CT-BASED CLASSIFICATION SYSTEM FOR ACETABULAR FRACTURES DEBUTS
Researchers at the University of Texas, Houston, have developed a new CTbased classification system for acetabular fractures that is simpler, less ambiguous, and more comprehensive than the traditional Judet-Letournel classification system. The report, published in the June American Journal of Roentgenology (AJR) , may redefine treatment protocol for patients with acetabular fractures.
“One of the core tenets of fracture management is to decrease the pain felt by patients throughout treatment,” says John H. Harris, Jr, MD, emeritus professor in the Department of Radiology at the University of Texas at Houston, and lead author of the study. “However, with the Letournel system, patients suffering from acetabular fractures are rolled in different directionsbecause plain x-ray captures only two-dimensional images of each hip viewcausing much harm to patients. The system also forces the attending radiologist and orthopedic surgeon to integrate the two-dimensional images into a three-dimensional (3D) image.”
With CT technology, patients lie on their back while a complete study of the acetabulum and pelvis can be conducted in less than a minute. Since CT captures cross-sectional images, 3D reformations can be done without additional radiation to patients, and surgeons can accurately determine whether to take an anterior, posterior, or combined approach to treatment. The advantages of CT-based classification are numerous.
“It could decrease the length of stay at the hospital, which reduces costs, because the exact fracture type can be determined the day the patient is brought to the hospital, and if there are no other contraindications, the patient can be operated on that day,” says Harris.
For the study, Harris and the other researchers studied 112 acetabular fractures, frequently running into more limitations of the Letournel method, specifically the requirement to fit all the fractures into 10 predetermined categories. As Harris and his team examined the fractures, they established four new categories: Type 0 fractures of the rim of the acetabulum; Type 1, fractures involving only one of the columns of the acetabulum; Type 2, fractures involving both columns of the acetabulum (Type 2 fractures also fall under four subcategories, including upward extension superiorly into the iliac wing, inferior extension, extensions in both directions, or no extensions); and Type 3, fractures where the acetabulum is separated from the skeleton.
|Type III: floating acetabulum. A: Three-dimensional reformatted CT scan shows anterior (long white arrows) and inferior pubic ramus fractures (short white arrow), which, together, separate acetabulum from axial skeleton anteriorly; posterior column fracture (long black arrow), which separates acetabulum from axial skeleton posteriorly; superior fracture extension to right iliac wing (arrowhead); and inferior fracture extension (short black arrow). B: Axial CT scan obtained through level of iliopectineal line shows right superior fracture extension. C: Axial CT scan shows comminuted, displaced right posterior column fracture (arrows). Arrowhead indicates iliopectineal line. D: Midpelvic axial CT scan shows comminuted, displaced anterior column fracture. E. Axial CT scan obtained through level of inferior pubic rami shows comminuted displaced fracture of right inferior pubic ramus. Source: AJR. 2004;182:1374.|
According to Harris, this classification encompasses the infinite possibilities of fracture types, and thus provides surgeons with clear descriptions of fracture lines and fragments, which help ensure optimal surgical decisions. The new categories also ensure accurate intra- and inter-departmental comparisons, allowing for consistent postsurgical follow-up. Harris states that such accuracy in pre- and post-surgical planning can lead to shorter operating times, and shorter recuperation times for the patient.
The study appears in two parts in the AJR . While Part 2 details the new CT-based classification systems, Part 1 describes the critical changes made to the Letournel method’s way of defining anterior and posterior columns of the acetabulum. In the Letournel definition, the anterior column extends up to the iliac crest, while the posterior column extends to the iliopectineal line, making it approximately half the distance of the anterior column. Based on the acetabulum anatomy and the growth centers and growth patterns of the pelvic bone, Harris and the other researchers redefined the anterior column to make it more comparable to the posterior column. This is a critical part to the study, according to Harris, since some of the fractures that would be defined as Type 2 with upward extension under the CT categories are currently a completely different type of fracture under the Letournel system.
CO: A POTENT ANTISTENOTIC AGENT
Smoking cigarettes may help keep the arteries open after angioplasty, states a new study published in the June issue of Radiology. Results showed that habitual to heavy smokers who continued to smoke after angioplasty had a lower rate of their arteries narrowing than nonsmokers.
According to the study’s lead author, Martin Schillinger, MD, associate professor of internal medicine at the University of Vienna Medical School, the carbon monoxide in cigarettes serves as a potent anti-inflammatory agent known to dilate blood vessels and inhibit the growth of smooth muscle cells within an artery wall, preventing restenosis, a common occurrence in patients who undergo angioplasty. Schillinger states that up to 60% of patients who receive endovascular interventions for peripheral artery disease (PAD) will experience restenosis.
For the study, researchers examined 650 patients with PAD who underwent angioplasty with or without stent placement to open arteries leading to the legs. The patients were separated into nonsmoking, light smoking, habitual smoking, or heavy smoking groups. Evaluations were performed at 6 months and 12 months after the patients received angioplasty to check for restenosis. Habitual smokers (10 to 20 cigarettes daily) had a reduced rate of restenosis at both intervals. Nonsmokers showed the highest rate of restenosis, 28% at 6 months and 45% at 12 months.
The authors of the study do not encourage smoking, but they suggest that delivering carbon monoxide to the site of the blockage could be an innovative concept.
Contrary to the conventional tactics of dealing with malpractice cases, physicians are using the power of two simple words to help decrease the number of lawsuits brought against them: “I’m sorry.”
A recent story featured in The Wall Street Journal highlighted the new trend of physicians who are taking proactive measuressometimes against hospital regulationsto personally apologize to patients or patients’ families for mistakes made in treatment protocols. The story cites examples of cases in which patients have settled the matter with the hospital directly rather than taking the case to court after receiving a personal apology from the physician.
In one case, an anesthesiologist inadvertently injected a painkilling drug in the wrong place, causing his patient’s heart to stop. To restart it, physicians at the Brigham and Women’s Hospital, Boston, sliced into the patient’s chest and cracked her rib cage. Against the hospital’s advice, the physician sent the patient a personal letter, and offered a verbal apology over coffee. The patient dropped her plans to sue. In another situation, the director of the Johns Hopkins Children’s Center, Baltimore, apologized and took full responsibility for the tragic death of an 18-month-old child who failed to receive proper treatment for severe dehydration. The child’s family settled with the hospital for an undisclosed amount, instead of suing, and then donated much of the settlement money to the hospital for improving the safety of pediatric patients.
Offering apologies may seem like an automatic admittance of guilt that would be used against a professing physician in court. However, hospitals are noticing that the straightforward approach to mistakes actually decreases the number of lawsuits taken to court, and hence decreases the average cost of error-related payouts, according to the WSJ article. Currently, two states, Colorado and Oregon, have passed laws specifically stating that an apology cannot be used against a physician in court. With the escalating costs of malpractice premiums, up-front apologies may be a valuable tool to decrease huge financial payments hospital incur when losing a malpractice case. Though not all patients are willing to drop charges after an apology, it is one step toward a solution.
At a recent meeting of the American Medical Association, members considered other solutions, including the creation of a special Internet site that would list the names of physicians who testify against other physicians in malpractice cases.
Department Salary Growth in 2003
The latest Compensation and Benefits Survey conducted by the American Healthcare Radiology Administrators (AHRA) showed that directors and department managers had an increase of approximately 10% of their salaries in 2003 versus 2001, rising from $71,529 to $78,700, and $57,408 to $64,002, respectively. As for hourly wages paid in the radiology department, the highest rate was commanded by the PACS administrator, at $29.51, followed by the PET/CT technologist, at $29.17. One of the lowest hourly rates went to the film librarian, at $10.79. The survey also showed that more than 70% of respondents’ organizations offer a basic health care plan, educational conferences/trips, a pension plan, a dental plan, and education/tuition reimbursement.
AHRA solicited more than 700 responses, of which 22.6% of the respondents were from imaging centers and 11.1% were from MRI centers. Responses for the survey came mainly from AHRA members who have spent approximately 14 years in imaging in a supervisory capacity, and 7 years in their current position.
Sonora Medical Systems, Longmont, Colo, has signed an exclusive license and supply agreement with Prosonic Company Ltd, Seoul, Korea, in which Sonora will release certain proprietary know-how and intellectual property to Prosonic, helping Prosonic to perform repair operations on diagnostic ultrasound transducers, and refurbish and supply diagnostic ultrasound systems in Korea and other select markets in Asia…The National Health Service (NHS) National Programme for Information Technology in England has selected Eastman Kodak Company’s Health Imaging Group, Rochester, NY, as one of its digital solutions suppliers. Kodak, part of an alliance led by Computer Sciences Corp, El Segundo, Calif, will design, build, and operate a system across the Northwest and West Midlands regions of England, which will enable images to be stored and mailed electronically. Part of a $6 billion initiative, the system will feature computed radiography machines, PACS, and a radiology information system…TeraRecon Inc, San Mateo, Calif, has made a strategic investment in Acrorad Co Ltd, Japan, manufacturers of cadmium-telluride (CdTe), a semiconductor used for direct conversion x-ray and gamma-ray detectors. TeraRecon’s investment involves the acquisition of 2,454 shares of previously issued common stock, and the exercise of a warrant for a further 1,400 shares of newly issued common stock. In other TeraRecon news, the company received capital investment from Fuji Film Co, Tokyo…CTI Molecular Imaging Inc, Knoxville, Tenn, and Siemens Medical Solutions USA Inc, Malvern, Pa, agreed to restructure and align their sales force to effectively market PET and PET/CT equipment manufactured by CPS Innovations, Knoxville, a joint venture between the two companies…Virtual Radiologic Consultants (VRC), Minneapolis, will expand its operations to include a reading facility in Hawaii, which will serve as a conference site and training center for radiologists new to VRC, which recently expanded its corporate headquarters in Minneapolis…NEC-Mitsubishi Electronics Display of America Inc, Itasca, Ill, entered into a strategic partnership with Richardson Electronics Ltd, Atlanta, and will roll out a new line of 21.3-inch 2 and 3MP LCD gray-scale monitors…Radiology Ltd, Tucson, Ariz, became the first commercial client of i3ARCHIVE Inc™, Berwyn, Pa, enabling Radiology Ltd to use i3ARCHIVE’s exclusive National Digital Mammography Archive solution for electronic sharing of patient images across physician practices.The company is an offshoot of a national research database containing 40,000 mammograms, developed at the University of Pennsylvania, Philadelphia…A sales, marketing, and support agreement has been reached between Fischer Imaging Corp, Denver, and InSiteOne Inc, Wallingford, Conn, bringing fully integrated storage services and data archive management services to Fischer’s digital mammography customers. InSiteOne has also entered into an agreement with Agfa Healthcare, Ridgefield Park, NJ, allowing Agfa to be an authorized dealer of InSiteOne’s InDexTM line of secure integrated DICOM storage solutions…FUJIFILM Medical Systems USA, Stamford, Conn, introduces new pricing models for its Synapse application. Customers can now purchase Synapse through: a volume-based license model that allows unlimited use; the Single Step to Digital program, which is designed for facilities conducting fewer than 45,000 radiological examinations a year; or the Information Technology Control and Predictability solution, which offers the lowest financing rates and requires no initial capital outlay…E-Z-EM Inc, Lake Success, NY, is moving its powder-based barium production to its manufacturing facility in Montreal…Sectra AB, Linkoping, Sweden, has become the owner of Mamea Imaging AB, Stockholm, Sweden, holding 100% of Mamea’s shares…MDS Nordion, Ottawa, and Molecular Insight Pharmaceuticals, Cambridge, Mass, have agreed to produce BMIPP, Molecular Insight’s leading molecular imaging pharmaceutical.
|Mary Beth Lang|
Mike Cassling, president and CEO of Cassling Diagnostic Imaging, Omaha, Neb, was recently appointed to the advisory committee for Health Care Administration at Bellevue University, Bellevue, Neb. Cassling will help the newly formed committee develop and keep current the curriculum of various health care programs offered at the university…Mary Beth Lang has been appointed as the first chief executive officer of Diagnostix LLC, Warrendale, Pa, a new data services company serving the health care industry…Jeffery Landman, MD, was named medical director of Evolved Digital Systems, Nashville, Tenn, a provider of integrated image and information management solutions. Landman will chair the company’s Clinical Advisory Board and actively participate with the company’s customer-user groups…Bette Schans, PhD, RT(R), FASRT, received the American Society of Radiologic Technologists 2004 Jean I. Widger Distinguished Author Award for an article that examined ethical reasoning among radiologic technologists and radiologic science students. The award is given annually for a peer-reviewed article appearing in Radiologic Technology…Victoria Hibbits was named vice president of national accounts at Stentor, San Francisco, and will report directly to CEO Jeff Otten. Hibbits’ responsibilities will focus on expanding Stentor’s integrated health care delivery network presence and corporate accounts base across North America…Christopher Cone was promoted to vice president of sales and marketing at Sonora Medical Systems, Longmont, Colo, with primary responsibilities for Sonora’s sales and marketing activities on a worldwide basis. Cone will report directly to the president and CEO of Sonora…Philip J. Lewis joins Eastman Kodak Company’s Health Imaging Group, Rochester, NY, as national sales manager, professional services, United States and Canada, and as vice president of health imaging. Lewis will be responsible for direct line management of Health Imaging’s professional services sales teams to drive growth of the organization’s professional services offerings in the United States and Canada. Todd VanderVen has been named general manager of programs, marketing, and business development, and vice president for the Health Imaging Group…Barry C. Muradian was named vice president and chief operating officer of Image Technology Laboratories Inc (ITL), Kingston, NY, and will be a key player in the rollout of ITL WarpSpeed, the company’s Health Insurance Portability and Accountability Act-compliant business solution…John Nelson, MD, an obstetrician-gynecologist from Salt Lake City, has been named the 2004-2005 president of the American Medical Association. Nelson stated three key priorities for his tenure: providing health care coverage to all Americans, creating a “better, fairer liability system” for physicians, and reforming Medicare.
The figure below, which illustrated an article on digital mammography by Martin J. Yaffe, PhD, and Roberta A. Jong, MD, in the May issue, now appears as it should have. We regret the error.
|Contrast digital mammography. (Left) Mask cranial caudal digital mammogram showing a density and some microcalcifications. (Right) Subtraction image where the uptake associated with angiogenesis is clearly seen. This was an invasive ductal carcinoma.|