Evaluation of a radiographic survey method of upper gastrointestinal examinations. A preliminary study comparing fluoroscopic and radiographic examinations in 100 cases.

Abstract

We have long suspected that fluoroscopy of the upper gastrointestinal tract may not be necessary for all patients but may be wasteful of time and effort. In addition, when used routinely, fluoroscopy exposes the patient and the physician to quantities of radiation which may be significant. Historically, fluoroscopic examination of the upper gastrointestinal tract antedated radiographic examination. Now, it is an integral part of such a study. Formerly, adequate power could not be generated or delivered, nor could x-ray tubes be built to obtain detailed, motion-free radiographs of the stomach. Hence, visualization of the stomach depended mainly on the primitive fluoroscope which could do no more than evaluate peristalsis, distensibility, pliability, and gross anatomic detail. With the advent of the modern Coolidge tube, Potter-Bucky diaphragm, high-power transformers, accurate controls, and cassettes with intensifying screens, visualization of the upper gastrointestinal tract by radiographic technic became more feasible and was incorporated into the standard examination. Lewis Gregory Cole and his associates soon developed technics utilizing the fluoroscope to position for the radiographic exposures, relying on the films almost entirely for diagnosis (1). Today we are witnessing the parallel development of fluoroscopic equipment (i.e., electronic amplification, closed-circuit television, tape-recording) as well as radiographic equipment, film, and rapid proc essing. Yet, fluoroscopy continues to be used routinely and emphasized by some (2, 3). The increasing shortage of radiologists forces a reappraisal of this method. The National Advisory Committee on Radiation of the Public Health Service concluded in a recently completed survey that there are 16,000 positions for the 8,000 radiologists today and by 1976 there may well be 30,000 positions available for 10,000 radiologists (4). Moreover, Medicare may seriously increase the load of elderly, debilitated, hard-to-examine patients. Certainly, fluoroscopy consumes a large portion of the practicing radiologist's time and energy. Campbell estimates that the general radiologist spends about one-half of his time in the examination of the gastrointestinal tract and recommends a method of cinefluorography performed by trained technicians as one method of meeting this problem (5). We believed it important to evaluate the safety, accuracy, and adequacy of a radiographic screening method of upper gastrointestinal examination, specifically when combined with immediate visualization of the radiographs by the radiologists utilizing a ninety-second processing system followed by closed-circuit television fluoroscopy of those patients with questionable findings or lesions. Method and Materials I. One hundred at-random patients—60 females and 40 males—were examined by our routine fluoroscopic and radiographic method.