INS TITU TE O F D IAGNO S TIC R AD IO LO GY AND

INS TITU TE O F D IAGNO S TIC R AD IO LO GY AND NE U R O R AD IO LO GY

FACTS AND FIGURES Ins titute of D iagnos tic Radiology and Ne uroradiology Fe rdinand- Saue rbruch - Straße 17475 Gre ifs w ald Te le ph one : + 49 (0)3834-8669 60 Te le fax: + 49 (0)3834-86709 7 E- m ail: h os te n@ uni- gre ifs w ald.de H om e page : h ttp://w w w.m e dizin.uni- gre ifs w ald.de /diagrad/ H e ad of de partm e nt: Se nior ph ys icians : Prof. D r. N. H os te n D r. M. Kirs ch (h e ad s e nior ph ys ician) D r. R. Puls D r. A. Sch im m ing D r. C. W e ige l D r. B. H arde r M e dicalte ch nicalas s is tant: M rs B. H arde r QM re pre s e ntative : D r. C. Ros e nbe rg Spe cialis ts Th e rm oablative th e rapie s Ne uroradiology Bre as t cance r s cre e ning W e s te rn Pom e rania D r. R. Puls D r. M. Kirs ch D r. A. Sch im m ing (re s pons ible for program m e ) D r. C. W e ige l In 2006 th e re w e re 3336 patie nts w h o re ce ive d inpatie nt tre atm e nt and 288 patie nts w h o re ce ive d outpatie nt tre atm e nt. Th e Ins titute of Radiology h as one be d available. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

T M ED ICAL CARE SERVICES h e Ins titute of D iagnos tic Radiology and Ne uroradiology pe rform s a ldiagnos tic and a lope rationalproce dure s w h ich include th e us e of im aging te ch niq ue s. Th e ins titute s diagnos tic and th e rape utic s e rvice s are available to th e w h ole unive rs ity clinic, th e clinic s partne rs and oth e r h os pitals in W e s te rn Pom e rania w h ich are m e m be rs of th e te le radiology ne tw ork. Th e ins titute s te ch nicale q uipm e nt h as be e n com ple te ly m ode rnis e d, w h ich is th e bas is of h igh - q uality tre atm e nt according to m ode rn s tandards. H ardw are capacitie s com pris e one m agne tic re s onance tom ograph (M RT, Sie m e ns Erlange n, 1,5 T fie ld pow e r), tw o com pute rize d tom ograph s (CT, 16- row Scanne r: Sie m e ns Erlange n, 8- row Scanne r: Ge ne ralele ctrics, USA), tw o angiograph y units (1 le ve l, 2 le ve ls ), tw o ultras ound de vice s, th re e Buck y w ork s tations, th re e radiofluoros copy w ork s tations, one m am m ograph y w ork s tation w ith pos itioning ch air and optionaldigital s te re otaxia, vacuum punch biops y during s te re o X- ray, th re e m obile X- ray units and th re e Nd- YAG las e rs (M e dilas D ornie r). Since w e introduce d a th re e - s h ift s ys te m for doctors in 2005, it is guarante e d th at th e re is alw ays at le as t one radiologis t pre s e nt in th e clinic w ith in 24 h ours. Th e m ajor units (M RT, CT) are us e d to th e ir optim um ove r a pe riod of 16 h ours a day until 10 pm. In th e be ginning of 2006 th e digitalization of th e im aging proce dure s and of th e w ork ing proce s s e s in th e ins titute w as com ple te d. A picture acq uis ition and com m unicating s ys te m (PACS) is us e d to ce ntra ly s tore and e dit digitalim age file s (D ICOM ). A radiology inform ation s ys te m (RIS) conne cts to th e h os pitalinform ation s ys te m (H IS) us e d by a lde partm e nts of th e unive rs ity clinic. Radiologicale xam inations are available online and re al- tim e for a lre fe rring clinicians. Film s are not us e d anym ore. Patie nts are give n a CD w ith th e ir s tudie s and radiologicalre adings, if re q ue s te d. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

INS TITU T FÜ R D IAGNO S TIS CH E R AD IO LO GIE U ND NE U R O R AD IO LO GIE Trans pare ncy is a k e y ph ilos oph y for our te am. Pre s e ntations are available online via inte rne t and intrane t. D e taile d inform ation on our m e dicalcare s e rvice s is available for a lus e rs. Curre nt s tandard protocols for patie nt pre paration can be dow nloade d, us age is obligatory for a las s igne d de partm e nts. Fre q ue ntly as k e d q ue s tions are ans w e re d im m e diate ly and com pre h e ns ive ly via e - m ailor ph one. M SPECIAL AREAS OF M ED ICAL CARE inim al- invas ive tum our th e rapy traditiona ly is a core s pe ciality w ith in th e ins titutionalproce dure catalogue. M odalitie s com pris e las e r ablation (LA) of lung tum ours unde r CT guidance and las e r- and radio- fre q ue ncy ablation of live r tum ours unde r CT/M RT guidance. Be s ide s th e rm alablative proce dure s, ch e m o- and radioe m bolization are fre q ue nt th e rapie s in m ultim odaltre atm e nt conce pts (D r. C. Ros e nbe rg, D r. R. Puls ).Im prove m e nt of m ode rn im aging- guide d proce dure s, as w e l as inte gration into e xis ting cance r th e rapy conce pts are s e e n as a tas k and de live r a varie ty of tre atm e nt options th at can be offe re d to our patie nts. Anoth e r s pe ciality is th e trans arte rialtre atm e nt of vas cular de form itie s and tum ours in th e brain. Th e Unive rs ity Clinic Gre ifs w ald is one of ve ry fe w s pe cialize d ce ntre s w h e re th is proce dure is pe rform e d. Th e clos e co- ope ration w ith th e unive rs ity clinic s ne urology and ne uros urge ry de partm e nts guarante e s a h igh q uality tre atm e nt (D r. S. Langne r, D r. M. Kirs ch ). Th e th ird s pe ciality of th e ins titute is th e trans arte rial tre atm e nt of arte rie s of th e pe lvis and th e le g including arte rials te nt grafts. Th e longs tanding co- ope ration w ith th e clinic for vas cular s urge ry e nable s us to s ucce s s fu ly tre at patie nts w ith com ple x occlus ive arte rialdis e as e s. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

INS TITU T FÜ R D IAGNO S TIS CH E R AD IO LO GIE U ND NE U R O R AD IO LO GIE Th us, th e am ount of diagnos tic and s urgicalvas cular proce dure s could be incre as e d w ith in th e las t ye ar. Als o vas cular dis e as e s can be diagnos e d and tre ate d on an outpatie nt bas is. W e als o e xte nde d th e capacity of D opple r s onograph y for ve s s e ls of th e e xtre m itie s. Founding an inte rdis ciplinary ve s s e lce ntre w e w e re able to furth e r bundle com pe te nce s w h ich w i lbe ne fit angiologic patie nts (D r. R. Puls ). Furth e r s e rvice s Proce dure s w h ich w e re late ly e s tablis h e d h ave be e n im prove d and s tandardize d ove r th e las t ye ar. Th is is e s pe cia ly true for cros s - s e ctionalim aging proce dure s applie d for diagnos is - CT colonograph y as an alte rnative to colos copy and colic contras t e ne m a (C. Lüh k e n), non- invas ive m agne tic re s onance or com pute rize d tom ograph y im aging of arte rie s in pe lvis and low e r e xtre m itie s, M RT and CT of th e h e art to diagnos e is ch e m ic m yocardium (D r. S. Langne r). Initiation of s e ve ralinnovative im aging m odalitie s in 2006 give s proof to th e incre as e d im portance of cros s - s e ctionalim aging w ith in th e fie ld of radiology. In clinicals tudie s w e us e diffus ion- w e igh te d m agne tic re s onance tom ograph y for e arly diagnos is of apople ctic s trok e (D r. S. Lange r), but als o for diffe re ntiation of inflam m atory and m alignant tis s ue. Th e re are als o s e ve raloth e r s tudie s w h ich e valuate pe rfus ion CT for its value in diagnos is of tum our and s trok e. Studie s inve s tigating s trok e im aging are part of an inte rnationalm ultice ntre s tudy. For m agne tic re s onance im aging th e q uality of diagnos is (J. Küh n) as w e las of th e rape utic proce dure s (D r. C. Ros e nbe rg) for live r m e tas tas is could be s ignificantly im prove d th rough th e us e of ne w live r ce l- s pe cific contras t m e dia, w h ich h ad be e n clinica ly approve d in as s ociation w ith th e ins titute. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

In addition to acute (e.g. ble e ding) and e le ctive (e.g. tum ours ), e m bolization proce dure s, th e ins titute participate s in a m ultice ntre s tudy on th e e m bolization of ute rus m yom as in coope ration w ith th e gynae cology de partm e nt and local gyne cologis ts (D r. R. Puls ). Arte riale m bolization w ith th e radiois otope Yttrium w as inte grate d into th e e xis ting catalogue of tre atm e nts for live r m e tas tas e s (D r. R. Puls ). Since th e Bre as t Ce ntre w as ce rtifie d, th e Ins titute of D iagnos tic Radiology and Ne uroradiology is th e m ain coordinator of th e s tandardize d s e cond opinion re ading in th e s cre e ning program m e Th e ins titute s bre as t im aging te am could e ncounte r one m ore s pe cialis e d doctor and now w ork s in fu ly re furnis h e d room s. Re ce ption and w aiting are a are de s igne d to cre ate a com fortable and m ode rn atm os ph e re e s pe cia ly for our fe m ale patie nts (D r. A. Sch im m ing, D r. C. W e ige l). Th e ins titute s doctors als o do re adings for affiliate d ins titutions as th e Ne urological Re h abilitation Ce ntre Ge ifs w ald (Gm bh ). As a m e m be r of th e te le m e dicine ne tw ork of W e s te rn Pom e rania (s upporte d by th e fe de ralgove rnm e nt of M e ck le nburg and W e s te rn Pom e rania via POM ERANIA) th e ins titute re gularly xe nodiagnos e s e xam inations pe rform e d in th e h os pitalin Pas e w alk (C. Fröh lich ). Th is s e rvice is available 24 h ours a day. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

T M EASURES OF INTERNAL QUALITY M ANAGEM ENT h e incre as ing digitalization of w ork ing proce s s e s h e lps to furth e r im prove our ove ra lpe rform ance. Es pe cia ly diagnos tic proce dure s are digitalize d and th us pe rform e d on s cre e n w ork s tations w ith th e h e lp of a voice re cognition s ys te m. A l re adings are re vie w e d by a s pe cialis t or a s e nior ph ys ician, be fore be ing fina ly approve d by th e h e ad of ins titute. Only th e n re adings can be s e e n by clinicians w ith auth orize d acce s s to th e H IS. At th e m om e nt th e re are s e ve n s pe cialis ts or s e nior ph ys icians w ith corre s ponding com pe te nce s w h o s upe rvice re adings. Th e q uality and th e corre ctne s s of th e findings, as w e las of diagnos tic and inte rve ntional proce dure s, are dis cus s e d during a daily ins titute - inte rnalm e e ting. Th is m e e ting is als o us e d to train re s ide nts and s tude nts.. Inte rdis ciplinary dis cus s ions tak e place in confe re nce s w ith re fe rring de partm e nts. For q uality m anage m e nt m e as ure s m ajor inte rdis ciplinary confe re nce s are of gre at im portance - th e s e nologicalco loq uium toge th e r w ith th e gynae cology clinic, radioth e rapy, path ology and oncology (once a w e e k ), Th e inte rdis ciplinary tum our confe re nce (once a w e e k ), th e Z NS tum our confe re nce (once a w e e k ), th e s pine ce ntre (once a w e e k ) and th e ve s s e lce ntre (once a w e e k ). Th e ins titutionaland w e e k ly m orbidity and m ortality confe re nce is e xce ptionalin th is conte xt. A lth re e m onth s a cons tancy te s t of our im age - acq uis ition and - re pre s e nting e q uipm e nt is pe rform e d by an in- h ous e m e dicalph ys icis t. Once a ye ar a cons ultative re vie w of th e inte rnalcons is te ncy ch e ck s, th e film e diting s urve i lance and of X- rays is pe rform e d by th e Ärztlich e Ste le. Re pe titive e xpe rtis e s are pe rform e d a lfive ye ars. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

Proje cts for q uality m ainte nance w ith in th e ins titute of radiology are : > Ce rtification of m am m ograph y s cre e ning by th e ce ntralauth ority in Cologne > Officialpe rm it of te le m e dicine e m e rge ncy CT for th e h os pitalin Pas e w alk > Re - ce rtification toge th e r w ith th e Bre as t Ce ntre W e s te rn Pom e rania at th e Unive rs ity Clinic Gre ifs w ald For furth e r training m os t s taff m e m be rs of th e ins titute participate d in m e e tings and/or topic- re late d s ym pos ia. Traditiona ly th e ins titute tak e s th e ch ance to dis cus s its fie lds of inte re s t w ith oth e r e xpe rts. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

Com pe te ncy diagnos e s according to ICD in 2006 ICD NAM E I70.2 Ath e ros cle ros is ofarte rie s ofe xtre m itie s S22.0 Fracture ofth oracic ve rte bra J86 D 48.6 Pyoth orax Ne oplas m ofunce rtain or unk now n be h aviour ofoth e r and uns pe cifie d s ite s : bre as t D 38.1 Ne oplas m ofunce rtain or unk now n be h aviour ofm iddle e ar and re s piratory and intrath oracic organs : trach e a, bronch us, lungs D37.7 Ne oplas m ofunce rtain or unk now n be h aviour oforalcavity and dige s tive organs C78.0 Se condary m alignantne oplas m oflung C78.7 Se condary m alignantne oplas m oflive r K75.0 Abs ce s s oflive r I67.1 Ce re bralane urys m, nonrupture d I65.2 Occlus ion and s te nos is of carotid arte ry K83.1 Obs truction ofbile duct Com pe te ncy proce dure s according to OPS in 2006 OPS NAM E 8-836.1 Tre atm e nt ofa ve s s e lvia a tube (cath e te r) w ith ba loons attach e d 8-836.f Tre atm e nt ofa ve s s e lvia a tube (cath e te r): im plantation ofa s te ntw h ich e m its drugs 8-836.9 Tre atm e nt ofa ve s s e lvia a tube (cath e te r): artificalclos ure ofa blood ve s s e lby liq uid plas tic, s m a lplas tic ba ls or fibrin s ponge s, e m itte d by cath e te r 8-836.2 Tre atm e nt ofa ve s s e lvia a tube (cath e te r): las e r- angioplas ty 3-706 Im aging proce dure us ing radioactive radiation to s h ow k idne ys : s zintigraph y 5-506 Im plantation, e xch ange or re m ovalof cath e te r in h e patic arte ry or in portalve in for ch e m oth e rapy 1-501 Tak ing ofa tis s ue s am ple from m am m ary gland th rough incis ion 1-442.0 Tak ing ofa tis s ue s am ple from live r, bile duct or pancre as th rough s k in, contro le d by im aging diagnos tic proce dure, e.g. ultras ound 5-501 Excis ion or de s truction ofaffe cte d tis s ue from live r 3-13c.1 X-ray ofbile ducts us ing contras tive age nts 3-607 X-ray ofarte rie s in le gs us ing contras tive age nts 3-601 X-ray ofarte rie s in ne ck us ing contras tive age nts 3-605 X-ray ofarte rie s in pe lvis us ing contras tive age nts 5-514.53 Oth e r s urge ry to bile duct: im plantation ofdrainage to run offliq uids 5-839.9 0 Oth e r s urge ry to s pine : 1s t s e gm e nt 1-859.y Oth e r e xam ination via tak ing ofa liq uid or a tis s ue s am ple w ith a ne e dle 8-83 Th e rapautic cath e te rization or cannulization ofve s s e ls 5-339.2 De s truction ofaffe cte d lung tis s ue th rough w arm th (th e rm o ablation) UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

Las e r ablation for h e patic m e tas tas e s of colore ctalorigin Long- tim e s urvivalrate s afte r las e r ablation of live r m e tas tas e s in th e Ins titute of Radiology of th e Unive rs ity Clinic Gre ifs w ald Synch ronic m e tas tas e s M alignant m e tas tatic tum our, diagnos e s at s am e tim e as cance r dis e as e M e tach ronic m e tas tas e s M alignant m e tas tatic tum our, diagnos e d afte r th e cance r dis e as e M e dium probability to s urvive 9 5% - are a oftrus t (w ith a probability of 9 5% th e m e dium probability to s urvive lie s w ith in th is are a) SYNCH RONIC M ETASTASES from point in tim e at w h ich m e tas tas e s w e re diagnos e d 34,3% 25,3 43,4% M ETACH RONIC M ETASTASES from point in tim e at w h ich m e tas tas e s w e re diagnos e d 38,8% 32 45,6% 1 ye ar probability to s urvive 9 0,9 % 9 1,9 % 2 ye ars probability to s urvive 64,8 % 81,8 % 3 ye ars probability to s urvive 35,3 % 44,9 % 4 ye ars probability to s urvive 21,2 % 30 % 5 ye ars probability to s urvive 14,1 % 20 % In m os t cas e s th e patie nts re ce ive d las e r th e rapy ye ars afte r th e ope ration of th e originaltum our. Th e num be rs give n re late jus t to th e s urviving from th e point of th e las e r th e rapy. Es pe cia ly 3- ye ar s urvivalrate s are h igh com pare d w ith data from th e lite rature (Le ncioni R e t al., 2004). RESEARCH Curre nt publications and re s e arch proje cts are dis playe d in th e ins titutionaldatabas e : h ttp://fodb.uni- gre ifs w ald.de /inde x.ph p. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD