Cost analysis of different protocols for imaging a patient with acute flank pain.

The aim of this study was to analyse the costs of different diagnostic approaches to patients with acute flank pain. Four different diagnostic approaches were considered: (a) spiral CT without contrast medium (CM); (b) plain film, ultrasonography (US) and intravenous urography (IVU)--the latter procedure is used in our department in cases still unsolved following the former investigations (28% in our experience); (c) plain film, US and spiral CT without CM (as an alternative to IVU in 28% of cases); and (d) IVU. The cost of each procedure in a university hospital was calculated, following analysis of the differential costs of each investigation (equipment, depreciation and maintenance costs, related materials and services, radiologists, radiographers, nurses) and their common costs (auxiliary personnel and indirect internal costs). Finally, we calculated the full cost of each procedure and applied it to the different diagnostic approaches. The full cost of each approach was: (a) spiral CT without CM = 74 Euro; (b) plain film, US and IVU (28%) = 66.89 Euro; (c) plain film, US and spiral CT without CM (28%) = 64.93 Euro; (d) IVU = 80.90 Euro. Intravenous urography alone or in unsolved cases is not to be considered because it provides higher costs and worse diagnostic results, whereas X-ray dose to patient is almost equal between IVU and spiral CT. Spiral CT integrated to plain film and US in unsolved cases could be preferred because of lower cost and dose to patient, though reaching a diagnostic conclusion may take longer than an immediate spiral CT.

Digital vs conventional radiography: cost and revenue analysis.

The objective of this study was to analyse and compare the operating and investment costs of two radiographic systems, a conventional and a digital one, and to evaluate the cost/revenue ratio of the two systems. The radiological activity over 1 year for chest and skeletal exams was evaluated: 13,401 chest and 7,124 skeletal exams were considered. The following parameters of variable costs were evaluated: the difference between variable proportional costs of the two technologies, the effective variable cost of any size film, including the chemicals, and for different sizes of digital film, variable costs of chest plus skeletal exams performed with the two techniques. Afterwards the economical effect was considered taking into account depreciation during a time of utilization ranging between 8 and 4 years. In the second part of the analysis the total cost and the revenues of the two technologies were determined. The comparison between the digital and conventional systems has shown the following aspects: 1. Digital radiography system has a much higher investment cost in comparison with the conventional one. 2. Operating costs of digital equipment are higher or lower depending on the film size used. Evaluating chest X-ray we reach a breakeven point after 1 year and 10,000 exams only if displayed over 8 x 10-in. film and after 30,000 if displayed over a 11 x 14-in. film. 3. The total cost (variable cost, technology cost, labour cost) of digital technology is lower than that of the conventional system by 20 % on average using 8 x 10-in. film size. 4. Digital technology also allows lesser film waste and lesser film per exam

Trieste PACS project: a functional assessment.

A picture archiving and communication (PAC) system (CommView by AT&T and Philips) has recently been installed in the Radiology Department of the University of Trieste, Italy, and is currently under experimental evaluation. The current status of the system and the planned developments are reported. A major project at present is the evaluation of the impact of the PAC system on the radiology system on a functional basis, by applying in the medical field a modelling methodology developed to analyse manufacturing systems. Other research in progress is devoted to technical, clinical and ergonomic aspects, on the basis of a comprehensive assessment project.

[The biphasic contrast method in the stomach examination. A comparative study with standard method and correlations with endoscopy (author's transl)]. / L'indagine radiologica dello stomaco mediante tecnica bifasica. Studio di confronto con la tecnica tradizionale e correlazioni con l'endoscopia.

A two years-experience, using the biphasic contrast method in the evaluation of the stomach, is reported. Endoscopic and radiological results are compared. Our previous reports with standard contrast method are also reviewed. Ulcerative and neoplastic pathologies were studied and classified as proposed in the "trial policentrico multidisciplinare paritetico". The double contrast method has greatly increased the accuracy of X-ray diagnosis, considerably reducing the difference with endoscopy.

[Gray scale echotomography of the kidney: technique and anatomy (author's transl)]. / Ecotomografia renale con scala dei grigi: tecnica ed anatomia.

The authors illustrate all the different scanning techniques for the kidney and review the normal anatomic patterns in every scanning plane. Using gray scale machines, high-frequency long focussed transducers and appropriate gain settings, it is possible to obtain well defined images, with high resolution; these allow to recognize the renal margins, the cortex, the medulla and the renal sinus structures. The large number of scanning planes, both longitudinal and transverse, allow a detailed evaluation of the normal renal anatomy, the relationships of the kidneys with the neighbouring structures (fasciae, ligaments, fat and vessels) and organs (liver, adrenals, spleen and pancreas) are well recognized. The authors systematically introduce the different echotomographic aspects of the normal kidney. Echotomography can also inform about the renal position and size.