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References

Clinical Evaluations

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Sheedy II, P., Stephans, D. H., "Computed Tomography Pancreatic Masses," Proceeding - "Computed Tomography", 1977, University of California. Merino-deVillasante, J., Taveras, J.M., "Computerized Tomography (CT) in Acute Head Trauma," Preprint.

Citrin, C. M., Davis, D. O., "Computerized Tomography in the Evaluation of
Pituitary Adenomas," Investigative Radiology, Vol. 12, p. 27-34, 1977.

Scott, W. R., New, P. F., Davis, K. R., Schnur, J. A., "Computerized
Axial Tomography of Intracerebral and Intraventricular Hemorrhage,"
Neuroradiology, Vol. 112, p. 73-80, 1974.

5. Mori, H., Lu, C. H., Chiu, L. C., Concilla, P. A., Christie, J. H., "Reliability of Computed Tomography: Correlation with Neuroparhologic Findings," AJR, Vol. 128, p. 795-798, May, 1977.

6. Koo, A. H., LaRogue, R. L., "Evaluation of Head Trauma by Computed Tomography," Radiology, Vol. 123, p. 345-350, May, 1977.

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Dublin, A. B., French, B. N., Rennick, J. M., "Computed Tomography in
Head Trauma," Radiology, Vol. 122, p. 365-369, Feb., 1977.

An

Goldberg, H. I., "Computed Tomography in the Evaluation of Jaundice,"
Proceedings from: Computed Tomography, Ultrasound and X-Ray:
Integrated Approach. p. 409-413.

Genant, H. K., "Computed Tomography in Assessing Lesions of the
Musculoskeletal System," Proceedings from: Computed Tomography,
Ultrasound, and X-Ray: An Integrated Approach, p. 589-590.

Stanley, R. J., Sagel, S. S., Levitt, R. G., "Computed Tomography of the
Liver," The Radiologic Clinics of North America, Copyright 1977,
W. B. Saunders Co., Philadelphia, PA, p. 331-348.

Sheedy, P. F., Stephens, D. H., Hattery, R. R., et al, "Computed Tomography of the Pancreas," The Radiologic Clinics of North America, Copyright 1977, W. B. Saunders Co., Philadelphia, PA, p. 349-366.

12. Stanley, Robert, Sagel, Stewart, CT Scanning of the Pancreas. Preliminary results presented at Society of Computed Body Tomography Annual Meeting, 1978.

13. Jacobs, L., et al., "Autopsy Correlations of Computerized Tomography: Experience with 6000 scans," Neurology 26: 1111-1118, 1976.

Modality Comparison Studies

1. New, P. F., W. R. Scott, J. M. Taveras, et al. "Computed Tomography with the EMI Scanner in the Diagnosis of Primary and Metastatic Intracranial Neoplasms," Radiology, Vol. 114, p. 75-87, January, 1975.

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Davis, K. R., J. M. Taveras, P. F. New et al., "Cerebral Infarction Diagnosis
By Computerized Tomography," Computerized Tomography, Vol. 124, No. 4,
p. 643-660., 1975.

Huete, I., T. Fuller, M. Gado, "CT and Conventional Radiographic Methods
in the Evaluation of Intracranial Meningiomas." Oral Presentation at 1977
International Symposium for Computerized Tomography, Miami, Florida.

Korobkin, M., R. A. Filly, P. B. Hoffer. "Gallium, Ultrasound, and Computed
Tomography in the Evaluation of Suspected Abdominal Abscess", Proceedings
from: Computed Tomography, Ultrasound and X-Ray: An Integrated
Approach, p. 535-539.

Sagel, S. S., "Computed Tomography of the Retroperitoneum," Proceedings from:
Computed Tomography, Ultrasound and X-Ray: An Integrated Approach,
p. 457-459.

Levitt, R. G., S. Sagel, R. J. Stanley, et al, "Complementary Use of Ultrasound and Computed Tomography in Studies of the Pancreas and Kidney," Radiology, Vol. 126, p. 149-152, January, 1978.

Sternick, E. S., F. W. Lane, B. Curran, "Comparison of Computed Tomography and Conventional Transverse Axial Tomography in Radiotherapy Treatment Planning," Radiology, Vol. 124, p. 835-836, September, 1977.

8. Sheedy II et al, (Preliminary results discussed at the "Society of Computed Body Tomography" San Diego, 1977. Comparing CT and Conventional Radiologic modalities in the examination of the Pancreas.)

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Goitein, M., et al, "Prospective Study of the Value of CBT Scanning in Radiation Therapy Planning," Presented to the International Symposium and Course on Computed Tomography, Miami Beach, April 3-8, 1977.

Pendergrass, H. P., et al, "Relative Efficacy of Radionuclide Imaging and
Computed Tomography of the Brain," Radiology 116: 363-366.

Clifford, J. R., et al, "Comparison of Radionuclide Scans with ComputerAssisted Tomography in Diagnosis of Intracranial Disease," Neurology 26: 1119-1123, 1976.

Cost Effectiveness and Utilization Studies to Date

1. Evens, Ronald, Arthur D. Little, Inc., Comparitive Cost Analysis: Computed Tomography vs. Alternative Diagnostic Procedures, 1977-1980.

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Baker, H. L., Campbell, J. R., Houser, O. W., Reese, D. F., Sheedy, P. F., et al: Computer Assisted Tomography of the Head: an Early Evaluation. Mayo Clinic Proceedings 49: 17-27, 1974.

Baker, H. L., Computerized Tomography of the Head. JAMA 233, No. 12: 1304-1308, 1975.

Baker, H. L., The Impact of Computed Tomography on Neuroradiologic Practice. Radiology 116: 637-640, 1975.

Larson, Omenn, Margolis, Loop, "Impact of Computed Tomography on Utilization of Cerebral Angiograms," AJR, Vol. 129, p. 1-3, July, 1977.

4. Laffey, Oaks, Swami, Teplick, Haskin, Computerized Tomography in Clinical Medicine, Copyright 1976 by Medical Directions Inc., Philadelphia, PA. Laffey, Mitchell, Teplick, Haskin, Computerized Tomography in Clinical Pediatrics, Copyright 1976, Medical Directions, Inc., Philadelphia, PA. Evens, R. G., Jost, R. G., Economic Analysis of Computed Tomography Units. American Journal of Roentgenology, Vol. 127, p. 191-198, 1976.

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Wortzman, G., Holgati, R. C., Morgan, P. P., Cranial Computed Tomography: an Evaluation of Cost Effectiveness, Radiology, Vol. 117, No. 1 p. 75-77, October, 1975.

Evens, R. G., Rujanavech, N., Mikhael, M., Utilization, Reliability and Cost Effectiveness of Cranial Computed Tomography in Evaluating Pseudotumor Cerebri, American Journal of Roentgenology, 129: 263-265, 1977.

8. Abramowitz, D., Steinhoff, P., "Is There a CT Scanner in Your Future?"

Efficacy Studies to Date

1. Wittenberg, J., Fineberg, H. V., Ferrucci, J. T., Black, E. B., Ikeda, M. K., The Influence of Computed Body Tomography on Medical Decision Making. (To be published.)

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Levitt, R. G., Jost, R. G., Trachtman, J., Sagel, S. S., Stanley, R. J.
A Computer-Assisted Method to Determine the Diagnostic Efficacy of
Computed Tomography of the Body. Radiology, Vol. 123, p. 97-101,
April, 1977.

Opinion

Body Computed Tomography: A Clinically Important
and Efficacious Radiologic Procedure1

Ronald G. Evens, M.D., Ralph J. Alfidi, M.D., John R. Haaga, M.D., Glen W.
Hartman, M.D., Robert R. Hattery, M.D., Ellas Kazam, M.D., Melvyn
Korobkin, M.D., Alexander R. Margulis, M.D., Thomas F. Meaney, M.D.,2
Stuart S. Sagel, M.D., Patrick F. Sheedy, II, M.D., Robert J. Stanley, M.D.,'
David H. Stephens, M.D., and Joseph P. Whalen, M.D.

In the institutions represented by the nuthors, more than 7,500 body CT examinations have
been performed Body CT has been found to be particularly useful in solving specific prob-
lems, especially when other diagnostic procedures yield confusing results. Radiologists and
their colleagues, and not governmental agencies and insurance companies, should define
the experimental, research and clinical usefulness of computed tomography.
INDEX TERMS: Computed tomography, abdominal 7[0].1211 Computed tomography,
thoracic 610.1211 Opinions

Radiology 123:239-240, April 1977

Opinion

Computed tomography (CT) was introduced in 1972 and
immediately recognized as a major improvement in ra-
diologic imaging. Initially available only for studying the
cranium because of limitations in technique. CT soon
revolutionized the diagnostic approach to many neurologic
problems. It proved to be a highly accurate, relatively
noninvasive test for evaluating intracranial disease and no
ono seriously questioned its use or diagnostic efficacy.

Approximately one year ago, technological improve-
ments allowed CT to be used throughout the body with
scanning speeds capable of completing a scan with sus-
pended respiration Although the time for evaluating body
CT has been short, more than 7,500 patient studies have
been performed in our institutions. The diagnostic efficacy
of CT has been questioned or challenged from many
sources, including governmental agencies and insurance
companies. We are confident that body CT provides im-
portant and clinically useful diagnostic information in many
patients.

Body CT is particularly useful in patients with a specific
problem to be solved, especially when other diagnostic
Information is confusing. Examples include the jaundiced
patient with suspected extrahepatic biliary obstruction;
moss lesions of the kidney; clinical suspicion of pancreatic
carcinoma or pseudocyst; determination of the cause of

mediastinal widening; and mass lesions of the chest wall,
diaphragm, retroperitoneum and pelvis.

Body CT is also useful when the extent of disease must
be determined in order to plan appropriate therapy or es-
timate prognosis. Examples include retroperitoneal me-
tastases and masses (tumors, abscess, hematoma, or
lymph nodes); tumors of the nasopharynx and neck; pri-
mary lung tumors; and mass lesions of the liver and pel-

vis.

The examples above should not be considered a com-
plete list as more uses for body CT are identified as ex-
perience grows. Some of us have also had experience with
body CT as an aid in biopsy procedures and radiation
therapy treatment planning, and find it efficacious for our
patients.

Finally, body CT has been classified as "experimental"
by various individuals and organizations. In our opinion,
body CT was never experimental in the traditional labo-
ratory meaning of the word. Computed tomography's di-
agnostic capabilities in the cranium were well known when
body CT became available in our institutions the first step
was to obtain radiation dosimetry measurements to be
certain that the radiation dose was within the usual limits
of diagnostic studies. We then proceeded to scientifically
study its diagnostic efficacy and limitations. While this

Mallinckort Institute of Radiology and Washington University School of Medicine, 510 South kingshighway. St. Louis. Mo 63110. Accepted
for publication in December 1976

Department of Radiology, Clovelard Clinic Foundation, 9500 Fuclid Avenue, Cleveland, Ohio 44100

Department of Diagnostic Radiolony. Mayo Clinic and Mayo Foundation Rochester, Minn. 55901.

⚫Dupartiment of Radiology. The New York Hospital-Cornell Medical Center, 525 East 08th Street, New York, NY 10021.
Department of Radiology, University of California, San Francisco, Calif 94143.

shan

240

OPINION

April 1977

approach can be classified as clinical research, it is not experimental. We believe that radiologists (with the help of our colleagues in other disciplines) should define experimental, research, and clinical use-not third-party payers or governmental agencies.

Ronald G. Evens, MD.

Mallinckrodt Institute of Radiology

Washington University School of Medicine

510 South Kingshighway

St. Louis, Missouri 63110

REFERENCES

1. Alfidi RJ. Haaga J. Meaney TF, et al: Computed tomography of the thorax and abdomen a preliminary report. Radiology 117: 257-264, Nov 1975

2. Haaga JR, Alfidi RJ. Precise biopsy localization by computed tomography Radiology 118.603-607, Mar 1976

3. Sagel S. Stanley RJ. Evens RG. Early clinical experience with motionless whole-body computed tomography. Radiology 119. 321-330, May 1976

4 Stephens DH, Hattery RR, and Sheedy PF II: Computed tomography of the abdomen. Radiology 119:331-335, May 1976

5. Evens RG: Now frontier for radiology: computed tomography. Am J Roentgenol 126:1117-1129. Jun 1976

6. Sheedy PF II, Stephens DH, Hattery RR, et al: Computed tomography of the body: Initial clinical trial with the EMI prototype. Am J Roentgenol 127:23-51, Jul 1976

7. Stanley RJ. Sagel SS. Levitt AG: Computed tomography of the body: Early trends in application and accuracy of the method. Am J Roentgenol 127:53 67. Jul 1976

8. Allidi PJ. Haaga JR, Havrilla TR, et al: Computed tomography of the liver Am J Roentgenol 127:69-74, Jul 1976

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