Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain.

BACKGROUND AND PURPOSE: We conducted a prospective randomized study of patients with acute low back pain and/or radiculopathy to assess the effect of knowledge of diagnostic findings on clinical outcome. The practice of ordering spinal imaging, perhaps unintentionally, includes a large number of patients for whom the imaging test is performed for purposes of reassurance or because of patient expectations. If this rationale is valid, one would expect to see a measurable effect from diagnostic information, per se. MATERIALS AND METHODS: A total of 246 patients with acute (<3 weeks) low back pain (LBP) and/or radiculopathy (150 LBP and 96 radiculopathy patients) were recruited. Patients were randomized using a stratified block design with equal allocation to either the unblinded group (MR imaging results provided within 48 hours) or the blinded group (both patient and physician blinded to MR imaging results.) After the initial MR imaging, patients followed 6 weeks of conservative management. Roland function, visual pain analog, absenteeism, Short Form (SF)-36 Health Status Survey, self-efficacy scores, and Fear Avoidance Questionnaire were completed at presentation; 2, 4, 6, and 8 weeks; and 6, 12, and 24 months. Improvement of Roland score by 50% or more and patient satisfaction assessed by Cherkin symptom satisfaction measure were considered a positive outcome. RESULTS: Clinical outcome at 6 weeks was similar for unblinded and blinded patients. Self-efficacy, fear avoidance beliefs, and the SF-36 subscales were similar over time for blinded and unblinded patients, except for the general health subscale on the SF-36. General health of the blinded group improved more than for the unblinded group (P = .008). CONCLUSIONS: Patient knowledge of imaging findings do not alter outcome and are associated with a lesser sense of well-being.

A comparison of preoperative imaging techniques for predicting patellar tendon graft length before cruciate ligament reconstruction.

Autogenous bone-patellar tendon-bone is commonly used as graft material for cruciate ligament reconstructions. If this type of graft is too long, graft fixation other than an interference screw may be required. If it is too short, selection of another type of graft may be necessary. If the length of the patellar tendon portion of the graft could be accurately predicted, preoperative planning could determine the adequacy of this graft and choice of fixation for the planned procedure. Using lateral radiographs with the knee flexed 30 degrees, standard magnetic resonance imaging, and magnetic resonance imaging with supplemental three-dimensional reconstructions, we measured the length of the patellar tendon in cadavers and then compared these measurements with the actual patellar tendon length measurements. Linear regression analysis resulted in r2 values of 0.80, 0.43, and 0.65 for lateral radiographs, standard magnetic resonance imaging, and magnetic resonance imaging with three-dimensional reconstructions, respectively. We concluded that lateral radiographs at 30 degrees of knee flexion are the most accurate predictors of patellar tendon length.

Selenium-based digital radiography versus conventional film-screen radiography of the hands and feet: a subjective comparison.

OBJECTIVE: The purpose of this study was to subjectively compare the visibility of normal anatomy of the hands and feet using selenium-based digital radiography versus conventional film-screen (100-speed) radiography. SUBJECTS AND METHODS: Digital and film-screen images of the hands and feet of 24 patients were obtained without an antiscatter grid using identical X-ray exposure. Each pair of images was evaluated independently by five experienced radiologists for visibility of normal anatomy using a six-point rating scale. Soft tissues, cortical bone, and trabeculae were evaluated. For each observer, "equivalence" was defined as a mean difference in image quality of less than 1 unit on the 0-5 scale used in the study. Paired t tests were also performed to determine whether the average visibility rating of one technique was statistically superior to that of the other at a .05 level of significance for each observer and at each anatomic landmark. RESULTS: In all categories, selenium-based digital images were rated equivalent to film-screen images by the five observers. Using the sum of the nine landmarks, four of the five observers rated the quality of selenium-based digital images superior to that of film-screen images. CONCLUSION: Subjective visibility of normal anatomy of the hands and feet using selenium-based digital radiography was similar to that achieved using conventional film-screen radiography.

Lobular carcinoma in situ: what clinicians need to know.

The essential point is that LCIS cells are not likely to progress to invasive cancer. Rather, they represent breast tissue that is predisposed to cancer. Management thus emphasizes close follow-up.