ABSTRACT
Screening mammography has not yet become a standard procedure. There are great variations in image quality and radiation dose. Mean glandular dose has become the most frequently used description of radiation dose in screening mammography. Because of the low energy x-ray beam required for the procedure, the use of mean glandular dose as the radiation exposure indicator may cause a misunderstanding of the dose-risk relationship and result in confusion about radiation exposure and the risk of induced neoplasm. Data are presented to show that increases in both maximum glandular dose and imparted energy are greater than the increases in mean glandular dose with comparable increases in breast thickness. In the future, an indication of total imparted energy should replace the use of mean glandular dose as the standard for describing radiation dose in screening mammography.
Subject(s)
Breast Neoplasms/etiology , Breast Neoplasms/prevention & control , Mammography/standards , Mass Screening/standards , Neoplasms, Radiation-Induced/etiology , Body Constitution , Breast/anatomy & histology , Dose-Response Relationship, Radiation , Female , Humans , Mammography/adverse effects , Maximum Allowable Concentration , Photons , Radiation Dosage , Risk FactorsABSTRACT
Current hospital policies controlling original diagnostic radiographs do not serve the best interests of either the patients or the institutions. A survey of 200 randomly selected hospitals shows that approximately 40% of the hospitals would not release the original radiograph directly to the patient. Even more important, hospitals will destroy original radiographs without prior notification of the patient. Although statutes and case law support the institutional ownership of the x-ray film, there is a strong legal trend allowing the patient the use of the film. There are potential problems with patient control of the original radiographic image, but there is no evidence that these problems would develop if current hospital policies were changed to allow the patient physical possession of the films. Because there are economic incentives for hospitals to destroy the original radiographs, hospital policies should be liberalized to allow patients to acquire and maintain possession of their own original radiographic images.
Subject(s)
Hospitals, Community , Medical Records , Ownership/trends , Patient Access to Records , Patient Rights , X-Ray Film , Copying Processes , Forms and Records Control , Humans , Medical Records/legislation & jurisprudence , Ownership/legislation & jurisprudence , Risk Assessment , Sampling Studies , Surveys and Questionnaires , Time Factors , United StatesABSTRACT
Preventive screening measures for low back pain are limited. Despite considerable evidence that anatomic narrowing of the lumbar spinal canal is a risk factor for specific back problems, difficulty in measuring the canal without unacceptable radiation exposure, cost, or discomfort has limited the assessment of its clinical significance. Using ultrasound to measure the lumbar canal is relatively easy to do, and provides accurate values. In this paper we review the reports on this use of ultrasound, including our own experience in a case control study, and discuss the potential use of ultrasonic measurement as a screening tool to identify narrow lumbar canals.
Subject(s)
Back Pain/prevention & control , Spinal Stenosis/prevention & control , Ultrasonography/methods , Back Pain/etiology , Evaluation Studies as Topic , Humans , Pilot Projects , Spinal Stenosis/complications , Spinal Stenosis/diagnosisABSTRACT
The oblique parasagittal diameter of the lumbar spinal canal at the L5-S1 level was measured in 49 employees of the Wm Jennings Bryan Dorn Veterans' Hospital using real time ultrasound in a case-control study. Individuals with a canal diameter of less than 14 mm represented the lowest 10th percentile in this population and being in the narrowest 10th percentile constituted a risk factor for time missed from work because of low back pain (odds ratio 10.7). Whereas numbers in this pilot study are small, results are consistent with earlier ultrasound studies done in the United Kingdom and with other research showing increased morbidity from low back pain in individuals with small lumbar canals. Ultrasound has advantages over other modalities for measuring the size of the lumbar canal and may be useful as a preplacement screening examination in industry.
Subject(s)
Back Pain/pathology , Occupational Diseases/pathology , Spinal Canal/pathology , Adult , Female , Humans , Male , Middle Aged , Pilot Projects , Racial Groups , Reference Values , Sex Factors , UltrasonographyABSTRACT
Results of a series of 2i liver scans with 131-I rose bengal in 21 patients who developed progressive jaundice in the neonatal period are described. Using the 131-I rose bengal scan alone, an attempt was made to separate the patients into two groups, the first with total bile obstruction (biliary atresia) and the second with only partial biliary tract obstruction (intrinsic liver disease). The diagnostic accuracy of the scan was 82%. An additional diagnostic criterion, the count radio, is suggested. The determination of this ratio requires no additional effort or expense and would improve the diagnostic accuracy of the scan used alone in this series of patients.