Medical Imaging Techniques: A Comparison

379 Pages·1979·12.19 MB·English

by  Patricia A. Gempel (auth.), Kendall Preston Jr., Kenneth J. W. Taylor, Steven A. Johnson, William R. Ayers (eds.)

MEDICAL
IMAGING
TECHNIQUES
A Comparison
MEDICAL
IMAGING
TECHNIQUES
A Comparison
Edited by
Kendall Preston. Jr.
Carnegje-Mellon University
Pittsburgh, Pennsylvania
Kenneth J. W. Taylor
Yale University School of Medicine
New Haven, Connecticut
Steven A. Johnson
Mayo Foundation
Rochester, Minnesota
and
William R. Ayers
Georgetown University School of Medicine
Washington, D. C.
Plenum Press· New York and London
Library of Congress Cataloging in Publication Data
Main entry under title:
Medical imaging techniques.
"Based on the proceedings of the Engineering Foundation Conference held in
Henniker, New Hampshire, August 15-20, 1976."
Includes indexes.
1. Diagnosis, Radioscopie - Congresses. 2. Imaging systems in medicine-
Congresses. I. Preston, Kendall, 1927- H. United Engineering Trustees, inc.,
New York. [DNLM. 1. Radionuclide imaging - Methods - Congresses. 2. Tomog-
raphy, Computerized axial - Congresses. WN445 M489 1976]
RC78.M34 616.07'57 79-4424
ISBN-13: 978-1-4684-3488-0 e-ISBN-13: 978-1-4684-3486-6
DOI: 10.1007/978-1-4684-3486-6
Based on the proceedings of the Engineering Foundation Conference
held in Henniker, New Hampshire, August 15-20, 1976.
This book was prepared with the support of NSF Grant APR 76-24161.
However, any opinions, findings, conclusions and/or recommendations herein
are those of the authors and do not necessarily reflect the views of NSF.
© 1979 United Engineering Trustees
Plenum Press, New Y ork
A Division of Plenum Publishing Corporation
227 West 17th Street, New York, N.Y. 10011
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, e1ectronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission
Preface
The need for a book on medica1 imaging techniques became evi-
dent to the editors of this vo1ume at the 1976 Engineering Founda-
tion Conference on Non-Invasive Medica1 Diagnosis. This conference
treated imaging of the thorax, abdomen, brain, and extremities
using ultrasound, radiology, computed tomography, and nuc1ear medi-
cine. During 1976 and 1977 the editors solicited participants in
the conference for contributions to this vo1ume. Other sources
were also sought in special areas of interest in medical imaging
beyond those individua1s who had been conference participants.
Most of the writing and editing was done in late 1977 and in 1978
resu1ting in this 25-chapter book which is organized into sections
on (1) Systems Considerations, (2) C1inical Results, (3) Research
Topics, and (4) Tutorials. A short survey of the book is contained
in the Introduction.
The editors wish to acknowledge the United States National
Science Foundation, particularly J. C. Aller, Program Manager, for
partial financia1 support of the conference and of the publication
of this book under Grant APR76-24161. The exce11ent typing services
of Caroline Wadhams's organization (Report Production Associates,
Cambridge, Massachusetts) and her staff, particu1ar1y Susan Dunham,
are acknowledged as weIl as the efforts of Meg Grant and Winnie
Garcia (Tucson, Arizona) who assisted with the subject index. The
splendid cooperation of the staff of Plenum Press, in particular
Stephen Dyer (Assistant Managing Editor) and Derrick Mancini
(Editor), has been inva1uab1e.
K. Preston, Jr.
K. J. W. Taylor
S. A. Johnson
W. R. Ayers
v
Contents
Introduction .......•.........•.....•. xvii
SYSTEMS CONSIDERATIONS
Health Planning for a New Technology: Computerized Tomography
Planning Issues in 1975 and 1976
Patricia A. Gempel
l. Introduction . 1
2. Information Needs of Health Planners 3
3. Effect of CT on Alternative Diagnostic Neurologie
Procedures .• .: .• . 3
4. Health Planning Issues . ... 5
4.1 Equipment Selection Criteria 5
4.2 Early Instrument Obsolescence 6
4.3 Diffusion of CT Scanning Systems 6
4.4 Geographie Location . . 6
5. Planning Approach. '" 7
5.1 Areawide Planning for CT Scanning Systems 7
5.2 Assessment of Areawide Need . • 7
5.3 Guidelines for Procurement of Initial CT Scanner 8
5.4 Guidelines of Procurement of Additional Scanners 10
5.5 Body Scanner Applications 10
6. References. . 11
vii
viii CONTENTS
An Overview of Government Regulation of the Use of
Computed Tomography through 1978
Patricia A. Gempel and Jane B. Hetzger
l. Introduction . . . . .. ............ . 15
2. Health Planning - The Health Resources Administration 15
2.1 The Certificate-of-Need Process (CON) 17
2.2 National Guidelines for CT ..... 19
3. Reimbursement Policy - The Social Security
Administration . . . . 21
4. Performance and Safety Standards - The Food and Drug
Administration . . . . 21
5. Legislative Assistance Groups 22
6. Conclusion 24
7. References 26
Hultiple Endpoints in the Assessment of Non-Invasive
Technology
W. R. Ayers
1. Introduction.... . . .. ....... . 29
1.1 Non-Invasive Technology for Clinical Chest
Diseases . . . . . . 29
1.2 Assessment of Hedical Technology 30
2. Levels of Technology . . . . . . 31
3. Health Services Delivery Systems 32
4. Conclusion 33
5. References. . . . . 35
The Evaluation of Diagnostic Tests
S. N. Rasmussen
l. Introduction . . . . . . . . . . . . . . . . . . 37
2. Hethods of Procedure . . . . . . . . . . . . . . 38
2.1 The Diagnostic Information Obtained by the
Investigation .............. . 39
2.2 The Therapeutic Consequence of Establishing or
Excluding a Diagnosis . . . . . . . 39
2.3 Discomfort and Risk to the Patient 39
2.4 Economic Cost ........ . 39
3. Evaluation of Diagnostic Information 39
4. The Direct Hethod 40
5. The Indirect Hethod 43
6. Summary 45
7. References . 45
CONTENTS ix
The Impact of Technology on Health Care Productivity
G. B. Devey
l. Introduction . . . . . . . . . . 47
2. Pitfalls of Inflexible Policies 48
3. Impact of Current Technology 49
3.1 Ultrasound 50
3.2 Nuclear Medicine 50
3.3 New Skills 50
4. Trend Toward Decentralization of Services 51
5. Summary 52
CLINICAL RESULTS
Scintigraphy, Ultrasound, and CT Scanning of the Liver
K. J. W. Taylor, D. Sullivan, J. Simeone, A. T. Rosenfield
1. Introduction . 55
1.1 Nuclear Medicine Imaging 55
1.2 Ultrasound Imaging and Computed Tomography 56
2. Comparison . . 56
2.1 Metastases 61
2.2 Diffuse Abnorrnalities 67
2.3 Ascites 69
2.4 Biliary Tree 69
2.5 Gallstones 70
3. Discussion 73
4. References 76
Comparison Between Conventional Rectilinear and Multiplane
Tomographic Nuclear Imaging of the Liver
W. F. SampIe
1. Introduction ..... 79
2. Materials and Methods 81
3. Results 82
4. Discussion .. . 85
5. Conclusion .. . 87
6. Acknowledgements 87
7. References. 88
A Preliminary Report on Computed Tomography of the Thorax
and Abdomen
R. J. Alfidi
1. Introduction 91
2. Materials and Methods 91
x CONTENTS
3. Results 92
3.1 Liver . 92
·
3.2 Effusions 94
3.3 Pancreas 96
3.4 Kidneys 96
·
3.5 Aorta . 98
·
3.6 Ga11bladder and Bile Ducts 99
3.7 Retroperitoneal Abnormalities 100
3.8 Mediastinal Masses 100
3.9 Bony Abnormalities 101
3.10 Breast 101
4. Discussion 103
Ultrasonic lmaging of Neoplasms
A. K. Freimanis
1. Introduction • • • • • • • • • . • • • • 105
2. Accepted Uses of Ultrasound in Detection 105
2.1 Gynecological Tumors 106
2.2 Abdominal Lymph Nodes • 107
2.3 Retroperitoneal Masses 107
2.4 Tumors of the Pancreas 108
2.5 Other Gastrointestinal Tumors 110
2.6 Liver Metastases 110
2.7 Neoplasms of the Kidney ••• 110
2.8 The Thyroid Gland ••.••. 111
3. Analysis of Ultrasound Patterns of Tumors 112
4. Diagnostic Ultrasound in the Management of Tumors 113
5. Refer ences • •• . 114
Computed Tomography of the Liver and Biliary Tract
S. Sagel and R. J. Stanley
1. Introduction.. •••• • •.•• 117
2. The Normal Liver and Biliary Tract • 117
3. The Abnormal Liver and Biliary Tract 118
3.1 Space-Occupying Hepatic Lesions 118
3.2 Jaundice •••.. 119
3.3 Gallbladder Disease 120
4. Discussion .. 120
5. References. • 122
Computed Tomography of the Liver
R. J. Alfidi
1. Introduction. • . • • 123
2. Materials and Methods 123
3. Results • • • • • 124
3.1 Normal Liver 124
CONTENTS xi
3.2 Tumors 124
3.3 Cysts. 126
3.4 Cirrhosis 126
3.5 Abcess 126
3.6 Obstructive Jaundice 126
4. Discussion ... 131
4.1 Contrast Agents .. . 131
4.2 CT Biopsy ..... . 132
4.3 Transhepatic Cho1angiography 132
5. References ........... . 133
Echographie Diagnosis of Lesions of the Abdominal Aorta
and Lyrnph Nodes
A. K. Freimanis
1. Introduction.......... 135
2. The Abdominal Aorta . . .. .. 135
2.1 Modern Echographie Procedure 136
2.2 Echographie Measurement 138
2.3 Echographie Measurernents in the Management of
Aneurysms 138
2.4 Method of Examination 138
2.5 Diagnostic Procedure 141
2.6 A Few Pitfa11s 142
2.7 Differential Diagnosis of Large Abdominal
Lyrnph Nodes ... 142
2.8 Indications for Procedure 142
2.9 Reliability . ... 143
2.10 Thoraeie Aortic Aneurysms 143
2.11 Inferior Vena Cava 144
3. Retroperitonea1 Lyrnph Node En1argement 144
3.1 Deve10pment of Examination Procedure 145
3.2 Acoustic Nature of Lyrnph Nodes 145
3.3 Distribution . . . . . . . . 147
3.4 Out1ining of Radiation Ports 148
3.5 Indications. . . . . 150
3.6 Differential Diagnosis 152
4. Summary . . . . 152
5. Acknow1edgements 152
6. References 153
xii CONTENTS
RESEARCH TOPICS
The Use of Computerized Tomography in the Diagnosis of
Pu1monary Nodu1es
W. R. Ayers and H. K. Huang
1. Introduetion . . . . . • . • . . . . .• 155
2. Standard Management of the Solitary Pu1monary Nodu1e 156
3. The Use of CT - Material and Methods . • . . • . • 157
3.1 Read a CT Sean from Magnetie Tape or Disk . •. 159
3.2 Iso1ate a Patho1ogiea1 Region in the CT Sean 159
3.3 Generate the Frequeney Distribution and Histogram 159
3.4 Determine Patho1ogiea1 Boundaries 160
3.5 Estimate Vo1ume . . . . • . 160
3.6 Produee Subtraetion Images 160
4. Resu1ts • . • . . • . . . . . . 160
4.1 An Illustrative Case Study 161
4.2 Comment 163
5. Summary 163
6. Referenees. 164
Image Proeessing of Computerized Tomographie Seans
J. A. Horton, C. W. Kerber, and J. M. Herron
1. Introduetion . . . . . . 165
1.1 Limitations of CT Seanning . 166
1.2 Lirnitations of Human Visua1 Pereeption 166
2. Materials and Methods 167
3. The Sigma Sean Image 167
4. Speeifie Case Studies 169
5. Diseussion . . 171
6. Aeknow1edgements 172
7. Referenees . 173
Determination of Organ Volume
S. N. Rasmussen
1. Introduetion 175
2. Kidney Vo1ume Determination 177
3. Liver Vo1ume Determination 179
3.1 Resu1ts •.. 181
3.2 Case Studies 181
4. Cone1usion 182
5. Referenees • • • . 183