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08-44 Computed tomography versus ultrasound in the evaluation of acute appendicitis
08-44 C o m p u t e d T o m o g r a p h y versus Ultrasound in t h e Evaluation of A c u t e Appendicitis Chris Cole, MD, Scott & White Memorial Hospital, Temple, TX, Michael L. Nipper, MD Purpose: To determine the usefulness of ultrasound (US) and computed tomography (CT) as adjunct tests to physical examination in the evaluation of acute appendicitis in the community hospital setting. Materials and Methods: Evaluation of 100 patients complaining of right lower quadrant abdominal pain was conducted utilizing physical examination, a limited US, and a limited CT with rectal contrast only. All tests were conducted and interpreted by both radiology and surgery residents, who documented their individual impressions independent of each other's findings. All findings were reviewed, the physical examination was repeated, and final disposition was made. Results: Both ultrasound and computed tomography were found to be useful in the evaluation of acute appendicitis. When the ultrasound findings were positive, there was a very high correlation with surgical resuits. However, the sensitlwty of ultrasound was not found to be as high as reported in the literature. Computed tomography also demonstrated a very high correlation with surgical results. Additionally, computed tomography was able to identify other causes of the patient's abdominal pain. Effects of other factors, such as patient body habitus, cost and time of examination, and radiation exposure, were considered. Conclusion: Both ultrasound and computed tomography are useful adjunct tests in the evaluation of acute appendicitis. 08-45 Radiological Evaluation of Abdominal and Pelvic Hernias Tim G. Raveill, MD, University of Kansas Medical Center, Kansas City, KS, A. James Beyer III, MD, Jinna S. Chen, MD Purpose: To review and illustrate the various radiological features of abdominal and pelvic hernias for the purpose of determming the most appropriate examination sequence and enabling timely, cost-effective workup of these patients. Materials and Methods: A review of the recent literature was performed m addition to compiling numerous departmental cases. All modalines are addressed, including CT, sonography, barium studies, and hemiography. Results: Sonographic, CT, and barium studies were obtained to ilhisIrate the various types of hernias including: (1) ventral-incisional, umbilical, epigastric, spigelian; (2) groin-inguinal (direct and indirect), femoral; (3) pelvic-obturator, sciatic; (4) internal hemias-paraduodenal, lesser sac, etc; (5) diaphragmatic-congenital, Natal, and traumatic. Review of these images, as well as the pertinent literature, suggests that while the sequence of the radmlogical workup must be individualized for each patient, sonography followed by CT or barium studies to address the specific diagnostic dilemma is often the most appropriate approach. Conclusion: Familiarity with multimodality imaging findings in the evaluation of patients with hernias allows a logical and cost-effective approach to radiological diagnosis. 08-46 Resident Performance in t h e Diagnosis of A c u t e Appendicitis on U n e n h a n c e d Helical CT with Enteric Contrast Richard H. Kim, MD, University of Chicago Hospitals, Chicago, IL, Brian S. Funaki, MD, Peter M. MacEneaney, M B B C h
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Purpose: To evaluate the performance of radiology residents in evaluating unenhanced helical CT for evaluation of acute appendicitis after formal training sessions. Materials and Methods: Ten residents retrospectively evaluated 20 unenhanced helical CT scans, using 5-ram collimation and rectal contrast, designed to diagnose acute appendicitis. Each resident was then given formal training in this technique. Over the following 15 months, 46 patients with clinically suspected appendicitis were scanned during "on-call" hours. Preliminary interpretations were prospectively issued by the resident on call. They were correlated with surgical pathology, clinical follow-up, or both. Results: For 20 sample CT scans, the sensitivity and specificity were 45% and 83%. respectively. Of the 46 scans interpreted prospectively. 5 were interpreted as positrve (5 true positives) and 40 were interpreted as negative for appendicttis (39 true negatives and 1 false negative). One scan was excluded from the statistics due to technical reasons. Sensitivity was 83%; specificity was 100%; positive predictive value was 100% and negative predictive value was 97% based on an incidence of 13%. Conclusion: With proper training, unenhanced helical CT for the evaluation of acute appendicitis can be successfully implemented in university hospitals where residents provide preliminary readings.
09-47 I m p a c t of PACS on Radiology Resident Education: T h e Resident's Perspective Mark E. Mullins, MD, PhD, Massachusetts General Hospital, Boston, MA, Hiren R. Patel, MD, Theresa C. McLoud, MD, Robert A. Novelline, MD Purpose: As our departments enter the PACS era, we are interpreting more examinations in less time. Because of concerns this may have a deleterious effect on resident education, the following survey was undertaken. Materials and Methods: As of October 1999, >75% of radiology studies were reviewed on digital soft copy via PACS. Residents of two diagnostic radiology-training programs (MGH, BWH) were surveyed. Topics included technical and didactic issues, using direct and indirect comparison to analog (conventional film) imaging. Results: Fifty residents were polled (20 respondents). The majority has been using PACS over 1 year (15/20, 75%) to interpret 75-100% of cases (15/19, 79%). The majority felt that PACS improved patient care (16/20, 80%) and their educational experience (16/20, 80%). Some felt that increased patient throughput was harmful to the educational experience (5/19, 26%). Some felt that PACS encouraged attending radiologists to go over cases too quickly (4/19, 21%). Residents favored PACS compared to analog images for ease of manipulation, resolution, and the ability to see pathology and normal anatomy. Conclusion: Residents beheve that PACS has positively affected their experience and is not a problem for resident education. 09-48 Assessing Student's Response to Administering t h e Radiology Clerkship through Web Technology Brian C. Davison, MD, MS, Boston Medical Center, Johan G. Blickman, MD, PhD, Richard J. Tello, MD Introduction: We assessed student response to RadClerk, a set of custom software modules designed to enhance the medical student's experience during the radiology clerkship RadClerk combines the educational benefits of the Internet with traditional radiology teaching tools. It features integration of instructional modules, online actrvity and lecture schedules, record keeping, student evaluation of course materials, online testing and student project submission, and cataloging into an online teaching file.
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Purpose: To evaluate the performance of radiology residents in evaluating unenhanced helical CT for evaluation of acute appendicitis after formal training sessions. Materials and Methods: Ten residents retrospectively evaluated 20 unenhanced helical CT scans, using 5-ram collimation and rectal contrast, designed to diagnose acute appendicitis. Each resident was then given formal training in this technique. Over the following 15 months, 46 patients with clinically suspected appendicitis were scanned during "on-call" hours. Preliminary interpretations were prospectively issued by the resident on call. They were correlated with surgical pathology, clinical follow-up, or both. Results: For 20 sample CT scans, the sensitivity and specificity were 45% and 83%. respectively. Of the 46 scans interpreted prospectively. 5 were interpreted as positrve (5 true positives) and 40 were interpreted as negative for appendicttis (39 true negatives and 1 false negative). One scan was excluded from the statistics due to technical reasons. Sensitivity was 83%; specificity was 100%; positive predictive value was 100% and negative predictive value was 97% based on an incidence of 13%. Conclusion: With proper training, unenhanced helical CT for the evaluation of acute appendicitis can be successfully implemented in university hospitals where residents provide preliminary readings.
09-47 I m p a c t of PACS on Radiology Resident Education: T h e Resident's Perspective Mark E. Mullins, MD, PhD, Massachusetts General Hospital, Boston, MA, Hiren R. Patel, MD, Theresa C. McLoud, MD, Robert A. Novelline, MD Purpose: As our departments enter the PACS era, we are interpreting more examinations in less time. Because of concerns this may have a deleterious effect on resident education, the following survey was undertaken. Materials and Methods: As of October 1999, >75% of radiology studies were reviewed on digital soft copy via PACS. Residents of two diagnostic radiology-training programs (MGH, BWH) were surveyed. Topics included technical and didactic issues, using direct and indirect comparison to analog (conventional film) imaging. Results: Fifty residents were polled (20 respondents). The majority has been using PACS over 1 year (15/20, 75%) to interpret 75-100% of cases (15/19, 79%). The majority felt that PACS improved patient care (16/20, 80%) and their educational experience (16/20, 80%). Some felt that increased patient throughput was harmful to the educational experience (5/19, 26%). Some felt that PACS encouraged attending radiologists to go over cases too quickly (4/19, 21%). Residents favored PACS compared to analog images for ease of manipulation, resolution, and the ability to see pathology and normal anatomy. Conclusion: Residents beheve that PACS has positively affected their experience and is not a problem for resident education. 09-48 Assessing Student's Response to Administering t h e Radiology Clerkship through Web Technology Brian C. Davison, MD, MS, Boston Medical Center, Johan G. Blickman, MD, PhD, Richard J. Tello, MD Introduction: We assessed student response to RadClerk, a set of custom software modules designed to enhance the medical student's experience during the radiology clerkship RadClerk combines the educational benefits of the Internet with traditional radiology teaching tools. It features integration of instructional modules, online actrvity and lecture schedules, record keeping, student evaluation of course materials, online testing and student project submission, and cataloging into an online teaching file.