Diagnostic imaging management in Manitoba: 1995-2000.

As part of a 5-year imaging management plan being developed for the single insurance carrier in Manitoba, the radiologic utilization for the province was reviewed. For the fiscal year 1993 (April 1, 1992, through March 31, 1993), 1,056,694 imaging studies were performed in a total patient population of 1,133,117 in 81 hospitals and 39 offices in which 648 units of equipment were operated by 773.4 full-time personnel at a cost of $100,302,812 ($75,227,109 in U.S. dollars). The skin dose for the total population for the year was 40,112 Gy, compared with 35,513 Gy in 1979. Since 1979, there has been a 9% increase in the number of radiologic examinations (from 972,426 examinations), a greater need for more personnel to conduct ultrasound, mammography, computed tomography, and magnetic resonance imaging examinations, and striking costs escalation (from $25,082,500 to $100,302,812). Reduction of total funding for imaging services will be possible only if the medical service infrastructure and physician behavior are altered, since imaging is a support service. Hospital services must be integrated and the infrastructure reduced, and physicians must adhere to guidelines and practice protocols for requesting consultations.

Hypersensitive lung disease due to avian antigens.

Five patients, three exposed to budgerigars (parakeets) and two to chickens, had immunological lung reactions. A Type III hypersensitivity response likely accounts for the pulmonary alteration. The inflammatory exudate accumulates within the alveolar walls and adjacent lobular septa. Radiologically, this is manifested as reticular linear densities and/or multiple small nodules, the interstitial pattern. With spillage into the distal air spaces, an acinar pattern emerges. As this disease is reversible in its early stages, increased awareness and proper management may lead to a reduction in the number of patients who are subsequently diagnosed as having "idiopathic pulmonary fibrosis".