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 ).

HomeRadiologyVol. 201, No. 1 PreviousNext Benefits of teleradiology.W J CasarellaW J CasarellaW J CasarellaPublished Online:Oct 1 1996https://doi.org/10.1148/radiology.201.1.8816511MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: 1996 FiguresReferencesRelatedDetailsCited ByRadiology and the LawRonald L.Eisenberg2004The value of current developments in radiology to the accident and emergency department--a pictorial review.D CLloyd1997 | Emergency Medicine Journal, Vol. 14, No. 6Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 201, No. 1 Metrics Altmetric Score PDF download

A study of biliary shock wave lithotripsy of gallstones sponsored by Dornier Medical Systems, Munich, began in the United States in May 1988 to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) and the need for adjunctive therapy with ursodeoxycholic acid (UDCA). One hundred forty-one symptomatic patients with one to three gallstones 5-30 mm in diameter were randomized to treatment. One week before ESWL, patients were given either UDCA or placebo. This treatment was continued for 6 months. All patients underwent follow-up at predetermined intervals. According to the protocol, re-treatment for fragments larger than 5 mm in diameter could be performed only at 6 weeks; 26 (18%) of the 141 patients were retreated. At 6 months, the stone-free rates for single stones were as follows: patients with noncalcified stones receiving UDCA, 29%; patients with noncalcified stones receiving placebo, 24%; and patients with partially calcified stones receiving either UDCA or placebo, 6%. No significant difference was noted between the UDCA and placebo groups. At 6 months, the stone-free rates in patients with single, noncalcified stones 20 mm or less in diameter were 40% (UDCA) and 32% (placebo), which is superior to rates for those with solitary, noncalcified gallstones 21-30 mm in diameter and those with two or three stones.

Representatives of eight professional societies present recommendations for the training of health care professionals in extracorporeal shock-wave gallstone lithotripsy,on the basis of data obtained from a questionnaire completed by 85 physicians who were selected because of their experience with gallstone lithotripsy. This training should be done in a medical facility that permits a multispecialty approach to patient care by physicians who are trained in gastroenterology, radiology, and general surgery and who are experienced and competent in the diagnosis and management of biliary tract disease. Candidates for training should be gastroenterologists, radiologists, or general surgeons who are licensed to practice medicine and who have had specific training and clinical experience in treating gallstone disease and in ultrasound imaging of the biliary tract. The guidelines specify requirements for the training site and the lithotripsy device, the qualifications of the training site director, and the components of the educational program. The experience must include not only didactic course work and clinical observation, but also practical "hands-on" experience at the training site. Subsequent additional practical experience under supervision at the trainee's own lithotripsy treatment facility is recommended. Credentialing of the trainee in this procedure should be the responsibility of an appropriate board or committee of the trainee's own institution or lithotripsy center.

The goal of radiologic intervention in patients with Budd-Chiari syndrome is to control portal hypertension and prevent further hepatocellular damage until collateral hepatic venous outflow channels can develop. Percutaneous balloon angioplasty was used to treat six patients with this syndrome who were followed up for an average of 43 months (range, 12-92 months). Standard interventional radiologic techniques were used to dilate the hepatic veins (two patients), inferior vena cava (three patients), and proximal anastomosis of a mesoatrial shunt (one patient). Angioplasty was the only invasive treatment in three patients, whereas the remaining three patients had previous portosystemic shunts. Clinical and hemodynamic improvement occurred after each angioplasty. Multiple dilatations were required in all patients (average, 3.2; range, 2-5) because of restenosis at the angioplasty site and ongoing hepatocyte necrosis shown by biopsy. Long-term benefit occurred in five patients despite ultimate caval occlusion in two patients and restenosis in one patient. One patient who was almost free of symptoms for 36 months developed gastrointestinal bleeding caused by portal hypertension. This experience suggests that balloon angioplasty is a safe and effective treatment for patients with Budd-Chiari syndrome. The therapy is not definitive, but serves to moderate the severity of the disease until collateral venous pathways develop. Multiple angioplasties are required for the long-term care of these patients.

Fourteen patients with sclerosing cholangitis underwent percutaneous cholangioplasty and stent placement with balloon-angioplasty and biliary-drainage catheters. There was initial clinical improvement in 13 of the 14 patients; one patient did not improve and died 1 month after the procedure. One of the 13 survivors developed encephalopathy and received a liver transplant 9 months after cholangioplasty; during the 9 months before transplantation, serum bilirubin and alkaline phosphatase levels returned to normal, and pruritus decreased. Restenosis of a duct following stent removal prompted repeat cholangioplasty in five of the 13 patients. Four of these five patients benefited from repeat cholangioplasty, and the fifth underwent liver transplantation 10 months after the second cholangioplasty. The other seven of the 13 survivors became either asymptomatic (n = 3) or less symptomatic than before cholangioplasty (n = 4) and did not require repeat cholangioplasty or liver transplantation during 10-42 months of follow-up.

Percutaneous angioplasty of the renal artery was performed in 79 patients who had stable or climbing serum creatinine levels greater than 1.7 mg/dl and hemodynamically significant stenosis of the renal artery. Patients who had nonrenal causes of azotemia, nephropathy caused by iodinated contrast material, or serum creatinine levels that were declining while the patients were receiving medical therapy before angioplasty were excluded from the study. Angioplasty resulted in a significant (greater than 20%) decline in the level of serum creatinine (average, 2.7 mg/dl before to 1.7 mg/dl after) in 43% of these patients during an average follow-up period of 16 months. A significant decrease in the level of serum creatinine was seen in 61% of patients with bilateral stenosis, 38% of patients with unilateral stenosis with absent contralateral renal blood flow, and 38% of patients with unilateral stenosis and normal contralateral renal blood flow. Recapture of lost nephron function was least successful in patients whose levels of serum creatinine were greater than 4.0 mg/dl (14%); this included one (11%) of nine patients who were already on hemodialysis. We conclude that angioplasty of the renal artery can play a major role in the treatment of patients who have mild azotemia and bilateral stenosis of the renal artery. It is less successful in treatment of patients who have severe azotemia and those who have unilateral disease.

Two hundred abdominal CT and angiographic examinations were performed on 137 patients with portal hypertension. These patients were being evaluated before or after a distal splenorenal shunt. CT increased the detection of umbilical and retroperitoneal varices. Angiography better detected peripancreatic varices and cavernous transformation. Both modalities together added more information than either alone in identification of coronary and/or gastroesophageal, retrogastric, and perisplenic-mesenteric varices. This additional anatomic information helped in the patient's management pre- and postoperatively.

A modified application of the Cope introduction setVP Chuang, JP Alspaugh, SA Harris, Jr, FW Sanchez, MD Skolkin, RA Zellmer, LG Martin and WJ CasarellaAudio Available | Share

Between January 1980 and July 1983, percutaneous transluminal angioplasty was attempted on 137 stenotic renal arteries in 100 patients. At termination of follow-up studies (3-39 months, mean of 16 months), 70% of those treated for hypertension had benefited from the procedure. Stenosis secondary to fibromuscular dysplasia responded better than stenosis from arteriosclerosis (85% and 65% of the patients, respectively). Benefit was minimal for those with stenosis of the renal artery ostium or renal insufficiency. Determining levels of renal vein renin before angioplasty is helpful in selecting patients; following angioplasty, this has considerable significance in predicting the success of the procedure.

A modified transfemoral technique for testicular venography and occlusion of the testicular vein (TV) was used to treat 30 patients with a total of 43 varicoceles (17 left-sided and 13 bilateral). Occlusion was satisfactory in all left varicoceles and 90% of right varicoceles. This coaxial technique facilitates subselective catheterization of the TV and its collaterals and enables coils to be placed deep within these vessels, either alone or in combination with detachable balloons.

Twenty-one human hepatic liver biopsy samples were evaluated by nuclear magnetic resonance spectroscopy. This spectroscopy was performed by obtaining multiple and not single T2 values (T2-long and T2-short). Neoplastic tissue had greater T2-long and T2-short values than diffuse liver disease. The T2-short correlated, r = 0.947 (p less than 0.01), with the percentage of cancer cellularity within the tissue specimens. There was no correlation between the multiple T2 values and the degree of fibrosis and inflammation. Minimal correlation was noted between the T2-long and percentage of fat within the diffuse disease (cirrhotic) specimens, r = 0.636 (p less than 0.05). The possible reasons for the above findings are discussed.

Three patients with bleeding jejunal diverticula that presented as life-threatening massive rectal hemorrhage were examined angiographically, with localization of the bleeding point. Vasopressin infusion did not result in adequate hemostasis in the two patients in whom it was attempted. Jejunal diverticula represent an uncommon, but not rare, source of massive gastrointestinal bleeding, usually presenting as "lower" tract hemorrhage. Without angiographic localization, surgical exploration for bleeding arising from jejunal diverticula has been difficult because of their occult nature and proximal location. A previously normal small intestine series does not preclude their presence.

The use of percutaneous drainage is reported in 6 patients with pancreatic pseudocysts and 6 patients with pancreatic abscesses. There have been no recurrences in the patients with pseudocysts. The success of the procedure is attributed to providing catheter drainage until the cavity was obliterated (mean time, 8 days), rather than using a single-needle aspiration. Percutaneous drainage of 6 pancreatic abscesses allowed desperately ill patients to improve enough to undergo elective surgery, and obviated surgery in 3 patients. The technique was performed without complications in all cases. Percutaneous drainage should find a significant place in the management of patients with complications of pancreatitis.

Twenty-two major intraabdominal abscesses in 19 postoperative patients were drained percutaneously using cross-sectional imaging techniques (computed tomography and sonography) for localization. Sixteen lesions were cured in 14 patients without reexploration. All patients were palliated by the percutaneous drainage procedure. All 22 abscess cavities were entered without complication or compromise of adjacent normal organs. Percutaneous abscess drainage is recommended as a safe, effective method of treating a major intraabdominal abscess in the postoperative patient.

The electrohydraulic lithotriptor, a machine which breaks up stones by generating a hydraulic shock wave, was assessed as a means of facilitating percutaneous extraction of biliary calculi. Tissue exposed to the lithotriptor showed no mucosal damage when studied histologically; however, round-cell infiltration was seen in one dog, raising the possibility of long-term stricture formation. Eighty per cent of the calculi could be fragmented with the lithotriptor. The application and limitations of the system are discussed.

Thermoluminescent dosimetry was used to measure the radiation exposure to the skin, thyroid and gonads in 50 consecutive pediatric patients undergoing cardiac catheterization and angiocardiography using cine photofluorography. Average exposures were 17.1 R to the skin, 2.3 R to the thyroid and 0.1 R to the gonads. Fluoroscopy accounted for approximately 80% of the skin and thyroid exposure and cine photofluorography for 20-25%. Occasional primary-beam irradiation was the major contributor to gonad exposure. Internal scatter of the incident x-ray beam was primarily responsible for thyroid exposure, so that infants received relatively high exposures; one receiving 7.3 R. The thyroid was not frequently in the primary beam. The significance of high radiation exposure to the thyroid, and in particular its relationship to thyroid carcinoma, are discussed. The results are compared with other series in the literature and relative exposures of cine photofluorography and serial filming are contrasted.

Percutaneous transluminal angioplasty was performed in 31 hypertensive patients with primary success in 26 patients (83%). Twenty-three patients had a mean follow-up of 13 months. The cure rate was 30% with a further 26% being improved. However, in the group of patients with lateralizing renal vein renin values, the cure rate rose to 47% with a further 33% improved. Of the eight patients with fibromuscular disease, 83% were normotensive without medication at follow-up; in the 13 patients with atherosclerotic disease, 22% were cured and 44% were classified as improved. Patients with fibromuscular disease and lateralization of renin production are the best candidates for long-term success.