Body Cross-Sectional Imaging
The Body Cross-Sectional Imaging Division provides CT and MRI studies mainly concerned with the chest, abdomen and pelvis. The division overlaps with and complements various subspecialties (e.g., cardiothoracic, MSK, abdominal) that also rely on cross-sectional imaging modalities. Most of the Radiology staff have general expertise in cross-sectional imaging, and most spend at least some of their clinical time on body CT. The division works closely with a variety of clinical departments. We attend the weekly the Gastrointestinal Tumor Board conference, the weekly multidisciplinary liver tumor clinic, and a GI-Radiology conference to review MRI and CT studies in a case presentation format. The division also actively supports the numerous investigators at the Norris Cotton Cancer Center, including recent collaborations concerning pancreatic imaging and treatment.
Computed tomography plays a critical role in diagnosis and management in emergent, inpatient and outpatient settings. Our facilities include four CT systems: two 16-slice GE Lightspeed scanners; a 64-slice Lightspeed multidetector CT system capable of extensive diagnostic evaluations including cardiac, vascular, and 3D studies; and the Siemens Somatom Definition Adaptive Scanner. Featuring fluoroscopic capabilities and instant multi-planar reformatting, the new Siemens system significantly facilitates CT-guided interventional procedures such as biopsies, drainages, and thermal ablation therapies. Interventional CT has been a rapidly growing component of our practice—698 CT-guided interventions were performed in 2009, a 150% increase over five years.
CT has benefited from Radiology's PACS system, which displays digital CT, Ultrasound and MR Images, and links them to the electronic patient record. The impact of PACS continues to be remarkable, allowing much quicker reading times and much quicker turnarounds of interpretations to referring clinicians.
Patient care and safety remains at the forefront of our mission. CT imaging is a powerful modality that has provided advances in diagnostic accuracy. Used appropriately, the medical benefits of CT far outweigh the risks associated with exposure to ionizing radiation. Monitoring patient dosages, minimizing exposure levels, and regular review of protocols are standard safeguards and constitute priorities in our practice. For younger patients, the need for caution is greater still, and the department participates in the nation-wide Image Gently campaign designed to find and share opportunities to reduce radiation exposure in children.
The division has established a CT colongraphy ("virtual colonscopy") service used on a limited basis in cases of failed colonscopies. High-resolution thin-section CT series can be reformatted on 3D workstations for accurate, non-invasive "fly-through" examinations of the colon lumen for polyp detection. Drs. Tsapakos and McNulty have both received training in the procedure. As of spring 2010, CT colonscopy for screening purposes remains on hold, pending regulatory agency approval and the availability of insurance reimbursements.
The safety, versatility, and range of unique imaging attributes of magnetic resonance imaging continues to drive increases in both the variety and volume of studies performed. In addition to its established role as an adjunct to CT, MRI is widely and increasingly used as a primary imaging modality for pediatric patients and for many soft-tissue imaging purposes, such as hepatic, kidney, pancreatic, prostate, and adrenal gland imaging. A number of the division's MRI services that have become key areas of interest include:
- MR enterography, used for evaluation of patients with inflammatory diseases of the bowel (e.g., Crohn's), produce detailed real-time imaging and permits radiation-free imaging for patients who will need ongoing monitoring over a period of many years;
- MR Cholangiopancreatography (MRCP) is a growing noninvasive corollary to Endoscopic Retrograde Cholangiopancreatography (ERCP).
- pelvic imaging, for detecting pelvic neoplasms, uterine congenital anomalies, and other ovarian and cervical pathologies;
- fetal imaging, as an adjunct to fetal ultrasound for certain types of multi-planar views;
- magnetic resonance angiography (MRA).
The department operates two permanent 1.5T magnets, a mobile 1.5T scanner, and as of March 2010, a new 3.0T magnet—the GE Discovery MR750 system. Fast and powerful, the MR750 provides exquisitely detailed studies that facilitate a range of chest, abdomen, pelvic and MSK exams, including fMRI for localizing prostate neoplasms in pre-surgical planning. (The 3T magnet also offers important enhancements and new capabilities in neuroimaging—most notably, fMRI.)
With ongoing advances in 3D post-processing, the plane of imaging has become irrelevant. Image series obtained from high speed multidetector CT scanners are now reconstructed as remarkably lifelike 3D volumes for angiographic imaging, cardiac imaging, excretory urographic imaging, and a range of endoluminal imaging purposes. Clinicians and, in particular, surgeons have increasingly come to rely on such studies to help with surgical planning.
Since 2008, 3D capabilities are available on workstations throughout the department, including various servicespecialized applications such as Prism Clinical Imaging (for fMRI reconstructions) and Vitrea (for virtualcolonoscopy). Visage CS, a web-based thin-client 3D application, is available at all workstations. In addition, the Body Cross-Sectional Division maintains a 3D lab for CT angiography reconstructions which uses GE Advantage workstations to generate highly sophisticated 3D volumes.
Education continues as a priority for the division. Didactic CT and MRI instruction is incorporated across all radiology sections to help residents handle the myriad CT cases they will encounter over the course of their residency, in both medical and surgical subspecialties. Our fellows and residents learn the intricacies of clinical imaging parameters and actively participate in reading MRI studies. We have incorporated cardiac imaging into our residency and fellowship training as an adjunct effort with Cardiology.
Cross-Sectional Imaging Fellowship
The highly competitive Cross-Sectional Imaging Fellowship, now in its 17th year, includes training in neuroradiology, abdominal imaging, musculoskeletal MRI, and ultrasound. The fellowship is unusually flexible, with opportunities for tailoring the program to meet the interests of individual fellows. Electives include cardiac imaging (with the Department of Cardiology), mammography, musculoskeletal radiology, and CT-guided interventional procedures.
Initiated in 2005, the one-year MRI fellowship program emphasizes—to an unusual degree in comparison with other such programs—a comprehensive range of MRI training that includes cardiac, neurologic, musculoskeletal, abdominal, pelvic, MR angiography and MR-guided interventional procedures. The MRI fellowship, like the Cross-Sectional, encourages individualizing the program to meet special interests and needs.
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