Richard G. Lester

The Significance of Coronary Calcification Detected by Fluoroscopy A Report of 360 Patients

Cardiac fluoroscopy to detect coronary calcification was performed on 360 patients before undergoing coronary arteriography for proven or suspected coronary artery disease. Among the 154 patients in whom coronary calcification was identified, 97% had significant coronary disease angiographically (≧ 70% stenosis). In this group, the distribution of one, two, and three vessel coronary disease was 9%, 25%, and 66% respectively. The prevalence of coronary calcification increased with age and severity of coronary disease, but no difference in males versus females was demonstrable. The angiographic severity of coronary disease increased with multiple vessel calcification; three vessel disease occurred in 45%, 66%, and 82% of patients with one, two, and three vessel calcification, respectively. Patients with hyperlipidemia or hypertension had no significant difference in the prevalence of coronary calcification. Among the 267 patients with significant coronary lesions, 56% had calcification detected by fluoroscopy.Five of the 93 patients with no significant coronary disease angiographically had coronary calcification fluoroscopically. Four of the five had a prior history of myocardial infarction, and two showed asynergy on left ventriculography.This study demonstrates that cardiac fluoroscopy is a valuable procedure for detecting significant coronary artery disease since this highly specific test is easily performed, inexpensive, noninvasive, and widely applicable for screening large patient populations.

Digital radiography using a computed tomographic instrument

A prototype computed radiography (CR) system was evaluated for its efficacy as an independent diagnostic modality. Preliminary measurements of high contrast resolution, low contrast perceptibility, and dose were obtained. Clinical examinations including skull, abdomen, liver, gallbladder, biliary system, spine, and extremities were performed as an adjunct to either computed tomography or CR. The data suggest that CR can be an effective diagnostic imaging modality by itself. Advantages over conventional radiography include high scatter rejection, low patient dose, wide dynamic range, and good low contrast sensitivity for large objects; disadvantages, its long exposure time and relatively poor high contrast spatial resolution.

Risk Versus Benefit in Mammography

Controversy surrounds the use of mammography in asymptomatic women 35-49 years of age. There is agreement that routine mammography is useful beyond 50 years. By extrapolating data from relatively high radiation exposures, a radiation carcinogenic risk at diagnostic levels has been calculated by some workers. Benefit for asymptomatic women in the 35-49 year age group has been questioned. This paper presents evidence that significant numbers of breast cancers are found in this age period on the basis of x-ray examination alone. Data also indicate absorbed dose from modern-day mammography is half to one quarter of that previously assumed. Based on these data, mammography is recommended as a tool for diagnosis of nonpalpable carcinomas of the breast.

One-View Mammographic Screening?

Repeated mammographic exposures of asymptomatic women in the screening situation has raised questions regarding possible risks. Obtaining only one view, regardless of imaging technique, would approximately halve the exposure. While retrospective analysis indicates further investigation is warranted, one-view mammographic screening is not yet recommended. The lateral view, including the chest wall, would reduce exposure by approximatley 44% but little savings in technologist time could be anticipated.

Kerley B lines in total anomalous pulmonary venous connection below the diaphragm (type III)

Abstract A case is presented of total anomalous pulmonary venous connection below the diaphragm, with roentgenographic evidence of pulmonary edema, interstitial edema and a normal cardiac silhouette. These findings led to a diagnosis of pulmonary venous obstruction proximal to the mitral valve. Our findings confirm that the morphologic substratum of Kerley B lines is predominantly edema of the interlobular septum.

Diagnosis of Aortic Atresia by Retrograde Aortography

VENOUS angiocardiographic demnonstration of a single arterial vessel leaving the heart and supplying both systenmic and pulmonary circulations, suggests the diagnosis of persistent truncus arteriosus. Such was the initial impression in the ease of a dyspneie, cyanotic, newborn male infant without a cardiac murmur. The electrocardiogram showed a normal sinus rhythm. The mean manifest electrical axis of the QRS complex was plus 1100. Lead V1 showed a qR patterni and flattened T waves. In lead V6 an Rs complex with an R wave of 17 min. and an S wave of 9 mm. were present. Since a murmur is commonly heard in persistent truncus arteriosus, absence of such a sign in this case led to this diagnosis being questioned. Accordingly, following the venous angiocardiographv, a retrograde aortogram was performed. Demonstration by the

X-ray appearance and clinical significance of left atrial wall calcification.

Ten patients with calcifications of the left atrium are reported with review of the literature. Calcification of the left atrium is frequently associated with history of rheumatic fever, longstanding congestive heart failure, atrial fibrillation, mural thrombus and embolization. Early recognition of such lesions is essential for the management of the patients, particularly when surgical intervention is contemplated. A practical classification of left atrial calcification is proposed according to the dominant lesion in each group: (a) Calcification of the left atrial appendage alone (Mitral stenosis). (b) cacification of all 3 component lesions of the left atrium, i.e., the left atrial appendage, the free wall, and the mitral valve (Severe mitral stenosis). (c) Calcification of the left atrium in MacCallums patch alone (Mitral insufficiency).

Transmission of Radiologic Information by Satellite

Fluoroscopic results from the first transmission of radiologic information by earth-satellite link were of diagnostic quality, but because of inadequacies in the sensor, the quality of transmitted radiographs was poorer. Experiments show that the entire gamut of radiologic information could be transmitted in real time from remote to central locations with no distance limitation and at reasonable cost if a satisfactory sensor of radiographic images were constructed to complement existing fluoroscopic capabilities.

Radiology and the delivery of health care.

Abstract Physicians, medical administrators, politicians, and community leaders have been parties to discussions of the inadequacies and inefficiencies of our present methods of providing medical services. Regardless of the justifications of the criticisms, new systems will inevitably supplant the present ones. With an awareness that radiologists should examine the place of their specialty in the changes now imminent in the practice of medicine, the RSNA sponsored a symposium on Radiology and the Delivery of Health Care at its 1971 Scientific Assembly and Annual Meeting.

Complete Interruption of the Aortic Arch

the correct diagnosis has been established prior to surgery or postmortem examination in only six instances. 1-4 Only once has the diagnosis been made within the first two months of life. Since the majority of the cases of complete interruption of the aortic arch succumb in this period, an early and precise diagnosis is necessary if successful surgery is to be achieved. The object of this communication is to report a case of this type which was diagnosed in the fifth week of life. The advantages of left atrial cardioangiography in establishing a diagnosis at this early age is emphasized.