Cost benefit analysis of computerized radiography system in a tertiary care hospital

Background: Computed radiography (CR) has presently proven to be both efficient and cost effective as against conventional radiography. Cost benefit and cost effectiveness analysis of a newly installed computerized radiography system in comparison with Conventional radiography set-up in a tertiary care hospital.Methods: Costs incurred under major heads were calculated and compared for both Computerized and Conventional radiography systems. A brief survey regarding the overall clinician and patients response towards the newly installed CR system was carried out and results were calculated.Results: CR system proves to be highly efficient tool in the department of radiology to provide not only better quality images and faster means of image acquisition and archiving but also higher rates of satisfaction amongst radiology staff, clinicians and patients. Overall cost-effectiveness as well as the consumer satisfaction of the new technology is good as compared to conventional radiography. CR reduces repetition of images due to artifacts caused by dark room procedures and due to the provision of multiple images on a single film an average reduction in film expenditure. It reduces waiting period for patients and increases level of satisfaction in clinicians working in critical care dept. and A&E dept. due to early processing of urgent films.Conclusions: cost benefit analysis of CR over conventional radiography proved overall running costs are comparable to the conventional system with a breakeven point achievement in a couple of years since installation especially in a high turnover tertiary care health setup

Cortical venous thrombosis in high altitude; result of an observational study

Background: High altitude, an extremely rare cause of cortical venous thrombosis (CVT) has no literature review available signifying the relation between two as per date. The aim of this study is to establish the relation of exposure to high altitude and occurrence of CVT in properly acclimatised healthy individuals exposed to high altitude having no pre-existing morbidities.Methods: An observational type of prospective study was conducted at a tertiary care centre in North India. Patients who were sent back from a high-altitude area with CNS symptoms (headache to coma) were included in the study. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV), blood investigations including complete blood count and D-dimer were done as routine examinations in all these patients. MRI and MRV findings were recorded and analyzed for features of CVT.Results: Twenty-eight patients with an average age of 31.5 years (23-51 years) were included in the study. All patients had CNS symptoms; with headache being the common symptom. In the patients of CVT, there were MRI features of parenchymal infarct in 7 (25%), hemorrhagic infarct in 11 (41.6%), subarachnoid hemorrhage in 7 (25%) and mass effect in 3 (8.4%) patients. MRV revealed involvement of multiple sinus involvement more common than single sinus involvement, of which most commonly involved sinuses were Superior sagittal sinus and transverse sinuses. D-Dimer levels were significantly raised in 23 (83%) patients.Conclusions: High altitude though a rare cause, can be the single most important contributory factor in the development of CVT in healthy acclimatised individuals with no predisposing factors. The physicians dealing with such patients at high altitude should be well aware of the scenario as early diagnosis via imaging and prompt management can drastically reduce mortality in this potentially lethal but treatable conditions

Ultrasound of abdomen in acute viral hepatitis and its role as a prognostic marker

Background: To assess the extent of Ultrasound (USS) abdomen findings in acute viral hepatitis and further assess the role of USS as a prognostic marker.Methods: From May 2013 to September 2016, a total of 220 patients of acute Enterogenic viral hepatitis were studied by routine USS within first seven days of onset of symptoms, followed by routine USS between 10 to 15 days and follow up scan after 12 weeks. Only patients with acute Enterogenic viral hepatitis (Hepatitis A and Hepatitis E) were included. All patients with chronic liver disease and other form of acute hepatitis i.e. Hepatitis B, C and D were excluded from the study.Results: Among 220 patients of acute viral hepatitis routine USS findings including hepatomegaly, bright liver and thickened GB wall and periportal adenopathy were in isolation or in combination up to varying degrees. The commonest routine USS finding in acute phase was thickened GB wall (80%). 14 patients exhibited triad of enlarged Portal Vein (PV), Splenomegaly and Ascites. These 14 patients had prolonged stay in hospital and 11 patients had deranged liver function tests at 12 wks. interval and three patients developed hepatic encephalopathy including one patient who went into fulminant hepatic failure. Out of the patients who did not exhibit this triad 72 patients still had deranged LFT at 12 weeks and maximum of these patients had a combination of USS markers at presentation.Conclusions: USS has very little if any role in the diagnosis of acute viral hepatitis. It can however play an important role as a prognostic marker during the acute phase where it can detect enlarged portal vein, splenomegaly and ascites. This triad of USS findings is suggestive of transient portal hypertension likely due to hepatic congestion. Also, other USS markers if seen in combination at presentation can reliably predict a poorer prognosi

Incorporation of Whole Spine Screening in Magnetic Resonance Imaging Protocols for Low Back Pain: A Valuable Addition

Study DesignA retrospective review of lumbar magnetic resonance imaging (MRI) studies conducted at the Department of Radiodiagnosis & Imaging of a Tertiary Care Armed Forces Hospital between May 2014 and May 2016.PurposeTo assess the advantages of incorporating sagittal screening of the whole spine in protocols for conventional lumbar spine MRI for patients presenting with low back pain.Overview of LiteratureAdvances in MRI have resulted in faster examinations, particularly for patients with low back pain. The additional detection of incidental abnormalities on MRI helps to improve patient outcomes by providing a swifter definitive diagnosis. Because low back pain is extremely common, any change to the diagnostic and treatment approach has a significant impact on health care resources.MethodsWe documented all additional incidental findings detected on sagittal screenings of the spine that were of clinical significance and would otherwise have been undiagnosed.ResultsA total of 1,837 patients who met our inclusion criteria underwent MRI of the lumbar spine. The mean age of the study population was 45.7 years; 66.8% were men and 33.2% women. Approximately 26.7% of the patients were diagnosed with incidental findings. These included determining the level of indeterminate vertebrae, incidental findings of space-occupying lesions of the cervicothoracic spine, myelomalacic changes, and compression fractures at cervicothoracic levels.ConclusionsWe propose that T2-weighted sagittal screening of the whole spine be included as a routine sequence when imaging the lumbosacral spine for suspected degenerative pathology of the intervertebral discs

Liver fibrosis assessment: a correlation of fibro scan values with gray scale assessment of portal vein

Background: FibroScan is an expensive modality with excellent accuracy for diagnosis of cirrhosis by measuring liver stiffness. In less developed countries it is not a financially viable method for fibrosis measurement. The aim of this study is to compare and correlate FibroScan values with gray scale sonographic assessment of portal vein calibre diameter which can be done using a basic ultrasonography machine.Methods: Prospective review of 124 patients with chronic liver disease done between Dec 2015 to May 2016 with the objective of correlating FibroScan values with gray scale assessment of portal vein.Results: In our study 50 patients had liver stiffness scores of > or = 7.5 kPa and above. A total of 45 patients had a respiratory phase variation of portal vein calibre of < 20%. Out of these, 37 patients had a liver stiffness score of 7.5 kPa or above. These 37 patients were correctly classified by portal vein calibre variability as having moderate to severe fibrosis. The results of this study revealed a significant correlation (Pearson coefficient, r = -0.617, p= 0.01) between calibre variation of the portal vein and FibroScan scores. We also noted that in presence of mild fibrosis as predicted by lower FibroScan scores, PV calibre variation is not a reliable indicator of mild fibrosis.Conclusions: We propose that, in less developed countries, gray scale assessment of portal vein diameter using any low cost ultrasound machine can be used as an optimal method for predicting moderate to severe liver fibrosis

Liver fibrosis assessment: a correlation of fibro scan values with gray scale assessment of portal vein

Background: FibroScan is an expensive modality with excellent accuracy for diagnosis of cirrhosis by measuring liver stiffness. In less developed countries it is not a financially viable method for fibrosis measurement. The aim of this study is to compare and correlate FibroScan values with gray scale sonographic assessment of portal vein calibre diameter which can be done using a basic ultrasonography machine.Methods: Prospective review of 124 patients with chronic liver disease done between Dec 2015 to May 2016 with the objective of correlating FibroScan values with gray scale assessment of portal vein.Results: In our study 50 patients had liver stiffness scores of > or = 7.5 kPa and above. A total of 45 patients had a respiratory phase variation of portal vein calibre of < 20%. Out of these, 37 patients had a liver stiffness score of 7.5 kPa or above. These 37 patients were correctly classified by portal vein calibre variability as having moderate to severe fibrosis. The results of this study revealed a significant correlation (Pearson coefficient, r = -0.617, p= 0.01) between calibre variation of the portal vein and FibroScan scores. We also noted that in presence of mild fibrosis as predicted by lower FibroScan scores, PV calibre variation is not a reliable indicator of mild fibrosis.Conclusions: We propose that, in less developed countries, gray scale assessment of portal vein diameter using any low cost ultrasound machine can be used as an optimal method for predicting moderate to severe liver fibrosis

Cost benefit analysis of computerized radiography system in a tertiary care hospital

Background: Computed radiography (CR) has presently proven to be both efficient and cost effective as against conventional radiography. Cost benefit and cost effectiveness analysis of a newly installed computerized radiography system in comparison with Conventional radiography set-up in a tertiary care hospital.Methods: Costs incurred under major heads were calculated and compared for both Computerized and Conventional radiography systems. A brief survey regarding the overall clinician and patients response towards the newly installed CR system was carried out and results were calculated.Results: CR system proves to be highly efficient tool in the department of radiology to provide not only better quality images and faster means of image acquisition and archiving but also higher rates of satisfaction amongst radiology staff, clinicians and patients. Overall cost-effectiveness as well as the consumer satisfaction of the new technology is good as compared to conventional radiography. CR reduces repetition of images due to artifacts caused by dark room procedures and due to the provision of multiple images on a single film an average reduction in film expenditure. It reduces waiting period for patients and increases level of satisfaction in clinicians working in critical care dept. and A&E dept. due to early processing of urgent films.Conclusions: cost benefit analysis of CR over conventional radiography proved overall running costs are comparable to the conventional system with a breakeven point achievement in a couple of years since installation especially in a high turnover tertiary care health setup

Serial brain MRI findings in a rare survivor of rabies encephalitis

Rabies is a neurotropic viral illness, almost always fatal, that is equally dreaded by healthcare practitioners and patients due to the dismal prognosis and limited treatment options once symptoms set in. There are hardly any reports on MRI changes in the brain in survivors of rabies encephalitis. We present the clinical course and the imaging findings on serial MRI examinations in a rare patient who survived rabies infection. Initial brain MRI done 8 days after onset of symptoms revealed bilaterally symmetrical non-enhancing areas of T1 and T2 hyperintensity in the basal ganglia, thalami, mid brain, and pons along with T2 hyperintensity and restricted diffusion in fronto-parietal cortical grey matter and left hippocampus. Subsequent MRI scans at 2 months and 5 months revealed progressive brain atrophy, leukoencephalopathy, and gliosis

A study of coronary artery variants and anomalies observed at a tertiary care armed forces hospital using 64-slice MDCT

Background: Isolated coronary artery anomalies are usually clinically silent and mostly detected incidentally during angiography or autopsy. However, few of them may be implicated in cases of sudden cardiac death even in the absence of additional heart abnormalities. Prior knowledge of such variants and anomalies is necessary for planning various interventional procedures. Multiple detector computed tomography coronary angiography has proved a very useful non-invasive modality in this field given its superiority over conventional coronary angiography in providing detailed coronary artery anatomy. Methods: A retrospective review of the coronary CT angiography studies was carried out at our center between August 2014 and December 2015 with the purpose of describing the coronary artery variants and anomalies that we came across in our cohort. Results: In our cohort, about 77% (n = 391) of the patients had a right dominant system while left dominant and co-dominant systems were seen in 12% (n = 61) and 11% (n = 56) respectively. Coronary CT angiography was successful in visualizing smaller branches, such as the conus artery (96.25%, n = 489), the sinus node artery (83.07%, n = 422), and the septal branches (95.27%, n = 484). Coronary anomalies were observed in the 10.04% of our population (n = 51). Eleven anomalies of origin and course were found. Conclusion: Coronary CT angiography gives us a good understanding of the variations and anomalies of the anatomy of the coronary arteries. This can be of immense help to the clinician planning interventional procedures