Clinical Radiology (1992) 46, 368 -369
Correspondence Letters are published at the discretion o f the Editor. Opinions expressed by correspondents are not necessarily those of the Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author o f the paper so that the reply can be published in the same issue. Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instructions to Authors at the front o f the Journal.
CAN W E R E D U C E T H E N U M B E R O F F I L M S F O R C O N T R A S T SIALOGRAPHY? SIR Doctors Pellegrini, Harris and Lipton's [1] assertion 'that no precontrast films are required' in the context of sialography flies in the face of m y experience as a radiologist. M y view is that a control film is essential before embarking u p o n any contrast radiography. Would the captain of an aircraft or ship embark upon an u n k n o w n journey without an idea of the likely terrain/seas to be encountered? Their paper is an example of the creeping, minimalist approach to contrast radiography, usually with (in m y view) the relatively unimportant goal of reduction in dose elevated to the status of some Holy Grail. I feel that when embarking on a contrast study a radiologist should err on the side of taking too many films rather than too few; on the basis that an incomplete, inconclusive examination does infinitely more h a r m than a meticulously conducted, complete study. -
M. F. C R E A G H
St Peter's District General Hospital Guildford Road Chertsey Surrey KT16 OPZ
Reference
I Pellegrini V, Harris I, Lipton M. Can we reduce the number of routine films required for contrast sialography? Clinical Radiology 1992;45: 254-255.
S i r - W e read Dr Creagh's letter with amazement. He states that reduction in radiation dosage is 'relatively unimportant' and that radiologists 'should err on the side of taking too many films' but we feel that the National Radiation Protection Board and the vast majority of radiologists and (informed) patients would not agree with him. In fact radiation dosage reduction should be to the forefront of every radiological procedure as long as diagnostic accuracy is maintained as we have shown in this current study. If Dr Creagh had read the paper carefully he would have seen our statement that 'if there is any doubt in interpretation then plain radiographs can be performed after the post-contrast examination following washout or at a later date'. In conclusion, therefore, in spite of Dr Creagh's rather rigid viewpoints, we feel that the whole concept of patient irradiation is a very important issue which should bc under constant review and audit. V. P E L L E G R I N I t. H A R R I S M. L I P T O N
(a)
Department of Radiology Royal Liverpool University Hospital Liverpool
O E S O P H A G E A L TEARS F O L L O W I N G P N E U M A T I C B A L L O O N D I L A T A T I O N F O R T H E T R E A T M E N T OF ACHALASIA S m - Our group [1] previously described the findings in contrast studies performed shortly after pneumatic balloon dilatation of the oesophagus for treatment of achalasia. Complications were detected in 15% of patients and included: 1 Complete rupture of the oesophagus. 2 A linear mucosal tear. 3 Outpouching of the distal oesophagus (in 10% of patients). We suggested that the cause of the radiological appearances in the latter group was either mucosal herniation through a tear in the muscle layers of the oesophagus, or a localized perforation. Further investigation of a recent, similar case has clarified the mechanism of this complication in at least some of the patients. A 68-year-old m a n presented with achalasia of the oesophagus and was treated with Rider-Moeller balloon dilatation according to our
(b) Fig. 1
Correspondence Letters are published at the discretion o f the Editor. Opinions expressed by correspondents are not necessarily those of the Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author o f the paper so that the reply can be published in the same issue. Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instructions to Authors at the front o f the Journal.
CAN W E R E D U C E T H E N U M B E R O F F I L M S F O R C O N T R A S T SIALOGRAPHY? SIR Doctors Pellegrini, Harris and Lipton's [1] assertion 'that no precontrast films are required' in the context of sialography flies in the face of m y experience as a radiologist. M y view is that a control film is essential before embarking u p o n any contrast radiography. Would the captain of an aircraft or ship embark upon an u n k n o w n journey without an idea of the likely terrain/seas to be encountered? Their paper is an example of the creeping, minimalist approach to contrast radiography, usually with (in m y view) the relatively unimportant goal of reduction in dose elevated to the status of some Holy Grail. I feel that when embarking on a contrast study a radiologist should err on the side of taking too many films rather than too few; on the basis that an incomplete, inconclusive examination does infinitely more h a r m than a meticulously conducted, complete study. -
M. F. C R E A G H
St Peter's District General Hospital Guildford Road Chertsey Surrey KT16 OPZ
Reference
I Pellegrini V, Harris I, Lipton M. Can we reduce the number of routine films required for contrast sialography? Clinical Radiology 1992;45: 254-255.
S i r - W e read Dr Creagh's letter with amazement. He states that reduction in radiation dosage is 'relatively unimportant' and that radiologists 'should err on the side of taking too many films' but we feel that the National Radiation Protection Board and the vast majority of radiologists and (informed) patients would not agree with him. In fact radiation dosage reduction should be to the forefront of every radiological procedure as long as diagnostic accuracy is maintained as we have shown in this current study. If Dr Creagh had read the paper carefully he would have seen our statement that 'if there is any doubt in interpretation then plain radiographs can be performed after the post-contrast examination following washout or at a later date'. In conclusion, therefore, in spite of Dr Creagh's rather rigid viewpoints, we feel that the whole concept of patient irradiation is a very important issue which should bc under constant review and audit. V. P E L L E G R I N I t. H A R R I S M. L I P T O N
(a)
Department of Radiology Royal Liverpool University Hospital Liverpool
O E S O P H A G E A L TEARS F O L L O W I N G P N E U M A T I C B A L L O O N D I L A T A T I O N F O R T H E T R E A T M E N T OF ACHALASIA S m - Our group [1] previously described the findings in contrast studies performed shortly after pneumatic balloon dilatation of the oesophagus for treatment of achalasia. Complications were detected in 15% of patients and included: 1 Complete rupture of the oesophagus. 2 A linear mucosal tear. 3 Outpouching of the distal oesophagus (in 10% of patients). We suggested that the cause of the radiological appearances in the latter group was either mucosal herniation through a tear in the muscle layers of the oesophagus, or a localized perforation. Further investigation of a recent, similar case has clarified the mechanism of this complication in at least some of the patients. A 68-year-old m a n presented with achalasia of the oesophagus and was treated with Rider-Moeller balloon dilatation according to our
(b) Fig. 1
