C.-G. Standertskjöld-Nordenstam

Early Detection of Acute Fulminant Pancreatitis by Contrast-Enhanced Computed Tomography

Twenty-eight consecutive patients with a first attack of acute alcohol-induced pancreatitis were examined by computed tomography (CT). After a survey scan of the abdomen a rapid contrast bolus (400 mg I/kg) was given intravenously, and the contrast enhancement of the pancreatic parenchyma was measured from a consecutive series of pancreatic scans. Nine patients with a fulminant course of the disease were operated on, and haemorrhagic necrotizing pancreatitis was found in eight. In all of these the contrast enhancement was decreased or absent. Patients recovering by conservative treatment showed normal or increased enhancement. The contrast enhancement seems to constitute a useful criterion for the early differentiation of acute fulminant pancreatitis from less severe forms of the disease.

Experimental Pancreatography: A Comparison of Three Contrast Media

Twenty-five piglets were subjected to experimental transduodenal pancreatography, using three contrast media (CM), namely sodium meglumine diatrizoate (Urografin), meglumine ioxaglate (Hexabrix), and iohexol (Omnipaque), all diluted to a concentration of 300 mg/ml of iodine. The emptying of CM from pancreatic ducts was studied by repeated roentgenograms, and pancreatic irritation by serum amylase and phospholipase A2 measurements. On the 3rd day after pancreatography the glands were removed for histologic examination of tissue damage. Hyperamylasaemia was seen in 53% of the animals 12 to 15 h after examination, to equal extents in each group. Minimal acinar destruction was seen on histologic examination in all cases. The changes were least when diatrizoate was used. The difference from the changes seen in the ioxaglate group was significant (p less than 0.05). Emptying of CM from the ducts was highly significantly (p less than 0.001) faster in the diatrizoate group than in the other groups. Rapid emptying may be an advantage in clinical endoscopic retrograde pancreaticocholangiography.

Microangiography of the Pancreas in Experimental Oedemic and Haemorrhagic Pancreatitis

UNLABELLED Microangiography of the pancreas was performed in five normal piglets and in 10 piglets with oedemic and haemorrhagic pancreatitis in order to evaluate the role of microcirculatory changes in experimental pancreatitis. Acute haemorrhagic pancreatitis was induced by intraductal infusion of trypsin-taurocholate and oedematous pancreatitis correspondingly by infusion of autologous diluted bile. Both types of pancreatitis were confirmed by histological examination. Microangiography of the control animals revealed well-filled arteries, arterioles and capillaries, which formed a dense capillary network. In the areas of histologically documented haemorrhagic pancreatitis, unfilled capillary nets were observed as empty areas in the microangiography. Other areas of focal extravasation of the contrast material could be seen. Arteries and arterioles were well filled. In oedematous pancreatitis, the microangiography was unchanged compared with the control. CONCLUSION Acute experimental haemorrhagic pancreatitis is associated with severe disturbances in the capillary circulation of the pancreas, whereas in oedematous pancreatitis the microangiography of the pancreas is normal.

Computed Tomography in Staging of Oesophageal Carcinoma

The computed tomographic (CT) findings in 45 patients with histologically proved oesophageal carcinoma are reviewed. In 20 of these patients the CT findings were correlated with findings at surgery (19 patients) or autopsy (1 patient). Correlation analysis showed that the accuracy of CT in assessing both invasion of adjacent organs and mediastinal and abdominal lymph node involvement is limited. Twenty-five patients were considered inoperable; in 15 of these the conclusion was based on CT findings of distant metastases (14 patients) or definite local invasion (1 patient). Ten patients were inoperable for other reasons (general health condition). We found the value of CT to be in detecting distant metastases, thus avoiding unnecessary radical surgery; it is not a reliable way of defining the primary tumour.

Activity-based costing in radiology: Application in a pediatric radiological unit

Purpose: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. Material and Methods: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. Results: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from −42% to +82%. Conclusion: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

Costs of plain-film radiography in a partially digitized radiology department : An activity-based cost analysis

Purpose: the aim of the study was to analyse the costs of computed radiography (CR) as part of a small picture archiving and communication system (mini-PACS), and to compare these costs with those of conventional analogue radiography using activity-based accounting (ABC) Material and Methods: the study was conducted at the Central Hospital of Vaasa where in 1993 the Radiology Department acquired a mini-PACS with a CR reader, a chest CR unit, and a CT unit as digital image processing modalities. of altogether 34140 plain-film examinations, 3/4 were made with CR and stored mostly on film, and 1/4 were made with conventional analogue radiography. the costs and activities of these two modes were analysed by means of the ABC method which identifies and allocates indirect costs in radiological procedures Results: the costs of CR imaging were 9% higher than those of conventional radiography. the costs of the chest CR unit were equal to those of conventional radiography. the difference was due to higher investment costs in digital image processing. the time gained from a reduction in the number of retakes did not shorten the time spent by patients in the examination room, and its effect on film costs was minimal Conclusion: in planning the step-by-step transition of conventional film-based analogue radiography to fully digitized radiography, it should be noted that films are still used in the transition period and that this is associated with higher costs than in the previous system of conventional analogue plain-film imaging

The efficacy of a continuous quality improvement (CQI) method in a radiological department: Comparison with non-CQI control material:

Objective: To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department. Material and Methods: Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at the OUH (Oulu University Hospital) with a traditional management process. For the CQI project, a team was formed to evaluate the process with flow-charts, cause and effect diagrams, Pareto analysis and control charts. Interventions to improve the process were based on the results of these analyses. Results: The team at the HUCH implemented the following changes: A radiologist was added to the evening shift between 15:00-22:00 and a radiographer was moved from the morning shift to 15:00-22:00. A clear improvement was achieved in the turn-around time, but in the follow-up some of the gains were lost. Only minimal changes were achieved at the OUH, where the intervention was based on traditional management processes. Conclusion: CQI was an effective method for improving the quality of performance of a radiology department compared with ordinary management methods, but some of this improvement may be subsequently lost without a continuous measurement system.

Hypovolemic Shock and Contrast-Enhanced Computed Tomography of the Pancreas

The effect of profound hemorrhagic hypovolemia on cardiac output and pancreatic blood flow was studied in pigs with the thermodilution method and microsphere technique. Approximately 30-40% of the circulating blood volume was withdrawn slowly during 5 h. Cardiac output and pancreatic blood flow decreased by 35% and 32%, respectively. The animals underwent contrast-enhanced computed tomography (CT) before hypovolemia and at 5 h after its onset. The changes in systemic and local blood flow were related to the contrast enhancement of the pancreas. In spite of profound hypovolemia and a significant decrease in pancreatic blood flow (p less than 0.005), the contrast enhancement remained normal. The results of the present study indicate that pancreatic hypoperfusion caused by hypovolemia does not affect the contrast enhancement of the pancreas in CT.

Ionic and non-ionic contrast media used for contrast-enhanced computed tomography in experimental pancreatitis

Contrast enhancement of the pancreas was studied in pigs using dynamic computed tomography in experimental oedematous and haemorrhagic/necrotizing pancreatitis during the first two minutes after injection of an intravenous bolus of non-ionic contrast medium (iohexol). The prospects of separating the two forms of the disease, known to be possible with ionic contrast media, were tested with a non-ionic contrast medium. In the oedematous form, contrast enhancement after 5 hours of the disease was significantly higher than in the haemorrhagic/necrotizing form. Contrast enhancement after 30 hours of disease tended to vary with the severity of the disease, showing that the course of oedematous pancreatitis is dynamic. Intermediate forms occur and follow-up studies are needed during the disease. A non-ionic contrast medium proved as good for separating the two forms of the disease in the early phase as were ionic contrast media. In severely ill patients, non-ionic contrast media should therefore be used.

Diagnosis of meningeoma. A comparison of costs before CT, during CT and after introduction of MR imaging.

Objective: To assess whether the capital investment required by advances in radiological technology is offset by savings in the direct costs of diagnostic services. Material and Methods: Meningeoma was used as an indicator case. All meningeoma patients from three study periods were included: Twenty patients in 1976-77 before the introduction of CT, 22 patients in 1984-85 when CT was used and 16 patients in 1992 when MR imaging had replaced CT as the most informative imaging modality. Radiological and other diagnostic investigations, and the hospital stay were identified and cost analyzed. Results: The costs of radiological examinations increased from 293 Euros in 1976-77 to 513 Euros in 1992. The average number of diagnostic examinations per patient decreased from 5.1 in 1976-77 to 2.4 in 1992. The length of hospital stay decreased from 11.5 to 2.7 days and the total costs of the diagnostic work-up decreased to one-third of the original, i.e. from 3423 Euros in 1976-77 to 1282 Euros in 1992. Conclusion: The costs of the radiological examinations rose, but the development of radiological technology simplified the diagnostic practice. The hospital stay drastically decreased. The total costs of diagnostic work-up per patient dropped to one-third of the baseline costs.