can replace a variety of duplicative and invasive procedures,” added Dr. Raptopoulos. “Its versatility and ability to diagnose disease fast will be used within our radiology department to detect and treat life-threatening conditions, including cancer, heart disease, stroke and other neurovascular conditions.”

 

To get impressed, head on to the Aquilion ONE Clinical Movie Theatre at Toshiba, and check out some of the studies presented there…

 

Cardiac: Coronary artery bypass evaluation acquired using Aquilion ONE.

Chantix- Quit Smoking or Die trying

The Federal Aviation Administration (FAA) ruled on Wednesday that “Chantix was no longer acceptable for use by pilots and controllers,” FAA spokesperson Les Dorr tells WebMD. And the Federal Motor Carrier Safety Administration — the branch of the U.S. Department of Transportation that oversees trucking and busing — has told medical advisors that Chantix use could put the brakes on an interstate truck or bus driver’s medical fitness for duty.

The FDA has been analyzing reported adverse events — including suicidal thoughts and suicidal behavior — in Chantix users since late last year.

“In November, we had put on the [Chantix] label a precaution about use when operating heavy machinery,” Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research, tells WebMD. 

The FAA knows of about 150 pilots and 30 air traffic controllers taking Chantix or have taken the drug in the past, notes Dorr, adding that the FAA told pilots and air traffic controllers to stop taking Chantix and to wait 72 hours before going back to work or flying.

In November 2007, the FDA announced that it was investigating reports of suicidal thinking, aggressive and erratic behavior, and drowsiness in people taking Chantix. At the time, the FDA advised patients to use caution when driving or operating machinery until they knew how Chantix may affect them. The FDA also stressed that it didn’t yet know if Chantix was responsible for those problems.

In February 2008, FDA officials noted that they have received nearly 500 reports of suicidal thoughts, behaviors, and completed suicides in people taking Chantix. Those reports don’t prove that Chantix was to blame for suicidal thinking, behaviors, or suicides. The FDA warned people taking Chantix that they might have trouble driving or operating heavy machinery.

Meanwhile, the FDA asks doctors and patients to report adverse events from Chantix — or any other drug — to the FDA’s MedWatch program.

This is shows how powerfull drug companies like Pfizer continue to turn a profit even at the sacrifice of others. Pfizer updated the Chantix web site with a “new safety information” link, dated May 2008, about reported mood changes, suicidal thoughts or behaviors, and cautions about driving or using heavy machinery. That information is already on the Chantix label.

 

 

 

NEJM- Starr-Edwards Heart Valve

This is a great case. showing the durable Starr-Edwards Heart valve in action. Check out the images and video at there site NEJM.  video

Check out MRI safety of this Valve here.

or

MRI safety.com

hypertensive encephalopathy

Background

Hypertension affects more than 60 million Americans. With adequate control, fewer than 1% of patients experience a hypertensive crisis. Hypertensive crisis is classified as hypertensive emergency or hypertensive urgency. Acute or ongoing vital target organ damage, such as damage to the brain, kidney, or heart, in the setting of severe hypertension is considered a hypertensive emergency. It requires a prompt reduction in blood pressure within minutes or hours. The absence of target organ damage in the presence of severe elevation of blood pressure with diastolic blood pressure frequently greater than 120 mm Hg is considered hypertensive urgency, and it requires reduction in blood pressure within 24-48 hours. A continuum exists between the clinical syndrome of hypertensive urgency and emergency; hence, their distinction may not always be clear and precise.

In 1928, Oppenheimer and Fishberg introduced the term hypertensive encephalopathy to describe the encephalopathic findings associated with the accelerated malignant phase of hypertension. The terms accelerated and malignant were used to describe the retinal findings associated with hypertension. Accelerated hypertension is associated with group 3 Keith-Wagener-Barker retinopathy, which is characterized by retinal hemorrhages and exudates on funduscopic examination. Malignant hypertension is associated with group 4 Keith-Wagener-Barker retinopathy, which is characterized by the presence of papilledema, heralding the neurologic impairment from an elevated intracranial pressure.

Hypertensive encephalopathy describes the transient migratory neurologic symptoms associated with the malignant hypertensive state in hypertensive emergency. The clinical symptoms usually are reversible with prompt initiation of therapy. In the evaluation of an encephalopathic patient, exclude systemic disorders and various cerebrovascular events that may present with a similar constellation of clinical findings.

Pathophysiology

The clinical manifestations of hypertensive encephalopathy are due to increased cerebral perfusion from the loss of blood-brain barrier integrity, resulting in exudation of fluid into the brain. In normotensive individuals, an increase in systemic blood pressure over a certain range (ie, 60-125 mm Hg) induces cerebral arteriolar vasoconstriction, thereby preserving a constant cerebral blood flow and an intact blood-brain barrier.

In chronically hypertensive individuals, the cerebral autoregulatory range gradually is shifted to higher pressures as an adaptation to chronic elevation of systemic blood pressure. This cerebral autoregulatory response is overwhelmed during a hypertensive emergency in which the acute rise in systemic blood pressure exceeds the individual’s cerebral autoregulatory range, resulting in hydrostatic leakage across the capillaries within the central nervous system. With persistent elevation of the systemic blood pressure, arteriolar damage and necrosis occur. The progression of vascular pathology leads to generalized vasodilatation, cerebral edema, and papilledema, which clinically manifest as neurologic deficits and altered mentation in hypertensive encephalopathy.

Frequency

United States

Of the 60 million Americans with hypertension, fewer than 1% of patients develop a hypertensive emergency.

Mortality/Morbidity

The morbidity and mortality associated with hypertensive encephalopathy are related to the degree of target organ damage. Without treatment, the 6-month mortality rate for hypertensive emergencies is 50%, and the 1-year mortality rate approaches 90%.

Race

The frequency of hypertensive encephalopathy corresponds to the occurrence of hypertension in the general population. Hypertension is more prevalent in black people, exceeding the frequency in other ethnic minority groups. The incidence of hypertensive encephalopathy is lowest in white people.

Sex

Hypertension is more prevalent in men than in women.

Age

Hypertensive encephalopathy mostly occurs in middle-aged individuals who have a long-standing history of hypertension.

Case Report

A 77-year-old man with a past medical history of hypertension,

a greater than 100 pack-year history of tobacco smoking, and right

internal carotid artery 90% stenosis was admitted to our institution

after new onset dysarthria and inappropriate behavior. His neurological

examination showed left hemineglect, confusion, and a

blood pressure of 250/150 mm Hg. In addition, there was prominent

dysarthria and dysphagia, with characteristic bulbar features

of hypophonia and oropharyngeal weakness. There was no seizure

activity, headache, or visual changes. Laboratory studies were unremarkable

(sodium 139 mM/l) except for a creatinine of 2.5 mg/dl

(baseline). He underwent MRI ( fi g. 1 c, d) which showed T2-weighted

hyperintensities in bilateral posterior cerebral white matter as

well as in the pontine and ventral medullary white matter, which

had not been observed on prior neuroimaging ( fi g. 1 a, b). DWI

showed no evidence of cytotoxic edema (data not shown). The patient

was transferred to the cardiac care unit, where with aggressive

blood pressure control, his confusion, hemiparesis and neglect

promptly improved over days. The dysarthria and dysphagia also

improved over the ensuing 2 weeks. Serial MRIs were performed

that showed interval resolution of prior white matter abnormalities

( fi g. 1 e, f); these fi ndings correlated with his clinical improvement.

On discharge, he no longer required a nasogastric tube for feeding,

his speech was no longer dysarthric, and he had returned to his

functional baseline.

Discussion

Hypertensive encephalopathy is a disease entity that has recently

been well characterized in the literature. A broader category

for this neurological syndrome has been coined: reversible posterior

leukoencephalopathy or PRES  . Besides acute severe hypertension,

several other conditions have been associated with PRES,

including renal disease, immunosuppressive and cytotoxic drugs,

collagen vascular disorders such as systemic lupus erythematosus,

ecclampsia, and hematological disorders, including thrombotic

thrombocytopenic purpura or hemolytic uremic syndrome. On MRI, the most

commonly observed characteristics include hyperintensities

on the T2 -weighted sequences in the parietal and occipital

and isointense or hyperintense signals on apparent

diffusion coeffi cient maps, suggesting a vasogenic edema pattern

While the exact underlying mechanism of PRES is unknown,

there are two prevailing theories regarding its pathogenesis and

predilection for areas of the brain supplied by the posterior circulation.

The most widely accepted theory proposes that the myogenic

component of autoregulation in the posterior circulation, with its

sparse sympathetic innervation, becomes overwhelmed by either

elevated blood pressure or endothelial toxins, leading to a capillary

leak phenomenon and vasodilatation, resulting in vasogenic

rather than cytotoxic edema [. In contrast, another theory hypothesizes

that at elevated blood pressures or from endothelial toxins,

the autoregulatory system overcompensates, resulting in decreased

blood fl ow, ultimately resulting in ischemia and therefore cytotoxic

edema 

GE’s new 3T MRI scanner MR750

Simply Powerful, Powerfully Simple It’s MR beyond boundaries, giving you every edge. Break free from traditional 3.0T scanning – powerfully, precisely, productively. Just for starters, we’re talking about a complete liver study in a 15-minute time slot, or the breast images you need in only two sequences. No more “what ifs” – it’s time for “right nows.”

The strongest whole-body gradients – the most powerful in the industry – and the new gold standard in body, breast and MSK imaging… now that’s powerfully simple MR.

 

 

Break the Bonds: Start from a Position of PowerThe Signa® MR750 3.0T’s stunning new technologies take 3.0T imaging to a new level. This remarkable technology allows you to focus on what’s most important – patients.

The most reliable 3.0T magnet, the Signa® MR750 3.0T is built around GE’s third-generation short-bore, superconducting 3.0T magnet – proven to deliver high homogeneity for excellent results…even in large or off-center FOV imaging, fat saturation techniques and high-performance applications such as cardiac, fMRI, diffusion tensor and spectroscopy. Other technical breakthroughs include:

• Sophisticated real-time SAR optimization.

• Unique heat extraction gradient architecture for faster acquisitions and fewer slowdowns.

• Exclusive OpTix optical RF technology for greater SNR.

• ARC, accelerated parallel imaging.

• Faster reconstructions.

• Anatomy-optimized RF coils and arrays.

• Easily scalable for future expansion.

 

 

Break Away: Routine Exams Faster, Advanced Exams Routine

As the most efficient scanner available, every scan is a study in speed. Conduct in-room patient set up in as little as 30 seconds and start scanning in just a few simple steps. The Signa® MR750 3.0T makes routine exams faster than the industry standard, and advanced exams routine.

 

The Signa® MR750 3.0T is designed around clinical workflow needs with a strong focus on improving productivity, such as:

• Automated clinical applications mean fewer steps to faster studies.

• A high-resolution color in-room operator console (iROC) equals quick exam set up.

• The Express Patient Table offers one-time patient transfer, comfort and operational efficiency. Two 32-channel surface coil connections integrated right into the table can simplify patient preparation outside the scanning room.

• With a simple, one-handed motion, the integrated arm boards can be optimally positioned to support the patient for injections and transport.

• Located to the left and right of the scanner bore, the dual-sided controls let you operate the scanner from either side of the patient table.

• Start scanning in just a few simple steps with IntelliTouch patient positioning.

• The system gives patients a quick, easy, and comfortable MR experience.

The strongest whole-body gradients – the most powerful in the industry – deliver incredible 50mT/m gradient field on each axis (X, Y and Z) simultaneously, plus a slew-rate of 200 T/m/s combined with OpTix – an exclusive optical RF technology. The result: higher accuracy and more reproducible scans. Additionally, you’ll experience up to 60% more anatomical coverage and resolution per unit time, 27% more SNR and faster reconstruction speeds. What’s more, enjoy the new gold standard in body, breast and MSK imaging.

Clinical Break Down: Fresh Vision, New Clarity

Thanks to unprecedented temporal system stability and high signal-to-noise, the subtle brain activation signal treats in the foreground and can be captured much more reliably. The Signa® MR750 3.0T delivers routine, accurate, repeatable fMRI studies with 60% more spatial resolution in the same scan time and with reduced number of paradigm repetitions.
Combining multiple series into one, VIBRANT – IDEAL helps reduce exam time and ensure “can’t miss” fat suppression in breast studies. With no need for shimming and ARC parallel imaging on the Signa® MR750 3.0T, your productivity benefits are substantial.

This system is ready for clinical prime time. Read about the details behind this remarkable technology.

• With Cube, you can more easily reformat sub-millimeter isotropic 3D volume image data from a single acquisition into any plane-axial, sagittal, coronal or oblique – with no gaps or loss of resolution. New, self-calibrated ARC parallel imaging engine speeds up the acquisition, while eliminating aliasing even in small FOV imaging.

• 3D MERGE: Generating excellent gray-white matter contrast in the spinal cord without sacrificing SNR, this high-definition, 3D application acquires 1 mm slices in a clinically relevant scan time, enabling reformats in different planes.

• Time of Flight imaging on the Signa® MR750 3.0T gives you more -more spatial resolution and more contrast between the flowing blood and the surrounding tissue- for more small vessel detail more confident diagnoses.

• Providing exceptionally uniform, consistent fat suppression across the entire image in a very large field of view, LAVA-IDEAL produces four contrasts in just one acquisition, for confident diagnoses and fewer repeat exams.

• Now delivering improved performance, which lets you more than double the slices or alternative to acquire more diffusion directions in the same scan time, DTI/FiberTrak lets you visualize white matter trajectories in the brain.

Gastric Tumors

Gastric tumors may be classified as benign or malignant on the basis of their biologic behavior; epithelial and mesenchymal tumors may be similarly classified on the basis of their origin. More than 95% of malignant tumors of the stomach are adenocarcinomas . The remaining malignant tumors include lymphoma, sarcoma (eg, malignant gastrointestinal stromal tumor), carcinoid tumor, metastasis, and so on. Between 85% and 90% of gastric tumors are benign . About half of these benign tumors are mucosal lesions (mostly hyperplastic or adenomatous polyps) and about half are mesenchymal tumors .
Mesenchymal tumors of the gastrointestinal tract are divided into two broad groups. The first group consists of tumors that are identical to those arising in the somatic soft tissue. These include smooth muscle tumors (eg, leiomyoma, leiomyosarcoma), neural tumors (eg, schwannoma, neurofibroma, plexosarcoma), lipocytic tumors (eg, lipoma, liposarcoma), tumors originating from vascular and perivascular tissues (eg, glomus tumor, hemangioma, lymphangioma), and other tumors . The benign neoplasms in this first group are composed of well-differentiated mesenchymal cells. The second group is far larger and more important and consists primarily of spindle cells or epithelioid cells, which are different from typical somatic soft-tissue tumors and are unique to the gastrointestinal tract. These lesions are called gastrointestinal stromal tumors and constitute the largest category of primary nonepithelial neoplasms of the stomach . Previously, many lesions in this group were erroneously referred to as leiomyoma or leiomyosarcoma .
Although these lesions demonstrate different histologic findings, the overlap of radiologic findings in many gastric tumors makes differentiation difficult. Clinical manifestations also overlap and can vary from severe abdominal pain and acute abdomen to vague signs such as weight loss and anemia. Therefore, some gastric tumors cause diagnostic confusion, which may result in unnecessary surgery or inappropriate follow-up. However, some unusual gastric tumors have characteristic radiologic features that may suggest a specific diagnosis.
Computed tomographic (CT) and barium imaging is often used to diagnose unusual gastric tumors including lipoma, schwannoma, glomus tumor, lymphangioma, Brunner gland hamartoma, carcinoid tumor, and lymphoma. In the CT evaluation of gastric lesions, water is often used as a negative oral contrast agent. Water is particularly well-suited for use as a gastric contrast agent because it has a relatively low attenuation (0–10 HU), which optimizes visualization of the enhancing gastric wall at CT and results in good gastric distention . Adequate gastric distention can be achieved with about 500–1000 mL of water . Find many examples of these tumors at Radiographics.com.

A Case of Advanced Gastric Cancer Resembling Submucosal Tumor of the Stomach

Abdominal imaging has come a long way for MRI. These images are some that I took of a patient with a tumor in the stomach. We have been able to shorten our scan time to make it possible to aquire nice abdominal images in one breath hold.