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In this review, I examine the multifaceted role of radiology in the diagnosis, staging, and management of lung cancer, highlighting new applications and modalities such as computer-aided detection of lung nodules and positron emission tomography/computed tomography for staging and monitoring response to therapy. Lung cancer screening is also discussed.
It has not been an easy century for African-Americans in radiology, but many accomplishments have been achieved, often in the face of considerable adversity. Many, many important persons have been omitted from this essay. This section (Fig. 5) has supported progress through the years. May it continue the good work.
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The complex shape of the scaphoid and its orientation within the carpus makes the radiological interpretation of scaphoid anatomy difficult. To improve our understanding of how the anatomy appears on plain X-ray, a study was performed using dry cadaver bones. Salient anatomical features were outlined using radiopaque markers, the bones set in wax blocks and the blocks X-rayed in the same axis as six "standard" scaphoid views. The pictures obtained were then compared with clinical X-rays.
OBJECTIVE: To evaluate the chest roentgenogram and CT characteristics of pulmonary hydatid disease (PHD). MATERIAL AND METHODS: Forty-seven (27 male and 20 female, aged between 3 and 11 years) consecutive pediatric patients with surgically proven pulmonary hydatid cysts were enrolled for the study. Posteroanterior and lateral chest roentgenograms, CT of the chest, and laboratory findings (latex agglutination, Casoni skin test, and eosinophil count) were obtained from all of the patients. The radiological features (localization, internal architecture, number, diameter) were determined. RESULTS: On CT examination, a total of 79 cysts were determined. On chest roentgenogram, 57 of 79 cysts were detected in all patients. Single cysts were seen in 33 patients, while multiple cysts were seen in 14. Median CT density of the cysts was 21 Hounsfield units (HU) (0-80). There were six giant cysts (>10 cm of cyst diameter). The crescent sign, water lily sign, and air-fluid level were seen in two, five and eight of the cysts, respectively. Apart from the classically described features of pulmonary hydatid cysts of the lung, a crescent-shaped rim of air at the lower end of the cyst (inverse crescent sign) was detected in three cysts. All of the liquid content of the cyst was expelled to the bronchial system (dry cyst sign) was observed in seven cysts. There were two infected cysts. Heavily calcified curvilinear cyst wall was present in one cyst. Pericystic reaction in the lung tissue was observed in five patients. Other features included pleural effusion (n=2), mediastinal shift (n=6) and atelectasis (n=7). CONCLUSIONS: Chest roentgenogram is helpful for diagnosis of intact cysts but, it is impossible to define entire morphology of the complicated cysts. CT imaging recognize certain details of the lesions and discover others that are not visible by conventional radiography. In conclusion, CT examination should be done to elucidate cystic nature of the lung mass and for accurate localization in the preoperative period. In addition, inverse crescent sign should be recognized as feature of pulmonary hydatid cysts on CT.
AIM: To review all previous mammograms of breast cancer cases diagnosed during a randomized trial comparing 3 yearly to annual mammographic screening with a view to identifying and quantifying cases that might potentially have been diagnosed earlier. METHODS: Mammograms of 602 breast cancer cases (399 screen-detected and 203 interval cases) were reviewed in chronological order and suspicious radiological features noted for each mammogram, up to and including the diagnostic mammogram. RESULTS: Of the 602 cases, 79 (13%) had features at diagnosis that were visible on previous mammograms, suggesting a sensitivity of interpretation of 87%. A similar proportion of screen-detected (14%) and interval cancers (11%) had signs at diagnosis that were visible on previous mammograms. The potential for improvement was particularly noted for asymmetric density (sensitivity = 77%, average time visible before diagnosis 14 months) and parenchymal deformity/stellate lesion (sensitivity = 81%, average time visible before diagnosis 12 months). CONCLUSION: The highest sensitivity was observed for comedo-type microcalcifications (sensitivity = 97%, average time visible before diagnosis 5 months). By improvements in sensitivity to asymmetric density and parenchymal deformity/stellate lesion, 4% of tumours could have their time of diagnosis advanced substantially.
A method was developed for prenatal, post-mortem angiography, post-mortem angiography of the venous system of the brain, head and neck; its development was studied in the embryos and foetuses of 80 cattle, 20 sheep and 20 pigs with a crown-rump lenght of 19 to 155 mm. Radiological and corrosion preparations were studied. The embryonic and foetal venous systems were filled with thin barium sulphate through the umbilical and omphalic veins. The development and transformation of the cerebral veins and sinuses are compared and are related to the corresponding vascular anatomy of the adult animal and to man. The radio-embryological method for demonstrating cerebral vessels is also applicable to live foetuses.
INTRODUCTION: The radiological assessment of osteoarthritis of the knee joint in longitudinal studies is usually performed with established classifications. It is disadvantageous that these features are always combined to describe a certain stage of the disease, even though they can develop independently. METHODS: A german score based on a publication by Scott et al. (1993) was designed. At first 100 X-ray series of knees were evaluated using the Jäger & Wirth, the Kellgren & Lawrence classification and the point score. Six observers then evaluated 200 anonymised radiographs of knee joints twice within 3 months. RESULTS: The most reliable criteria for the inter-observer reliancy were medial osteophytes, medial joint-line narrowing, patella osteophytes and chondrocalcinosis. At least 4 out of 6 observers had a high match in these criteria. The reproducability of most of the individual radiographic features was good, with a higher level of orthopaedic training resulting in a higher consistency of the score. DISCUSSION: A certain level of orthopaedic training is necessary for consistent results. The main focus of the score will be less the daily routine assessment of radiographs of the knee joint, but more the scientific assessment of radiographic progression of osteoarthritis in longitudinal studies.
OBJECTIVE: Our objective was to evaluate interobserver variability in interpretations performed by on-call radiology fellows and subsequently by attending radiologists of CT angiograms obtained for clinically suspected pulmonary embolism and to evaluate factors contributing to discrepancies. MATERIALS AND METHODS: Written interpretations made by on-call fellows were compared with reports approved by attending radiologists for all CT angiograms obtained for suspected pulmonary embolism after work hours and on weekends in a recent 19-month period. Interpretations were stratified as positive, negative, or equivocal for pulmonary embolism. In cases of discordant interpretations, those CT angiograms were rereviewed by two thoracic radiologists; then patient medical records were reviewed for evidence of clinical effect. Technical and patient-related reasons for discordant interpretations of CT angiograms were recorded. RESULTS: Six hundred fifty-eight oncology patients were examined on CT angiography; five were examined twice. The fellows reported 137 CT angiograms (21%) as positive, 498 (75%) as negative, and 28 (4%) as equivocal for pulmonary embolism. Interpretations of the fellows and attending radiologists agreed in 93% (615/663) of CT angiograms (kappa = 0.80). The concordance rates for CT angiograms interpreted by fellows as positive (89%, 122/137), negative (96%, 479/498), and equivocal (50%, 14/28) were significantly different from each other (p < 0.001 for each). A significantly greater proportion of CT angiograms with discordant interpretations was reported to be technically limited (p < 0.01). No clear adverse clinical events were attributed to discordant interpretations of CT angiograms, although the death of one patient in that subgroup was of indeterminate cause. CONCLUSION: In the evaluation of CT angiograms obtained for suspected pulmonary embolism, on-call fellows showed good agreement with attending radiologists. CT angiograms with discordant interpretations often were limited by technical or patient-related factors.
The bedside chest images obtained with conventional radiology and with "on line" and "off line" digital modalities were compared to evaluate the respective capabilities in visualizing chest anatomical structures. Seventy patients were submitted to bedside chest examinations with a portable unit; both a conventional film and a digital system (PCR Graphics 1, Philips) with photostimulable phosphor imaging plate were fitted in the radiographic cassette. The former was digitized using an "off line" laser beam unit (FD 2000, Dupont); the latter was subsequently postprocessed by modifying contrast, optical density and spatial frequencies. Thus, 4 different viewing modalities were obtained for each examination: a) conventional radiography; b) standard digital radiography; c) postprocessed digital radiography; d) digitized conventional radiography. Detectability rates of chest anatomical structures were analyzed by 4 independent radiologists on the different images and expressed by a score 1-4. The values were always higher with digital modalities than with the conventional one and the differences were statistically significant (Student's t-test modified by Bonferroni). In particular, the greatest difference was found between c) and a) in retrocardiac lung parenchyma and in skeletal structures, in favour of c). Concerning the comparative adequacy of the various digital modalities, higher detectability rates of chest anatomical structures were obtained with c), but also with b), than with d).
Seventy-six consecutive leprosy patients with disabilities were subjected to radiological examination of hands and feet, and bone changes were found in 63 of them (82.9%). Specific, nonspecific and osteoporotic bone changes were observed in 22.4%, 78.9% and 28.9% of cases respectively. Bone cysts (10.5%), subarticular erosions (10.5%) and enlargement of nutrient foramina (5.3%) were the common specific bone changes whereas bone absorptive changes (59.2%), soft tissue changes (39.5%) and concentric absorption (39.5%) were the most frequent nonspecific bone changes. Specific bone changes were more common in older patients (age 40 years) and nonspecific bone changes correlated with duration of disease, duration of deformity, and disability index. Osteoporotic bone changes were found to be affected by ageing and severity of disability of hands and feet.
581 patients referred to the Radiology Department of the University Hospital in Cadiz took part in a dosimetric study. 56.69 per 100 underwent chest X-rays and 43.20 per 100 had some type of bone X-ray examination. We have established the Dose Absorbed by the patient at the point of incidence of the direct beam and at other points of interest, such as bone marrow, eyeball, thyroid, ovaries and testicles. We also calculate the Equivalent Effective Dose (EED).
The authors describe the recent emergence of an interventional radiologic procedure, percutaneous gastrostomy and gastroenterostomy. They present a case report, and discuss indications, methods, and advantages of the procedure for some patients.
The reasons for using measurements of bone density for further analysis of changes in metabolic bone diseases are pointed out. Besides the easy methods of visual comparison of X-ray images and "microradioscopy", the methods of quantitative radiology are discussed. The X-ray morphometry method is presented, including the new results of measurement of various bones of the skeleton. Structural analysis of spongy and compact bone tissue from the X-ray image using opto electronic image transformation is demonstrated. The techniques of X-ray photodensitometry and isotope-densitometry are explained. The importance of a reproducible calibration standard and the special value of reference systems containing a known concentration of hydroxyapatite are shown. Special information is given regarding the present status of the development of the new technique of quantitative computer tomography (QCT) or computer tomometry with the aid of a solid reference system. This new reference system is constructed from various concentrations of hydroxyapatite in "solid water" (a polyethylene mixture) and is demonstrated in detail. The results of comparing measurements of the 2nd lumbar vertebral body are shown. Finally, the clinical importance of measurements of the "apatite value" of vertebral trabecular bone tissue and of various trabecular areas of the skeleton is emphasized.
Based on a material of 90 patients with malignant ovarian tumours the results of a chirurgical-radiological combination therapy are discussed. The radiotherapy with telecobalt in the area of small pelvis and regional lymphatic drainage represented achieves good results with justifiable secondary effects. The 5-year survival rate is 36,1%.
A report is given on therapy results of 99 cases of oropharyngeal carcinoma (ICD 146) treated between 1971 and 1979. The healing rate is 80% for the NO stades I and II, 47% for stade III and 37% for stade IV. About one third of all patients of all stades were exclusively irradiated, about two thirds were submitted to a combined surgical and radiologic treatment. The authors study the time after which local recurrences are appearing and describe different irradiation methods. The combined treatment seems to be superior to primary radiotherapy even in NO stades.
European radiological literature of the year 1975 reviewed, concerning colon diseases. Subjects like colon preparation, appendicitis, lymphoid hyperplasia, juvenile polyposis, villous adenomata, angiography in bleeding diverticulosis and lymphomata of the colon have been described in that year. Most attention is paid to the colon with oral laxatives and without enemas.
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