Radiology

Host: Jason Birnholz, MD

Guest: Dushyant Sahani, MD

More often, the diagnosis of causes of upper abdominal pain and specialty triage of patients as necessary has become the province of the radiologist. How do radiologists best approach diagnosis and management for these patients, and what factors underlie positive interactions between referring physician and radiologist for this common clinical problem? Host Dr. Jason Birnholz is joined by Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to examine the radiology of upper abdominal pain and the expanding role of the radiologist.

Host: Jason Birnholz, MD

Guest: Dushyant Sahani, MD

Autoimmunity has been identified in over 100 separate diseases. Depending on the target tissues, these disorders may be systemic, localized, or perhaps somewhere in between. The characteristics of autoimmune pancreatitis represent one such example of diffuse-to-localized disorders, and is the subject of this discussion. New forms of imaging enable us to map the inflammatory components of this and other diseases, often identifying conditions that were not part of the original differential diagnosis. How does this both aid and complicate management strategies for patients? Host Dr. Jason Birnholz welcomes Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to share insights and expertise on imaging autoimmune pancreatitis.

Host: Larry Kaskel, MD

Guest: Alan Moody, MBBS

Can three-dimensional MRI help us measure potential risks for stroke associated with an intraplaque hemorrhage? We are rapidly learning more about the significance of intraplaque hemorrhage, and its role in cardiac and cerebrovascular disease. A better look at potential trouble spots could allow for earlier detection of an impending event, even in relatively asymptomatic individuals. Dr. Alan Moody, professor in the department of medical imaging at the University of Toronto Faculty of Medicine, shares his perspective on 3D MRI as an important tool to lead us in this direction. On a related note, Dr. Moody also provides some insight on what we can do patients with an intraplaque hemorrhage who is already on a statin, aspirin or another therapy to reduce their risk of having this happen again. Dr. Larry Kaskel hosts.

Host: Janet Wright, MD

Guest: Robert Hendel, MD

We're seeing some progress in cardiac imaging toward this lofty goal, thanks, in part, to a system that combines online technology with science-based selection criteria. The system will help us track patterns of care, provide insights into variations in care across the country and ensure that patients get the test that brings the most value to their care. Host Dr. Janet Wright probes the areas where we can further develop our goals for providing the most appropriate care with Dr. Robert Hendel, clinical cardiologist at Midwest Heart Specialists, based in suburbs west of Chicago, and professor of medicine at Rush University Medical College in Chicago. Dr. Hendel also explores trends in the appropriate ordering of tests within a practice versus those referring to that same practice.

Host: Jason Birnholz, MD

Guest: Andrea Doria, MD, PhD, MSc

In 1888, William Osler wrote in the Lancet the following: "In patients with suspected acute appendicitis, one should urge towards laparotomy. The indications for surgical interference are not always clear, but in my experience I have been taught that the abdomen is much more frequently left untouched than it should be, and that an operation is too often deferred until practically useless." Clearly, diagnosis of acute appendicitis has come a long way since then. But challenges remain in selecting the safest, most timely, and cost-effective diagnostic modalities for this condition. Dr. Andrea Doria, associate professor in the department of medical imaging at the University of Toronto School of Medicine, clarifies the use of ultrasound versus CT for evaluation of acute appendicitis in children. Dr. Jason Birnholz hosts.

Host: Jason Birnholz, MD

Guest: Scott Holland, PhD

Guest: Daniel Choo, MD

Successful cochlear implantation has remarkable impact on quality of life for children with congenital and early onset hearing loss. How do clinicians best evaluate these children for likelihood of success with implants, and what are the imaging challenges when following up with these patients later on? Drs. Scott Holland and Daniel Choo from the University of Cincinnati examine new technologies on the horizon, from fMRI to near-infrared spectrophotometry, for screening and following candidates of cochlear implantation. In the process, they outline salient features of sensorineural hearing deficits and share the state-of-the-art in operative methods for implantation. Dr. Jason Birnholz hosts.

Host: Jason Birnholz, MD

Guest: Stephanie Wilson, MD, FRCPC

Many clinicians are well familiarized with standard contrast agents such as barium and iodinated compounds to enhance angiographic imaging. Ultrasound, capable of visualizing bloodflow with the use of doppler alone, is yet insufficiently sensitive to capture perfusion of organs and/or tumors at the capillary level. What special kinds of contrast enhancements are needed for ultrasound in this case? Dr. Stephanie Wilson, professor of medical imaging and obstetrics and gynecology at the University of Calgary in Alberta, Canada, discusses the science and art of using micro-bubble contrast agents, and the emergence of contrast-enhanced ultrasound (CEUS) as a safer alternative to traditional angiography. Dr. Jason Birnholz hosts.

Host: Mark Nolan Hill, MD

Guest: John Byrne, MD

Cardiac surgery is one of just a few medical specialties where before-and-after imaging is not yet standard. As surprising as this may seem, the effect on procedural outcomes is not surprising: current strategies for intraoperative graft assessment, for example, are not detecting all of the defects in the grafts we implant. How can we change this practice, and how can an innovative, hybrid catheterization lab-turned-operating room help us do this? Dr. John Byrne, professor of surgery and chair of cardiac surgery at Vanderbilt University School of Medicine, takes us inside this distinctive operating theatre and details the improvements in graft-defect detection seen by his team at Vanderbilt. Dr. Mark Nolan Hill hosts.

Host: Jason Birnholz, MD

Guest: James B. Spies, MD

It's not uncommon for women to report experiencing menstrual changes after having given birth two or more times. These changes include shorter cycles, increased cramping, and heavier bleeding, at times with clots. Such changes are hallmark signs of adenomyosis. Definitive diagnosis of adenomyosis can be made easily with MRI or ultrasound, but are there therapeutic options from interventional radiology as well? If so, can these methods replace hysterectomy? Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, joins host Dr. Jason Birnholz to resolve these questions.

Host: Jason Birnholz, MD

Guest: James B. Spies, MD

Host Dr. Jason Birnholz and Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, look at fibroid tumors- their incidence and treatment. They discuss the populations in which there is a high prevalence, as well as genetic factors and the basics of interventional radiology protocol.