A. Rimondini

Cost analysis of different protocols for imaging a patient with acute flank pain.

Abstract. The aim of this study was to analyse the costs of different diagnostic approaches to patients with acute flank pain. Four different diagnostic approaches were considered: (a) spiral CT without contrast medium (CM); (b) plain film, ultrasonography (US) and intravenous urography (IVU) – the latter procedure is used in our department in cases still unsolved following the former investigations (28 % in our experience); (c) plain film, US and spiral CT without CM (as an alternative to IVU in 28 % of cases); and (d) IVU. The cost of each procedure in a university hospital was calculated, following analysis of the differential costs of each investigation (equipment, depreciation and maintenance costs, related materials and services, radiologists, radiographers, nurses) and their common costs (auxiliary personnel and indirect internal costs). Finally, we calculated the full cost of each procedure and applied it to the different diagnostic approaches. The full cost of each approach was: (a) spiral CT without CM = 74 Euro; (b) plain film, US and IVU (28 %) = 66.89 Euro; (c) plain film, US and spiral CT without CM (28 %) = 64.93 Euro; (d) IVU = 80.90 Euro. Intravenous urography alone or in unsolved cases is not to be considered because it provides higher costs and worse diagnostic results, whereas X-ray dose to patient is almost equal between IVU and spiral CT. Spiral CT integrated to plain film and US in unsolved cases could be preferred because of lower cost and dose to patient, though reaching a diagnostic conclusion may take longer than an immediate spiral CT.

Digital vs conventional radiography: cost and revenue analysis

Abstract. The objective of this study was to analyse and compare the operating and investment costs of two radiographic systems, a conventional and a digital one, and to evaluate the cost/revenue ratio of the two systems. The radiological activity over 1 year for chest and skeletal exams was evaluated: 13,401 chest and 7,124 skeletal exams were considered. The following parameters of variable costs were evaluated: the difference between variable proportional costs of the two technologies, the effective variable cost of any size film, including the chemicals, and for different sizes of digital film, variable costs of chest plus skeletal exams performed with the two techniques. Afterwards the economical effect was considered taking into account depreciation during a time of utilization ranging between 8 and 4 years. In the second part of the analysis the total cost and the revenues of the two technologies were determined. The comparison between the digital and conventional systems has shown the following aspects: 1. Digital radiography system has a much higher investment cost in comparison with the conventional one. 2. Operating costs of digital equipment are higher or lower depending on the film size used. Evaluating chest X-ray we reach a breakeven point after 1 year and 10,000 exams only if displayed over 8 × 10-in. film and after 30,000 if displayed over a 11 × 14-in. film. 3. The total cost (variable cost, technology cost, labour cost) of digital technology is lower than that of the conventional system by 20 % on average using 8 × 10-in. film size. 4. Digital technology also allows lesser film waste and lesser film per exam

Radiologic evaluation in planning surgery of renal tumors

The evolution in diagnostic imaging modalities, mainly in computed tomography (CT) and magnetic resonance imaging (MRI), have made it possible to extend the applications of these techniques from diagnosis to staging and surgical planning. Nowadays, the possibility to present images on different planes with an intrinsic resolution close to that of the original axial sections allows presentation of the kidney on sagittal, coronal, and oblique planes. Three-dimensional reconstructions can be obtained with different methods and have attained excellent image quality. Multidetector spiral CT presently is the best technique for planning surgery, but MRI also enables high-quality images to be obtained if state-of-the-art equipment is available. This update reviews the current status and possibilities of diagnostic imaging modalities in planning surgery of renal tumors.

Contribution of CT to treatment planning in patients with GIST

PurposeThe aim of this study was to illustrate the morphological and structural computed tomography (CT) patterns of gastrointestinal stromal tumours (GIST) and to discuss the technique’s role in identifying lesions at a higher risk for malignant potential, in treatment planning and in the follow-up of patients with GIST.Materials and methodsWe retrospectively reviewed the CT scans of 26 patients who underwent surgery for histologically confirmed GIST of the stomach (20 cases), the duodenum (1), the caecum (1), the small bowel (2), the descending colon (1) and the rectum (1). CT exams were performed with a single-slice scanner and a 5-mm collimation before and after the intravenous administration of contrast material.ResultsCT allowed us to correctly define the site, size and structure of lesions in all cases and to identify signs of invasion of neighbouring structures in some cases. The lesions exhibited solid density on the unenhanced scan and poor enhancement after contrast-medium administration; lesion structure was homogeneous in ten cases and inhomogeneous in 16; in one case, histology revealed microcalcification that had not been detected by CT.ConclusionsCT, with its panoramic capabilities and high contrast resolution, provides essential information for treatment planning and for the follow-up of GIST patients treated with surgery or chemotherapy.RiassuntoObiettivoLo scopo di questo lavoro è stato quello di riportare quelle che sono le caratteristiche dei tumori gastro-intestinali stromali (GIST) evidenziabili in TC ed utili nell’identificazione delle lesioni a maggior rischio di malignità e nella pianificazione della terapia e nel follow-up.Materiali e metodiSono stati valutati retrospettivamente gli esami TC di 26 pazienti sottoposti ad intervento chirurgico con diagnosi istologica di GIST localizzato allo stomaco (20 casi), al duodeno (1), al cieco (1), all’intestino tenue (2), al colon discendente (1) ed al retto (1). Gli esami TC sono stati eseguiti utilizzando un’apparecchiatura TC spirale a singolo strato con collimazione di 5 mm, mediante scansioni dirette e dopo MdC per via endovenosa.RisultatiLa TC ha consentito sempre di individuare correttamente sede, dimensioni e struttura delle lesioni ed in alcuni casi anche segni di infiltrazione dei tessuti circostanti. Le lesioni presentavano densità solida alle scansioni dirette, uno scarso enhancement dopo MdC, struttura omogenea in 10 casi, disomogenea in 16; in un caso si sono evidenziate alcune microcalcificazioni all’esame istologico, non riscontrate all’esame TC.ConclusioniLa TC in virtù della sua elevata panoramicità e risoluzione di contrasto fornisce informazioni indispensabili nella pianificazione terapeutica e nel follow-up dei pazienti trattati sia chirurgicamente sia mediante terapia farmacologica.