Randy Ernst - Profile on Academia.edu (original) (raw)

Papers by Randy Ernst

Journal of Digital Imaging, May 1, 1999

We present an effective approach to manage, review, and distribute Digital Imaging and Communicat... more We present an effective approach to manage, review, and distribute Digital Imaging and Communications in Medicine (DICOM) images with multiple monitors using Windows98 (Microsoft Corp, Redmond, WA) that can be implemented in an office-based setting. Computed tomography (CT), magnetic resonance imaging (MRI), and angiographic DICOM images were collected, compressed, and stored using Medweb (Medweb, Inc, San Francisco, CA) software. The Medweb server used the Linux/UNIX operating system on a Pentium 333-MHz processor with 128 MB of RAM. Short-term storage capacity was about 2 weeks with routine usage of an 11-GB hard drive. Images were presented for reading on a dual-monitor Windows98 Pentium display station with 160 MB of RAM using a Medweb/Netscape (Netscape Communications Corp, Mountain View, CA) viewer. There was no significant discrepancy in diagnosis between electronic and conventional film images. Mean reading time for 32 cases was 118 seconds. The Medweb JAVA plug-in viewer Ioaded the first image within 30 seconds of selecting the case for review. Full uncompressed 16-bit images allowed different window settings to better assess for pathology. Multiple monitors allowed viewing various hanging protocols. Cine viewing was also possible. Key diagnostic images were electronically transmitted to referring physicians. On-call radiologists were able to access images through the Internet. By combining Medweb, DICOM, and web-browser software using desktop personal computers (PCs), an easily accessible picture archiving and communications system (PACS) is available to radiologists and referring physicians. Multiple monitors are easily configured and managed using Windows98. This system can sustain changes and can be extended to provide variable functions using inexpensive PCs.

Journal of Oncology Practice, May 1, 2015

Purpose: Colon cancer surveillance guidelines do not routinely include positron emission tomograp... more Purpose: Colon cancer surveillance guidelines do not routinely include positron emission tomography (PET) imaging; however, its use after surgical resection has been increasing. We evaluated the secular patterns of PET use after surgical resection of colon cancer among elderly patients and identified factors associated with its increasing use. Patients and Methods: We used the SEER-linked Medicare database (July 2001 through December 2009) to establish a retrospective cohort of patients age Ն 66 years who had undergone surgical resection for colon cancer. Postoperative PET use was assessed with the test for trends. Patient, tumor, and treatment characteristics were analyzed using univariable and multivariable logistic regression analyses. Results: Of the 39,221 patients with colon cancer, 6,326 (16.1%) had undergone a PET scan within 2 years after surgery. The use rate steadily increased over time. The majority of PET scans had been performed within 2 months after surgery. Among patients who had undergone a PET scan, 3,644 (57.6%) had also undergone preoperative imaging, and 1,977 (54.3%) of these patients had undergone reimaging with PET within 2 months after surgery. Marriage, year of diagnosis, tumor stage, preoperative imaging, postoperative visit to a medical oncologist, and adjuvant chemotherapy were significantly associated with increased PET use. Conclusion: PET use after colon cancer resection is steadily increasing, and further study is needed to understand the clinical value and effectiveness of PET scans and the reasons for this departure from guideline-concordant care.

Journal of Digital Imaging, Jun 1, 2001

This presentation describes our experience in combining speech recognition software, clinical rev... more This presentation describes our experience in combining speech recognition software, clinical review software, and other software products on a single computer. Different processor speeds, random access memory (RAM), and computer costs were evaluated. We found that combining continuous speech recognition software with Digital Imaging and Communications in Medicine (DICOM) workstation software on the same platform is feasible and can lead to substantial savings of hardware cost. This combination optimizes use of limited workspace and can improve radiology workflow.

Diseases of The Colon & Rectum, Apr 1, 2012

Background-Use of rectal MRI evaluation of patients with rectal cancer for primary tumor staging ... more Background-Use of rectal MRI evaluation of patients with rectal cancer for primary tumor staging and for identification for poor prognostic features is increasing. MR imaging permits precise delineation of tumor anatomy and assessment of mesorectal tumor penetration and radial margin risk. Objective-To evaluate the ability of pre-treatment rectal MRI to classify tumor response to neoadjuvant chemoradiation. Design-Retrospective, consecutive cohort study, central review. Setting-Tertiary academic hospital. Patients-62 consecutive patients with locally advanced (stage cII-cIII)rectal cancer who underwent rectal cancer protocol high resolution MRI prior to surgery(12/09-3/11). Main Outcome Measures-Probability of good (ypT0-2N0) vs. poor (≥ypT3N0) response as a function of mesorectal tumor depth, lymph node status, extramural vascular invasion, and grade assessed by uni-and multi-variate logistic regression. Results-Tumor response was good in 25, 40.3% and poor in 37, 59.7%.Median interval from MRI to OP was 7.9weeks (IQR: 7.0-9.0). MRI tumor depth was <1 mm in 10 (16.9%), 1-5 mm in 30 (50.8%), and >5 mm in 21(33.9%). LN status was positive in 40 (61.5%) and vascular invasion was present in 16 (25.8%). Tumor response was associated with MRI tumor depth (P=0.001), MRI lymph nodes status (P=<0.001)and vascular invasion (P=0.009). Multivariate regression indicated >5mm MRI tumor depth (OR=0.08, 95% CI=0.01-0.93, p=0.04) and MRI LN positivity (OR=0.12, 95% CI=0.03-0.53, p=0.005) were less likely to achieve a good response to neoadjuvant chemoradiotherapy.

Journal of Digital Imaging, May 1, 1999

To improve radiology access to full uncompressed Digital Imaging and Communications in Medicine (... more To improve radiology access to full uncompressed Digital Imaging and Communications in Medicine (DICOM) data sets, we evaluated satellite access to a DICOM server. Radiologists' home computers were connected by satellite to a Medweb DICOM server (Medweb, San Francisco, CA). A 10.2-kb data set containing a 19-image head computed tomography (CT) scan was transferred using DirecPC (Hughes Electronics Corp, Arlington, VA) at three different times of the day; 6 AM, 3 PM, and 8 PM. The average transfer time for all 19 images from the DICOM server was 4 minutes and 17 seconds (257 seconds). The slowest transfer rate of 670 seconds (121 kbps) was obtained at 8 PM. The best transfer rate of 2 minutes, 54 seconds (467 kbps) was obtained at 6 AM. The full 16-bit DICOM images were viewed with bone, brain, and soft tissue windows. The Medweb plug-in viewer Ioaded the first image within 30 seconds of selecting the case for satellite transfer. In conciusion, satellite internet transfer of radiology studies is suitable for timely review of full DICOM data sets and can expand the range of teleradiology consultation.

Journal of Digital Imaging, Dec 1, 2003

Surgical oncology clinics of North America, 2017

Anal canal cancer is an uncommon malignancy but one that is often curable with optimal therapy. O... more Anal canal cancer is an uncommon malignancy but one that is often curable with optimal therapy. Owing to its unique location, histology, risk factors, and usual presentation, a careful diagnostic approach is warranted. This approach includes an excellent history and physical examination, including digital rectal examination, laboratory data, and comprehensive imaging. Anal cancer staging and formulation of a treatment plan depends on accurate imaging data. Modern radiographic techniques have improved staging quality and accuracy, and a thorough knowledge of anal anatomy is paramount to the optimal multidisciplinary treatment of this disease.

Surgical case reports, 2015

Superior mesenteric artery syndrome (SMAS) after a surgical operation is very rare. We experience... more Superior mesenteric artery syndrome (SMAS) after a surgical operation is very rare. We experienced an extremely rare case of ileal pouch-anal anastomosis with subsequent development of SMAS requiring duodenojejunostomy. A 74-year-old Asian woman underwent total colectomy, ileal pouch-anal anastomosis (J-pouch), covering ileostomy, splenectomy, and distal pancreatectomy for treatment of descending colon cancer associated with ulcerative colitis. She complained of abdominal discomfort and vomiting 17 days postoperatively. Computed tomography (CT) revealed fluid collection at the pancreatic stump. We diagnosed a pancreatic fistula and performed CT-guided drainage. SMAS was thereafter diagnosed by contrast-enhanced CT, which revealed a narrow aortomesenteric angle of 36° and short aortomesenteric distance of 2 mm. The SMAS did not respond to conservative therapy. Finally, we performed duodenojejunostomy. This case illustrates that ileal pouch-anal anastomosis might induce relative stret...

Journal of oncology practice / American Society of Clinical Oncology, Jan 7, 2015

Colon cancer surveillance guidelines do not routinely include positron emission tomography (PET) ... more Colon cancer surveillance guidelines do not routinely include positron emission tomography (PET) imaging; however, its use after surgical resection has been increasing. We evaluated the secular patterns of PET use after surgical resection of colon cancer among elderly patients and identified factors associated with its increasing use. We used the SEER-linked Medicare database (July 2001 through December 2009) to establish a retrospective cohort of patients age ≥ 66 years who had undergone surgical resection for colon cancer. Postoperative PET use was assessed with the test for trends. Patient, tumor, and treatment characteristics were analyzed using univariable and multivariable logistic regression analyses. Of the 39,221 patients with colon cancer, 6,326 (16.1%) had undergone a PET scan within 2 years after surgery. The use rate steadily increased over time. The majority of PET scans had been performed within 2 months after surgery. Among patients who had undergone a PET scan, 3,64...

Emergency Radiology, 2005

The purpose of this study was to determine the sensitivity and specificity of computed tomography... more The purpose of this study was to determine the sensitivity and specificity of computed tomography (CT) without administration of oral contrast in confirming suspected acute appendicitis. One hundred seventy-three patient studies were retrieved by a computer-generated search for the word "appendicitis" in radiology reports. Patients presenting to the emergency department over an 8month period were examined for acute abdominal pain or suspected acute appendicitis. IV-contrast-enhanced CT scans of the abdomen and pelvis were obtained without oral or rectal contrast. Criteria for diagnosis of acute appendicitis included a dilated appendix (>6 mm), periappendiceal inflammation, or abscess. Final diagnoses were established with surgical/clinical follow-up, histopathological analysis or both. The standard time (1 h) for the administration of oral contrast prior to the CT scan was eliminated. Fifty-nine CT diagnoses were made of acute appendicitis, 56 of which were histologically verified and three of which resulted in another diagnosis. One hundred fourteen CT diagnoses were negative for appendicitis. This corresponds to a sensitivity of 100% and specificity of 97%, a positive predictive value of 95%, and a negative predictive value of 100%. CT with IV contrast is sensitive and specific for the confirmation or exclusion of acute appendicitis. By eliminating the time required to administer oral contrast, the diagnosis might be made more rapidly.

Emergency Radiology, 2003

Traumatic diaphragmatic rupture is a frequently missed diagnosis. We present a patient with traum... more Traumatic diaphragmatic rupture is a frequently missed diagnosis. We present a patient with traumatic diaphragmatic hernia. Diagnosis was suggested by a emergent computed tomography (CT) examination without oral contrast. Diaphragmatic rupture and herniation of stomach were confirmed by repeating CT examination after the administration of oral contrast and using multiplanar reconstruction.

Medical Imaging 2006: Image Processing, 2006

Polyp size is an important feature descriptor for clinical classification and follow-up decision ... more Polyp size is an important feature descriptor for clinical classification and follow-up decision making in CT colonography. Currently, polyp size is measured from computed tomography (CT) studies manually as the single largest dimension of the polyp head, excluding the stalk if present, in either multi-planar reconstruction (MPR) or three-dimensional (3D) views. Manual measurements are subject to intra- and inter-reader variation, and can be time-consuming. Automated polyp segmentation and size measurement can reduce the variability and speed up the process. In this study, an automated polyp size measurement technique is developed. Using this technique, the polyp is segmented from the attached healthy tissue using a novel, model-based approach. The largest diameter of the segmented polyp is measured in axial, sagitttal and coronal MPR views. An expert radiologist identified 48 polyps from either supine or prone views of 52 cases of the Walter-Reed virtual colonoscopy database. Automated polyp size measurements were carried out and compared with the manual ones. For comparison, three different statistical methods were used: overall agreement using chance-corrected kappa indices; the mean absolute differences; and Bland-Altman limits of agreement. Manual and automated measurements show good agreement both in 2D and 3D views.

AJR. American journal of roentgenology, 2014

The purpose of this study is to evaluate whether intraoperative ultrasound (IOUS) during open par... more The purpose of this study is to evaluate whether intraoperative ultrasound (IOUS) during open partial nephrectomy alters the surgical management for renal cell cancer (RCC). One hundred ninety-eight consecutive patients undergoing IOUS during open partial nephrectomy for RCC were selected for retrospective review of clinical and imaging data. Patient age and sex, the local extent of the primary lesion, and the presence of additional lesions were recorded. Ultrasound findings were compared with preoperative CT or MRI to determine whether the IOUS findings changed surgical management. Summary statistics were performed to assess what percentage of patients with additional IOUS findings had a change in their surgical management. The Kaplan-Meier method was used to estimate 5-year overall survival (OS) and event-free survival (EFS) rates for all patients. Patients were followed for 9-12 years to assess survival and measure recurrence rates. Twenty-one of 198 patients (10.6%; 95% CI, 6.7-...

RadioGraphics, 2014

■ List the key FIGO and MR imaging staging criteria for endometrial and cervical cancer. ■ Descri... more ■ List the key FIGO and MR imaging staging criteria for endometrial and cervical cancer. ■ Describe the most important prognostic factors for patients with endometrial and cervical cancer. ■ Discuss the role of high-resolution MR imaging and its modifications in the staging of endometrial and cervical cancer. See www.rsna.org/education/search/RG. SA-CME LEARNING OBJECTIVES RG • Volume 34 Number 4 Rauch et al 1083 with minimally invasive laparoscopic hysterectomy and bilateral salpingo-oophorectomy, an approach that decreases morbidity and hospital stays and has comparable outcomes in this group compared with more extensive surgical resection, which should be reserved for highrisk patients with stage IB grade 3 endometrioid disease, stage II and higher, and all grades of nonendometrioid disease (4-7). However, effective implementation of this treatment approach relies heavily on accurate preoperative staging. Magnetic resonance (MR) imaging, particularly the multiparametric approach, has been shown to reliably depict the key prognostic factors for endometrial cancer: depth of myometrial invasion and cervical stromal involvement (7-11). Although it is not part of the FIGO criteria, staging MR imaging is recommended by the National Cancer Institute of France, the European Society of Radiology Guidelines, and the Royal College of Radiologists (12-14). Assessing lymph node involvement in patients with endometrial cancer on the basis of size criteria has substantial limitations. However, the incidence of nodal involvement correlates with the depth of myometrial invasion and cervical stromal involvement; consequently, these characteristics may be used as surrogates to determine whether lymph node dissection is necessary (13,15,16). The incidence of lymph node metastasis increases from 3% when the depth of tumor invasion is less than 50% of myometrial thickness to 46% when more than 50% of myometrial thickness is involved (5,17,18). The role of imaging in endometrial cancer staging potentially received a boost when the FIGO staging system was modified in 2009 (3). The new staging system combines superficial invasion (less than 50% of myometrial thickness) and disease that is confined to the endometrial cavity as stage IA, whereas tumors that invade the outer one-half of the myometrium (greater than 50% thickness) are classified as stage IB. In addition, the definition of stage II changed with the removal of cervical mucosal involvement as a determinate of upstaging, with only cervical stromal invasion now used to define stage II tumors. Distinguishing disease that is confined to the endometrial cavity from superficial myometrial invasion and defining cervical mucosal involvement, which were part of the previous FIGO staging system, was a limitation of imaging; eliminating these categories could improve the accuracy of staging MR imaging in patients with endometrial cancer (19). Cervical cancer is the only gynecologic malignancy that is still clinically staged according to the revised 2009 FIGO classification system (Table 2) This journal-based SA-CME activity has been approved for AMA PRA Category 1 Credit TM. See www.rsna.org/education/search/RG.

RadioGraphics, 1999

Owing to recent advances in magnetic resonance (MR) imaging, the role of obstetric MR imaging has... more Owing to recent advances in magnetic resonance (MR) imaging, the role of obstetric MR imaging has increased in cases in which the results of ultrasonography are equivocal. Fast MR imaging sequences, such as T2weighted fast spin-echo (SE), half-Fourier single-shot fast SE, 0.5-signalacquired single-shot fast SE, and echo-planar imaging, have virtually eliminated the need for fetal premedication, with a concomitant improvement in image resolution and diminished blurring. Artifacts related to maternal respiratory motion and fetal motion no longer limit the anatomic detail that can be demonstrated with MR imaging. With such advances in obstetric MR imaging, knowledge of normal fetal anatomy at MR imaging is essential to detect disease in utero. MR imaging can demonstrate fetal anatomy in detail, especially the brain, thorax, abdomen, pelvis, and vasculature. Major developmental structures of the fetus, particularly the cranial nervous system, naso-and oropharynx, lungs, and major abdominal viscera, can be adequately evaluated with targeted fast MR imaging as early as the beginning of the second trimester. However, MR imaging of the heart remains limited. Fetal MR imaging during the first trimester remains controversial secondary to biosafety issues and is limited due to diminutive fetal size.

RadioGraphics, 2012

High-resolution magnetic resonance (MR) imaging plays a pivotal role in the pretreatment assessme... more High-resolution magnetic resonance (MR) imaging plays a pivotal role in the pretreatment assessment of primary rectal cancer. The success of this technique depends on obtaining good-quality high-resolution T2-weighted images of the primary tumor; the mesorectal fascia, peritoneal reflection, and other pelvic viscera; and superior rectal and pelvic sidewall lymph nodes. Although orthogonal axial high-resolution T2-weighted MR images are the cornerstone for the staging of primary rectal cancer, high-resolution sagittal and coronal images provide additional value, particularly in tumors that arise in a redundant tortuous rectum. Coronal high-resolution T2-weighted MR images also improve the assessment of nodal morphology, particularly for superior rectal and pelvic sidewall nodes, and of the relationship between advanced-stage tumors and adjacent pelvic structures. Rectal gel should be used in MR imaging examinations conducted for the staging of polypoid tumors, previously treated lesions, and small rectal tumors. However, it should not be used in examinations performed to stage large or low rectal tumors. Diffusion-weighted imaging is useful for identifying nodes and, occasionally, the primary tumor when the tumor is difficult to visualize with other sequences. Three-dimensional T2-weighted imaging provides multiplanar capability with a superior signal-to-noise ratio compared with two-dimensional T2-weighted imaging. ©

RadioGraphics, 2002

A teaching file of Digital Imaging and Communications in Medicine (DICOM) images was developed. S... more A teaching file of Digital Imaging and Communications in Medicine (DICOM) images was developed. Selected computed tomographic, magnetic resonance, angiographic, nuclear medicine, and ultrasonographic images were transferred to a personal computer (PC) with a 75-GB hard drive. The database created from the DICOM header information was modified to include American College of Radiology (ACR) Learning File categories. Database modification allowed cases to be searched by diagnosis, by findings, and by patient age, sex, and demographics. Technologists inputted ACR codes into the DICOM headers before the images were acquired, thereby reducing database maintenance time. Images were manipulated and reviewed and were used for case presentations, board review, and conferences. Selected images were transferred via a hospital network to workstations for consultation, saving time for referring clinicians. The teaching file is reliable, cost-effective, and easy to install and takes advantage of recent technologic advances in computer hardware and software. Rapid cost reductions and increases in PC storage capacity allow maintenance of the teaching file in DICOM format without intermediate steps involving automation or manual conversion. This setup rivals any of the proprietary software currently available from other vendors. © RSNA, 2002 Abbreviations: ACR ϭ American College of Radiology, DICOM ϭ Digital Imaging and Communications in Medicine, JPEG ϭ Joint Photographic Experts Group, PC ϭ personal computer Index terms: Computers • Computers, educational aid • Computers, multimedia • Digital imaging and communications in medicine (DICOM)

Journal of Digital Imaging, May 1, 1999

We present an effective approach to manage, review, and distribute Digital Imaging and Communicat... more We present an effective approach to manage, review, and distribute Digital Imaging and Communications in Medicine (DICOM) images with multiple monitors using Windows98 (Microsoft Corp, Redmond, WA) that can be implemented in an office-based setting. Computed tomography (CT), magnetic resonance imaging (MRI), and angiographic DICOM images were collected, compressed, and stored using Medweb (Medweb, Inc, San Francisco, CA) software. The Medweb server used the Linux/UNIX operating system on a Pentium 333-MHz processor with 128 MB of RAM. Short-term storage capacity was about 2 weeks with routine usage of an 11-GB hard drive. Images were presented for reading on a dual-monitor Windows98 Pentium display station with 160 MB of RAM using a Medweb/Netscape (Netscape Communications Corp, Mountain View, CA) viewer. There was no significant discrepancy in diagnosis between electronic and conventional film images. Mean reading time for 32 cases was 118 seconds. The Medweb JAVA plug-in viewer Ioaded the first image within 30 seconds of selecting the case for review. Full uncompressed 16-bit images allowed different window settings to better assess for pathology. Multiple monitors allowed viewing various hanging protocols. Cine viewing was also possible. Key diagnostic images were electronically transmitted to referring physicians. On-call radiologists were able to access images through the Internet. By combining Medweb, DICOM, and web-browser software using desktop personal computers (PCs), an easily accessible picture archiving and communications system (PACS) is available to radiologists and referring physicians. Multiple monitors are easily configured and managed using Windows98. This system can sustain changes and can be extended to provide variable functions using inexpensive PCs.

Journal of Oncology Practice, May 1, 2015

Purpose: Colon cancer surveillance guidelines do not routinely include positron emission tomograp... more Purpose: Colon cancer surveillance guidelines do not routinely include positron emission tomography (PET) imaging; however, its use after surgical resection has been increasing. We evaluated the secular patterns of PET use after surgical resection of colon cancer among elderly patients and identified factors associated with its increasing use. Patients and Methods: We used the SEER-linked Medicare database (July 2001 through December 2009) to establish a retrospective cohort of patients age Ն 66 years who had undergone surgical resection for colon cancer. Postoperative PET use was assessed with the test for trends. Patient, tumor, and treatment characteristics were analyzed using univariable and multivariable logistic regression analyses. Results: Of the 39,221 patients with colon cancer, 6,326 (16.1%) had undergone a PET scan within 2 years after surgery. The use rate steadily increased over time. The majority of PET scans had been performed within 2 months after surgery. Among patients who had undergone a PET scan, 3,644 (57.6%) had also undergone preoperative imaging, and 1,977 (54.3%) of these patients had undergone reimaging with PET within 2 months after surgery. Marriage, year of diagnosis, tumor stage, preoperative imaging, postoperative visit to a medical oncologist, and adjuvant chemotherapy were significantly associated with increased PET use. Conclusion: PET use after colon cancer resection is steadily increasing, and further study is needed to understand the clinical value and effectiveness of PET scans and the reasons for this departure from guideline-concordant care.

Journal of Digital Imaging, Jun 1, 2001

This presentation describes our experience in combining speech recognition software, clinical rev... more This presentation describes our experience in combining speech recognition software, clinical review software, and other software products on a single computer. Different processor speeds, random access memory (RAM), and computer costs were evaluated. We found that combining continuous speech recognition software with Digital Imaging and Communications in Medicine (DICOM) workstation software on the same platform is feasible and can lead to substantial savings of hardware cost. This combination optimizes use of limited workspace and can improve radiology workflow.

Diseases of The Colon & Rectum, Apr 1, 2012

Background-Use of rectal MRI evaluation of patients with rectal cancer for primary tumor staging ... more Background-Use of rectal MRI evaluation of patients with rectal cancer for primary tumor staging and for identification for poor prognostic features is increasing. MR imaging permits precise delineation of tumor anatomy and assessment of mesorectal tumor penetration and radial margin risk. Objective-To evaluate the ability of pre-treatment rectal MRI to classify tumor response to neoadjuvant chemoradiation. Design-Retrospective, consecutive cohort study, central review. Setting-Tertiary academic hospital. Patients-62 consecutive patients with locally advanced (stage cII-cIII)rectal cancer who underwent rectal cancer protocol high resolution MRI prior to surgery(12/09-3/11). Main Outcome Measures-Probability of good (ypT0-2N0) vs. poor (≥ypT3N0) response as a function of mesorectal tumor depth, lymph node status, extramural vascular invasion, and grade assessed by uni-and multi-variate logistic regression. Results-Tumor response was good in 25, 40.3% and poor in 37, 59.7%.Median interval from MRI to OP was 7.9weeks (IQR: 7.0-9.0). MRI tumor depth was <1 mm in 10 (16.9%), 1-5 mm in 30 (50.8%), and >5 mm in 21(33.9%). LN status was positive in 40 (61.5%) and vascular invasion was present in 16 (25.8%). Tumor response was associated with MRI tumor depth (P=0.001), MRI lymph nodes status (P=<0.001)and vascular invasion (P=0.009). Multivariate regression indicated >5mm MRI tumor depth (OR=0.08, 95% CI=0.01-0.93, p=0.04) and MRI LN positivity (OR=0.12, 95% CI=0.03-0.53, p=0.005) were less likely to achieve a good response to neoadjuvant chemoradiotherapy.

Journal of Digital Imaging, May 1, 1999

To improve radiology access to full uncompressed Digital Imaging and Communications in Medicine (... more To improve radiology access to full uncompressed Digital Imaging and Communications in Medicine (DICOM) data sets, we evaluated satellite access to a DICOM server. Radiologists' home computers were connected by satellite to a Medweb DICOM server (Medweb, San Francisco, CA). A 10.2-kb data set containing a 19-image head computed tomography (CT) scan was transferred using DirecPC (Hughes Electronics Corp, Arlington, VA) at three different times of the day; 6 AM, 3 PM, and 8 PM. The average transfer time for all 19 images from the DICOM server was 4 minutes and 17 seconds (257 seconds). The slowest transfer rate of 670 seconds (121 kbps) was obtained at 8 PM. The best transfer rate of 2 minutes, 54 seconds (467 kbps) was obtained at 6 AM. The full 16-bit DICOM images were viewed with bone, brain, and soft tissue windows. The Medweb plug-in viewer Ioaded the first image within 30 seconds of selecting the case for satellite transfer. In conciusion, satellite internet transfer of radiology studies is suitable for timely review of full DICOM data sets and can expand the range of teleradiology consultation.

Journal of Digital Imaging, Dec 1, 2003

Surgical oncology clinics of North America, 2017

Anal canal cancer is an uncommon malignancy but one that is often curable with optimal therapy. O... more Anal canal cancer is an uncommon malignancy but one that is often curable with optimal therapy. Owing to its unique location, histology, risk factors, and usual presentation, a careful diagnostic approach is warranted. This approach includes an excellent history and physical examination, including digital rectal examination, laboratory data, and comprehensive imaging. Anal cancer staging and formulation of a treatment plan depends on accurate imaging data. Modern radiographic techniques have improved staging quality and accuracy, and a thorough knowledge of anal anatomy is paramount to the optimal multidisciplinary treatment of this disease.

Surgical case reports, 2015

Superior mesenteric artery syndrome (SMAS) after a surgical operation is very rare. We experience... more Superior mesenteric artery syndrome (SMAS) after a surgical operation is very rare. We experienced an extremely rare case of ileal pouch-anal anastomosis with subsequent development of SMAS requiring duodenojejunostomy. A 74-year-old Asian woman underwent total colectomy, ileal pouch-anal anastomosis (J-pouch), covering ileostomy, splenectomy, and distal pancreatectomy for treatment of descending colon cancer associated with ulcerative colitis. She complained of abdominal discomfort and vomiting 17 days postoperatively. Computed tomography (CT) revealed fluid collection at the pancreatic stump. We diagnosed a pancreatic fistula and performed CT-guided drainage. SMAS was thereafter diagnosed by contrast-enhanced CT, which revealed a narrow aortomesenteric angle of 36° and short aortomesenteric distance of 2 mm. The SMAS did not respond to conservative therapy. Finally, we performed duodenojejunostomy. This case illustrates that ileal pouch-anal anastomosis might induce relative stret...

Journal of oncology practice / American Society of Clinical Oncology, Jan 7, 2015

Colon cancer surveillance guidelines do not routinely include positron emission tomography (PET) ... more Colon cancer surveillance guidelines do not routinely include positron emission tomography (PET) imaging; however, its use after surgical resection has been increasing. We evaluated the secular patterns of PET use after surgical resection of colon cancer among elderly patients and identified factors associated with its increasing use. We used the SEER-linked Medicare database (July 2001 through December 2009) to establish a retrospective cohort of patients age ≥ 66 years who had undergone surgical resection for colon cancer. Postoperative PET use was assessed with the test for trends. Patient, tumor, and treatment characteristics were analyzed using univariable and multivariable logistic regression analyses. Of the 39,221 patients with colon cancer, 6,326 (16.1%) had undergone a PET scan within 2 years after surgery. The use rate steadily increased over time. The majority of PET scans had been performed within 2 months after surgery. Among patients who had undergone a PET scan, 3,64...

Emergency Radiology, 2005

The purpose of this study was to determine the sensitivity and specificity of computed tomography... more The purpose of this study was to determine the sensitivity and specificity of computed tomography (CT) without administration of oral contrast in confirming suspected acute appendicitis. One hundred seventy-three patient studies were retrieved by a computer-generated search for the word "appendicitis" in radiology reports. Patients presenting to the emergency department over an 8month period were examined for acute abdominal pain or suspected acute appendicitis. IV-contrast-enhanced CT scans of the abdomen and pelvis were obtained without oral or rectal contrast. Criteria for diagnosis of acute appendicitis included a dilated appendix (>6 mm), periappendiceal inflammation, or abscess. Final diagnoses were established with surgical/clinical follow-up, histopathological analysis or both. The standard time (1 h) for the administration of oral contrast prior to the CT scan was eliminated. Fifty-nine CT diagnoses were made of acute appendicitis, 56 of which were histologically verified and three of which resulted in another diagnosis. One hundred fourteen CT diagnoses were negative for appendicitis. This corresponds to a sensitivity of 100% and specificity of 97%, a positive predictive value of 95%, and a negative predictive value of 100%. CT with IV contrast is sensitive and specific for the confirmation or exclusion of acute appendicitis. By eliminating the time required to administer oral contrast, the diagnosis might be made more rapidly.

Emergency Radiology, 2003

Traumatic diaphragmatic rupture is a frequently missed diagnosis. We present a patient with traum... more Traumatic diaphragmatic rupture is a frequently missed diagnosis. We present a patient with traumatic diaphragmatic hernia. Diagnosis was suggested by a emergent computed tomography (CT) examination without oral contrast. Diaphragmatic rupture and herniation of stomach were confirmed by repeating CT examination after the administration of oral contrast and using multiplanar reconstruction.

Medical Imaging 2006: Image Processing, 2006

Polyp size is an important feature descriptor for clinical classification and follow-up decision ... more Polyp size is an important feature descriptor for clinical classification and follow-up decision making in CT colonography. Currently, polyp size is measured from computed tomography (CT) studies manually as the single largest dimension of the polyp head, excluding the stalk if present, in either multi-planar reconstruction (MPR) or three-dimensional (3D) views. Manual measurements are subject to intra- and inter-reader variation, and can be time-consuming. Automated polyp segmentation and size measurement can reduce the variability and speed up the process. In this study, an automated polyp size measurement technique is developed. Using this technique, the polyp is segmented from the attached healthy tissue using a novel, model-based approach. The largest diameter of the segmented polyp is measured in axial, sagitttal and coronal MPR views. An expert radiologist identified 48 polyps from either supine or prone views of 52 cases of the Walter-Reed virtual colonoscopy database. Automated polyp size measurements were carried out and compared with the manual ones. For comparison, three different statistical methods were used: overall agreement using chance-corrected kappa indices; the mean absolute differences; and Bland-Altman limits of agreement. Manual and automated measurements show good agreement both in 2D and 3D views.

AJR. American journal of roentgenology, 2014

The purpose of this study is to evaluate whether intraoperative ultrasound (IOUS) during open par... more The purpose of this study is to evaluate whether intraoperative ultrasound (IOUS) during open partial nephrectomy alters the surgical management for renal cell cancer (RCC). One hundred ninety-eight consecutive patients undergoing IOUS during open partial nephrectomy for RCC were selected for retrospective review of clinical and imaging data. Patient age and sex, the local extent of the primary lesion, and the presence of additional lesions were recorded. Ultrasound findings were compared with preoperative CT or MRI to determine whether the IOUS findings changed surgical management. Summary statistics were performed to assess what percentage of patients with additional IOUS findings had a change in their surgical management. The Kaplan-Meier method was used to estimate 5-year overall survival (OS) and event-free survival (EFS) rates for all patients. Patients were followed for 9-12 years to assess survival and measure recurrence rates. Twenty-one of 198 patients (10.6%; 95% CI, 6.7-...

RadioGraphics, 2014

■ List the key FIGO and MR imaging staging criteria for endometrial and cervical cancer. ■ Descri... more ■ List the key FIGO and MR imaging staging criteria for endometrial and cervical cancer. ■ Describe the most important prognostic factors for patients with endometrial and cervical cancer. ■ Discuss the role of high-resolution MR imaging and its modifications in the staging of endometrial and cervical cancer. See www.rsna.org/education/search/RG. SA-CME LEARNING OBJECTIVES RG • Volume 34 Number 4 Rauch et al 1083 with minimally invasive laparoscopic hysterectomy and bilateral salpingo-oophorectomy, an approach that decreases morbidity and hospital stays and has comparable outcomes in this group compared with more extensive surgical resection, which should be reserved for highrisk patients with stage IB grade 3 endometrioid disease, stage II and higher, and all grades of nonendometrioid disease (4-7). However, effective implementation of this treatment approach relies heavily on accurate preoperative staging. Magnetic resonance (MR) imaging, particularly the multiparametric approach, has been shown to reliably depict the key prognostic factors for endometrial cancer: depth of myometrial invasion and cervical stromal involvement (7-11). Although it is not part of the FIGO criteria, staging MR imaging is recommended by the National Cancer Institute of France, the European Society of Radiology Guidelines, and the Royal College of Radiologists (12-14). Assessing lymph node involvement in patients with endometrial cancer on the basis of size criteria has substantial limitations. However, the incidence of nodal involvement correlates with the depth of myometrial invasion and cervical stromal involvement; consequently, these characteristics may be used as surrogates to determine whether lymph node dissection is necessary (13,15,16). The incidence of lymph node metastasis increases from 3% when the depth of tumor invasion is less than 50% of myometrial thickness to 46% when more than 50% of myometrial thickness is involved (5,17,18). The role of imaging in endometrial cancer staging potentially received a boost when the FIGO staging system was modified in 2009 (3). The new staging system combines superficial invasion (less than 50% of myometrial thickness) and disease that is confined to the endometrial cavity as stage IA, whereas tumors that invade the outer one-half of the myometrium (greater than 50% thickness) are classified as stage IB. In addition, the definition of stage II changed with the removal of cervical mucosal involvement as a determinate of upstaging, with only cervical stromal invasion now used to define stage II tumors. Distinguishing disease that is confined to the endometrial cavity from superficial myometrial invasion and defining cervical mucosal involvement, which were part of the previous FIGO staging system, was a limitation of imaging; eliminating these categories could improve the accuracy of staging MR imaging in patients with endometrial cancer (19). Cervical cancer is the only gynecologic malignancy that is still clinically staged according to the revised 2009 FIGO classification system (Table 2) This journal-based SA-CME activity has been approved for AMA PRA Category 1 Credit TM. See www.rsna.org/education/search/RG.

RadioGraphics, 1999

Owing to recent advances in magnetic resonance (MR) imaging, the role of obstetric MR imaging has... more Owing to recent advances in magnetic resonance (MR) imaging, the role of obstetric MR imaging has increased in cases in which the results of ultrasonography are equivocal. Fast MR imaging sequences, such as T2weighted fast spin-echo (SE), half-Fourier single-shot fast SE, 0.5-signalacquired single-shot fast SE, and echo-planar imaging, have virtually eliminated the need for fetal premedication, with a concomitant improvement in image resolution and diminished blurring. Artifacts related to maternal respiratory motion and fetal motion no longer limit the anatomic detail that can be demonstrated with MR imaging. With such advances in obstetric MR imaging, knowledge of normal fetal anatomy at MR imaging is essential to detect disease in utero. MR imaging can demonstrate fetal anatomy in detail, especially the brain, thorax, abdomen, pelvis, and vasculature. Major developmental structures of the fetus, particularly the cranial nervous system, naso-and oropharynx, lungs, and major abdominal viscera, can be adequately evaluated with targeted fast MR imaging as early as the beginning of the second trimester. However, MR imaging of the heart remains limited. Fetal MR imaging during the first trimester remains controversial secondary to biosafety issues and is limited due to diminutive fetal size.

RadioGraphics, 2012

High-resolution magnetic resonance (MR) imaging plays a pivotal role in the pretreatment assessme... more High-resolution magnetic resonance (MR) imaging plays a pivotal role in the pretreatment assessment of primary rectal cancer. The success of this technique depends on obtaining good-quality high-resolution T2-weighted images of the primary tumor; the mesorectal fascia, peritoneal reflection, and other pelvic viscera; and superior rectal and pelvic sidewall lymph nodes. Although orthogonal axial high-resolution T2-weighted MR images are the cornerstone for the staging of primary rectal cancer, high-resolution sagittal and coronal images provide additional value, particularly in tumors that arise in a redundant tortuous rectum. Coronal high-resolution T2-weighted MR images also improve the assessment of nodal morphology, particularly for superior rectal and pelvic sidewall nodes, and of the relationship between advanced-stage tumors and adjacent pelvic structures. Rectal gel should be used in MR imaging examinations conducted for the staging of polypoid tumors, previously treated lesions, and small rectal tumors. However, it should not be used in examinations performed to stage large or low rectal tumors. Diffusion-weighted imaging is useful for identifying nodes and, occasionally, the primary tumor when the tumor is difficult to visualize with other sequences. Three-dimensional T2-weighted imaging provides multiplanar capability with a superior signal-to-noise ratio compared with two-dimensional T2-weighted imaging. ©

RadioGraphics, 2002

A teaching file of Digital Imaging and Communications in Medicine (DICOM) images was developed. S... more A teaching file of Digital Imaging and Communications in Medicine (DICOM) images was developed. Selected computed tomographic, magnetic resonance, angiographic, nuclear medicine, and ultrasonographic images were transferred to a personal computer (PC) with a 75-GB hard drive. The database created from the DICOM header information was modified to include American College of Radiology (ACR) Learning File categories. Database modification allowed cases to be searched by diagnosis, by findings, and by patient age, sex, and demographics. Technologists inputted ACR codes into the DICOM headers before the images were acquired, thereby reducing database maintenance time. Images were manipulated and reviewed and were used for case presentations, board review, and conferences. Selected images were transferred via a hospital network to workstations for consultation, saving time for referring clinicians. The teaching file is reliable, cost-effective, and easy to install and takes advantage of recent technologic advances in computer hardware and software. Rapid cost reductions and increases in PC storage capacity allow maintenance of the teaching file in DICOM format without intermediate steps involving automation or manual conversion. This setup rivals any of the proprietary software currently available from other vendors. © RSNA, 2002 Abbreviations: ACR ϭ American College of Radiology, DICOM ϭ Digital Imaging and Communications in Medicine, JPEG ϭ Joint Photographic Experts Group, PC ϭ personal computer Index terms: Computers • Computers, educational aid • Computers, multimedia • Digital imaging and communications in medicine (DICOM)