Trends and Predictors of Imaging Utilization by Modality within an Academic Health System's Active Patient Population.

RATIONALE AND OBJECTIVES: Evaluate trends and demographic predictors of imaging utilization at a university-affiliated health system. MATERIALS AND METHODS: In this single-institution retrospective study, per capita estimates of imaging utilization among patients active in the health system were computed by cross-referencing all clinical encounters (2004-2016) for 1,628,980 unique patients with a listing of 6,157,303 diagnostic radiology encounters. Time trends in imaging utilization and effects of gender, race/ethnicity, and age were assessed, with subgroup analyses performed by imaging modality. Utilization was analyzed as both a continuous and binary outcome variable. RESULTS: Over 13 years, total diagnostic exams rose 6.8% a year (285,947-622,196 exams per annum), while the active population size grew 7.0% a year (244,238-543,290 active patients per annum). Per capita utilization peaked in 2007 at 1.33 studies/patient/year before dropping to 1.06 from 2011 to 2015. Latest per capita utilization was 0.22 for computed tomography, 0.10 for MR, 0.20 for US, 0.03 for NM, 0.51 for radiography, and 0.07 for mammography. Over the study period, ultrasound utilization doubled, whereas NM and radiography utilization decreased. computed tomography, MR, and mammography showed no significant net change. Univariate analysis of utilization as a continuous variable showed statistically significant effects of gender, race/ethnicity, and age (P < 0.0001), with utilization higher in males and Blacks and lower in Asian/Pacific Islanders and Hispanics. Utilization increased with age, except for a decline after age 75. Many of the effects of age, gender, and race/ethnicity were also found when analyzing the binarized utilization variable. CONCLUSIONS: Although absolute counts of imaging studies more than doubled, the net change in per capita utilization over the study period was minimal. Variations in utilization across age, gender, and race/ethnicity may reflect differential health needs and/or access disparities, warranting future studies.

Síndrome de la bilis calcárea. Presentación de un caso / Calcareous-bile syndrome

Se realiza una breve revisión de la literatura extranjera y se añade a la literatura médica cubana, un caso de síndrome de la bilis calcárea. Se insiste en que el desconocimiento de esta entidad hace que se diagnostique poco, y es por ello que son escasos los informes que existen en la literatura médica. Las posibilidades de pasar por alto el diagnóstico puede conducir a errores en la terapéutica. el examen radiográfico simple favorece su hallazgo, no así los examenes contrastados. El tratamiento quirúrgico se fundamenta en el proceso inflamatorio previo que ocasiona trastornos en las sales del calcio en el interior de la vesícula, y que provocan el estado de "prelitiasis". Se informa un caso tratado en nuestro Servicio y se recogen experiencias que condujeron a una terapéutica inadecuada con un desenlace fatal (AU)