For those of our readers not familiar with the Journal of Surgical Radiology ( we encourage them to put on their radar this online & print journal that explores the intersection of surgery and radiology. One reason is that the publisher has seen the impact of the internet on traditional journals and is aiming to be ahead of the curve, instead of trying to react. Another is that the articles will likely be of interest to the technologically oriented medical professionals who follow iMedicalApps.

The October issue is available online now (link) and we want to highlight a few items of potential interest.

Column: How To Obtain Quality IT Help

In this opinion column (link), a health IT specialist provides an honest appraisal of the state of IT consulting and a dose of reality on what physicians can expect in the transition to electronic heath records. The author describes the types of HIT consultants and advises that, in these early days of  meeting “meaningful use” criteria to qualify for Federal subsidy, the level of enthusiastic marketing aimed at physicians may not always be accompanied by a corresponding depth of expertise:

Beware, though, that while the purchase and use of computers and their associated software has been popular, there has possibly been very little strategic planning for exactly how computerization should be optimized.

Original Article: PET Guided Biopsy of Isolated Bone Metastasis in GE Junction Adenocarcinoma

201009150750.jpgThis is a case report (link ) of the use of PET (positive emission tomography) augmented CT imaging to localize a bone lesion for the purposes of biopsy. The authors encountered a not-uncommon clinical problem. A patient has a bone lesion that is visible on MRI or PET but has not affected the mineralized portion of the bone so as to be visible on CT. Currently, when a biopsy is required, the radiologist is left with using nearby bone landmarks and measurements extrapolated from the MRI to guide the biopsy needle.

In this clever twist, the authors performed the biopsy using a PET/CT scanner. This type of scanner which allows for simultaneous  anatomic visualization and metabolic localization of tumors and other lesions, and is becoming increasingly common in hospitals,

PET guided biopsy should be considered in circumstances where indeterminate findings are not accompanied by correlates on cross-sectional imaging, particularly when the results will dramatically alter management of the patient.

Original Article: The Use of Radioactive Seed Localization for Non-Palpable Non-Breast Lesions

This is a case series (link) from the Mayo Clinic which demonstrates a novel and useful method, comprised of two commonly used techniques. The problem they tried to solve is intraoperative localization of non-palpable masses. Not uncommonly, a surgeon removing a small tumor is challenged when it it has the same consistency as surrounding tissues. Assuming the lesion can be seen on imaging, the authors demonstrated that insertion of tiny, low-energy radioactive “seeds” by the radiologist can assist the surgeon who then uses a commonly available radioactivity sensor to find the mass at the time of surgery. Initially attempted in the breast, the authors demonstrated that the technique can work in other locations.

There is an increasing use of advanced radiologic imaging for staging and surveillance of solid malignancies resulting in the identification of subclinical non-palpable metastases. Radioactive seed localization (RSL) … utilizes technology currently available in most operating rooms, specifically, a handheld gamma probe. These probes are commonly employed for sentinel lymph node (SLN) biopsy.

Be sure to check out the other articles in October’s Journal of Surgical Radiology. Since our interests in medical technology, imaging applications and medicine overlap, iMedicalApps will be collaborating on with the journal on future topics.