A retrospective study of 97 patients undergoing 101 image-guided adrenal biopsies (IGABs) was performed to analyze the effects of specific pathologic results on test characteristics. Three categories of pathologic results (benign adrenal tissue, malignant tissue, and nondiagnostic) were compared with outcomes. Diagnostic samples were obtained in 86% of cases. Among 72 patients with proved outcomes, IGAB had an accuracy of 96%, a sensitivity of 93%, and a negative predictive value of 91% (92% in patients with bronchogenic carcinoma). In this subset of patients, 33 had biopsy specimens that contained benign adrenal tissue. In these 33 patients, three masses (each smaller than 3 cm) proved malignant. In the 14 patients with nondiagnostic samples, two masses proved malignant. Obtaining benign adrenal tissue was highly predictive of benignity, even in the setting of lung cancer. The authors conclude that IGAB is an accurate procedure in both oncologic and nononcologic patients. However, when the biopsy specimen does not contain benign adrenal tissue or malignant cells, repeat percutaneous biopsy or surgery should be considered.

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The authors present an adaptation of the macro recording feature on the Siemens Magic View 1000 workstation, which, with the click of one button, launches a macro that performs 3 clinically useful image manipulations. Using a Magic View 1004 Siemens unix workstation, the following Macro sequence was programmed: (1) select all images, (2) reverse grayscale, (3) edge enhancement, (4) display full-resolution all screens, (5) reverse grayscale, (6) enable zoom/pan function. This sequence of commands takes 11 seconds to complete for a 2-view chest x-ray, and 16 seconds for a 3-view hand series. A pause occurs while the CPU performs the edge enhancement algorithm; this "pause" is used to provide time for the radiologist to assess the images. The time to implement and view these manipulations is reduced dramatically with the automatic viewing macro. More importantly, because the macro takes over the workstation operation, radiologist attention can be focused totally on image assessment and interpretation. Automatic hands-free image manipulation can improve the speed and accuracy of radiologist interpretation for both chest and extremity digital radiography.

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