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The Diagnostic Radiology Department (DRD) provides radiological consultation
for patients in the Clinical Center and performs interventional procedures
under imaging guidance. The Department also collaborates with clinicians
of the Institutes in their intramural clinical research projects. For the
first time, members of the DRD are functioning as Principal Investigators
in clinical research protocols, a privilege that has resulted from the discontinuation
of the contract for radiological services and the resorption of the clinical
radiologists into the federal workforce.
The Diagnostic Radiology Department has acquired three units for computed
radio-
graphy (CT) in the past year, two sited in the General Diagnostic Section
of the DRD and one in the Medical Intensive Care Unit (MICU). This adds
general diagnostic radiography to the array of other imaging modalities
CT, ultrasound, magnetic resonance imaging and angiography currently obtained
in the digital format at this time and moves us one step forward towards
a "filmless department" targeted for the year 2000 by our new
chairman, Dr. R. Nick Bryan. Most general diagnostic and some chest studies
are now acquired digitally. Although their interpretations are still performed
on hard copy of these images, the next step involves interpreting them directly
from computer workstations with an eye towards eventually eliminating films
completely as an imagerecord. The transition to digitally-acquired general
radiographic images has been smooth and such images are now readily accepted
by both the radiological staff and clinicians. A workstation will soon be
installed in the MICU so that the images can be viewed simultaneously at
the bedside and in the DRD. This will facilitate timely consultations between
Critical Care physicians and radiologists.
In addition, the digital format allows for teleconferencing. Several radiographic teleconferences have already been conducted by Dr. Peter Choyke between the DRDs of the Clinical Center and the National Navy Medical Center. We have credentialed Dr. Andrew Poznanski, Chief of Pediatric Radiology at Children's Memorial Hospital in Chicago, IL, to serve as a Consultant in bone dysplasias. Online teleconferencing with digital imaging will allow both the radiologists and clinicians to discuss patients and their images in real time with Dr. Poznanski, taking advantage of his broad experience in this uncommon field of bone pathology.The placement of central venous access devices has become the single major activity of the interventional section of the DRD. To assure that patients receive the most approprate central line and to provide in-house, 24-hour service for problems with these catheters, the DRD initiated, in conjunction with the Critical Care Medicine Department (CCM), a centralized "line service". All requests for central venous access devices are made through the CCM where nurse experts decide on the most appropriate catheter and place when indicated peripheral venous access or PIC lines. Patients with difficult access because of thrombosed central vein and patients in need of more complicated access devices, such as tunneled catheters, are referred to Special Procedures of Diagnostic Radiology. With our fluoroscopic capabilities, we can generally place lines in the most difficult clinical patients. The number of Clinical Center patients requiring venous access has increased dramatically and the creation of a centralized service for venous access has improved the service to these patients.
The number of collaborative research protocols with institute clinicians
has increased. Current projects include investigation (together with the
Hematology Service of the Clinical Center) of a novel technique for thrombolysis
of occluded veins using a pulse spray delivery system to infiltrate clot
with recombinant rATP; the use of magnetic resonance angiography (MRA) to
replace the conventional and more invasive angiographic studies visualizing
the arterial and venous anatomy in cancer staging; the use of rapid assays
of parathyroid hormone during angiographic localization of parathyroid adenomas
to provide online feedback that can shorten and improve the efficiency of
the procedure; the use of ultrasound imaging to detect early inflammatory
musculoskeletal conditions and direct biopsies in patients with myositis;
refinement of virtual bonchoscopy, an imaging technique using computerized
reconstruction of ordinary chest CTs to display the inner surfaces of the
trachea and bronchi as if viewed from within through a bronchoscope; and
application of virtual bronchosopy techniques to image the lumen of obstructed
carotid arteries and to search for polyps of
the large bowel.
The total number of radiographic procedures from October '95 through September '96 was 69,149.
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Questions about the Clinical Center? OCCC@nih.gov Or call: (301) 496-2563 National Institutes of Health, Warren Grant Magnuson Clinical Center, Bethesda, Maryland 20892. Last Modified 3/98 |