Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

The authors discuss the assessment of the contribution of diagnostic imaging to the patient management process. A hierarchical model of efficacy is presented as an organizing structure for appraisal of the literature on efficacy of imaging. Demonstration of efficacy at each lower level in this hierarchy is logically necessary, but not sufficient, to assure efficacy at higher levels. Level 1 concerns technical quality of the images; Level 2 addresses diagnostic ac curacy, sensitivity, and specificity associated with interpretation of the images. Next, Level 3 focuses on whether the information produces change in the referring physician's diagnostic thinking. Such a change is a logical prerequisite for Level 4 efficacy, which concerns effect on the patient management plan. Level 5 efficacy studies measure (or compute) effect of the information on patient outcomes. Finally, at Level 6, analyses examine societal costs and benefits of a diagnostic imaging technology. The pioneering contributions of Dr. Lee B. ...

The efficacy of diagnostic imaging.

https://medicinainternaucv.files.wordpress.com/2013/02/exceso-de-confianza-como-causa-de-error-diagnc3b3stico.pdf

Overconfidence as a cause of diagnostic error in medicine.

Breast cancer is a major public health problem worldwide. Management of breast cancer was last reviewed in the Journal in 1992.1 The accumulation of new biologic information, the results of recent clinical trials, and the availability of new diagnostic and therapeutic tools make it appropriate to review the subject again. Epidemiology The incidence of breast cancer in the United States has been increasing gradually for the past three decades.2,3 It was estimated that 181,600 new cases of breast cancer were diagnosed in the United States in 1997 and that 44,190 people would die of breast cancer during the same . . .

Treatment of breast cancer

A novel, fully 3D, high-resolution T(1) and T(2) relaxation time mapping method is presented. The method is based on steady-state imaging with T(1) and T(2) information derived from either spoiling or fully refocusing the transverse magnetization following each excitation pulse. T(1) is extracted from a pair of spoiled gradient recalled echo (SPGR) images acquired at optimized flip angles. This T(1) information is combined with two refocused steady-state free precession (SSFP) images to determine T(2). T(1) and T(2) accuracy was evaluated against inversion recovery (IR) and spin-echo (SE) results, respectively. Error within the T(1) and T(2) maps, determined from both phantom and in vivo measurements, is approximately 7% for T(1) between 300 and 2000 ms and 7% for T(2) between 30 and 150 ms. The efficiency of the method, defined as the signal-to-noise ratio (SNR) of the final map per voxel volume per square root scan time, was evaluated against alternative mapping methods. With an efficiency of three times that of multipoint IR and three times that of multiecho SE, our combined approach represents the most efficient of those examined. Acquisition time for a whole brain T(1) map (25 x 25 x 10 cm) is less than 8 min with 1 mm(3) isotropic voxels. An additional 7 min is required for an identically sized T(2) map and postprocessing time is less than 1 min on a 1 GHz PIII PC. The method therefore permits real-time clinical acquisition and display of whole brain T(1) and T(2) maps for the first time.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/mrm.10407

Rapid combined T1 and T2 mapping using gradient recalled acquisition in the steady state.

Biopsy of radiologically suspicious breast lesions that are not palpable clinically or even at operation has become commonplace since the introduction of modern mammographic technics. Surgical localization of such lesions can be difficult because the position and shape of the breast are altered by the vertical and horizontal compression employed during mammography. The simple, rapid technic described below for the preoperative localization of such lesions by means of a self-retaining radiopaque marker has been found reliable. Method The localizing procedure is done immediately before operation in the radiology department with the patient supine in the position to be assumed in . . .

Preoperative localization of nonpalpable breast lesions demonstrated by mammography.

Overutilization of radiological studies has become a significant economic consideration in this country. The reasons for unnecessary examinations include indirect financial benefit to physicians, medicolegal considerations, inadequate history provided to the radiologist, and simply inappropriate requests. In many radiological examinations, the indications are controversial or unknown. Recent Professional Standards Review Organization legislation will probably diminish overutilization of radiological studies, both directly through peer review and indirectly by providing comparison statistical data to facilitate better assessment of the value of individual examinations. The final common pathway of the radiological examination is the radiologist, who has the right and the duty to refuse studies, particularly when they involve risk to the patient.

Overutilization of radiological examinations.

There is general agreement in the medical community with the recommendations of the American Cancer Society and the American College of Radiology (ACS/ACR) that all women have a base-line mammogram...

Screening mammography--potential problems on the horizon.

Bone mineral screening for osteoporosis.

Controversies regarding medical screening and many other cost-benefit health care decisions are increasingly societal issues rather than purely scientific ones, and therefore, open-minded public discussion and education should be welcome.

Ferris M. Hall

Papers

Preoperative localization of nonpalpable breast lesions demonstrated by mammography.

Overutilization of radiological examinations.

Screening mammography--potential problems on the horizon.

Bone mineral screening for osteoporosis.

More Mammography Muddle: Emotions, Politics, Science, Costs, and Polarization