Letters
Downloaded from www.ajronline.org by 67.63.199.50 on 11/13/15 from IP address 67.63.199.50. Copyright ARRS. For personal use only; all rights reserved
Catheter
Venography
innovations would add $5-$l0 to the price of each barium enema examination. If this method of preparation were to spread throughout the nation, as proposed by these workers, and inasmuch as there are over 3.5 million such studies performed annually in the country, the potential overall increase in cost to the public would be $18-$35 million. It is estimated that $160 billion will be spent on health care in
I would like to comment on the case report on catheter venography in the superior vena cava syndrome by Webb et al. in the July 1977 issue [1]. Catheter venography has been such a logical extension of selective arteniognaphy that I would suspect that most angiographers have been performing the procedure for the past 10-15 years. It hardly seems worthy of publication
the United States during 1977, and the figure is rising geometnicaliy [4]. According to officials of the Department of Health, Education, and Welfare, physicians generate 70% of total health costs by ordering hospitalizations, various tests, and drugs.
at this time. John M. Riley Radiology Medical Group, Inc. San Diego, California 92101
Since REFERENCE 1 . Webb WA, Gamsu G, Rohlfing BM: Catheter the superior vena cava syndrome. Am 129:146-148, 1977
venography J Roentgenol
some
of these
in
responsibility
public
on
not possibly
The failure to obtain a clean colon prior to the performance of a lower gastrointestinal examination has been a problem for radiologists for many years. Our colleagues have repeatedly bemoaned the fact that their patients either would not, on could not, assume the responsibility of the self-administration of enemas
to
effect
proper
colon
of not being
of cleaning
the
colon
of the
patient
because
he is
the
importance
of
achieving
a clean
colon
prior
to
fulfill
it. Radiologists
should
present
themselves
to
the public as “partners for good health,” and as partners with our patients, we must emphasize that we each have responsibilties: the patient to clean his colon properly, and the nadiologist to perform the examination well and apply his skill and
The Clean Colon: Whose Responsibility?
cleansing
physicians
the barium enema study. Perhaps local radiologic societies should go so far as to place advertisements in newspapers and magazines explaining why it is important to prepare the colon, and how cleansing may be accomplished in the patient’s own home or private surroundings. Radiologists should not tell their patients, “Don’t worry about preparing your colon, just leave it all to us,” for even if we could afford such a promise, we could
Gordon Gamsu University of California San Francisco, California 94143
and
accuse
responsible for the results of the examination. But this is not correct. Physicians have never been the guarantors of satisfactony results, and radiologists in particular have never been the guarantors of accuracy. The sole duty of every physician is no more and no less than to possess and apply competent skill and knowledge. I believe it is the obligation of radiologists to educate the
Reply Our paper was intended to point out the usefulness of catheten venography in selected patients with the superior vena cava syndrome. In fact, we consider Riley’s comments as support for our conclusions that this procedure is easily performed, safe, and valuable. As we stated in the paper, catheter venognaphy is neither a new technique non a technique devised by us. However, we feel its value is not generally recognized among radiologists not specializing in angiography, and that the limitations of routine antecubital venography in patients with the superior vena cava syndrome need emphasis. W. Richard Webb
cathartics
officials
concerned with holding down medical expenditures, it behooves us to consider carefully the cost-benefit ratio of any new procedure or innovation. Simply on a cost basis alone, I do not think we can justify the luxury of shifting the responsibility of preparing the colon from the patient to the radiologist. According to Miller [1, 2], the radiologist must assume the
knowledge
to interpretthe findings.
The responsibility for the clean colon should lie with the individual whose vital interest is most served by the performance of an accurate lower gastrointestinal series-the patient. Leonard Berlin 518 Meadow Drive West
prepa-
ration. Realizing that early detection of colon carcinoma is essential if acceptable cure rates are to be achieved, and that the presence of retained fecal matter is a common cause for failure to detect small lesions, several authors have suggested that the responsibility for achieving a clean colon be taken away from the patient. Miller [1] stated the radiologist must take the responsibility for preparing the colon and, indeed, has suggested that his failure to do so ‘ ‘ may be considered poor practice and may well put that examiner in legal and financial jeopardy” [2]. Vasilas et al. [3] put this concept to practical use by building a suite of two 1 .8 x 3.7 m clysis rooms, purchasing separate colonic lavage tables, and hiring a specially trained clysmatologist. While they do not mention cost, it seems such
Wiimette,
Illinois
60091
REFERENCES 1 . Miller RE: The barium enema in the high-risk patient. Radiology 123 : 81 3-81 4, 1977 2. Miller RE: The clean colon. Gastroenterology 1976 3. Vasilas A, Batillas J, Sibal AC: Establishment cleansing facility.Appl Radiol 6:75-76, 1977 4. America’s doctors: a profession in trouble. World Report, Oct. 17, 1977, pp 50-58
403
carcinoma 70:289-290, of a colon U.S.
News
&
Downloaded from www.ajronline.org by 67.63.199.50 on 11/13/15 from IP address 67.63.199.50. Copyright ARRS. For personal use only; all rights reserved
Catheter
Venography
innovations would add $5-$l0 to the price of each barium enema examination. If this method of preparation were to spread throughout the nation, as proposed by these workers, and inasmuch as there are over 3.5 million such studies performed annually in the country, the potential overall increase in cost to the public would be $18-$35 million. It is estimated that $160 billion will be spent on health care in
I would like to comment on the case report on catheter venography in the superior vena cava syndrome by Webb et al. in the July 1977 issue [1]. Catheter venography has been such a logical extension of selective arteniognaphy that I would suspect that most angiographers have been performing the procedure for the past 10-15 years. It hardly seems worthy of publication
the United States during 1977, and the figure is rising geometnicaliy [4]. According to officials of the Department of Health, Education, and Welfare, physicians generate 70% of total health costs by ordering hospitalizations, various tests, and drugs.
at this time. John M. Riley Radiology Medical Group, Inc. San Diego, California 92101
Since REFERENCE 1 . Webb WA, Gamsu G, Rohlfing BM: Catheter the superior vena cava syndrome. Am 129:146-148, 1977
venography J Roentgenol
some
of these
in
responsibility
public
on
not possibly
The failure to obtain a clean colon prior to the performance of a lower gastrointestinal examination has been a problem for radiologists for many years. Our colleagues have repeatedly bemoaned the fact that their patients either would not, on could not, assume the responsibility of the self-administration of enemas
to
effect
proper
colon
of not being
of cleaning
the
colon
of the
patient
because
he is
the
importance
of
achieving
a clean
colon
prior
to
fulfill
it. Radiologists
should
present
themselves
to
the public as “partners for good health,” and as partners with our patients, we must emphasize that we each have responsibilties: the patient to clean his colon properly, and the nadiologist to perform the examination well and apply his skill and
The Clean Colon: Whose Responsibility?
cleansing
physicians
the barium enema study. Perhaps local radiologic societies should go so far as to place advertisements in newspapers and magazines explaining why it is important to prepare the colon, and how cleansing may be accomplished in the patient’s own home or private surroundings. Radiologists should not tell their patients, “Don’t worry about preparing your colon, just leave it all to us,” for even if we could afford such a promise, we could
Gordon Gamsu University of California San Francisco, California 94143
and
accuse
responsible for the results of the examination. But this is not correct. Physicians have never been the guarantors of satisfactony results, and radiologists in particular have never been the guarantors of accuracy. The sole duty of every physician is no more and no less than to possess and apply competent skill and knowledge. I believe it is the obligation of radiologists to educate the
Reply Our paper was intended to point out the usefulness of catheten venography in selected patients with the superior vena cava syndrome. In fact, we consider Riley’s comments as support for our conclusions that this procedure is easily performed, safe, and valuable. As we stated in the paper, catheter venognaphy is neither a new technique non a technique devised by us. However, we feel its value is not generally recognized among radiologists not specializing in angiography, and that the limitations of routine antecubital venography in patients with the superior vena cava syndrome need emphasis. W. Richard Webb
cathartics
officials
concerned with holding down medical expenditures, it behooves us to consider carefully the cost-benefit ratio of any new procedure or innovation. Simply on a cost basis alone, I do not think we can justify the luxury of shifting the responsibility of preparing the colon from the patient to the radiologist. According to Miller [1, 2], the radiologist must assume the
knowledge
to interpretthe findings.
The responsibility for the clean colon should lie with the individual whose vital interest is most served by the performance of an accurate lower gastrointestinal series-the patient. Leonard Berlin 518 Meadow Drive West
prepa-
ration. Realizing that early detection of colon carcinoma is essential if acceptable cure rates are to be achieved, and that the presence of retained fecal matter is a common cause for failure to detect small lesions, several authors have suggested that the responsibility for achieving a clean colon be taken away from the patient. Miller [1] stated the radiologist must take the responsibility for preparing the colon and, indeed, has suggested that his failure to do so ‘ ‘ may be considered poor practice and may well put that examiner in legal and financial jeopardy” [2]. Vasilas et al. [3] put this concept to practical use by building a suite of two 1 .8 x 3.7 m clysis rooms, purchasing separate colonic lavage tables, and hiring a specially trained clysmatologist. While they do not mention cost, it seems such
Wiimette,
Illinois
60091
REFERENCES 1 . Miller RE: The barium enema in the high-risk patient. Radiology 123 : 81 3-81 4, 1977 2. Miller RE: The clean colon. Gastroenterology 1976 3. Vasilas A, Batillas J, Sibal AC: Establishment cleansing facility.Appl Radiol 6:75-76, 1977 4. America’s doctors: a profession in trouble. World Report, Oct. 17, 1977, pp 50-58
403
carcinoma 70:289-290, of a colon U.S.
News
&
