Diagnostic Radiology Division

 

Introduction

The Diagnostic Radiology Division is comprised of four groups, divided according to their area of concentration into the gastrointestinal tract group, the hepatobiliary and pancreas group, the nuclear medicine group, and the chest group. Over 96,800 inpatient and outpatient radiographic procedures were performed in 2000. In our division, the major activities are to make a diagnosis of patients with malignant tumors using several imaging modalities and to develop new imaging techniques to improve the quality of diagnostic images. Our division has now five helical computed tomography (CT) systems, two 1.5T magnetic resonance imaging (MRI) systems, two digital subtraction angiographic (DSA) systems, three gamma-cameras, three digital radiographic (DR) systems for gastrointestinal examinations, and two mammographic systems. One DSA system is equipped with a helical CT and is referred to as an IVR-CT system. All medical images in our new hospital are digitized. Original or compression images of computed radiography (CR), digital radiography (DR), radioisotope (RI), CT, and MRI can be easily and rapidly referenced on the medical information system for research, administration, and clinical expertise (MIRACLE).

 

Routine Activities

1. Gastrointestinal Tract Group

Two radiologists belong to this group, which carries out upper GI, barium enema, DIP, and mammography. Over 2,340 gastrointestinal and colorectal examinations using THE DR system were performed. Many early-stage malignant tumors have been detected using the double contrast method.

2. Hepatobiliary and Pancreas Group

Five radiologists belong to this group, which performs integrated diagnostic imaging using CT, MRI, angiography, and IVR-CT for diagnosing cancer in parenchymatous organs, including the liver, pancreas, kidney, spleen, ovary, uterus, and brain. Over 18,600 CT examinations, over 4900 MRI examinations, and 462 angiographic examinations were performed. We are actively involved in performing interventional radiology, especially therapeutic arterial embolization combined with chemotherapy and fluoro-CT guided percutaneous ethanol injection (PEI) for treatment of hepatocellular carcinoma (HCC).

3. Nuclear Medicine Group

Two radiologists belong to this group, which conducts over 3400 scintigraphic examinations for malignant tumors annually. Of these examinations, 75% are bone scintigraphies, 15% are Ga-67 scintigraphies, and 1% are Tl-201 scintigraphies for malignant bone and soft tissue tumors. Bone scintigraphies are useful for checking bone metastasis in patients with advanced cancer.

4. Chest Group

One radiologist and two doctors from another division belong to this group, which carried out over 44300 chest radiographic examinations and over 10,800 CT examinations in 2000. Helical CT examination is routinely used for the detection of lung tumors and various lung abnormalities in addition to routine chest radiographs. High-resolution CT or thin-slice CT examinations are routinely performed in the diagnosis of small peripheral bronchogenic carcinomas and other subtle abnor-malities. In addition, in order to obtain a cytopatho-logical diagnosis, fluoro-guided percutaneous needle biopsy for various intrathoracic lesions is often performed.

5. Conferences

We have several conferences with other divisions,     including preoperative gastric conferences, hepato-biliary conferences, breast conferences, chest conferences, and the like; some of the conferences are held as remote TV conferences.

 

Research Activities

This division has been developing medical imaging instruments with the support of the new Ten-year Strategy for Cancer Control. A multi-detector-CT was newly installed and the basic trial is ongoing. A computer-aided diagnosis (CAD) system for both breast cancer using Fuji Computed Radiography (FCR) mammograms and lung cancer using a helical CT has been more developed. GI groups have achieved digitalization of images in gastrointestinal examination by a DR system using CCD (Charge Coupled Device) with 4 million pixels (CCD-DR). Using this system, the differentiation of diagnostic accuracy between new CRT diagnosis and laser hardcopy diagnosis has been clarified. In hepato-biliary and pancreas groups, three-dimensional displays of several organs with neoplasms based on CT and MR imaging data are used in planning treatment.

Hemodynamics of the pancreas was clarified by using the IVR-CT (Furukawa et al.). Transarterial oily chemoembolization using a unified helical CT and angiography system (targeted TOCE) is routinely performed to treat inoperable HCC, and showed low local recurrence (37.8% at 3 years after a single targeted TOCE) and good survival rate (77.1% at 3 years) especially in small HCCs (<5cm) (Takayasu et al.).

 

Clinical Trials

1. Gastrointestinal groups are attempting to estimate a further developed system of CRT diagnosis including digital reporting system in gastrointestinal studies.

2. We are attempting to estimate the usefulness of our new CAD system in the detection of breast cancer and lung cancer.

3. We have a plan to estimate the clinical usefulness of the multi-detector-CT in the diagnosis of HCC, bile duct cancer, pancreas cancer, breast cancer and lung cancer.

4. We are making clinical stages based on imaging diagnosis in HCC and pancreas cancer. This new clinical stage is expected to be useful in the selection of medical treatments.

5. We can now perform several new imaging methods, including functional imaging, diffusion imaging, MR-mammography, MR-angiography, and MR-cholangiopancreatography (MRCP). MRCP is routinely used instead of ERCP in our hospital. Using these methods, we can obtain new information about tumors and other abnormalities.

6. Original or compressed images of CR, DR, RI, CT, and MRI can be easily and rapidly referenced on the medical information system for research, administration, and clinical expertise (MIRACLE) during past 5 years. Some chest X-ray and MRI reports are made by using this system.

 

Number of Patients Who underwent Angiography and Transarterial Chemoembolization Therapy (TACT) for Hepatocellular Carcinoma

 Year

No of pts

No of pts with HCC

 Recurrent pts /Fresh pts

No of TACT for HCC (%)

1997

387

264

  141/123

177 (67.0)

1998

399

246

190/56

190 (77.2)

1999

356

224

176/48

177 (79.0)

 Total

1142

734

  507/227

544 (74.1)

 

(Y. MURAMATSU)

Table of Contents