Radiology
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The role of chest computed tomography (CT) in the evaluation of clinically staged T1N0M0 lung cancer is controversial. Using quantitative methods of decision analysis and data already available in the medical literature, the authors show how the clinical utility and cost effectiveness of chest CT are dependent on several variables: the prevalence of mediastinal metastases in T1N0M0 patients; the sensitivity and specificity of chest CT; patient life expectancy; and the morbidity, mortality, and monetary costs of CT, invasive mediastinal biopsy procedures, and curative surgical resection. When average values for these variables are used in the analysis, routine chest CT adds about 1 day to a T1N0M0 patient's life expectancy and saves about $150 per patient. Furthermore, a true-positive yield of 6% is sufficient for chest CT to be both clinically useful and cost saving, provided CT is readily available.
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Two hundred and fifty consecutive patients with suspected appendicitis were examined with graded compression sonography. The initial diagnostic criterion for appendicitis was visualization of a noncompressible appendix; this was later modified to include the dimensions of the visualized appendix. The appendix was visualized in 91 of 250 patients (36%). ⋯ In the remaining six, symptoms resolved spontaneously, and no surgery was required. In the absence of compelling clinical findings or an appendicolith, adult patients with maximal appendiceal diameters of 6 mm or less should undergo a period of close observation rather than immediate surgery. A diagnosis of appendicitis can be made in adult patients with persistent right lower quadrant pain and a visualized appendix greater than 6 mm in diameter.