[Frequency and causes of civil and criminal proceedings in radiology. Analysis of a survey]. / Häufigkeit und Ursache zivil- und strafrechtlicher Verfahren in der Radiologie. Auswertung einer Befragung.

The eagerness of German patients to go to court on account of actual or suspected malpractice of their physicians has increased over the years, as is the case in other Western countries. Media coverage has given rise to criticism of physicians and their services rendered more than before. This naturally also concerns the discipline of radiology, even though the probability of a radiologist being accused in a lawsuit is clearly minor in comparison to the surgical disciplines. In contrast to other fields, the X-ray pictures are always available for a second opinion. In this study, 4760 radiologists were sent a questionnaire by mail and 1503 answered. The questionnaires were evaluated regarding interrogative and informative data from pending or completed proceedings. Lawsuits were directed towards the assessment of examinations (38%), the actual performance of an examination (30%) and not towards providing patients with information as we had expected. Angiographies, mammographies, and radiographies were the most frequent reasons for instituting proceedings. The majority of litigating patients was between 40 and 50 years old. The proceedings led to civil convictions in 30% and criminal convictions in 5.5%. Of the physicians accused of incorrect conduct, 73% were of the opinion that they had been treated unjustly, 26% supported the reproach as justified, and the rest had formed no opinion. Physicians in private practice and senior consultants (70%) were most frequently sued.

Virtual intra-arterial angioscopy (VIA) of the carotid artery based on helical CT data.

The purpose of this study was to visualize both the vessel wall and atherosclerotic plaques in virtual intra-arterial angioscopy (VIA) based on helical CT data sets. To achieve this in vitro, the optimal reconstruction threshold of the vessel wall was determined to be 56.4% of the maximum enhancement. Using this threshold, 20 patients suffering from symptomatic carotid disease were examined in a helical CT scanner. The degree of stenosis was defined using the North American Symptomatic Endarterectomy Trial (NASCET) criteria and compared with results from digital substraction angiography (DSA). Grading of stenoses was only possible by adding the separately computed plaque geometry to the geometry of the vessel wall in a second step. Correlation between VIA and DSA in low grade, medium grade and high grade stenosis was 88%, 93% and 71%, respectively. Complete occlusions were diagnosed correctly in all patients. Sensitivity and specificity for the correct diagnosis of high grade stenosis was 93.7% and 91.3%, respectively. A realistic depiction of intraluminal structures in carotid arteries can only be generated by displaying both the vessel wall and plaque structures simultaneously.

[Role of radiotherapy in the treatment of multiple myeloma]. / Wertigkeit der Radiotherapie in der Behandlung des multiplen Myeloms.

BACKGROUND: Chemotherapy is the treatment of choice in multiple myeloma; but there are no curative options. Therefore, the treatment rationale is characterized by reduction of symptoms and inhibition of complications. Regarding reduction of pain, treatment of (impending) fractures, and spinal cord compression radiation is an important part of palliative treatment. In our retrospective study we report the effect of radiotherapy on reduction of pain, recalcification and the reduction of neurological symptoms and evaluate factors which have an impact on therapeutic outcome. PATIENTS AND METHODS: From 1, Jan 1988 to 31, Dec 1998, 42 patients (19 women, 23 men; range of ages 46 to 85 years, median age 64.9 years) with 71 target volumes were irradiated (median dose 36 Gy, 2 to 3 Gy 5 times/week) because of symptomatic disease (67/71: osseous pain, 45/71: fractures/impending fractures, 13/71: spinal cord compression) (Tables 1 and 2). The median time from diagnosis to the first course of radiotherapy was 11.9 months (0.3 to 90 months). At the time of first irradiation, 5 and 37 patients were in tumor Stage II and III (Salmon/Durie), respectively. The median value of the Karnofsky performance was 70% (40 to 90%). RESULTS: During follow-up (at least 6 months) in 85% of target volumes complete and partial pain relief (measured by patients' perception and the use of analgetic medication) was achieved; recurrences were seen in 8.8%. In 26/56 (46.4%) lesions evaluable a recalcification was seen whereas 17.9% showed progressive disease (comparison of radiographs before and after radiation). In 22.3% of all lesions initially with impending fracture (4/18) radiotherapy failed because of fracture after treatment (Tables 3 and 4). Simultaneous chemotherapy and a Karnofsky performance > or = 70 had a significant impact on a positive response to treatment, respectively. Spinal cord compression symptoms were reduced in 7/13 (53.8%) of patients (scaled due to the classification by Findlay 1987). The median survival from diagnosis for the entire group was 34.9 months (7.5 to 119.3 months), after irradiation 13.1 months (0.2 to 105.3 months) (Figure 1). CONCLUSION: When adequately indicated radiotherapy has shown to be an effective palliative treatment. Taking under consideration that the results are retrospective we suppose that in multiple myeloma the local response to radiation is supported by a favorable performance status and simultaneous chemotherapy. Irradiation treatment does not change prognosis regarding overall survival.