Improved brain scan specificity utilizing 99mTc-pertechnetate and 99mTc(Sn)-diphosphonate.

Each of 36 patients was studied with two separate brain scans performed sequentially after the injection of 20 mCi of 99mTc-pertechnetate or 20 mCi of 99mTc(Sn)-diphosphonate. The resulting scans were qualitatively compared, and lesion-to-nonlesion ratios of activity determined. Diagnoses were established by clinical criteria and were supported in the majority of cases by computerized axial tomography or roentgen angiography or both. Histologic confirmation was available in five cases of tumor and in the single cases of subdural hematoma and cerebral abscess. Of 22 cerebral infarctions, 15 were better demonstrated with 99mTc-(Sn)-diphosphonate than with 99mTc-pertechnetate. Of the seven remaining cases, three were visualized equally well with each agent, and three were better demonstrated with 99mTc-pertechnetate. One was not seen with either agent. Of the 12 tumors, 11 were visualized better with 99mTc-pertechnetate than with 99mTc-(Sn)-diphosphonate while in one case the lesion was seen equally as well with both agents. In no case was a lesion definitely seen with one radiopharmaceutical and not with the other. These results indicate that this dual method is helpful in differentiating gliomas and metastases from cerebral infarctions.

Accreditation of graduate medical education in radiology. Historic perspectives.

Initially, accreditation represented a somewhat informal and voluntary relationship between the AMA Council on Medical Education and Hospitals and representatives of the specialty board organizations to jointly survey hospitals where training programs were conducted. In recent years, changes in public policy and the law, and the greater involvement of governmental agencies have institutionalized accrediting decisions as a consideration in noneducational actions such as funding. The accreditation process today has an indirect but important influence upon regulatory activities carried out by governmental agencies; accreditation has thus been transformed, by governmental action, into a public service performed by quasipublic agencies. In order to reconcile educational and professional objectives with present-day societal needs, certain standards must be followed. Accreditation must have autonomy to function independent of political or economic influence and must be impartial and free to act without actual or apparent conflicts of interest. Those involved in the review process must be highly knowledgeable and respected in their own discipline and should be trained in the work of the accrediting agency. The decision-making process must be formal, uniform, and consistent with public standards and procedures that are available to all interested parties. All parties directly affected by the accreditation decision must have the opportunity to present their views under due process. In a separate but related issue, the United States Congress, third-party carriers, and perceptive leaders of the medical education establishment are presently reviewing critically the funding of graduate medical education.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of enzyme, clinical, radiographic, and radionuclide methods of detecting bone metastases from carcinoma of the prostate.

Patients (219) with prostatic adenocarcinoma were classified on the basis of whether or not their bone scans were positive for metastasis. Acid and alkaline phosphatase determinations and clinical evaluations for bone metastases were reviewed. Of those with proved metastases, 43% had no bone pain, 39% had normal acid phosphatase levels, 23% normal alkaline phosphatase levels, 19% normal levels of both enzymes, and 15% normal enzyme levels without bone pain. Twenty-four per cent of the patients with normal enzyme levels and clinically unsuspected bone metastases had bone scans which proved positive for metastasis; 62% of these had normal radiographs.

Magnetic resonance imaging of the spine.

Magnetic resonance imaging provides exciting new perspectives of a broad variety of conditions, including spinal tumors, disc disease, bony changes and degenerative disorders. This technology provides a view of anatomic and pathologic changes in the spinal cord without exposing the patient to ionizing radiation. Disease processes identified only indirectly by other imaging modalities can now be directly identified by magnetic resonance imaging.

Diseases related to asbestos exposure: historical perspective.

Our goal in this brief and limited historical summary of asbestos-related diseases has been to bring the clinician up to date with the current status of this important medical and public health issue. The references will provide an information source for those who require more comprehensive knowledge.

Accuracy of 99mTC-diphosphonate bone scans and roentgenograms in the detection of prostate, breast and lung carcinoma metastases.

A technetium 99m diphosphonate scan is a sensitive detector of bony metastases of breast, prostate, and lung cancer. For these particular neoplasms, a negative bone scan in an asymptomatic patient is adequate evidence for absence of bony metastases and a correlative roentgenographic examination may not be necessary. Positive studies demonstrating multiple characteristic discrete areas of increased activity should be considered strong evidence for metastases. Single equivocal lesions require roentgenographic and occasionally biopsy correlation. If roentgenography fails to reveal the source of increased uptake, (e.g., degenerative disease) the scan lesion should remain suspicious for metastases.

Certificate-of-need in an antitrust context.

Recent cases such as National Gerimedical Hospital and Gerontology Center v. Blue Cross of Kansas City have found that certificate-of-need (CON) legislation did not intend to remove antitrust considerations. This note discusses the exemptions from antitrust provided by the state action doctrine of Parker v. Brown as well as the Noerr-Pennington doctrine, both of which appear to protect provider input into the CON process. Providing information that assists decision-making must be carefully distinguished from providing data that serve the interests of physicians and hospitals.

Radiographic manifestations of gastrointestinal tuberculosis.

Barium studies of a gastrointestinal tract and chest radiographs of 109 patients with gastrointestinal tuberculosis were investigated. The type and site of the tuberculous lesions in the bowel, as well as its association with pulmonary tuberculosis and surgical complications, were reviewed. The ileocecal region is the portion of the gastrointestinal tract most frequently involved. The ulcerohypertrophic type of tuberculous lesion was the most common. Thirty-two percent of the patients had a normal chest radiograph. Nineteen patients had a significant surgical complication. Fistulous tracts and intestinal perforation are rare. The radiographic differential diagnosis with regional enteritis and other forms of inflammatory bowel disease is discussed.

Relative efficacy of radionuclide imaging and computed tomography of the brain.

Computed tomography (CT) with the EMI scanner has been demonstrated to possess a wide spectrum of capabilities in the diagnosis of suspected intracranial disease. This review of 418 dual CT and radionuclide (RN) brain images indicates that RN and CT are complementary in the diagnosis of cerebral infarction, but that CT has a greater capability in brain tumor detection. The classical RN static brain image does not detect cerebral atrophy, hydrocephalus or intraventricular hemorrhage; these conditions are clearly defined by CT.

Antitrust aspects of exclusive contracts in medical imaging.

Exclusive contracts between radiologists and hospitals may be more frequently scrutinized for antitrust violations because of the Hyde v Jefferson Parish Hospital District No. 2 case. In the Hyde case, the lower court decided antitrust law had been violated, and it was the first antitrust case about exclusive medical contracts to be reviewed by the U.S. Supreme Court. The case is a precedent for considering similar circumstances according to traditional business antitrust analyses such as per se violations, tying arrangements, group boycott, and market foreclosure. Areas that may be scrutinized for anticompetitiveness include hospital privileges when radiologists have exclusive contracts with the community's only hospital or provide services unique within an area, and physicians' access to scarce resources (e.g., computed tomography [CT], magnetic resonance [MR] imaging). Radiologists must understand antitrust implications of their hospital contracts; examine the terms of staff appointment, bylaws, and rights; and be able to guide their attorneys through contract negotiations.

Medical image management.

Medical image management is becoming increasingly complex as additional data are produced by equipment using digital techniques. As the requirements to store and display these images increase, the following questions become important: (a) What methods can be used to ensure that information given to the physician represents the originally acquired data? (b) What technology and methods are needed to guarantee that information is presented in a timely fashion when requested? (c) How can an image archiving and transmission system be designed to protect the patient's rights of confidentiality? The authors discuss the legal implications of digital archiving of image information and propose some approaches to designing systems that provide the most information to the physician and yet attempt to minimize infringement of the patient's rights.