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PubMed2002

Establishing a health outcomes and economics center in radiology: strategies and resources required.

PURPOSE: To describe the resources and strategies required to establish a health outcomes and economics center in radiology. METHODS: Human and nonhuman resources required to perform sound outcomes and economics studies in radiology are reviewed. RESULTS: Human resources needed include skilled medical and nonmedical staff. Nonhuman resources required are: (1). communication and information network; (2). education tools and training programs; (3). budgetary strategies; and (4). sources of income. Effective utilization of these resources allows the performance of robust operational and clinical research projects in decision analysis, cost-effectiveness, diagnostic performance (sensitivity, specificity, and ROC curves), and clinical analytical and experimental studies. CONCLUSION: As new radiologic technology and techniques are introduced in medicine, society is increasingly demanding sound clinical studies that will determine the impact of radiologic studies on patient outcome. Health-care funding is scarce, and therefore third-party payers and hospitals are demanding more efficiency and productivity from radiologic service providers. To meet these challenges, radiology departments could establish health outcomes and economics centers to study the clinical effectiveness of imaging and its impact on patient outcome.

Budgets↗
PubMed1989

[Diagnosis of performance of the locomotor system--wish or reality?].

Originally, the aim and purpose of performance diagnostics in sports were mainly analysed and defined by researchers in sports medicine, training, performance physiologists and internistic specialists in sports medicine. Meanwhile this term has been overused by almost all groups connected with sports in some way or another, to such a degree that scientific standards and the serious purpose of the problem are completely missed. By no means will every testing method connected with sports and sports performance in a very general sense automatically meet the demands that must be made on performance diagnosis. In orthopaedics and sports traumatology, performance diagnosis has neither been set up nor has it been defined in any way. This article is meant to stimulate interest in the problem in these fields as well.

Athletic Injuries↗
PubMed2000

Computer-aided epiluminescence microscopy of pigmented skin lesions: the value of clinical data for the classification process.

Early melanoma is often difficult to differentiate from benign pigmented skin lesions (PSLs). Digital epiluminescence microscopy (DELM) and automated image analysis could represent possible aids for inexperienced clinicians. We designed an automated computerized image analysis system that has the potential for use as an additional tool for the differentiation of melanoma from dysplastic naevi and common naevi. The PC-based pilot system was attached to a common DELM system as the image source. Digital images of PSLs were automatically segmented and a panel of 107 morphological parameters were measured. Additionally, seven clinical parameters were evaluated and used as an additional source of information. Neural networks were then trained to distinguish melanoma from benign PSLs. One class of networks was trained solely based on the morphometric features, whereas the second class of networks was trained on the combination of morphometric and clinical features. The automatic segmentation algorithm was correct in 96% of cases. Using three-way receiver operating characteristic (ROC) analysis, for networks trained solely on morphometric features the volume under surface (VUS) was 0.617 (SD 0.036). The performance was significantly better for networks trained on the combination of both morphometric and clinical features (VUS = 0.682, SD 0.035). In a dichotomous model, distinguishing benign lesion (common naevi + dysplastic naevi) from melanoma, the area under the curve (AUC) from two-way ROC analysis was 0.942 (SD 0.018) for networks trained solely on morphometric features and 0.968 (SD 0.012) for those trained on the combination of clinical and morphometric data (P= NS). Automated feature extraction from PSLs and the training of neural networks as classifiers has thus shown satisfactory performance in a large scale experiment. The addition of clinical data significantly increases the diagnostic performance for distinguishing three classes of lesions (i.e. common naevi, dysplastic naevi and melanoma). Such integrated systems hold promise as a decision aid for the diagnosis of PSLs.

Algorithms↗
PubMed1999

Peritoneal fluid analysis in the differentiation of ovarian cancer and benign ovarian tumor.

PURPOSE: The aim of the study was to try to identify the biochemical markers in peritoneal fluid which might be useful in discrimination between ovarian cancer and benign ovarian tumor. METHODS: The study included 75 patients: 43 with invasive ovarian cancer, 6 with borderline ovarian cancer and 26 with benign ovarian tumor. The peritoneal fluid samples from all these patients were subjected to cytologic examination and to analysis of lactate dehydrogenase (LDH), total protein, albumin and cholesterol. In addition, peritoneal fluid to serum ratio of LDH and total protein, as well as serum CA-125 were assayed. The biochemical parameters were compared between cases of ovarian cancer and cases of benign ovarian tumor, as well as between the different histological types and stages of ovarian cancer. RESULTS: All the examined parameters demonstrated a significant difference comparing patients with ovarian cancer and those with benign ovarian tumor (p<0.001). Yet, the greatest diagnostic accuracy was achieved by measuring peritoneal fluid LDH (86%) and cholesterol (93%). Moreover, significant differences in the level of assayed parameters were found when comparing different histological types and stages of ovarian cancer. In order to further corroborate the diagnostic performance, we combined the parameters of LDH and cholesterol with cytology, thus increasing the diagnostic accuracy to 96%. CONCLUSION: The association of peritoneal fluid LDH and cholesterol may represent a primary tool for the discrimination of patients with ovarian cancer (even borderline) from those with benign ovarian tumor, particularly in the presence of negative cytology.

Adult↗
PubMed2000

The assessment of quality in medical diagnostic tests: a comparison of ROC/Youden and Taguchi methods.

Diagnostic tests are widely used in many areas of modern technological society, but they are of particular importance in medicine, where early and accurate diagnosis can decrease morbidity and mortality rates of disease. How the quality of diagnostic information and decisions should be measured in a meaningful way has become increasingly important in recent years as an abundance of new diagnostic tests have been introduced. A number of seemingly independent indices are studied for evaluating diagnostic performance such as the receiver operating characteristic curves and signal-to-noise ratios. Designing robustness into diagnostic tests can only be achieved by minimizing the variation in the total number of false diagnosis. This article has undertaken a comparison of signal-to-noise ratios developed by Taguchi in quality engineering and system performance in manufacturing industry. A hybrid is also computed and its relevance to physicians as an efficient assessment method is proposed and strongly encouraged.

Decision Support Techniques↗
PubMed2001

Diagnosing acute cardiac ischemia in the emergency department: a systematic review of the accuracy and clinical effect of current technologies.

STUDY OBJECTIVE: Acute cardiac ischemia (ACI) encompasses the diagnoses of unstable angina pectoris and acute myocardial infarction (AMI). Accurate diagnosis and triage of patients with ACI in the emergency department should increase survival for these patients and reduce unnecessary hospital admissions. METHODS: We conducted a systematic review of the English-language literature published between 1966 and December 1998 on the accuracy and clinical effect of diagnostic technologies for ACI. We evaluated prospective and retrospective studies of adult patients who presented to the ED with symptoms suggesting ACI. Outcomes were diagnostic performance (test sensitivity and specificity) and measures of clinical effect. Meta-analyses were performed when appropriate. A decision and cost-effectiveness analysis was conducted that investigated various diagnostic strategies used in the diagnosis of ACI in the ED. RESULTS: We screened 6,667 abstracts, reviewed 407 full articles, and included 106 articles articles in the main analysis. Single measurements of biomarkers at presentation to the ED have low sensitivity for AMI, although they have high specificity. Serial measurements greatly increase the sensitivity for AMI while maintaining their excellent specificity. Diagnostic technologies to evaluate ACI in selected populations, such as electrocardiography, sestamibi perfusion imaging, and stress ECG, may have very good to excellent sensitivity; however, they have not been sufficiently studied. The Goldman Chest Pain Protocol has good sensitivity (about 90%) for AMI but has not been shown to result in any differences in hospitalization rate, length of stay, or estimated costs in the single clinical effect study performed. Its applicability to patients with unstable angina pectoris has not been evaluated. The use of an Acute Cardiac Ischemia-Time-Insensitive Predictive Instrument led to the appropriate triage of 97% of patients with ACI presenting to the ED and reduced unnecessary hospitalizations. CONCLUSION: Many of the current technologies remain underevaluated, especially regarding their clinical effect. The extent to which combinations of tests may provide better accuracy than any single test needs further study.

Acute Disease↗
PubMed2001

Can electronic medical images replace hard-copy film? Defining and testing the equivalence of diagnostic tests.

Electronic medical images are an efficient and convenient format in which to display, store and transmit radiographic information. Before electronic images can be used routinely to screen and diagnose patients, however, it must be shown that readers have the same diagnostic performance with this new format as traditional hard-copy film. Currently, there exist no suitable definitions of diagnostic equivalence. In this paper we propose two criteria for diagnostic equivalence. The first criterion ('population equivalence') considers the variability between and within readers, as well as the mean reader performance. This criterion is useful for most applications. The second criterion ('individual equivalence') involves a comparison of the test results for individual patients and is necessary when patients are followed radiographically over time. We present methods for testing both individual and population equivalence. The properties of the proposed methods are assessed in a Monte Carlo simulation study. Data from a mammography screening study is used to illustrate the proposed methods and compare them with results from more conventional methods of assessing equivalence and inter-procedure agreement.

Breast Neoplasms↗
PubMed2004

Hysteroscopic surgery at the Aga Khan Hospital, Nairobi.

OBJECTIVES: To determine the experience, acceptability and outcome of hysteroscopic surgery at the Aga Khan Hospital, Nairobi. DESIGN: A retrospective study. SETTING: Aga Khan Hospital, Nairobi. PATIENTS: Between May 2000 and April, 2003, 463 cases of hysteroscopy were undertaken at the Aga Khan Hospital, Nairobi, of these 54 patients (11.7%) underwent various hysteroscopic surgical procedures. A review of these cases and their outcomes are analysed and presented. RESULTS: In a thirty six month period 463 cases of Hysteroscopy were done at the Aga Khan Hospital, Nairobi. Of these 54 cases had operative intervention (11.7%). The case load of diagnostic hysteroscopy increased from 50 in the year 2000, to 206 and 159 respectively in the years 2001 and 2002. By this time, some consultants were performing diagnostic hysteroscopies on their own. The surgical procedures performed included hysterscopic retrieval of "lost" IUCD's, and intrauterine bone spicules and hysteroscopic resection of submucous fibroids (25.9% of the cases), resection of endometrial polyps (25.9%) hysteroscopic synechiolysis, (16.6%) and endometrial resection or ablation (cauterisation) (7.4%). All the patients were reviewed by the consultant pool after one week. Three cases of complications were encountered, two cases of uterine perforation and one case of fluid overload (TURP syndrome) following a resection of a submucous fibroid. CONCLUSION: Hysteroscopy and hysteroscopic surgery are the established gold standards for the management of intrauterine pathology. The procedures were well accepted amongst patients who had undergone these procedures. RECOMMENDATIONS: In Kenya, gynaecologists still have to embrace change and undergo adequate and sustained training in the various aspects of hysteroscopy, so as to make the proecdures acceptable and accessable to more patients.

Attitude of Health Personnel↗
PubMed2003

Performance of an immunochromatography test for vivax malaria in the Amazon region, Brazil.

The study was carried out to evaluate the diagnostic performance of the ICT malaria Pf/Pv test for vivax malaria diagnosis in Bel m, Amazon region, Brazil. The results of blood malaria parasites examination using an immunochromatography test were compared with thick blood film (TBF) examination. It was also evaluated the performance of this test storaged at three different temperatures (25 degree C, 30 degree C, and 37 degree C) for 24 hours before use. Overall sensitivity of ICT Pf/Pv was 61.8% with a specificity of 100%, positive and negative predictive value of 100% and 71.8%, respectively and accuracy of 80.6%. The test sensitivity was independent of the parasite density. This test needs to be further reviewed in order to have better performance for P. vivax malaria diagnosis.

Animals↗
PubMed2004

Detecting mental disorders in general hospitals by the SCL-8 scale.

OBJECTIVE: The objective of this study is to validate the eight-item dichotomised version of the Symptoms Check List (SCL-8d) as a screening tool for psychiatric disorders. METHODS: The study population included 198 consecutive new neurological inpatients and outpatients and 294 consecutive internal medical inpatients, aged 18 or older. All patients received the SCL-8d questionnaire, and a stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external SCL-8d validity using the SCAN interview as gold standard. The test was performed based on weighted data to correct for the skewness introduced by stratification. RESULTS: The diagnostic performance of the SCL-8d was excellent in the internal medical setting but not quite as good in the neurological sample. It performed better among the older compared with the younger patients, whereas the scale was not affected by gender. In the combined sample at the cut point 0/1, the sensitivity (SE) of the SCL-8d was 0.73 (confidence interval [CI](95%): 0.60-0.82), the specificity (SP) 0.61 (CI(95%): 0.53-0.68) and the positive predictive value (PPV) 0.42 (CI(95%): 0.34-0.50), using any International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychiatric disorder, excluding somatoform and substance abuse disorders, as gold standard. The risk of a patient having a mental disorder (except phobia, substance abuse or somatoform disorder) was less than 6% in case of a negative screening test. In patients with a current depressive disorder, 87.1% (27/31) were screening positive, and all except 1 (93.0%) of the 14 patients with a modest to severe depression scored 1 or higher on the SCL-8d. All 17 patients with an anxiety disorder, excluding phobias, were screening positive. CONCLUSION: The study suggests that the SCL-8d is a valid, brief screening tool for use in nonpsychiatric medical settings, especially to detect emotional psychiatric disorders (EPDs).

Adolescent↗
PubMed2003

Computerized diagnostic decision support system for the classification of preinvasive cervical squamous lesions.

Previous studies have revealed considerable interobserver and intraobserver variation in the histological classification of preinvasive cervical squamous lesions. The aim of the present study was to develop a decision support system (DSS) for the histological interpretation of these lesions. Knowledge and uncertainty were represented in the form of a Bayesian belief network that permitted the storage of diagnostic knowledge and, for a given case, the collection of evidence in a cumulative manner that provided a final probability for the possible diagnostic outcomes. The network comprised 8 diagnostic histological features (evidence nodes) that were each independently linked to the diagnosis (decision node) by a conditional probability matrix. Diagnostic outcomes comprised normal; koilocytosis; and cervical intraepithelial neoplasia (CIN) I, CIN II, and CIN III. For each evidence feature, a set of images was recorded that represented the full spectrum of change for that feature. The system was designed to be interactive in that the histopathologist was prompted to enter evidence into the network via a specifically designed graphical user interface (i-Path Diagnostics, Belfast, Northern Ireland). Membership functions were used to derive the relative likelihoods for the alternative feature outcomes, the likelihood vector was entered into the network, and the updated diagnostic belief was computed for the diagnostic outcomes and displayed. A cumulative probability graph was generated throughout the diagnostic process and presented on screen. The network was tested on 50 cervical colposcopic biopsy specimens, comprising 10 cases each of normal, koilocytosis, CIN I, CIN II, and CIN III. These had been preselected by a consultant gynecological pathologist. Using conventional morphological assessment, the cases were classified on 2 separate occasions by 2 consultant and 2 junior pathologists. The cases were also then classified using the DSS on 2 occasions by the 4 pathologists and by 2 medical students with no experience in cervical histology. Interobserver and intraobserver agreement using morphology and using the DSS was calculated with kappa statistics. Intraobserver reproducibility using conventional unaided diagnosis was reasonably good (kappa range, 0.688 to 0.861), but interobserver agreement was poor (kappa range, 0.347 to 0.747). Using the DSS improved overall reproducibility between individuals. Using the DSS, however, did not enhance the diagnostic performance of junior pathologists when comparing their DSS-based diagnosis against an experienced consultant. However, the generation of a cumulative probability graph also allowed a comparison of individual performance, how individual features were assessed in the same case, and how this contributed to diagnostic disagreement between individuals. Diagnostic features such as nuclear pleomorphism were shown to be particularly problematic and poorly reproducible. DSSs such as this therefore not only have a role to play in enhancing decision making but also in the study of diagnostic protocol, education, self-assessment, and quality control.

Bayes Theorem↗
PubMed1997

Tuned-aperture computed tomography (TACT). Theory and application for three-dimensional dento-alveolar imaging.

OBJECTIVES: To introduce a new method for creating three-dimensional (3-D) radiographic displays based on optical aperture theory known as tuned-aperture computed tomography (TACT). With a number of advantages over conventional plain film and tomographic imaging. METHODS: The TACT algorithm and some of its capabilities are explained and published with results of in vitro simulations produced from a well-tested multi-tube tomosynthetic x-ray system. Examples of TACT reconstructions of a tooth with naturally occurring caries which were produced from multiple projections and generated with a new servo-controlled single-tube prototype are illustrated. Current imaging strategies in dentistry and their shortcomings in the detection of dento-alveolar disease are reviewed. Pertinent theoretical aspects of the TACT reconstruction algorithm are described and dental applications discussed in light of these limitations. RESULTS: Results of several published in vitro investigations derived from a prototype TACT system are referenced. Sample images of a tooth with naturally occurring caries derived from an even newer system are displayed. All data are consistent with the hypothesis that TACT imaging yields diagnostic performance either comparable, or superior, to that obtainable from conventional control modalities depending on the diagnostic task. Moreover, all investigations cited demonstrated conclusively the obvious theoretical benefits associated with the acquisition of multiple projections in three dimensions. CONCLUSIONS: TACT shows promise as a supplement to film-based dental radiography and as a digital alternative to conventional tomographic systems used in dento-alveolar applications.

Algorithms↗
PubMed1998

Digital radiography and caries diagnosis.

Direct digital acquisition of intra-oral radiographs has been possible only in the last decade. Several studies have shown that, theoretically, there are a number of advantages of direct digital radiography compared with conventional film. Laboratory as well as controlled clinical studies are needed to determine whether new digital imaging systems alter diagnosis, treatment and prognosis compared with conventional methods. Most studies so far have evaluated their diagnostic performance only in laboratory settings. This review concentrates on what evidence we have for the diagnostic efficacy of digital systems for caries detection. Digital systems are compared with film and those studies which have evaluated the effects on diagnostic accuracy of contrast and edge enhancement, image size, variations in radiation dose and image compression are reviewed together with the use of automated image analysis for caries diagnosis. Digital intra-oral radiographic systems seem to be as accurate as the currently available dental films for the detection of caries. Sensitivities are relatively high (0.6-0.8) for detection of occlusal lesions into dentine with false positive fractions of 5-10%. A radiolucency in dentine is recognised as a good predictor for demineralisation. Radiography is of no value for the detection of initial (enamel) occlusal lesions. For detection of approximal dentinal lesions, sensitivities, specificities as well as the predictive values are fair, but are very poor for lesions known to be confined to enamel. Very little documented information exists, however, on the utilization of digital systems in the clinic. It is not known whether dose is actually reduced with the storage phosphor system, or whether collimator size is adjusted to fit sensor size in the CCD-based systems. There is no evidence that the number of retakes have been reduced. It is not known how many images are needed with the various CCD systems when compared with a conventional bitewing, nor how stable these systems are in the daily clinical use or whether proper cross-infection control can be maintained in relation to scanning the storage phosphor plates and the sensors and the cable. There is only sparse evidence that the enhancement facilities are used when interpreting images, and none that this has changed working practices or treatment decisions. The economic consequences for the patient, dentist and society require examination.

Contrast Media↗
PubMed2006

Role of positron emission tomography in the (re-)staging of oesophageal cancer.

BACKGROUND: Various studies have demonstrated that 18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET), measuring altered tissue glucose metabolism, is a promising non-invasive method for detecting both distant nodal and haematogenous metastases in patients with oesophageal carcinoma (OC) and might thus prevent futile esophagectomy. Moreover, FDG-PET is a promising tool in assessing response to non-surgical treatment, and might therefore be used for an early decision on whether treatment should be stopped or continued. MATERIAL AND METHODS: Review of the recent literature regarding the diagnostic performance of FDG-PET in the preoperative staging of patients with OC and regarding diagnostic accuracy of FDG-PET in assessing response to neoadjuvant therapy in patients with OC compared to conventional techniques (especially computed tomography (CT) and endoscopic ultrasonography (EUS)). RESULTS: A search of the literature resulted in the inclusion of 16 studies on the diagnostic value of FDG-PET. Sensitivity and specificity for the detection of locoregional metastases were moderate. Sensitivity and specificity were reasonable for distant metastases. The diagnostic accuracy of FDG-PET in assessing response to treatment was similar to the accuracy of EUS, but significantly higher than that of CT. CONCLUSIONS: The staging value of FDG-PET in OC patients is limited in the detection of locoregional metastases; however; its value is higher in the detection of distant lymphatic and haematogenous metastases. Moreover, FDG-PET is a valuable tool for the non-invasive assessment of histopathologic tumour response after neoadjuvant therapy..

Adenocarcinoma↗
PubMed2004

Validity of scores generated by a web-based multimedia simulated patient case software: a pilot study.

PURPOSE: The value of multimedia simulated patient cases (MSPCs) in medical education remains unclear. The authors conducted a pilot study to assess the validity of automated scores of diagnostic reasoning ability provided by DxR Clinician, a widely available Web-based MSPC software. METHOD: In 2002-03, all 89 students enrolled in a required third-year primary care clerkship at the University of California, Davis, School of Medicine were assigned to complete four MSPCs. The authors determined the degree of correlation between the Clinical Reasoning Score (CRS) and Level of Diagnostic Performance (LDP) generated by the MSPC software and subscale scores from a validated measure of diagnostic reasoning sophistication, the Diagnostic Thinking Inventory (DTI). RESULTS: Of 356 completed case events, instructor override of automated scoring was required in 206 (58%) to obtain an accurate LDP and CRS. Mean DTI subscale scores improved significantly from the beginning to the end of the year (p <.0001, Wilcoxon signed rank test). However, there were no significant correlations between CRS or LDP scores on any of the four cases and either of the two DTI subscale scores. CONCLUSION: Automated diagnostic reasoning scores generated by one widely available MSPC software appear to lack criterion validity. The validity of automated diagnostic reasoning scores generated by MSPCs should be established before such cases can be confidently employed as educational tools.

Clinical Clerkship↗
PubMed2001

Technologic advances for evaluation of cervical cytology: is newer better?

Among those women who have cervical cancer and have been screened, 14% to 33% of the cases represent failure to detect abnormalities that existed at the time of screening. New technologies intended to improve detection of cytologic abnormalities include liquid-based, thin-layer cytology (ThinPrep, AutoCyte), computerized rescreening (PAPNET), and algorithm-based computer rescreening (AutoPap). This report combines evidence reviews conducted for the U.S. Preventive Services Task Force and the Agency for Healthcare Research and Quality, in which we systematically identified articles on cervical neoplasia, cervical dysplasia, and screening published between January 1966 and March 2001. We note the challenges for improving screening methods, providing an overview of methods for collecting and evaluating cytologic samples, and examining the evidence about the diagnostic performance of new technologies for detecting cervical lesions. Using standard criteria for evaluation of the diagnostic tests, we determined that knowledge about the sensitivity, specificity, and predictive values of new technologies is meager. Only one study of liquid-based cytology used a reference standard of colposcopy, with histology as indicated, to assess participants with normal screening results. Lack of an adequate reference standard is the overwhelming reason that test characteristics cannot be properly assessed or compared. Most publications compare results of screening using the new technology with expert panel review of the cytologic specimen. In that case, the tests are not independent measures and do nothing to relate the screening test findings to the true status of the cervix, making determination of false-negatives, and thus sensitivity, specificity, and negative predictive value, impossible. We did not identify any literature about health outcomes or cost effectiveness of using these tools in a system of screening. For the purposes of guiding decision making about choice of screening tools, the current evidence is inadequate to gauge whether new technologies are "better" than conventional cytology..

Colposcopy↗
PubMed1999

Tumor-adopted diagnosis of bladder cancer.

70% of our patients suffering from bladder cancer present themselves initially with a superficial tumor (Tis, Ta, T1) and only 30% are initially seen with a muscle-invasive carcinoma (T2, T3-4, N+, M+). Clinical history, physical examination, urine cytology, IVP and cystoscopy in combination with adequate tissue harvest by transurethral resection are the basis of our diagnostic procedures. Bimanual palpation, systematic biopsies, sonography, computed tomography, bone scan and further procedures are not to be considered as routine examinations and are only used in special situations. Only exactly defined diagnostic algorithms permit the development and use of valid prognostic parameters. They further allow to perform a tumor-orientated therapy and to compare patient groups which have been treated in different institutions according to similar or different therapeutic regimens. This includes the importance of a TNM-oriented therapy. It has to be stressed though that the prevalence of distinct pathological changes, such as bone metastases in T1 tumors, as well as financial resources, have to be taken into account. Further, definite therapeutic intention such as a curative vs. palliative regimen is a decisive criterium for the amount of performed diagnostic procedures. It also is of importance that new diagnostic modalities, if introduced into the clinical routine, have to be investigated concerning their validity in relevant and large patient cohorts and their rationale in our diagnostic algorithm has to be defined. This is predominantly not the case in radiological imaging techniques and thus a large amount of resources are wasted.

Algorithms↗
PubMedDate not supplied

Large-image intensifier photofluorography and conventional radiography in pulmonary emphysema. Correlation with computed tomography.

Large-screen image intensifier (II) photofluorography was compared with full-size screen-film chest radiography in the diagnosis of pulmonary emphysema in 84 patients. Photospot films and conventional radiographs were interpreted independently by three radiologists. Computed tomography (CT) was used as an independent reference technique, and diagnostic performance of chest radiography in various CT patterns of emphysema was evaluated. The difference in diagnostic sensitivity for emphysema in favor of conventional chest radiography over photofluorography (0.65 versus 0.56) was statistically significant (p less than 0.05). Specificity of the imaging modalities was equal: 0.78 in full-size films and 0.77 in photospot films. All CT patterns of emphysema had great false negative response rates in chest radiography, which is an inaccurate technique for the diagnosis of emphysema. CT is required for reliable radiologic evaluation of emphysema.

Emphysema↗