OBJECTIVE: To determine whether a Bayesian method of lung scan (LS) reporting could influence the management of patients with suspected pulmonary embolism (PE). DESIGN: 1) A descriptive study of the diagnostic process for suspected PE using the new reporting method; 2) a non-experimental evaluation of the reporting method comparing prospective patients and historical controls; and 3) a survey of physicians' reactions to the reporting innovation. SETTING: University of Virginia Hospital. PATIENTS: Of 148 consecutive patients enrolled at the time of LS, 129 were completely evaluated; 75 patients scanned the previous year served as controls. INTERVENTION: The LS results of patients with suspected PE were reported as posttest probabilities of PE calculated from physician-provided pretest probabilities and the likelihood ratios for PE of LS interpretations. RESULTS: Despite the Bayesian intervention, the confirmation or exclusion of PE was often based on inconclusive evidence. PE was considered by the clinician to be ruled out in 98% of patients with posttest probabilities less than 25% and ruled in for 95% of patients with posttest probabilities greater than 75%. Prospective patients and historical controls were similar in terms of tests ordered after the LS (e.g., pulmonary angiography). Patients with intermediate or indeterminate lung scan results had the highest proportion of subsequent testing. Most physicians (80%) found the reporting innovation to be helpful, either because it confirmed clinical judgement (94 cases) or because it led to additional testing (7 cases). CONCLUSIONS: Despite the probabilistic guidance provided by the study, the diagnosis of PE was often neither clearly established nor excluded. While physicians appreciated the innovation and were not confused by the terminology, their clinical decision making was not clearly enhanced.

Adult↗

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New radiopharmaceuticals and new applications in medicine.

All areas of radiology are constantly evolving. At times rapid advances are made because new equipment or pharmaceuticals are introduced. At others the evolution is gradual as established procedures and techniques are refined. The following review of selected areas in nuclear medicine includes both dramatic changes due to new developments and evolutionary changes in established techniques. The first section reviews the development of monoclonal antibodies for use in radioscintigraphy of neoplastic disease. Although many articles have been written about this topic over the years, the clinical applications have suddenly expanded because the Food and Drug Administration (FDA) recently approved one monoclonal antibody for use in the imaging of colorectal and ovarian cancer. It is anticipated that a number of other antibodies will be approved for clinical scintigraphy of both malignant and benign disease and immunotherapy. It is advised that the radiologist performing nuclear medicine procedures become knowledgeable about this expanding area of clinical application. The second section reviews several new radiopharmaceuticals that are being used with increasing frequency for myocardial imaging. The behavior of these tracers is different from that of thallium, and specialized imaging techniques are required. Although the clinical value of these agents is still questioned by some, they are widely used. Familiarity with this topic is recommended. The last section reviews some of the radiopharmaceuticals available for renal imaging and functional evaluation. The relatively new technetium-labeled pharmaceutical that approximates the behavior of hippuran is emphasized. New applications with the renal cortical imaging agent technetium DMSA are also reviewed. A thorough knowledge of the biologic behavior of these tracers and appropriate imaging and measurement techniques is extremely important for their appropriate clinical use.

Antibodies, Monoclonal↗

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CT measurements of the anterior portions of the diaphragm with illustrative abnormal cases.

One hundred and two adult patients without evidence of diaphragmatic disease were examined by computed tomography. Patients were excluded who had evidence of neoplasma frequently associated with peritoneal implants, liver metastases, ascites, or pleural effusions. The anterior portion of the right diaphragm leaflet could be evaluated in thirteen patients and the left in 82. The normal range of diaphragm thickness was 1.2-28.6 mm on the left and 2.6-26 mm on the right. Causes for apparent increased thickness of the diaphragm leaflets are discussed and several abnormal cases illustrated.

Colonic Neoplasms↗

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Epicardial lipoma: a CT diagnosis.

Primary cardiac tumors are rare and epicardial lipomas are rare within this group. We are reporting a case diagnosed by CT in an 89-yr-old female.

Aged↗

PubMedDate not supplied

Update on nuclear medicine.

Explore the source record for details and available documents.

Antibodies, Monoclonal↗