Biomedical subjects
Publications and source records attributed to G A Gooding.
Ultrasound is an effective means of evaluating the iliac arteries, especially in (a) patients with aortofemoral grafts, who are subject to false aneurysm, hematoma, and abscess; and (b) elderly patients with abdominal aortic aneurysms who are at greater risk for iliac aneurysms. While iliac aneurysms are uncommon, recognition is essential, since the complications of rupture are lethal.
The remnant of the umbilical vein, the ligamentum teres, is seen on a high percentage of normal ultrasonograms. In patients with portal hypertension, the umbilical vein often reopens as a collateral vessel and can be visualized sonographically; the authors have recently demonstrated this finding in 30 patients. Recognition of a patent umbilical vein is important, since it currently is the only ultrasonographic finding specific for portal hypertension.
Gray scale ultrasonography permits markedly improved visualization of the parotid gland compared with bistable methods. The normal parotid is echogenic, similar in echo generation to thyroid tissue, but flatter anatomically. Ultrasound can detect a mass lesion in the area of the parotid gland and define whether it is intrinsic or extrinsic, but as yet has limited usefulness in determining the specificity of an abnormality.
Ultrasonograhy is an accurate, effective technique for defining femoral artery aneurysms whether they are atherosclerotic, traumatic, or anastomotic. This noninvasive method of femoral artery assessment allows definition of size and configuration of the lumen and walls of the vessel, detection of intra- and extraluminal thrombus, and characterization of the surrounding tissues.
Radiographic interpretation is often the major factor in the decision to award compensation for job-related complaints, especially in the Veterans Administration system. Three board-certified radiologists reviewed 200 consecutive lumbar and cervical spine examinations and assigned each case to one of three categories: normal, normal for age (not compensable), or degenerative disease (compensable). A critical disagreement, in which at least one radiologist considered the examination compensable and another not compensable, occurred in interpretation of 31% of the cervical and 46% of the lumbar spine examinations. Although the overall detection of radiographic findings was similar among all three radiologists, diagnostic interpretation of the findings varied greatly. Although most radiologists and orthopedists agree that the use of plain radiography of the spine as a deciding factor in awarding compensation is unjustified and inappropriate, until the regulations are changed there is a pressing need for strict, objective, radiographic criteria for determining "normal aging" of the cervical and lumbar spines so that interpreatations can be more uniform.
A major goal of the radiologist is to devise methods to decrease health care costs and radiation exposure without sacrificing diagnostic accuracy. In a large Veterans Administration (VA) hospital, a prospective study was undertaken to determine the optimum number of radiographic projections needed to assess applicants for VA compensation for chest disease or injury claimed to be service-related. Three separate readings of every chest radiographic assessment could have been made from a single posteroanterior view. In eight cases, granulomas or mild hyperexpansion of the lungs were only appreciated using the lateral projection, but these findings were not clinically significant and did not affect decisions as to whether compensation sould be awarded. The only potentially serious lesion missed (a possible pulmonary nodule) using the posteroanterior view alone was also missed using the lateral and only suggested by the oblique views. Extrapolating these results to data on compensation examinations performed in the entire VA system (fiscal year 1978), it was concluded that limiting the radiographic examination of the chest to a single posteroanterior view would eliminate 150,000 radiographs in the evaluation of 190,000 applicants and yield an annual savings of almost $900,000.
In a large Veterans Administration (VA) hospital, a prospective study was undertaken to determine the optimum number of radiographic projections needed to assess applicants for VA compensation for cervical and lumbar spine disease or injury claimed to be service-related. Results show that the final radiographic assessment could be made in 100% (245) of cervical spine examinations using two views (anteroposterior and lateral) and in 99.3% (699/704) of lumbar spine examinations using two views (anteroposterior and a single well centered lateral). Extrapolating these results to data on compensation examinations performed in the entire VA system (fiscal year 1978), it was concluded that limiting the radiographic examinations of the cervical and lumbar spines to these views would eliminate 193,000 radiographs in the evaluation of 100,000 applicants and yield an annual savings of about $1,000,000.
In a large Veterans Administration (VA) hospital, a prospective study was undertaken to determine the optimum number of radiographic projections needed to assess applicants for VA compensation for knee, hand, and foot diseases or injury claimed to be service-related. Results show that the final radiographic assessment could be made in all 535 (100%) of the knee examinations using two views (anteroposterior and lateral), all 181 (100%) of the hand examinations using one view (anteroposterior), and all 223 (100%) of the foot examinations using two views (anteroposterior and lateral). Extrapolating these results to data on compensation examinations performed in the entire VA system (fiscal year 1978), it was concluded that limiting the radiographic examinations of the knee, hand, and foot to these views would eliminate 91,000 radiographs in the evaluation of 119,000 applicants and yield an annual savings of about $500,000.
Arteriography remains the definitive radiologic procedure for diagnosing complications of vascular prosthetic grafting. Gray scale B-mode ultrasonography is well suited for detection of false aneurysms, abscesses, and hematomas. The gastrointestinal series is of limited value in assessing most grafts. In non emergent cases, excretory urography may provide useful diagnostic information as well as determine the location of the kidneys and ureters preoperatively. Computed tomography may aid in demonstrating and following the course of postoperative hematomas; it may also be valuable in demonstrating periprosthetic abscess. A strategy is suggested for selecting the appropriate method of evaluating vascular prosthetic grafts.
A technique of rapid water infusion into the stomach is described as an ultrasonic method to differentiate the gas-free stomach presenting as a solid mass from a mass in the tail of the pancreas. The infusion permits delineation of the tail of the pancreas as a discrete structure.
Ultrasonograms of most pseudocysts have a typical appearance--sharply defined, smooth wall, ovoid, located in the region of the pancreas. However, in reviewing the sonographic appearance of pseudocysts, other ultrasonographic characteristics may occasionally be encountered. Eleven patients with atypical pseudocysts are presented. The demonstration of multiple septations, multiple echoes within a sonolucent mass, and even failure to enhance posteriorly should not exclude the diagnosis of pancreatic pseudocyst in the proper clinical setting. The value of serial scans is also stressed. In this series, it was possible to suggest the diagnosis of infection, hemorrhage, and rupture of pseudocysts by demonstrating cysts with more typical appearances on prior examinations.
Adrenal masses are amenable to ultrasonic examination. The ultrasonic characteristics of eight adrenal masses in 6 patients are described. In particular, an ultrasonic study of the natural history and progression of a large adrenal adenoma is reported. Adrenal masses on the right side may mimic right posterior liver masses on transverse scans alone. They may compress and displace the liver with expansion. Posterolateral impressions on the inferior vena cava occur. Differentiation from a superior pole renal mass is not always possible.
Ultrasonography may be useful as a screening test for carotid body tumors before arteriography. Such tumors are seen as solid, well-circumscribed, weakly echogenic masses located at the carotid bifurcation.
In a study to determine the presence of bacteria on ultrasonic transducers, the authors found micro-organisms in 82% of cultures. The results show that 70% isopropyl alcohol is not a consistently effective germicide for the sterilization of transducers. The presence of bacteria, however, appears to be of little clinical consequence.
Explore the source record for details and available documents.
A 54 year old man was found to have a simple ureterocele with a dilated ureter. Ultrasonography demonstrated the ureterocele as an echo-free structure at the base of the bladder without involvement of the bladder wall. The course of the dilated ureter and its entrance into the bladder were clearly defined.
A splenic lobulation interposed between the tail of the pancreas and the left kidney is not uncommon. On prone ultrasonic scans, this variant of splenic configuration must be considered in the differentiation of anterior masses adjacent to the left kidney and masses originating in the tail of the pancreas. Computed tomography is the most sensitive method to use in making this distinction.
The role of contact B-mode ultrasonography in demonstrating prosthetic vascular grafts was assessed in 24 patients (27 grafts). All grafts were well delineated. End-to-side bypass grafts could be separated from end-to-end replacement grafts by their characteristic appearance. Patent and occluded grafts could not be distinguished either in vivo or in vitro. However, B-mode ultrasonography was ideally suited to the detection of other complications of vascular prosthetic grafts: hematoma, infection, and false aneurysm formation.