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Noninvasive detection of early asbestos-related disease of the thorax: algorithmic analysis of radiographic, nuclear, and serologic tests.

Improved imaging techniques may assist in the diagnosis of early asbestosis, such as could occur from "asbestos in place." These include (1) increased visualization of visceral pleural thickening, (2) high-resolution computed tomography (HRCT), and (3) gallium scanning, combined with evidence of serum markers indicating inflammation-associated pulmonary collagen formation. Combining these imaging and serum test observations with a clinically useful algorithmic approach may permit the diagnosis of "early" asbestosis, which is not now possible from the individual test results or from an unweighted combination of such data.

Asbestos↗

Temperature distributions in hyperthermia by electromagnetic induction: a theoretical model for the thorax.

Steady-state temperature solutions to the bioheat equation are presented for magnetic induction heating of a thoracic model consisting of a spherical tumor embedded in lung tissue which is layered by muscle and fatty tissue. Analytical solutions are presented for each of the tissue regions along with their numerical evaluations over a range of physical characteristics, including surface cooling effects. A strong dependence of tumor temperature on size and blood perfusion rate is shown to exist and can be used to optimize treatment parameters. Tendencies of the chest muscles and overlaying fatty tissue to overheat, particularly in the case of an obese patient, are discussed along with the alleviating influence of surface cooling. Healthy lung tissue, on the other hand, is shown to be safe from any significant damage in such a heating situation. Transient times required for tumors to achieve thermal equilibrium are computed and shown to depend strongly on tumor size and, to a lesser extent, on blood perfusion rate. Finally, the overall results obtained from the model are compared with available clinical data and are found to be in line with those observations.

Hot Temperature↗

A comprehensive physical image quality evaluation of a selenium based digital x-ray imaging system for thorax radiography.

A selenium based digital x-ray system dedicated to chest radiography has been installed by the UK Department of Health's Medical Devices Agency at Leeds General Infirmary, UK, to undergo a comprehensive evaluation, including the physical image quality. The underlying characteristics which define the overall image quality of a system are the following: sensitometric response, modulation transfer function, and noise power spectrum. These have been measured objectively on preprocessed digital data acquired under relevant radiographic conditions. The image data is further processed prior to hard copy display. The displayed image quality may only be measured subjectively; threshold contrast detail detectability is such a measure which can be related to the objective measures of image quality. The objective imaging characteristics suggest that Thoravision has a significant advantage over conventional radiography imaging systems. However, subjective measures have demonstrated that the image processing can have a significant effect on the perceived image quality. Thoravision has the potential to deliver a significantly improved image quality to clinicians with no increase in radiation exposure to the patient, or image quality may be maintained with a reduction in radiation exposure. Digital image processing is central to the efficiency with which it achieves this.

Biophysical Phenomena↗

Role of computed tomographic scanning of the thorax prior to bronchoscopy in the investigation of suspected lung cancer.

BACKGROUND: Fibreoptic bronchoscopy (FOB) is the usual initial investigation of choice in patients with suspected endobronchial carcinoma, but it is often non-diagnostic. Once a positive diagnosis has been made, many patients undergo staging by computed tomographic (CT) scanning to assess the extent of the disease and its suitability for radical treatment. To determine whether initial CT scanning before FOB is a cost effective way of reducing subsequent unnecessary or unhelpful invasive diagnostic procedures, a study was undertaken in 171 patients with suspected endobronchial carcinoma. METHODS: A randomised two group study was performed with all patients undergoing an initial CT staging scan. In group A the CT scans were reviewed before FOB, allowing cancellation or a change to an alternative invasive procedure if considered appropriate. In group B all patients proceeded to FOB with the bronchoscopist blinded to the result of the CT scan until after the procedure. RESULTS: In group A six of 90 patients (7%) required no further investigations as the CT scan was either normal, consistent with benign disease, or consistent with widespread metastatic disease. Of the remainder, bronchoscopy was diagnostic in 50 of 68 (73%) in group A compared with 44 of 81 (54%) in group B (p = 0.015). Overall, a positive diagnosis was made after a single invasive investigation in 64 of 84 patients (76%) in group A compared with only 45 of 81 patients (55%) in group B (p = 0.005). Only seven of 90 patients (8%) in group A required more than one invasive investigation compared with 15 of 81 patients (18.5%) in group B. In patients with malignancy, bronchoscopy was more likely to be diagnostic in group A (50 of 56 patients (89%)) than in group B (44 of 62 (71%); p = 0. 012), and the diagnosis was more frequently made on the initial invasive investigation (group A, 63 of 70 (90%); group B, 44 of 62 (71%); p = 0.004). Because of the lower number of invasive procedures performed in group A than in group B, the cost of performing CT scans before FOB in all patients in group A would have equated to a projected cost of performing CT scans in 60% of patients after FOB in group B. CONCLUSIONS: Performing initial CT thoracic scans before bronchoscopy in patients with suspected endobronchial malignancy is a cost effective way of improving diagnostic yield from invasive diagnostic procedures and occasionally may obviate the need for any further investigation.

Adult↗