Kevin McEnery - Academia.edu (original) (raw)
Papers by Kevin McEnery
American Journal of Roentgenology, Feb 1, 1995
Technology is revolutionizing education. Global networks, powerful personal computers, and user f... more Technology is revolutionizing education. Global networks, powerful personal computers, and user friendly, graphically onented software are creating a new infrastructure that promotes rapid, efficient access to information. Images, text, audio, and video can be integrated Into Interactive multimedia presentstions, providing a hierarchy of knowledge that can be traversed http://www.xray.hmc.psu.edu/ home.html http:i1 30.219.1 .246/ http:llgamma.wustl.edu/tt/ caic.html http:llzax.radiology.anzona.edu http://www-radiology.ucdmc. ucdavis.edu/ http:llwww.med.ufl.edu/medinfo/ rademo/raintro.html http:iiitcsunlO.med.miami.edu/ http:llmipgsun.mipg.upenn.edu/
PubMed, 1996
We describe the implementation of a World Wide Web-based Continuing Medical Educational (CME) pro... more We describe the implementation of a World Wide Web-based Continuing Medical Educational (CME) program in Diagnostic Radiology which allows accumulation of Category I credit. The program implements an unknown case presentation format which includes multiple choice questions, didactic information, and literature references with links to abstracts. Physician participation is anticipated to occur in brief sessions during which the program automatically tracks CME credit accumulation. To allow an interactive presentation, HTML electronic form documents are created "on the fly" by a Common Gateway Interface (CGI) application interfacing with several relational databases. The system is scalable with bandwidth intensive image transfers distributed over multiple internationally distributed image servers. For CME participants, the system utilizes documents encryption to ensure confidential physician interactions.
Journal of Digital Imaging, 2003
PubMed, 2000
RadStation is a digital dictation system having an integrated display of clinical information. Th... more RadStation is a digital dictation system having an integrated display of clinical information. The three-tiered system architecture provides robust performance, with most information displayed within one second after a request. The multifunctional client tier is a unique client/browser hybrid. A Web browser display window functions as the client application's data display window for clinical information, radiology reports, and laboratory and pathology results. RadStation provides a robust platform for digital dictation functionality. The system's internal status checks ensure operational integrity in a clinical environment. Also, the programmable dictation microphone and bar-code reader supplant the mouse as the system's primary input device. By merging information queries into existing work flow, radiologist's interpretation efficiency is maintained with instant access to essential clinical information. Finally, RadStation requires minimal training and has been enthusiastically accepted by our radiologists in an active clinical practice.
Radiology, Feb 1, 1996
Page 1. William F. Conway, MD, PhD #{149} William G. Totty, MD #{149} Kevin W. McEnery, MD S CT a... more Page 1. William F. Conway, MD, PhD #{149} William G. Totty, MD #{149} Kevin W. McEnery, MD S CT and MR Imaging ofthe Hip 297 State ofthe Art B EFORE the 1970s, musculoskeletal radiology relied on plain radiog-raphy ...
Journal of Vascular and Interventional Radiology, Apr 1, 2013
Purpose The purpose of this study was twofold 1)create a software application that could provide ... more Purpose The purpose of this study was twofold 1)create a software application that could provide a patient radiation dose history (IR and CT exams)prior to any interventional procedure 2)measure the impact of this information on radiation dose. Materials and Methods A software application was built which could access all available radiation dose information from the EMR and RIS, then create a report including previous IR and CT exams. To minimize workflow interruption, this was launched via a web link that was placed on the desktop adjacent to every procedure room. The study included all potentially high dose IR cases. Prior to performing a case, the MD logged into the system and 50% of the time would be provided the radiation dose passport. If the MD received the dose passport, they were later sent an email questionnaire to determine the subjective value of the information. Comparison of case cohorts and patient radiation dose between instances when the IR MD received or did not receive the information provided objective value and impact of the IR radiation dose passport. Results Over 8 months there were 140 procedures performed as part of the study for which dose information was available. The most common was embolization (n=59). In 3% of cases, the MD changed their procedure based on receiving the dose passport. There was no statistically significant difference between the dose used for similar cases, whether the IR MD received or did not receive the IR radiation dose passport (mean without dose passport=951mGy, mean with dose passport=968mGy). Conclusion Providing IR MDs information about the amount of radiation dose a patient had previously received had little impact on the current procedure. This is most likely because the majority of patients undergoing complex interventional procedures who qualified for our study had advanced cancer. Given their prognosis, the risk/benefit is such that performing the procedure,regardless of the dose, was more important that the remote possibility of a skin injury or radiation induced neoplasm. However, the IR dose passport may provide more value in a practice with a different patient mix, perhaps where children or benign conditions (e.g. UAE) are more commonly treated.
American Journal of Roentgenology, Nov 1, 1994
The purpose of this in vitro study was to determine the value of spiral CT for detecting displace... more The purpose of this in vitro study was to determine the value of spiral CT for detecting displacement of fractures of the tibial plateau. The exact amount of inferior plateau depression, if any, is a primary criterion for deciding between surgical management and conservative management. MATERIALS AND METHODS. An artificial fracture was produced in a cadaveric tibial plateau. Inferior displacements of 0, i , 3, and 5 mm were created at the fracture. Spiral CT scans of each displacement were obtained with table speeds of 2, 3, and 5 mm/sec. Section collimation equaled table increment. Coronal image reconstructions were produced by use of standard scanner software. The images were interpreted by six musculoskeletal radiologists.
Radiology, Nov 1, 1994
To compare conventional and storage phosphor radiography of the injured cervical spine. Sixty-fiv... more To compare conventional and storage phosphor radiography of the injured cervical spine. Sixty-five patients underwent imaging in a supine position while wearing a cervical collar. Matched storage phosphor and conventional lateral cervical spine radiographs were obtained with an 18 x 24-cm hybrid cassette. Edge-enhanced and nonenhanced copies of each computed radiograph were printed on film, and the images were sent via a computer network to a remote imaging workstation. Four radiologists read the conventional radiographs, the two hard-copy computed radiographs, and the soft-copy images and used a binary scale to score the visibility of bone and soft-tissue structures. All readers scored better in all areas with computed radiographs, and a statistically significant (P = .030) improvement in performance was seen for soft-tissue structures. Storage phosphor imaging offers advantages over conventional radiography, and digital images may be a viable alternative to film.
Radiologic Clinics of North America, Mar 1, 1995
This articles focuses on the principles of spinal surgery, the basic types of spinal instrumentat... more This articles focuses on the principles of spinal surgery, the basic types of spinal instrumentation, and imaging of the postoperative spine. It is the first of three articles in this issue that discuss the spine. Complications are discussed and illustrated throughout. This article should assist radiologists in the review of spinal, chest, and abdominal films of spinal surgery patients.
Radiologic Clinics of North America, Mar 1, 1995
This article emphasizes the techniques and instrumentation used in the cervical spine to provide ... more This article emphasizes the techniques and instrumentation used in the cervical spine to provide insight into the identification and function of the fixation, grafting, and wiring techniques used for stabilization and fusion. Fracture reduction and stabilization in degenerative disease, the most common reasons for spinal fixation in the cervical spine, are discussed, as are infections, spinal stenosis, and tumors.
Investigative Radiology, Jul 1, 1994
American Journal of Roentgenology, Apr 1, 1999
Radiologic Clinics of North America
This article emphasizes the techniques and instrumentation used in the cervical spine to provide ... more This article emphasizes the techniques and instrumentation used in the cervical spine to provide insight into the identification and function of the fixation, grafting, and wiring techniques used for stabilization and fusion. Fracture reduction and stabilization in degenerative disease, the most common reasons for spinal fixation in the cervical spine, are discussed, as are infections, spinal stenosis, and tumors.
Practical Imaging Informatics, 2021
One of medical education's primary goals is for the student to be proficient in the gross and... more One of medical education's primary goals is for the student to be proficient in the gross and microscopic identification of disease. The videodisc, with its storage capacity of up to 54,000 photomicrographs is ideally suited to assist in this educational process. “Slide Star” is a method of interactive instruction which is designed for use in any subject where it is essential to identify visual material. The instructional approach utilizes a computer controlled videodisc to display photomicrographs. In the demonstration program, these are slides of normal blood cells. The program is unique in that the instruction is created by the student's commands manipulating the photomicrograph data base. A prime feature is the use of computer generated multiple choice questions to reinforce the learning process.
Journal of the National Comprehensive Cancer Network, 2006
Higher incidences of osteoporosis and osteopenia are found in cancer patients, particularly in wo... more Higher incidences of osteoporosis and osteopenia are found in cancer patients, particularly in women receiving aromatase inhibitors or with chemotherapy-induced ovarian failure, or in men with prostate cancer and androgen deprivation therapy. Therefore, management of long-term bone health is emerging as an important aspect of comprehensive cancer care. Patients with cancer typically have a number of additional risk factors for osteoporosis that should prompt screening, regardless of patient age or sex. Maintaining bone health requires a broad knowledge base, including understanding underlying bone metabolism and how it is affected by both cancer itself and the drugs used to treat cancer, the effect of chemotherapy-induced menopause on bone health, bone markers and imaging techniques used to assess bone health, therapeutic strategies to maintain bone health, and treatment of bone metastases, including surgery for pathologic fractures. Multiple members of the healthcare team may need ...
Radiology: Imaging Cancer, 2020
To determine the diagnostic efficacy of gadolinium-based contrast agents for the detection of rec... more To determine the diagnostic efficacy of gadolinium-based contrast agents for the detection of recurrent soft-tissue sarcoma compared with non-contrast-enhanced conventional MRI sequences. Materials and Methods: A retrospective study of patients with soft-tissue sarcomas who were imaged from January 2009 to December 2014 was performed. MRI studies from 69 patients (mean age, 61 years ± 15 [standard deviation], 45 men) with recurrent soft-tissue sarcoma and 63 age-, sex-, and tumor-matched controls with positive findings (nonrecurrence) were presented to six musculoskeletal radiologists at a tertiary cancer center in three image groupings. Group 1 consisted of precontrast T1-weighted and fat-suppressed T2weighted images (no contrast agent). Group 2 consisted of precontrast and postcontrast fat-saturated T1-weighted images. Group 3 consisted of precontrast and fat-saturated postcontrast T1-and fat-suppressed T2-weighted images. Images within these three groups contained either recurrent soft-tissue sarcomas or positive postoperative findings (nonsarcoma). The presentation order of the first two image sets was reversed for half the readers. The readers were asked to classify presence of tumor on a five-point scale. The average score from the readers was used as consensus score for each case, and a case was considered positive if the average score was less than 3. Receiver operating characteristic (ROC) analysis was performed using the average score for each image set. Results: Assessment of the group 3 image set resulted in higher sensitivity (74%, 95% confidence interval [CI]: 62%, 83%) than the group 2 image set (64%, 95% CI: 51%, 75%), which was also more sensitive than the assessment of the group 1 images set (49%, 95% CI: 37%, 61%), with P = .02 for both. There was no significant difference in specificity between the three groups. The area under the ROC curve (AUC) for the assessment of group 1 was 0.78 (95% CI: 0.70, 0.86), which was significantly lower than that of group 2, 0.92 (95% CI: 0.87, 0.96) and group 3, 0.93 (95% CI: 0.88, 0.97), with P values of .0006 and < .0001, respectively. There was no difference between the AUCs of groups 2 and 3 (P = .58). Conclusion: Gadolinium-based contrast agents improved diagnostic performance in detection of recurrent soft-tissue sarcoma. Addition of fat-saturated T2-weighted images provided modest improvement in sensitivity.
Journal of the American College of Radiology, 2020
A probabilistic forecast is one that assigns a probability (or likelihood) to the occurrence of a... more A probabilistic forecast is one that assigns a probability (or likelihood) to the occurrence of an event. Radiologists commonly make probabilistic judgments in their reports, even if these predictions are not explicitly expressed as numbers. There are calls for radiologists to commit to their probabilistic predictions in a standardized fashion; however, without a mechanism for feedback, there is no opportunity for improvement. Analysis techniques familiar to radiologists (eg, calculation of sensitivity and specificity and construction of receiver operating characteristics curves) have a blind spot with regard to calibration of these probabilities to reality and are the main obstacle to improvement along this axis. We review statistical and graphical methods for calibration analysis in wider use outside the medical literature and present a framework for implementation of these techniques for quality improvement and radiologist self-assessment.
American Journal of Roentgenology, Feb 1, 1995
Technology is revolutionizing education. Global networks, powerful personal computers, and user f... more Technology is revolutionizing education. Global networks, powerful personal computers, and user friendly, graphically onented software are creating a new infrastructure that promotes rapid, efficient access to information. Images, text, audio, and video can be integrated Into Interactive multimedia presentstions, providing a hierarchy of knowledge that can be traversed http://www.xray.hmc.psu.edu/ home.html http:i1 30.219.1 .246/ http:llgamma.wustl.edu/tt/ caic.html http:llzax.radiology.anzona.edu http://www-radiology.ucdmc. ucdavis.edu/ http:llwww.med.ufl.edu/medinfo/ rademo/raintro.html http:iiitcsunlO.med.miami.edu/ http:llmipgsun.mipg.upenn.edu/
PubMed, 1996
We describe the implementation of a World Wide Web-based Continuing Medical Educational (CME) pro... more We describe the implementation of a World Wide Web-based Continuing Medical Educational (CME) program in Diagnostic Radiology which allows accumulation of Category I credit. The program implements an unknown case presentation format which includes multiple choice questions, didactic information, and literature references with links to abstracts. Physician participation is anticipated to occur in brief sessions during which the program automatically tracks CME credit accumulation. To allow an interactive presentation, HTML electronic form documents are created "on the fly" by a Common Gateway Interface (CGI) application interfacing with several relational databases. The system is scalable with bandwidth intensive image transfers distributed over multiple internationally distributed image servers. For CME participants, the system utilizes documents encryption to ensure confidential physician interactions.
Journal of Digital Imaging, 2003
PubMed, 2000
RadStation is a digital dictation system having an integrated display of clinical information. Th... more RadStation is a digital dictation system having an integrated display of clinical information. The three-tiered system architecture provides robust performance, with most information displayed within one second after a request. The multifunctional client tier is a unique client/browser hybrid. A Web browser display window functions as the client application's data display window for clinical information, radiology reports, and laboratory and pathology results. RadStation provides a robust platform for digital dictation functionality. The system's internal status checks ensure operational integrity in a clinical environment. Also, the programmable dictation microphone and bar-code reader supplant the mouse as the system's primary input device. By merging information queries into existing work flow, radiologist's interpretation efficiency is maintained with instant access to essential clinical information. Finally, RadStation requires minimal training and has been enthusiastically accepted by our radiologists in an active clinical practice.
Radiology, Feb 1, 1996
Page 1. William F. Conway, MD, PhD #{149} William G. Totty, MD #{149} Kevin W. McEnery, MD S CT a... more Page 1. William F. Conway, MD, PhD #{149} William G. Totty, MD #{149} Kevin W. McEnery, MD S CT and MR Imaging ofthe Hip 297 State ofthe Art B EFORE the 1970s, musculoskeletal radiology relied on plain radiog-raphy ...
Journal of Vascular and Interventional Radiology, Apr 1, 2013
Purpose The purpose of this study was twofold 1)create a software application that could provide ... more Purpose The purpose of this study was twofold 1)create a software application that could provide a patient radiation dose history (IR and CT exams)prior to any interventional procedure 2)measure the impact of this information on radiation dose. Materials and Methods A software application was built which could access all available radiation dose information from the EMR and RIS, then create a report including previous IR and CT exams. To minimize workflow interruption, this was launched via a web link that was placed on the desktop adjacent to every procedure room. The study included all potentially high dose IR cases. Prior to performing a case, the MD logged into the system and 50% of the time would be provided the radiation dose passport. If the MD received the dose passport, they were later sent an email questionnaire to determine the subjective value of the information. Comparison of case cohorts and patient radiation dose between instances when the IR MD received or did not receive the information provided objective value and impact of the IR radiation dose passport. Results Over 8 months there were 140 procedures performed as part of the study for which dose information was available. The most common was embolization (n=59). In 3% of cases, the MD changed their procedure based on receiving the dose passport. There was no statistically significant difference between the dose used for similar cases, whether the IR MD received or did not receive the IR radiation dose passport (mean without dose passport=951mGy, mean with dose passport=968mGy). Conclusion Providing IR MDs information about the amount of radiation dose a patient had previously received had little impact on the current procedure. This is most likely because the majority of patients undergoing complex interventional procedures who qualified for our study had advanced cancer. Given their prognosis, the risk/benefit is such that performing the procedure,regardless of the dose, was more important that the remote possibility of a skin injury or radiation induced neoplasm. However, the IR dose passport may provide more value in a practice with a different patient mix, perhaps where children or benign conditions (e.g. UAE) are more commonly treated.
American Journal of Roentgenology, Nov 1, 1994
The purpose of this in vitro study was to determine the value of spiral CT for detecting displace... more The purpose of this in vitro study was to determine the value of spiral CT for detecting displacement of fractures of the tibial plateau. The exact amount of inferior plateau depression, if any, is a primary criterion for deciding between surgical management and conservative management. MATERIALS AND METHODS. An artificial fracture was produced in a cadaveric tibial plateau. Inferior displacements of 0, i , 3, and 5 mm were created at the fracture. Spiral CT scans of each displacement were obtained with table speeds of 2, 3, and 5 mm/sec. Section collimation equaled table increment. Coronal image reconstructions were produced by use of standard scanner software. The images were interpreted by six musculoskeletal radiologists.
Radiology, Nov 1, 1994
To compare conventional and storage phosphor radiography of the injured cervical spine. Sixty-fiv... more To compare conventional and storage phosphor radiography of the injured cervical spine. Sixty-five patients underwent imaging in a supine position while wearing a cervical collar. Matched storage phosphor and conventional lateral cervical spine radiographs were obtained with an 18 x 24-cm hybrid cassette. Edge-enhanced and nonenhanced copies of each computed radiograph were printed on film, and the images were sent via a computer network to a remote imaging workstation. Four radiologists read the conventional radiographs, the two hard-copy computed radiographs, and the soft-copy images and used a binary scale to score the visibility of bone and soft-tissue structures. All readers scored better in all areas with computed radiographs, and a statistically significant (P = .030) improvement in performance was seen for soft-tissue structures. Storage phosphor imaging offers advantages over conventional radiography, and digital images may be a viable alternative to film.
Radiologic Clinics of North America, Mar 1, 1995
This articles focuses on the principles of spinal surgery, the basic types of spinal instrumentat... more This articles focuses on the principles of spinal surgery, the basic types of spinal instrumentation, and imaging of the postoperative spine. It is the first of three articles in this issue that discuss the spine. Complications are discussed and illustrated throughout. This article should assist radiologists in the review of spinal, chest, and abdominal films of spinal surgery patients.
Radiologic Clinics of North America, Mar 1, 1995
This article emphasizes the techniques and instrumentation used in the cervical spine to provide ... more This article emphasizes the techniques and instrumentation used in the cervical spine to provide insight into the identification and function of the fixation, grafting, and wiring techniques used for stabilization and fusion. Fracture reduction and stabilization in degenerative disease, the most common reasons for spinal fixation in the cervical spine, are discussed, as are infections, spinal stenosis, and tumors.
Investigative Radiology, Jul 1, 1994
American Journal of Roentgenology, Apr 1, 1999
Radiologic Clinics of North America
This article emphasizes the techniques and instrumentation used in the cervical spine to provide ... more This article emphasizes the techniques and instrumentation used in the cervical spine to provide insight into the identification and function of the fixation, grafting, and wiring techniques used for stabilization and fusion. Fracture reduction and stabilization in degenerative disease, the most common reasons for spinal fixation in the cervical spine, are discussed, as are infections, spinal stenosis, and tumors.
Practical Imaging Informatics, 2021
One of medical education's primary goals is for the student to be proficient in the gross and... more One of medical education's primary goals is for the student to be proficient in the gross and microscopic identification of disease. The videodisc, with its storage capacity of up to 54,000 photomicrographs is ideally suited to assist in this educational process. “Slide Star” is a method of interactive instruction which is designed for use in any subject where it is essential to identify visual material. The instructional approach utilizes a computer controlled videodisc to display photomicrographs. In the demonstration program, these are slides of normal blood cells. The program is unique in that the instruction is created by the student's commands manipulating the photomicrograph data base. A prime feature is the use of computer generated multiple choice questions to reinforce the learning process.
Journal of the National Comprehensive Cancer Network, 2006
Higher incidences of osteoporosis and osteopenia are found in cancer patients, particularly in wo... more Higher incidences of osteoporosis and osteopenia are found in cancer patients, particularly in women receiving aromatase inhibitors or with chemotherapy-induced ovarian failure, or in men with prostate cancer and androgen deprivation therapy. Therefore, management of long-term bone health is emerging as an important aspect of comprehensive cancer care. Patients with cancer typically have a number of additional risk factors for osteoporosis that should prompt screening, regardless of patient age or sex. Maintaining bone health requires a broad knowledge base, including understanding underlying bone metabolism and how it is affected by both cancer itself and the drugs used to treat cancer, the effect of chemotherapy-induced menopause on bone health, bone markers and imaging techniques used to assess bone health, therapeutic strategies to maintain bone health, and treatment of bone metastases, including surgery for pathologic fractures. Multiple members of the healthcare team may need ...
Radiology: Imaging Cancer, 2020
To determine the diagnostic efficacy of gadolinium-based contrast agents for the detection of rec... more To determine the diagnostic efficacy of gadolinium-based contrast agents for the detection of recurrent soft-tissue sarcoma compared with non-contrast-enhanced conventional MRI sequences. Materials and Methods: A retrospective study of patients with soft-tissue sarcomas who were imaged from January 2009 to December 2014 was performed. MRI studies from 69 patients (mean age, 61 years ± 15 [standard deviation], 45 men) with recurrent soft-tissue sarcoma and 63 age-, sex-, and tumor-matched controls with positive findings (nonrecurrence) were presented to six musculoskeletal radiologists at a tertiary cancer center in three image groupings. Group 1 consisted of precontrast T1-weighted and fat-suppressed T2weighted images (no contrast agent). Group 2 consisted of precontrast and postcontrast fat-saturated T1-weighted images. Group 3 consisted of precontrast and fat-saturated postcontrast T1-and fat-suppressed T2-weighted images. Images within these three groups contained either recurrent soft-tissue sarcomas or positive postoperative findings (nonsarcoma). The presentation order of the first two image sets was reversed for half the readers. The readers were asked to classify presence of tumor on a five-point scale. The average score from the readers was used as consensus score for each case, and a case was considered positive if the average score was less than 3. Receiver operating characteristic (ROC) analysis was performed using the average score for each image set. Results: Assessment of the group 3 image set resulted in higher sensitivity (74%, 95% confidence interval [CI]: 62%, 83%) than the group 2 image set (64%, 95% CI: 51%, 75%), which was also more sensitive than the assessment of the group 1 images set (49%, 95% CI: 37%, 61%), with P = .02 for both. There was no significant difference in specificity between the three groups. The area under the ROC curve (AUC) for the assessment of group 1 was 0.78 (95% CI: 0.70, 0.86), which was significantly lower than that of group 2, 0.92 (95% CI: 0.87, 0.96) and group 3, 0.93 (95% CI: 0.88, 0.97), with P values of .0006 and < .0001, respectively. There was no difference between the AUCs of groups 2 and 3 (P = .58). Conclusion: Gadolinium-based contrast agents improved diagnostic performance in detection of recurrent soft-tissue sarcoma. Addition of fat-saturated T2-weighted images provided modest improvement in sensitivity.
Journal of the American College of Radiology, 2020
A probabilistic forecast is one that assigns a probability (or likelihood) to the occurrence of a... more A probabilistic forecast is one that assigns a probability (or likelihood) to the occurrence of an event. Radiologists commonly make probabilistic judgments in their reports, even if these predictions are not explicitly expressed as numbers. There are calls for radiologists to commit to their probabilistic predictions in a standardized fashion; however, without a mechanism for feedback, there is no opportunity for improvement. Analysis techniques familiar to radiologists (eg, calculation of sensitivity and specificity and construction of receiver operating characteristics curves) have a blind spot with regard to calibration of these probabilities to reality and are the main obstacle to improvement along this axis. We review statistical and graphical methods for calibration analysis in wider use outside the medical literature and present a framework for implementation of these techniques for quality improvement and radiologist self-assessment.