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Although the value of medical imaging is unquestioned, many have raised concerns regarding inappropriate utilization, which increases healthcare costs, often requires ionizing radiation, and may uncover incidental findings that require further evaluation. One of the areas of greatest concern is the use of CT in the ED. Radiologists and equipment manufacturers have both worked hard to minimize the radiation dose needed for diagnostic CT imaging. The campaigns of Image Gently and Image Wisely have been endorsed by major radiologic societies and are common practice across the country. Equipment manufacturers should also be credited with producing CT scanners capable of obtaining diagnostic images at dramatically reduced radiation doses. Emergency room physicians are in a difficult position as they care for patients who are often acutely ill. Immediately available medical imaging, such as CT, provides a high degree of value in this setting. Furthermore, patients often expect medical imaging, and may even be sent to the ED by their primary care physicians specifically to get imaging examinations (1,2). In medical imaging, physicians must weigh the risk of the examination with the potential benefit of the diagnostic information. To help referring physicians do a better job, clinical decision support systems are being developed (3). However, this is also a challenging area as recommendations for the use of medical imaging must be updated in a timely fashion to reflect changes in medical practice. Casey Chong’s comment correctly identifies an area in which there is an opportunity for improvement.

PURPOSE: To analyze the effectiveness of core-needle biopsy for evaluation of possible primary musculoskeletal neoplasms, which often are evaluated with open biopsy. MATERIALS AND METHODS: Core-needle biopsy was performed at a tertiary care institution in 141 patients suspected of having a mesenchymal neoplasm. In 85 patients, the lesion was in soft tissue; in 56 patients, the lesion was in bone. Eighty-nine patients had a malignant lesion, and 52 had a benign lesion. Twenty-eight patients had undergone previous surgery. RESULTS: In 105 (74%) patients, core-needle biopsy results were concordant with results from specimens subsequently obtained at surgery with respect to tumor histologic features and grade, or they provided sufficient diagnostic information to obviate surgery. In 36 (26%) patients, inaccurate core-needle biopsy results were obtained: In nine, results were imprecise about exact histologic features; in three, results were correct about histologic features but incorrect about tumor grade. In 25 (18%) patients, open biopsy was performed after core-needle biopsy. The accuracy and rate of performance of open biopsy for soft-tissue lesions were not significantly different from those for bone lesions. CONCLUSION: Percutaneous core-needle biopsy can be an effective alternative to open biopsy in the evaluation of possible mesenchymal neoplasms of either bone or soft tissue. Needle biopsy of such lesions, however, is best performed as part of a multidisciplinary team approach to tumor management.

To evaluate objectively the effects of a microbubble contrast agent on the color Doppler ultrasound (US) examination of breast lesions.Forty-seven patients aged 23-71 years underwent color Doppler US before and after intravenous injection of a microbubble contrast agent. A 3-minute computer-assisted assessment of the color pixel density (CPD) was used to evaluate objectively the increase in the number of color Doppler US signals, the transit time of the microbubble bolus, and the potential additional differential diagnostic information.Peak CPD at contrast agent-enhanced color Doppler US was 14.3% +/- 8.1 (mean +/- 1 standard deviation) for carcinomas and 9.3% +/- 4.9 for benign lesions (P = .04). The time to peak enhancement was shorter in carcinomas (38 seconds +/- 20) than in benign tumors (71 seconds +/- 48, P = .02). Final CPD was close or equal to baseline values. With the median of 13% for peak CPD as a threshold, the sensitivity for this parameter was 55%, the specificity was 79%, and the accuracy was 62% (P = .04). For a median time to peak of 50 seconds, the sensitivity was 84%, the specificity was 57%, and the accuracy was 76%.After microbubble contrast agent injection, carcinomas and benign lesions behave differently in degree, onset, and duration of Doppler US enhancement. High interindividual variability and temporal variations in the Doppler US signal still limit the value of these criteria for prospective diagnosis.

PURPOSE: To determine the clinical utility of three-dimensional (3D) helical computed tomography (CT) in pretherapy evaluation of the angioarchitecture of pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS: Thirty-seven PAVMs were prospectively evaluated with both helical CT and pulmonary angiography. Single-threshold shaded-surface displays were obtained with 2- or 5-mm section thickness, a pitch of 1, and a 360 degrees linear interpolation algorithm but without injection of contrast medium. RESULTS: A reliable analysis of the angioarchitecture of 28 PAVMs (76%)--25 simple and three complex--was provided by 3D reconstructions; combined interpretation of 3D images and transverse sections led to accurate evaluation of 35 PAVMs (95%). Positioning of the target anatomy in the reconstructed volume, threshold value, number of stacked sections, and section thickness influenced the diagnostic information. CONCLUSION: Unenhanced 3D helical CT appears to be a reliable noninvasive tool for prether...

To evaluate the use of coronal magnetic resonance (MR) imaging in assessment of disk position in the temporomandibular joint (TMJ), sagittal and coronal 1.5-T MR images were obtained of 158 TMJs in 79 patients. From the sagittal images, medial or lateral displacement was suspected in 24 joints. Displacement could be confirmed from coronal images in 21 joints but could not be confirmed in three. In 18 other joints, the coronal images revealed a lateral or medial displacement that was not evident on sagittal images. In seven of these 18, displacement was purely lateral or purely medial, whereas the other 11 had a combination of anterior and lateral or medial displacement. On the basis of only sagittal images, the seven with pure displacement would have been diagnosed as normal. Use of the coronal plane added diagnostic information to that obtained with sagittal imaging and may increase diagnostic accuracy. Coronal images are therefore recommended as a supplement to sagittal images in MR imaging evaluation of the TMJ.

Transabdominal (TA) and transvaginal (TV) sonograms (n = 116) were obtained in 84 patients aged 12-21 years (mean, 16.2 years) with the clinical diagnosis of acute pelvic inflammatory disease (PID). The studies were compared for image quality and unique diagnostic information. TV sonography demonstrated superior resolution of 25 dilated fallopian tubes. Heterogeneous pelvic masses, described as tubo-ovarian abscesses on TA sonograms, could be separated on TV sonograms into various stages of PID including pyosalpinx, hydrosalpinx, tubo-ovarian complex, and tubo-ovarian abscess. Thirty-one TA and TV studies were normal despite patients fulfilling strict clinical criteria for PID. The level of severity of PID, as determined at TA sonography, was altered in 28 cases, with medical therapy changed in 23 cases because of additional TV sonographic findings. TV sonography provided superior anatomic detail in the evaluation of patients with PID, demonstrating abnormalities that were not seen at TA sonography in 71% of patients.

310 radiology.rsna.org Radiology: Volume 271: Number 1—April 2014 trocardiographic triggering at the optimal phase and reduce the radiation exposure. However, we did not perform this analysis as this has been previously studied in heart transplant patients by Bastarrika et al (1) with use of a dual-source CT scanner. Bastarrika et al found that the endsystolic phases from 35%–45% of the RR interval resulted in the best image quality. To the best of our knowledge, however, systolic triggering may only be possible with dual-source CT scanners or the latest generation of singlesource scanners. We agree with Dr Meng’s comments about the lack of reliability of absent CAC for predicting significant coronary artery disease. However, in scanners where the radiation dose of CT angiography is much higher than that of CAC scanning, the latter may still be helpful to plan the craniocaudal extent of the CT angiogram and thus reduce the overall dose. We are thus of the view that individual centers that perform cardiac CT in heart transplant patients should adapt the precise protocol to their scanner capabilities in order to minimize the radiation dose while obtaining the required diagnostic information (2).

To compare the prenatal ultrasonographic (US) features of skeletal dysplasia by using two-dimensional (2D) and three-dimensional (3D) US to determine whether 3D US can reveal additional diagnostic information.Seven pregnant women suspected of having skeletal dysplasia were examined by using 2D US and 3D US. Data regarding the thorax, spine, face, limbs, hands, and feet were compared. Multiplanar and volume-rendered US images were evaluated.The skeletal dysplasias studied included camptomelic dysplasia (n = 2), thanatophoric dysplasia (n = 1), osteogenesis imperfecta (n = 1), arthrogryposis (n = 2), and short-limbed dysplasia (n = 1). Three-dimensional US, by allowing review in a standard anatomic orientation, was better than 2D US in depicting abnormal spatial relationships such as short ribs, splayed digits, and absent bones. Three-dimensional US enabled the acquisition of additional information in two fetuses with facial abnormalities and in two fetuses with scapular aplasia or hypoplasia (one fetus had both facial and scapular anomalies); it enabled a specific diagnosis in one fetus. The archiving capabilities of 3D US allow the review and manipulation of data after the patient has left the clinic.In three of seven patients, 3D US provided additional information in the evaluation of skeletal dysplasias, as compared with 2D US.

Forty patients with complete obstruction to retrograde barium flow on barium enema examinations, without clinical or radiographic evidence of obstruction, were studied further with orally administered barium in the same session. All patients had undergone aborted double-contrast barium enema studies and had received antispasmodics intramuscularly before the examination. The authors describe the technique, as well as the clinical and radiologic findings, that allows the safe ingestion of oral barium in patients with stenotic lesions of the colon. In all patients, oral barium passed through the small bowel and the stenotic site in an average of 148 minutes, with no complications. In seven patients, there were synchronous lesions in the colon and small bowel, and the findings were determined better with oral barium studies in 19 patients. If a barium enema study is done and retrograde passage of barium is obstructed by a lesion in the left side of the colon, additional diagnostic information can be obtained by giving the patients oral barium. This practice is safe if precise criteria are applied.

The utility of computed tomography (CT) in evaluation of mediastinal abnormalities was assessed in 23 pediatric patients. By comparison with standard chest radiography, CT provided additional diagnostic information in 82% of the patients. In 65%, the CT findings contributed to a change in clinical management. CT was most useful in documenting a benign process (near-water-density mass or a normal vascular or soft-tissue structure) and in demonstrating the full extent of a malignant tumor.

A study was undertaken of five patients with Cushing syndrome due to adrenocorticotropin (ACTH) production by thymic carcinoid tumor (primary mediastinal APUDomas), including two recent patients examined by computed tomography (CT) of the chest. Plain roentgenography of the chest initially failed to detect tumor in four of the five patients, while CT of the chest yielded definitive diagnostic information in both patients in whom it was employed. For one of these patients, a mediastinal tumor could be seen retrospectively on plain roentgenograms of the chest, although it had been missed on the first examination. One of the tumors appeared to be partially calcified on CT scan, a finding not previously reported. Blastic osseous metastasis, which is common when malignant carcinoid tumors spread to bone, was seen in one patient. Our data suggest that in patients with suspected ectopic ACTH production, CT scanning of the mediastinum should be performed early in order to avoid delay in diagnosis of an ACTH-secreting carcinoid tumor of the mediastinum.

A retrospective examination was performed to assess the accuracy of metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis. Of 81 consecutive scoliotic children studied by myelography, 30 had only MM while the remaining 51 had CTMM immediately afterward. CTMM added essential diagnostic information in 13 cases of dysraphism and 4 cases of idiopathic scoliosis; in the remaining cases, both methods gave the same information. The authors conclude that in patients with severe scoliosis, dysraphism, and scoliosis with localized neurological disturbances, CTMM should always be added to MM or be the only examination; while in idiopathic scoliosis with vague neurological disturbances a survey of the entire spine is essential, preferably with MM.

Acoustical holography achieves real-time imaging of bodily structures through ultrasound. The fundamentals of acoustical holography and a description of a prototype unit undergoing trials at the authors' institution are presented. Physical parameters and means of calibrating the acoustic beam are discussed, and results of preliminary experimental and clinical studies reviewed. Acoustical holography has the potential for providing complementary diagnostic information which, after further technical developments, may furnish clinically useful information.

A new technique using air arthrography followed by computed tomography enables identification of free osteocartilaginous fragments in the knee joint. Clinical examples with useful diagnostic information are presented, and potential pitfalls in the interpretation of this information are discussed.

Uterine perforation and deep embedding by an intrauterine device (IUD) require exact determination of its location as a necessary step to safe and effective retrieval. Six cases of uterine perforation and four of embedding by an IUD were studied with ultrasonography (US) and hysterography. While US findings suggested the correct diagnosis of perforation in five of the six cases, hysterography yielded more exact diagnostic information. Deep embedding could only be diagnosed with hysterography. A classification of the types of perforation and an algorithm for diagnosing ectopic IUD are presented. Undue reliance on the sonographic appearance of an IUD in the center of the uterine image may lead to hazardous attempts at transvaginal removal of a device that is partly intramural. In this study, hysterography offered the most precise diagnostic information.

Transvaginal (TV) and transabdominal (TA) sonography were compared in a prospective study. A total of 230 examinations (126 pelvic, 104 pregnancy) were performed on 215 patients, ranging in age from 14 to 80 years. The improved anatomic detail on TV scans yielded new information in 138 (60%) examinations and better visualization of pelvic structures in 51 (22%) examinations. There was no important difference in diagnostic information provided by the two imaging modalities in 36 (16%) cases, and TV images were worse in five (2%). The clinical diagnosis was altered on the basis of TV sonographic findings in 54 (24%) cases and confirmed with certainty in 166 (72%). Diagnostic problems posed by TA scanning were not resolved by TV scanning in ten (4%) instances. Statistical analysis indicated that TV scanning was significantly better than TA scanning in the visualization of gestational sac contents (P less than .005), detection of fetal heart motion (P less than .001), and evaluation of the endometrial canal in the retroverted or retroflexed uterus (P less than .001). TV scanning was significantly better than TA scanning in visualization of the ovaries in patients with uterine leiomyomas (P less than .005) but not significantly better in peri- and postmenopausal patients (P greater than .05).

Ten intramedullary and two intradural extramedullary masses of the spinal canal were evaluated with 16 separate needle aspirations. Cord fluctuance at air myelography and/or low density within the cord on computed tomography determined the level of aspiration. The condition of two patients with cystic neoplasms and one with syringohydromyelia improved after fluid removal. Endomyelography demonstrated the extent of eight intramedullary cavities. In syringohydromyelia, this information was used in determining the surgical approach. Aspiration and tissue biopsy enabled successful diagnosis of two cases of intradural extramedullary masses of unknown etiology. Needle aspiration yields valuable diagnostic information and is safe when proper guidelines are followed.

The sonographic appearance in 4 cases of primary carcinoma of the gallbladder is correlated with the surgical and pathological findings. A fungating tumor had the greatest chance of resection, with findings dependent on the location and size of the mass. Infiltrating lesions were highly malignant. In less advanced cases, tumor infiltration caused irregular thickness of the gallbladder wall which was readily distinguishable from edema due to cholecystitis. In advanced cases, gallstones and stone shadowing coexistent with the tumor were important diagnostic clues, permitting differentiation between primary gallbladder carcinoma and neoplasms originating elsewhere. Sonography can provide critical diagnostic information which cannot be obtained by other conventional procedures.

Arthrography was assessed in 300 cases of ankle injury to determine its diagnostic information yield and its aid in classifying ankle injuries. No complications occurred as a result of the procedure. In 59 cases, information gained from the procedure was verified at surgery. Arthrography was considered to give valuable information in 85% of the cases of ligament ruptures.

Diagnosis of the thoracic outlet syndrome is often difficult, particularly in patients without osseous abnormalities on plain radiographs. The radiographic and computed tomographic (CT) findings were reviewed from 27 patients with thoracic outlet syndrome and 21 normal subjects. The plain radiographs and CT scans were assessed by two independent observers without awareness of the clinical history. Fifteen patients with thoracic outlet syndrome had osseous abnormalities (anomalous cervical ribs; abnormally long, drooping C-7 transverse processes) identifiable on plain radiographs. CT did not provide further diagnostic information in the patients with abnormal radiographs. Eight of 12 patients (66%) with normal plain radiographs had abnormal findings on CT scans, consisting of impingement of the C-7 transverse process on the scalene triangle or anteromedial aspect of the middle scalene muscle. Only two of 21 control patients (9.5%) displayed this CT abnormality (P less than .01). CT may be useful in patients with symptoms suggestive of thoracic outlet syndrome and no osseous abnormalities on plain radiographs.

Duplex sonography was used to evaluate the cranial contents of 75 infants. The first 35 were scanned to establish technique and evaluate basic flow patterns. All cranial vessels scanned in healthy term infants produced diphasic (low-resistance) waveforms, although certain cerebral vessels had characteristic Doppler signatures. The pericallosal, callosomarginal, anterior cerebral, basilar, middle cerebral, and internal carotid arteries and the vein of Galen were isolated and evaluated in almost every subject. In the second part of the study duplex characteristics of healthy term infants, healthy preterm infants, preterm infants with intracranial hemorrhages, and hydrocephalic infants were evaluated. Relative flow velocity at peak systole and end diastole and pulsatility index were investigated. The most significant variable was gestational age. Preterm infants frequently had no forward flow during diastole. Duplex sonography does not appear to add significant diagnostic information to routine real-time cranial studies. It does, however, permit more exact evaluation of cerebral blood flow than does non-pulse-gated, nondirected Doppler scanning.

A computer follow-up system has been developed which automatically prepares follow-up summaries for consultant physicians. This makes it possible to provide reliable feedback of diagnostic information in place of the traditional but haphazard word-of-mouth process. This system has been tested initially for surgical and autopsy-pathology follow-up of neuroradiology and nuclear medicine consultations using report conclusions available from the UCLA Natural Language Information Storage and Retrieval System.

Radionuclide imaging with technetium-99m phosphate compounds was performed in 18 patients with deep-seated soft-tissue masses. The histologically established diagnosis was intra- or intermuscular lipoma in 13 patients and liposarcoma in five. Radionuclide scans demonstrated disparate scintigraphic characteristics in these two often clinically similar lesions. Soft-tissue radionuclide accumulation occurred in two lipomas and corresponded to radiographically evident calcification. All liposarcomas were uncalcified and demonstrated intense radionuclide activity. This activity may be related to the angiographic and histologic hypervascularity of liposarcomas, which is also demonstrable on computed tomography as contrast enhancement; hence, these modalities offer the same nonspecific diagnostic information. It is concluded, however, that plain radiography and radionuclide scaning should suffice to establish the diagnosis of lipoma.

The central problem in the study of radiographic image quality is to gain knowledge of the effect of physical image quality on diagnosis. Methods are being developed to study transfer of diagnostically important information by the radiological process. Parts of this process are being analyzed via optical communication theory methods. Radiographic images can be assessed according to physical or diagnostic criteria. An image that reproduces the primary input most faithfully from a physical standpoint may not contain the most useful diagnostic information. Images of highest diagnostic quality best facilitate and least inhibit achievement of a one-to-one relationship between diagnosis given (output) and actual status of the part examined (input).

The use of percutaneous transfemoral pelvic arteriography in assessing pelvic lesions of gynecological and obstetrical origin was introduced by Borell et al. in 1952 (4). In a monograph published in 1955 Fernstrom further elaborated on the abnormal appearances of the uterine artery caused by various pathologic conditions (6). He illustrated in detail the changes in both size and position of various subdivisions of the uterine artery and its branches resulting from space-occupying pelvic masses. Although extrinsic iliac compression was employed to augment the amount of contrast medium reaching the hypogastric arteries, Fernstrom's use of aortic injections provided diagnostic information in only 60 per cent of adnexal tumors. In the following report simultaneous bilateral selective hypogastric arterial injections were used to better assess the ability of pelvic angiography to distinguish uterine from extrauterine masses. In addition, an attempt was made to evaluate its worth in delineating both vascular and...

Using a new x-ray system, the authors have been able to record four-dimensional studies on a single conventional film. Dynamic studies are presented directly, without recourse to multiple films. In addition to its three-dimensional aspects, temporal playback of true physiological sequence is possible. Clinical studies have been promising and reveal the potential of this system. The diagnostic information is obtained in a more convenient way and presented in a more meaningful form.

It is our purpose to review certain pertinent radiological aspects of the clinicopathological entity, multiple cysts of the renal medulla. This was initially described in 1949 by Cacchi and Ricci (1) as “sponge kidney,” and subsequently in 1951 by Vermooten (2) as “congenital idiopathic dilatation of the collecting tubules.” The only previous reference to this condition in the American radiological literature was by Abeshouse and Salik (3). Although the condition is uncommon, it is easily recognized if one is aware of its existence. We believe the urographie manifestations to be characteristic and the radiologist's impression may provide important diagnostic information. In the 2 cases to be presented here the diagnoses were made by excretory urography. Case Presentations Case I: E. F., a 33-year-old colored female, was admitted to St, Michael Hospital on Feb. 28, 1959, with a history of hematuria for four days prior to admission. She also complained of discomfort on the left side of the abdomen. She had ...

A fatty meal was given to 231 patients who had a well-visualized gallbladder with no stones. The radiological diagnoses on fluoroscopic spot films made before and after the fatty meal were compared. Only one case was diagnosed differently after the fatty meal. In 4 patients the post-fat film was useful in confirming a suspected diagnosis. Indications for administration of a fatty meal include (a) overlying gas shadows, (b) differentiation of a stone from a polyp, (c) adenomyomatosis, (d) a distended gallbladder, and (e) suspected common bile duct obstruction. In the absence of these indications, the time, effort, and cost involved in making the post-fat film are not justified by the additional diagnostic information obtained.

Teletherapy sources such as cobalt 60 and cesium 137 have been used for localizing studies in conjunction with radiation therapy for some time. In fact, one of the few references in the literature (1) points out that, under certain circumstances, radiography with these high-energy sources can provide diagnostic information beyond that provided by routine radiography. In view of the obvious advantages to using the teletherapy source for radiographic localization, it is surprising that so little has appeared concerning the procedure in the literature. This may well be due to the equally obvious limitation imposed on a radiographic system in which the energy of the radiation results in practically 100 per cent Compton interaction with the subject. Since Compton interactions are essentially independent of atomic number, the resulting differentials in absorption for the various structures in the human body are not very large and contrast, therefore, is at a minimum. In high-energy radiography, the proper filmi...

Computed tomography (CT) and magnetic resonance (MR) imaging studies were done prospectively in 21 unselected patients in whom 28 major salivary glands had pathologic changes. Blinded and final readings were used to establish the relationship of the lesion to the plane of the facial nerve (parotid masses), whether the lesion was intrinsic to the gland, and whether the lesion was aggressive. In the blinded reading, CT was superior to MR imaging in eight instances; in the final reading, however, with clinical information available, CT was superior in four cases of inflammatory salivary gland "masses." CT and MR imaging provided the same diagnostic information in all cases of salivary gland neoplasms. T1- and T2-weighted images proved of equal value in detection of salivary gland lesions, and use of both provided no additional specificity. In most cases, T1-weighted images alone provided the information necessary for surgical management. MR imaging is a reasonable first choice if a neoplasm is likely; the potential for improved tissue contrast at the margins of a tumor may be particularly useful. If a mass may be of inflammatory origin, contrast material-enhanced CT is a more reasonable first choice.

Phlebography of the spermatic veins may yield valuable information about metastases from testicular tumors. Retrograde venous injection of contrast medium is not always possible but the antegrade approach performed in connection with orchidectomy was successful in all of the 5 cases attempted. If funicular lymphography is performed in connection with the removal of the testis, spermatic vein phlebography may be added with a minimum of additional effort. Whenever orchidectomy for malignant testicular tumor is planned, the possible value of additional diagnostic information from spermatic vein phlebography should be considered.

Forty-three chest (noncardiac) and 75 abdominal computed tomographic (CT) examinations were studied by obtaining four sections of a pertinent area using 2.25-, 4.5-, 9-, and 18-second scan speeds. Chest scans obtained with the three faster speeds were perceived to be qualitatively similar to one another but were rated better than the 18-second sections. While these qualitative differences were statistically significant, most were relatively unimportant clinically. Analysis of the abdominal sections showed significant qualitative improvement with each successively faster scan speed. The only sections rated unreadable and/or showing large numbers of motion artifacts were abdominal studies, primarily 18-second studies. A statistically significant loss of diagnostic information was noted with 18-second scans, especially in the upper abdomen.

Breast ultrasound imaging performed with an automated machine was carried out in 89 patients, and images obtained with a conventional ceramic single-focus 4-MHz transducer and a 7.5-MHz polyvinylidene fluoride (PVDF) transducer were compared. The 7.5-MHz PVDF transducer improved overall image quality in 77% of patients and had equal penetration in 83%. It yielded greatly increased diagnostic information in 43% of 81 masses and improved visualization of calcification in 57% of 14 lesions in which calcium was visible on mammograms.

The advent of scanners with an air gap and a tilting gantry have made possible the use of the coronal view in computed tomography of the skull and brain in infants and children. Of 400 axial scans performed over a four-month period, 50 were supplemented by the coronal projection. Although the artifacts, uncomfortable position, and prolonged scanning time associated with coronal scanning make it impractical as the only modality, when used as an adjunct to the axial view it can provide valuable additional diagnostic information.

Computed tomography is an extremely accurate method of obtaining more definitive diagnostic information about a renal mass discovered on a urogram. Benign renal cysts are readily distinguished from solid renal neoplasms, and CT is often valuable in characterizing possible juxtarenal masses. The cause of a nonfunctioning kidney(s) on a urogram can often be discerned, and hydronephrosis is easily detected.

Computed tomography (CT) was used to examine 17 patients with various pathologic conditions (trauma, neoplasm, infection, or arthropathy) involving the sternoclavicular joint or sternum. CT required less time to perform and caused less discomfort to the patient than did conventional linear tomography. CT also demonstrated abnormalities better or provided additional useful diagnostic information in the majority of patients. When plain radiographs are not conclusive, CT is the preferred radiologic modality for the evaluation of the sternoclavicular joint and sternum.

Experience with 2500 patients over age 30 studied by physical examination, x-ray mammography, and sonography enabled definition of several specific clinical situations in which sonography adds meaningful diagnostic information not provided by either of the other examinations. These include: palpable breast masses for cyst-solid differentiation; nonpalpable mammographic masses for cyst-solid differentiation; and women with a symptomatic area in the breast that shows only uniformly dense fibro-glandular tissue on x-ray mammograms. For women with radiographically dense breasts who have no breast symptoms, abnormal physical findings, or mammographic lesions, sonography will identify many benign cysts and also some benign solid lesions, but at best only rarely (none of the 587 cases in this study) will it detect an otherwise occult breast cancer. Our data suggest that sonography should not be a substitute for physical examination and mammography in women over age 30, but rather that in three specific clinical situations it can be a valuable addition to the standard diagnostic evaluation.

The pharmacoangiographic effect of a vasoconstrictor (angiotensin) and a vasodilator (to-lazoline) was compared in 18 patients with bone and soft-tissue tumors. Angiotensin was found to be the drug of choice in increasing diagnostic information on angiography. Ten to 15 µg of angiotensin seems to be a convenient dose in the axillary, iliac, and femoral arteries.

The sonographic findings in 200 patients who underwent concurrent transabdominal and transvaginal pelvic ultrasound were reviewed. The sonographic techniques were compared for image quality, completeness of anatomic detail depicted, and unique diagnostic information. Transvaginal image quality was better in 79%-87% of scans; transabdominal image quality was better in 3%-5% of scans; images of both techniques were equally good in 10%-18% of scans. The techniques provided equivalent diagnostic information in 60%-84% of cases. Transvaginal sonography was particularly helpful when exclusion of ectopic pregnancy was the clinical concern. Individual organs and fine structures were better seen transvaginally, but the regional survey offered by the transabdominal full-bladder approach remains necessary to provide anatomic orientation, particularly when the patient has not been studied previously.

Currently there is considerable interest in the specific use and value of angiography. At The New York Hospital it is used extensively since it provides diagnostic information which cannot be otherwise obtained and gives accurate and specific information for the surgeon. Recently the opportunity arose to study a patient with a large abdominal tumor which was found to be a cystadenoma of the pancreas. The pancreatic arteriogram aided the surgeon in defining the pathologic anatomy and thus helped to make its removal possible. Since cystadenoma of the pancreas is a rare tumor and the study was of such value in the management of this patient, the case report is being presented. A review of the literature reveals approximately 50 to 75 reported cases of cystadenoma of the pancreas (1, 9, 11). The tumor occurs predominantly in the female, with 66 per cent presenting before the age of fifty. The most common site is the body and tail of the pancreas (4, 5). The onset is usually insidious, and the growth may reach...

A little over fifteen years has passed since it was shown by Hertz et al. (8) and Hamilton (7) that radioactive iodine could be put to good use in studying thyroid physiology. Most of the earlier thyroid function studies consisted in indirect measurements of the amount of a tracer dose of radioactive iodine excreted in the urine over a twenty-four to seventy-two-hour period (10, 23, 24, 25, 28). These tests were based on the premise that the thyroid gland was the only tissue which utilized iodine to any extent, and that amounts which were not metabolized were rapidly excreted in the urine. Keating and his group (11) extended these studies to show that more diagnostic information could be obtained if serial samples of urine were collected during the early hours of the test and assayed for radioactivity. If these samples were plotted against time, the renal excretion rate could be calculated, and from this the extrarenal (or thyroidal) rate of accumulation could be determined. While fairly accurate results ...

It is sometimes necessary to immobilize for radiography the head of an unconscious or uncooperative patient. It is unsatisfactory to have it held by personnel, whose hands, with or without lead gloves, would appear on the radiographs, interfering with diagnostic information. Furthermore, it may be difficult to obtain a true lateral skull view of patients who are unable to cooperate. One of us (M. W.) has devised a wooden head-holder shaped like a box, open at the top and one end, which is quite helpful. It was made for us in the hospital's carpenter shop, with glue instead of nails so that it cannot be seen on the radiographs. We are able to obtain satisfactory anteroposterior and lateral views of the skull without moving the patient to the x-ray table, by use of a grid-cassette. The lateral view is achieved by placing the cassette at the side of the box and employing a horizontal x-ray beam. Wedges of slightly compressible radiolucent material (polyurethene foam plastic) are placed on each side of the he...

Percutaneous transhepatic cholangiography is a highly useful and valuable technic providing important anatomic information that can be obtained in no other way. It is particularly helpful in the presence of clinical or chemical jaundice, where conventional diagnostic x-ray examination of the gallbladder and bile ducts offers no help. It permits the differentiation between obstructive and hepatocellular jaundice and offers the opportunity of diagnosis prior to surgical exploration. It is furthermore capable of demonstrating intrahepatic disease not identifiable by other known preoperative or operative diagnostic methods. It furnishes far more information regarding the intrahepatic bile ducts than is obtainable by operative cholangiography. We have been impressed by the ability of this technic to provide definitive diagnostic information in situations which might otherwise require exploratory laparotomy. Obstructive lesions of the biliary system are difficult problems for the surgeon. Patients are frequentl...

Angiography is of great value in the diagnosis and treatment of pulmonary disease. Celis (1) in 1946 described his technic of pulmonary angiography, and in 1951 angiographic findings in pulmonary disease were reported by D otter and Steinberg (2). Lyons (3) in 1957, after angiographic examination of over 600 patients with pulmonary disease, concluded that study of the pulmonary vasculature by angiocardiography was frequently a helpful procedure with rewarding diagnostic information. Pacheco and del Castillo (4) found that angiographic studies following pulmonary resection gave valuable intelligence as to the functional state of the pulmonary vessels and mediastinum. Cicero et al. (5, 6) have also done selective angiography with excellent results. When a pathological process in the lung causes obstruction of the arteries, examination of the veins becomes impossible if one depends on the forward flow of the contrast material. A review of the literature did not disclose a technic for direct opacification of ...

The fluoroscope is an indispensable piece of x-ray apparatus, and when used by a roentgenologist it renders valuable diagnostic information. However, it may be considered one of the most hazardous of all x-ray apparatus. When reports of x-ray burns were frequent, the fluoroscope accounted for a large portion of them. This was particularly true in the instances wherein the roentgenologists suffered burns. Thus it is well known to the radiological profession that the use of the fluoroscope is attended by a certain danger, even in the hands of experts, and has a distinct limitation to certain x-ray diagnoses. Our attention has been called to a monthly review, issued by the National Tuberculosis Association (May, 1931, 14, No.5), in which there appeared a lengthy presentation on the importance of the fluoroscopic examination in suspected cases of pulmonary tuberculosis.1 In order to fortify their situation, and impress their readers with certain arguments in favor of the fluoroscopic examination, they present...

By Sven Dahlgren, M.D., Department of Pathology, and Bjorn Nordenstrom, M.D., Director, Department of Thoracic Radiology, Karolinska Institutet, Stockholm, Sweden. Cloth, $12.50. Pp. 132, with 70 figures. Chicago, Yr. Bk. Pub'rs., 1966. This very good monograph reports in detail on a large clinical experience with transthoracic needle biopsy. The material is well organized, clearly presented, reads easily, and will be a useful basic reference work for all those interested in initiating this technic. The authors have shown quite conclusively that needle biopsy of pulmonary lesions under roentgen television control has been sufficiently developed to become a clinically valuable diagnostic tool. It provides the opportunity for obtaining specific diagnostic information in those lesions that otherwise would not be obtainable except through open thoracotomy and excisional biopsy. Although needle biopsy of pulmonary lesions is not a new procedure, it was never generally accepted as a safe and accurate diagnostic...