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F Stacul

Publications and source records attributed to F Stacul.

65 records · Page 4Linked to original sources
PubMedDate not supplied

Trieste PACS project: a functional assessment.

A picture archiving and communication (PAC) system (CommView by AT&T and Philips) has recently been installed in the Radiology Department of the University of Trieste, Italy, and is currently under experimental evaluation. The current status of the system and the planned developments are reported. A major project at present is the evaluation of the impact of the PAC system on the radiology system on a functional basis, by applying in the medical field a modelling methodology developed to analyse manufacturing systems. Other research in progress is devoted to technical, clinical and ergonomic aspects, on the basis of a comprehensive assessment project.

Hospital Information Systems↗
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[Modular project of the Picture Archiving and Communication System (PACS). Preliminary clinical experience. II].

In the previous paper in this volume the PAC System installed in the Radiology Department of the University of Trieste has been described and its advantages and limitations have been analyzed, mainly from an operational point of view. This paper deals with the clinical evaluation of the system in ordinary operative conditions. A series of cases with specific characteristics was monitored in order to reveal different performances in both diagnostic process and conclusions using the PACS viewing console (DW) vs. conventional CRT film images on alternators. In a first test, 100 routine (not pre-selected) brain CT cases were independently analyzed by 4 radiologists, each of them giving 2 interpretations of the same case, one based on film and the other on PACS. The data were analyzed by conventional statistical methods, showing a substantial agreement of the results obtained with the 2 modalities. A second test concerned the evaluation of 100 lumbar intervertebral disks by CT, with the same procedure as above. Four radiologists were again asked to decide on film and PACS images about normality, protusion, or herniation of the disks. The results demonstrate the possibility of adequately reporting on the PACS monitor and stress the need of an adequate training period and the efficacy of the image processing capabilities of the system.

Brain Diseases↗
PubMedDate not supplied

[Modular project of the Picture Archiving and Communication System (PACS). Preliminary operational experience. I].

Since september 1988 a PAC System (Comm View by AT & T and Philips) has been operating in the Radiology Department of the University Hospital, Trieste. A research project is presently in progress aiming at providing factual evidence for the evaluation of this kind of systems as far as operational, technical, clinical and economic aspects are concerned. The general approach to this research consists in implementing and monitoring a PACS in a stepwise way, starting with a small system connected to some digital modalities only, in order to test the feasibility and effectiveness of the system within a Radiology Department, and to test the possibility of matching the PACS to the Radiological System. The present paper describes in detail the present configuration of this entry-level system and its technical features. The planned development (october 1989) is also depicted. Further developments devise at managing in an integrated way all the radiological images of the four hospitals of Trieste. At present, the PACS is currently used to manage and store on optical disks all the images acquired from the connected modalities plus the related reports, and to perform the reporting sessions for CT examinations (brain and abdomen). The present research effort is devoted to two main areas: clinical evaluation and operational analysis. The object of the operational analysis was the assessment of the impact of PACS on the operations of a Radiology Department. The general approach followed for this research consists in analysing the procedures as they are performed in the conventional way (manual operations), and comparing them to the way they are, or could be, performed using a PACS System (automatic operations). This stage of the project is divided into three phases, concerning respectively the analysis of the organization and operations before PACS, the analysis of the impact of PACS in its initial configuration and the forecast of the influence of PACS in its future setting. A first evaluation concerned the activities carried out from the moment the images are generated to the moment they are ready to be achieved. They include image acquisition, reporting, delivering and returning of images from the departments. The time required to carry out each of the activities involved was recorded, both in the manual and in the automatic version; furthermore, a more detailed analysis was performed on the reporting procedure. The conclusions reached through this analysis are that this kind of operation is mostly affected by the way the Radiology Department is managed, rather than by the tools employed.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Systems↗
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[An information system for the management support of a radiology institute. Critical analysis and experience].

The Radiology Information System (RIS) for the management of the Radiology Department at the Trieste University Hospital is here presented. It consists of 3 subsystems: the first one is devoted to the management of the patients archive and to the examination scheduling function, the second deals with the statistical and administrative reporting task, and the third manages the archives of scientific data. Each subsystem is analysed in details, in terms of functions, hardware, software, archives, and personnel. The actual implementations of such systems are considered, with respect to the main functions of the Radiology Department, on the basis of the authors' actual experience. An attempt is made to set aside features related to the local situation, thus providing useful data for different realities. Specific quantitative measures are presented, whenever appropriate, to provide a solid ground to explain and motivate the most relevant aspects relative to the management of the Radiology Department in general and of the RIS in particular. Workloads and/or execution times of the main functions were collected and the RIS has turned out to yield significant benefits (e.g., easier and more confident access to the information). On the other hand, the costs are not negligible and must be carefully planned during the projecting phase. Some expected future developments of the RIS are outlined: in the short run the network conversion is devised, and a functional integration among the subsystems; in the medium run an autonomous system is planned, and in the long run a connection is considered with a Picture Archiving and Communication System (PACS) and with the Hospital Information System (HIS).

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

[Digital radiography in urography].

The clinical utility was evaluated of a computed radiographic system in urography. The system (FCR 101, Philips Medical Systems, Inc., Shelton, CT) is based on a photo-stimulatable phosphor screen (imaging plate) for X-ray image detection and storage. The X-ray information recorded on the imaging plate is converted into digital from and processed by means of a computer. After processing is completed, the digitized image is reversed back to analogic signals, which modulate the intensity of a laser beam scanning the image on a single-emulsion film (Fuji CR 633). Two hundred IVP's were obtained in four groups, of 50 patients each, with normal azotemic values by rapid infusion of a low osmolality contrast medium (iopamidol 150 mgI/ml). While conventional radiographs were performed on the first group of patients with the injection of 0.6 gI/kg body weight of contrast medium, digital examinations were carried out, in the remaining three groups, with the injection of 0.6, 0.3 and 0.12 gI/kg, respectively. The digital images were processed with the "Abdomen-routine" program. A specific algorithm was implemented in order to reduce the excessive contrast resolution of the bladder, which is due to the characteristics of the nonionic contrast medium and enhanced by the reading program. The image details were evaluated by two observers and then statistically analyzed with nonparametric tests. Statistical analysis did not show any difference in the quality of digital and screen-film images. Image processing improved some inadequate images, by reducing the contrast resolution of the bladder, and allowed a better detection of some details. Low doses (0.3 gI/kg) of a low osmolality (150 mgI/kg) contrast medium were enough to obtain good images. Another biological advantage was obtained by a consistent radiation dose reduction (about 40%).

Adolescent↗
PubMedDate not supplied

[Echography in renal colic].

To determine the role of sonography (US) in patients with renal colic, 40 patients were examined by means of US, plain abdominal film (PF), and intravenous pyelography (ivp). US sensitivity was 92.3% in diagnosing hydronephrosis and 75% in detecting calculi. Small calculi were correctly identified, irrespective of their chemical composition. It must be stressed how US, as compared to ivp, proved unsatisfactory in such cases as difficult visualization of the middle portion of the ureter, unsuccessful identification of acute obstructions without hydronephrosis (although the patient's hydratation may be useful in this respect), poor functional information (although there was a correlation between renal hyper-echogenicity and obstructive nephrogram). US is safe and easy to perform, and is suggested for the initial evaluation of patients with renal colic, together with PF, and as an alternative to ivp. Moreover, US is the ideal technique in the follow-up of these patients. Therefore, ivp should be performed in case of differing clinical and sonographic findings, when the calculus is not ejected within the expected time, and when surgery or lithotripsy are foreseen.

Adult↗
PubMedDate not supplied

[The quality of urography with iopamidol and various diuretic agents].

The results obtained in four successive trials based on the analysis of urography performed on patients with normal kidney function are reported. The scores obtained with a non-ionic contrast (iopamidol) were compared with those produced after injecting the same contrast medium with the addition of various diuretics (furosemide, various quantities of 5% glucose solution, 20% mannitol). The results obtained by injecting the diuretic together with the iopamidol were usually unsatisfactory. Injection of diuretic 15 ms after the iopamidol gave better results in the lower urinary tract, particularly the bladder. The best results were obtained by injecting 250 ml, 20% mannitol, after 15 ms. However this technique is not applicable to patients requiring a voiding cystourethrogram due to the inadequate opacification of the urethra it provides.

Adult↗
PubMedDate not supplied

[Cardiac complications of intravenous digital angiography. Comparison of ionic and nonionic contrast media].

The review of 1405 digital intravenous subtraction angiographies carried out in the period may 1982-february 1985 showed in about 2% of the cases cardiac symptoms, which arose during or after the examination. In the great majority of the cases the symptomatology was characterized by angina pectoris. In order to better understand these data and analysing the results of the literature, a trial has been performed in 100 patients who underwent DSA. They have been divided into two groups in which two different contrast media, ionic (sodium meglumine diatrizoate) and non ionic (iopamidol) have been randomly injected. A detailed cardiologic anamnesis has been collected and EKG has been performed before and after each injection with pre-established gaps. The results showed that the incidence of cardiac symptoms and EKG variations is lesser with the non ionic contrast medium: therefore this agent is to be preferred at least in patients at risk from cardiologic point of view.

Acute Disease↗
PubMedDate not supplied

[Comparison between ionic and non ionic contrast media in fast injection nephro-urography (author's transl)].

The authors judged the quality of the films in two groups of patients who underwent fast injection nephro-urography with iopamidol and meglumine sodium diatrizoate. The scores ascribed to the urograms obtained with the two contrast media have been compared. The ionic contrast medium got a higher score, at it allowed a better evaluation of ureters and bladder. Tolerability of the two contrast media has been evaluated.

Adult↗
PubMedDate not supplied

[Morpho-functional study of the kidney in patients with kidney disease and liver disease with magnetic resonance].

INTRODUCTION: We studied renal function and perfusion after the i.v. injection of Gd-DTPA-BMA, a nonionic paramagnetic contrast agent, to assess renal morphology and function in normal subjects, in renal insufficiency patients and in patients with hepatic failure and normal renal function. The latter were chosen because some patients with advanced hepatic failure may suffer from the hepatorenal syndrome, characterized by severe vasoconstriction in the renal cortical vessels. We investigated if dynamic MRI can detect early renal perfusion abnormalities in the patients who will eventually develop this syndrome. MATERIAL AND METHODS: Thirty MR examinations were carried out on 30 subjects after the i.v. injection of Gd-DTPA-BMA. Our series consisted of: 10 normal subjects; 10 renal insufficiency patients; 10 patients with hepatic failure and normal renal function. MR examinations were performed on a Philips ACS II scanner operating at 1.5 T. Two sequences were carried out in all cases: T1-weighted SE and T1-weighted TGE sequences after the bolus injection of .1 mmol/kg contrast agent. Renal longitudinal diameter and parenchymal thickness were measured in all cases and signal intensity time curves were always made. The signal intensity of the cortex, corticomedullary junction, medulla and pyelocaliceal system of each kidney was measured using a region of interest (ROI). The signal intensity curves were made considering quantitative parameters, including the area below the curve (ASC), the peak (P) and the time to peak (T-P). RESULTS: Longitudinal diameter and parenchymal thickness values were significantly lower in renal insufficiency patients than in normal subjects. Four phases were demonstrated after i.v. contrast agent injection in normal subjects, namely A) the cortical phase, B) the corticomedullary junction phase, C) the medullary phase, D) the pyelocaliceal phase. No signal intensity decrease in the medullary and pyelocaliceal curves was observed in renal insufficiency patients. Signal intensity curves values were lower in hepatic failure patients than in those with normal renal function. Hepatic failure patients could be divided into two groups: 5 patients had low P and ASC values and 4 had normal P and ASC values. The patients with lower P and ASC values developed the hepatorenal syndrome within a few months of the MR examination. DISCUSSION: Signal intensity decreased in the pyelocaliceal system phase in normal subjects because of the high paramagnetic contrast agent concentration. The lack of signal intensity decrease in renal insufficiency patients was caused by the reduced capability of concentrating Gd-DTPA-BMA. Lower signal intensity values in hepatic failure patients may be considered an early sign of the hepatorenal syndrome.

Adult↗