Ronald G. Evens

Efficacy of Routine Screening and Lateral Chest Radiographs in a Hospital-Based Population

Abstract A prospective study of chest roentgenographic examinations was conducted to determine if the elimination of some examinations or films often routinely obtained might be medically and econo...

Early Clinical Experience with Motionless Whole-Body Computed Tomography

A new computed tomographic body scanner, capable of completing a scan in 18 sec., produces dramatically clearer and more precise pictures of the abdomen and thorax than heretofore possible. Other technical improvements result in increased clarity in areas of the body not affected by motion, including the brain. Potential clinical uses are illustrated.

The treatment of osteoporosis with calcium infusions: Clinical studies

Abstract An increase in the serum calcium (Ca) concentration normally suppresses parathyroid function and stimulates the secretion of thyrocalcitonin. Hypercalcemia resulting from intravenous administration of Ca should therefore lead to a net retention of Ca. This hypothesis was tested in six patients with osteoporosis. After twelve Ca infusions, four patients showed clinical improvement, net Ca retention, enhanced bone formation and reduced bone resorption and an increase in the gastrointestinal absorption of Ca. These effects persisted for many months after Ca infusions were stopped. If calcium given in this way leads to a prolonged suppression of parathyroid function and a comparably enhanced stimulation of thyrocalcitonin secretion, it may reverse the metabolic errors that constitute osteoporosis.

Complementary use of ultrasound and computed tomography in studies of the pancreas and kidney.

113 cases of pancreatic and renal disease studied by both ultrasound and computed tomography (CT) were analyzed retrospectively. CT provided a diagnosis when pancreatic ultrasound was unsuccessful due to overlying bowel gas or obesity and when renal ultrasound was unsuccessful due to obesity, reverberations from ribs, small lesions, or multiple lesions. Conversely, ultrasound provided a diagnosis when CT was unsuccessful due to lack of fat planes or respiratory motion. CT usualy distinguished carcinoma from pancreatitis when ultrasound showed a focal echogenic mass. CT resolved renal cyst from neoplasm when ultrasound showed a mixed echo pattern mass.

Staining of Parathyroid Adenomas by Selective Arteriography

LOCALIZATION of parathyroid adenomas by arteriography was originally described by Seldinger (8) in 1954. Recent reports (2, 5, 7, 8) have stressed displacement of the cranial and caudal loops of the inferior thyroid artery as the principal arteriographic sign. With this sign, successful preoperative localization has been achieved in 66 per cent (7, 8) down to 0 per cent (4) of cases studied. These “localizations” based on displacement are really “lateralizations” without specific identification of the abnormal parathyroid. Our preliminary findings with this technic indicated that such displacements were often inadequate, especially in patients with previous neck explorations and persistent hyperparathyroidism. This small but important group, for whom an accurate localizing technic would be most beneficial, included the ones most likely to show falsepositive vascular displacements. Although staining of parathyroid adenomas during arteriography has been reported previously (1, 3, 6, 7, 10, 11), this diagnos...

Results of and Comments on the 2000 Survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES The American Association of Academic Chief Residents in Radiology annually surveys residency programs on a variety of issues related to residency training. The survey allows for comparison between programs regarding training and follows trends on current issues. MATERIALS AND METHODS Questionnaires were mailed to all accredited programs in the United States (188 programs). The questionnaire consisted of questions regarding general demographic information and specific topics regarding residency training. The 1998 survey focused on turf issues, teleradiology use, residency selection, and prior training. RESULTS Completed surveys from 61 programs (32.4%) were returned. Important findings included (a) the ongoing turf battles regarding vascular and obstetric-gynecologic ultrasound, both in general hospital and emergency department patients, (b) the use of teleradiology by most residents, and (c) the low percentage of women in radiology residency programs. CONCLUSION The information obtained during yearly surveys is useful for program evaluation and future planning. Current survey results indicate an increasing use of teleradiology in residency over the past 4 years. The turf battles in ultrasonography (both vascular and obstetric) have remained unchanged over the same time frame.

The clinical efficacy and cost analysis of cranial computed tomography and the radionuclide brain scan

Cranial computed tomography (CCT) has already been demonstrated to provide significant diagnostic information in patients with neurologic disease and to reduce the need for special neuroradiologic procedures. The important question remaining is: Should CCT replace the radionuclide brain scan (RBS) as the first diagnostic study in most patients with suspected intracranial pathology? Data are now available to define the costs and benefits of this substitution. The technical costs of CCT have been determined by a national survey and have shown to be

Using Information to Optimize Medical Outcomes

130 per patient at a volume of 50 patients per week. The costs of RBS at the Mallinckrodt Institute have been estimated at

The physiologic factors affecting regional ventilation and perfusion.

51 per patient. Data from the literature indicate that CCT is slightly more sensitive and considerably more accurate than RBS. Eighteen to twenty-eight percent of patients studied by CCT and RBS have abnormalities (e.g. cerebral atrophy and ventricular dilatation) that are only detected by CCT, and the overall accuracy of CCT is 95%, while the accuracy of RBS is approximately 70%. Substituting CCT for RBS is cost-beneficial. Although CCT is more costly, it increases overall accuracy by approximately 25%. The cost benefit is further increased by the reduction of complicated diagnostic procedures (and associated hospitalization and morbidity) and improvement in diagnostic information for the individual patient. Substituting CCT for RBS may not be more costly because a positive RBS will be followed by CCT (because of increased diagnostic information), and a negative RBS may be followed by CCT (because of increased accuracy), whereas a positive or negative CCT is unlikely to be followed by RBS.

Factors influencing choice of academic or practice careers in radiology.

AN IMPORTANT HEALTH CARE–RELATED DECISION OF the Obama administration is to reduce waste and harm by modernizing health care information technology systems. This decision would be met with more enthusiasm if the design of the final system were driven by the goal of improving the efficacy and efficiency of medical processes through a strategy of collecting meaningful data. Before spending billions creating and implementing such systems, careful consideration must be given to how this information will be integrated into medical decision making. Some of the current health care information technology systems seem to have been planned using a “ready, fire, aim” approach, with little or no concern for how the data will be used. Ideally, health care information technology systems should collect and use information to improve the probability that patients will receive optimal care. Optimized decision making is the essence of evidence-based medicine. However, collecting, organizing, and storing information is only the first step in this process. The systems must also be designed to facilitate data analysis. Information by itself is useless. Deming, a pioneer in datadriven optimization programs, acknowledged that many systems are drowning in information. Most physicians will agree. Deming argued that what is needed is knowledge. Knowledge is generated from analyzing information and finding the relevant patterns within the data set. These patterns are typically obscured by random noise, but once revealed, provide an understanding or mental model of the underlying processes. These models allow observations of past events to be transformed into future predictions. Although all attempts to predict the future are imperfect, predictions are useful because a series of failed predictions signals that mental models could be inaccurate. Once recognized, such errors prompt improvement in predictive models and can optimize future performance.