Since 1972, Babat, Katz, and Samuelson MD's has been serving the Pinellas area of Florida, growing from 3 to 10 fully credentialed, board-certified radiologists. Their staff includes fellowship-trained radiologists in MRI, Neuroradiology, and Interventional Radiology, as well as expertise in breast imaging, cardiac imaging and musculoskeletal imaging. In addition to providing a full range of outpatient diagnostic interpretation services, they offer extensive inpatient and outpatient interventional procedures with state-of-the-art image guidance equipment. Dr. Samuelson adds, "Our combination of diagnostic and interventional experience focuses our interpretations and improves our communication with referring physicians. Working with IOC will enable us to provide our services to patients and physicians beyond our core hospitals."

RadNet and Pioneers Memorial Hospital have entered a series of agreements to provide a comprehensive array of radiology services. Pioneers Memorial Hospital is a highly regarded, Joint Commission-accredited, 107-bed acute care facility located in the Imperial Valley in southern California. The services include:

• A joint venture to build and operate a 12,000-square-foot multimodality outpatient imaging center that will provide state-of-art medical imaging services to the 160,000 area residents.
• Imaging On Call is providing subspecialty offsite radiology interpretation and after-hours teleradiology support to the hospital and will be providing these services to the newly created outpatient imaging center.
• eRAD, Inc., a subsidiary of RadNet, installed and is supporting a state-of-the art Picture Archiving and Communication System (PACS) and a Radiology Information System (RIS) in Pioneers Memorial Hospital and will be doing this in the newly created outpatient center.
• RadNet and Pioneers are also developing a Breast Disease Management Center that will incorporate RadNet's BreastLink services, including specialized breast imaging, biopsy and interventional radiology capabilities, medical oncology, breast surgery and breast reconstruction.

By partnering with RadNet, Pioneers is more equipped to meet the growing needs of the community.

A 45-year-old-male presents to the emergency room with acute, severe right-sided back and flank pain after falling on his back during a basketball game. CT was performed to rule out renal injury.

Diagnosis: Acute hemorrhagic adrenal myelolipoma

Discussion:
Adrenal myelolipoma is a relatively rare, benign adrenal neoplasm containing varying proportions of fat and myeloid tissue. Usually these lesions are relatively small, but rarely they can grow to large sizes. Most myelolipomas are asymptomatic and produce no hormones. They do not metastasize. They are usually discovered incidentally on imaging studies. Large myelolipomas can, however, produce symptoms by mass effect on other organs, as well as pain. The origins of adrenal myelolipomas are not clearly understood. On CT and MR imaging, most myelolipomas with predominantly fatty elements are easily recognized as such, and only periodic imaging surveillance is required. However, when there is a significant proportion of myeloid elements producing soft tissue densities, it may be difficult to distinguish myelolipomas from retroperitoneal liposarcomas, and biopsy may be necessary.

Our case was unusual in that the myelolipoma had bled after relatively minor trauma. There have been case reports of hemorrhage in myelolipomas, but these are rare. Hemorrhage is more commonly associated with renal angiomyolipoma, which is a benign renal tumor composed of varying proportions of fat, smooth muscle and vascular elements. This tumor may appear similar to myelolipoma on imaging studies, but the angiomyolipoma is a renal, not an adrenal tumor; it is different histologically, and a large angiomyolipoma is at greater risk of hemorrhage than a myelolipoma.

Nevertheless, as our case suggests, even tumors that are not known to commonly bleed are still at risk for hemorrhage, probably because the vascular elements of most neoplasms are abnormal and likely less stable.

Imaging On Call serves more than 85 sites in multiple geographic areas with diverse patient populations. Our radiologists are exposed to a wide variety of pathologies every day, which reinforces knowledge, confidence and accuracy in interpretation of routine studies. It also increases their ability to confidently diagnose less common conditions and diseases that may not often be seen in a classic private practice or even an academic setting that may cover only one or a few sites.

Fig 1:
Coronal reformatted contrast-enhanced CT shows large right suprarenal mass with both fatty (long arrow) and soft tissue (asterisk) elements. Note soft tissue stranding peripheral to the lesion (short arrow), representing hemorrhage. The lesion exerts mass effect on the right kidney.

Fig 2:
Axial images show mildly hyperdense elements within the lesion, likely representing acute blood (arrows).

Fig 3:
Axial images at the level of the right upper renal pole (inferior to Fig 2) show blood (arrows) from the lesion leaking into the perirenal space.

UltraDISTRIBUTOR software from UltraRAD allows an imaging facility to securely deliver electronic results and images to its customers and patients.

The software application allows aggregation of clinical information and distribution of results and information to referring physicians within the facility and to any remote locations: hospitals, imaging centers, offsite archives, etc. UltraDISTRIBUTOR gives sites a method to securely deliver results and images to their referring physicians and patients without the need for costly VPNs. Referring practices opting in for electronic distribution receive an application that periodically "polls" the UltraDISTRIBUTOR server for exams waiting. Using secure web services, the exams are automatically fetched from UltraDISTRIBUTOR and stored locally in the software client. The referring physician can chose to simply print results and review images in a DICOM viewer within the client, or forward directly to the practice management system or EHR.

Key Features:

• Automatic distribution of results
• Eliminate the need for VPNs
• Local web client allows fast and efficient review of results
• HIPAA logging of all access to patient information
• Simple mail client look and feel for intuitive ease of use
• Vendor-neutral

UltraRAD has been a partner of IOC's for many years, providing DICOM routers and teleradiology software applications. If you are interested in more information about this product, please contact Sean Kowaliw, Executive Director of Information Systems, at (845) 891-2142, or skowaliw@imagingoncall.com.

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