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R H Choplin

Publications and source records attributed to R H Choplin.

16 recordsLinked to original sources
PubMed1992

Picture archiving and communication systems: an overview.

Organizational techniques that enable small departments to function efficiently often fail as departments become larger. With the recent growth in imaging technology, the capacity of film-based systems to meet the increasing needs of radiology departments has decreased. Electronic picture archiving and communication systems (PACS) have been developed in an attempt to provide economical storage, rapid retrieval of images, access to images acquired with multiple modalities, and simultaneous access at multiple sites. Input to a PACS may come from digital or analog sources (when the latter have been digitized). A PACS consists primarily of an image acquisition device (an electronic gateway to the system), data management system (a specialized computer system that controls the flow of information on the network), image storage devices (both short- and long-term archives), transmission network (which serves local or wide areas), display stations (which include a computer, text monitor, image monitors, and a user interface), and devices to produce hard-copy images (currently, a multiformat or laser camera). The goals of PACS are to improve operational efficiency while maintaining or improving diagnostic ability.

Radiology Information Systems↗
PubMed1992

Systems integration: requirements for a fully functioning electronic radiology department.

Disparate computer-based information systems such as hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS) have been introduced into radiology departments at various times to meet specific operational objectives. Typically, these systems are implemented without an integration strategy. Systems integration, which optimizes integrity of data and labor savings, can be achieved by two general approaches. The first links the HIS to the PACS; the second involves interlinking of the HIS, RIS, and PACS, with the RIS as the central controlling system. Standardization in hardware, operating systems, and data base formats--which will allow true integration--is being addressed nationally and worldwide. Operational issues to resolve include ways to increase network capacity, control of data flow, and strategies for dealing with downtime. In the future, systems integration will enable prefetching, two-way interfaces, interfaces with digital dictation systems, and improved linkages with external digital input devices.

Computer Communication Networks↗
PubMed1992

Plain and computed radiography for detecting experimentally induced pneumothorax in cadavers: implications for detection in patients.

Pneumothorax was induced in cadavers to determine the effects of patient positioning and imaging modality (conventional screen-film and computed radiography) on radiographic findings. Chest radiography, with cadavers in the supine frontal, erect frontal, and left lateral decubitus positions, was performed at baseline and after injection of incremental quantities of air into the pleural space. Five radiologists independently interpreted each radiograph. The ability of the radiologists to diagnose pneumothorax varied by cadaver position and depended on volume of air. Overall, the left lateral decubitus view was most sensitive (88%) for diagnosis of pneumothorax, followed by the erect (59%) and supine (37%) views. Receiver operating characteristic curves and multiple repeated measures analysis of variance revealed no statistically significant difference between diagnostic proficiency with conventional screen-film radiography and that with computed radiography. The authors conclude that the lateral decubitus view is superior to the erect and supine views for pneumothorax detection and that conventional and computed radiography perform similarly in pneumothorax detection.

Cadaver↗
PubMed1992

Evaluation of PACS in ultrasonography.

We review our experience with a picture archiving and communication system to replace film in the ultrasound section of a clinical radiology department. The system includes three ultrasound units connected by a fiberoptic network via acquisition nodes to a central data management system, workstation, and optical jukebox. The system handles 80% of sonographic studies in the department. Image production, interpretation, storage, and retrieval are evaluated. Despite limitations, a picture archiving and communication system can be integrated into a functioning ultrasound section of an active radiology department with minimal disruption and promising results.

Computer Systems↗
PubMed1991

Pleural infections: a clinical-radiologic review.

Pleural space infection is a common disorder that may result from a wide variety of causes and is associated with a wide range of etiologic agents. The authors reviewed retrospectively records of 102 patients with discharge diagnoses of empyema and/or bronchopleural fistula. Chest radiographs and computed tomography closest to the time of initial diagnosis were evaluated separately. In 78 cases of empyema, the etiologies included primary pulmonary infections (49%), postsurgical (23%), traumatic (11.5%), intraabdominal pathology (5%), and unknown (11.5%). In 24 cases of bronchopleural fistulas, the etiologies were previous surgical procedures (37.5%), pulmonary infections (37.5%), traumatic (4%), and unknown (21%).

Adolescent↗
PubMed1991

Image-guided catheter drainage of the infected pleural space.

Thoracic empyema occurs at all ages and has reported mortality rates of 10% to 75%. Most authors agree that complete drainage of complicated effusions or organized empyemas and reexpansion of atelectatic lung are important in obtaining a satisfactory clinical outcome. For initial tube drainage, a 26-F to 36-F chest tube traditionally has been inserted at the bedside. The results of this method of empyema evacuation have varied widely, with an overall cure rate reported to be 47%. Image-guided placement of smaller 8-F to 14-F catheters has been offered as an alternative therapy with an overall reported cure rate of 81% in 104 patients.

Catheterization↗
PubMed1990

Radiographic detection of esophageal malpositioning of endotracheal tubes.

Insertion of an endotracheal tube into the esophagus is an infrequent but life-threatening complication of endotracheal intubation. This complication is difficult to detect on standard, anteroposterior, portable chest radiographs because the incorrectly placed endotracheal tube is usually projected over the tracheal air column. To evaluate the use of chest radiographs to detect the malposition, we performed a two-part study. First, we analyzed the findings on chest radiographs in six patients in whom an endotracheal tube had been inserted in the esophagus, and then we analyzed 328 portable chest radiographs of patients with both endotracheal and nasogastric tubes to determine the best radiographic position for identifying the exact location of an endotracheal tube. The findings in the six patients included projection of the tube lateral to the trachea (five patients), gastric distension (four patients), esophageal air (two patients), and deviation of the trachea by the balloon cuff (one patient). The study of the portable chest radiographs showed that the endotracheal tube position could be identified correctly in 81 (92%) of 88 of the films made with the patient in a 25 degrees right posterior oblique position. The trachea and esophagus were superimposed in 25 (96%) of 26 of the radiographs made with the head turned to the left and with the patient in a 25 degrees left posterior oblique projection. Our results show that by positioning patients for chest radiographs in a 25 degrees right posterior oblique position, the location of endotracheal tubes can be identified accurately.

Esophagus↗
PubMed1990

Computed tomography versus chest radiography: impact on management of patients with lymphoma.

To assess the influence of computed tomography of the thorax (CTT) in management of patients with lymphoma, we compared results of CTT and chest radiography (CXR) for 42 patients (65 examinations) with Hodgkin's disease (HD) with 48 patients (57 examinations) with non-Hodgkin lymphoma (NHL). Six percent (7/122) of all CTs resulted in major changes in patient management (95% confidence interval = 2-12%). In four patients with HD, influential findings included of additional sites of lymphoma and clarification of x-ray results. In three patients with NHL (5%), management was altered as a result of identification of additional sites of lymphoma on CTT. Eleven percent of CTT examinations clarified equivocal CXR findings in NHL, and management was affected in two of these cases. Our findings suggest that CTT is valuable in clarifying equivocal CXR findings, and in staging or restaging patients for whom the detection of mediastinal adenopathy affect patient treatment.

Hodgkin Disease↗
PubMed1989

Relationship between mammographic features and hormone receptor content in patients with breast cancer.

Recurrences of breast cancer are more responsive to hormone therapy if the tumors are positive for estrogen receptors or progesterone receptors. To assess the relationship between hormone receptor content, mammographic tumor morphology, and breast parenchymal patterns, we reviewed charts and mammograms of 210 patients with primary unilateral breast cancer. Mammograms of tumors in 97 patients were divided morphologically into five groups: (1) spiculated mass, (2) architectural distortion, (3) calcifications only, (4) circumscribed mass, and (5) tumor not visible. Estrogen receptor positivity was 81% (39/48) in group 1, 37% (7/19) in group 2, 17% (2/12) in group 3, 31% (4/13) in group 4, and 60% (3/5) in group 5 (P less than .001). Mean estrogen receptor content was also significantly different among groups (P less than .001). There was no statistically significant association between tumor morphology and progesterone receptors, or between calcifications and receptor status. In all 210 patients, hormone-receptor-positive tumors showed no association with mammographic parenchymal pattern. When direct assay of estrogen receptors is unavailable, mammographic appearance of the tumor may suggest the estrogen receptor status.

Breast Neoplasms↗
PubMed1986

The abnormal nephrogram.

Recognition of qualitative abnormalities in the nephrogram may be as important as the recognition of structural abnormalities for the detection of renal disease.

Angiography↗
PubMed1986

Atypical carcinoid of the lung: radiographic features.

Atypical carcinoid of the lung is a neuroendocrine neoplasm with cellular and clinical features intermediate between those of typical carcinoid and small cell undifferentiated carcinoma of the lung. These neoplasms exhibit a wide range of histologic appearances and are misdiagnosed in up to 50% of cases. The clinical records and radiographs of 32 patients with this diagnosis from the University of Virginia Medical Center and Wake Forest University Medical Center were reviewed. Sixteen of these cases had been misdiagnosed pathologically. While the most frequent radiographic finding was a round or avoid lobulated peripheral mass, other appearances included thin-walled cavities, poorly defined nonsegmental infiltrates, and mediastinal masses. Fifty percent of the patients in this study have died from their tumor, with a mean survival of 15.5 months. This contrasts with both typical carcinoid and small cell undifferentiated carcinoma, in which patients develop fatal metastatic disease in 5% and nearly 100%, respectively. Proper categorization of typical carcinoid, atypical carcinoid, and small cell undifferentiated carcinoma is necessary to determine appropriate therapy, prognosis, and reporting of end results.

Adult↗
PubMed1986

Occult lesions of the breast.

The biopsy of 148 clinically occult lesions of the breast found at mammographic examination yielded 21 instances of carcinoma (14.2 per cent). Five malignant lesions were lobular or in situ carcinoma, 16 were infiltrating ductal carcinomas and 11 were minimal carcinoma of the breast. Carcinomas found by mammographic examination were smaller and less likely to be associated with metastases to the axillary nodes than carcinomas of the breast diagnosed by palpation during the same time period. Biopsy of the breast was performed by several methods: 1, quandrantectomy with the patient under general anesthesia (the results of 29 biopsies yielded five instances of carcinoma, 17.2 per cent); 2, generous excision of breast tissue with the patient under general anesthesia and the lesion being localized by geometric co-ordinates based upon the mammograms (the results of 35 excisions yielded four instances of carcinoma, 11.4 per cent), and 3, mammogram-directed needle localization (the results of 84 procedures yielded 12 instances of carcinoma, 14.3 per cent). Because needle-directed biopsy causes less distortion of the breast, we prefer it to other biopsy techniques in the evaluation of occult lesions of the breast.

Adenofibroma↗
PubMed1985

Superior vena caval obstruction: detection using CT.

A review of 210 chest computed tomographic (CT) examinations demonstrating upper chest masses revealed 16 cases of superior vena caval obstruction (SVCO); 11 of these were clinically occult. Two of the occult cases subsequently became clinically evident. Contrast-enhanced chest CT permits the diagnosis of clinically occult SVCO and should be considered in patients with upper chest masses, even in the absence of any physical signs of SVCO.

Aged↗