Spinal injections: medico-legal and insurance considerations.

A series of serious accidents following spinal, cervical and lumbar foraminal injections has led French medical insurers to start discussions with professional radiologists to ask us to take the necessary measures allowing them to continue to cover the exceptional but considerable risks of these interventional radiology procedures. This article summarises the facts and the insurers' recommendations and insists on the need to adopt a new and permanent strategy to improve the quality and safety of our practice.

[Implications and details of the responsibility of radiologists in organized screening activities].

Medical responsibility in screening activities. In 1992 a national breast cancer screening programme was launched by the ministry of health in Luxembourg. This programme refers to the "European Guidelines for quality assurance in mammography".

[The value of teleradiology in the management of neuroradiologic emergencies].

First, to summarize the results of teleradiology programs on neurosurgical emergency care in France. Second, to compare French data with the international literature. Third, to discuss the likely developments and future of teleneuroradiology and teleneurosurgery.

Clinical, hormonal and magnetic resonance imaging (MRI) predictors of transsphenoidal surgery outcome in acromegaly.

Objective: Progress in the treatment of acromegaly with drugs is making it necessary to improve the prediction of the outcome of transsphenoidal surgery.

Design: We evaluated clinical, hormonal and radiologic predictors based on magnetic resonance imaging (MRI) of surgical outcome in patients with acromegaly.

Methods: This retrospective analysis included 125 consecutive patients investigated for acromegaly in a single endocrine unit since the use of MRI imaging began (1988).

[Radiodermatitis in interventional radiology (hand dose measurement, screening and compensation)].

It is to be feared that the expansion of interventional radiology could lead to the reappearance of chronic radiodermatitis. Only a few studies mention the doses received by the hands, however these radiation doses are always high. Whereas clinical examinations lead to a belated diagnosis, capillary microscopy, a quick and non invasive test, enables to detect vascular injuries at the subclinical stage.

[Proper technics and the reduction of radiation in helical computed tomography].

Helical computed tomography is the main source of ionizing radiation delivery in diagnostic radiology. For each series, average radiation dose is between 20 and 30 mGy. This dose can potentially be reduced by decreasing intensity or voltage and by increasing pitch.

[Exposure and good practice in helical computed tomography].

Helical CT is the imaging modality that delivers the highest exposure to patients. For each acquisition, the average radiation dose is between 20 and 30 mGy. This dose can potentially be reduced by decreasing the intensity or voltage and by increasing the pitch.

[Medico-legal aspects of thoracic imaging in 2000].

The radiologist's responsibility for the radiographic procedure concerns control of the indication and patient information and consent, as well as the examination procedure itself, including safety measures, interpretation, report delivery, and patient follow-up until referral to a colleague. Details on five specific medico-legal points are examined here: 1) patient information and consent, a problem recently brought to the forefront by the recent French Supreme Court decision, 2) lung cancer unrecognized on a radiography, 3) implications of complementary examinations related to the discovery of a suspect lesion, 4) fortuitous discovery of a malignant lesion in a patient undergoing exploration for another reason, 5) questions of a legal and ethical nature raised by the development of telemedicine.

Swallowing disorders in paralysis of the lower cranial nerves: a functional analysis.

Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of skull base tumors may cause disabling swallowing disorders. To assess the mechanisms of swallowing disorders involved in such cases, we performed functional examinations: a videoendoscopic swallowing study and simultaneous manometry and videofluoroscopy in 7 patients. This study shows that the main mechanism of the swallowing disorders was a disturbance of the pharyngeal stage, including a decrease of pharyngeal propulsion, reduced laryngeal closure, and cricopharyngeal dysfunction, which led to aspiration.

Role of videoendoscopy in assessment of pharyngeal function in oropharyngeal dysphagia: comparison with videofluoroscopy and manometry.

Objective: The purpose of the current report is to evaluate the ability of videoendoscopic swallowing study in assessing pharyngeal propulsion and aspiration episodes when compared with videofluoroscopy and manometry.

Study Design: Prospective study.

Methods: Thirty-four patients with oropharyngeal dysphagia underwent videoendoscopy of swallowing to assess pharyngeal propulsion as pathologic or nonpathologic, and aspiration.

[Imaging of adrenal incidentalomas].

Imaging plays an important role in evaluating fortuitously discovered adrenal masses. These unanticipated masses (incidentalomas) are usually discovered at CT examinations. Although most incidentally discovered adrenal tumors are non-hyperfunctioning adenomas, they must be distinguished from primary or secondary malignant lesions.

[Value of high-frequency (20 MHz)in the diagnosis of cutaneous tumors].

The purpose of the present study is to asses the value of high frequency ultrasonography (20 MHz), a new noninvasive imaging technique, in cutaneous tumors. Cutaneous tumors are clinically varied and their diagnosis is still based on histopathological analysis. 140 cutaneous tumors have been examined with US and imaging findings have been compared to the results of clinical and histological examinations.

Technetium-99m sestamibi scintigraphy, magnetic resonance imaging and venous blood sampling in persistent and recurrent hyperparathyroidism.

Surgical treatment for primary hyperparathyroidism (HPT) is effective in 90% of cases. Recurrent or persistent HPT occurs in 10% of cases. Parathyroid imaging is indicated to confirm and locate an abnormal gland before reoperation.

[Internal supporting mammary lamina. Results of the detection of breast lesions].

In order to stabilize the curves of a surgically remodelled breast, Bustos associated to a periareolar mammaplasty a synthetic internal supporting lamina. At the beginning, in 1985, a smooth perforated silicone sheet was used. Since then, other materials were proposed (radioopaque ou radiotransparent, resorbable or not).

Hepatic artery thrombosis after liver transplantation: diagnosis with spiral CT.

Objective: The purpose of this study was to prospectively evaluate spiral CT with maximum-intensity projection in the diagnosis of hepatic artery thrombosis in patients with liver transplants.

Subjects And Methods: Thirty liver transplant recipients (19 men, 11 women; mean age, 49 years) underwent Doppler sonography and spiral CT with maximum-intensity projection to evaluate both hepatic parenchyma and hepatic vessels. In five cases, these examinations were followed by angiography for suspected hepatic artery thrombosis.

MR imaging and CT of surgical materials currently used in ophthalmology: in vitro and in vivo studies.

Purpose: To assess methods of imaging postoperative changes in the eyeball by performing in vitro and in vivo studies of the main solid and fluid materials used in the treatment of cataract and retinal detachment.

Materials And Methods: The samples were analyzed in vitro with computed tomography (CT) and magnetic resonance (MR) imaging performed at 0.5 T.

Hyperacute rejection in liver transplantation: CT findings.

Hyperacute rejection is rare after liver transplantation. We report a case of early graft failure following liver transplantation in a 46-year-old woman. On the 5th postoperative day, progressive loss of graft function occurred.

[Radiology in the medicolegal identification of cadavers. A new technique of radiography of the maxilla].

After removal, the maxilla and the mandible are placed on a standard radiologic cassette and a X-ray is performed with a low energy beam. Different views can be obtained if required. These radiographic images provide a complete, permanent and detailed record of dental anatomy and restorations, for comparison with antemortem radiographies.