Evaluation of teleradiology for interpretation of intravenous urograms.

The diagnostic yield of a commercial teleradiology/picture archiving and communication system (ATT-Philips Comm View T/PACS) was evaluated for 100 urograms. A single image from each examination was digitized (2048 x 1684 x 12-bit pixels) and transmitted from a satellite hospital over a T-1 line using the T/PACS system. The video display of each digitized image was reviewed independently by four radiologists. The same four radiologists reviewed the original film images at a different time without knowledge of their T/PACS interpretation. There was no statistically significant difference in the sensitivity for clinical findings between T/PACS (86%) and film (89%). The false positive rate, however, was significantly higher with T/PACS than with film (44 versus 32 false positive findings per 100 films). We conclude that T/PACS of the type studied here demonstrates sufficient sensitivity for the detection of clinically important urographic findings in the emergency setting. A final reading of the original films is still necessary, however, to assure appropriate specificity.

Acute asthma. Admission chest radiography in hospitalized adult patients.

The utility of admission chest radiography has been controversial in the management of adult patients admitted to the hospital with acute asthma. We reviewed the impact of admission chest radiography on in-hospital management of 54 adult patients with acute asthma. Each patient was admitted after a failed 12-h course of bronchodilator therapy in the emergency ward. Major radiographic abnormalities were found in 20 (34 percent) of 58 occasions. These abnormalities included focal parenchymal opacities, IIM, enlarged cardiac silhouette, pulmonary vascular congestion, new solitary pulmonary nodule and pneumothorax. Subsequent antibiotic use correlated with radiographic focal opacities or IIM, even in afebrile patients, but did not correlate with elevated blood leukocyte count. Based on the evidence of in-hospital alteration of management independent of elevated blood leukocyte count and body temperature, we recommend that chest radiographs be obtained for all adult patients admitted because of acute asthma.

The impact of routine chest radiography on the management of patients admitted from an emergency service.

Adult patients entering a hospital usually undergo a routine admission chest radiographic examination (RACXR). Recently, this practice has been questioned. The clinical course of 188 patients admitted to an adult medical service from the emergency area of an inner city hospital was assessed prospectively. Each of these patients underwent RACXR, ie, the only indication for the examination was admission to the hospital. Four subpopulations considered to be at high risk for treatment-altering radiographic abnormalities were defined prospectively: age of 65 years or older, cigarette smokers, altered mental status, and human immunodeficiency virus (HIV) positivity. RACXR abnormalities were significantly more common in the subpopulations at high risk (104/127, 82%) than in the population at low risk (37/61, 61%) (P less than .01). Abnormalities on RACXR led to altered treatment in five (3%) of the 188 inpatients. Each of these five patients was a member of a subpopulation at high risk (5/127, 4%). Because results suggest that various clinical considerations may affect the yield of RACXR, it is proposed that a blanket recommendation to eliminate RACXR is premature.

Evaluation of a quadtree-based compression algorithm with digitized urograms.

The effect of a quadtree-based data-compression algorithm on the diagnostic yield in digitized radiographs was studied for 100 urograms. Each image was digitized and reviewed at nine decreasing compression ratios ranging from 90:1 to 4.2:1, followed by a review of the uncompressed digital images. Four radiologists independently reviewed the digitized images and the original radiographs and agreed on a reference standard of 201 findings. Sensitivity, measured by the number of findings noted on the compressed digital images, decreased with increasing compression ratios at and above the 11:1 level. No loss of sensitivity was noted with a compression ratio of 4.2:1. Sensitivity decreased more precipitously for calcifications than for soft-tissue masses. Only a minimal loss of sensitivity for bilateral renal function was noted, even with high compression ratios. False-positive rates were unaffected by compression. The authors conclude that quadtree compression ratios of 11:1 and higher may result in loss of sensitivity in clinically relevant findings.

Retained surgical sponge simulating a pancreatic mass.

An abdominal mass evaluated angiographically suggested either a carcinoma or a pseudocyst of the pancreas. Exploratory laparotomy revealed a cystic mass containing a surgical sponge left in the patient's abdomen during a surgical procedure 12 years previously. A review of the literature is included and complications caused by surgical foreign bodies and means of avoiding such complications are discussed.