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Objective: To collect data on the operation of two private radiation oncology practices which operate linear accelerators in order to compare their patterns of practice with that of the practice of a public teaching hospital radiation oncology department., Method: Retrospective review of practice records and collection of data on the utilisation of the respective radiation oncology practices., Results: Patient data was analysed to provide a "summarised" profile of treatment of the major cancers, by primary site, for each practice. Problems were encountered in adapting existing records at the various centres in order to obtain compatible data for comparison. The study demonstrated the need for adequate and consistent data to be collected by Australian radiation oncology facilities so that valid comparisons of practice patterns can be undertaken.

In the mid-1970s, after decades of clinical use, the utility of electrocardiographic exercise testing for the evaluation of patients with suspected ischemic heart disease was critically examined and questioned. Concurrent with this critique, two sophisticated, more expensive and powerful "nuclear" exercise tests were introduced sequentially for clinical use: myocardial perfusion imaging with thallium-201 and radionuclide ventriculography with technetium 99m. The published indications for the two tests are similar, and both have been shown to offer advantages over ECG stress testing in selected populations. However, few data are available regarding the comparative utility of thallium versus ventriculographic imaging. As part of a prospective study to assess the efficacy of cardiovascular nuclear medicine studies, we undertook the present analysis to assess the clinical evolution of these tests and to elucidate factors responsible for clinicians' choice for the often competing examinations. The study examined 213 consecutive patient referrals for thallium scintigraphy and 183 referrals for ventriculography, ranging from patients with no symptoms or highly non-specific chest pain syndromes (21% of referrals) to patients with proven coronary disease (28% of the referrals). Twenty-one percent of patients were referred to confirm the clinical impression that the patient did not have coronary disease, 40% to confirm its presence, and 37% to determine its severity. Analyses were undertaken to determine the factors that dictated a preference for thallium scintigraphy rather than ventriculography; only the physician's intent in testing and level of training were significant predictors for a particular nuclear test.

Analyses of procedure utilization are of importance if accurate projections are to be made of local and national needs as the population ages. Nuclear Medicine records of a general hospital were analyzed for 1986, to determine utilization patterns in the oldest old (age 85 years and greater) as compared with younger patients. The most elderly comprised 1.3% of the population of this state, but "consumed" 3.9% of the studies carried out in Nuclear Medicine (or a rate 3 times greater than expected). The average number of procedures/patient during the year was 1.56 in the oldest old vs 1.57 in younger individuals. The sex ratio of procedure utilization was 65% female (slightly lower than state wide national estimates of the female portion of the population). A far lower percentage of studies were performed as outpatients in the oldest old (12.2%) than in the younger population (44.9%); contributing factors were discussed. Of the procedures, several had the same percentage utilization in the oldest old and younger groups (gated cardiac blood pool, liver plus hepatobiliary, and radiogallium imaging). Bone scans were slightly less common in the very elderly. However, thyroid studies and radiothallium cardiac imaging were performed significantly less frequently in the more elderly. Procedures carried out more frequently in the very elderly were gastrointestinal bleeding examinations and lung imaging. Possible reasons for this were pointed out.