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Marmy Grubu

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Naum Shooters
Naum Shooters

Diagnostic Imaging: Chest 2nd Edition (2012) (P...


Results: The panel generated 29 guidance statements, 13 of which are graded as strong recommendations, covering aspects of antithrombotic management of VTE from initial management through secondary prevention and risk reduction of postthrombotic syndrome. Four new guidance statements have been added that did not appear in the 9th edition (2012) or 1st update (2016). Eight statements have been substantially modified from the 1st update.




Diagnostic Imaging: Chest 2nd Edition (2012) (P...


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Computed tomography is a specific use of ionizing radiation that plays an important diagnostic role in pregnancy, and its use increased by 25% per year from 1997 to 2006 1. Use of CT and associated contrast material should not be withheld if clinically indicated, but a thorough discussion of risks and benefits should take place 8. In the evaluation for acute processes such as appendicitis or small-bowel obstruction, the maternal benefit from early and accurate diagnosis may out-weigh the theoretical fetal risks. If accessible in a timely manner, MRI should be considered as a safer alternative to CT imaging during pregnancy in cases in which they are equivalent for the diagnosis in question. Radiation exposure from CT procedures varies depending on the number and spacing of adjacent image sections Table 2. For example, CT pelvimetry exposure can be as high as 50 mGy but can be reduced to approximately 2.5 mGy (including fetal gonad exposure) by using a low-exposure technique that is adequate for diagnosis. In the case of suspected pulmonary embolism, CT evaluation of the chest results in a lower dose of fetal exposure to radiation compared with ventilation-perfusion scanning 2. With typical use, the radiation exposure to the fetus from spiral CT is comparable with conventional CT.


CT scanning has several advantages over traditional two-dimensional medical radiography. First, CT eliminates the superimposition of images of structures outside the area of interest.[126] Second, CT scans have greater image resolution, enabling examination of finer details. CT can distinguish between tissues that differ in radiographic density by 1% or less.[127] Third, CT scanning enables multiplanar reformatted imaging: scan data can be visualized in the transverse (or axial), coronal, or sagittal plane, depending on the diagnostic task.[128]


This is the second edition of a successful book, much more extensive and detailed in respect to the first one, published 15 years ago, mainly as a consequence of the innovations in CT technology. In this sense, many chapters including new methodological applications have been added and most of the images have been replaced by new ones of better quality. The authors are Francis A. Burgener, Professor of Radiology, and Steven P. Meyers, Professor of Radiology and Neurosurgery, both working at the University of Rochester Medical Center, USA, Christopher Herzog from the Department of Radiology at the Rotkreuzklinikum of Munich, Germany and Wolfgang Zaunbauer from the Institute of Radiology at the Kantonsspital in St. Gallen, Switzerland. The contributions of Gregory Dieudonné, Scott A. Mooney and Richard T. White also have to be recognized.


Hobbs HA, Bahl M, Nelson RC, Kranz PG, Esclamado RM, Wnuk NM, Hoang JK. Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system? AJR Am J Roentgenol. 2014 Jan;202(1):18-24.


The soft tissues of the chest, abdomen, and the pelvis represent the most radiosensitive tissues, an important factor when considering that imaging wisely implies balancing cost and availability with using the most diagnostic test that minimizes or avoids exposure to the ionizing radiation from CT scanning.


Community-acquired pneumonia (CAP) remains a common condition associated with considerable morbidity and mortality. Outcome is improved by early recognition and rapid institution of empirical antibiotic therapy. A number of international guidelines recommend a chest radiograph (x-ray) is obtained when pneumonia is suspected; the argument forwarded is that chest radiographs are relatively inexpensive and enable pneumonia (lung consolidation) to be confirmed or excluded. But, radiographs are not available in the community setting and introduce a delay in diagnosis and treatment. For these reasons, in mild CAP treated by primary care, guidelines suggest criteria for clinical diagnosis. However, there is debate as to whether clinical features alone are sufficiently reliable to support a diagnosis of CAP with some suggesting diagnostic precision is improved by chest radiographs. Conversely, several studies have demonstrated a lack of agreement in the interpretation of chest radiographs bringing their role as the ultimate arbiter of diagnosis into question. Below we debate the diagnostic role of the humble chest radiograph in the context of suspected CAP.


In a review on the use of cardiac MRI in the diagnosis of acute coronary syndrome (ACS), Breuckmann et al (2008) noted that in contrast to chronic myocardial infarction, data concerning the value of cardiac MRI in patients with acute onset of chest pain are still rare. Even in the presence of characteristic clinical parameters, cardiac MRI might provide independent evidence especially in the absence of typical ECG alterations and prior to biomarker elevation. Besides the ability to demonstrate wall motion abnormalities, cardiac MRI gains additional potential as to the detection of myocardial edema, microvascular obstruction (no-reflow) and myocardial necrosis. However, cardiac MRI is expensive and time-consuming, and thus may not be cost-effective. Currently, a lack of sufficient diagnostic and prognostic data would make cardiac MRI unsuitable for routine stratification of chest pain patients in an emergency department. 041b061a72


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