Cryptorchidism: strategies in detection

Imaging evaluation of the patient with a non-palpable testis has evolved over recent decades. The rational explanation of imaging in these patients requires a clear understanding of the various causes of a non-palpable testis, and an appreciation of the utility and limitations of the available imaging modalities. This review describes the classification of non-palpable testis and discusses the role of modern imaging in evaluation. In particular, the relative accuracies of ultrasound, CT and MRI is reviewed. Received: 14 May 1998; Accepted: 27 May 1998     

Fencing: Conversations in Steel

Athletes with a high pain tolerance may delay medical treatment for idiopathic spontaneous pneumothorax, even when significant symptoms are present.     

Neurosarcoidosis: findings in MRI

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. Neurologic manifestations occur usually as a part of the spectrum of the systemic disease. The aim of this retrospective study was to evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of patients with neurosarcoidosis (NS). Seven patients with sarcoidosis could be included into the study. All patients had neurological symptoms and were evaluated with MRI revealing a wide spectrum of findings: periventricular and white matter lesions, multiple or solitary supra- and infratentorial brain lesions, leptomeningeal enhancement, involvement of brain nerves and intramedullar lesions. These findings are not specific for sarcoidosis and must be considered with the clinical course of the patient in arriving at the correct diagnosis.     

Progress in radiology: colorectal tumors: pathology and detection.

The prognosis in colorectal neoplasia has not improved in the past 20 years despite improved diagnostic techniques. The greatest promise lies in wider screening and earlier radiographic and endoscopic detection. To clarify the radiologist's role in finding large bowel tumors, the clinical, pathologic, and radiologic literature is reviewed. Since individuals over 40 years of age harbor the bulk of colon neoplasms, the most diligent efforts to detect these lesions should be made in this group. Controlled studies comparing single and double contrast barium enema techniques are lacking, but available data suggest that the double contrast examination is more sensitive for detection of the numerous small, but potentially malignant colon tumors. Careful radiographic technique, including a thoroughly clean colon, is critical for accurate detection regardless of which technique is used.     

Radiation doses in interventional radiology procedures: the RAD-IR study: part II: skin dose

PURPOSE: To determine peak skin dose (PSD), a measure of the likelihood of radiation-induced skin effects, for a variety of common interventional radiology and interventional neuroradiology procedures, and to identify procedures associated with a PSD greater than 2 Gy. MATERIALS AND METHODS: An observational study was conducted at seven academic medical centers in the United States. Sites prospectively contributed demographic and radiation dose data for subjects undergoing 21 specific procedures in a fluoroscopic suite equipped with built-in dosimetry capability. Comprehensive physics evaluations and periodic consistency checks were performed on each unit to verify the stability and consistency of the dosimeter. Seven of 12 fluoroscopic suites in the study were equipped with skin dose mapping software. RESULTS: Over a 3-year period, skin dose data were recorded for 800 instances of 21 interventional radiology procedures. Wide variation in PSD was observed for different instances of the same procedure. Some instances of each procedure we studied resulted in a PSD greater than 2 Gy, except for nephrostomy, pulmonary angiography, and inferior vena cava filter placement. Some instances of transjugular intrahepatic portosystemic shunt (TIPS) creation, renal/visceral angioplasty, and angiographic diagnosis and therapy of gastrointestinal hemorrhage produced PSDs greater than 3 Gy. Some instances of hepatic chemoembolization, other tumor embolization, and neuroembolization procedures in the head and spine produced PSDs greater than 5 Gy. In a subset of 709 instances of higher-dose procedures, there was good overall correlation between PSD and cumulative dose (r = 0.86; P <.000001) and between PSD and dose-area-product (r = 0.85, P <.000001), but there was wide variation in these relationships for individual instances. CONCLUSIONS: There are substantial variations in PSD among instances of the same procedure and among different procedure types. Most of the procedures observed may produce a PSD sufficient to cause deterministic effects in skin. It is suggested that dose data be recorded routinely for TIPS creation, angioplasty in the abdomen or pelvis, all embolization procedures, and especially for head and spine embolization procedures. Measurement or estimation of PSD is the best method for determining the likelihood of radiation-induced skin effects. Skin dose mapping is preferable to a single-point measurement of PSD.