First operation in SPIDER and the path to complete MITICA

The requirements of ITER neutral beam injectors (1 MeV, 40 A negative deuterium ion current for 1 h) have never been simultaneously attained; therefore, a dedicated Neutral Beam Test Facility (NBTF) was set up at Consorzio RFX (Padova, Italy). The NBTF includes two experiments: SPIDER (Source for the Production of Ions of Deuterium Extracted from Rf plasma), the full-scale prototype of the source of ITER injectors, with a 100 keV accelerator, to investigate and optimize the properties of the ion source; and MITICA, the full-scale prototype of the entire injector, devoted to the issues related to the accelerator, including voltage holding at low gas pressure. The present paper gives an account of the status of the procurements, of the timeline, and of the voltage holding tests and experiments for MITICA. As for SPIDER, the first year of operation is described, regarding the solution of some issues connected with the radiofrequency power, the source operation, and the characterization of the first negative ion beam.

Advances in the imaging of common duct stones using magnetic resonance cholangiography, endoscopic ultrasonography, and laparoscopic ultrasonography

Advances in magnetic resonance cholangiography (MRC) have resulted in consistently high sensitivity and specificity for the detection of common duct stones by MRC. There are multiple advantages to using MRC over endoscopic retrograde cholangiography (ERC) in the diagnosis of common duct stones, thereby reserving the use of ERC mainly as a therapeutic tool. Endoscopic ultrasonography has emerged as a modality capable of common duct stone detection and, when available, will compete with MRC and ERC for the diagnosis of common duct stones. However, its ability to image intrahepatic or proximal common duct stones would seem to be limited. Laparoscopic ultrasonography helps shorten operative time and costs less compared with intraoperative cholangiography. As more surgeons gather experience with laparoscopic ultrasonography and it becomes widely available, it has the promise to substitute for intraoperative cholangiography.

Evaluating the impact of workstation usage on radiology report times in the initial 6 months following installation

Picture archiving and communications systems (PACS) workstations are reported to improve workflow by making studies immediately available for review upon their completion. This study tested the hypothesis that a workstation would decrease the time from completion of a study to dictation of results (report time). A four-monitor, 2K x 2K workstation (Imation Cemax-Icon, Fremont, CA), was installed in a body imaging computed tomography (CT) reading room. Use of the workstation by the staff radiologists was voluntary. Images were also printed on film and films continued to be hung at the routine hanging times. To evaluate the workstation's maximum impact, data were collected for report times for studies completed during the routine day shift of the staff radiologist (Monday to Friday, 8 AM to 5 PM). Data were collected before workstation installation (August 1997 to November 1997) and for the subsequent 6 months. Histograms of the number of studies (743 v 103) versus report time (mean, 11.7 v 7.4 hours) showed a bimodal distribution, with peaks at approximately 6 and 24 hours, both before (8/97-11/97) and after (6/98) the workstation's installation. However, the number of studies dictated greater than 60 hours (25.2% v 20.4%) and the percentage of studies in the second peak (16 to 48 hours; 4.4% v 0%) both decreased. In conclusion, the workstation decreased the mean (11.7 v 7.4 hours) and standard deviation (19.8 v 9.1 hours) for report times. This was due to a decrease in both the number of cases dictated the day following their completion and the number of outliers (markedly delayed dictations). The decrease in outliers is probably due to a decrease in the number of "lost" film-based studies.

Renal inflammatory disease: the current role of CT

Computed tomography (CT) plays a significant role in establishing the diagnosis in clinically equivocal cases of renal infection, determining the extent of the disease process, and assessing its complications. Gas, calculi, renal parenchymal calcifications, hemorrhage, and masses can be revealed with unenhanced CT. A subsequent study with contrast enhancement is crucial for the complete evaluation of patients with renal infection in order to demonstrate the areas of altered nephrogram that occur as a result of the inflammatory process and to identify complications. In this article we review a spectrum of renal inflammatory disease, with illustrations of the CT findings in representative cases. We also review the role and potential pitfalls of fast scanning techniques that can image a particular phase of the nephrogram in a renal infection. In acute pyelonephritis, enhanced CT scans obtained during the cortical nephrographic phase typically demonstrate solitary or multifocal hypodense areas with obliteration of the corticomedullary differentiation. Delayed images obtained during the excretory phase are frequently more helpful in defining the extent of the disease process, identifying the complications such as renal abscess, and confirming the presence of urinary obstruction than are early images.

Intrathoracic stomach. Another cause of IVC pseudothrombosis

We report the case of a patient with a large hiatal hernia accompanied by partial gastric volvulus in whom the computed tomography (CT) findings mimic the appearances of thrombus in the inferior vena cava (IVC). To our knowledge, this has not been previously reported as a cause of "pseudothrombosis" of the IVC on CT.

Portal vein thrombosis: imaging findings

Portal vein thrombosis (PVT) is usually a complication of pre-existing cirrhosis, abdominal malignancy (e.g., pancreatic or hepatocellular carcinoma), or abdominal inflammation (e.g., appendicitis, diverticulitis, pancreatitis). Less frequently, PVT can be associated with myeloproliferative or connective tissue disorders or inflammatory bowel disease [1]. PVT can cause or exacerbate portal hypertension; variceal bleeding or hypersplenism may then develop acutely or several years later. PVT also complicates portosystemic shunt surgery or hepatic transplantation. Unfortunately, the signs and symptoms of PVT can be subtle or nonspecific and can be overshadowed by the underlying illness. The radiologist may be the only physician to suggest the preoperative or premortem diagnosis of PVT. Familiarity with the imaging findings of PVT, therefore, is imperative.

Perforation of the colon due to endometriosis

Endometriosis is a common disease which affects the bowel in 12 to 35% of cases. Despite extensive serosal and intramural involvement, the intestinal mucosa usually remains intact and bowel perforation rarely occurs. We describe a patient with perforation of the sigmoid colon due to endometriosis. To our knowledge, this is the first such case to be reported in the radiologic literature.

Leiomyoma involving the gastrocolic ligament: CT demonstration

A case of a large leiomyoma involving both the transverse colon and the greater curvature of the stomach is presented. Computed tomography (CT) demonstrated contiguous extension of the mass along the gastrocolic ligament. Although similar findings have been described in colonic and gastric carcinoma and in omental metastases, this is the first report in which these findings were due to a leiomyoma.

CT diagnosis of acquired small bowel volvulus

Small-bowel volvulus is an uncommon but important cause of small-bowel obstruction and often results in ischemia or infarction. Clinical examination and plain film radiography may be nondiagnostic, leading to delay in surgical intervention with subsequent increase in morbidity and mortality. We present two patients in whom the diagnosis of strangulating small-bowel volvulus was made by computed tomography (CT), allowing rapid surgical correction of this potentially life-threatening condition.

Spontaneous necrosis and hemorrhage in an enlarged accessory spleen: CT demonstration

Enlargement of an accessory spleen following splenectomy may be due to compensatory hypertrophy or recurrence of hematologic or other disorders. Spontaneous necrosis and hemorrhage in an accessory spleen are rarely described. We report a case in which an enlarged accessory spleen complicated by spontaneous hemorrhage was identified on computed tomography (CT) and confirmed at surgery.

CT diagnosis of perforated duodenal diverticulum

We present a case of perforated duodenal diverticulum diagnosed preoperatively on computed tomography. This rare but potentially fatal condition has been difficult to detect with more conventional radiographic techniques.

Spontaneous free perforation of the ileum in Crohn disease: CT demonstration

A case of spontaneous free perforation of the ileum in Crohn disease is presented. This rare complication was demonstrated by computed tomography (CT) before becoming evident on plain films.

Omental cakes in American Burkitt lymphoma. Computed tomography demonstration

Diffuse tumor infiltration of the omentum or so-called omental "cakes" is well recognized on computed tomography (CT) and is usually associated with pelvic or gastrointestinal carcinoma. However, this has not been described in American Burkitt lymphoma despite frequent intraabdominal involvement in this disease. We report two cases of American Burkitt lymphoma in which omental cakes were demonstrated by CT.

Feasibility of fast MR imaging of the liver at 1.5 T

A phantom with T1 and T2 relaxation times encompassing normal liver and liver lesions was constructed to evaluate fast magnetic resonance pulse sequences using TR from 21-100 milliseconds, TE 12-60 milliseconds and flip angles from 5 degrees-90 degrees. Ten of these fast MR sequences were then selected and compared with conventional spin-echo sequences in normal volunteers (n = 3) and in patients with liver lesions (n = 6). Subjectively, the fast MR sequences eliminated motion artefacts. Objectively, 8 of 10 fast sequences had signal-to-noise ratios comparable to spin-echo imaging whereas only 2 of 10 had contrast-to-noise ratios that were similar to spin-echo imaging. This preliminary study, performed at 1.5 Tesla, does not show any clear-cut advantage of fast imaging over spin-echo imaging in the detection of liver lesions. The use of a liver tissue equivalent phantom provides a rapid, practical approach in evaluation of fast scans.

Fast magnetic resonance in vascular diseases of the abdomen

Fast magnetic resonance (MR) imaging provides a consistent and predictable appearance of vascular abnormalities as shown by four patients with thrombi, dissection and aneurysm. Fast MR images are obtained during breath-holding, resulting in an absence of respiratory motion artifacts. The time of MR study is much less with fast MR than with spin echo sequences.

Role of computed tomography in diverticulitis

Fourteen patients with diverticulitis who were clinically believed to require radiologic investigation form the basis of this report. An inflammatory mass (n = 10) or abscess (n = 2) were reliable findings on computed tomography. Other signs encountered were abnormal density of pericolic fat, thickening of colonic wall, and narrowing of the lumen of the colonic wall. Colovesical fistulas, all of which were suspected clinically, occurred in three patients. Computed tomography should be performed with administration of rectal contrast medium to demonstrate the origin of inflammation from the colon, assess pericolic extent, and confirm colovesical fistula.

Use of computed tomography in appendicitis: technique, findings, and pitfalls

Twelve patients with acute appendicitis were studied by computed tomography. Our technique of conducting the examination, the computed tomography signs, and the pitfalls encountered in studying these patients are presented. Use of computed tomography should be considered whenever the clinical presentation is atypical or confirmation of the clinical diagnosis is necessary.

Computed tomography of complicated cholecystitis

Reported are 10 patients with surgically verified acute cholecystitis and its complications. Of these 10 patients, 6 (60%) had atypical clinical presentation so that cholecystitis was not the primary diagnosis being considered before computed tomography. Common computed tomography findings included gallbladder wall thickening (100%), pericholecystic fluid (80%), gallstones (50%), and air in the gallbladder lumen and wall (20%). An awareness of the computed tomography appearances can be helpful in the diagnosis of complicated cholecystitis even when the clinical presentation is atypical.

Computed tomography of vaginitis emphysematosa

Vaginitis emphysematosa is characterized by multiple gas-filled spaces in the vagina and exocervix. Although the diagnosis can be made on physical examination and on plain radiography, it is important to recognize its appearance on CT since it may constitute a serendipitous finding that should be differentiated from more serious diseases that have a similar appearance.

Retroaortic left renal vein: an interpretive pitfall on computed tomography

In a patient with retroaortic left renal vein, the anomalous vessel is demonstrated by computed tomography to take a caudal course of several centimeters before crossing in a retroaortic fashion to join with the inferior vena cava. This case differs from previously published reports. Computed tomography provided excellent anatomic details of the vascular anomaly and highlighted the value of postcontrast dynamic computed tomography scanning.

Computed tomography demonstration of traumatic suburothelial hemorrhage

We report a patient with the characteristic findings of suburothelial hemorrhage secondary to blunt trauma that was initially detected by computed tomography.

Computed tomography of the kidney

The development and refinement of computed tomography have revolutionized the diagnostic evaluation of patients in urologic practice. This article reviews the applications and interpretation, as well as the limitations, of renal computed tomography and compares this modality with other imaging studies of the kidney.

CT diagnosis of fluid in lesser sac mimicking thrombosis of inferior vena cava

A patient with ascites and fluid in the lesser sac mimicking the appearance of a clot in the inferior vena cava is described. A knowledge of liver anatomy, particularly the lesser sac in the region of porta hepatis, aids in avoiding this CT pitfall.

Computed tomography detection of transplant renal artery pseudoaneurysm

Clinically unsuspected pseudoaneurysm formation of the arterial anastomosis in a patient with a renal transplant was initially diagnosed by computed tomography. This rare but serious complication can also be detected by ultrasound or radionuclide flow study, as shown in our patient. An awareness of this lesion and familiarity with its appearance can permit its early detection before exsanguinating hemorrhage occurs.

Artifact-free computed tomography of the chest and abdomen in the severely ill patient

A method is described for obtaining consistently high-quality images during nonneurologic computed tomography of the severely ill and uncooperative patient using a neuromuscular blocker to induce apnea. Careful control of respiration during data acquisition eliminates motion artifacts.

A pseudomass on pelvic computed tomography: a pitfall to avoid

Reported here is a patient with celiac disease in whom a spurious pelvic mass was suggested by computed tomography. This pitfall can be prevented by an awareness of the normal appearance of the small bowel following intravenous contrast enhancement and by monitoring of the examination by a radiologist. Delayed scanning or real-time ultrasound examination will confirm that the initial computed tomography appearance is due to small bowel loops.

Computed tomographic diagnosis of hepatic metastases in fatty infiltration

A patient with carcinoma of head of pancreas is described. The density of liver metastases on computed tomography was much higher than the density of the surrounding liver parenchyma due to the fatty infiltration of liver.

Computed tomography in detection of occult hypernephroma

Five cases in which computed tomography (CT) detected a hypernephroma that had been missed by one or more of the other imaging modalities are reported here. Computed tomography may have an important role in the diagnosis of radiologically occult hypernephroma.

An unusual presentation of mediastinal Hodgkin's lymphoma on computed tomography

Untreated mediastinal Hodgkin's lymphoma may present with calcification within the tumor mass. Therefore, Hodgkin's lymphoma should be included among the possible diagnoses of calcification in an anterior mediastinal mass, as visible on chest CT or mediastinal tomography.

Radiologic investigation of suspected extrahepatic biliary obstruction

Data for 94 patients clinically suspected of having extrahepatic biliary obstruction who were referred for radiologic investigations were studied to compare the value of various imaging modalities used to detect this condition. Computed tomography emerged as the best indirect, noninvasive technique and percutaneous transhepatic cholangiography as the best direct technique. A standard approach to investigating suspected extrahepatic biliary obstruction is suggested that takes into consideration the interventional radiologic techniques currently used to treat this condition.

Endoscopic papillotomy

Endoscopic papillotomy is a major therapeutic advance in the management of common bile duct obstruction. During 1981, the procedure was performed in 48 of 51 patients between 17 and 93 years of age. There were 13 men and 35 women. Common duct stones were removed in 26 of 31 patients (84%), six of whom had their gallbladders in place and two of whom had cholangitis. Failure in five patients occurred because of stone adherence to the common duct wall, stone size, ductal stenosis, or caught Dormia basket. Papillotomy was done in 10 of 11 patients for stenosis, two for recurrent pancreatitis, two with the sump syndrome, one for hemobilia, and one for bile duct tumor biopsy. The "precut" technique was required in 11 patients. Mild pancreatitis developed in three patients and severe hemorrhagic pancreatitis in one. Three of the four had the precut technique. One patient had minor bleeding, and two developed acute cholangitis requiring laparotomy, one of whom died (2.1%) 40 days after initial endoscopic papillotomy. A Dormia basket became caught in one patient. The duration of hospitalization was 24 to 36 hours after endoscopic papillotomy. Endoscopic papillotomy is considered the method of choice in the management of postcholecystectomy choledocholithiasis.

The role of computed tomography in abdominal and pelvic trauma

CT findings in 32 patients with abdominal and pelvic trauma are the subject of this report. Four patients had more than one organ involved. The most common abdominal organ to be injured in our series was the pancreas, unlike other series. Findings of pancreatic, splenic, hepatic, renal, and pelvic injuries are described. The role of CT in the investigation of a patient with abdominal and pelvic trauma is discussed and compared with other imaging modalities. CT was found to be superior especially as it is highly sensitive and not organ specific.

Sagittal and coronal reconstruction in body CT

A review of 15 months' experience shows the major indications for sagittal and coronal reconstruction images in computed body tomography (CBT) are in the differentiation of lung disease from disease of the chest wall; of supradiaphragmatic from infradiaphragmatic lesions; of intrahepatic from perihepatic abnormality; of renal from perirenal disease; in establishing the level of obstruction in the jaundiced patient and in mapping pelvic malignancy. The accurate definition of the extent of disease proved beneficial in planning further diagnostic procedures (needle aspiration for malignant cells or abscess drainage), in determining the surgical approach, and in planning radiation therapy.

Primary Chylopericardium: combined lymphangiographic and CT diagnosis

A case of primary chylopericardium is reported, and the usefulness of combined computed tomography and lymphangiography diagnosis of lymphatic leakage is demonstrated.