1010 N. Kansas Wcgme
Wichita KS 67214
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 9407855
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
ACR Appropriateness Criteria Acute Nonspecific Chest Pain-Low Probability ofÂ Coronary Artery Disease. - Journal of the American College of Radiology : JACR
Primary imaging options in patients at low risk for coronary artery disease (CAD) who present with undifferentiated chest pain and without signs of ischemia are functional testing with exercise or pharmacologic stress-based electrocardiography, echocardiography, or myocardial perfusion imaging to exclude myocardial ischemia after rule-out of myocardial infarction and early cardiac CT because of its high negative predictive value to exclude CAD. Although possible, is not conclusive whether triple-rule-out CT (CAD, pulmonary embolism, and aortic dissection) might improve the efficiency of patient management. More advanced noninvasive tests such as cardiac MRI and invasive imaging with transesophageal echocardiography or coronary angiography are rarely indicated. With increased likelihood of noncardiac causes, a number of diagnostic tests, among them ultrasound of the abdomen, MR angiography of the aorta with or without contrast, x-ray rib views, x-ray barium swallow, and upper gastrointestinal series, can also be appropriate. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. This recommendation is based on excellent evidence, including several randomized comparative effectiveness trials and blinded observational cohort studies.Copyright Â© 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Small pulmonary artery defects are not reliable indicators of pulmonary embolism. - Annals of the American Thoracic Society
To evaluate the rate of agreement of pulmonary embolism diagnosis in computed tomography (CT) pulmonary angiogram studies and to evaluate the rate of inaccurate interpretations in the community hospital setting.Using the keywords "pulmonary embolism/embolus/emboli," the radiology information system was searched for CT pulmonary angiograms performed over a 3-year period at three U.S. community hospitals. Studies containing probable or definite pulmonary emboli were independently reviewed by four subspecialty thoracic radiologists.Agreement about the presence of pulmonary embolism progressively decreased with decreasing diameter of pulmonary vascular lesions (Pâ€‰<â€‰0.0001). There was a sharp fall in observer agreement for pulmonary embolism of subsegmental lesions (Pâ€‰<â€‰0.0001). The frequency of agreement decreased with decreasing quality of the imaging examination (Pâ€‰<â€‰0.0001). Community radiologists were prone to false-positive pulmonary embolism diagnosis of subsegmental and/or small pulmonary arterial defects. The probability of a false-positive diagnosis and indeterminate examinations progressively increased with: (1) more peripheral location of the lesion, (2) decreased size (short-axis diameter) of the lesion, and (3) diminishing quality of the CT examination. Forty-eight of 177 (27%) of subsegmental vascular defects identified by community radiologists were deemed indeterminate, and 27 of 177 (15%) of subsegmental vascular defects were judged to be false positive for pulmonary embolism by the consensus diagnosis. Fifty-four of 274 (20%) vascular defects with short axis less than 6 mm were indeterminate for pulmonary embolism, and 37 of 274 (14%) of vascular defects with short axis less than 6 mm were false positive for pulmonary embolism. Eleven of 13 (85%) of vascular lesions identified as pulmonary emboli on the lowest-quality CT examinations were false positive or indeterminate for pulmonary embolism. False-positive examinations were most often due to respiratory motion artifact (19/38, 50%).There is relatively poor interobserver agreement for subsegmental and/or small pulmonary artery defects, especially in CT pulmonary angiograms degraded by technical artifacts. These factors can lead to an increased frequency of inaccurate interpretation or indeterminate diagnosis of subsegmental and/or small defects. Caution is indicated in interpreting the significance of small vascular defects in CT pulmonary angiograms.
Evaluation and management of urinary tract infections in the school-aged child. - Primary care
The evaluation and management of urinary tract infection in the school-aged child is an important part of primary care in the ambulatory setting. In this article, the salient features of how this condition presents to the clinician, how it is properly diagnosed and treated, and follow-up care are reviewed.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Bronchoscopic extraction of a chicken bone 5 years after aspiration. - Ear, nose, & throat journal
A 58-year-old man with a remote history of choking on a chicken bone 5 years earlier presented with chronic cough but had no remarkable clinical examination findings. He was being followed for recurrent pneumonias complicated by a resistant empyema, for which he had undergone thoracotomy and decortication. Imaging studies initially missed a foreign body (the chicken bone), which was found on follow-up studies and was removed with a flexible bronchoscope despite the fact that 5 years had passed since the aspiration.
Effective arterial elastance is insensitive to pulsatile arterial load. - Hypertension
Effective arterial elastance (E(A)) was proposed as a lumped parameter that incorporates pulsatile and resistive afterload and is increasingly being used in clinical studies. Theoretical modeling studies suggest that E(A) is minimally affected by pulsatile load, but little human data are available. We assessed the relationship between E(A) and arterial load determined noninvasively from central pressure-flow analyses among middle-aged adults in the general population (n=2367) and a diverse clinical population of older adults (n=193). In a separate study, we investigated the sensitivity of E(A) to changes in pulsatile load induced by isometric exercise (n=73). The combination of systemic vascular resistance and heart rate predicted 95.6% and 97.8% of the variability in E(A) among middle-aged and older adults, respectively. E(A) demonstrated a quasi-perfect linear relationship with the ratio of systemic vascular resistance/heart period (middle-aged adults, R=0.972; older adults, R=0.99; P<0.0001). Aortic characteristic impedance, total arterial compliance, reflection magnitude, and timing accounted together for <1% of the variability in E(A) in either middle-aged or older adults. Despite pronounced changes in pulsatile load induced by isometric exercise, changes in E(A) were not independently associated with changes pulsatile load but were rather a nearly perfect linear function of the ratio of systemic vascular resistance/heart period (R=0.99; P<0.0001). Our findings demonstrate that E(A) is simply a function of systemic vascular resistance and heart rate and is negligibly influenced by (and insensitive to) changes in pulsatile afterload in humans. Its current interpretation as a lumped parameter of pulsatile and resistive afterload should thus be reassessed.Â© 2014 American Heart Association, Inc.
Differential background clearance of fluorodeoxyglucose activity in normal tissues and its clinical significance. - PET clinics
The clearance of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) activity in normal tissues varies significantly with extended distribution time. Although most tissues have lower standardized uptake value (SUV) on 2-hour/3-hour delayed images, others may have stable or higher FDG activity with longer distribution times. The continuously decreased SUV on delayed imaging in some tissues, especially in the liver, indicates that longer distribution time will decrease background activity, increase lesion-to-background ratio, and thus improve imaging quality, whereas the continuously increased SUV from 1 to 3 hours in the heart suggest that longer distribution time will improve detection of viable myocardium in a viability study.Published by Elsevier Inc.
Serial changes of FDG uptake and diagnosis of suspected lung malignancy: a lesion-based analysis. - Clinical nuclear medicine
This study prospectively evaluates the serial change of FDG uptake and its diagnostic value in malignant versus benign lung lesions in patients with suspected lung cancer.Patients with suspected lung malignancy underwent whole-body FDG PET/CT at 1, 2, and 3 hours after an IV injection of F-FDG. The SUVs of FDG in lung nodules and hilar/mediastinal nodes at each time point were correlated with biopsy/surgical pathologic findings.There were a total of 45 malignant lesions and 80 benign lesions from 43 patients with pathologic diagnosis that were included for analysis. The SUVmax had an average of 25.5% increase in all tumor-positive lesions from 1 to 2 hours (vs 1.6% decrease in all tumor-negative lesions, P < 0.0001) and an average of 39.1% increase from 1 to 3 hours (vs 4.5% increase in all tumor-negative lesions, P < 0.0001). The receiver operating characteristic analysis showed that the 2-hour and 3-hour SUVmax had similar area under the curve and outperformed the SUVmax on the 1-hour initial imaging or retention index (RI). The optimal cutoff values to differentiate malignancy from benign lesions were 3.24 for 1-hour SUVmax, 3.67 for 2-hour SUVmax, and 4.21 for 3-hour SUVmax, with 11.6% for 1- to 2-hour RI and 23.9% for 1- to 3-hour RI. The 3-hour delayed SUVmax of 4.21 provided the best overall performance (accuracy of 88.8%). The analysis of the lesion-to-background ratio revealed that delayed imaging improved the image quality significantly, leading to much easier detection of either malignant or benign lesions.Multiple time point FDG PET/CT imaging moderately improves the diagnostic accuracy of lung cancer and significantly improves the image quality.
ACR appropriateness criteria asymptomatic patient at risk for coronary artery disease. - Journal of the American College of Radiology : JACR
Atherosclerotic cardiovascular disease is the leading cause of death for both men and women in the United States. Coronary artery disease has a long asymptomatic latent period and early targeted preventive measures can reduce mortality and morbidity. It is important to accurately classify individuals at elevated risk in order to identify those who might benefit from early intervention. Imaging advances have made it possible to detect subclinical coronary atherosclerosis. Coronary artery calcium score correlates closely with overall atherosclerotic burden and provides useful prognostic information for patient management. Our purpose is to discuss use of diagnostic imaging in asymptomatic patients at elevated risk for future cardiovascular events. The goal for these patients is to further refine targeted preventative efforts based on risk. The following imaging modalities are available for evaluating asymptomatic patients at elevated risk: radiography, fluoroscopy, multidetector CT, ultrasound, MRI, cardiac perfusion scintigraphy, echocardiography, and PET. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.Copyright Â© 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Delayed time-point 18F-FDG PET CT imaging enhances assessment of atherosclerotic plaque inflammation. - Nuclear medicine communications
The aim of this study was to determine the ideal circulation time of fluorine-18 fluorodeoxyglucose (F-FDG) in order to detect and quantify atherosclerotic plaque inflammation with PET computed tomography (CT) imaging.Fifteen patients underwent multiple time-point imaging at âˆ¼60, 120, and 180 min after F-FDG administration. For each time point, global assessment of aortic and carotid F-FDG uptake was determined qualitatively by visual assessment and semiquantitatively by calculation of the mean and maximum standardized uptake values (SUV) and the corresponding target-to-background ratio (TBR).Delayed imaging achieved significant improvement in visualization of atherosclerotic plaque inflammation [Friedman's Ï‡ statistic (d.f.=2, n=15)=24.13, P<0.001, Kendall's W=0.80]. This observation was confirmed by semiquantitative image analysis. At 1 h, the aortic and carotid SUVmean-calculated TBR was 1.05 [95% confidence interval (CI)=0.98, 1.11] and 0.88 (95% CI=0.81, 0.96), respectively. At 3 h, the TBR significantly increased to 1.57 (95% CI=1.28, 1.86; P=0.001) for the aorta and to 1.61 (95% CI=1.36, 1.87; P<0.001) for the carotid arteries. SUVmax-calculated TBRs showed a similar increase over time.One- and 2-h F-FDG PET CT imaging is suboptimal for global assessment of atherosclerotic plaque inflammation compared with imaging at 3 h. Our data support the utilization of 3-h delayed imaging to obtain optimal data for the detection and quantification of atherosclerotic plaque inflammation in human arteries.
Differential washout of FDG activity in two different inflammatory lesions: implications for delayed imaging. - Clinical nuclear medicine
We describe the changes of FDG uptake in different inflammatory lesions on multiple time point FDG PET/CT. FDG uptake in granulomatous lesions was more intense and focal, with higher intensity on delayed images. In contrast, FDG uptake in chronic arthritic joint inflammation was diffuse and mild, without significant change over time, while FDG uptake in nonarthritic joints was at near-background level with decreased activity on delayed images. The retention index was significantly higher in patients with granulomatous lesions than that in other groups. Our finding indicates differential FDG uptake and clearance in active granulomas versus chronic inflammation.
Map & Directions
1010 N. Kansas Wcgme Wichita, KS 67214