Use Of Radiologic Examinations Research Articles

Early Detection of Heart Failure with Autonomous AI-Based Model Using Chest Radiographs: A Multicenter Study.

The opportunistic use of radiological examinations for disease detection can potentially enable timely management. We assessed if an index created by an AI software to quantify chest radiography (CXR) findings associated with heart failure (HF) could distinguish between patients who would develop HF or not within a year of the examination. Our multicenter retrospective study included patients who underwent CXR without an HF diagnosis. We included 1117 patients (age 67.6 ± 13 years; m:f 487:630) that underwent CXR. A total of 413 patients had the CXR image taken within one year of their HF diagnosis. The rest (n = 704) were patients without an HF diagnosis after the examination date. All CXR images were processed with the model (qXR-HF, Qure.AI) to obtain information on cardiac silhouette, pleural effusion, and the index. We calculated the accuracy, sensitivity, specificity, and area under the curve (AUC) of the index to distinguish patients who developed HF within a year of the CXR and those who did not. We report an AUC of 0.798 (95%CI 0.77-0.82), accuracy of 0.73, sensitivity of 0.81, and specificity of 0.68 for the overall AI performance. AI AUCs by lead time to diagnosis (<3 months: 0.85; 4-6 months: 0.82; 7-9 months: 0.75; 10-12 months: 0.71), accuracy (0.68-0.72), and specificity (0.68) remained stable. Our results support the ongoing investigation efforts for opportunistic screening in radiology.

Radyolojik Görüntülemelerdeki Artışın Analizi: Altta Yatan Faktörler ve Sonuçları

Since the discovery of X-rays, radiological examinations have held a crucial role in diagnosis. With the progression of technology over time, the diversity and applications of imaging methods have expanded significantly. In recent years, there has been a notable increase in the use of radiological examinations. This surge can have adverse effects in various domains, primarily impacting healthcare and the economy. In order to cope with the numerical increase in radiological imaging, excessive or unnecessary imaging should be taken under the spotlight. In this review, the reasons and consequences of the increase in the number of radiological examinations will be revealed.

Is a non-radiological-assisted method valid for establishing crown-root relationships in an orthodontic set-up incorporating the roots? A retrospective study

This study aimed to obtain information on the relationship between crown and root in terms of morphology - dimensions and crown-root angles -to be used for orthodontic set-ups without the use of radiological examinations. All the good quality CBCTs of patients obeying the eligibility criteria, from 2000 to 2015, were analysed. All teeth were analysed except for third molars. Six variables were evaluated: crown (CL) and root length (RL), crown width (CW), root width (RW), crown-root angles in both the frontal (CR-frontal) and sagittal plane (CR-sagittal). All teeth were divided into 3 groups according to number of root (single, two, three-rooted). The measurements were assessed with the Invivo professional software and then, subjected to correlation matrices and linear regression statistical analysis in order to find any significant correlations between crown and root measurements (α≤0.05). Seventy-three out of 247 good quality CBCTs were assessed. Correlation matrices statistical analysis showed linear correlations for some variables investigated, especially for CW/RW pairing in all subgroups (r=0.81, r=0.70 and r=0.58 respectively for single-, two- and three-rooted) and CL/RL in the single-rooted subgroup (r=0.29). Subsequent linear regression analysis allowed to obtain information about roots starting from crown measurements by means of equations [RW=0.76+(0.73×CW) and RL=10.94+(0.25×CL) for single-rooted teeth; RL=1.11+(0.73×CW) and RW=0.99+(0.76×CW), respectively for single- and two-rooted teeth]. No linear correlation was found between crown measurements and C-R angular values. It is possible to obtain root information starting from some crown measurements but these do not fulfil the need of minimal information to guarantee a perfect root position starting from that of crown.

ROLE OF CT SCAN EXAMINATION ON COVID-19

Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The role of radiology has a very important role in diagnosis and evaluation. CT scan has a potential role in diagnosing and complications of COVID-19, such as acute respiratory distress syndrome, pulmonary embolism, and heart failure, while its role in determining prognostics requires further investigation. The images on a COVID-19 CT scan generally show ground glass opacities, consolidation, air bronchogram and poving stone. CT scan examination can be used in the use of triage in the hospital in enforcing COVID-19 patients who need immediate treatment. The use of radiological examinations in combination with RT-PCR can help diagnose and manage COVID-19.

Diagnosis of COVID-19 from chest X-ray images using wavelets-based depthwise convolution network

Coronavirus disease 2019 also known as COVID-19 has become a pandemic. The disease is caused by a beta coronavirus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The severity of the disease can be understood by the massive number of deaths and affected patients globally. If the diagnosis is fast-paced, the disease can be controlled in a better manner. Laboratory tests are available for diagnosis, but they are bounded by available testing kits and time. The use of radiological examinations that comprise Computed Tomography (CT) can be used for the diagnosis of the disease. Specifically, chest X-Ray images can be analysed to identify the presence of COVID-19 in a patient. In this paper, an automated method for the diagnosis of COVID-19 from the chest X-Ray images is proposed. The method presents an improved depthwise convolution neural network for analysing the chest X-Ray images. Wavelet decomposition is applied to integrate multiresolution analysis in the network. The frequency sub-bands obtained from the input images are fed in the network for identifying the disease. The network is designed to predict the class of the input image as normal, viral pneumonia, and COVID-19. The predicted output from the model is combined with Grad-CAM visualization for diagnosis. A comparative study with the existing methods is also performed. The metrics like accuracy, sensitivity, and F1-measure are calculated for performance evaluation. The performance of the proposed method is better than the existing methodologies and thus can be used for the effective diagnosis of the disease.

Inferior Turbinate Mucocele.

In what follows, it is extremely rare for the inferior turbinate to occur with a mucocele. The authors aim to evaluate the characteristics, clinical features, and treatment outcome of the inferior turbinate mucocele in our hospital. Five patients with radiologically confirmed inferior turbinate mucocele between January 2006 and December 2017 were enrolled in this study. Out of the 5 patients with inferior turbinate mucocele reviewed, 2 out of the 5 patients had symptoms of nasal obstruction and headache respectively, whereas the other 3 remaining patients were found incidentally by radiological examinations without any nasal symptoms. Four patients were performed the surgery by the transnasal endoscopic marsupialization. One patient had a very small size of an inferior turbinate mucocele and had no symptoms, and in that case the authors decided to do a periodic observation without a surgical intervention. There were no major complications resulting from this surgical intervention, and no recurrence of the inferior turbinate mucocele. The inferior turbinate mucocele is an extremely rare disease and can be diagnosed accurately by the use of radiologic examinations. The prevailing discipline is that endoscopic marsupialization is the best treatment for the inferior turbinate mucocele, which is known for showing very good results without recurrence of the condition.

An assessment of medical students\u2019 proficiency regarding the hazards of radiological examinations on the health of workers and patients: a cross-sectional study from Palestine

BackgroundThe use of radiological examination is increasing worldwide. Since radiation exposure can result in many health hazards, medical professionals, as well as medical students, should possess adequate knowledge regarding radiation and its related hazards to protect themselves and the patients. Many studies have assessed medical students’ knowledge on this topic, but never in Palestine. In this study, we aimed to examine Palestinian medical students’ awareness and knowledge regarding radiological examination modalities and their risks on themselves and their patients.MethodsThis was an observational, cross-sectional, population-based study, conducted to assess the awareness of radiation exposure and its risks among Palestinian medical students. An online questionnaire was implemented on medical students at An-Najah National University. A total knowledge score that ranged from 0 to 22 was calculated for each participant, with higher scores indicating better knowledge regarding radiation doses and the related hazards.ResultsTwo hundred eighty and seven students participated in our study, with a response rate of 71%. The average knowledge score of the participants was 10.97 ± 4.31 out of a maximum of 22 points. Male participants and participants in advanced study years achieved better knowledge scores (p-values were 0.034 and < 0.001, respectively). Perceived radiology knowledge was significantly associated with the actual knowledge score among the participants (p-value< 0.001). Receiving radiology lectures in fourth and fifth years significantly affected the participants’ knowledge score (p-values were < 0.001).ConclusionsWe found a severe lack of knowledge regarding radiation doses and related risks among medical students. Therefore, we recommend that medical schools update and supplement their curriculum regarding knowledge on radiation.

Trends in Primary Kidney Cancer: A South Australian Registry Review

Background The incidence of primary kidney cancer (PKC) has been increasing over the last three decades. This has been attributed to the liberal use of radiological examinations for unrelated indications. We investigated the incidence and survival trends of PKC in South Australia. Methods Data were provided through the South Australian Cancer Registry and comprised pathology, hospital admission and death notifications between 1977- 2013. Basic demographic data at diagnosis, tumour grade, and overall survival (OS) were available for analysis. Results During 1977-2013 there were 5529 cases of PKC diagnosed. Mean overall survival was 70.6 months (standard deviation 80.2). The age adjusted incidence of PKC has increased from 5 per 100,000 to 12.7 per 100,000. However, CSS and OS has significantly improved at each decade of diagnosis since 1977 (p&lt;0.001). Conclusion Since 1977 the incidence of kidney cancer has doubled in South Australia with step-wise improvement in OS at each decade of diagnosis.

Bone marrow abnormalities detected by magnetic resonance imaging as initial sign of hematologic malignancies.

The increasing use of radiological examination, especially magnetic resonance imaging (MRI), will probably increase the risk of unintended discovery of bone marrow abnormalities in patients where a hematologic disease would not be expected. In this paper we present four patients with different hematologic malignancies of nonplasma cell types. In all patients the MRI bone marrow abnormalities represent an initial presentation of the disease. These case reports illustrate the importance of a careful diagnostic follow-up without delay of patients with MRI bone marrow abnormalities, because such abnormalities can represent the first sign of both acute promyelocytic leukemia as well as other variants of acute leukemia.

Decreasing Radiation Exposure in Pediatric Trauma Related to Cervical Spine Clearance: A Quality Improvement Project.

Quality improvement project. Reduce the amount of radiation exposure in the pediatric trauma population 5 years of age and older in relation to cervical spine clearance. The evaluation of pediatric cervical spine injuries must be accurate and timely to avoid missed injuries. The difficult clinical examination in pediatric trauma patients necessitates the use of radiologic examinations to avoid missing catastrophic injuries. However, exposure to radiation at an early age increases the pediatric patients' risk of developing cancer (R. A. ). A retrospective chart review was conducted to assess radiation exposure in pediatric patients requiring evaluation for cervical spine clearance. Surgical staff and emergency department physicians received education on the risks related to pediatric radiation exposure and information related to the institution's diagnostic trends for cervical spine clearance. An algorithm was then developed to assist with determining the necessary imaging study for cervical spine clearance. Radiation exposure was monitored following initial education and use of the algorithm to determine its effect on radiation exposure. The retrospective chart review identified cervical spine computed tomography (CT) in 34%, with an average radiation exposure of 3.5 mSv. Following education and introduction of an algorithm, 18% of patients underwent CT for cervical spine clearance with an average radiation exposure of 3.2 mSv, representing a 47% decrease in the use of CT. Staff education and the use of an algorithm show promise in the reduction of radiation exposure and provide safe, effective clearance of the cervical spine in pediatric trauma.

RADIOPROTECTION CAMPAIGN AND CARD: EDUCATIONAL STRATEGIES THAT REDUCE CHILDREN'S EXCESSIVE EXPOSURE TO RADIOLOGICAL EXAMS.

ABSTRACTObjectives: To analyze the results of an initiative aimed at improving the reasonable use of radiological examinations, ensuring their technical quality, implementing a radioprotection campaign that includes training of the professional team, and introducing the radioprotection card for children under 12 years old as a tool for parents and doctors to control children’s exposure to radiation. Methods: The study was held in a health care insurance system covering 140,000 people. A radioprotection campaign was implemented according to Image Gently • protocols, ensuring the lowest dose of radiation and the quality of examinations, and the radioprotection card was implemented. To assess the effectiveness of these actions, the number of radiological examinations performed at the pediatric emergency room in a period of one year preceding the campaign was compared with the number of radiological examinations performed one year after the campaign. Results: The campaign was well accepted by all professionals, families, and patients involved. In the year following the implementation of radioprotection strategies, there was a 22% reduction of radiological examinations performed at the pediatric emergency room. There was also a 29% reduction in the request of two or more radiological examinations for the same child or examinations with two or more incidences. Conclusions: The campaign and the radioprotection card for children under 12 years old proved to be feasible strategies and correlated with a reduction in radiological examinations requested and performed at the pediatric emergency room.

Evaluation of Three-Dimensional Tomography of Interorbital, Biorbital and Bizigomatic Distances in Zeytinli Island (2nd century AD 12th century BC) Individuals

Zeytinli Island, which is connected to Balıkesir province Erdek county, is one of the important archaeological excavation sites in our country. The anthropological evaluations of human skeletons obtained from Zeytinli island excavations gave important information about age and gender especially when the skull was taken into account and especially the use of radiological examinations increased the reliability of this information. In particular, theuse of radiological examination sincreas esther reliability of this information. Our study was carried out between 2007 and 2011 by taking the skulls of a total of 22 individuals, 6 females and 16 males between the 2nd century BC and the 12th century AD, uncovered as a result of the excavations performed in Zeytinli Island. The image staken by multislice computed tomography were transformedin to three-dimensional form with workstation software, and their interorbital, biorbital and bizygomatic measurements were performed. The skull measurement values were presented as median (range) with a whisker graphic. The median female and male values were comparedusing the Mann-Whitney test. The Pearson correlation test was used to examine the correlations between the measurement values. The fact that the p-value was below 0.05 was considered significant. Upon evaluating the data, the difference between the male and female interorbital and bizygomatic distances was not found significant (p>0,05). When the biorbital distances were taken into account, the biorbital distances of male skulls were found to be significantly higher compared to those of female skulls (p<0,05) . No significant relationship was found when the analyses of the correlation between interorbital and biorbitaland bizygomatic distances were examined. In our study, the bizigotic distances in the skulls belonging to male individuals are longer than the skulls of female individuals. This shows that the lateral protrusions of the male's skull are more prominent. This is an important criterion for gender discrimination.

Radiology and sustainable development

Purpose – The purpose of this paper is to highlight the relation between radiology and sustainable development with emphasis on the UK and European countries, and to spotlight its possible application in the developing countries. Design/methodology/approach – This is a review paper where data about sustainable development and radiology are collected from selected journals, websites, articles and conferences, e.g. Royal College of Radiology, European Society of Radiology, World Health Organization and other different radiology societies. Findings – Adoption of sustainable diagnostic radiology by many countries in Europe and the UK helps to provide imaging services efficiently and effectively, with simultaneous preservation of the natural resources, patient health and environment much better than before. The developing and underdeveloped countries should follow this knowledge hoping to reach the same goals. Practical implications – Limiting the use of radiologic examinations, guide the clinicians to use clinical skills before rushing to radiology examinations will save money, preserve equipment and protect patients from possible radiation hazards. The use of teleradiology will indirectly reduce global warming, and will deliver medical services to poor countries. Social implications – Improving the health of people of poor countries will improve their socioeconomic level. Originality/value – This paper focuses on the value of applying sustainable development in radiology not only in general medicine.

Imaging and cancer survivorship: challenges and changing concepts

The widening gap between cancer incidence and mortality testifies to the increasing success of cancer treatment. For example, in Queensland Australia, there are now more than 7 cancer survivors for each patient newly diagnosed with cancer. These individuals represent a population at risk for recurrent malignancy for whom there is a growing demand for imaging services. Imaging for suspected recurrence may be prompted by symptoms or rising tumour markers, whilst for some tumours, imaging contributes to regular surveillance. The benefits of early detection of recurrence through imaging surveillance need to be balanced against cost, patient anxiety and radiation exposure. A recent study has estimated the absolute risk of second cancer induction resulting from use of radiological examinations in this context to be between 0.1% and 10% [1]. Targeting patients at greatest risk of recurrence would improve the balance between risk and benefit for imaging surveillance and is potentially achievable through the use of prognostic imaging biomarkers derived from imaging procedures performed at staging or post-treatment [2]. Increasingly sophisticated treatments for recurrent disease present further challenges to the use of imaging in cancer survivorship. There are now more therapeutic options for patients with localised disease or recurrence to a few sites (oligometastatic disease). Although well established for hepatic metastases from colorectal cancer, surgical resection of localised recurrence is increasingly adopted for alternative sites of recurrence and for other tumour types. For tumour sites unamenable to surgery, stereotactic body radiotherapy can allow focal delivery of high-dose radiation with single or few fractions with promising local control and overall survival rates [3]. These developments create new questions for imaging. Firstly, should imaging surveillance programmes of asymptomatic cancer survivors be developed to allow identification of the oligometastatic state prior to disseminated disease? The potential benefits of surveillance are highlighted by a study of patterns of distant failure and progression in breast cancer which found oligometastatic disease to be more common amongst asymptomatic patients [4]. Secondly, how can imaging be optimised to distinguish oligometastatic from disseminated disease? Imaging in this context must have high sensitivity and specificity on a lesion-by-lesion basis because an accurate assessment of the number of metastases is required to avoid the morbidity of inappropriate oligometastatic treatment, as well as the possibility of oligometastatic treatment being wrongly withheld due to the presence of benign lesions that are indistinguishable from additional metastases. Hybrid imaging techniques that combine modalities with complementary sensitivity and specificity are likely to offer the greatest opportunities for accurate assessment of oligometastatic disease. Higher accuracy for skeletal metastases can be achieved by diphosphonate SPECT/CT or fluoride PET/CT in place of planar scintigraphy [5] whilst integrated FDG-PET/MRI has the potential to optimise detection of skeletal and hepatic recurrence in a single examination [6,7]. The new PET tracer Gallium-68 Prostate Specific Membrane Antigen demonstrates high accuracy for nodal and skeletal recurrence prostate cancer [8]. Imaging protocols for cancer staging are now well established. Increasing cancer survivorship has created a need to develop equivalent protocols for the diagnosis and assessment of tumour recurrence.

Informed Consent in Human Research

To ensure that the possibility of harm to human research subjects is minimized, clinical trials and other research protocols are subject to oversight by Institutional Review Boards (IRBs). IRBs require that subjects be fully informed about the real or potential risks of participation in a research study. The use of radiological examinations in research protocols subjects the participants to exposure to ionizing radiation, which in theory carries a risk of stochastic effects such as radiation-induced cancer, and in practice may lead to deterministic effects such as skin injury. Because IRB members and clinical study coordinators may have little knowledge of radiation effects or how best to communicate the risk to the research subjects, they will consult with institutional Radiation Safety Committees and radiation protection professionals regarding how to integrate radiation risk information into the informed consent process. Elements of radiation informed consent include: (1) comparison of the radiation dose to some benchmark that enables the study subjects to make a value judgment regarding the acceptability of the risk; (2) a quantitative expression of the absolute risk of stochastic effects; (3) an expression of uncertainty in the risk; and (4) understandability. Standardized risk statement templates may be created for specific radiological examinations. These standardized risk statements may be deployed as paper forms or electronically in the form of internet-based applications. The technical nature of creating useful radiation risk statements represents an opportunity for radiation protection professionals to participate productively in the clinical research process.

Assessment of physicians’ knowledge and awareness about the hazards of radiological examinations on the health of their patients

Previous studies have shown that physicians tend to underestimate the risks to patients of radiation exposure. This study in 2 Palestinian hospitals aimed to assess physicians' knowledge about the risks associated with the use of radiological examinations. A questionnaire answered by 163 physicians revealed many gaps in knowledge. Only one-third of physicians had received a radiation protection course during their undergraduate study or in the workplace. Few physicians were able to answer correctly many scientific, knowledge-based questions. For example, only 6.1% of the respondents were able to identify the ALARA principle and 98.2% did not know that there is no safe dose limit according to international recommendations. Physicians' practices in terms of frequency of use of routine X-rays and discussing the risks with patients were also poor. These results clearly indicate the need to increase Palestinian physicians' knowledge and awareness about the potential hazards associated with the use of radiological examinations.

Radiological examination in low back pain patients: Anxiety of the patient? Anxiety of the therapist?

A review of the recent literature shows that guidelines on the management of low back pain (LBP) have little impact on the use of radiological imagery. Among the factors which might account for the use of radiological examination, a review of the literature points to some that refer to the patient, others to the clinician and still others to the therapeutic interaction. This leads one to question the importance of radiological examination for both the patient and the physician. The matter at stake in this review is the relationship that may exist between this type of examination and the patient's and/or the physician's anxiety. If these aspects are associated or causally related, this relationship can be two-sided and is thus susceptible to affect the patient, the physician, or both. Some possible keys which emphasize the central role of the therapeutic relationship in this predicament are also reviewed.

Otitic hydrocephalus: Role of radiology for diagnosis

The pathogenesis of otitic hydrocephalus remains unclear. The use of radiological examination is very important to clarify both the diagnosis and the pathogenesis. In this article the role of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) is discussed. Two patients with the diagnosis of otitic hydrocephalus and their MRI and MRV findings are presented. Both of the patients presented had thrombus in their transverse sinuses pre-operatively demonstrated by MRI causing decreased flow on MRV. After the treatment blood flow through the sinus increased significantly as the symptoms subsided. MRI and MRV are valuable tools for diagnosis and follow-up of otitic hydrocephalus.

Periostitis: Clause, form and frequency in paleopathology

Key words: Periostitis, paleopathology, Polish cemeteries. Periostitis, which accompanies the majority of disease processes, is one of the most important symptoms in paleopathology. Its characters manifested by intensity and location of the disease is very helpful in diagnosing. Some kinds of periostitis were well described in the excellent book on paleopathology by Ortner and Putschar (1981), yet to my mind a more thorough text on the subject is still very much awaited. As is already known from the rich paleopathological literature, periostitis is a main symptom of many diseases (Cockburn 1959, Stloukal, Vyhnanek 1976, Steinbock 1976, Brotwell 1976, Bennike 1985, Capasso 1985, GladykowskaRzeczycka 1989, 1993 a, 1993 b, Kihl 1995). Periosteal changes are known to be possibly limited to one bone only where the disease manifests less extensively, or they can be more generalized and seen in numerous bones. The picture of the disease can consequently be much differentiated and this results mainly from the fact that periosteal changes are due to numerous diseases many of an infectious kind including osteitis, syphilis, leprosies, tumors-as those of the lungscarcinoma, developmental disorders (pachydermoperiostitis), and endocrinologic disturbances like those of the pituitary gland. These diseases mainly cause generalized periostitis. Limited periosteal changes are usually due to local factors such as the varicose vein of crus. Periostitis can also be provoked by processes of unknown etiology. The picture provided by periosteal changes is now known to be dependent also on the phase of the disease (early, acute, chronic, recovering or healing) as well as on the age and immunity of the organism. Such a symptom as periostitis is therefore very difficult to systematize. Cases where periosteal changes are limited to a small area always present special difficulty since they may be due not only to a local factor (trauma, inflammatory process of soft tissue) but also to the acute, recovering or healing phase as observed in osteitis for example. Estimation of the cause of periostitis is experimentally known to be very difficult and that is mainly because of differences in bone preservation. The kind, location, intensity and incidence of periostitis therefore can only be assessed approximately. This paper is an attempt to present several cases with periosteal changes. The different kinds of periostitis which I encountered in my material are illustrated. In most cases a diagnosis was possible because of good bone preservation and the use of radiological examination, though in some cases the verdict remains questionable. Table I represents an attempt to systematize the periostitis changes observed in my material. The incidence of trauma-caused periostitis is demonstrated to be very high and the healing phase of the disease appears dominant. Periostitis as a result of limited tumors is sporadic, since the frequency of tumors is low in the material. Nonspecific inflammatory diseases are prevalent in the skull and are connected with teeth condition (abscesses, paradentosis). Osteitis is the second commonest disease with the chronic and healing phases dominating there. …

Appropriateness of the use of clinical and radiologic examinations and laboratory tests in the follow-up of surgically-treated breast cancer patients: Results of the Working Group on the Clinical Aspects of Follow-up

The aim of this working group was to assess the appropriateness of use of radiologic examinations, laboratory tests and periodic check-ups for surgically-treated, disease-free breast cancer patients. A total of 252 clinical scenarios (36 for each of the 8 exams considered: clinical examination, mammography, chest roentgenography, hematochemical tests, markers, bone scan, liver echography/abdominal CT scan), each representing a specific surgically treated and disease-free breast cancer patient, were rated by the members of the panel. A 3 point scale was utilized as to whether the test in question was judged inappropriate (1), questionable (2), or appropriate (3) (in the latter case the panel member was also asked for the advised frequency of the exam expressed in months). After two assessment sessions, consensus among members of the panel was reached on 216 of the 252 scenarios; disagreement remained on only 36 clinical scenarios. The panel agreed that only clinical examinations and mammographies should be recommended for routine clinical follow-up of surgically-treated breast cancer patients. Given the current available therapeutic options, these would assure adequate medical care and psychological aid.