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Background: Given the Affordable Care Act (ACA) implementation and the rapid transformation underway in the U.S. hospital system, it is important to take stock of the context in which governmental entities and nonprofit hospitals are meeting their shared responsibility for the public’s health. This article discusses key requirements for hospital tax exemption at the federal and state levels, and specifically discusses the responsibilities of nonprofit hospitals with regard to community benefit and to lessening the burdens of government. The emerging convergence of responsibilities presents a unique opportunity for government, hospital and community collaboration to improve public health in the U.S. Purposes: The purpose is to suggest the foundation and incentives for nonprofit hospitals and government to work more closely in addressing the public health needs of the populations they serve. Methodology/Approach: Our analysis focused on case law, statutory language and journal articles. Findings: As part of the ACA, an important policy objective of the Community Health Needs Assessment (CHNA) requirement for nonprofit hospitals is to encourage greater responsibility for public health into the nonprofit hospital sector. The CHNA requires input from the community and public health experts. Providing community benefit and lessening the burden of government are tax-exempt requirements in many states. The closer that nonprofit hospitals and local governments work together during the CHNA process, the greater the opportunities to tangibly improve public health, and at the same time reduce hospital risk of taxation at the local level. Practice implications: The sum of state and local tax exemption laws and regulations and the new CHNA federal requirements under the Affordable Care Act set the stage for a convergence of hospital government public health responsibilities. Therefore, for those states and communities interested in promoting and improving public health, the CHNA requirement of the ACA provides a unique opportunity for governmental entities to partner with their community hospitals to improve the public’s health.

Serial sonographic examinations were performed on 15 volunteers five days during the expected midcycle. The 75 sonographic studies were evaluated in a nonbiased manner, and the following features were assessed: (1) the presence or absence of a follicle within the ovary; (2) if present, the average dimension of the follicle; (3) the ability to delineate both ovaries; and (4) the presence of associated changes, such as involution of the follicle, echogenic texture within the follicle, or fluid in the cul-de-sac. The sonographic findings were correlated with serial leutinizing hormone (LH) assays as well as basal body temperature charts. As defined in the study, the correlation between the sonographic findings and hormonal determination were considered excellent in 70% of the cases, good in 20%, and poor in 10%. Both ovaries were delineated in 73% of the examinations performed, thus substantiating the ability of sonography to detect maturing ovarian follicles.

The four major types of hiatal hernia repairs are described with regard to the surgical procedures, postoperative radiological manifestations, and differential features. Following a diaphragmatic crural repair, no subdiaphragmatic esophagus is seen. The fundus of the stomach appears normal. Other common procedures create an intra-abdominal esophagus; fundoplication creates a “fundic pseudotumor” effect, posterior gastropexy leaves a smoothly curved lower esophagus, and Mark IV repair creates an acutely angulated terminal esophagus. Recognition of these features is essential in analyzing the effectiveness of the repair and in evaluating surgical complications.

Exclusive contracts between radiologists and hospitals may be more frequently scrutinized for antitrust violations because of the Hyde v Jefferson Parish Hospital District No. 2 case. In the Hyde case, the lower court decided antitrust law had been violated, and it was the first antitrust case about exclusive medical contracts to be reviewed by the U.S. Supreme Court. The case is a precedent for considering similar circumstances according to traditional business antitrust analyses such as per se violations, tying arrangements, group boycott, and market foreclosure. Areas that may be scrutinized for anticompetitiveness include hospital privileges when radiologists have exclusive contracts with the community's only hospital or provide services unique within an area, and physicians' access to scarce resources (e.g., computed tomography [CT], magnetic resonance [MR] imaging). Radiologists must understand antitrust implications of their hospital contracts; examine the terms of staff appointment, bylaws, and rights; and be able to guide their attorneys through contract negotiations.

Spontaneous cerebrospinal fluid rhinorrhea has been known to occur in association with hydrocephalus. The specific pathophysiology which results in a potential communication between the cerebrospinal fluid space (subarachnoid space) and the nasopharynx is unknown. The relationship of CSF movement and rhinorrhea was evaluated in ten random source mongrel dogs. These data suggest that spontaneous CSF rhinorrhea may occur during the early developmental phase of communicating hydrocephalus in dogs. At this time radiopharmaceutical movement showed ventricular entry and clearing. When the lateral ventricles enlarged, ventricular radiopharmaceutical stasis was seen and the rhinorrhea disappeared. This suggests that CSF rkinorrhea may act as a compensatory mechanism which partially protects the CSF compartment to withstand the extra CSF during the early development of communicating hydrocephalus.

To facilitate the proper interpretation of MR images, it is necessary for the radiologist to be alert to the many potential sources of image artifacts.

Radioactive chelates such as 99mTc-DTPA are advantageous in renal imaging, particularly in defining functional and morphological abnormalities of the excretory tract. In a review of more than 200 studies, 19 cases of lower-tract disease were diagnosed by the gamma camera image alone. In 16 of them, the diagnosis was confirmed by excretory urography. Normal radionuclide patterns are described and compared with the characteristic findings in caliectasis, hydronephrosis, and hydroureter. By facilitating evaluation of renal perfusion, renal glomerular function, and gross renal structure as well as good definition of excretory function, radioactive chelate imaging is ideally suited for use as a general screening test.

Recent cases such as National Gerimedical Hospital and Gerontology Center v. Blue Cross of Kansas City have found that certificate-of-need (CON) legislation did not intend to remove antitrust considerations. This note discusses the exemptions from antitrust provided by the state action doctrine of Parker v. Brown as well as the Noerr-Pennington doctrine, both of which appear to protect provider input into the CON process. Providing information that assists decision-making must be carefully distinguished from providing data that serve the interests of physicians and hospitals.

When small or large bowel is distended with fluid, certain characteristic features can be seen on ultrasound which cannot be visualized when the bowel is collapsed. The proximal and distal portions of the small bowel can frequently be differentiated both in vitro and in vivo by the echoes emanating from the valvulae conniventes ("keyboard sign"). This depends upon the angle at which the bowel segment is scanned in relation to its long axis, the relative amount of intraluminal fluid and gas, the diameter of the bowel in relation to the beam width of the transducer, and the intrinsic resolution of the scanning system. Similarly, the ascending and transverse colon can be recognized by haustral sacculations, the distal rectosigmoid colon and rectum by the rectal valves. The tubular shape, characteristic arrangement and location, and peristaltic motion of most fluid-filled bowel segments are helpful in differentiating loops of bowel from cystic masses in the abdomen or pelvis.

The response of cerebrospinal fluid (CFS) pressure to increased arterial carbon dioxide tension (Pco2) was evaluated in 5 control animals and 7 animals with experimentally induced communica

Two cases of Hemophilus injluenzae meningitis in infants are presented. In both cases, narrowing of vessels at the base of the brain and mUltiple small vessel occlusions of the middle and callosal systems were demonstrated at angiography, and acute communicating hydrocephalus was demonstrated by cisternography. Cisternography is a safe diagnostic technique that will demonstrate bulk movement of cerebrospinal fluid and changes associated with acute meningitis, thereby aiding in the selection of patients who may benefit from diversionary shunts.

Post-tracheostomy lesions are becoming more commonplace and surgical techniques for definitive repair of these abnormalities are being developed. These lesions, in general, occur at two sites, the proximal lesions at the tracheostomy incision and the distal lesions 1·5 to 2·5 cm inferior in the area of the tracheostomy balloon cuff. Granuloma formation, stenosis, tracheomalacia, and perforation of the tracheal wall have been encountered in our experience. Clinical symptoms depend upon the type and location of the lesion as well as on the patient's awareness and physical activity. Radiological evaluation offers an accurate method to depict the anatomical and physiological alterations. This radiological assessment should begin with routine postero-anterior and lateral chest radiographs followed by fluoroscopy. Laminograms and special oblique views are often helpful. Contrast tracheograms using powdered tantalum allow good mucosal detail as well as excellent delineation of structural and physiological abnormalities.

Cerebrospinal fluid images (cisternograms) are obtained after injection of an appropriate radiopharmaceutical into the subarachnid space. Abnormal accumulations of radioactivity may be seen in cisternographic images of patients with localized enlargement of the CSF space. A number of these patterns including post craniotomy defects, leptomeningeal, porencephalic, and posterior fossa cysts, and focal atrophy on the external cranial surface as well as meningoceles, myelomeningoceles and cerebellar atrophy are demonstrated.

The introduction of a radiopharmaceutical into the lumbar subarachnoid space and subsequent imaging of the CSF pathways has proven useful in children for the evaluation of hydrocephalus, CSF leaks, diversionary shunts, and abnormal communications with the cerebrospinal fluid space.Cisternography is safe, simple, and has low morbidity.The procedure is accurate and we believe that it will become more widely used.

The cisternographic appearance of 6 patients with cerebellar atrophy is reviewed. These findings are correlated with those found at pneumoencephalography in 5.The analysis suggests that one cannot, at present, specifically diagnose cerebellar atrophy by CSF imaging, but that it offers excellent promise as a screening procedure.

Pseudoxanthoma elasticum (PXE) is a systemic disorder characterized by xanthoma-like skin lesions, angioid streaks in the optic fundus, and gastrointestinal hemorrhage. This disorder is transmitted by an autosomal recessive gene and may represent a basic defect of calcium metabolism resulting in primary calcification of elastic tissue. The most common roentgenologic manifestations are soft tissue and vascular calcifications, atheromatous plaques, and narrowing of peripheral arteries. These roentgenologic features must be correlated with the clinical and pathologic findings.

Meningitis causes inflammatory changes that alter cerebrospinal fluid absorption acutely. Healing with fibrosis can lead to localized or generalized obliteration of the cerebrospinal fluid space which can also end in an absorptive abnormality. The result in both instances may be hydrocephalus usually of the communicating type.The cisternograms, cerebral angiograms, and pneumoencephalograms of a series of 10 postmeningitis patients were analyzed to characterize the findings, especially with regard to the CSF flow pattern as reflected by cisternography.Eight patients had communicating hydrocephalus and 2 showed a normal CSF movement pattern. Of the 8 patients with communicating hydrocephalus, 4 had stasis of the radiopharmaceutical in the ventricular area from 24-48 hours after lumbar injection. This suggests that certain of these patients might benefit from a CSF diversionary shunt.

A summary of the lung scan patterns in pulmonary embolism versus those in congestive heart failure and emphysema is given in Table v.The following conclusions may be drawn:1. Pulmonary emboli most frequently cause focal segmental or lobar defects. Ninety per cent of individual emboli resulted in this pattern.2. Congestive heart failure usually presents as: (a) an irregular inhomogeneous perfusion pattern; (b) focal nonsegmental perfusion defects superimposed on the irregular pattern with the focal defects corresponding to the alveolar pattern on the concurrent chest roentgenogram; (c) a reversal of the normal perfusion ratio between upper and lower lobes; (d) cardiac enlargement; and (e) changes due to pleural effusion.3. The most common pattern in emphysema is an irregular inhomogeneous distribution of perfusion. Focal, nonsegmental defects are the next most common pattern. In contrast to pulmonary emboli, focal segmental and lobar defects occur infrequently. The perfusion lung scan is as sensitive as th...

SummaryThe histological characteristics of neoplasms that occur in the posterior cranial fossa can often be predicted by a knowledge of the patient’s age and the specific anatomical location of the tumor. Dividing the posterior fossa into midline, cerebellar fossa and cerebellopontine angle provides a scheme to characterize abnormal accumulations of radioactivity according to their anatomical locations. Midline lesions arise from bases activity on the lateral view and are in the midline on the posterior view. Lesions of the cerebellar fossa may be adjacent to but do not appear to arise from the basal structures and are not in the midline. Cerebellopontine angle tumors are adjacent to and appear to arise from the normal radioactivity at the skull base but lie lateral to the midline. The expected distribution of histological types of neoplasms in each area according to age are discussed.

The "fissure sign" appears as a linear area of decreased radioactivity on a perfusion scan which corresponds in position and configuration to the interlobar fissure. This pattern is seen in association with pleural fluid, thickening of the interlobar fissure, chronic lung disease, and pulmonary microemboli.