asim choudhri | University of Tennessee Health Science Center (original) (raw)
Papers by asim choudhri
Academic Radiology, 2008
Although myocardial perfusion positron emission tomography (PET), using either cyclotron-produced... more Although myocardial perfusion positron emission tomography (PET), using either cyclotron-produced ammonia or generator-produced rubidium 82, has reported excellent diagnostic capabilities in the detection of coronary artery disease (CAD) in individual studies, the technique is not widely used in practice. This may be driven by cost and availability or by unawareness of performance. The purpose of our study was to conduct an evidence-based evaluation of PET in the diagnosis of CAD. We examined studies from January 1977 to July 2007 using MEDLINE and EMBASE. A study was included if it (1) used PET as a diagnostic test for CAD and (2) used catheter x-ray angiography as the reference standard (> or =50% diameter stenosis). Analysis was performed on a subject and coronary territory level. Nineteen studies (1442 patients) met the inclusion criteria. On a patient level, PET demonstrated a sensitivity of 0.92 (95% confidence interval [CI]: 0.90-0.94) and specificity of 0.85 (CI: 0.79-0.90), with a positive likelihood ratio (LR+) of 6.2 (CI: 3.3-11.8) and negative likelihood ratio (LR-) of 0.11 (CI: 0.08-0.14). On a coronary territory level (n = 1130), PET showed a sensitivity of 0.81 (CI: 0.77-0.84) and specificity of 0.87 (CI: 0.84-0.90), with an LR+ of 5.9 (CI: 4.5-7.9) and an LR- of 0.19 (CI: 0.09-0.38). PET demonstrates excellent diagnostic properties in the diagnosis of CAD, especially at the patient level. The capabilities appear superior to those reported in meta-analyses for perfusion imaging with Tl-201 and sestamibi, or anatomical imaging with coronary MDCT angiography or MRA. Given that previous studies have found PET to be cost-effective and the current findings of excellent sensitivity and specificity, the modality should be more widely considered as an initial test in the diagnosis of CAD.
Radiographics : a review publication of the Radiological Society of North America, Inc, 2015
The end-user of mobile device apps in the practice of clinical radiology should be aware of secur... more The end-user of mobile device apps in the practice of clinical radiology should be aware of security measures that prevent unauthorized use of the device, including passcode policies, methods for dealing with failed login attempts, network manager-controllable passcode enforcement, and passcode enforcement for the protection of the mobile device itself. Protection of patient data must be in place that complies with the Health Insurance Portability and Accountability Act and U.S. Federal Information Processing Standards. Device security measures for data protection include methods for locally stored data encryption, hardware encryption, and the ability to locally and remotely clear data from the device. As these devices transfer information over both local wireless networks and public cell phone networks, wireless network security protocols, including wired equivalent privacy and Wi-Fi protected access, are important components in the chain of security. Specific virtual private netwo...
Radiographics : a review publication of the Radiological Society of North America, Inc
Recent advances in prenatal imaging have made possible the in utero diagnosis of cleft lip and pa... more Recent advances in prenatal imaging have made possible the in utero diagnosis of cleft lip and palate and associated deformities. Postnatal diagnosis of cleft lip is made clinically, but imaging still plays a role in detection of associated abnormalities, surgical treatment planning, and screening for or surveillance of secondary deformities. This article describes the clinical entities of cleft lip with or without cleft palate (CLP) and isolated cleft palate and documents their prenatal and postnatal appearances at radiography, ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT). Imaging protocols and findings for prenatal screening, detection of associated anomalies, and evaluation of secondary deformities throughout life are described and illustrated. CLP and isolated cleft palate are distinct entities with shared radiologic appearances. Prenatal US and MR imaging can depict clefting of the lip or palate and associated anomalies. While two- and thr...
Journal of neurosurgery. Pediatrics, Jan 16, 2015
OBJECT Malignant tumors of the brainstem, excluding classic diffuse intrinsic pontine gliomas (DI... more OBJECT Malignant tumors of the brainstem, excluding classic diffuse intrinsic pontine gliomas (DIPGs), are a very rare, heterogeneous group of neoplasms that have been infrequently described in the literature. In this paper, the authors present their experiences with treating these unique cancers. METHODS A retrospective chart review was conducted to identify eligible cases over a 15-year period. All tumors involving the pons were, by consensus, felt not to be DIPGs based on their neuroimaging features. Demographic information, pathological specimens, neuroimaging characteristics, surgical and nonsurgical management plans, and survival data were gathered for analysis. RESULTS Between January 2000 and December 2014, 29 patients were identified. The mean age at diagnosis was 8.4 years (range 2 months to 25 years), and 17 (59%) patients were male. The most common presenting signs and symptoms were cranial neuropathies (n = 24; 83%), hemiparesis (n = 12; 41%), and ataxia or gait disturb...
Circulation
Vasodilatory shock requiring catecholamine pressors occurs in some patients following cardiopulmo... more Vasodilatory shock requiring catecholamine pressors occurs in some patients following cardiopulmonary bypass. Prompted by a clinical observation, we investigated the use of vasopressin as a treatment for this syndrome in a randomized, controlled trial. Patients undergoing placement of a left ventricular assist device (n=23) were evaluated for post-bypass vasodilatory shock requiring catecholamine pressors, and consecutive eligible subjects (n=10) were evenly randomized to blinded intravenous vasopressin or saline placebo. Vasopressin (0.1 U/min) increased mean arterial pressure (57+/-4 to 84+/-2 mm Hg, P<.001) and systemic vascular resistance (813+/-113 to 1188+/-87 dyne-s/cm5, P<.001), with decreased norepinephrine administration. There was no significant response to saline, but in three subjects who crossed over, blinded vasopressin increased mean arterial pressure (69+/-8 to 93+/-4 mm Hg) and systemic vascular resistance (898+/-88 to 1443+/-72 dyne-s/cm5) with decreased norepinephrine administration. Plasma vasopressin concentrations prior to randomization clustered in two groups: one (n=5) with concentrations inappropriately low for the degree of hypotension (8.4+/-2.1 pg/mL) and a second (n=3) with moderately elevated levels (33.7+/-1.6 pg/mL); vasopressin increased mean arterial pressure in the low vasopressin group from 57+/-4 to 85+/-2 mm Hg (P<.01) and in the high vasopressin group from 68+/-8 to 86+/-4 mm Hg. Vasopressin is an effective pressor in vasodilatory shock after cardiopulmonary bypass. An absolute vasopressin deficiency was observed in the majority of patients, but all subjects responded to vasopressin administration.
PURPOSE/AIM Stenoses, shunts, and occlusions are often encountered when reviewing angiographic st... more PURPOSE/AIM Stenoses, shunts, and occlusions are often encountered when reviewing angiographic studies, however accurate interpretation of the hemodynamic implications of vascular lesions requires an appreciation of fluid mechanics. We present clinical examples of vascular lesions which demonstrate basic physics principles. CONTENT ORGANIZATION 1- A summary of Ohm's law, and how it applies to fluid dynamics 2- Description of laminar flow, turbulence, and Reynold's number with animated examples 3- Analysis of the difference between concentric versus eccentric luminal narrowing 4- Discuss differences between long-segment mild stenoses and focal high-grade tandem lesions 5- Analysis of competitive flow and steal-syndromes 6- Angiographic, CTA, MRA, and sonographic cases of vascular lesions demonstrating the above principles SUMMARY Improved understanding of basic principles of fluid mechanics can improve evaluation of the clinical significance of vascular lesions. Application o...
PURPOSE/AIM Pediatric stroke is a heterogeneous clinical entity that can be difficult to diagnose... more PURPOSE/AIM Pediatric stroke is a heterogeneous clinical entity that can be difficult to diagnose, with etiologies and treatment that vastly differ from adult stroke. We have created a multidisciplinary pediatric stroke institute and optimized neuroimaging protocols for the varying ages and presentations of acute pediatric cerebrovascular emergencies. CONTENT ORGANIZATION We will summarize different etiologies of pediatric stroke with imaging examples, and a summary of diagnostic protocols. Etiologies include sickle cell disease, connective tissue disorders, vasculitis, trauma, congenital heart defects, neuro-oncology, hematologic disorders, venous occlusive disease, and toxic/metabolic disorders. We will discuss why specific diagnostic pathways have been chosen, with an emphasis on radiation dose, rapidity of image acquisition and reproducibility of results. SUMMARY Pediatric stroke can be difficult to diagnose, however implementation of a well-thought out diagnostic pathway in a m...
BACKGROUND There are increasing applications of MR diffusion tensor fiber tracking, which allows ... more BACKGROUND There are increasing applications of MR diffusion tensor fiber tracking, which allows for delineation of multiple interconnecting white matter fiber tracts in the brain. Proper interpretation of this information requires understanding the complex 3D relationships, beyond that required for conventional cross-sectional neuroimaging. With the recent surge in rapid prototyping technologies, new opportunities have emerged for discovering innovative applications through low-cost 3D printers, which use virtual 3D datasets to construct solid forms in a layer-by-layer technique. We propose that this technology may offer additional advantages in the visualization of white matter tracts, in settings such as neurosurgical planning, patient counseling and resident training. EVALUATION The challenge in the case of tractography lies in the fact that the data format of fiber tracts is not ideally suited for surface reconstruction methods used in medical applications. Fiber tracts are der...
CONCLUSION Mobile decision support and communication tools have potential to encourage appropriat... more CONCLUSION Mobile decision support and communication tools have potential to encourage appropriate radiological examinations for safe, timely, efficient, and effective patient care. A modular web-app ensures dynamic, up-to-date information customizable for other multi-facility academic medical centers. BACKGROUND The era of web-based PACS has led to decreased face-to-face interaction between ordering clinicians and radiologists. Finding time within daily workflow for communication about indicated or appropriate studies may be difficult. Differing schedules and shifts represent an additional barrier to effective clinical discussion, often leading to unclear, non-indicated, or inappropriate exam orders. Mobile decision support tools have promise to aid both clinicians and radiologists in ordering and performing appropriate studies. Such tools have the potential to educate, lower communication barriers, and facilitate safe, timely, efficient, and effective patient care.
PURPOSE/AIM 1. Highlight the need for clinical decision support and communication among clinician... more PURPOSE/AIM 1. Highlight the need for clinical decision support and communication among clinicians and radiologists 2. Overview the design and implementation of a modular decision support mobile web-app at a multi-facility academic medical center 3. Discuss how this web-app can be customized and deployed at your own institution for improved clinical education and patient care CONTENT ORGANIZATION The Era of Web-based PACS -Barriers to communication between clinicians and radiologists -Effects of unclear and inappropriate examination orders Design and Implementation of a Radiologic Decision Support Tool -Modular, mobile web-app design for ease of use and customizability -Integration of national guidelines and communication tools -Deployment at a multi-facility academic medical center -Use of feedback for tool refinement and patient care quality improvement Customization and Deployment at Your Own Institution -Identifying specific group needs and gathering useful information -Strategi...
CONCLUSION Mobile device-based systems show great promise for secure yet rapid consultation and s... more CONCLUSION Mobile device-based systems show great promise for secure yet rapid consultation and sharing of interesting cases. Such systems have already been deployed on an institutional and cross-institutional basis and have demonstrated great success. BACKGROUND With the wide variety of PACS in use, radiologists in a group covering different hospitals often find communication between different PACS difficult. This is especially cumbersome when quick and informal consultations are desired between colleagues. With the recent improvements in camera optics and sensors in mobile devices, coupled with highly secure text and picture messaging networks, such limitations in communication can be more easily overcome. EVALUATION Several mobile device-based applications were evaluated for ease of use, fidelity of image capture, security of transmission, and ease of sharing images among a group of colleagues. Applications tested were on different mobile device platforms and deployed across diff...
The American Journal of Human Genetics, 2015
Progeroid disorders overlapping with De Barsy syndrome (DBS) are collectively denoted as autosoma... more Progeroid disorders overlapping with De Barsy syndrome (DBS) are collectively denoted as autosomal-recessive cutis laxa type 3 (ARCL3). They are caused by biallelic mutations in PYCR1 or ALDH18A1, encoding pyrroline-5-carboxylate reductase 1 and pyrroline-5-carboxylate synthase (P5CS), respectively, which both operate in the mitochondrial proline cycle. We report here on eight unrelated individuals born to non-consanguineous families clinically diagnosed with DBS or wrinkly skin syndrome. We found three heterozygous mutations in ALDH18A1 leading to amino acid substitutions of the same highly conserved residue, Arg138 in P5CS. A de novo origin was confirmed in all six probands for whom parental DNA was available. Using fibroblasts from affected individuals and heterologous overexpression, we found that the P5CS-p.Arg138Trp protein was stable and able to interact with wild-type P5CS but showed an altered sub-mitochondrial distribution. A reduced size upon native gel electrophoresis indicated an alteration of the structure or composition of P5CS mutant complex. Furthermore, we found that the mutant cells had a reduced P5CS enzymatic activity leading to a delayed proline accumulation. In summary, recurrent de novo mutations, affecting the highly conserved residue Arg138 of P5CS, cause an autosomal-dominant form of cutis laxa with progeroid features. Our data provide insights into the etiology of cutis laxa diseases and will have immediate impact on diagnostics and genetic counseling.
CONCLUSION Obstetric ultrasound images posted on publicly accessible websites often result in ina... more CONCLUSION Obstetric ultrasound images posted on publicly accessible websites often result in inadvertent disclosure of protected health information. Radiologists are well positioned to educate patients on taking charge of their own information security. BACKGROUND With the increasing availability of high quality camera phones and mobile devices, patients now have greater access to their own imaging and ability to capture screenshots at the point of care. A particularly common scenario is the new mother who uses a mobile device to obtain an image of her obstetric (OB) ultrasound and then directly posts the images to a public website or forum. The oft-overlooked concern is the public posting of protected health information, now publicly available for any would-be identity thief to take. EVALUATION A consecutive series of OB ultrasound images were acquired from a publicly accessible website and analyzed using several criteria, including method of image capture, visibility of patient n...
PURPOSE Kissing stents are commonly placed for aortic bifurcation lesions with disappointing mid ... more PURPOSE Kissing stents are commonly placed for aortic bifurcation lesions with disappointing mid and long term patency compared to common iliac stents. Covered stents may provide better patency. We reviewed outcomes of percutaneous placement of kissing covered iliac stents for aortic bifurcation atherosclerotic lesions compared to non-covered stents. METHOD AND MATERIALS A retrospective review of patients with aortic bifurcation disease treated with bilateral common iliac kissing balloon expandable stents was performed for cases between 1/1/2002 and 4/1/2007. Fifty six consecutive patients were identified and divided into two groups: non-covered stents (NCS) and covered stents (CS). Thirty one patients (13 males, median age 62 years, range 38-82) received NCS and 25 patients (18 males, median age 60 years, range 39-77) received CS. Indications for stent placement included claudication in 44 patients (24 NCS and 20 CS) and limb-threatening ischemia in 12 (7 NCS and 5 CS). Kaplan-Meie...
Academic Radiology, 2008
Although myocardial perfusion positron emission tomography (PET), using either cyclotron-produced... more Although myocardial perfusion positron emission tomography (PET), using either cyclotron-produced ammonia or generator-produced rubidium 82, has reported excellent diagnostic capabilities in the detection of coronary artery disease (CAD) in individual studies, the technique is not widely used in practice. This may be driven by cost and availability or by unawareness of performance. The purpose of our study was to conduct an evidence-based evaluation of PET in the diagnosis of CAD. We examined studies from January 1977 to July 2007 using MEDLINE and EMBASE. A study was included if it (1) used PET as a diagnostic test for CAD and (2) used catheter x-ray angiography as the reference standard (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =50% diameter stenosis). Analysis was performed on a subject and coronary territory level. Nineteen studies (1442 patients) met the inclusion criteria. On a patient level, PET demonstrated a sensitivity of 0.92 (95% confidence interval [CI]: 0.90-0.94) and specificity of 0.85 (CI: 0.79-0.90), with a positive likelihood ratio (LR+) of 6.2 (CI: 3.3-11.8) and negative likelihood ratio (LR-) of 0.11 (CI: 0.08-0.14). On a coronary territory level (n = 1130), PET showed a sensitivity of 0.81 (CI: 0.77-0.84) and specificity of 0.87 (CI: 0.84-0.90), with an LR+ of 5.9 (CI: 4.5-7.9) and an LR- of 0.19 (CI: 0.09-0.38). PET demonstrates excellent diagnostic properties in the diagnosis of CAD, especially at the patient level. The capabilities appear superior to those reported in meta-analyses for perfusion imaging with Tl-201 and sestamibi, or anatomical imaging with coronary MDCT angiography or MRA. Given that previous studies have found PET to be cost-effective and the current findings of excellent sensitivity and specificity, the modality should be more widely considered as an initial test in the diagnosis of CAD.
Radiographics : a review publication of the Radiological Society of North America, Inc, 2015
The end-user of mobile device apps in the practice of clinical radiology should be aware of secur... more The end-user of mobile device apps in the practice of clinical radiology should be aware of security measures that prevent unauthorized use of the device, including passcode policies, methods for dealing with failed login attempts, network manager-controllable passcode enforcement, and passcode enforcement for the protection of the mobile device itself. Protection of patient data must be in place that complies with the Health Insurance Portability and Accountability Act and U.S. Federal Information Processing Standards. Device security measures for data protection include methods for locally stored data encryption, hardware encryption, and the ability to locally and remotely clear data from the device. As these devices transfer information over both local wireless networks and public cell phone networks, wireless network security protocols, including wired equivalent privacy and Wi-Fi protected access, are important components in the chain of security. Specific virtual private netwo...
Radiographics : a review publication of the Radiological Society of North America, Inc
Recent advances in prenatal imaging have made possible the in utero diagnosis of cleft lip and pa... more Recent advances in prenatal imaging have made possible the in utero diagnosis of cleft lip and palate and associated deformities. Postnatal diagnosis of cleft lip is made clinically, but imaging still plays a role in detection of associated abnormalities, surgical treatment planning, and screening for or surveillance of secondary deformities. This article describes the clinical entities of cleft lip with or without cleft palate (CLP) and isolated cleft palate and documents their prenatal and postnatal appearances at radiography, ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT). Imaging protocols and findings for prenatal screening, detection of associated anomalies, and evaluation of secondary deformities throughout life are described and illustrated. CLP and isolated cleft palate are distinct entities with shared radiologic appearances. Prenatal US and MR imaging can depict clefting of the lip or palate and associated anomalies. While two- and thr...
Journal of neurosurgery. Pediatrics, Jan 16, 2015
OBJECT Malignant tumors of the brainstem, excluding classic diffuse intrinsic pontine gliomas (DI... more OBJECT Malignant tumors of the brainstem, excluding classic diffuse intrinsic pontine gliomas (DIPGs), are a very rare, heterogeneous group of neoplasms that have been infrequently described in the literature. In this paper, the authors present their experiences with treating these unique cancers. METHODS A retrospective chart review was conducted to identify eligible cases over a 15-year period. All tumors involving the pons were, by consensus, felt not to be DIPGs based on their neuroimaging features. Demographic information, pathological specimens, neuroimaging characteristics, surgical and nonsurgical management plans, and survival data were gathered for analysis. RESULTS Between January 2000 and December 2014, 29 patients were identified. The mean age at diagnosis was 8.4 years (range 2 months to 25 years), and 17 (59%) patients were male. The most common presenting signs and symptoms were cranial neuropathies (n = 24; 83%), hemiparesis (n = 12; 41%), and ataxia or gait disturb...
Circulation
Vasodilatory shock requiring catecholamine pressors occurs in some patients following cardiopulmo... more Vasodilatory shock requiring catecholamine pressors occurs in some patients following cardiopulmonary bypass. Prompted by a clinical observation, we investigated the use of vasopressin as a treatment for this syndrome in a randomized, controlled trial. Patients undergoing placement of a left ventricular assist device (n=23) were evaluated for post-bypass vasodilatory shock requiring catecholamine pressors, and consecutive eligible subjects (n=10) were evenly randomized to blinded intravenous vasopressin or saline placebo. Vasopressin (0.1 U/min) increased mean arterial pressure (57+/-4 to 84+/-2 mm Hg, P<.001) and systemic vascular resistance (813+/-113 to 1188+/-87 dyne-s/cm5, P<.001), with decreased norepinephrine administration. There was no significant response to saline, but in three subjects who crossed over, blinded vasopressin increased mean arterial pressure (69+/-8 to 93+/-4 mm Hg) and systemic vascular resistance (898+/-88 to 1443+/-72 dyne-s/cm5) with decreased norepinephrine administration. Plasma vasopressin concentrations prior to randomization clustered in two groups: one (n=5) with concentrations inappropriately low for the degree of hypotension (8.4+/-2.1 pg/mL) and a second (n=3) with moderately elevated levels (33.7+/-1.6 pg/mL); vasopressin increased mean arterial pressure in the low vasopressin group from 57+/-4 to 85+/-2 mm Hg (P<.01) and in the high vasopressin group from 68+/-8 to 86+/-4 mm Hg. Vasopressin is an effective pressor in vasodilatory shock after cardiopulmonary bypass. An absolute vasopressin deficiency was observed in the majority of patients, but all subjects responded to vasopressin administration.
PURPOSE/AIM Stenoses, shunts, and occlusions are often encountered when reviewing angiographic st... more PURPOSE/AIM Stenoses, shunts, and occlusions are often encountered when reviewing angiographic studies, however accurate interpretation of the hemodynamic implications of vascular lesions requires an appreciation of fluid mechanics. We present clinical examples of vascular lesions which demonstrate basic physics principles. CONTENT ORGANIZATION 1- A summary of Ohm's law, and how it applies to fluid dynamics 2- Description of laminar flow, turbulence, and Reynold's number with animated examples 3- Analysis of the difference between concentric versus eccentric luminal narrowing 4- Discuss differences between long-segment mild stenoses and focal high-grade tandem lesions 5- Analysis of competitive flow and steal-syndromes 6- Angiographic, CTA, MRA, and sonographic cases of vascular lesions demonstrating the above principles SUMMARY Improved understanding of basic principles of fluid mechanics can improve evaluation of the clinical significance of vascular lesions. Application o...
PURPOSE/AIM Pediatric stroke is a heterogeneous clinical entity that can be difficult to diagnose... more PURPOSE/AIM Pediatric stroke is a heterogeneous clinical entity that can be difficult to diagnose, with etiologies and treatment that vastly differ from adult stroke. We have created a multidisciplinary pediatric stroke institute and optimized neuroimaging protocols for the varying ages and presentations of acute pediatric cerebrovascular emergencies. CONTENT ORGANIZATION We will summarize different etiologies of pediatric stroke with imaging examples, and a summary of diagnostic protocols. Etiologies include sickle cell disease, connective tissue disorders, vasculitis, trauma, congenital heart defects, neuro-oncology, hematologic disorders, venous occlusive disease, and toxic/metabolic disorders. We will discuss why specific diagnostic pathways have been chosen, with an emphasis on radiation dose, rapidity of image acquisition and reproducibility of results. SUMMARY Pediatric stroke can be difficult to diagnose, however implementation of a well-thought out diagnostic pathway in a m...
BACKGROUND There are increasing applications of MR diffusion tensor fiber tracking, which allows ... more BACKGROUND There are increasing applications of MR diffusion tensor fiber tracking, which allows for delineation of multiple interconnecting white matter fiber tracts in the brain. Proper interpretation of this information requires understanding the complex 3D relationships, beyond that required for conventional cross-sectional neuroimaging. With the recent surge in rapid prototyping technologies, new opportunities have emerged for discovering innovative applications through low-cost 3D printers, which use virtual 3D datasets to construct solid forms in a layer-by-layer technique. We propose that this technology may offer additional advantages in the visualization of white matter tracts, in settings such as neurosurgical planning, patient counseling and resident training. EVALUATION The challenge in the case of tractography lies in the fact that the data format of fiber tracts is not ideally suited for surface reconstruction methods used in medical applications. Fiber tracts are der...
CONCLUSION Mobile decision support and communication tools have potential to encourage appropriat... more CONCLUSION Mobile decision support and communication tools have potential to encourage appropriate radiological examinations for safe, timely, efficient, and effective patient care. A modular web-app ensures dynamic, up-to-date information customizable for other multi-facility academic medical centers. BACKGROUND The era of web-based PACS has led to decreased face-to-face interaction between ordering clinicians and radiologists. Finding time within daily workflow for communication about indicated or appropriate studies may be difficult. Differing schedules and shifts represent an additional barrier to effective clinical discussion, often leading to unclear, non-indicated, or inappropriate exam orders. Mobile decision support tools have promise to aid both clinicians and radiologists in ordering and performing appropriate studies. Such tools have the potential to educate, lower communication barriers, and facilitate safe, timely, efficient, and effective patient care.
PURPOSE/AIM 1. Highlight the need for clinical decision support and communication among clinician... more PURPOSE/AIM 1. Highlight the need for clinical decision support and communication among clinicians and radiologists 2. Overview the design and implementation of a modular decision support mobile web-app at a multi-facility academic medical center 3. Discuss how this web-app can be customized and deployed at your own institution for improved clinical education and patient care CONTENT ORGANIZATION The Era of Web-based PACS -Barriers to communication between clinicians and radiologists -Effects of unclear and inappropriate examination orders Design and Implementation of a Radiologic Decision Support Tool -Modular, mobile web-app design for ease of use and customizability -Integration of national guidelines and communication tools -Deployment at a multi-facility academic medical center -Use of feedback for tool refinement and patient care quality improvement Customization and Deployment at Your Own Institution -Identifying specific group needs and gathering useful information -Strategi...
CONCLUSION Mobile device-based systems show great promise for secure yet rapid consultation and s... more CONCLUSION Mobile device-based systems show great promise for secure yet rapid consultation and sharing of interesting cases. Such systems have already been deployed on an institutional and cross-institutional basis and have demonstrated great success. BACKGROUND With the wide variety of PACS in use, radiologists in a group covering different hospitals often find communication between different PACS difficult. This is especially cumbersome when quick and informal consultations are desired between colleagues. With the recent improvements in camera optics and sensors in mobile devices, coupled with highly secure text and picture messaging networks, such limitations in communication can be more easily overcome. EVALUATION Several mobile device-based applications were evaluated for ease of use, fidelity of image capture, security of transmission, and ease of sharing images among a group of colleagues. Applications tested were on different mobile device platforms and deployed across diff...
The American Journal of Human Genetics, 2015
Progeroid disorders overlapping with De Barsy syndrome (DBS) are collectively denoted as autosoma... more Progeroid disorders overlapping with De Barsy syndrome (DBS) are collectively denoted as autosomal-recessive cutis laxa type 3 (ARCL3). They are caused by biallelic mutations in PYCR1 or ALDH18A1, encoding pyrroline-5-carboxylate reductase 1 and pyrroline-5-carboxylate synthase (P5CS), respectively, which both operate in the mitochondrial proline cycle. We report here on eight unrelated individuals born to non-consanguineous families clinically diagnosed with DBS or wrinkly skin syndrome. We found three heterozygous mutations in ALDH18A1 leading to amino acid substitutions of the same highly conserved residue, Arg138 in P5CS. A de novo origin was confirmed in all six probands for whom parental DNA was available. Using fibroblasts from affected individuals and heterologous overexpression, we found that the P5CS-p.Arg138Trp protein was stable and able to interact with wild-type P5CS but showed an altered sub-mitochondrial distribution. A reduced size upon native gel electrophoresis indicated an alteration of the structure or composition of P5CS mutant complex. Furthermore, we found that the mutant cells had a reduced P5CS enzymatic activity leading to a delayed proline accumulation. In summary, recurrent de novo mutations, affecting the highly conserved residue Arg138 of P5CS, cause an autosomal-dominant form of cutis laxa with progeroid features. Our data provide insights into the etiology of cutis laxa diseases and will have immediate impact on diagnostics and genetic counseling.
CONCLUSION Obstetric ultrasound images posted on publicly accessible websites often result in ina... more CONCLUSION Obstetric ultrasound images posted on publicly accessible websites often result in inadvertent disclosure of protected health information. Radiologists are well positioned to educate patients on taking charge of their own information security. BACKGROUND With the increasing availability of high quality camera phones and mobile devices, patients now have greater access to their own imaging and ability to capture screenshots at the point of care. A particularly common scenario is the new mother who uses a mobile device to obtain an image of her obstetric (OB) ultrasound and then directly posts the images to a public website or forum. The oft-overlooked concern is the public posting of protected health information, now publicly available for any would-be identity thief to take. EVALUATION A consecutive series of OB ultrasound images were acquired from a publicly accessible website and analyzed using several criteria, including method of image capture, visibility of patient n...
PURPOSE Kissing stents are commonly placed for aortic bifurcation lesions with disappointing mid ... more PURPOSE Kissing stents are commonly placed for aortic bifurcation lesions with disappointing mid and long term patency compared to common iliac stents. Covered stents may provide better patency. We reviewed outcomes of percutaneous placement of kissing covered iliac stents for aortic bifurcation atherosclerotic lesions compared to non-covered stents. METHOD AND MATERIALS A retrospective review of patients with aortic bifurcation disease treated with bilateral common iliac kissing balloon expandable stents was performed for cases between 1/1/2002 and 4/1/2007. Fifty six consecutive patients were identified and divided into two groups: non-covered stents (NCS) and covered stents (CS). Thirty one patients (13 males, median age 62 years, range 38-82) received NCS and 25 patients (18 males, median age 60 years, range 39-77) received CS. Indications for stent placement included claudication in 44 patients (24 NCS and 20 CS) and limb-threatening ischemia in 12 (7 NCS and 5 CS). Kaplan-Meie...