Utility of Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas.

CSF-venous fistulas are an increasingly recognized type of CSF leak that can be particularly challenging to detect, even with recently improved imaging techniques. Currently, most institutions use decubitus digital subtraction myelography or dynamic CT myelography to localize CSF-venous fistulas. Photon-counting detector CT is a relatively recent advancement that has many theoretical benefits, including excellent spatial resolution, high temporal resolution, and spectral imaging capabilities. We describe 6 cases of CSF-venous fistulas detected on decubitus photon-counting detector CT myelography. In 5 of these cases, the CSF-venous fistula was previously occult on decubitus digital subtraction myelography or decubitus dynamic CT myelography using an energy-integrating detector system. All 6 cases exemplify the potential benefits of photon-counting detector CT myelography in identifying CSF-venous fistulas. We suggest that further implementation of this imaging technique will likely be valuable to improve the detection of fistulas that might otherwise be missed with currently used techniques.

Method for rehabilitation of the alcohol-addicted pilot in a commercial airline.

Based upon data available from the National Council on Alcoholism and encouraged by the emerging concept of alcoholism as a disease responsive to the multidisciplinary approach to its management, a program to assist alcoholic employees was instituted in 1968 at the United Airlines Maintenance Operations Center in San Francisco. This program was developed through the tripartite efforts of management, union and the medical department. Using this basic model, a similar effort to assist flight crew members of our San Francisco pilot domicile emerged in 1970. The method is oriented to the three-fold process of identification, referral for treatment, and followup. The mechanism of identification includes an intervention process. Treatment is accomplished in a specialty hospital embracing the principles of Alcoholics Anonymous. The essential monthly followup is continued for 2 years. Twenty-five pilots in United's system have been returned to flight deck duties after treatment and recertification.