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PubMed1998

Fate of the contralateral leg after infrainguinal bypass.

PURPOSE: To identify variables predictive of the need for future vascular intervention in a leg contralateral to one currently undergoing infrainguinal bypass. METHODS: We reviewed the records of 450 consecutively treated patients undergoing infrainguinal bypass for occlusive disease to examine the outcome of a previously untreated contralateral leg. Patients with coexistent contralateral limb-threatening ischemia at the time of initial ipsilateral operation were excluded, as were patients with bilateral disease who underwent a staged contralateral procedure within 3 months of the ipsilateral operation. This yielded a study cohort of 383 patients with no anticipated intervention in the contralateral leg who were followed for a mean value of 38 months. Patient survival and subsequent intervention in the contralateral leg were examined with life-table and regression analysis. RESULTS: Mean age of the patients was 68 years; 60% were men; 54% had diabetes; and 50% had coronary artery disease. The initial ipsilateral operation was performed for limb threat in 90% of instances. Twenty percent of patients subsequently needed intervention in the contralateral leg (infrainguinal bypass 83%, primary major amputation 17%). According to life-table analysis, 30% of patients needed intervention at 5 years, and the overall survival rate was 51% at 5 years. Multivariate analysis indicated that the need for future contralateral intervention was independently predicted with the following four risk factors: diabetes (relative risk [RR] 2.4x), coronary artery disease (RR 1.8x), lower initial ankle-brachial index (RR 2.1x with ankle-brachial index less than 0.7), and younger age (RR 2.2x if age less than 70 years). Regression models predicted the need for contralateral intervention for only 8% of patients at 5 years when none of these risk factors was present but for 67% when all risk factors were present. CONCLUSION: The fate of the contralateral leg after infrainguinal bypass is affected by diabetes, coronary artery disease, contralateral ankle-brachial index, and age at initial ipsilateral bypass. The effect of these risk factors is additive in prediction of the likelihood of future intervention. Knowledge of these factors may help identify instances in which the contralateral greater saphenous vein will be important for future limb salvage and also determine which patients need more careful follow-up care.

Adult↗
PubMed2006

Resident teaching versus the operating room schedule: an independent observer-based study of 1558 cases.

Efforts to improve operating room efficiency may threaten clinician training. Therefore, we designed a prospective, observational study to determine the actual time spent teaching anesthesiology residents during the interval from patient-on-table to skin incision and to determine whether anesthesia teaching in the peri-induction period increases the time to surgical incision. This study was conducted in an inpatient operating room suite of a tertiary academic medical center. Of 1558 cases examined, 75% had an element of teaching (mean percent teaching per case = 46.4). A 33% decrease in teaching occurs when the attending anesthesiologist concurrently directed care in 2 rooms (P < 0.001). The percent teaching significantly increased as a function of ASA physical status classification and time of day of surgical case (P = 0.001). Teaching accounted for a mean increase of time to incision of 4.5 +/- 3.2 min, but represented only 3% of the mean surgical case length (207 +/- 132 min). We conclude that teaching occurs in the majority of cases in the operating room and although it contributes to increased time to incision, this increase is insignificant compared with the time required to complete the surgical procedure.

Anesthesiology↗
PubMed1977

A computerized system for the evaluation of community dental programs.

This paper reports on a relatively uncomplicated and inexpensive computerized system for prospective evaluation of clinical dental programs from the point of view of effectiveness and efficiency. Availability of this system does away with some high start-up costs. Three forms of input data, new case information, examination findings and operative procedure information, are regularly collected on data sheets and specially designed Port-a-punch IBM cards. Easily interpreted output tables are generated monthly on such variables as completed cases according to treatment series and clinician, number of various procedures performed by clinicians, etc. Productivity is measured, in part, by application of monetary constants to procedure data. This paper describes the computer programs used, the cost of setting up and operating the system (which is within the budgetary constraints of most small, publicly funded programs) and the benefits that can be derived from the use of such a system. The system provides prompt feedback of relevant administrative data, thus allowing for relatively quick response to problems. Use of the system reduces clerical needs to a minimum and the program can easily be implemented on any except the very smallest digital computer.

Community Dentistry↗
PubMedDate not supplied

Using breakeven analysis to examine price sensitivity.

Increased competition and managed care have brought about a need to reexamine how operating expenses are portrayed. Distinguishing between fixed and variable costs and using breakeven analysis can determine the implications of price concessions that may be requested by insurance companies. This technique also identifies areas of operating that hurt profitability of a specific imaging site or a modality within a single site. Breakeven analysis can also be used to investigate the effect of capitation and to strategize in an environment where commercial insurers sometimes establish fees that are so low, providers would prefer capitated contracts. In that situation the only option may be to manage utilization to enhance profit. This article includes financial models that can be used to simulate the implications of changes in the average income per scan (Table 1) and to examine the profitability of each segment of service within an imaging center (Table 2). Table 2 allows management to trendline each modality and examine cost chracteristics. That enables those responsible for overseeing operations to isolate and understand problem areas.

Capitation Fee↗
PubMed1988

"Maximal" thymectomy for myasthenia gravis. Results.

Thymectomy has been shown to be effective in the treatment of myasthenia gravis. The logical goal of operation has been complete removal of the thymus, but there has been controversy about the surgical technique and its relation to results. Surgical-anatomic studies have shown gross and microscopic thymus widely distributed in the neck and mediastinum. We believe that an en bloc transcervical-transsternal "maximal" thymectomy is required to remove all thymic tissue predictably. Ninety-five patients with generalized myasthenia gravis underwent "maximal" thymectomy consecutively between 1977 and 1985 and were evaluated 6 months to 89 months after operation. In Group A (N = 72), myasthenia gravis without thymoma, the uncorrected data revealed that 96% (69) had benefited from operation: 79% (57) had no symptoms; 46% (33) were in remission; 33% (24) were symptom free when receiving minimal doses of pyridostigmine; and none were worse. Life table analysis yielded a remission rate of 81% at 89 months. In group B (N = 8), myasthenia gravis without thymoma for which patients underwent reexploration for incapacitating weakness after earlier transcervical or transsternal operations, residual thymus was found in all. One patient was in remission, two were symptom free when receiving medication, one was unchanged, and none were worse. In group C (N 15), myasthenia gravis and thymoma, two patients were in remission and nine were symptom free when receiving medication. Two patients in this group died 2 and 4 years postoperatively in crisis. Response to thymectomy in group A was greater in patients with mild myasthenia gravis and may have been better in patients who had symptoms for less than 60 months preoperatively, but the response did not depend on age, sex, presence or absence of thymic hyperplasia or involution, or titers of acetylcholine receptor antibodies. The response to thymectomy in group B was striking but slower than in group A, perhaps because symptoms were more severe and of longer duration. The response in group C was also less good than in group A and proportionately fewer benefited. These results support the recommendation for thymectomy in the treatment of patients with generalized myasthenia gravis and indicate the desirability of a maximal procedure. For persistent or recurrent severe symptoms after previous transcervical or submaximal transsternal resections, reoperation by this technique is also recommended.

Actuarial Analysis↗
PubMed2001

[Enucleation with on-the-table evisceration. Is it a good technique?].

PURPOSE: To evaluate the surgical technique of enucleation followed by an "on-the-table evisceration" and placement of a hydroxyapatite orbital implant wrapped by the patient's own sclera for the treatment of blind phthisis painful eyes. PATIENTS AND METHODS: In this single-center retrospective study, 50 consecutive patients undergoing an operation using the same surgical technique, between April 1993 and November 1999, were studied. Patients underwent enucleation, then the eyeball was eviscerated "on the table". The patient's own cleaned sclera was used to wrap a hydroxyapatite orbital implant, the posterior pole of the sclera was placed at the anterior pole of the implant. Conjunctival breakdown, sphere size, conjunctival discharge, the first signs of sympathetic ophthalmia motility, and cosmetic results were analysed. RESULTS: After an average follow-up of 13.3 months few complications were encountered: 4 cases (8%) of inclusion cyst and 3 cases (6%) of discharge. The implant placed had a diameter of 18 mm, 20 mm, 22 mm in, respectively, 48%, 48%, and 4% of the eyes. The prosthesis motility was good, medium, and poor in, respectively, 33 (78.6%) cases, 8 (19%) cases, and 1 (2.4%) case. The prosthesis tolerance was good, medium, and poor in respectively 86%, 10%, and 4% of the cases. CONCLUSION: The surgical technique of enucleation followed by an "on-the-table" evisceration and autologous sclera wrapping a hydroxyapatite implant is an easy procedure. It allows, on phthisis eyeballs, the placement of a large orbital implant for good cosmesis results, without major complications.

Adolescent↗
PubMed1989

Long-term results of combined iliac balloon angioplasty and distal surgical revascularization.

Long-term results of combined use of iliac artery percutaneous transluminal angioplasty (PTA) and distal surgical revascularization for the management of multilevel occlusive disease were evaluated over a 12-year period. A total of 79 combined procedures were performed in 75 patients. All patients had tandem occlusive disease, with the inflow lesion felt to preclude a distal revascularization procedure alone. Revascularization was performed for incapacitating claudication in 17 (22%) and limb salvage indications in 62 (78%) cases. A mean resting iliac artery pressure gradient of 29 +/- 11 mmHg pre-PTA was reduced to 0.9 +/- 0.4 post-PTA. Major complications of PTA occurred in five (6%) cases, but four were successfully corrected at the time of the distal surgical procedure without alteration of the operative plan. Infrainguinal operations included 55 femoropopliteal or tibial bypass grafts, 18 femorofemoral grafts, and 6 profundaplasties. Mean follow-up was 43 months. By life table analysis, the 5-year primary patency rate of the distal surgical procedures was 76%; a secondary patency of 88% at 5 years was achieved by various means of reintervention. Mean pretreatment ankle/brachial index of 0.31 +/- 0.14 increased to 0.80 +/- 0.16 after operation (p less than 0.0001). The 5-year limb salvage rate was 90%. There were no operative deaths. We conclude that in carefully selected patients, combined use of iliac PTA and distal surgical reconstruction is effective and durable, safely reducing the extent of surgical intervention while reliably increasing the comprehensiveness of revascularization.

Actuarial Analysis↗
PubMedDate not supplied

Late results following extra-anatomic bypass procedures for chronic aortoiliac occlusive disease.

During the period from 1970 to 1983 150 extra-anatomic bypass operations were carried out on 129 high risk patients revascularizing 157 extremities. There were 124 axillofemoral and 26 femorofemoral bypass grafts. In elective operations the mortality ranged from 4.9% for the axillofemoral bypass and 3.7% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate (according to life table method) of 80.21% for the femorofemoral bypass, 79.90% for the axillobifemoral bypass (Type IV) and 45.77% for the unilateral axillofemoral bypass (Type I and II). Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure, the femorofemoral bypass and in many ways also the axillobifemoral bypass represent suitable and effective methods of operation for high risk patients, whereas unilateral and bilateral axillofemoral grafts showed a high rate of graft thrombosis and poor long term results (Type I and III).

Adult↗
PubMed1985

[Errors and dangers in intestinal sutures and anastomoses using stapler suture instruments (EEA, TA55, TA90, GIA)].

UNLABELLED: In different tables the most important faults with enteral sutures and anastomoses in general and at special operations are demonstrated: end-to-end anastomoses with congruent diameter, anastomoses with different diameters, B I, B II, low anterior resection, esophago-jejunostomy. CONCLUSION: Only if the surgeon has experience in standard technique, faults and risks with mechanical staplers and manual sutures, the advantage-progress of staplers will be effective avoiding special risks. Surgeons without experience may produce real catastrophes which may turn out hopeless without training in manual suture technique.

Gastrointestinal Diseases↗
PubMed2006

Unified method for Bayesian calculation of genetic risk.

Bayesian inference has been used for genetic risk calculation. In this traditional method, inheritance events are divided into a number of cases under the inheritance model, and some elements of the inheritance model are usually disregarded. We developed a genetic risk calculation program, GRISK, which contains an improved Bayesian risk calculation algorithm to express the outcome of inheritance events with inheritance vectors, a set of ordered genotypes of founders, and mutation vectors, which represent a new idea for description of mutations in a pedigree. GRISK can calculate genetic risk in a common format that allows users to execute the same operation in every case, whereas the traditional risk calculation method requires construction of a calculation table in which the inheritance events are variously divided in each respective case. In addition, GRISK does not disregard any possible events in inheritance. This program was developed as a Japanese macro for Excel to run on Windows.

Algorithms↗
PubMed1995

Retroperitoneal nonresective staple exclusion of abdominal aortic aneurysms: clinical outcome and fate of the excluded abdominal aortic aneurysms.

PURPOSE: The purpose of this article was to prospectively study analyses outcome after staple exclusion of abdominal aneurysms with specific follow-up of the excluded aneurysm. Whether these data may predict behavior of aneurysms excluded from the circulation by transluminal grafting procedures is also addressed. METHODS: Staple exclusion of abdominal aneurysms with bypass via retroperitoneal incisions was performed in 100 consecutive patients undergoing elective procedures. Risk factors, clamp time, operative time, transfusions, length of stay, complications, platelets, fibrinogen, and fibrin split products were documented. Duplex imaging was performed quarterly for 1 year after exclusion and at least annually thereafter. Serial measurements of aneurysm size and evaluation for thrombosis was obtained. RESULTS: Aneurysm size averaged 5.5 cm. Risk factors included history of smoking (54%), history of heart disease (51%), hypertension (41%), hyperlipidemia (34%), and chronic obstructive pulmonary disease (25%). Clamp time averaged 51 minutes. Forty-eight required no intraoperative transfusion, and 19 needed only autologous blood; the average 24-hour transfusion was 313 cc. Length of stay averaged 11 days, with a median of 8 days, and correlated with age, aneurysm size, and risk factors. The 30-day mortality rate was 4%. Death was associated with longer operative and anesthesia times and with age and risk factors. As calculated by life-table analysis to 5 years, 96.8% of aneurysms thrombosed. No aneurysm expanded, became symptomatic, nor ruptured. Perioperative platelet, fibrinogen, and fibrin split product assays show no evidence of disseminated intravascular coagulation or consumptive coagulopathy. CONCLUSIONS: Staple exclusion and bypass of abdominal aneurysms as described in this study is safe and effective. There has been neither aneurysm expansion nor rupture, and the technique reliably leads to thrombosis of aneurysms without coagulopathy.

Aged↗
PubMed2000

Tacky but refined: a "slick" technique for dressings that hold better.

For decades benzoin has been used to enhance the "stickiness" of the skin for improved adherence complementing the protective and functional aspects of well-constructed surgical bandages/dressings. The fully adherent and longer-lasting pressure dressing is both aesthetically pleasing to the patient (and surgeon) and, at the same time, functions to decrease seroma or hematoma formation, enhances antisepsis by blocking transient bacterial contamination, and inhibits traumatic sabotage of surgical wounds due to patient overactivity or inadvertent collision with a door jam, car door, table leg, or grandchild, etc. Also, when the bandage looks good, the patient realizes the operation was a success (at least aesthetically). Although simple, our additional steps of deoiling the skin with acetone, followed by multiple compress/release cycles of gauze to the Mastisol area reaps benefits to the patient and surgeon both in function (adherence) and in the production of a truly "dressy" beautiful and long-lasting dressing. In this way, the dressing "bed" is not only more receptive to one's aesthetically pleasing bandage, but is more tacky, yet refined. This same technique can be utilized prior to application of adhesive strips to healing wounds after sutures have been removed, allowing them to "stay on" longer with potentially better cosmesis and less spreading of the scar.

Adhesiveness↗
PubMed2002

Endoscopically assisted zygomatic fracture reduction and osteosynthesis revisited.

In comminuted fractures of the zygoma open reduction of the malar arch is essential for correct anatomic repair. Avoiding exposure of this landmark may result in severe functional and aesthetic impairment. Exposure of the malar arch necessitated traditionally a coronal incision. However, recently several authors reported good results in malar fracture repair with minimal incisions and endoscopic assistance. To establish this technique a cadaver study was performed. Different approaches to the malar arch, fracture reduction and internal fixation were evaluated. After establishment of a satisfactory technique 12 patients with comminution of the zygoma were treated with endoscopic assistance. Repositioning of the fragments was excellent in nine cases, minimal remaining dislocation was seen in two cases and in one case revision was necessary. Postoperatively the frontal branch of the facial nerve was intact in all patients. Scarring was minimal. In three patients plating of the malar arch on a side table resulted in arch necrosis and resorption in the long-term follow-up. Operating time was remarkably longer than in conventional procedures due to the difficult technique.

Adolescent↗
PubMed1993

Nonoperative treatment of superficial femoral artery disease: long-term follow-up.

PURPOSE: Between 1977 and 1991, 405 patients with atherosclerotic occlusive disease of the superficial femoral artery underwent clinical as well as noninvasive laboratory evaluation and were recommended for nonoperative treatment. METHODS: Limbs with uncorrected aortoiliac occlusive disease, aneurysmal degeneration, or previous femoropopliteal bypass were excluded, leaving 568 involved extremities. Complete follow-up, which forms the basis for this report, was available in 377 patients (93%) with 520 limbs (93%). Patients were monitored for a minimum period of 2 years (range, 24 to 164 months; median, 86 months). During the surveillance period 45 limbs (8.6%) in 42 patients (11.1%) required arterial intervention. This entailed operation in 39 cases and endovascular treatment in six cases. With use of life-table analysis, the risk for intervention was found to be 11% at 5 years and 14% at 10 years. A total of 14 limbs (2.7%) in 14 patients (3.7%) ultimately required major limb amputation, either after failed bypass (8 patients) or as a primary procedure (6 patients). RESULTS: Analysis of risk factors revealed that female sex (p = 0.04), chronic renal failure (p = 0.0001), diabetes mellitus (p = 0.0011), history of contralateral femoropopliteal bypass (p = 0.0005), level of disease (p = 0.003), and entry ankle/brachial index less than 0.50 (p = 0.004) were associated with an increased risk over time for intervention. Other factors, including age, current or prior smoking history, hypertension, and the presence of coronary artery disease or cerebrovascular disease failed to reach statistical significance. CONCLUSIONS: These data support the continued conservative approach to surgery for patients with superficial femoral artery occlusive disease without limb-threatening symptoms. Patients with multilevel disease, lower ankle/brachial index, a history of contralateral femoropopliteal bypass, chronic kidney failure, or diabetes mellitus are at increased risk and should be monitored more closely.

Adult↗
PubMed1996

External fixation in war traumatology: report from the Rwandese war (October 1, 1990 to August 1, 1993)

Modern missiles cause important damage in the tissues. In case of bone injury, apart from the presence of foreign bodies and soil dirt in the foyer, the lesion is characterized by a certain instability caused by the smashing and resulting in the comminutive fractures, as well as severe lesions of the soft tissues. If primary treatment includes the necessity of a large wound excision, of which the modalities have been described for centuries, it also includes a rigorous immobilization of the foyer as precaution against shock and infection. All techniques proposed during former conflicts proved that they are little adapted to the final goal. Their inadequacy may lead to amputation, at any rate to severe sequelae. In war traumatology, opposed to the shortcomings of nonoperative methods and opposed to the prohibitions of intrafocal synthesis, external fixation is considered to be the best among compromises: it stabilizes fractures efficiently without risk, retains the distance between bone fragments, and prevents contracture of the muscles. External fixators promote debridement of the wounds, permit vascular repairs and control of the wounds, allow mobilization of the limbs, improve the injured's comfort, and facilitate evacuation . All types of external fixators can be used, but a number of military imperatives must be taken into account. Fixing of the device must be easy to every user, even with little training. A minimal number of parts must allow a maximal number of assemblies. Easy use implies simplicity, but the assembled set must be stable. It must reduce the reprise of reductions, its compression, and its distraction to a minimal number of acts. Moreover, it must be relatively cheap. In theory, all open war fractures should be treated by means of an external fixator. The problem, however of mass surgery under uncertain circumstances, the limited equipment, and a precarious supplying must be considered. Rwanda was involved in a war from October 1, 1990 to August 1, 1993 (Arusha's agreement). A Belgian medical team from the Military Cooperation had to cope with 4,646 different casualties. We treated 1,129 fractures, and among them 115 fractures of the arm, 122 fractures of the forearm, 80 fractures of the femur (including the neck and the condylae), and 148 fractures of the leg. We had to cope with 315 fractures of the hand, of which 220 fractures were of the metacarpal bone. "Strangely," there were always more lesions of the left hand (9.5%) than the right hand (5.8%), sometimes up to five times (the only exception was met in August 1993). We placed 209 external fixators (of which 20 bridging the joint in case of important impairment), including those used for an arthrodesis. In the majority fo the cases (93.3%), we used the French device Fixateur Externe du Service de Sante des Armees (FESSA). Until March 1993, we had no "orthopedic table." Since March 1988, we had an Image Intensifier, but not very appropriate to an operating room (no mobile C-arm). A more accurate one was lent by the Belgian Medical Service and set up in September 1992. The average time to place an external fixator was about 30 minutes. General practitioners were also trained to handle external fixators. According to the importance of mass casualties, an external fixator was used immediately upon arrival of the wounded or at revision day (5th day after debridement). The only exception were femoral fractures that were at first time-treated by traction for 10 days. Sometimes we had precarious supplying because the supplies had to be ordered in Europe. Sometimes one patient had to wait until material became available from another patient. External fixation was also used for reconstructive surgery, mainly for ankle arthrodesis. In conclusion, it was possible for a very small surgical team, on its own for 18 months, to cope with a lot of difficulties caused by lack of readiness of the Rwandan Armed Forces, lack of organization, and lack of discipline of the R

External Fixators↗
PubMed2000

Carbon nanotube-based nonvolatile random access memory for molecular computing

A concept for molecular electronics exploiting carbon nanotubes as both molecular device elements and molecular wires for reading and writing information was developed. Each device element is based on a suspended, crossed nanotube geometry that leads to bistable, electrostatically switchable ON/OFF states. The device elements are naturally addressable in large arrays by the carbon nanotube molecular wires making up the devices. These reversible, bistable device elements could be used to construct nonvolatile random access memory and logic function tables at an integration level approaching 10(12) elements per square centimeter and an element operation frequency in excess of 100 gigahertz. The viability of this concept is demonstrated by detailed calculations and by the experimental realization of a reversible, bistable nanotube-based bit.

Journal Article↗
PubMed1993

Image quality in dynamic CT: a clinical discussion.

Modern state-of-the-art computed tomographic (CT) scanners emphasize three capabilities: image quality, dynamic scan capability, and a high-resolution thin-section technique. Image quality is fundamental and dependent on optimum performance and the interrelationship of all system components. Variables that affect the performance of the scanner include x-ray tube output and rate of heat dissipation; quantum detection efficiency; electronic noise in the acquisition system; speed, accuracy, and integration of mechanical motion in the gantry and table; and the algorithm used for image reconstruction. System design must allow for dynamic scan operation, either in the single-scan or cluster mode, with short interscan or intergroup delays or, as more recently developed, with helical acquisition. Dynamic scanning is frequently used for nonneurologic applications, including diagnosis of vascular and perivascular diseases and multifocal organ disease, particularly hepatic disease. Efficient operation depends on rapid reconstruction and display capability. Modern systems have been engineered to provide flexible modes of operation, particularly in dynamic scanning, and rapid on-line review and analysis, all of which serve to improve the quality of images produced with dynamic CT scanning.

Contrast Media↗
PubMed2005

Breast lesion detection and classification: comparison of screen-film mammography and full-field digital mammography with soft-copy reading--observer performance study.

PURPOSE: To retrospectively compare screen-film and full-field digital mammography with soft-copy interpretation for reader performance in detection and classification of breast lesions in women in a screening program. MATERIALS AND METHODS: Regional ethics committee approved the study; signed patient consents were obtained. Two-view mammograms were obtained with digital and screen-film systems at previous screening studies. Six readers interpreted images. Interpretation included Breast Imaging Reporting and Data System (BI-RADS) and five-level probability-of-malignancy scores. A case was one breast, with two standard views acquired with both screen-film mammography and digital mammography. The standard for an examination with normal findings was classification of normal (category 1) assigned by two independent readers; for cases with benign findings, the standard was benign results at diagnostic work-up in patients who were recalled. Cases with normal or benign findings that manifested as neither interval cancer nor as cancer at subsequent screening were considered the standard. All cancers were confirmed histologically. Images were interpreted by readers in two sessions 5 weeks apart; the same case was not seen twice in any session. Receiver operating characteristic (ROC) analysis and, for a given true-positive fraction, 2 x 2 table analysis and the McNemar test were used. For binary outcome, classification of BI-RADS category 3 or higher was defined as positive for cancer. RESULTS: Cases with proved findings (n = 232) were displayed: 46 with cancers, 88 with benign findings, and 98 with normal findings. ROC analysis for all readers and all cases revealed a higher area under ROC curve (A(z)) for digital mammography (0.916) than for screen-film mammography (0.887) (P = .22). Five of six readers had a higher performance rating with digital mammography; one of five demonstrated a significant difference in favor of digital mammography with A(z) values; two showed a significant difference in favor of digital mammography with ROC analysis for a given false-positive fraction (P = .01 and .03, respectively). For cases with cancer, digital mammography resulted in correct classification of an average of three additional cancers per reader. For digital versus screen-film mammography, 2 x 2 table analysis for cancers revealed a higher true-positive rate; for benign masses, a higher true-negative rate. Neither of these differences nor any others from analysis of subgroups between the modalities were significant. CONCLUSION: Digital mammography allowed correct classification of more breast cancers than did screen-film mammography. A(z) value was higher for digital mammography; this difference was not significant.

Aged↗