Intravenous urographic technique

In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.     

Changes in CT utilization between 1981 and 1984: implications for Medicare payment for MR imaging under the prospective payment system

In the absence of data on current or likely patterns of use of magnetic resonance (MR) imaging, use of computed tomography (CT) at one institution in 1981 and 1984 was analyzed to provide data relevant to current federal deliberations regarding Medicare payment for inpatient MR imaging. Between 1981 and 1984 inpatient CT utilization increased 59%, primarily due to a 265% increase in body CT. In 1984 inpatients who underwent at least one CT procedure were as likely to undergo more than one procedure as to undergo only one. CT procedures were performed in a high proportion of diagnosis-related groups (DRGs), with more than one-half of head CT procedures performed in non-neurologic DRGs. Given the similarities between clinical applications of CT and MR imaging, these findings regarding CT utilization have the following implications: (a) a delay in recalibration of DRG payment rates may not take account of expected growth in utilization of MR imaging, (b) a DRG "add-on" for MR imaging should reflect the likelihood that more than one MR imaging procedure will be performed in many hospitalizations, and (c) adjustments in DRG payments for MR imaging should not be limited to the 35 neurologic DRGs.     

Chorea in systemic lupus erythematosus and “lupus-like” disease: Association with antiphospholipid antibodies

Twelve patients with chorea from a population of 500 patients with SLE and "lupus-like" disease were reviewed. Clinical histories, including time relationships of chorea to the systemic illness and other neurologic manifestations, are reported. Chorea appeared early in the course of disease in most patients, but the development of cerebral infarctions or TIAs occurred subsequently in seven of nine patients demonstrating antiphospholipid antibodies. The relationship of chorea to the presence of these antibodies in nine of 12 patients and the therapeutic outcome are briefly discussed.