Mass Radiography Research Articles

Mass Radiography in Scotland

Mass Radiography in Scotland

Tuberculosis in a common lodging-house.

In most European countries tuberculosis mortality has been decreasing during the last few decades, but this decrease has not been uniformly experienced by all age and sex groups (Clarke, 1952; Cheeseman, 1952). Generally, old men as a group have benefited least and this contention is supported in some countries by the trends of notification rates (Cheese man, 1956; Lowe, 1954; Stocks, 1950; Ministry of Health, 1958). Residents of common lodging-houses in Northern Ireland are mostly old men and their experience of tuberculosis has not been studied with the detail which the apparent vulnerability of this age and sex group would appear to demand. This paper des cribes a study of the disease in one particular common lodging-house in Belfast and assesses its importance as a focus of infection in the Belfast community. Laidlaw (1956) reviewed 125 persons in Glasgow suffering from tuberculosis who gave as their place of residence a common lodging-house or a working men's hostel. Of these 34 (27 per cent.) refused to co-operate in any way after diagnosis, and a further 27 (22 per cent.) did not co-operate fully in hospital or out-patient treatment. Tuberculosis was the fourth commonest cause of death amongst lodgers in Glasgow common lodging-houses, accounting for one tenth of all deaths during 1950-53, the average length of survival after diagnosis being 3 years. In a recent survey of tuberculosis in Glasgow, 860 residents of common lodging-houses were visited and offered examination by mass miniature radiography. Only 193 (22 per cent.) accepted and of these 67 were referred to a chest clinic. Only 56 attended, among whom 22 were found to have significant pulmonary tuberculosis (i.e. 26 per 1,000 residents originally visited). Of those admitted to hospital the majority were either prematurely discharged because of ill-behaviour or left against advice (Geddes, 1959).

A ten years' survey of routine ante-natal chest x-rays

Between 1951 and 1959 the Southampton mass miniature radiography unit did routine chest x-rays of 8,721 ante-natal patients referred by ante-natal clinics and general practitioners. 50 were found to have abnormalities requiring further investigation at chest clinics. One was already attending a clinic and 5 were not fully investigated. All the remaining 44 had pulmonary tuberculosis. 34 (3·9 per 1000) were classed as requiring close clinic supervision or treatment and 10 (1·1 per 1000) occasional supervision only. The present policy of using full-sized films for ante-natal examinations, to minimize exposure to ionizing radiations, is criticized.

Four episodes of sarcoidosis after pulmonary tuberculosis

A young woman was discovered by mass radiography to have pulmonary tuberculosis. This was confirmed by the later development of calcification at the same site. Five years later radiographic changes typical of sarcoidosis were found. These regressed completely within a year. Two further similar episodes occurred, followed each time by complete regression of the radiographic abnormalities; a fourth episode has developed and the radiographic abnormalities again regressing. Each ‘cycle’ has occurred during the same season, i.e. the summer, in alternate years.

An investigation in volunteers undergoing mass-radiography examination in the City of Canterbury, 1958

Since tuberculosis is the only disease which can reasonably be excluded on the basis of a chest radiograph, it will be increasingly important to consider the problem of mass radiography volunteers with symptoms caused by other diseases, if the tuberculosis yield from mass radiography units continues to fall during the next few years. Questioning of a sample of volunteers at a mobile Mass Radiography Unit in the City of Canterbury in 1958 showed that 10·4 per cent of the people came because of symptoms of respiratory disease and 6·4 per cent came because of the history of contact with tuberculosis. A history of respiratory disease, the presence of non-respiratory symptoms and a desire for company were among other reasons given for attending. The evolution of so called ‘mass radiography’ is already guiding it towards the examination of the sick (‘G.P. referrals’ and static units) and it seems that some form of clinical mediation may, eventually, be necessary in all branches of this work if the individual, as well as the community, is to get the best value from this important method of investigation.

Parenchymatous (Bronchopulmonary) Manifestations of Pulmonary Bilharziasis

The chest findings in 57 cases of bilharzia admitted to hospital have been analyzed. The only finding directly attributed to the bilharzial infection was presence of ova in the sputum, which were present in three of 29 cases. The following findings were possibly, but not certainly, due to bilharzia: (a) localized rales, (b) radiological shadows of a localized patchy or strandy nature, (c) asthma in which improvement occurred after antibilharzial treatment. The following findings were most probably associated, and not casually related: (a) asthma or asthmatic bronchitis, in which no improvement occurred after specific treatment, (b) generalized emphysema, (c) minimal dilatation of subsegmental bronchi. In a mass radiography survey of an endemic area, the incidence of parenchymatous pulmonary shadows was comparable in bilharzial and non-bilharzial subjects.

Mega-aorta in a young man

A healthy young man was examined by mass radiography, and diffuse dilatation of the aorta was fortuitously discovered. Aortography showed that the lesion was most pronounced in the thoracic aorta. The possible etiology is discussed.

Pneumoconiosis in Makers of Artificial Grinding Wheels, Including a Case of Caplan's Syndrome

Mass miniature radiography surveys in a factory producing artificial grinding wheels detected cases of pneumoconiosis, mostly of the silicotic type. All cases were traced to the department where the so-called “bond” is prepared and mixed with the abrasive grains of carborundum and artificial corundum. This ceramic-vitrified bond, similar in composition to English general earthenware, contained until recently a significant proportion of free silica. The miniature film survey was followed up by an investigation on full-sized films, in which 92% of all workers in the bond department participated. The radiographs were subjected to dual independent viewing and it was found that 66% of the men who had worked in the bond department for more than 10 years showed radiological evidence of pneumoconiosis with a high proportion of progressive massive fibrosis (P.M.F.) Recently the amount of free silica in the ceramic bond has been reduced by the introduction of “frits” in place of powdered flint and part of the factory has been rebuilt and new methods of dust suppression and dust extraction have been introduced. One of the cases presented with the rheumatoid-pneumoconiotic syndrome, first described by Caplan. It is suggested that some of the cases of pneumoconiosis, attributed to carborundum, may be due to the binding materials of artificial grinding wheels.

Smoking habits related to injury and absenteeism in industry.

In February, 1957, a mass radiography unit visited the General Electric Company Limited at Witton, Birmingham, and 7,680 employees (70 per cent, of the population) were x-rayed. As the employees attended for examination a smoking history was taken from them by the clerks of the unit. The data collected formed part of a larger survey of smoking habits in the Midlands, the results of which have already been published (Cross, McDowell, and Posner, 1957). Among the employees of the General Electric Company who were questioned there were 3,341 male workers who remained with the firm throughout the 12 months ended December 31, 1957. This paper examines the frequency of attendance at ambulance rooms for treatment of injury and the frequency of absenteeism among these men in relation to their smoking habits.

Cancer of the lung—A public health problem?

Summary The increasing incidence of lung cancer is noted. The methods of its diagnosis are outlined with the difficulties involved. The criteria by which a diagnosis was made in a series of 96 cases are listed. Treatment is discussed and it is noted that only one third of all cases are suitable for radical surgery in spite of a more general awareness of the disease and improved diagnostic facilities. The immediate prognosis is poor. Only 10 of 48 cases, diagnosed as a result of mass radiography drive, were alive at two years. Similarly only five of a series of 48 cases referred to the clinic by general practitioners were alive at two years. In the light of those results even early diagnosis does not offer much hope for victims of the disease. Until we have a specific cure for cancer the approach to the problem should be by an increased preventive drive. Local Authorities should be given much more government backing to tackle known hazards such as cigarette smoking, atmosphere pollution and certain trades where there is a risk. Such action would incidentally help to solve the problem of chronic bronchitis. Research into cancer's causation and treatment should be increased.

An experiment in mass radiography.

An experiment in mass radiography.

Anatomo-clinical and radiological considerations on neoplasms of the thymus (case contribution)

Ten thymic tumours are described (7 thymomas, 1 lymphosarcoma, 1 lymphoepithelioma, 1 cylindrocellular carcinoma). Two asymptomatic thymomas were casually detected by mass radiography and a roentgenological investigation. In 1 case symptoms had been present for 10 years, in 1 for 5 years, and in the others for 3 years to 40 days. Myasthenia was present in 2 thymomas: in 1 of them the patient treated with prostigmine was able to begin pregnancy and to bring it to term. The clinical and radiological diagnosis was correct in 4 cases. The tumour was located in 6 cases in the anterosuperior mediastinum, in 3 in the antero-inferior mediastinum, in 1 in the hilar region. Radical treatment was possible in 3 patients; two of them are alive after 3 and 4 years from operation, the third had a recurrence 9 months after the operation. In 3 cases pleuropulmonary metastases occurred. Roentgen-therapy produced tumour reduction in 3 cases and decrease of the myasthenic condition in 1. Thymomas are easily distinguishable from the other thymic tumours, and those with myasthenia show a higher cellular differentiation. Radiotherapy must be employed as a complement of surgery or when the latter is contraindicated.

Bronchogenic carcinoma: A mass radiography group compared with a practitioners' group

Summary Forty-eight cases of bronchogenic carcinoma seen at one clinic in Glasgow after the City-wide Mass Radiography survey are compared with 48 consecutive cases sent with symptoms to the clinic by practitioners. Only 12 of the M.M.R. group had no symptoms, and it is concluded that more propaganda is necessary to make the public X-ray conscious as regards chest symptoms. Difficulties of diagnosis arose with those cases which presented as pneumonia, peripheral abscess, or with lymphangitis carcinomatosa, resembling tuberculosis on the X-ray, and with negative bronchoscopic findings. On the whole the M.M.R. group fared better than the practitioners' group, and at eighteen months from first attending the clinic 13 of them were alive, compared with 8 in the practitioners' group. Operation, be it removal of one lobe or pneumonectomy, offers the best hope of survival to eighteen months.

Bronchial carcinoma in men detected by selective and unselective miniature radiography: A review of 228 cases

An analysis of 228 cases of bronchial carcinoma in men discovered by selective and unselective radiography during 1952/56 is reported. The high rate of detection in those presenting with chest symptoms at a static miniature radiography unit (selective radiography) was compared with the low yield in assumed healthy examinees attending a mobile unit (unselective radiography). There is a strong suggestion that the patients discovered by unselective radiography have a greater chance of having the cancer removed and of surviving than the patients with symptoms who are discovered by selective radiography. The need for further investigation of the value of unselective mass radiography is emphasized.

Mass radiography and cancer of the lung.

Mass radiography and cancer of the lung.

Hazards of Mass Radiography

Hazards of Mass Radiography

The epidemiology of sarcoidosis.

Summary The nationality, social factors, exposures, morbidity, mortality, and hospital discharge notes have been analysed in a series of patients with histologically proven sarcoidosis, and correlated with clinical and radiological features. Compared with the expected prevalence according to the Central London population obtained from the 1961 Census, Irish and West Indians attended the Sarcoidosis Clinic twice as frequently as British, whereas African Negroes are under-represented. Sarcoidosis is slightly commoner in women, particularly those in the childbearing years of life. Mass miniature radiography rates per 100,000 population reveal prevalence rates of twenty overall, forty-three in those aged 25-34 years, and ten in those aged over 45 years. Erythema nodosum, other skin lesions, and ocular involvement occurred twice as often in women. The death-rate of about 1·7/106 population is slightly higher in women and in those living in rural districts. Hospital discharge rates are about three per 100,000 people at risk each year.

The value of dual reading in mass radiography

An experiment is described in which 10,000 35 mm. chest films were read by two independent observers during a routine mass radiography survey. A method of dual reading was used which minimized the interruption to normal working of the unit. Radiologically, the results followed closely those of other workers. Patients recalled by one or both readers for large films and subsequently referred for further investigation were followed up for a year. Judged by the clinical significance of the lesions as shown by the follow-up, dual reading was found to have produced little gain.

CHAPTER 11: Tuberculosis in Industry — The Role of Mass Radiography

CHAPTER 11: Tuberculosis in Industry — The Role of Mass Radiography

Construction of a mass miniature radiography vehicle.

Construction of a mass miniature radiography vehicle.