A comparison of junior hospital doctors interpretation of acute radiographs using an X-ray box and a window.
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A statistically significant number of clinically important features are missed when radiographs are interpreted by holding an X-ray up against the window when compared with using an X-ray box. These findings are most probably accounted for by a quantifiable difference in light intensity. (+info)
Can computed tomography identify patients with anaemia?
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Thirty-three in-patients attended for non-contrast enhanced computed tomography (CT) of chest and/or abdomen within a six-week period (11 M, 21 F) . All had measurement of their full blood profile within the previous 72 hours. Patients with a blood dyscrasia or known history of active bleeding were excluded. All patients were imaged using a Siemens Somatom Plus S scanner. The scanning parameters were standardised at 210 mA, 120 kV, 10 mm slice thickness, pitch of 1. Following image review, circular regions of interest (ROI) were defined within the lumina of the aorta and inferior vena cava (IVC) at the level of the superior mesenteric artery origin. The mean attenuation value was calculated using on-board computer software, and recorded. The mean patient age was 59.6 years (range 18-85 years). A non-parametric correlation analysis was performed and a linear regression plot obtained. A significant correlation was demonstrated between haemoglobin measurement and the aortic and IVC attenuation value. The correlation was stronger (r = 0.64) for the aortic attenuation value than for the IVC attenuation values (r = 0.57). In addition, if anaemia is defined as less than 14g/I for a male and less than 12g/I for a female, then, in our study group, no male with an aortic attenuation value greater than 50HU and no female with an aortic attenuation greater than 45 HU was found to be anaemic. The results demonstrate a significant correlation between patients' haemoglobin measurement and the derived aortic attenuation value. We do not propose this as a method of accurately measuring the patient's haemoglobin; however, we feel that it may be possible for a radiologist at non-contrast enhanced CT examination to note the probable presence of anaemia. (+info)
Plain abdominal radiographs in acute medical emergencies: an abused investigation?
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Plain abdominal radiographs are commonly requested for acute medical emergencies on patients with non-specific abdominal symptoms and signs. In this study 131 plain abdominal radiographs performed on the day of admission were prospectively analysed. In only 16 cases (12%) the reasons for requests conformed to the recommended guidelines by the Royal College of Radiologists. The reason for the request was stated in the case notes in only three cases. In 62 cases (47%), there was no comment made on the film by the requesting clinician. There was a discrepancy in the interpretation of the radiograph between the clinician and the radiologist in 31 cases (24%). The clinical management was influenced by plain abdominal radiographs in only nine cases (7%). The majority of plain abdominal radiographs requested on acute medical emergencies is inappropriate. There is a need to ensure guidelines are followed to prevent unnecessary exposure of patients to radiation as well as preventing expenditure on irrelevant investigations. (+info)
Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study.
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OBJECTIVES: To compare ultrasonography and abdominal radiography with intravenous urography in the investigation of urinary tract infection in men. DESIGN: Prospective study in two hospital departments. Radiological procedures and urological assessments performed on different days by different clinicians SETTING: District general hospital. PARTICIPANTS: Consecutive series of men (n=114) referred to the department of urology for investigation of proved urinary tract infection. INTERVENTIONS: Ultrasonography and intravenous urography of renal tract and assessment of urinary flow rate. Clinical assessment, cystoscopy, urodynamic studies, and transrectal ultrasonography with biopsy. MAIN OUTCOME MEASURES: Sensitivity and specificity of ultrasonography and abdominal radiography compared with intravenous urography. RESULTS: Important abnormalities were seen in 53 of 100 fully evaluated patients, the most common being a poorly emptying bladder (34). The combination of plain radiographs of kidneys, ureter, and bladder and ultrasonography detected more abnormalities than intravenous urography alone. No important abnormality was missed by this combination (sensitivity 100% and specificity 93%). CONCLUSIONS: Ultrasonography with abdominal radiography is as accurate as intravenous urography in detecting important urological abnormalities in men presenting with urinary tract infection. This combination is safer than intravenous urography and should be the initial investigation for such patients. Additional determination of urinary flow rate is useful for the assessment of an incompletely emptying bladder. (+info)
Helical computed tomography of the abdomen: evaluation of image quality using 1.0, 1.3, and 1.5 pitches.
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BACKGROUND: The purpose of this study was to investigate whether trained radiologists can distinguish minor differences among computed tomography (CT) images of extended helical pitches of 1.0 to 1.5. METHODS: Between September 2000 and February 2001, 72 patients were randomized into 1 of 3 equal groups: helical pitches of 1.0, 1.3, and 1.5. The imaging parameters of all patients were kept constant. Twelve of the 72 patients were excluded because of various pathological conditions. In a total, 60 examinations were enrolled in the evaluation study. Three radiologists blinded to the image parameters were asked to independently evaluate 9 normal structures and overall images of 60 studies using a scale from 1 (worst) to 5 (best). RESULTS: There were no statistically significant differences in evaluation of image quality among helical pitches 1.0, 1.3, and 1.5 of abdominal CT when assessing 9 normal structures and overall images independently (p > 0.05). CONCLUSIONS: Abdominal CT performed with helical pitches of 1.0, 1.3, and 1.5 were equivalent in this study. With the use of a helical pitch greater than 1, clinicians can benefit from increased scan coverage in less time and with less radiation than can be achieved with standard helical pitch-1.0 protocols. (+info)
Idiopathic retroperitoneal fibrosis: prompt diagnosis preserves organ function.
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Prompt diagnosis of idiopathic retroperitoneal fibrosis improves chances of preserving renal function, preventing involvement of other organs, and relieving symptoms. Computed tomography or magnetic resonance imaging helps to exclude secondary causes, but open biopsy remains the gold standard for diagnosis. Management typically includes surgery (ureterolysis, stent placement), and drug treatment (corticosteroids), or a combination of both. However, no surgical or medical therapy has been tested in a randomized, controlled trial. (+info)
Migration of ventriculoperitoneal shunt into the heart--case report.
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A 76-year-old man underwent ventriculoperitoneal shunting for hydrocephalus after subarachnoid hemorrhage. Eighteen days after the shunt operation, fluoroscopy revealed the peritoneal catheter in the heart. Three-dimensional computed tomography demonstrated penetration of the catheter into the internal jugular vein. Under local anesthesia, part of the peritoneal catheter was pulled out through the cervical incision and cut off. The ends of the peritoneal catheter were connected so that the distal end was settled in the right atrium of the heart under fluoroscopic visualization. The migration of the peritoneal catheter into the heart presumably occurred because the subcutaneous wire guide of the shunt catheter perforated the internal jugular vein and the catheter was drawn into the heart through the internal jugular vein by the negative pressure of the vein and thoracic cavity. (+info)
Intestinal obstruction in autosomal dominant polycystic kidney disease.
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A 42-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital on April 29, 1999, with complaints of abdominal pain. A diagnosis of intestinal obstruction was reached on the basis of clinical findings and X-ray evidence. A computed tomography scan of the abdomen showed massively enlarged kidneys, especially the right kidney, which seemed to compress the small intestine. The patient underwent percutaneous aspiration of the largest cysts on the surface of the right kidney. The symptoms, in this rare case of intestinal obstruction by an enlarged kidney in ADPKD, were alleviated the day after the aspiration procedure. (+info)