Joseph E. Whitley

Experimental simulation evaluation of ECG-gated heart scans with a small number of views.

Computed tomography (CT) scanning techniques designed to visualize the beating heart utilize the electrocardiogram (ECG) waveform to gate or select the phase of the cardiac cycle being imaged. Most such methods require that each slice to be imaged be scanned many times to obtain the usual number of projections in a single phase interval of the cardiac cycle. We are studying a new method in which only a single scan of 20 s should be required per imaged slice. The central problem in the proposed technique is to test the diagnostic utility of images reconstructed from a very limited number (about 25) of projections. An essential part of the proposed algorithm is the elimination of all material outside a circle chosen to contain only the heart and the structures immediately surrounding it. Experiments are reported here on scans of calfs heart in an 11-cm container of water, with most views deleted so as to simulate the results from this type of gated scan. The results show that if no high-contrast objects are within the chosen circle, then image quality is satisfactory and could be clinically useful.

MEDICAL AND SURGICAL TREATMENT OF AZOTEMIC OSTEODYSTROPHY.

Excerpt Although osteomalacia and osteitis fibrosa resulting from primary kidney disease are found relatively frequently at autopsy (1), symptomatic bone disease during the course of renal insuffic...

Computed tomography for localization of parathyroid adenomas.

Fourteen consecutive patients with the clinical diagnosis of primary hyperparathyroidism had computed tomography (CT) preoperatively to evaluate the use of CT in localizing parathyroid adenomas. The patients were scanned from above the level of the thyroid cartilage to the bifurcation of the trachea. Computed tomography correctly identified, prospectively, the site of the adenoma in 7 of 14 patients, including one adenoma that was ectopic in location. Nine of these patients also had barium esophagrams, and this study was accurate in only three of the nine. Our study suggests that CT may be beneficial in the preoperative localization of parathyroid adenomas, particularly those in ectopic locations.

Effectiveness of small-group self-instruction in radiographic anatomy.

A small-group self-instructional program with 11 slide-tape units was designed to teach medical students radiographic anatomy concurrently with their course in gross anatomy. The effectiveness of the program was examined by administering an objective multiple choice examination at three medical schools. One school offered the slide-tape program alone; one, the slide-tape program plus lecture-demonstrations; and one acted as a control. The results indicate that students will, on their own, learn some radiographic anatomy. With exposure to an objectives-based, small-group slide-tape program, the students can learn significantly more. Such a slide-tape program plus lecture-demonstrations can further enhance learning. Student attitudinal results were uniformly positive toward this slide-tape program.

Tumor volume and treatment outcome in small cell lung carcinoma

The volume of some tumors correlates with local disease control, response, and survival. Small cell lung carcinoma presents with variable and often large intrathoracic masses. We assessed volume by two methods (summation of cross-sectional areas and Simpsons rule for estimating volume) and correlated volume with treatment outcome. Twenty-nine patients with small cell lung carcinoma (12 limited disease and 17 extensive disease) were analyzed for volume outcome correlations. There were five early deaths. Twenty-four had response correlations (11 limited disease and 13 extensive disease). Eighteen of the twenty-four achieved complete response. There was no apparent correlation between complete and/or partial response and pretreatment tumor volume. There was no apparent correlation between survival and volume. The methods of volume assessment correlate well with each other (r = 0.88) and either can be used with accuracy. So far there is also no correlation between chest tumor volume and intrathoracic recurrence. Our projections suggest that there is a low probability of correlating chest tumor volume and either response or survival. This is in keeping with the disseminated nature of the tumor which is its limiting factor in survival.

Fundamentals of Radiology

Dr Lucy Frank Squire is joined by Dr Robert A. Novelline in revising and updating this classic medical student text on diagnostic radiology. The original 1964 edition was written specifically as an introduction to diagnostic radiology for medical students in their clinical years of training. The book concerns itself with teaching general principles of the subject, and it is not designed to be the reference book that the student might later wish to own in practice. This singleness of purpose made and makes this text unique. These traits, plus the authors skill, resulted in the largest-selling book published to date by Harvard University Press. Predictably, this edition will follow in the path of its predecessors. With this revision, the authors have introduced computed tomography and magnetic resonance imaging and have added 330 new illustrations. Yet with skillful rewriting and deletion, the increase in the number of pages has been held

Roentgen Appearance of the Hand in Diffuse Disease

The roentgenographic image of the hand and wrist is capable of portraying bone and soft tissue in exquisite detail with a relatively low expense and radiation hazard. The proper analysis of this image can substantiate or primarily lead to the diagnosis of many inborn and acquired diseases. This text is proffered as a comprehensive reference and guide to diseases that have diffuse involvement visible in roentgenograms of the hand. Localized diseases are excluded. Four hundred thirty-eight pages of the book are narrative. Each entity is succinctly defined, the clinical and roentgenographic features are detailed, and pertinent references are included. A brief discussion of pathogenesis and/or differential diagnosis is frequently included. The remaining 212 pages are an atlas of roentgenographic reproductions of the hand and wrist with descriptive legends. Not only the typical roentgenographic appearance of a disease is portrayed, but frequently, a spectrum of appearances in different age groups, and

The Heart and Its Actions: Roentgenokymographic Studies

Kymography has apparently been a dead issue in the clinical practice of cardioradiology for almost 20 years. Dr. Alexander, however, presents us with a text based on ten years clinical experience with more than 3,000 patients, using a Germanbuilt kymograph based on a design by Dr. P. Strumpf published in 1931. The basic mechanism consists of a moving radiopaque plate with multiple parallel slits 0.4 mm wide at intervals of 12 mm. The plate is placed between the patient and thefilm and moves vertically or horizontally 11 mm, with the usual exposure time being 1.5 seconds. The author describes his technique and findings with many of the types of congenital heart disease which survive into adolescence and adult life, as well as the common forms of acquired heart disease. The additional information the technique affords over routine films is generously illustrated, and its limitations are also catalogued. The average stated

A Second Portfolio of Chest Radiographs for Undergraduate and Postgraduate Students

The book is a sequel to A Portfolio of Chest Radiographs , and both books attempt to fuse the clinical and radiologic approaches to chest disease. An interesting collection of roentgenographic reproductions, organized by a British thoracic surgeon and a British radiographer, is presented to illustrate a text written with sound conservative surgical philosophy. The authors stress basic diagnostic procedures such as routine chest roentgenography, bronchoscopy, and bronchography. The illustrations center on plain films of the chest supplemented with only a few bronchographs, three aortograms, and two pulmonary arteriograms. In this volume we find described and illustrated some usually unsaid truths, such as the lack of diagnostic value of many isolated routine chest roentgenograms as well as the lack of specificity of some roentgenographic signs. The ambitious undertaking of a description of the pulmonary vasculature in congenital heart disease falls flat, due to a lack of proper angiographic illustrations. A few