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At least 19 recordsLinked to original sources
PubMed1981

Intraoperative roentgenography in the surgical removal of renal calculi.

Complete surgical removal of staghorn or multiple renal calculi is extremely difficult. Intraoperative roentgenography has been used to decrease the incidence of residual calculi. We herein assess the effectiveness of intraoperative roentgenography and emphasize important operative technical aspects. Between 1973 and 1979, 42 patients underwent 50 operations for the removal of staghorn or multiple renal calculi. Intraoperative roentgenography was used in 47 operations and omitted in 3. Of the 47 operations done with intraoperative roentgenography 31 units were free of stones and 12 had small retained fragments known intraoperatively with verification by postoperative tomography or plain abdominal film. In 1 case of calculus recognized intraoperatively passed during the postoperative period and tomograms demonstrated no residual calculi. Only 3 patients had residual stones postoperatively with negative intraoperative films. The 3 patients who did not have intraoperative roentgenography all had residual fragments. All 3 kidneys were thought to be free of residual stones as determined by visual inspection and nephroscopy. With the aid of intraoperative roentgenography the incidence of residual stones was 23 per cent. Followup for up to 6 years in 45 renal units showed 73 per cent to be free of stones. When properly used intraoperative roentgenography is highly accurate. Films should be obtained before any stones are removed and care should be taken to x-ray the entire kidney even if 2 films are required. Final films should be obtained after all fragments are removed.

Humans↗
PubMed1992

Chest tumor response measurement during lung cancer chemotherapy. Comparison between computed tomography and standard roentgenography.

Chemotherapy of lung cancer has, until now, been an experimental approach that requires careful evaluation of tumor response. The growing number of lung cancer patients now undergoing chemotherapy has led to a rapid increase in the number of computed tomography (CT) scans performed. Eighty consecutive lung cancer patients (55 non-small cell and 25 small cell lung cancers) were included in a prospective study to analyze whether the standard chest roentgenography is as effective as computed tomography in evaluating tumor response. Both standard chest roentgenography and CT scanning were performed before the chemotherapy began and were repeated after 10 to 12 wk of treatment. Response evaluations were performed according to the World Health Organization recommendations. When two-dimensional measurements were possible, the indicator lesions were defined as measurable tumors. Both roentgenography methods were used, independently, to classify the response into the following categories: complete response, partial response, minor response, stable disease, and progressive disease. A comparison of CT scans versus standard chest roentgenography as a measurement of indicator lesion showed a concordance of borderline significance (kappa = 0.146, p less than 0.05); a significant asymmetry was demonstrated (McNemar = 35.6, p less than 0.001), indicating that CT scanning may be a more appropriate method for measuring tumors than standard chest roentgenography. Moreover, no concordance was observed comparing CT scan and standard chest roentgenography measurability in the subgroups of patients with T3 or T4 tumor, hilar tumor, and patients with pleural effusion or atelectasis in which the McNemar test of symmetry constantly showed a better measurability using CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Routine chest roentgenography on admission to intensive care unit after heart operations: is it of any value?

The need for routine immediate postoperative chest roentgenography after heart operations has recently been questioned. In this study we investigated the impact of routine postoperative chest roentgenography on treatment instituted in the cardiovascular intensive care unit immediately after heart operations done via median sternotomy. A total of 404 random patients admitted to the cardiovascular intensive care unit underwent clinical (positioning of endotracheal tube, nasogastric tube, and pulmonary artery catheter) and laboratory (oxygenation) assessment by a cardiovascular intensive care unit physician according to a strict protocol. After clinical assessment, chest roentgenography was done for all admitted patients and the findings reviewed by the same physician. Pathologic conditions noted were recorded on the study form together with any required treatment. Eighteen patients (4.5%) out of 404 required intervention because of abnormalities detected by the chest x-ray film but not predicted by the initial physical and laboratory assessment. None of the pathologic conditions detected was life threatening. We conclude that chest roentgenography done on admission to the cardiovascular intensive care unit should be done only if clinical and laboratory assessment indicate the possibility of underlying pathologic conditions that can only be confirmed or diagnosed by chest roentgenography.

Aged↗
PubMed1995

Usual care and outcomes in patients with sinus complaints and normal results of sinus roentgenography.

OBJECTIVE: To describe the usual care and outcomes of patients with sinus symptoms and normal sinus roentgenograms. DESIGN: Prospective cohort with 60-day follow-up. SETTING: Medical outpatient clinics at a university-affiliated Veterans Affairs medical center. PATIENTS: Consecutive patients (n = 126, 88% follow-up rate) with rhinorrhea (88%), facial pain (65%), or self-suspected sinusitis (24%) and normal four-view sinus roentgenography (median age, 47 years; 90% male; 56% white). MAIN OUTCOME MEASURE: Fourteen-day self-reported symptom status. RESULTS: Sixteen history and five physical examination items were recorded by clinicians who were blinded to the results of sinus roentgenography; clinical diagnoses and treatment plans were formulated by clinicians with knowledge of the results of sinus roentgenography. Clinical diagnoses included allergic rhinitis (27%), sinusitis (22%), viral respiratory tract infection (14%), and bronchitis (11%). Treatments included administration of antibiotics (40%), decongestants (32%), antihistamines (25%), and nasal steroids (9%). Forty-nine percent achieved 14-day clinical success (13.5% were cured and 36% were much improved). Improvement was more likely among patients who presented with cough (odds ratio, 3.0; 95% confidence interval, 1.3 to 6.9) but was less likely among those with itchy eyes (odds ratio, 0.18; 95% confidence interval, 0.07 to 0.43). Patients with cough and without itchy eyes had significantly shorter clinical courses (P = .003). Of patients who achieved clinical success on day 14, 30% relapsed or recurred by day 60. CONCLUSION: With usual medical care, the syndrome of sinus symptoms and normal results of sinus roentgenography persists for at least 14 days in many patients; however, patients with cough but without itchy eyes may have shorter clinical courses.

Adult↗
PubMed1987

Reducing roentgenography use. Can patient expectations be altered?

Many roentgenographic tests, including lumbar spine roentgenograms, may be overutilized. We examined the psychological, functional, and financial consequences of omitting spine films for patients with back pain with little risk of underlying systemic illness. Patients were randomized to receive immediate roentgenograms (n = 49) or a brief educational intervention, with roentgenography only for failure to improve (n = 52). After three weeks, 73% of the roentgenography group believed "everyone with back pain should have an x-ray," vs 44% of the education group. After three months, although 31% in the education group had received roentgenograms, overall radiology charges were still far less than those of the roentgenography group. No serious diagnoses were missed, and symptom resolution, functional improvement, and satisfaction were similar for the two groups. Thus, eliminating or delaying spine films need not cause anxiety, dissatisfaction, or dysfunction. This strategy may modify future expectations of roentgenography use and reduce health care costs.

Adult↗
PubMed1998

Chest roentgenography after outpatient thoracentesis.

OBJECTIVE: To evaluate the clinical utility of posteroanterior chest roentgenograms after thoracentesis in the outpatient setting. DESIGN: We undertook a retrospective study of clinical records of outpatient thoracentesis performed between January and December 1996 by the Division of Pulmonary and Critical Care Medicine at Mayo Clinical Rochester. MATERIAL AND METHODS: The medical records of 54 men and 39 women who underwent 123 outpatient thoracentesis were reviewed. Exclusion criteria were the need for pleural biopsy at time of thoracentesis or the need for ultrasound-guided assistance for completion of the procedure. Indications for thoracentesis and postthoracentesis chest roentgenography were analyzed. RESULTS: Of 123 thoracentesis performed in the outpatient setting during the specified study period, 104 met the inclusion criteria. Of these 104 thoracentesis, 54 (52%) were followed by chest roentgenography. Pneumothorax occurred in only 5 of these 104 procedures (5%), in 5 separate patients. Three of these patients were asymptomatic and did not require therapeutic intervention; the two symptomatic patients required hospitalization and chest tube drainage. Of the two pneumothoraces in patients with symptoms, one was detected on the same day as the thoracentesis, and the other was diagnosed 2 days later. The patients who did not undergo postthoracentesis chest roentgenography had no reported complications. Of the 54 chest roentgenograms, 52 were obtained in asymptomatic patients, with no suspicion of pneumothorax. These x-ray studies led to a total cost of $4,862 and detection of three pneumothoraces that did not require therapy. CONCLUSION: Routine performance of chest roentgenography after outpatient thoracentesis can incur substantial cost. A more selective approach to this practice is needed, both to optimize patient care and to manage limited medical resources efficiently. Postthoracentesis chest roentgenograms should be limited to patients with symptoms indicative of thoracentesis-induced pneumothorax.

Aged↗
PubMed1995

Decision rules for roentgenography of children with acute ankle injuries.

OBJECTIVE: The Ottawa Ankle Rules (OAR) assist emergency physicians in the appropriate use of roentgenography in adults with acute ankle injuries. The OAR state that ankle roentgenograms are needed only if there is pain near the malleoli and one or more of the following exists: (1) age 55 years or older; (2) inability to bear weight; or (3) bone tenderness at the posterior edge or tip of either malleolus. This study assessed the utility of the OAR on pediatric patients with acute ankle injuries. DESIGN: Prospective, consecutive survey of pediatric patients with acute ankle injuries. SETTING: Pediatric emergency department of an urban university hospital. PARTICIPANTS: Seventy-one children with acute ankle injuries were enrolled from July 22, 1993, to December 1, 1993. INTERVENTIONS: Twenty-four standardized clinical variables were assessed and recorded by physicians in the pediatric emergency department. The OAR were applied to each patient by the investigator to determine which ones would qualify for roentgenography. MAIN OUTCOME MEASURES: Sensitivity and specificity of the OAR were calculated, as was percent reduction in roentgenograms ordered. RESULTS: Seventy-one of 73 eligible patients were enrolled. The two missed patients had open fractures of the tibia. Sixty-eight of 71 patients had ankle roentgenography during the visit. Fourteen patients (21%) (mean age, 11.8 +/- 4.0 years) had fractures noted on the roentgenograms. Fifty-four patients (79%) (mean age, 12.0 +/- 3.6 years) had no fracture. Application of the OAR would have reduced the number of roentgenograms ordered by 25% without missing any fractures. Sensitivity of OAR was 100% (95% confidence interval, 77% to 100%), specificity was 32% (95% confidence interval, 21% to 43%), negative predictive value was 100% (95% confidence interval, 80% to 100%), and positive predictive value was 28% (95% confidence interval, 17% to 39%). CONCLUSIONS: Initial testing suggests that the OAR may help determine which children with acute ankle injuries could safely forgo roentgenograms without risk of missing fractures.

Acute Disease↗
PubMed2000

Evaluation of pelvic descent disorders by dynamic contrast roentgenography.

PURPOSE: For precise diagnosis and rational treatment of the increasing number of patients with descent of intrapelvic organ(s) and anatomic plane(s), dynamic contrast roentgenography of multiple intrapelvic organs and planes is described. METHODS: Sixty-six patients, consisting of 11 males, with a mean age (+/- standard deviation) of 65.6+/-14.2 years and with chief complaints of intrapelvic organ and perineal descent or defecation problems, were examined in this study. Dynamic contrast roentgenography was obtained by opacifying the ileum, urinary bladder, vagina, rectum, and the perineum. Films were taken at both squeeze and strain phases. On the films the lowest points of each organ and plane were plotted, and the distances from the standard line drawn at the upper surface of the sacrum were measured. The values were corrected to percentages according to the height of the sacrococcygeal bone of each patient. From these corrected values, organ or plane descents at strain and squeeze were diagnosed and graphically demonstrated as a descentgram in each patient. RESULTS: Among 17 cases with subjective symptoms of bladder descent, 9 cases (52.9 percent) showed roentgenographic descent. By the same token, among the cases with subjective feeling of descent of the vagina, uterus, peritoneum, perineum, rectum, and anus, roentgenographic descent was confirmed in 15 of 20 (75 percent), 7 of 9 (77.8 percent), 6 of 16 (37.5 percent), 33 of 33 (100 percent), 25 of 37 (67.6 percent), and 22 of 36 (61.6 percent), respectively. The descentgrams were divided into three patterns: anorectal descent type, female genital descent type, and total organ descent type. CONCLUSIONS: Dynamic contrast roentgenography and successive descentgraphy of multiple intrapelvic organs and planes are useful for objective diagnosis and rational treatment of patients with descent disorders of the intrapelvic organ(s) and plane(s).

Aged↗
PubMed1987

Patient preference in upper gastrointestinal studies: roentgenography versus endoscopy.

We prospectively compared roentgenography and endoscopy of the upper gastrointestinal tract in terms of patient acceptance and tolerance. Endoscopy was significantly better tolerated and easier overall for patients. Patients found no difference between endoscopy and radiography with respect to pain or life-style interruption. Patients stated that they would prefer endoscopy to roentgenography if repeat evaluation were needed. We conclude that UGI endoscopy is better tolerated and more acceptable to patients than UGI roentgenography.

Adult↗
PubMed2003

[Roentgenography and CT appearance in patients with severe acute respiratory syndrome].

OBJECTIVE: To evaluate the appearance and dynamic change of chest roentgenography and CT in patients with severe acute respiratory syndrome (SARS). METHODS: Serial roentgenography and CT of 61 confirmed SARS patients were analyzed. RESULTS: The onset symptom was fever in all patients. In the early phase of SARS, the main abnormal appearance was single or bilateral localized patchy clouding opacity on roentgenography, which progressed rapidly. The area of opacity peaked at about 2 weeks, involving the majority area of the lung in 57% of the patients. The area involved was correlated with the severity of clinical symptoms. The opacity disappeared gradually in 5 weeks in 84% of the patients. Lungs complicated infection were found in 6 patients with a prolonged duration of the illness. Among the 61 patients, 4 died. CT scan was performed in 16 SARS patients in the recovery phase, of whom 13 showed lung fibrosis. CONCLUSIONS: Lung infiltration in early phase develops rapidly and involves most area of the lung in advanced phase in most SARS patients. Lungs fibrosis was found in some patients in the recovery phase.

Adult↗
PubMed2000

Use of roentgenography and magnetic resonance imaging to predict meniscal geometry determined with a three-dimensional coordinate digitizing system.

To evaluate and improve on the procedures used by a tissue bank in selecting donor menisci for transplantation, this study was designed to fulfill four objectives: (a) define and quantify a set of independent parameters for describing the geometry of the medial and lateral menisci, (b) determine how well the sizing protocol of the tissue bank (i.e., two transverse roentgenographic measurements obtained from the injured knee or six transverse magnetic resonance imaging measurements obtained from the contralateral knee) predicts the four standard transverse parameters of the menisci, (c) determine if including one additional transverse roentgenographic measurement for each compartment improves the ability of roentgenograms to predict transverse meniscal parameters, and (d) determine if five magnetic resonance imaging measurements at three different meniscal cross sections of the contralateral knee predict the 15 standard cross-sectional parameters of the meniscus in the injured knee. A laser-based, noncontacting three-dimensional coordinate digitizing system was used to determine surface coordinates from which menisci were reconstructed in a computer. For each reconstructed meniscus, four parameters in the transverse plane and five cross-sectional parameters in each of three regions (i.e., anterior, middle, and posterior) were defined, yielding a set of 19 standard parameters to describe the geometry. Through a correlation analysis, these standard parameters were shown to be largely unrelated to one another, thus confirming that the parameters form an independent set describing the three-dimensional geometry of the menisci. The two roentgenographic measurements were poor predictors of transverse standard meniscal parameters, predicting only one of four standard parameters for the medial meniscus and none of four standard parameters for the lateral meniscus with coefficients of determination greater than or equal to 0.5. Including one additional roentgenographic measurement to the tissue bank protocol increased the number of standard transverse parameters predicted to three of four for the medial meniscus and two of four for the lateral meniscus. Magnetic resonance imaging was better than roentgenography for predicting the three-dimensional meniscal geometry. The transverse measurements from magnetic resonance imaging predicted three of four standard transverse parameters for the medial meniscus and all four for the lateral meniscus. With the addition of the cross-sectional measurements by magnetic resonance imaging, seven of 15 standard cross-sectional parameters were predicted for both the medial and lateral menisci. Assuming that a successful clinical outcome depends on how well an allograft matches the size and shape of the original meniscus, magnetic resonance imaging rather than roentgenography should be used for allograft size-matching by tissue banks.

Adult↗