A comparison of patient dose for examinations of the upper gastrointestinal tract at 11 conventional and digital X-ray units in The Netherlands.

The objective of this study was to derive the effective dose to patients from examinations of the upper gastrointestinal (GI) tract at 11 X-ray units in 10 Dutch hospitals. Entrance dose and entrance dose rate were measured at the surface of a homogeneous PMMA phantom and at the entrance surface of the image intensifier. Dose-area products (DAPs) were assessed during examinations of patients. The patients (334 females and 256 males) ages were 18-95 years (average 52 years). Effective dose was assessed from DAP using Monte Carlo computer calculations for male and female mathematical anthropomorphic phantoms. The DAPs measured during the survey showed substantial variations, i.e. an overall average value of 21 Gy cm2 and a range of average DAP per X-ray unit varying from 7 to 56 Gy cm2. Variations in the number of images (8-28) and the fluoroscopy time (1.7 min-7.0 min) were also large. A DAP to effective dose conversion factor of 0.32 mSv Gy cm-2 was derived for upper GI studies. The dose survey yielded an overall average effective dose of 6.7 mSv. At one location an examination involving as many as 28 projections was performed, whilst maintaining a DAP well below 15 Gy cm2 and an effective dose below 6 mSv. This was achieved using modern equipment (i.e. high frequency generator, digital spot films) with 0.2 mm additional copper filtration and a relatively high tube voltage. For examinations of the upper GI tract, the application of a reference value of 30 Gy cm2 for the DAP will ensure that, in general, the effective dose to individual patients will not exceed 15 mSv.

Gastric outlet obstruction as a presenting manifestation of systemic lupus erythematosus.

A patient with nausea and vomiting who subsequently proved to have systemic lupus erythematosus is described. Although gastrointestinal involvement is common in systemic lupus erythematosus it is rare as an initial manifestation. Gastric outlet obstruction was shown on the air contrast examination while the mucosa at endoscopy was normal. The gastric symptoms regressed after treatment with high dose corticosteroids and a repeat air contrast examination of the stomach was normal. This stricturing process may have been caused by a local peritonitis.

[Comparison of biphasic radiologic stomach and duodenum studies with fiber endoscopy for the diagnosis of peptic ulcer and stomach carcinoma]. / Vergelijking van bifasisch radiologisch maag-en duodenumonderzoek met fiberendoscopie voor de diagnostiek van peptische zweren en maagcarcinomen.

In a prospective, blind study of 385 patients with dyspepsia, the diagnostic value of biphasic radiological examination of stomach and duodenum was compared with endoscopy. The patients were examined for presence of peptic ulcers and gastric carcinomas. No golden standard being available, kappa values were calculated for the comparison. The kappa values were 0.67 and 0.77 for gastric and duodenal ulcers, respectively; for gastric carcinomas the value was 0.91. These values indicate good agreement. The sensitivity and specificity of both methods were high; a lower sensitivity of radiological examination for duodenal ulcers was accounted for by ulcers smaller than 5 mm; for larger ulcers, the sensitivity and specificity of both methods were practically the same. It is concluded that the two methods are of equal value for the diagnosis of peptic ulcers and gastric carcinomas. Endoscopy offers the major advantage that biopsy samples can be taken for histological examination or culturing. The biphasic radiological examination, on the other hand, is cheaper and often better tolerated by the patient.