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Guest: Dushyant Sahani, MD Host: Jason Birnholz, MD More often, the diagnosis of causes of upper abdominal pain and specialty triage of patients as necessary has become the province of the radiologist. How do radiologists best approach diagnosis and management for these patients, and what factors underlie positive interactions between referring physician and radiologist for this common clinical problem? Host Dr. Jason Birnholz is joined by Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to examine the radiology of upper abdominal pain and the expanding role of the radiologist.

Host: Jason Birnholz, MD Guest: Dushyant Sahani, MD Autoimmunity has been identified in over 100 separate diseases. Depending on the target tissues, these disorders may be systemic, localized, or perhaps somewhere in between. The characteristics of autoimmune pancreatitis represent one such example of diffuse-to-localized disorders, and is the subject of this discussion. New forms of imaging enable us to map the inflammatory components of this and other diseases, often identifying conditions that were not part of the original differential diagnosis. How does this both aid and complicate management strategies for patients? Host Dr. Jason Birnholz welcomes Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to share insights and expertise on imaging autoimmune pancreatitis.

Guest: Andrea Doria, MD, PhD, MSc Host: Jason Birnholz, MD In 1888, William Osler wrote in the Lancet the following: "In patients with suspected acute appendicitis, one should urge towards laparotomy. The indications for surgical interference are not always clear, but in my experience I have been taught that the abdomen is much more frequently left untouched than it should be, and that an operation is too often deferred until practically useless." Clearly, diagnosis of acute appendicitis has come a long way since then. But challenges remain in selecting the safest, most timely, and cost-effective diagnostic modalities for this condition. Dr. Andrea Doria, associate professor in the department of medical imaging at the University of Toronto School of Medicine, clarifies the use of ultrasound versus CT for evaluation of acute appendicitis in children. Dr. Jason Birnholz hosts.

Guest: Scott Holland, PhD Host: Jason Birnholz, MD Guest: Daniel Choo, MD Successful cochlear implantation has remarkable impact on quality of life for children with congenital and early onset hearing loss. How do clinicians best evaluate these children for likelihood of success with implants, and what are the imaging challenges when following up with these patients later on? Drs. Scott Holland and Daniel Choo from the University of Cincinnati examine new technologies on the horizon, from fMRI to near-infrared spectrophotometry, for screening and following candidates of cochlear implantation. In the process, they outline salient features of sensorineural hearing deficits and share the state-of-the-art in operative methods for implantation. Dr. Jason Birnholz hosts.

Guest: Stephanie Wilson, MD, FRCPC Host: Jason Birnholz, MD Many clinicians are well familiarized with standard contrast agents such as barium and iodinated compounds to enhance angiographic imaging. Ultrasound, capable of visualizing bloodflow with the use of doppler alone, is yet insufficiently sensitive to capture perfusion of organs and/or tumors at the capillary level. What special kinds of contrast enhancements are needed for ultrasound in this case? Dr. Stephanie Wilson, professor of medical imaging and obstetrics and gynecology at the University of Calgary in Alberta, Canada, discusses the science and art of using micro-bubble contrast agents, and the emergence of contrast-enhanced ultrasound (CEUS) as a safer alternative to traditional angiography. Dr. Jason Birnholz hosts.

Guest: James B. Spies, MD Host: Jason Birnholz, MD It's not uncommon for women to report experiencing menstrual changes after having given birth two or more times. These changes include shorter cycles, increased cramping, and heavier bleeding, at times with clots. Such changes are hallmark signs of adenomyosis. Definitive diagnosis of adenomyosis can be made easily with MRI or ultrasound, but are there therapeutic options from interventional radiology as well? If so, can these methods replace hysterectomy? Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, joins host Dr. Jason Birnholz to resolve these questions.

Host: Jason Birnholz, MD Guest: James B. Spies, MD Host Dr. Jason Birnholz and Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, look at fibroid tumors- their incidence and treatment. They discuss the populations in which there is a high prevalence, as well as genetic factors and the basics of interventional radiology protocol.

Guest: J. Herman Kan, MD, FACR Host: Jason Birnholz, MD Pre-treatment MRI can eliminate unnecessary diagnostic or surgical procedures for children with suspected musculoskeletal infections. Host Dr. Jason Birnholz and Dr. J. Herman Kan, assistant professor of radiology at Vanderbilt University Medical Center, specializing in pediatric and adolescent radiology, discuss the application of MRIs and the results of his recent study which showed that a significant number of surgeries could be avoided with early MRI evaluation. Tune in to hear the valuable role MRI plays in the evaluation of musculoskeletal infection. 

Guest: Sharlene Teefey, MD Host: Beverly Hashimoto, MD Dr. Sherry Teefey, professor of radiology at Washington University School of Medicine in St. Louis, discusses with host Dr. Beverly Hashimoto her experience in Bhutan and Uganda, teaching medical professionals how to use ultrasound and computed tomography and enhancing current techniques. Tune in to hear the challenges to providing imaging services in these countries and the future goals to introduce new modalities and improve radiological services in third world countries.

Guest: Sharlene Teefey, MD Host: Beverly Hashimoto, MD Ultrasound images of the musculoskeletal system provides pictures of muscles, tendons, ligaments, joints and soft tissue throughout the body. Dr. Sherry Teefey, associate professor of radiology at Washington University School of Medicine in St. Louis, discusses with host Dr. Beverly Hashimoto some of the common uses for this procedure. Dr. Teefey also discusses the application of musculoskeletal ultrasound in conjunction with aspiration or injection. Tune in to hear the benefits and limitations of diagnostic musculoskeletal ultrasound.

Guest: Fiona Gilbert, MD, MBChB, DMRD Host: Jason Birnholz, MD Dr. Fiona Gilbert, Roland Sutton Chair of Radiology at University of Aberdeen Institute of Medical Sciences, discusses her research findings that showed that the rate of breast cancer detection by two experts reading a mammogram was the same as one expert aided by a computer. Dr. Gilbert explains to host Dr. Jason Birnholz that, unlike in the United States, it is normal practice in the United Kingdom for two trained readers to examine mammograms. Tune in to hear how computer-aided detection is likely to improve breast cancer detection in those countries where a single reader is used, as well as improve efficiencies in countries that require two readers. 

Host: Beverly Hashimoto, MD Guest: Jonn Cronan, MD, FACR Thanks to extremely sensitive ultrasound technology, thyroid nodules are being detected and treated at unprecedented rates. Host Dr. Beverly Hashimoto welcomes Dr. John Cronan, professor of diagnostic imaging at the Brown University School of Medicine and chairman of the diagnostic imaging department at Rhode Island Hospital, to discuss the phenomenon of over-treatment of thyroid nodules. Is this pattern of care helping or harming our patients?

Guest: Roee Lazebnik, MD, PhD Host: Jason Birnholz, MD Developments in ultrasound technologies yield superior image quality.  But these new technologies are also designed to maximize information density– minimizing acquisition time, decreasing analysis time, and simplifying reporting. Dr. Roee Lazebnik, a radiologist with a PhD in biomedical engineering, employed by Siemens Healthcare, explains to host Dr. Jason Birnholz how the new ultrasound imaging equipment gives greater information density by increasing the amount of clinical information derived from an image.  

Guest: Vicki Noble, MD Host: Beverly Hashimoto, MD Dr. Vicki Noble, director of the Division of Emergency Ultrasound at Massachusetts General Hospital in Boston, discusses with host Dr. Beverly Hashimoto the importance of ultrasound in the critical care setting.  In the emergency department, ultrasound can improve the physican's ability to administer appropriate treatment during the crucial "golden hour" of trauma.  Dr. Noble also discusses six additional applications for ultrasound in the emergency department.

Host: Beverly Hashimoto, MD Guest: Beryl Benacerraf, MD More than amazing images, the utility of three dimensional ultrasound images in obstetrics is expansive, according to guest Dr. Beryl Benacerraf, director of obstetrical ultrasound at Massachusetts General Hospital. Dr. Benacerraf and host Dr. Beverly Hashimoto talk about the ability of volume imaging to capture an image of the uterus from a coronal view, a view that is critical for assessment but could not be obtained through traditional portals of entry prior to 3-D imaging. Dr. Benacerraf also illuminates the diagnostic benefits of other display modalities permitted by volume imaging, such as surface renderings and tomographic cuts.

Guest: Brian Garra, MD Host: Jason Birnholz, MD Ultrasound elastography, or tissue strain imaging, can provide real-time quantitative analysis on deep tissue and small nodules that elude palpation.  Dr. Brian Garra, professor and vice chair of radiology at the University of Vermont College of Medicine, discusses with host Dr. Jason Birnholz, what makes this method of imaging like “palpation on steroids.”  How can elastography technology help catch disease in its earliest stages, and in some cases even make biopsy unnecessary?  

Guest: Eyal Herzog, MD, FACC Host: Jason Birnholz, MD So small, it is called the ‘pocket ultrasound,' Dr. Eyal Herzog, director of the cardiac care unit at St. Luke's-Roosevelt Hospital Center in New York, discusses with host Dr. Jason Birnholz the results of his research on the handheld portable ultrasound unit in the cardiac care department. Dr. Herzog reports no significant differences in image quality compared to the larger, high-end machine. The portability of the handheld has the capacity to improve care by increasing the speed at which we can assess critically ill patients.    

Guest: Mani Vannan, MBBS Host: Jason Birnholz, MD Dr. Mani Vannan, professor of clinical internal medicine at the Ohio State University College of Medicine, reports how the latest ultrasound technology has dramatically improved echocardiography by enabling the acquisition of a full volume image in one heartbeat. In addition, the new technology of the ultrasound equipment produces meaningful output information from the image. Dr. Vannan also explains to host Dr. Jason Birnholz the practical implications these enhancements have in terms of diagnosing cardiovascular conditions and enhancing workflow productivity.

Host: Beverly Hashimoto, MD Guest: Dawna Kramer, MD Although most abnormal vaginal bleeding is caused by hormone imbalance, it can be indicative of polyps, myomas, and cancers of the cervix and endometrium. Dr. Dawna Kramer, a radiologist within the department of radiology, ultrasound section at the Virginia Mason Medical Center in Seattle, discusses with host Dr. Beverly Hashimoto several ultrasound techniques, including sonohysterography, for determining the cause of post- and pre-menopausal vaginal bleeding.

Guest: Dawna Kramer, MD Host: Beverly Hashimoto, MD Have new techniques changed the long-standing paradigm of breast cancer detection by mammogram? Dr. Dawna Kramer, radiology quality assurance officer and section head of the patient access area in the radiology department at the Virginia Mason Medical Center in Seattle, talks with host Dr. Beverly Hashimoto about the applications and inter-relationship of mammography and breast ultrasound in the diagnosis of breast masses. Dr. Kramer highlights the reasons mammography continues to account for the majority of breast mass detections. What are the benefits of digital mammogram and what is the usefulness of breast ultrasound and MRI?