Radiologe最新文献

Background: Low-field magnetic resonance imaging (MRI) is experiencing a renaissance due to technical innovations. The new-generation devices offer new applications for imaging and a possible solution to increasing cost pressures in the healthcare system.

Objectives: Effects of field strength on technique, physics, image acquisition, and diagnostic quality of examinations are presented.

Methods: Important basic physical parameters for image acquisition and quality are summarized. Initial clinical experience with a new 0.55 T low-field scanner is presented.

Results: Field strengths that are lower than the currently used 1.5 T and 3 T field strengths are characterized by an expected lower signal-to-noise ratio in image acquisition. Whether this is a diagnostic limitation needs to be evaluated in studies, as there are several options to offset this perceived drawback, including increasing measurement time or artificial intelligence (AI) postprocessing techniques. In addition, it is necessary to meticulously investigate whether low-field systems allow diagnostically adequate image quality to be achieved in different body regions and different disease entities. Initial studies in our clinic are promising and show, for example, diagnostic quality without relevant loss of time for examinations of the lumbar spine. Advantages of low-field MRI include reduced susceptibility artifacts when imaging the lungs and in patients with metallic implants.

Conclusion: Low-field scanners offer a variety of new fields of application with field strength-related advantages. In most other clinical examination fields, at least diagnostic quality can be expected.

Background: Low-field magnetic resonance imaging (MRI) scanners offer an opportunity for cost reduction in the healthcare system. This is due to lower manufacturing costs and reduced construction requirements for installation and operation.

Objectives: To discuss potential cost reductions in acquisition, installation, and maintenance by using new low-field MRI systems.

Methods: We provide an overview of key cost drivers and an evaluation of the potential savings of a recent generation 0.55T low-field MRI compared to conventional 1.5T and 3T MRI systems in routine clinical practice.

Results: In terms of purchase price, the savings potential of a 0.55T MRI compared to a 1.5T MRI system is about 40-50%. The 25% lower weight of the system reduces the transportation costs incurred, and the smaller size of the unit allows for installation by a remotely controlled mobile robotic system without opening the exterior façade, if the operating site is at ground level. Together with the lack of need to install a quench pipe, this reduces the total cost of installation by up to 70%. The maintenance cost of a 0.55T MRI is approximately 45% less than that of a 1.5T unit with a comparable service contract. Further cost reductions result from the smaller room size and potentially lower energy consumption for examinations and cooling.

Conclusion: The use of lower field strength MRI systems offers enormous economic and environmental potential for both hospitals and practice operators, as well as for the healthcare system as a whole.

Modern patient-centered and cost-efficient care concepts in hospitals require the mapping of multidisciplinary process chains into clinical pathways. Clinical decision support systems and operations research methods use algorithms to classify patients into homogeneous groups and to model a complete clinical pathway for scheduling individual procedures. An improvement of the economic situation of the care facility can be achieved through improved resource utilization, reduced patient waiting times and a shortening of the length of stay. The interdisciplinary use of centrally stored interoperable information and comprehensive care management via information technology (IT) services lay the foundation for the dissolution of traditional IT system architectures in medicine and the development of flexibly integrable modern system platforms. New IT approaches such as the semantically standardized definition of procedures and resource properties, the use of clinical decision support systems and the use of service-oriented system architectures form the basis for the deep integration of radiology services into comprehensive interdisciplinary care concepts.

Background: To improve the efficient use of magnetic resonance imaging (MRI) in routine clinical practice, an expert panel has revised the guidelines for its use in the diagnosis and monitoring of multiple sclerosis (MS).

Objectives: The revised guidelines now take into account new developments and relevant advances in knowledge, such as the ongoing debate about safety related to intravenous gadolinium-based contrast agents. The value of spinal cord MRI for diagnostic, prognostic, and surveillance purposes has been re-evaluated. Standardization of brain and spinal cord MRI protocols for diagnosis, assessment of prognosis, and monitoring of therapy, as well as the use of 3D-FLAIR (three-dimensional fluid-attenuated inversion recovery) as the most important sequence in the diagnosis of lesions in the brain have been included, as this allows better interpretation and comparability, e.g., in follow-up assessments.

Background: Based on the lump sum system which is calculated by the InEK (Institut für das Entgeltsystem im Krankenhaus), it is possible to compare one hospital's own performance data with all hospitals in Germany billing according to the Diagnosis-Related Group (DRG). The aim of this article is to investigate exceeding or undercutting of computed tomography (CT) or magnetic resonance imaging (MRI) in comparison to the calculations made by the InEK to reveal potential for improvement.

Methods: InEK calculation data for 2021 were used to form comparative ratios for CT and MRI diagnostics at the DRG level. Data from a university hospital was compared at the hospital, departments, DRG and main diagnosis levels.

Results: At the hospital level, there were 1025 more MRIs and 371 more CTs compared to InEK. Analysis by department showed, e.g., in neurology, 489 more MRIs and 620 fewer CTs. The benchmark of the DRGs showed in particular that DRG B70B was the driver of deviations in both diagnostic modalities (MRI [Formula: see text] CT [Formula: see text]). The identified deviations can be further analysed at the main diagnosis level.

Conclusion: Awareness of above-average use of cross-sectional imaging diagnostics can provide impetus for further development of clinical pathways of a hospital. The methodology of the InEK benchmark is applicable to every hospital and is able to identify processes with potential for improvement. The review of influencing factors as well as the evaluation by clinicians and economists are prerequisite for acceptance and success of the measures generated from the benchmark.

Transarterial chemoembolization (TACE) is used as palliative and neoadjuvant treatment for patients with hepatocellular carcinoma (HCC). TACE should be offered as palliative treatment to patients with intermediate stage large or multinodular HCC if no curative treatment option is available by resection or thermoablation and if extrahepatic metastases and tumor infiltration of main portal and systemic veins has been excluded. TACE is possible only in patients with preserved liver function (Child-Pugh A-B, best up to 7 points) and with good performance status (ECOG 0). TACE can be used for bridging and for downstaging prior to liver transplantation with the intention to maintain or reach limited intrahepatic tumor load defined by Milan criteria. TACE should be adapted to the vascularization pattern of the HCC nodules and performed as selective as possible and repetetively if necessary with the goal of complete devascularization of the tumor tissue. Conventional TACE (cytotoxic drugs, iodized oil and embolic particles) and drug-eluting TACE (anthracycline preloaded in microspheres) can be used in a comparable way. During drug-eluting TACE, peripheral concentration of cytotoxic drugs is lower. Using conventional TACE in a palliative setting, survival benefit for patients was 8-11 months compared to best supportive care; however, this requires that all known contraindications and other criteria in terms of tumor and liver disease, respectively, associated with negative prognosis be taken into consideration. Better local response is achieved by drug-eluting TACE; however, no related survival benefit was shown compared to conventional TACE so far. Response to neoadjuvant local treatment is associated with improved prognosis after liver transplantation.

Background: Hepatocellular carcinoma (HCC) is fifth most common cancer worldwide. The German S3 guideline on the diagnosis and the treatment of hepatocellular and biliary carcinoma was recently revised.

Objective: Determination of the current status of thermal ablation in HCC according to the German S3 guideline.

Materials and methods: Based on the current guideline and a selective literature search, the current status on indication and application of thermal ablation in HCC was revisited.

Results: Radiofrequency ablation (RFA) and microwave ablation (MWA) provide similar survival when compared with surgery. Accordingly, RFA und MWA are considered first-line treatments for HCCs ≤ 3 cm in cirrhotic livers. For HCCs with diameters of 3-5 cm, a combination of transarterial chemoembolization and thermal ablation is recommended.

Conclusion: The current S3 guideline on diagnosis and treatment of HCC comprises relevant changes regarding thermal ablation in HCC. The overall role of interventional oncology procedures in the treatment of HCC was reinforced.

The updated German S3 guideline "Diagnostics and therapy of hepatocellular carcinoma and biliary carcinomas" covers two tumor entities. The original guideline published in 2013 focusing only on the diagnosis and therapy of hepatocellular carcinoma (HCC) has been expanded to include intrahepatic cholangiocarcinoma. These guidelines were developed within the framework of the guideline program on oncology of the Scientific Medical Society e. V. (AWMF), the German Cancer Society (DKG) and German Cancer Aid Society (DKG) under the auspices of the German Society for Digestive and Metabolic Diseases (DGVS). In addition to updated recommendations regarding histopathology, radiological diagnostics and treatments, the main innovations of the revised guidelines on HCC include a complete revision of the section on the systemic therapeutic approach in advanced stages of the disease. This article presents the significance of the current recommendations for diagnostic and interventional radiology in comparison to other national and international guidelines and should serve to improve the quality of patient care through more widespread dissemination.