Radiologie (Heidelberg, Germany)最新文献

Radiological diagnostics are a central component of many treatment pathways and are usually carried out within a horizontal division of responsibilities between radiologists and referring physicians. The exact content of the referral request is always decisive, as it determines the scope of the radiologist's obligations. Ambiguous or diagnostically inappropriate referrals require clarification to avoid patient harm and liability risks. Radiologists may generally rely on referring physicians to perform their professional duties carefully, but this trust ends when obvious deficits in qualification or performance become apparent. When preparing reports, findings must be complete, clear, and comprehensible-especially because referring physicians often lack radiological expertise. This includes providing explicit recommendations for any necessary additional diagnostics to prevent misinterpretations or omissions. Incidental findings outside the primary diagnostic question must also be taken seriously, documented, and further evaluated if necessary, not least as overlooking them may have legal consequences. Communication of findings is another key aspect: results must be transmitted securely and to the correct referring physician to avoid data-protection violations and delays in treatment. Only in rare cases involving acute danger is there a direct duty to inform the patient.

Background: Radiological practices are highly specialized medical facilities that care for patients with special requirements on a daily basis. Many patients are elderly, have limited mobility, or are under the influence of medication. At the same time, technical equipment such as magnetic resonance imaging (MRI) and computed tomography (CT) systems pose special risks.

Objective: The following article shows typical sources of danger, deals with the legal framework for avoiding health impairments for patients before, during, and after radiological treatment and examination, and gives the owners of radiological practices appropriate recommendations for risk and liability management.

Results: In radiology practices, there are a large number of liability risks, which can be minimized by a consistently implemented quality management system, structured standard operating procedures (SOPs), preventive measures and, among other things, with a pronounced safety culture.

Importance of informed consent: Informed consent and the patient's declaration of consent are of central importance in any medical treatment. They serve to protect the patient's right to self-determination. Properly provided informed consent is a prerequisite for the validity of the patient's consent; without it, a medical procedure is unlawful and may give rise to liability for damages.

Scope of informed consent: Pursuant to section 630e(1) of the German Civil Code (BGB), the treating physician is obligated to inform the patient of all circumstances essential to consent, in particular regarding the nature, scope, implementation, expected consequences, and risks of the procedure, as well as its necessity, urgency, suitability, and prospects of success. In addition, the patient must be informed of possible treatment alternatives.

Treatment alternatives: Information regarding treatment alternatives is always required when several equally indicated treatment methods with different risks and prospects of success are available.

Formal requirements: Informed consent must be provided verbally during a face-to-face consultation; simply handing over an informed consent form is not sufficient. It must also be provided in a timely manner and be understandable.

Special considerations in radiology: In radiology, informed consent is also of central importance, as many radiological examinations carry potential risks, e.g., due to radiation exposure or contrast agents. Information about treatment alternatives is particularly relevant with regard to the varying levels of radiation exposure associated with different radiological procedures.

Recommendations for practice: Since the burden of proof for proper informed consent lies with the treating physician, careful documentation of the content of the informed consent discussion is recommended. When using informed consent forms, individualized notes are also recommended for evidentiary purposes.

Lumbar spinal canal stenosis primarily affects older individuals over 65 years old and is often associated with typical symptoms, such as spinal claudication. Aside from rare congenital causes, it usually develops secondarily due to age-related changes, such as disc protrusion, facet joint degeneration and ligament hypertrophy. Apart from the typical clinical symptoms, native upright X‑ray images in two planes and magnetic resonance imaging (MRI) are decisive. Patients without relevant neurological deficits should primarily undergo conservative treatment. In cases of pain that cannot be alleviated by conservative approaches, neurological deficits and ineffective conservative treatment the indications for surgical treatment can be justified. A minimally invasive decompression should be strived for whenever possible. A fusion can become necessary in the presence of a clinically relevant instability, stenosis or malalignment.

The willingness of patients to cooperate is essential when it comes to attending appointments, diagnostics and the implementation of treatment measures. If a patient does not cooperate properly, this can have consequences under liability law, but also for the physician's remuneration. In addition, aggressions and verbal as well as physical violence on the part of patients and their relatives are increasing. This prevents the development of mutual trust or destroys it. Under certain conditions, physicians may then refuse or discontinue treatment. The operator of a medical facility can then also make use of their householder's rights and issue a house ban. If the refusal of (further) treatment is not justified because there is an acute need for treatment, it may be necessary to apply liberty-depriving measures. Through internal compliance measures, in particular communication training or standard operating procedures, staff can be prepared to deal with patients who are aggressive or use violence.

Background: We explored the feasibility of reducing both radiation and contrast doses while improving image quality using low-energy virtual monochromatic images (VMIs) in dual-energy computed tomography (CT) pulmonary angiography (DECTPA) with deep learning image reconstruction at a high setting (DLIR-H).

Materials and methods: A total of 60 patients scheduled for CTPA were randomly divided into two groups: group A (n = 30) with 120 kV, contrast dose of 0.8 mL/kg, and adaptive statistical iterative reconstruction‑V (ASIR-V) at a 60% strength level, and group B (n = 30) with dual-energy CT (DECT), contrast dose of 0.6 mL/kg, and DLIR‑H at 40 keV, 50 keV, 60 keV and 70 keV VMIs. The CT and standard deviation (SD) values of the pulmonary arteries were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image quality was subjectively scored blindly by two radiologists using a five-point scale.

Results: There were no differences in general patient demographics between the two groups (all p > 0.05). In group B, the contrast and radiation doses decreased by 29.6% and 53.1%, respectively, compared to group A (p < 0.05). Compared to group A, group B had significantly higher CT and SNR values for the 40 keV-60 keV VMIs and higher CNR for the 40 keV-70 keV VMIs (all p < 0.05), with similar image noise at 60 keV. The two radiologists had substantial agreement in subjective scoring (kappa > 0.80). There were significantly higher scores for the 40 keV-60 keV VMIs in group B compared to group A (all p < 0.05), with the 40 keV VMIs having the highest scores.

Conclusion: Combining DLIR‑H with VMIs, especially 40 keV, in DECTPA leads to reduced contrast and radiation doses while improving image quality.

Objectives: We retrospectively determined imaging characteristics of primary tumors of the ribs in conventional radiography (CR), computed tomography (CT), and magnetic resonance imaging (MRI) to differentiate between benign and malignant lesions.

Methods: A total of 124 patients with 179 primary tumors of the ribs were included and analyzed for morphologic features in CR, CT, and MRI including localization, tumor size and extension, lytic or sclerotic appearance, and signal characteristics. In addition to epidemiological data, clinical parameters such as comorbidity, tobacco consumption, and local pain symptoms were collected from all patients. The data collected were grouped into subcollectives and statistically analyzed concerning distinctive features between malignant and benign tumors.

Results: The majority of primary tumors of the rib were benign (74%), without significant differences in gender distribution. Lesions in patients with a history of smoking and lesions causing local pain had a higher risk of malignancy. Regarding localization, there was no significant difference between benign and malignant lesions. Primary malignant tumors were larger on average, showed an osteolytic and infiltrative growth pattern, and were associated with pathological fractures more frequently. Sclerotic bone lesions and marginal sclerosis of osteolytic lesions were more common in benign tumors. Contrast enhancement and T1-/T2-weighted MRI signals could not differentiate between malignant and benign lesions.

Conclusion: In addition to imaging characteristics that reliably contribute to the assessment of the biological behavior of a primary rib tumor, there are features that overlap in benign and malignant lesions. Radiological assessment of the risk of malignancy of a primary rib tumor seems particularly successful when CR, CT, and MRI are combined and used in conjunction with clinical presentation.

Background: The introduction of digital systems in healthcare has been under discussion for over two decades. While implementation within individual facilities is well advanced, there is still considerable room for improvement in cross-facility data exchange.

Research question: To describe the current state of digital connectivity and organizational frameworks in Germany and Austria.

Materials and methods: Analysis and description of the legal framework and the various initiatives in both countries.

Results: In Germany, the comprehensive introduction of an electronic health records in 2026 marks a significant step toward increasing digitalization. While the current focus is primarily on documents and electronic medication, this structure could also prove useful for image data exchange in the future. Austria, on the other hand, created structures several years ago with the introduction of ELGA (electronic health records) that allow for more comprehensive digital communication. Consequently, more has already been achieved in terms of implementing Europe-wide EU recommendations.

Conclusion: The status of national infrastructure implementation differs between the two countries. Overall, increasing acceptance has been observed in recent years. The European initiative for a European Health Data Space (EHDS) could lead to further intensification of the integration of digital services and interoperability.

Background: The rising demand for imaging studies, increasing diagnostic complexity, and limited personnel resources are organizational challenges for radiology departments. Efficient management of the examination process is essential to ensure timely and high-quality patient care. Digital technologies and artificial intelligence (AI)-based systems have the potential to optimize imaging workflows within the examination room.

Objectives: To present digital processes used during radiological examinations and to assess their implications for radiology workflow, personnel structure, and patient care.

Materials and methods: Current scientific publications and reviews on digital workflows, automated planning, deep learning reconstruction, real-time quality control, and remote scanning concepts in radiological image acquisition were summarized and systematically analyzed.

Results: Digital systems enable increased patient comfort, standardized protocol initialization, automated slice planning, deep learning reconstruction, and quality monitoring during image acquisition. These approaches may improve efficiency, and robustness of examinations while reducing the need for repeat scans. Remote scanning provides opportunities for cross-site support and expertise sharing.

Conclusion: The digital transformation of radiological examination workflows represents a key lever for optimizing clinical processes. Digital and AI-based approaches may enhance efficiency and patient-centered care, but require thorough validation, interoperability, and responsible integration into existing healthcare structures.