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PubMedDate not supplied

Radiographic screening for cancer. Proposed paradigm for requisite research.

Computed tomography (CT) imaging as an excellent approach to the detection and characterization of small solitary pulmonary nodules (SSPN) raises three questions: (1) How often does CT imaging lead to detection of SSPN? (2) How often is such an SSPN malignant? (3) If malignant, how curable is it? The first question pertains to decisions about screening use of CT (clinical or mass screening), the second to decisions about screening for SSPN and diagnosis of malignancy given SSPN, and the third--in the context of known curability at ordinary clinical diagnosis--to decisions about screening for SSPN, diagnosis given SSPN and intervention given malignant SSPN. We present a three component study design that addresses these questions. The first is directed primarily to the first question. Some 1000 persons at high risk for lung cancer will be screened for SSPN using screening-type CT. The primary aim is to determine the prevalence of CT-detectable SSPN as a joint function of risk-relevant aspects of the person. The second component addresses the prevalence of malignancy among the detected cases of SSPN. To develop the prevalence function, a larger series of CT-detected SSPN will be obtained by developing a multi-center SSPN "registry." A subsequent, third component will focus on the registered cases of malignant SSPN screening incidentally detected and address their curability on the basis of long-term follow-up. This design, in lieu of a randomized trial, may represent a new paradigm for applied research on radiologic technologies in cancer screening, given its advantages in terms of research efficiency and implications to decisions about diagnostic workup and therapeutic intervention.

Decision Making↗
PubMed2004

Mammography: will adequate manpower exist?

Data exist that clearly demonstrate the dominant role of screening mammography in breast cancer mortality reduction with an ever-increasing population of women who are eligible to receive the benefits of screening. The critical question now concerns the current and future availability of those who perform and interpret these life-saving examinations.

Breast Neoplasms↗
PubMed1999

Percutaneous vertebral biopsy through intact bone: a coaxial bone transgressing technique with 18 gauge needle.

Advancement of radiologic technologies allows the detection of vertebral lesions at an earlier stage, thereby increasing the proportion of vertebral lesions that are surrounded by intact bone when they are detected. While biopsy guns are effective in obtaining good-quality tissue samples of osteolytic bone lesions, lesions that are covered by intact bone are not accessible with a biopsy gun. For percutaneous biopsy of osteolytic vertebral lesions, an intact-bone transgressing technique is described in which a simple, inexpensive and small-calibre (18-gauge) instrument is used to allow multiple passage of 20-gauge biopsy guns for effective tissue sampling. In this series consisting of metastatic and myeloproliferative lesions, the effectiveness and safety of this well-tolerated technique are demonstrated in thoracic and lumbar vertebrae.

Biopsy, Needle↗
PubMed1984

Radiation exposure to patient and urologist during percutaneous nephrostolithotomy.

Radiation exposure to the patient and urologist was determined during 60 procedures for percutaneous removal of calculi from the upper collecting system. For male patients the average radiation dose at the surface of the testis was 160 mrem (1.6 mSv.). Surface dose to the female patient at the ovary level averaged 580 mrem (5.8 mSv.). Radiation doses to the small field or region of fluoroscopy on the skin surface anterior to the kidney averaged 25 rem (0.25 Sv.). Radiation exposure to the urologist at collar level averaged 10 mrem (0.1 mSv.) per case. Patient gonad doses from percutaneous nephrostolithotomy are similar to those from a 7-view excretory urogram. Patient surface exposures at the nephrostomy are comparable to skin doses from standard angiographic procedures. The exposure to the urologist is similar to that from other interventional fluoroscopic procedures and is within acceptable limits. Appropriate use of radiological technology and shielding can keep radiation exposures during percutaneous nephrostolithotomy within acceptable limits for patients and physicians.

Adult↗
PubMed2002

Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography imaging for pancreaticobiliary pathology: the gastroenterologist's perspective.

With advances in noninvasive radiologic technology, additional adjunctive techniques are developing, and the roles for ERCP and EUS are continuously changing. In a diagnostic setting, ERCP is currently best reserved for patients with a high likelihood of needing endoscopic therapy, and EUS is especially useful for cases in which other imaging techniques have been inconclusive or are of inferior diagnostic capability. In a therapeutic setting, ERCP and EUS retain important roles in the management of both benign and malignant pancreatic and biliary disease. Certainly, technological advances also directly affect these modalities and expanded applications for ERCP and EUS for the pancreas and biliary tract are anticipated.

Biliary Tract Diseases↗
PubMed1992

Alternative methods in the management of bile duct stones.

Common bile duct stones may now be dealt with, in most cases, without the need for surgery. To be sure, surgery continues to remain the gold standard for duct clearance and treatment of biliary sepsis. Improvements in endoscopic and radiologic technology and methodology have permitted excellent access to the biliary tree by the transduodenal and transhepatic approaches. In the majority of patients, total duct clearance and excellent drainage can be accomplished, averting sepsis and the need for open surgery.

Cholangiography↗
PubMed2002

A brief history of x-rays.

The identity of x-rays was initially mysterious, their connotations including morbidity and the otherworldly. Gradually they became routine, finding a place in the high-energy end of the electromagnetic spectrum. Radiologists established a niche in hospitals, contributing to the industrialization of healthcare. Control of x-ray tube output was improved while an infrastructure enforcing radiation protection accompanied the continued growth of the field. X-ray diffraction proved a powerful tool with which to examine substances at the atomic scale. Since 1950, x-ray researchers have taken advantage of synchrotrons' copious production of continuous x-ray spectra, and the marriage of x-rays with electronics has led to a cornucopia of cheap and highly efficient analytical tools.

Germany↗
PubMed2003

Imaging modalities in obstetrics and gynecology.

The practicing emergency physician often encounters diagnostic dilemmas involving the choice of the most appropriate radiologic study to evaluate patients in the emergency department. In addition, the uncertainty of potentially harmful fetal effects of radiation in the pregnant patient may add unnecessary delay and concern in the workup of obstetric emergencies. An emergency physician's in-depth understanding of the strengths, limitations, and potentially harmful effects of radiologic studies allows the safest and most appropriate studies to be ordered for the gynecologic and obstetric population. With the explosion of interest and growing level of expertise in focused emergency department ultrasonography during the last decade, the practicing emergency physician should add this skill to his or her armamentarium in the future. Many emergency physicians are already comfortable in using radiologic technologies in their daily practice and have discovered how quickly vital and specific information can be obtained.

Diagnostic Imaging↗
PubMed2002

Endoscopic retrograde cholangiopancreatography should no longer be used as a diagnostic test: the case against.

Endoscopic retrograde cholangiopancreatography has been used successfully in diagnosis of pancreatico-biliary diseases. Over the past decade, there have been tremendous developments in radiological technologies which have led to the emergence of new and less invasive modalities like endoscopic ultrasound and spiral computed tomography and magnetic resonance cholangiopancreatography. Understandably, the usefulness of diagnostic endoscopic retrograde cholangiopancreatography is being questioned primarily because of its potential attendant complications. Therefore, this controversial question needs to be debated in the gastroenterology community. In this article, we compare the efficacy of newer diagnostic tools with existing "gold standard" modality--endoscopic retrograde cholangiopancreatography, and put forward our arguments in favour of a continuing role for endoscopic retrograde cholangiopancreatography as a diagnostic tool in certain circumstances.

Bile Duct Diseases↗