Value of laser-assisted angioplasty in the community hospital.

The experience with laser-assisted angioplasty at a community hospital was reviewed. One hundred twenty patients required angioplasty during a 7-month period, and in only 17-13 of whom had superficial femoral artery occlusions--was the use of lasers deemed appropriate. The success rate was 65% for laser-assisted angioplasty and 98% for balloon angioplasty. Laser-assisted angioplasty was the initial intervention in eight of the 13 superficial femoral artery occlusions. In two cases, a wire had been first advanced across the lesion, and in three cases, attempts to cross the lesion with a wire had been unsuccessful. The availability of the laser did not significantly increase the number of cases amenable to angioplasty, and at present laser angioplasty, does not seem to be cost-effective for community hospitals.

Venous "lakes" of the hands.

Following pharmacologic vasodilatation, multiple vascular "lakes" were observed on angiograms of the hand in 55 patients. Most had no history of vascular anomalies or disease. The authors believe that these lakes are venous structures and that their filling is a physiologic phenomenon.

Digital subtraction angiography in the community hospital.

Although digital angiography may involve the same physician processes in the university as in the community hospital, it can be seen that the indications, approaches, and utility of DSA are somewhat different in the two environments. DSA is presently in a state of change, in part because of the maturing of other modalities and also because of the present emphasis on cost-saving in medical imaging. As referring physicians become used to digital arteriographic images, more and more procedures will be performed with DSA. We believe the DSA will have an important role in the community hospital for years to come. Its emergence as the first of the "conventional" imaging techniques to be digitized can be seen as an initial step toward the total digital imaging department of the future.

The value of searching films without specific preconceptions.

The detection of simulated pulmonary nodules was measured in three different situations that required: (1) reports of all significant chest findings (Free Search), (2) only reports of possible nodules (Nodule Search), or (3) evaluation of particular film locations as nodules (Specified Location). ROC curves from these conditions compared how accurately readers could distinguish between the nodule and normal "test locations," and between the films that did and did not contain nodules. In replication of previous results for heterogeneous chest findings, detection accuracy was superior when readers had to search the films. Each reader's distinctions between the nodule and normal test locations became considerably less accurate when these locations were prespecified for explicit evaluation. When asked to search only for pulmonary nodules, most readers substantially increased their false reports of nodules at each level of confidence, with little improvement in their (already high) true-detection rates. Searching for nodules increased both the true-detection and false-detection rates for two readers, who simply appeared to relax a strong bias against reporting nodules in the initial Free-Search situation.