Radiographic Monitoring Research Articles

Heart-Lung Transplantation in 1990 - Indications, Surgical Technique, Postoperative Complications and Outcome

Using cyclosporine A (CyA), long-term results after heart-lung transplantation became possible. Since 1981, 761 clinical heart lung transplantations have been registered at the International Society for Heart Transplantation. Candidates for this operation reveal signs of irreversible heart and lung diseases which are caused by cardiac lesions (e.g. valvular disease, Eisenmenger reaction due to congenital malformation) or pulmonary disorders (e.g. primary pulmonary hypertension, emphysema, fibrosis). The standard surgical procedure necessitates three anastomoses which combine donor and recipient tracheae, right atria and aortae. Immunosuppression consists of CyA (blood levels of 300-500 ng/ml), azathioprine (1-2 mg/kg/d) and rabbit antithymocyte globuline (RATG) (IgG: 2-4 mg/kg/d). After the first 2 postoperative weeks, RATG is replaced by low dose methylprednisolone (0.3-0.1 mg/kg/d). As an alternative, RATG may be omitted completely. Postoperatively, a variety of complications may evolve. Early problems (within the first month) comprise acute pulmonary rejection, bacterial pneumoniae, and multiorgan failure. Diagnosis of acute lung rejection proves difficult; it includes clinical signs, chest radiographic appearances and cytoimmunological monitoring of the peripheral blood. Transbronchial lung biopsies are for precise diagnosis of similar value to endomyocardial biopsies after heart transplantation. Late postoperative complications comprise viral, bacterial, fungal, and protozoal infections and chronic obliterative bronchiolitis. With increasing experience, the 30 day mortality fell to below 20% according to the International Society for Heart Transplantation. The one-year survival rate between 1986 und 1988 was reported to be 61%. The results of some individual groups are even better.

Stereotaxic approach to hypothalamic nuclei of the Shiba goat with radiographic monitoring.

Practical method was devised for precise approach to hypothalamic nuclei in the Shiba goat. A stereotaxic instrument and a brain atlas with stereotaxic coordinates were developed. For an accurate placement of probes into specific hypothalamic regions a radiographic method was employed in which radio-opaque material was injected into the lateral ventricle and the ventricular outline was depicted. A sagittal diagram showing the arrangement of hypothalamic nuclei in relation to the brain ventricular system was constructed from the transverse stereotaxic atlas. This diagram was revealed extremely useful in pinpointing the target on the radiographs of lateral view. Precision of this method was evaluated in female Shiba goats (n = 4) by comparing radiographically estimated positions of hypothalamic nuclei with those histologically determined. Despite of cranial variability among individual animals these two parameters matched well each other in all the nuclei examined. Furthermore, chronic cannulae were implanted into different hypothalamic structures of one goat and the accuracy of their placement was confirmed histologically. Thus, it was revealed that the stereotaxy by aid of radiography herein described was accurate enough to apply to various neuroendocrinological studies in the Shiba goat.

Invasive papillary breast carcinoma: mammographic and sonographic appearance.

A retrospective study of the records of xeromammographic examinations of 940 patients with invasive carcinoma of the breast diagnosed during an 11-year period in an out-patient facility yielded four cases of invasive papillary carcinoma. In each of these four patients, xeromammography demonstrated multiple, round or oval, circumscribed areas of density in one quadrant of a breast. Sonographic examination of three patients showed the lesions to be solid. Two patients had previously had multiple benign intraductal papillomas, and one patient had had a solitary papilloma in the same breast. The possible association of invasive papillary carcinoma with previous multiple intraductal papillomas suggests that close clinical and radiographic monitoring of these patients may be necessary.

Survey of radiologic practices among dental practitioners

The purpose of this study was to determine the factors that influence and contribute to patient exposure in radiologic procedures performed in the offices of 132 staff members within the dental department of a teaching hospital. A questionnaire was prepared in which data were requested on brands of film used, type of x-ray unit used, processing, and use of leaded apron, cervical shield, and film holder. Offices were also visited to evaluate performance of existing dental x-ray equipment. Both the Dental Radiographic Normalizing and Monitoring Device and the Dental Quality Control Test Tool were evaluated. The average exposure was equivalent to the class D film (220 mR), but only 13% of those surveyed used the faster class E film, which would reduce patient exposure in half. The survey indicates that dentists are not using the newer low-exposure class E film in their practices.

In-process radiographic monitoring of arc weld penetration : Rokhlin S.I.; Guu A.C. Proceedings of the 16th symposium on nondestructive evaluation, San Antonio, Texas (United States), 21–23 Apr. 1987. pp. 209–217

In-process radiographic monitoring of arc weld penetration : Rokhlin S.I.; Guu A.C. Proceedings of the 16th symposium on nondestructive evaluation, San Antonio, Texas (United States), 21–23 Apr. 1987. pp. 209–217

Monitoring radiation exposure to medical personnel during percutaneous nephrolithotomy

To ascertain radiation exposure to medical personnel during percutaneous nephrolithotomy, lithium fluoride thermoluminescent dosimeters (TLDs) were utilized for the radiographic monitoring of 7 consecutive patients. Average fluoroscopy time per procedure was 27.8 minutes of which 15.1 minutes were for nephrostomy tube insertion and 12.7 minutes were for calculi extraction. The 2 radiologists received 4.5 and 5.1 mrad per procedure, while the 2 urologists received 2.5 and 3.7 mrad. All other ancillary personnel received less than 2.1 mrad per procedure except the anesthesiologists whose mean exposure was 4.7 mrad. By taking appropriate precautions and using the proper equipment, percutaneous nephrolithotomy can be performed with a low level of radiation exposure for all involved physicians and personnel.

Lag screw fixation of sagittal navicular bone fractures in five horses

A sagittal fracture of the navicular bone in five horses was treated by means of lag screw. Intra-operative radiographic monitoring and a specially developed guide apparatus was necessary to implant the screw precisely along the transverse axis of the navicular bone. Internal fixation resulted in progressive radiographic narrowing of the fracture zone. In all five patients the fracture healed (bony union) without superfluous callus formation.

Segmented-field radiography in scoliosis.

A method of scoliosis imaging using segmented fields is presented. The method is advantageous for patients requiring serial radiographic monitoring, as it results in markedly reduced radiation doses to critical organs, particularly the breast. Absorbed dose to the breast was measured to be 8.8 mrad (88 microGy) for a full-field examination and 0.051 mrad (5.1 microGy) for the segmented-field study. The segmented-field technique also results in improved image quality. Experience with 53 studies in 23 patients is reported.

Early skeletal hyperostoses secondary to 13-cis-retinoic acid.

Prolonged therapy with retinoid drugs (chemically similar to vitamin A) often results in skeletal hyperostoses, similar to those seen in idiopathic skeletal hyperostosis. Eight patients, aged 5-26 years, with dermatologic disorders were treated with 13-cis-retinoic acid. Skeletal surveys were obtained before and during treatment. In 1 year, six of the eight patients had developed such skeletal hyperostoses in both axial and appendicular regions. The cervical spine was the most common site of involvement. None of the children demonstrated accelerated skeletal maturation. Two of the patients had mild musculoskeletal discomfort during this period. The findings indicate that high-dose 13-cis-retinoic acid therapy may cause skeletal hyperostoses, requiring radiographic monitoring during prolonged periods of treatment. An implication of these observations, relating to the etiology of idiopathic skeletal hyperostosis, is discussed.

A new video urodynamics: Combined ultrasonotomographic and urodynamic monitoring

AbstractA new video urodynamics to evaluate lower urinary tract function is presented. Video urodynamics was described originally as a combined radiographic and urodynamic monitoring. We describe certain modifications of original method, using the ultrasonotomographic method instead of the radiographic method. The urodynamic data and the simultaneous ultrasonotomography can be displayed through the display controller on the color display monitor. Our technique will be an extremely reliable method for the evaluation of lower urinary tract function.

The importance of radiographic monitoring of endoscopic sphincterotomy.

The radiographic features of endoscopic sphincterotomies performed in 44 patients were evaluated. Radiographic landmarks aided in proper sphincterotome placement and also disclosed conditions and anatomic variations that made catheter placement difficult. Fluoroscopic and radiographic monitoring not only assisted the performance of endoscopic sphincterotomy, but also confirmed successful results and revealed reasons for failure. Radiographic changes in the biliary tract after sphincterotomy, as well as potential complications of sphincterotomy, are discussed and illustrated.

Combined Radiographic and Urodynamic Monitoring: Advances in Technique

An electronic unit that simultaneously displays urodynamic data with radiographic visualization of the urinary tract on television monitors is described. A new photographic technique permits high quality film reproduction of the combined radiographic-urodynamic image from either live or videotape recorded signals.

Radiographic Aspects of Total Parenteral Nutrition During Infancy

In a retrospective radiographic study the authors reviewed the position of 82 central venous catheters in 57 consecutive infants receiving total parenteral nutrition between 1972 and 1976. Sixteen of the 82 catheters (19%) were initially not positioned within the superior vena cava and 11 (14%) migrated from a satisfactory position during therapy; peripheral edema, pleural effusion, and vascular thrombosis occurred more frequently in this group than in those infants with the catheter remaining in the superior vena cava. Unusual complications of intersititial pulmonary edema, hydrocephalus, and cardiac arrhythmia were noted in three different patients. An increased incidence of clinical complications is associated with catheter malposition or migration during total parenteral nutritional therapy. Radiographic monitoring with repositioning or removal of a malpositioned catheter may reduce the number of clinical complications.

Technique for radiofrequency gasserian ganglionectomy.

Indications, technical procedures, and complications are discussed for the performance of thermal electrocoagulation of the trigeminal preganglionic rootlets and gasserian ganglion. Specific steps in preoperative evaluation, premedication, anesthetic management, and technical performance of graded lesion-making utilizing radiographic control, physiologic stimulation and intraoperative patient monitoring are discussed. A survey of complications is presented.

Tissue reaction to pure and impregnated silastic

In experiments on rats, silver-impregnated silastic implants into muscle evoked the same degree of reaction as plain silastic and barium-impregnated silastic. Silver- and barium-silastic intracaval implants also produced comparable degrees of reaction and did not cause caval thrombosis. These findings, coupled with satisfactory clinical experience in the use of silver-silastic catheters, lead the authors to recommend the use of these catheters for caval intravenous alimentation and ventriculoatrial shunts, as their dense radioopacity facilitates radiographic monitoring.

Perforation of the interventricular septum by transvenous pacemaker catheter: Diagnosis by change in pattern of depolarization on the electrocardiogram ∗

A case of interventricular septal perforation caused by a transvenous catheter electrode is presented. This complication occurred during temporary pacing and was first detected by a change in the pattern of depolarization shown on the electrocardiogram and later confirmed by thoracic roentgenogram and cinefluorography. Predisposing factors are discussed, and the need for electrocardiographic and radiographic monitoring is emphasized.

Experiences With Two-Way Television in a Teaching Hospital Complex

Television has been developed and used extensively at the University of Vermont College of Medicine for consultation, patient care, teaching, and research. Present uses include televised monitoring of fluoroscopic examinations, radiographs, electrocardiograms, microscopic images, teaching conferences, operative procedures, and patients undergoing radiation therapy. Projected plans include the development of a two-way audiovisual transmission between the medical center and peripheral community hospitals for teaching and consultation purposes.

Radiolucent artefacts.

Early in its history radiology depended solely upon natural contrasts. It is the appropriate use of artificial media, however, which accounts for its expanding scope as a diagnostic procedure. But just as every coin has two faces, artificial contrasts present two aspects. On this basis they can be divided into the desirable and the unwanted, the good and the bad. The desirable contrasts are, of course, the various solutions, gases, instruments, and tubes which we deliberately put into the body. The unwanted contrasts we usually label artefacts. Another basis for classification is the density of the contrast material in relation to the adjacent structures. Combining the two classifications, we emerge with two groups which are of practical significance: (A) wanted and unwanted contrasts which are dense enough to be recognized without real difficulty; (B) wanted and unwanted contrasts of lesser density which are poorly seen, or not at all, through surrounding tissue. Group A does not concern us here, and we will not pursue it. Group B deserves attention from radiologists because of the rapidly increasing use of radiolucent material (largely plastics) during the last two decades. Most physicians who use orthopedic instruments or slender catheters for angiography or urography are educated to the implications of fluoroscopic and radiographic monitoring of their procedures and insist on implements appropriately marked with radiopaque material. The field of gastroenterology in which radiology is so intimately involved presents special problems. Here plastic tubes may interfere seriously with the radiologic examinations. The use of such tubing, satisfactory for procedures which from a radiographic standpoint can be performed “blind,” has unfortunately been extended to more complicated studies in which roentgenologic control is desirable. Plastic tubes may do a good job of decompression, but they cannot be demonstrated on a view-box. Some specific objections to their use follow: 1. Plastic tubes cannot be seen, localized, or recorded. 2. Even though the clinician may know about a tube and how far down it has progressed, that information is usually not available to the radiologist and is never demonstrable to future viewers of the films. Thus, consultants on the present situation get less than they should from the films, and the films suffer as a teaching vehicle for future students or for publication. 3. Some tubes have opaque objects at their extremities, as mercury bags, Rehfuss bulbs, or Crosby biopsy capsules. If the tubes are not radiopaque, their localization is practically impossible. Indeed, it sometimes happens that the terminal object may become separated from its attachment, but no one can tell whether or not it is free. 4. Blakemore tubes, for compression of esophageal varices, have a sausage-shaped esophageal balloon and a globular gastric balloon, beyond which are several inches of free tubing.