Embolization of cerebral aneurysm (cerebral aneurysm embolization) by neuroimagen.info

Embolized aneurysm
I just had to share this fine work with my followers, I think this micro-embolization is amazing! what skill! Such technique and level of patience to pull this off. WOW!  Check out more here http://laneuroimagen.blogspot.com.es/
We extend our archive of imaging with these two angiographic images , which were obtained during and after embolization of aneurysms of the saccular branch of the anterior cerebral artery would be appreciated. In the image on the left you can see the end of the radiopaque marker microcatheter positioned within the aneurysm prior to placement of the coils . The right image shows the final result once embolized the aneurysm and removal of the microcatheter inside.

SIIM: Radiology providers should not ignore social media

source Aunt Minnie

Social media is important to a radiology department or practice because it’s a marketing tool with the potential to reach millions. It can help healthcare providers communicate with patients and physicians, delivering focused, timely messaging to target audiences and generating dialogue in ways that conventional websites cannot.

For a medical specialty that is invisible to some patients and misunderstood by many others, social media provides a way for radiologists to more directly connect with their constituents, and the tools can be used to enhance brand awareness with referring physicians, according to Dr. Safwan Halabi of Henry Ford Health System.

“This is free advertising,” he said. “It expands your sphere of impact. You can use it to deliver timely, engaging, entertaining, informal, thought-provoking information. You can begin a dialogue with patients and potential patients who want to communicate the way they prefer to communicate: right now, when they want to, with texting and tweeting. Don’t ignore this opportunity.”

Develop a plan

Like all marketing tools, it’s important to develop a strategic plan. A radiology department needs to identify its target markets and create a communications plan for each of them. It doesn’t hurt to look at what the competition is doing — or, for that matter, what anyone else in the world is doing, as social media has no boundaries. Develop a competitive analysis portfolio, he urged.

Halabi also offered the following suggestions:

    • Allocate staff to use social media. It’s time consuming to generate content, and when you start a social media dialogue, someone has to be at the other end to respond.
    • Create a daily or weekly plan to stay fresh; stagnant sites don’t get revisited. The impact is worse if a Facebook page is stagnant.
    • Incorporate blogging.
    • Create a form of measurement to analyze the effects of your initiatives. Google Analytics is one excellent free tool.
    • Recommend and share content that originates from other sources. This isn’t considered plagiarism in the world of social media.


Crowdsourcing is defined by the Merriam-Webster dictionary as “the practice of obtaining needed services, ideas, or content by soliciting contributions from a large group of people and especially from the online community rather than from traditional employees or suppliers.”

It’s used by Johns Hopkins Medical Institutions to solve problems and make intelligent decisions. The powerful and versatile tool represents one way that social media can positively affect hospital operations.

Getting feedback from clinical users regarding new software has been a challenge for IT managers for decades. Dr. Carl Miller conducted a poll of SIIM session attendees to ask how many clinicians had participated in the latest software evaluation they’d undertaken.

Not surprising to him, the average number of clinicians with an opinion was three to five. “Now what if you could get dozens? Crowdsourcing has the power to do this,” he said.

Not having clinical input by future users can impede adoption and utilization of software programs, with costly results. Miller cited a $34 million mistake made by Cedars-Sinai Hospital in 2002, when a computerized physician order-entry (CPOE) system was implemented with minimal clinician input. The software was not a hit. In fact, the clinicians refused to use it.

“Few clinicians have the time to attend an onsite scheduled demo,” Miller said. “You need to bring the demo to the clinicians, make it convenient for them, and remind them repeatedly that their opinion is needed and they should participate. Online access and social media can make this happen.”

When selecting clinical viewing software for medical imaging, the evaluation team members at Hopkins first screened commercial offerings. The process included assessments of what platforms were the fastest and most convenient to use, and what they thought would meet the needs of clinicians at patients’ bedsides, doing rounds, or in their offices. They narrowed the selection to three viewers, and then set up simulations that could be assessed online.

A campaign was launched to invite clinicians to participate, to engage their interest, and to remind them to take a test drive because their opinions mattered. More than 300 participated, which included reviewing the simulations followed by a simple survey.

“The response was overwhelming and definitive,” he said. “One viewer got the overwhelming vote from the clinicians. It became very easy for us to make a decision, and we were confident that its adoption would be a success.”

The negative side of social media

Inappropriate comments through social media have cost otherwise vital employees their jobs at Indiana University Health. An appalling lack of common sense with a single tweet can have horrific repercussions.

Attorney Valita Fredland, associate general counsel and chief privacy officer, advised of an alarming number of events relating to inappropriate use of social media.

“The dark side of social media is that tweets and Facebook postings by employees are not controlled by a hospital and yet can do intense damage,” she said. “I see too many instances in which otherwise intelligent people do not use common sense.”

“Think of anything that you post in the following context: Would you want what you say displayed on a billboard adjacent to a freeway for the world to see?” Fredland asked.

She cited examples of residents’ posts that ended up being screen-captured and mailed to the hospital’s chief executive officer. The consequences for those individuals were dire.

“Don’t let a post be a career-breaker,” she warned. “It has that potential.”

She also pointed out that the law is very hazy about what an employer can legally do or not do. An example of this uncharted area is forcing employees to open their Facebook pages to access those of a friended colleague.

All healthcare facilities need to be proactive with education and policies for social media posting. The American Medical Association (AMA), among other organizations, offers guidelines. Employees and staff need to thoroughly understand how social media can violate HIPAA regulations.

It’s vital to continually monitor what is being said about one’s healthcare facility or practice, Fredland said. Patients’ comments can be very damaging, and they need to be responded to in a timely manner. At larger organizations, this is a full time job.

Everyone needs to remember that nothing disappears with social media, she emphasized.

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Regulate minimal MRI patient safety standards for all MRI facilities

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MRI systems exert powerfully invisible electromagnetic forces. The FDA Medwatch program shows a 500+% increase in reported MRI-related incidents/accidents since 2004. There are NO federal regulations overseeing MRI patient safety or defining minimal levels of training, experience, education or certification as to who may operate MRI systems. Almost all MRI accidents result from operator errors and lack of education and a lack of minimal safety standards. Entirely avoidable serious MRI-related injuries continue to occur due to the absence of minimal MR safety performance standards which, if standardized and enforced, would prevent these injuries.

Regulation is required to ensure that minimal MRI patient safety standards are established and enforced for all MRI facilities.

Created: Jun 05, 2012





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A case of primitive trigeminal artery infarction

Within minutes following an altercation with police, a 55-year-old man noted onset of speech difficulty and right-sided weakness without headache or neck pain. Dysarthria and right hemiparesis (grade 4/5) without ocular disturbance was found. Left ventral hemipontine infarction was documented from the ipsilateral tortuous primitive trigeminal artery (figure). Cerebral angiogram failed to reveal underlying arterial dissection.

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White arrow points to the primitive trigeminal artery (A–D). MRI, fluid-attenuated inversion recovery sequence, demonstrating the left ventral pontine infarction (A). Magnetic resonance angiography demonstrates proximal hypoplastic-stenotic vertebrobasilar system (B). Selective left internal carotid artery angiogram: lateral (C) and anteroposterior view (D) (same viewing angle as in B). Triangular arrowhead points to the left internal carotid artery (B–D).

Persistent anastomosis from a cavernous portion of internal cerebral artery to rostral basilar artery is unusual, with an estimated incidence of 0.2%.1 Although the artery has been implicated as a conduit of a carotid artery to posterior cerebral artery distribution embolic stroke,2 our case illustrates that localized occlusive process may also occur.

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Dynamic Susceptibility Contrast Perfusion MRI

Above color maps are from MRI Dynamic Susceptibility Contrast Perfusion (DSCP) study of the patient with follow-up after resection and radiotherapy of the parieto-occipitally located Anaplastic Astrocytoma eight years ago. There is no recurrent tumor – only gliosis. Sometimes DSCP can help in characterization of the enhancement pattern of rest or recurrent tumor to differentiate if from radiation necrosis. This case has no contrast enhancement. Reason for this blog post is to mention this interesting MRI technique that I hope to expand on in the future.
What we see are the color maps representing:
TTP (Time To Peak) – that shows the regional distribution of arrival time of the bolus in the tissue
CBF (Cerebral Blood Flow)
CBV (Cerebral Blood Volume)
MTT (Mean Transit Time)

Dynamic Susceptibility Contrast-Enhanced
Perfusion and Conventional MR Imaging
Findings for Adult Patients with Cerebral
Primitive Neuroectodermal Tumors

Dynamic susceptibility contrast perfusion MR imaging in distinguishing malignant from benign head and neck tumors: A pilot study

Full Text (PDF)

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Intracranial Hemorrhage on MRI

The table above shows how we stage (name) hematomas according to time. Important observation is that the very early (hyperacute) hematomas contain Oxyhemoglobin and are difficult to see (isodense to brain) on T1 sequences. Same with Deoxyhemoglobin. Then after about 3 days we start to see high signal of Methemoglobin on T1. That continues to be high on T1 even when Methemoglobin is released from the hemolyzed Red Blood Cells, but then we start to see it as high even on T2. Late remains of the hemorrhage on MR can be seen as a rim of Hemosiderin deposits – that is just black. Gradient Echo (T2*) (GRE) sequences show hemorrhage as black since it is a sort of susceptibility artefact. It also exaggerates the volume of bleeding (“blooming artefact”).

Hemorrhagic Choroid Plexus Cyst
Late Subacute Hemorrhage on DWI
Hemorrhagic Brain Metastases



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