Abstract The purpose of this study was to analyze the costs incurred during the transitional period when a radiology department is gradually digitalized and magnetic resonance imaging (MRI) is gaining ground as guidance for interventions. The specific aims were: to compare the costs of computed (CR) radiography with the costs of conventional radiography, to analyze the cost structures of procedures and the effects of procedure volumes in a multipurpose interventional MRI (IMRI) unit, to compare the costs of MRI and computed tomography (CT)-guided bone biopsies, and to compare the costs of MRI-guided laser ablation and surgery in the treatment of osteoid osteoma. 34 140 plain-film examinations were analyzed; 3/4 of them were CR and 1/4 conventional radiography. The costs of CR were 9% higher compared to conventional radiography, due to the higher capital cost. In the IMRI unit, 563 diagnostic MRI examinations, 89 MRI-guided interventions, and 39 MRI-guided neurosurgical operations were performed. The cost analyses of the alternative simulation models of IMRI usage showed that the volume of diagnostic imaging had an effect on the unit costs of these procedures. Volume was not such a deterministic factor in interventions due to the high material costs. The volume of the neurosurgical use of IMRI had a major effect on the costs of radiological procedures. The costs of 18 MRI-guided and 12 CT-guided bone biopsies were compared. The cost of MRI-guided biopsy was 2.55-fold compared to CT-guided biopsy, due to the longer procedure time and the expensive MRI-compatible instrumentation. The costs of 7 MRI-guided laser ablations and 6 surgical treatments of osteoid osteoma were compared. The cost of laser ablation was higher than the cost of excision of a superficial osteoid osteoma. The cost of excision of a deep osteoma with metallic fixation was considerably higher, due to the higher material, personnel, and ward costs. Laser ablation diminishes the need for sick days and the duration of restricted weight bearing. In conclusion, a higher cost of a new method should be anticipated. The use of a new method should be justified by other factors, such as better efficiency, accuracy, lack of radiation, or mini-invasiveness.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18878号 / 医博第3989号 / 新制||医||1008(附属図書館) / 31829 / 京都大学大学院医学研究科医学専攻 / (主査)教授 坂井 義治, 教授 坂田 隆造, 教授 平岡 眞寛 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Mitte des Jahres 2009 wurden an 30 Tagen am neu installierten Herzkatheterarbeitsplatz der Abteilung für Kardiologie und Angiologie, der Klinik für Innere Medizin Messungen durchgeführt um die Exposition von Untersucher und assistierender Pflegekraft während koronarangiographischer und –interventioneller Prozeduren an einer der modernsten Herzkatheterarbeitsplätze zu erfassen. Dazu wurden an 8 Körperteilen des Untersuchers und Assistenzpersonals (jeweils Auge, Schulter, Handrücken und Unterschenkel beidseits) Thermolumeszenzdosimeter angebracht und diese dann nach einem Untersuchungstag ausgewertet. Bei den Ergebnissen stellte sich heraus, dass die empfohlenen jährlichen Expositionswerte unter den vorherrschenden Bedingungen nicht erreicht werden und die Arbeit an einem modernen Herzkatheterarbeitsplatz als sicher gilt. Jedoch ist das Strahlenfeld als solches sehr inhomogen und weist auch starke Schwankungen je nach Art der Untersuchung, der Erfahrung des Untersuchers und auch der Komplexität des Falles auf. Desweiteren muss beachtet werden, dass die technischen Neuerungen der letzten Jahre erheblich zur Verminderung der Exposition geführt haben und somit an älteren Anlage eine Überschreitung der jährliche empfohlenen Teilkörperdosis als wahrscheinlich gilt.

No description available.

Skeletal muscle metastasis from breast carcinoma is a relatively rare clinical entity. We report two cases of breast cancer metastatic to the skeletal muscle, diagnosed by ultrasound guided fine needle aspiration (US-FNA) biopsy done by interventional cytopathologists at an outpatient cytopathology center. Our two patients presented with lower anterior neck firmness and chest wall mass, respectively. Ultrasound evaluation of our first case demonstrated hypo-echoic thickened anterior strap muscles while in the second case there was significant distortion of the anatomy from previous surgeries. It was necessary to proceed with FNA biopsy even when their ultrasound findings were equivocal, to establish a definite rapid diagnosis. The immediate onsite evaluation findings were suggestive of malignancy in both cases with subsequent core biopsy confirming the diagnosis of metastatic breast carcinoma. In cytopathology, point-of-care (POC) ultrasound is used as an adjunct tool that offers visual guidance during FNA of nonpalpable masses and enables sampling of lesional “hot” spots to ensure specimen adequacy. Studies have demonstrated a reduction in FNA nondiagnostic rates with the use of ultrasound-guidance consequently reducing health care costs associated with nondiagnostic FNAs. US-FNA also provides adequate samples for cell block preparations. Metastatic lobular carcinoma of the breast has a wide range of clinical presentations and a high level of suspicion is advised. Cytopathologists-performed US-FNA is a proven, less-invasive, cost-effective tool that provides timely cytologic diagnosis.

Stress cardiomyopathy can cause significant morbidity in the functional life of patients. The most common finding is apical ballooning of the left ventricle on cardiac catheterization. Some cases present with atypical imaging findings. This report presents a case of atypical stress cardiomyopathy with midventricular hypokinesis.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13540号 / 論医博第2280号 / 新制||医||1066(附属図書館) / (主査)教授 小濱 和貴, 教授 近藤 尚己, 教授 妹尾 浩 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

No description available.