Routine abdominal and pelvic ultrasound examinations: an audit comparing radiographers and radiologists.

An audit of 202 routine abdominal and pelvic ultrasound examinations was carried out to evaluate the clinical performance and interpretation of these scans by radiographers and compare them with radiologists, and to investigate the extended role of radiographers in performing these scans. Each scan was first performed by a radiographer and then repeated by the radiologist. The findings were subsequently compared and any discrepancy resolved by re-scanning the patient with or without the involvement of an independent radiologist, or by follow-up of the patient by other imaging studies. In 158 (78.2%) scans, there was complete agreement between the radiographer's and radiologist's findings. In 44 scans (21.8%), there was incomplete agreement--there were 108 abnormal findings in these scans with incomplete agreement/discrepancy in 53 abnormalities. Overall, the accuracy of radiographers was 92.0% and radiologists was 91.7%; however, the accuracy rates were 94.0% and 96.4%, respectively, when minor abnormal findings without significant influence on the patient's clinical outcome were excluded.

Case report: Tuberculous hepatic and splenic abscess.

Tuberculous abscess of the liver is rare and delay in diagnosis is common. The case of a 66-year-old Singaporean Chinese female with tuberculous liver abscess is reported. The abscess had an unusual septated ('honeycomb-like') ultrasonographic and computed tomographic appearance and the diagnosis was made with difficulty from material aspirated from the hepatic lesion.

Computed tomography and ultrasound diagnosis of mycotic aneurysm of the abdominal aorta due to Salmonella.

The case of a 56 year old diabetic Chinese male, with a Salmonella bovismorbificans (serogroup C) mycotic aneurysm of the abdominal aorta is presented. The lesion was seen by computed tomography and ultrasound and the patient was successfully treated by primary resection, debridement and grafting. Computed tomography criteria for the diagnosis of mycotic aneurysms of the abdominal aorta are discussed. Ultrasound identified the aortic aneurysm correctly but was unable to demonstrate the associated psoas abscess in this case.

Trends of diverticular disease of the large bowel in a newly developed country.

Five hundred twenty four consecutive barium enemas done over an 18-month period were reviewed in Singapore to ascertain the prevalence and distribution of diverticular disease in the large bowel. In this study, the prevalence rate was 20 percent, which is comparable to European and American studies but higher than similar studies in Asian countries. However, the distribution of the disease showed a predominance of right-sided disease (70 percent). This is a pattern that is markedly different from that seen in Europe and North America, where the disease involves largely the left side of the large bowel. The high prevalence rate in this series is at variance with the widely held belief that diverticulosis occurs less frequently in oriental communities.

Results of intermediate measures from a population-based, randomized trial of mammographic screening prevalence and detection of breast carcinoma among Asian women: the Singapore Breast Screening Project.

BACKGROUND: Although increasing rates of breast carcinoma incidence have been observed in Asian countries, appropriate strategies for detecting early stage breast carcinoma in such communities have been difficult to formulate, particularly because no large population screening trial specifically involving Asian women has been reported. The objective of this study was to evaluate the effectiveness and quality of mammography as a screening technique for Singaporean women, who are predominantly Chinese. METHODS: In this prospective study, 166,600 women in Singapore ages 50-64 years were randomized to either 2-view mammography without physical examination (67,656) or observation (97,294, controls) over 2 years. RESULTS: Of these women, 28,231 (41.7%) responded and were screened; they were more likely to be married, have more formal education, be working, be Chinese, and be in a higher socioeconomic group (P < 0.001 for all variables). To assess for response bias that could affect outcome, results were also evaluated for nonrespondents (n = 39,425). The incidence rate of cancers among nonrespondents (1 per 1000 woman-years) was less than the 1.3 in women not invited to have screening (P = 0.03, relative risk [RR], 1.3; 95% confidence interval [CI], 1.0-1.7). However, cancers arising from nonrespondents did not differ significantly in stage distribution when compared with cancers within the control group. For every 1000 women screened, 4.8 cancers were detected. The prevalence ratio (the number of cancers detected per 1000 women at first screening divided by the corresponding incidence rate in controls per year) was 3.6 for screened women and 2.4 for women invited to have screening. The majority of cancers detected through screening were early stage, with 64% as either ductal carcinoma in situ (26%) or Stage I disease (38%) and was significantly more than the corresponding 26% in women not invited to have screening (P < 0.001). When only invasive cancers were considered, screened women still had more early cancers, with 65% having no lymph node involvement, compared with 47% in the group not invited to have screening (P = 0.001; RR, 1.4; 95% CI, 1.2-1.7). Women who were screened had half the risk of having Stage II or later cancers (P < 0.0001; RR, 0.5; 95% CI, 0.4-0.7) when compared with women not invited to have screening. This higher detection rate of early cancers through screening was accomplished with acceptable recall rates of 8% for further mammographic films or physical examination and a biopsy rate of 1.0% (10 per 1000 women screened). The interval cancer rate was 2.1 per 10,000 women screened in the first year of follow-up. CONCLUSIONS: These positive results of intermediate measures suggest that, in Asian communities, screening mammography could be an important modality for detecting early stage breast carcinoma. However, the low compliance rates suggest that health education efforts must focus on issues related to acceptability if such programs are to succeed.