In 1969 the Intersociety Commission for Heart Disease Resources was established through a contract with the American Heart Association under Public Law 89-239. Its responsibility was to produce guidelines defining optimal medical resources and care for the prevention and treatment of cardiovascular disease, including guidelines for radiologic facilities ( 1 Report of the Inter-Society Commission for Heart Disease ResourcesOptimal radiologic facilities for examination of the chest and the cardiovascular system. Circulation. 1971; 43: A-129-AA156 PubMed Google Scholar ). This resource guideline was revised in 1976 ( 2 Judkins MP Abrams HL Bristow JD Carlsson E Criley JM Elliott LP Ellis KB Friesinger GC Greenspan RH Viamonte Jr, M Report of the Inter-Society Commission for Heart Disease Resources. Optimal resources for examination of the chest and cardiovascular system: a hospital planning and resource guideline. Circulation. 1976; 53: A1-A37 Crossref PubMed Scopus (12) Google Scholar ) and again in 1983 ( 3 Friesinger G Adams DF Bourassa MG Carlson E Elliott LP Gessner IH Greenspan RH Grossman W Judkins MP Kennedy JW et al. Examination of the Chest and Cardiovascular System Study Group. Optimal resources for examination of the heart and lungs: cardiac catheterization and radiographic facilities. Circulation. 1983; 68: 891A-930A Crossref PubMed Scopus (163) Google Scholar ).

OBJECTIVE:Our research was conducted to ascertain the importance of noninvasive cardiovascular imaging to the practice of radiology and to determine what percentages of noninvasive cardiovascular imaging are performed by radiologists and by other types of physicians.MATERIALS AND METHODS:Using the national 1998 Medicare Part B database, we reviewed all 460 procedure codes pertaining to noninvasive diagnostic imaging and identified 65 that were specifically related to the cardiovascular system. These 65 codes were grouped in five categories: cardiac MR imaging, MR angiography, cardiovascular nuclear medicine, echocardiography, and vascular sonography. For each code and category, we determined the nationwide examination volume, the utilization rate per 1,000 Medicare fee-for-service enrollees, Part B physician reimbursements, and the percentages of examinations performed by radiologists, cardiologists, surgeons, and other physicians.RESULTS:During 1998, 19,244,001 noninvasive cardiovascular imaging studies were performed on Medicare enrollees, which accounted for 17.7% of all Medicare diagnostic imaging studies carried out that year and 33.6% of all Part B imaging-related reimbursements paid. The utilization rate for noninvasive cardiovascular imaging was 603 per 1,000 Medicare enrollees per year. Echocardiography alone accounted for 63.4% of these examinations. Radiologists conducted 16.7% of all noninvasive cardiovascular imaging, whereas cardiologists conducted 61.5%, surgeons 4.8%, and other physicians 16.9% of the examinations. The strong role of cardiologists was largely attributable to their dominance in echocardiography. Radiologists had a substantial role in all categories except echocardiography.CONCLUSION:Noninvasive cardiovascular imaging represents an important component of the practice of radiology. Radiologists have substantial participation in all aspects of the field with the exception of echocardiography.

PURPOSE: To compare the success of percutaneous varicocele embolization to surgical ligation with regard to changes in semen characteristics and pregnancy outcome.MATERIALS AND METHODS: Infertility records from 346 men who underwent correction of their varicocele for infertility (surgical ligation 149; embolization 197) were reviewed retrospectively. Preprocedural and postprocedural semen analyses and pregnancy outcomes were obtained with use of chart and telephone follow-up.RESULTS: In men who successfully impregnated their partners, there were significant improvements in sperm density, percent total improvement, motility, and progression, Postprocedural (embolization vs surgery) percentage increases in seminal parameters were density, 156.8% versus 138.5%; total, 168.8% versus 157.9%; and motility, 2.7% versus 3.2%, The percent of individuals who had a change in sperm progression was 31% versus 41%, There was no statistical difference between the techniques based on t tests, The pregnancy rates were similar for the two groups, 39% and 34% for embolization and surgery, respectively.CONCLUSION: There is no significant statistical difference in seminal values or pregnancy outcome between the two techniques.

PURPOSE To evaluate the cost-effectiveness of magnetic resonance (MR) angiography in the preoperative planning of treatment in patients with limb-threatening peripheral vascular disease (PVD). MATERIALS AND METHODS A decision model was developed to study the effects of MR angiography on the outcome and cost of treatment. The authors calculated the incremental cost per quality-adjusted life-years gained (ie, cost-effectiveness ratio) when conventional angiography was replaced or supplemented with MR angiography. Previously reported data regarding the accuracies of MR and conventional angiography were used in the analysis. RESULTS The cost-effectiveness ratio of MR angiography ranged from negative (cost-reducing) values to $78,000. For the base case in which the sensitivity and specificity of MR angiography for the evaluation of inflow vessels were 92% and 88% and those of conventional angiography were 97% and 97%, respectively, the cost-effectiveness ratio was $25,895. CONCLUSION MR angiography may be a cost-effective alternative to conventional angiography in patients with limb-threatening PVD if its accuracy for the inflow evaluation reaches certain thresholds. Further prospective investigation is warranted.

PURPOSE: The authors prospectively compared the nature and incidence of hepatic arterial injuries resulting from creation of a transjugular intrahepatic portosystemic shunt (TIPS) with large-and small-gauge needle systems.PATIENTS AND METHODS: Fifty patients underwent hepatic and superior mesenteric angiography immediately before and after shunt creation, A sheathed 16-gauge needle system was used to locate and puncture the portal vein in 24 patients, A al-gauge needle system was used in 26 patients.RESULTS: Shunts were successfully created in all patients, Three inadvertent hepatic arterial punctures were recognized during shunt placement, two with the small needle and one with the large needle system. No hepatic arterial lesions were detected in any patient. Two incidental hepatomas were identified at angiography.CONCLUSION: TIPS-related hepatic arterial injuries are rare. In this series, large and small needle systems were indistinguishable with respect to this complication.

PURPOSE: To compare a technique of mechanical balloon declotting of thrombosed hemodialysis grafts with conventional pulsed-spray thrombolysis.MATERIALS AND METHODS: Forty patients had 53 episodes of graft thrombosis over a 19-month period. Twenty-nine grafts were randomly treated with thrombolysis with urokinase and 24 grafts with mechanical declotting by placement of crossed balloon catheters within the graft Patency was determined by retrospective review of hemodialysis records.RESULTS: Successful hemodialysis for 1 week after the procedure was achieved in 21 (88%) of the 24 grafts treated mechanically and 26 (90%) of 29 grafts treated with thrombolysis. Continuous pulse oximetry showed no change in oxygen saturation in either group, and no clinical signs or symptoms of pulmonary embolism were noted. Average total procedure times were 2.2 hours for mechanical declotting and 3.5 hours for thrombolysis (P < .05). Probability of patency (mechanical vs thrombolysis) was 42% vs 45% at 3 months, 36% vs 25% at 6 months, and 8% vs 4% at 12 months. One major complication of ulnar artery embolization occurred in the thrombolysis group.CONCLUSION: Mechanical declotting of hemodialysis grafts is faster and as effective as thrombolysis.