Dr. Bill W.

Practice Management
Imaging self-referral: An inside manifesto
My name is Bill W. Like the fellow in the AA meetings. I'm a radiologist, and I'm addicted to imaging self-referral. Maybe you know something about this, maybe you participate too, and maybe you don't care. But you should. For your wake-up call, I think it's time to share an inside view of a very ugly issue.
March 18, 2009
2009 03 18 16 29 16 358 Silouette 70
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Top Stories
(A,B) Images from an initial ultrasound examination showed no identifiable lesions and received a consensus ultrasound category of US-1. Nearly the entire liver is visualized, with minimal shadowing (“s”, A and B), and the examination received consensus result of VIS-A. The AFP level was 7.1 ng/mL on assessment six months before the ultrasound, 9.1 ng/mL on assessment three months before examination, and 14.2 ng/mL on assessment on exam day. The AFP result was thus assessed as positive based on a progressive increase on two consecutive tests. The atient was considered to have negative surveillance result according to LI-RADS Ultrasound Surveillance v2017, but positive surveillance result according to LI-RADS Ultrasound Surveillance v2024. (C-D) Axial arterial-phase (C) and portal-venous phase (D) T1-weighted images from subsequent gadoxetic acid-enhanced MRI show a 2-cm arterial-phase hyperenhancing observation (arrow, C) with portal-venous washout (arrow, D) in segment 7. This observation was classified on MRI as LR-5, thus meeting the present study’s reference standard for diagnosis of HCC. The mass is located in the periphery of the liver, an anatomic area where ultrasound visualization can be challenging due to shadowing.
Ultrasound
LI-RADS ultrasound surveillance version 2024 improves HCC detection
The 2024 version of the LI-RADS Ultrasound Surveillance system improves detection of hepatocellular carcinoma (HCC) over earlier iterations.
Lung Ct Images
CT
Deep learning helps find, segment lung tumors on CT imaging
Images in a 74-year-old male patient who presented at the hospital with acute symptoms of a right hemispheric ischemic stroke and a National Institutes of Health Stroke Scale (NIHSS) score of 24. (A) Nonenhanced CT image shows no signs of early infarction, whereas (B) CT perfusion image shows a large perfusion deficit in the territory of the middle cerebral artery and anterior cerebral artery caused by an extracranial occlusion in the right internal carotid artery. (C) Digital subtraction angiography shows the occlusion in the C1 segment. The extracranial occlusion was passed, reperfused, and subsequently stented (D, E). The final contrast injection did not reveal any intracranial occlusions within the territory of the internal carotid artery (F). At the 24-hour follow-up, there was no infarction on (G) the nonenhanced CT image, and the NIHSS score had decreased to 3 points. Image courtesy of RSNA.
Interventional
EVT promising in patients with extracranial ICA occlusions
Images depict a 49-year-old female participant with cryptogenic cirrhosis who presented with a 3.2-cm liver lesion. This biopsy-confirmed hepatocellular carcinoma (HCC) with an initial categorization of Liver Imaging Reporting and Data System (LI-RADS) category LR-4 (probably HCC) at CT was upgraded to LR-5 (definitely HCC) at contrast-enhanced ultrasound (CEUS). (A) Precontrast CT images in the liver show vague hypoattenuation in the medial left hepatic lobe (arrows). (B) Arterial phase images demonstrate no definite arterial phase hyperenhancement (arrows). (C) Washout and an enhancing capsule (arrows) on a late-phase image resulted in an LR-4 categorization. (D) B-mode ultrasound shows a round hypoechoic nodule (arrows). (E) An early-phase CEUS image shows clear arterial-phase hyperenhancement (arrows); (F) No washout at one minute (arrows), and (G) late, mild washout at four minutes (arrows) resulted in a CEUS LR-5 categorization.
Ultrasound
CEUS resolves indeterminate CT, MRI liver observations
Ctca
Molecular Imaging
PET/CT can rule out CAV in heart transplant patients
More in Home
LI-RADS ultrasound surveillance version 2024 improves HCC detection
By Amerigo Allegretto
The 2024 version of the LI-RADS Ultrasound Surveillance system improves detection of hepatocellular carcinoma (HCC) over earlier iterations.
January 22, 2025
(A,B) Images from an initial ultrasound examination showed no identifiable lesions and received a consensus ultrasound category of US-1. Nearly the entire liver is visualized, with minimal shadowing (“s”, A and B), and the examination received consensus result of VIS-A. The AFP level was 7.1 ng/mL on assessment six months before the ultrasound, 9.1 ng/mL on assessment three months before examination, and 14.2 ng/mL on assessment on exam day. The AFP result was thus assessed as positive based on a progressive increase on two consecutive tests. The atient was considered to have negative surveillance result according to LI-RADS Ultrasound Surveillance v2017, but positive surveillance result according to LI-RADS Ultrasound Surveillance v2024. (C-D) Axial arterial-phase (C) and portal-venous phase (D) T1-weighted images from subsequent gadoxetic acid-enhanced MRI show a 2-cm arterial-phase hyperenhancing observation (arrow, C) with portal-venous washout (arrow, D) in segment 7. This observation was classified on MRI as LR-5, thus meeting the present study’s reference standard for diagnosis of HCC. The mass is located in the periphery of the liver, an anatomic area where ultrasound visualization can be challenging due to shadowing.
Deep learning helps find, segment lung tumors on CT imaging
By Kate Madden Yee
Using a deep-learning model with lung CT imaging shows promise for identifying and segmenting tumors, researchers have reported.
January 22, 2025
Lung Ct Images
EVT promising in patients with extracranial ICA occlusions
By Will Morton
Endovascular thrombectomy (EVT) and best medical treatment are both effective and safe options for patients with acute extracranial internal carotid artery occlusions.
January 21, 2025
Images in a 74-year-old male patient who presented at the hospital with acute symptoms of a right hemispheric ischemic stroke and a National Institutes of Health Stroke Scale (NIHSS) score of 24. (A) Nonenhanced CT image shows no signs of early infarction, whereas (B) CT perfusion image shows a large perfusion deficit in the territory of the middle cerebral artery and anterior cerebral artery caused by an extracranial occlusion in the right internal carotid artery. (C) Digital subtraction angiography shows the occlusion in the C1 segment. The extracranial occlusion was passed, reperfused, and subsequently stented (D, E). The final contrast injection did not reveal any intracranial occlusions within the territory of the internal carotid artery (F). At the 24-hour follow-up, there was no infarction on (G) the nonenhanced CT image, and the NIHSS score had decreased to 3 points. Image courtesy of RSNA.
CEUS resolves indeterminate CT, MRI liver observations
By Amerigo Allegretto
Contrast-enhanced ultrasound (CEUS) can resolve some high-risk indeterminate liver observations initially seen on CT or MRI.
January 21, 2025
Images depict a 49-year-old female participant with cryptogenic cirrhosis who presented with a 3.2-cm liver lesion. This biopsy-confirmed hepatocellular carcinoma (HCC) with an initial categorization of Liver Imaging Reporting and Data System (LI-RADS) category LR-4 (probably HCC) at CT was upgraded to LR-5 (definitely HCC) at contrast-enhanced ultrasound (CEUS). (A) Precontrast CT images in the liver show vague hypoattenuation in the medial left hepatic lobe (arrows). (B) Arterial phase images demonstrate no definite arterial phase hyperenhancement (arrows). (C) Washout and an enhancing capsule (arrows) on a late-phase image resulted in an LR-4 categorization. (D) B-mode ultrasound shows a round hypoechoic nodule (arrows). (E) An early-phase CEUS image shows clear arterial-phase hyperenhancement (arrows); (F) No washout at one minute (arrows), and (G) late, mild washout at four minutes (arrows) resulted in a CEUS LR-5 categorization.
PET/CT can rule out CAV in heart transplant patients
By Will Morton
Cardiac PET/CT scans can effectively rule out moderate to severe cardiac allograft vasculopathy (CAV) in heart transplant patients.
January 17, 2025
Ctca
Machine learning can predict immunotherapy response in NSCLC patients
By Kate Madden Yee
Machine learning (ML) can help clinicians predict immunotherapy response in patients with inoperable non-small cell lung cancer (NSCLC).
January 17, 2025
Lung Ct Images
Current topics in mammography
By Sandy Coffta
Sandy Coffta of Healthcare Administrative Partners discusses changes in reporting and reimbursement for mammography exams.
January 17, 2025
Coffta Sandy Thumbnail
Surgeon General's alcohol advisory puts patient counseling at the fore
By Amerigo Allegretto
Patient communication and education may be key for radiologists in the wake of the Surgeon General’s advisory on alcohol-related cancer risk.
January 17, 2025
Wine Red Glass 400
FAPI-PET shows promise for imaging gastric cancers
By Will Morton
Gallium-68 fibroblast activation protein inhibitor (FAPI) PET/CT is a promising new method for imaging gastric cancer.
January 16, 2025
Fapi Pet Gastric Cancer Thumbnail
CEM has slightly higher mean glandular dose than DBT, mammography
By Amerigo Allegretto
Contrast-enhanced mammography (CEM) has a slightly higher mean glandular dose than other breast imaging modalities.
January 16, 2025
Contrast Injector
ACS: Cancer mortality continues to drop
By Kate Madden Yee
Cancer mortality rates continue to drop -- although incidence of the disease is rising in women, according to an annual study released by the ACS.
January 16, 2025
Cancer Cell Target2
POCUS useful for diagnosis of retained conception tissue
By Amerigo Allegretto
Point-of-care ultrasound (POCUS) can be a useful tool for diagnosing the presence of retained conception tissue.
January 15, 2025
Ultrasound Portable
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