mto 'Health Planning FT Bibliography Series p- 7 9g Selected Bibliographic 4{ References on Computerized Axial Tomography LySH )/ PAM - ANMALS . £" Ai2 H4 mo. 5 PUBL OCT 20 1977 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration The Division of Planning Methods and Technology, BHPRD, through the National Health Planning Information Center, is a primary resource for current information on a wide variety of topics relevant to health planning and resources devel- opment. To facilitate the dissemination of information to health planners, the Center will publish selected monographs and bibliographies in three series: 1. Health Planning Methods and Technology This series will focus on the technical and administrative aspects of the health planning process, including such areas as methods and approaches to the various aspects of the health planning process, techniques for ana- lyzing health planning information and problems, and approaches to the effective dissemination and utilization of technical information. 2. Health Planning Information This series will focus on data and information to support the health planning process, including sources of information and data for use in health planning. 3. Health Planning Bibliography This series will focus on general and specialized bibliographies that relate to topical subject areas in health planning. ~ Selected Bibliographic References on Computerized Axial Tomography is the fourth publication in the Health Planning Bibliography Series. Selected Bibliographic References on Computerized Axial Tomography Developed under Contract No. HRA 230-75-0073 by Aspen Systems Corporation Germantown, Maryland 20767 August 1977 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration Bureau of Health Planning and Resources Development Division of Planning Methods and Technology National Health Planning Information Center DHEW Publication No. (HRA) 77-4538 PREFACE This publication is fifth in the National Health Planning Information Center's Health Planning Bibliography Series. Topics for these bibliographies are selected on the basis of the frequency of inquiries received by the Center for reference material. This bibliography was compiled as a result of the recent demand for reference material on computerized axial tomography scanners. The introduction provides information on how this bibliography was developed by the Center's Reference Staff, as well as the source of its information and its organization and format. Although extensive, this bibliography is not exhaustive with respect to all available information on the topic.: In addition, its usefulness may depend on the user's prior knowledge of the subject and need for specific types of reference tools. To prepare for possible future revisions of this bibliography, additional citations relevant to this topic and useful to health planners are needed and will be appreciated. Suggested references, or donations of documents should be submitted to: National Health Planning Information Center Acquisitions Department P.0. Box 31 Rockville, Maryland 20850 $11 3440 How To Obtain Documents All citations to documents, whether published or unpub-, lished, contain source availability information. For each reference, this information is noted in the citation after the prefix "SO:" The availability source for articles published in journals and other periodicals is the name of the journal noted after the statement "PUB. IN...... "_ Issue information (volume, number, etc.) and page numbers are included. To obtain copies of the journal articles cited, consult a local university librarian or contact the librarian in your Regional Medical Library, where many of the journals can be found. References to documents which are available for purchase also include ordering and price information. Price is indicated by the prefix "PR:" in the document's citation. Price information quoted in the document is subject to change by the supplier. For information on the price of a document listed as available from the National Technical Information Service (NTIS), write (do not call) to the address listed below. Include the order number of the referenced document ag indicated in its citation. s National Technical Information Service 5285 Port Royal Road Springfiéld, virginia - 22161 Unless specified, do not contact the National Health Planning Information Center for a copy of the document. Questions concerning the development of this bibliography should be addressed to: National Health Planning Information Center P .0.,. Box:: 31 Rockville, Maryland 20850 Additional copies of this bibliography may be obtained from: The Superintendent of Documents U.S. Government Printing Office Washington, D.C. 20402 For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 iv Preface ;... . . wl.l alls. s CONTENTS How To Obtain Documents. Introduction. -. .( .}. }. Format and Organization. Bibliographic References. Page «Ai + INTRODUCTION The impact of advances in diagnostic and therapeutic medical technology concerns both health planners and health-, care providers. In planning for the integration of new health care technology into the delivery system, information on which to base dectsfons is often limited. Buring the last year, the National Health Planning Information Center (NHPIC) has received numerous requests for information concerning computerized axial tomography, a recent innovation in radiologic diagnostic technology. Of particular importance to health planners is information concerning standards, criteria, and guidelines relevant to project review of both brain scanners and whole-body scanners. This bibliography brings together much of the literature prepared by individuals, organizations, and agencies on computerized axial tomography. It includes citations and, if available, abstracts of documents identified by the National Health Planning Information Center between November 1976 and January 1977 from literature searches of the files of the Center, the National Technical Information Service, and Medline and other automated and manual sources of information. This bibliography is not intended to be 'an exhaustive literature search on the subject. It is designed to be used as a reference aid to a collection of documents relevant to health planners on computerized axial tomography. References to documents included in this bibliography were reviewed for their relevancy to the health planning process. The factors considered in this bibliography's review criteria include: UTILIZATION/NEED e Number of operations per month/year, e Percent of time in use, e - Access to emergency use, e Appointment policies, e Efficiency in diagnosis. COST e Impact on hospital/patient charges, e Self-pay or third-party coverage. GEOGRAPHIC DISTRIBUTION AND RELATED FACTORS e Shared service policy, e Affiliation issues, e Influence on referral patterns. QUALITY @- Poser review of scanner unit activity, ® Inappropriate admissions and use, e - Adverse effects. SUPPORTING RESOURCES e - Adequate facility to house, e Qualified technical manpower to staff. TIME e - Rapid image to speed up diagnosis/treatment. REQUIRED DATA e Data to support need, e Continuing data of use, e - Breakdown patient type by inpatient v. outpatient, e Positive v. negative results, e Other data concerning listed factors. The following sections provide information on the overall organization of the bibliography and the format of the document references. Format and Organization References to documents included in this bibliography are cited as follows: AU: Corporate or Personal Author(s) TI Title of the Document sO: Availability Source PR: Price AN: Annotation or Abstract All references include the title of the document and its availability source. An annotation or abstract is included only if it already exists on the National Health Planning Information Center's automated searchable information file. All references, except those without an identified personal or corporate author, are arranged alphabetically by first personal author's last name or, if no personal author is indicated, alphabetically by corporate author name. Citations to documents which do not contain a personal author or corporate author are arranged alphabetically by the document's title in the beginning of the "Bibliographic References" section. T I: so: A N: % TI: so: AN: TIF; so: TI% SO: BIBLIOGRAPHIC REFERENCES BRITONS DEVELOP NON-INVASIVE DIAGNOSTIC SYSTEM PUB. IN JOURNAL OF THE AMERICAN MEDICAL ASSOC- IATION, V223 N1, PT-8, JANUARY 1973. Routine diagnostic use of a recently - developed, computerized, axial TOMOG RAPHY scanning unit in a suburban London, England hospital is discussed in this article. The scanning unit is being evaluated at the hospital while engineers completes refinements on a computer that will be 'mated' with it. The equipment employs a narrow beam of roentgen rays to scan the patient's head (encased in a rubber cap in the SCANNER unit) in 'slices' 8.8 cm to 1.3 cm thick. These rays pass through the skull to two sensing devices which remain in constant alignment on the opposite side. The scanning unit is rotated around the head, stopping for 180 scans at one - degree intervals, with each detector taking atotal of 28,000 readings per scan. The readings are stored on a magnetic disk, from which the computer calculates absorption values. The computer then produces a picture made up of 6, 400 matrix points, discriminating between tissues of minutely varying (as little as 0.5 percent) density. Radiologists can distinguish tumors, cysts, Or hemorrhages on these pictures. The computer's picture can be produced on a cathode ray tube viewing unit for direct examination or it can be recorded photographically. ComPUTER-ASSISTED TOMOGRAPHY OF THE BRAIN PUB. IN LANCET, Y2 N7888, P1052-1054, NOVEMBER 2, 1974. Discusses the development of EMI scanning and notes that it promises to be particularly valuable in the assessment of acute head injuries with suspected intracranial hema toma. COMPUTER-AUGMENTED RADIATION ONCOLOGY PUB. IN CANCER, V34 (4 SUPPL), P2129- 2139, APRIL 1976. LETTER: SOME LIKE CAT FEVER PUB. IN NEW ENGLAND JOURNAL OF MEDICINE, v295 N5, P282-283, JULY 29, 1976. T I: so: AN: H3 FH sa MEDICAL NEWS: TOMOGRAPHIC SCANNER PRODUCES CLEAR, DETAILED AND COLORFUL IMAGES PUB. IN JOURNAL OF THE AMERICAN MEDICAL ASSOCI- ATION, V226 N8, PB41-842, NOVEMBER 19, 1973. The automatic computerized transverse axial (ACTA) SCANNER, developed by the National Biomedical Research Foundation in affiliation with Georgetown University Hospital, is described. The SCANNER, which produces cross section views of a patients's body in color on a television screen, is a second -generation device, closely following the EMT SCANNER developed in England for diagnosing brain disorders. Both SCANNERS combine the use of x-rays, computers, and a Polaroid camera to obtain pictures. - ACTA's clinical advantages include its abilities to define both the precise location and nature of a tissue abnormality, to present information in a variety of ways (color and black and white television, color photographs, and numerical printouts), and its versatility in that it can be used to scan the entire body. The system's great accuracy results from multiple measurements of individual points from various angles, in contrast to an ordinary x-ray plate, in which the precise absorption of radiation by any one point cannot be determined. The TOMOGRAPHIC SCANNER can complete a series of up to 1280 sean - passes of any plans of the body in less than nine minutes, rotating as little as one degree between each pass. Examples of x-ray profiles from the ACTA SCANNER are illustrated, and the Yay "'in which 'the SCANNER produces the cross sections is explained briefly. NON-INVASIVE INVESTIGATIONS OF THE BRAIN PUB.s LN BRITISH MEDICAL JOURNAL, V2 N5966, P295- 296, MAY 10, 1975. TUMOR LOCALIZATION TECHNIQUES IN RADIATION THERAPY PUB. IN CANCER V37 (4 SUPPL), P2035-2045, APRIL 1976. ALDERSON, PO ; MIKHAEL,M ; ; GADO,M OPTIMAL UTILIZATION OF COMPUTERIZED CRANIAL TOMO- GRAPHY AND RADIONUCLIDE BRAIN IMAGING PUB. IN NEUROLOGY, V¥26 N9, P803-807, SEPTEMBER 1976. AU: ALFICI,RJ ; EBT. AL. TI:; EXPERIMENTAL STUDIES TO DETERMINE APPLICATION OF CAT SCANNING TO THE HUMAN BODY sO: PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, RADIUM THERAPY AND NUCLEAR MEDICINE, V124 N2, P199-207, JUKE 1975. AU: ALFIDI,RJ ; HAAGA, JR TI; COMPUTED TOMOGRAPHY OF THE BODY: A NEW HORIZON S0: PUB. IN POSTGRADUATE MEDICINE, - Y59 N8, F133- 136, AUGUST 1976. . AU:; j. HAAGA, JR: ; ; o PEPE,BRG ; COOK, SA TI: COMPUTED TOMOGRAPHY OP THE LIVER SO:; PUB. IN AMERICAN JOURNAL OF ROENTGENOLCGY, V 127 N1, FP69-74, JULY 1976. AU: ALFIDI,RJ ; MACINTYRE, WJ TI: COMPUTED TOMOGRAPHY STANDARDIZATION so;: PUB. IN RADIOLOGY, V119 N3, P743-744, JUNE 1976. . AU: AMBROSE, J TL: BRIEF REVIEW OF THE EMI SCANNER sO: PUB. IN BRITISH JOURNAL OF RADIOLOGY, V¥48 N571, P6095°606, JULY 1975. AN: rraces the development of the EMI SCANNER from the beginnings of radionuclide brain scanning through the production of a prototype SCANNER to the addition of a mini-computer to complete the system. AU: AMBROSE, J TI:; COMPUTERIZED X-RAY SCANNING OF THE BRAIN sO: PUB. IN JOURNAL OF NEUROSURGERY, V40 N6, P679-695, JUNE 1974. AU: AMBROSE, J TI:; THE USEFULNESS OF COMPUTERIZED TRANSVERSE AXIAL SCANNING IN PROBLEMS ARISING FROM CEREBRAL HAEMOR- RHAGE, INFARCTION COR OEDEMA sO: PUB. IN BRITISH JOURNAL OF RADIOLOGY, V46 N549, P736, SEPTEMBER 1973. i AU: TIL : 301 AU: TI «® S04 PR: AU TI SQ ; PR TI: S0: ZR: AU : TL;: AMBROSE, J ; GOODING,MR ; RICHARDSON, AE AN ASSESSMENT OF THE ACCURACY OF COMPUTERIZED TRANS- VERSE AXIAL SCANNING (EMI SCANNER) IN THE DIAGNOSIS OF INTRACRANIAL TUMOUR: A REVIEW OF 366 PATIENTS PUR. ITN BRALN, Y¥98 N4, P5G9-582, DECEMBER 1975. AMERICAN ASSOCIATION FOR COMPREHENSIVE HEALTH PLANNING - (AACHP) CT SCANNING? NOVEMBER 1977, AVAILABLE FROM AACHP, 801 NORTH FAIRFAX STREET, ALEXANDRIA, VIRGINIA 22314 $8.00 (NON-MEMBERS) $4.00 (MEMBERS). AMERICAN COLLEGE OF - RADIOLOGY PROCEEDINGS OF THE CONFERENCE ON COMPUTERIZED TOMOGRAPHY IN RADIOLOGY, ST. LOUIS, MISSOURI, APRIL 25-28, 1976 AVAILABLE FROM THE AMERICAN COLLEGE OF RADIOLOGY, 6900 WISCONSIN AVENUE, CHEVY CHASE, MARYLAND 20015 $30.00 (NON-MEMBERS) $25.00 (MEMBERS) . AMERICAN COLLEGE OF RADIOLOGY PLANNING GUIDES FOR RADIOLOGIC INSTALLATIONS FASCICLE 3 : COMPUTERIZED TOMOGRAPHIC FACILITIES AVAILABLE FROM THE AMERICAN COLLEGE OF RADIOLOGY, 6900 WISCONSIN AVENUE, CHEVY CHASE, MARYLAND 20015 $6.00. AMERICAN HOSPITAL ASSOCIATION CT SCANNERS: A TECHNICAL REPORT 1977, AVAILABLE FROM THE AMERICAN HOSPITAL ASSOCIATION, 840 NORTH LAKE SHORE DRIVE, CHICAGO, ILLINOIS 60611 $9.50. AMERICAN NEUROLOGICAL ASSOCIATION, JOINT COMMITTEE FOR STEOKE FACILITIES f cOMPUTIED TOMOGRAPHY IN THE MANAGEMENT CF CBEREBRO- VASCULAR DISEASE so : P R AN: AU TI S0: AU: TI; SO: 12P, 1974, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL RCAD, SPRINGFIELD, VIRGINIA 2216 1 CONTACT NTIS (ORDER NUMBER HRP-0008791. The radiological technique of computed TOMOGRAPHY (CT) used in neurological diagnosis of vascular diseases of the brain is explained, and its application to specific clinical situations is described. Cerebral infarcts of varying ages can be visualized, with a recent ischemic infarct appearing as a region of decreased density. Hemorrhagic infarcts in acute and subacture stages also can be visualized, and the advantage to the patient is that the procedure is virtually without risk. CT is the procedure of choice in confirming a diagnosis of hemorrhage into the brain parenchyma or into the ventricular system. Hematomas not readily detectable by conventional angiography may be demonstrated by CT, particularly if they are large. Cerebral aneurysms and arteriovenous malformations cannot be detected by CT unless calcification or clotted blood is present. However, several radiologists have noted enhancement of the diagnostic capability for both neoplasms and vascular lesions such as aneurysms and AV malformations, when an intravenous infusion of angiographic contrast material is started prior to the scan. - It is noted that considerable technical skill is required to keep CT equipment operating properly, and photographs of scans may be made a part of the patients's clinical record. An attachment to this document corrects an error on a previous technical assistance memorandum. ARTHUE D.LITTLE, INC. A HEALTH PLANNING DOCUMENT: COMPUTERIZED TOoMOGRAPHIC SCANNING SYSTEMS NOVEMBER 1975, TEMPORARILY AVAILABLE FROM THE NATIONAL HEALTH PLANNING INFORMATION CENTER, P.O. BOX 31, ROCKVILLE, MARYLAND 20850 (ORDER NUMBER HRA-0 14573) . BA KER , HL COMPUTED TOMOGRAPHY AND NEURORADIOLOGY: A FORTUNATE PRIMARY UNION PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, V127 N1, P10 1-110, JULY 1976. AU TI SO : BAKER , HL CRANIAL COMPUTED TOMOGRAPHY:; ITS IMPACT UPON CLINICAL NEURORADIOLOGIC PRACTICE IN PROCEEDINGS OF THE CONFERENCE ON CCMPUTERIZED TOMOGEAPHY IN RADIOLOGY, ST. LOUIS, MISSOURI, APRIL 25-28, 1976 (ORDERING INFORMATION LISTED ' UNDER AU: AMERICAN COLLEGE OF RADIOLOGY). A U TI: 00 So: PR AN aa # * AU TI a # 50: BAKE R , HL IMPACT OF COMPUTED TOMOGRAPHY ON NEURORADIOLOGIC PRACTICE 15P, 1974, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 cONTACT NTIS (ORDER NUMBER HRP-0O008793). Computed TOMOGRAPHY (CT) of the head was studied to determine the impact on neuroradiologic and neurodiagnostic practice at the Mayo Clinic over an 18-month period. After an initial training period, the CT project program gained recognition, until, eight months after inception, the new modality had reached 100 percent saturation of the schedule (defined as 14 patients examined per eight-hour working day). Eventually more technologists were trained and operating hours were extended to provide 24-hour emergency service. Data on other neurodiagnostic tests, -- elect ography, A-mode echoencephalography (EEG), cerebral angiography, cerebral pneumography, and nuclide brain scans also are analyzed. All techniques, except the EEG, were employed less often for diagnostic purposes as the capabilities of CT became known to the clinicians. CT has operied new vistas of diagnosis and has pointed out the limitation of previous neuroradiologic methods. An improvement in format (the development of a 160 by 160 matrix) has been added to the basic CT system and has provided identification of intracrarial structures that were formerly undetectable. BA KER, HL THE IMPACT OF COMPUTED TOMOGRAPHY ON NEURORADIOLOGIC PRACIICE PUB. IN RADIOLOGY, V116 N3, P637-640, SEPTEMBER 19.75. AU: T7 I S0 AN: AU A TE4 so AN BAKER,HL ; CAMPBELL,JK ; HOUSER,OW ; REESE, DF ; SHEETY, PF COMPUTER ASSISTED TOMOGRAPHY OF THE HEAD PUE. IHX MAYO CLINIC PROCEEDINGS, Y49, P17-27, JANUARY 1974. The use of Computer Assisted TOMOGRAPHY (CAT) in 529 examinations of 500 patients at the Mayo Clinic is described and evaluated. The diagnoses made with the aid of CAT were of three main categories: normal (190 patients); enlargement of spaces containing cerebrospinal fluid (107); and difference in density of tissue, as compared with the surrounding brain, indicating a parenchymal lesion (193). Density changes were produced by various lesions, particularly neoplasms, infarcts, and hemorrhages. Initial interpretation of the 529 examinations resulted in ten false - negative diagnoses, three false - positive diagnoses, and five incorrect diagnoses. It is concluded that CAT appears to represent a major advance in neuroradiologic diagnosis and in the care of patients with neurologic disorders, the major advantages being the noninvasive character of the technique and the absence of morbidity. The diagnostic error rate encountered with the first 500 patients (3.5 percent) compares favorably with rates associated with other neuroradiologic procedures used at the Clinic. Major disadvantages of CAT, it is concluded, relate to the relative slowness of scanning time and the limitation in viewing capabillity, both of which restricted the number of diagnostic procedures to 15 per day. It is noted that radiologists and clinicians will need time to acquaint themselves with the unfamiliar mode of data presentation used by the CAT. Tabular data, illustrations, and photographs accompany the article. BAKER,jHL ;.CAMPBELL,JK ; HOUSER,OW ;. :REESE,DF EARLY EXPERIENCE WITH THE EMI SCANNER FOR STUDY OF THE BRAIN PUB. IN RADIOLOGY, VT1I1G K2, P327-333, 1975. The diagnostic capabilities of the EMI computerized TOMOGRAPEHIC brain SCANNER are assessed, based on the early experience of the Mayo Clinic with the device. Diagnoses of some 800 patients with a variety of clinical diagnoses, ranging from headache to various lesions of the brain and orbital region, are evaluated. The overall detection rate for intracranial lesions is found to be high. Rate AU J I sO : AU : TI: S0: of diagnostic error is decreasing as physicians gain experience in the use of the scanning device. During the first 170 days, the Mayo Clinic evaluated an average of 10 patients per day using the EMI technique. It is observed that the availability of computerized TOMOGRAPHY could lead to major changes in neuroradiologic practice and in the application of traditional as angiography, pneumography, and radionuclide brain scanning. The analysis of early clinical use indicates that the appearance of the computed tomogram in some conditions is unique and that increasing experience with the device allows the neuroradiologist to predict the position and nature of disease processes with greater accuracy. Photographs of computed TOMOGRAPHS accompany the text. BAKER, HL ; HOUSE R, OW cOmnPUIED TOMOGRAPHY IN THE DIAGNOSIS OF POSTERIOR FOSSA LESIONS PUB. IN RADIOLOGY CLINIC OF NORTH AMERICA, V14 N1; B129-147, NXPBREL 1976. BERSER,PE ; KIRKS, DN j GILDAYZDLE ; FITZI,CR ; HA RWCCD-NASH , DC COMPUTED TOMOGRAPHY IN INFANTS AND CHILDREN: INTRA- CRANIAL NEOPLA SMS PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, V127 N1, P129- 137, JULY 1976. BERGSTRYOMjM °; GREITZ,T STEREOTAXIC COMPUTED TOMOGRA PHY PUB. IN AMERICAN JOURNAL OF ROENTGENOLCGY, V127 N1, Pp167- 179, JULY 1976. BERGSTR"OM, M ; SUNCMAN, R ANALYSIS OF REGIONS OF INTEREST IN EMI SCANS PUB. IN BRITISH JOURNAL OF RADIOLOGY, V49 NS582, P549-550, JUNE 1976. BERGVALL,U ; GREITZ,T ; STEINER,L COMPUTER TOMOGRA PHY IN POST-MORTEM EXAMINATION OF THE BRRAIN AND OTHER SPECIMENS PUB. IN ACTA RADIOLOGY (SUPPL) , V346, P39- 44, 1975. -10- AU: T I% so AU: T L:: 30: AU 3 I AU TI sO: BOGDANOFF,BM ; - STAFFORD,CR ; GREEN, L ; GONZALEZ,CF COMPUTERIZED TRANSAXIAL TOMOGRAPHY IN THE EVALUA- TION CF-PATIENTS WITH- FOCAL EPILEPSY PUB.: IN: NEUROLOGY, cvV25 N11, P10 13-1017, KQVENMBER 1975. BOKfRL <; NEW WHOLE-BODY UNIDIRECTIONAL MOVING SCANNER: COMPARATIVE STUDY CF PERFORMANCES PUB. IN JOURNAL OP NUCLEAFP MEDICINE, V16 H6, P516, 1975. BOULWA RS, FT COMPUTERIZED TRANSAXIAL TOMOGRAM: RELATIONSHIP TO OTHER NEURODIAGNOSTIC PROCEDURES PUB. IN ROCKY MOUNTAIN MEDICAL JOURNAL, V72 N10, 'P435~438, OCTOBER 1975. BRITTON, KE ; WILLIAMS, ES E. M. I. AND -RADIOISOTOPE BRXINX. IMAGING PUB. IN LANCET, V1 N7957, P477-478, FEBRUART 28, 1976. BROOKS, RA ; DI CHIRO,G STATISTICAL LIMITATIONS IN X-RAY RECONSTRUCTIVE TOMOGRA PHY PUB. IN MEDICAL PHYSICS,; V3 NL, P237-240, JULY - AUGUST, 1976. BROWNELL , G NEW INSTRUMENTATION FOR COMPUTERIZED TOMOGRAPHY IN PROCEEDINGS OF THE CONFERENCE ON COMPUTERIZED TCMOGERAPHY IN RADIOLOGY, ST. LOUIS, MISSOURI, APRIL 25-28, 1976 (ORDERING INFORMATION LISTED UNDER AU: AMERICAN COLLEGE OF RADIOLOGY). BRUCHEZ,M ; BISCHOFDELALOYE,A ; DELALCYE,B MULTIDETECTOR WHOLE-BOBY SCANNER (MULTISCAN) : TECHNICAL AND CLINICAL ASPECTS PUB. IN EUROPEAN JOURNAL OF NUCLEAR MECICINE, V1 N2, FHG, 1976. 0 #11 AU : TI: A U TI S0: AU S0 : AU TL 20; AU : TIL BUEINGER, TF; -GULLBERG,GT ; NOHR,;ML ; MCRAB,J ; ANGER, HO QUANTITATIVE SEQUENTIAL IMAGING OF RADICNUCLIDE DISTRIBUTION USING THE WHOLE-BODY SCANNER AND THE GAMMA CAMERA: ABSOLUTE ACCURACY AND ASBECTS OF THREE-CIMENSIONAL RECONSTRUCTION 20P, SEPTEMBER 1973, FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT - ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 cONTACT NTIS (ORDER NUMBER LBL-2161) . BUENGER, RE cOMPUTED BRAIN TOMOGRAPHY UTILIZATION, 1973-1976 IN PECCEEDINGS OF THE CONFERENCE ON COMEUTERIZED TOMOGEAPHY IHX RADIOLOGY, ST. LOULS,. MISSOURI, APRIL 25-28, 1976 (ORDERING INFORMATION LISTED UNDER AU: AMERICAN COLLEGE OF RADIOLOGY). BUENGER,RE ; BASS,GB EXPERIENCE ANALYSIS AND PREDICTIONS FOR COMPUTED TOMOCGEKAPHY COSTS AT RUSH-PRESBYTERLAN-SI. LUKE'S MEDICAL CENTER IN PRCCEEDINGS OF THE CONFERENCE ON COMPUTERIZED TOMHMOGERAFHY IN RADIOLOGY, ST. LOUIS, MISSOURI, APRIL 25-28, 1976 (ORDERING INFORMATION LISTED UNDER AU: AMERICAN COLLEGE OF RADIOLOGY). BULL, J THE CHANGING FACE OF NEURORADIOLOGY OVER NEARLY FORTY YEARS PUB. IN NEURORADIOLOGY, V9 N3, P111-115, 1975. BULL,JW ; HUNGERFORD,GD ; GAWLER, J COMPUTER ASSISTED TOMOGRAPHY AND ANGIOGRAPHY IN THE PBIAGNOSIS OF CEREBRAL TUMOURS: THE CHANGING ROLE CF ANGIOGRAPHY P342-345, 1975, IN SALAMONX,G ; ADVANCES IN CEREBRAL ANGIOGRAPHY, BERLIN. BUREAU OF HEALTH PLANNING AND RESOURCES DEVELOPMENT, HEALTH RESOURCES ADMINISTRATION, PHS, DHEW CCMEUTERIZED AXIAL TOMOGRAPHY SCANNERS v9. sO: PR A N 3P, JUNE 6, 1974, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 POET ROYAL ROAD, SPRINGFIELD, VIRGINIA, 22161 CONTACT NTIS (ORDER NUMBER HRP-0004167). Available computerized axial TOMOGRAPHY (CAT) scanning equipment is described, with an eye toward responsibilities of comprehensive health planning (CHP) agencies in approving capital expenditures for such equipment. CAT equipment provides a non-invasive method for studing cerebral lesions without hazard or discomfort to the patient. CAT scanning can be carried out in an ambulant care setting, significantly reducing the need for brain scans, pneumoencephalography, and some contrast media studies. Two types of SCANNERS are described: the EMI SCANNER and the Automated Computerized Transverse Axial-Scanner {ACTAY). Thelatter reportedly is capable of scanning the entire body, allowing identification of pathological lesions in areas other than the brain. The price of 'the ACTA SCANNZR.is about half that of the EMI instrument. In reviewing hospital requests for CAT equipment, CHP agencies should consider amortization, availability of personnel in terms of optimal usage, and the rapidity of design changes likely in such newly developed equipment. CHP agencies may wish to give priority consideration to: medical school affiliated teaching centers; hospitals with qualified neuroradiologists and caseloads which would effectively utilize'CAT equipment; and hospitals whose geographic location would assure optimal access to CAT equipment; and hospitals whose geographic location would assure optimal access to CAT equipment for as many neurological patients as possible. Portions of this document are not fully legible. AU: € s sO: AU:; T I : S01 AU : TI4 20: AU TI SO : AV: ZI : 30% CARELLA, RJ ; PAY,N ; NEWELL,J ; FARINA,AT ; KRICHEFF.,IL JS COMPUTERIZED (AXIAL) TOMOGRAPHY IN THE, SERIAL STUDY OF CEREBRAL TUMORS BY RADIATION : A PRELIMIN- ARY EEEORT PUB. N6, P2719- 2728, JUNE: 1976. CcHERNAK,ES _;; RODRIQUEZ-ANTUNEZ, A ; JELDEN,GL ; DHALIWAL,RS ; LAVILEK,PS THE USE OF COMPUTED TOMOGRAPHY FOR RACIATION THERAPY TREATMENT PLANNING : PUB., IN RADIOLOGY, Y117 K3 PT 1, P613-614, DECEMBER 1975% CHRISTIE,JH ; MORI,H ; GO,RT ; CORNELL,SH ; SCHAPIRO, RL COMPUTED TOMOGRAPHY AND RADIONUCLIDE STUDIES IN THE DIAGNOSIS OF INTRACRANIAL DISEASE PUB. IN AMERICAN JCURNAL OF RORNTGENOLCGY, ¥127 N1, P171-174, JULY 1976. CLO E, LE HEALTH PLANNING FOR COMPUTED TOMOGRAPHY: PERSPECT- IVES AND PROBLEMS PUB. IN AMERICAN JOURNAL OF ROENTGENOLCGY, V¥127 N1, P 187-190, JULY 1976. COLLARD,M ; DUPONT, HP COMPUTERIZED TRANSVERSE AXIAL TOMOGRAPHY WITH THE EMI SCANNER: FIRST REVIEW AFTER 1000 CBSERVATIONS PUB. IN JOURNAL OF BELGIUM RADIOLOGY, vV58 N4, P289-328 , JULY-AUGUST 1975. COMPREHENSIVE HEALTH PLANNING COUNCIL OF NORTHERN NEW JERSEY PLANNING FOR COMPUTERIZED AXIAL TOMOGRAPHY: A REPORT OF METHODOLOGY DEVELOPMENT AND APPLICATION IN THE NORTHERN NEW JERSEY REGION 132P, SEPTEMBER 1975, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 ~]J4- PR: AN : AU: 7 I P R AN: UJ CONTACT NTIS (ORDER NUMBER HRP-0009905) . The use of computerized axial TOMOGRAPHIC (CAT) equipment for brain disorder diagnosis is evaluated, based on its application in northern New Jersey. In 1973-74, the New Jersey medical community generated a rapid demand for CAT units from manufacturers despite high costs and the anticipation of more technically and productively significant generations of equipment. Health planners for the State and areawide jurisdictions were required to develop criteria for the allocation of CAT units which considered consumer needs, costs, and possible technical obsolescence of first-generation CAT units. An areawide planning council in New Jersey developed and applied allocation criteria which included State interim guidelines, technical state of the art information, direct medical provider input and participation, areawide planning data, and directly related medical utilization data. The council designed a survey questionnaire to obtain information on which groups in the planning area desired to use CAT equipment, the magnitude and cost of procedures likely to be delivered with CAT equipment, staff and institutional capability to operate CAT equipment, and willingness to report on the utilization of CAT equipment after it became operational. An areawide seminar was held to obtain the opinions of areawide providers and interested consumers on planning issues involved in the use of CAT equipment. The allocation criteria that were developed for CAT equipment allow for maximum areawide patient utilization and take into consideration local demography, use availability for institutions not planning acquisition of .CAT units,. and opportunity for the addition of later generations. of CAT units as they may be required. Portions of this document are not fully legible. COMPREHENSIVE HEALTH PLANNING coynxCcIL Or NORTH - WESTERN PENNSYLVANIA, INC. CCMPUTERIZED AXIAL TOMOGRAPHY 21P, JANUARY 1976, AVAILABLE FRCM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 § CONTACT NTIS (ORDER NUMBER HRP-0009635) . Guidelines for the development of computerized transaxial TOMOGRAPHY (CTT) services in northwestern Pennsylvania are presented. It is notel that rational =15- AU: TI SO development of these services is essential because CTT is expansive, with equipment ranging from $170,000 to $600,000, depending on whether the SZANNER is head only or for the body. - Also, a> broad spectrum of specialists is needed to have patients referred for CTT scanning procedures in all areas of the body. - Various problems associated with CTT are outlined, and recommendations are made that certain criteria for x-ray volume and head scan volume be employed, and that staffing criteria be met. Definitions of terms used in CTT are provided, and the evolution of the technology is discussed. Problems in the use of CTT includer . daily utilization rates, inpatient and outpatient use, impact on present diagnostic studies, cost of equipment, rapid evolution of technology, and patient charges. Criteria are presented for establishing need, qualifications of staff, financial feasibility, and physical design of facilities. COMPREHENSIVE HEALTH PLANNING COUNCIL OF SOUTH FLORIDA EMI SCANNER NEED STUDY 5P, JUNE 17,1974, TEMPORARILY AVAILABLE FROM THE NATIONAL HEALTH PLANNING INFORMATION CENTER, P.O. BOX .31, ROCKVILLE, MARYLAND 20850 (ORDER NUMBER HRP-0006230). COWLEY, EJ NEW CONCEPTS IN RADIOGRAPHY PUB. IN RADIOGRAPHY, V41 N487, P153-164, JULY 1975. DALLCW, RL ; MOMOSE,KJ ; WEBER, AL ; WRAY,SH COMPARISON OF ULTRASONOGRAPHY, COMPUTERIZED TOMO- GRAPHY (EMI SCAN), AND RADIOGRAPHIC TECHNIQUES IN EVALUATION OF EXOPHTHALMOS PUB. IN TRANSACTIONS OF THE AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY, V¥81 N2, P305- 322, MARCH-APRIL 1976. ="16- AU : *I; heel DAVIS,DO ; PRESSMAN, BD COMPUTERIZED TOMOGRAPHY OF THE BRAIN PUB. IN: RADTOLOGIC. CLINICS OF NORTH AMERICA, v12 N2, -KUGCUST 1974. Describes the techniques, clinical use, and results of computer-assisted transaxial TOMOGRAPHY for various brain conditions and diseases. DOWNEY,GW A SCANNER FOR EVERY HOSPITAL PUB. IN MNODEEN HEALTH CARE, 'VS5 N2, P165-16X, FEBRUARY 1976. ELL, PJ ; MYERS,HM NEW WHOLE-BODY SCANNER: COMPARISON WITH A LARGE _ CRYSTAL SCANNING CAMERA IN ORGAN AND WHCLE-BODY MODE PUB. IN EUROPEAN JOURNAL OF NUCLEAR MEDICINE, V1 N2, Pi15,: 1976. EV ENS, RG NEW FRONTIER FOR RADIOLOGY: COMPUTED TOMOGRAPHY 40 TH ANNUAL PRESTON M. HICKEY MEMORIAL LECTURE PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, V126 N6, E1MI-1129, : JUNZ . 1976. EVENS,RG ; <~JOST,RG ECONOMIC ANALYSIS OF COMPUTED TOMOGRAPHY UNITS PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, V127 N1, B191- 198, JULY 1976. FORSYTH HEALTH PLANNING COUNCIL COMPUTED TOMOGRAPHY OF THE HEAD: STAFF ANALYSIS 27P, CCTOBER 8, 1975, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 CONTACT NTIS (ORDER NUMBER HRP-0008849) . Relative to a request for computed TOMOGRAPHIC equipment submitted by an area hospital, a report on computed TOMOGRAPHY is presented by the staff of the Forsyth Health Planning Council, -17- AU: TL: S0: AU T Lf S0: AU TL 50: AU TI SO% Winston-Salem, North Carolina to aid the Council in the project review process. The report contains summary descriptions of the computed TOMOGRAPHY process and of the various types of equipment available (the EMI head SCANNER and full-body SCANNER, -and the ACTA full-body SCANNER). - Data on the occurrence of disease in the area and the rate of use of related health services are presented as bases for calculations of the need for the head SCANNERS requested by Forsyth Memorial Hospital. Other considerations noted are the benefits of computed TOMOGRAP HY compared to other diagnostic techniques, the likelihood of rapid developments in SCANNER technology in the future, and community and provider roles with regard to the new technology. The report also contains a glossary of terms, a bibllography, and supporting data reflecting projected need for computed TOMOGRAPHY diagnosis and projected costs of the process. FOX, JH THE USE OF COMPUTERIZED TOMOGRAPHY IN SENILE DEMENTIA PUB. IN JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, Y38 N10, 1975. FOX, JH ; HUCKMAN, MS COMPUTERIZED TOMOGRAPHY: A RECENT ADVANCE IN EVALUATING SENILE DEMENTIA PUB. IN GERIATRICS, V30 N11, P97-100, NOVEMBER 1975. FREELFAN,GS C. T. IN- CT - OR-CATS: IN CONN.: OR; COMPUTERIZED AXIAL TOMOGEAPHY 'I PUB. IN CONNECTICUT MEDICINE, Y40-NK11, NOVEMBER 1976. GALBBRAITHL;S' ; BLAIKLOCK,CT ; JENNETI,B ; STEVEN,JL PROCEEEINGS: THE: BRELIABLLITY OF COMPUTERIZED TRANSAXIAL TOMOGRA PHY IN DIAGNOSING ACUTE TRAUMATIC INTRACRANIAL HAEMATOMA PUB. IN. BRITISH JOURNAL OF SURGERY, Y¥63 N2, 'P157, FEBRUARY 1976. -18« AU TI # * so: AU TI SO: - TI GASTAUT,JL ; RAYBAUD,C ; REGIS, H PRELIMINARY STUDY OF THE APPLICATION OF COMPUTER- IZED AXIAL TOMOGRAPHY IN THE ETIOLOGIC DIAGNOSIS oF EPILEPSY 3P, 1975, IN SALAMON,G ; ADVANCES IN CEREBRAL ANGIOGRAPHY, BERLIN. GRA NT , N PROCEEDINGS: FURTHER EXPERIENCE WITH EMI SCANNING IN PAEDIATRIC NEUROSURGERY PUB. IN JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, Y38 N8, PR23-S8284, AUGUST 1975. GREITZ,T COMPUTER TOMOGRAPHY FOR DIAGNOSIS OF INTRACRANIAL TUMOURS COMPARED WITH OTHER NEURORADIOLOGIC PRO- CED URES PUB. IN ACTA RADIOLOGY (SUPPL) , - V346, P14-20, 1975. GREITZ, T ONE YEAR'S EXPERIENCE WITH COMPUTER TOMOGRAPHY PUB. -IN ACTA RADIOLOGY (SUPPL), V.346, P7-13, 1975. GUNN,WYV ; ET. AL. IMAGE GENERATION AND DISPLAY TECHNIQUES FOR CT SCAN [CATA PUB. IN INVESTIGATIVE RADIOLOGY, V10, P4O03-4 16, 197 5% HAAGA, JR ; ALFIDI, RJ PRECISE BIOPSY LOCALIZATION BY COMPUTER TOMO- GRA PHY PUB. IN RADIOLOGY, V118 N3, P60 3-607, MARCH 1976. HARTLEY, RC MINIMUM CRITERIA AND STANDARDS FOR COMPUTERIZED AXIAL TOMOGRAPHY SCANNERS (HEAD) 2P, 1975, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, -19- PR : AN: AU SO AU : TI 50; A U TL # ¢ so: SPRINGFIELD, VIRGINIA 22161 : cONTACT NTIS (ORDER NUMBER HRP-0O0077C4). Minimum criteria and standards for computerized axial TOMOGRAPHY (CAT) SCANNERS are reviewed. The need for a CAT SCANNER depends upon whether or not an institution has an active neurosurgical service, an active neurology service, and an appropriate annual volume of certain diagnostic procedures such as brain scans and skull x- rays, cerebral arteriograms / angiograms, and pneumoencephalograms. - The feasibility of a proposal to acquire the CAT SCANNER from a particular institution is dependent upon regionalization (geographic proximity to neighboring hospitals, referral arrangements with other hospitals, and mechanism by which an institution will generate patients from outside the institution); manpower, especially the availability of a qualified neuroradiologist; and facilities (ability to offer patient utilization beyond the normal working day and research capability). Economic and developmental factors associated with CAT SCANNER utilization and services are discussed . HASSANI, N ; KHOMEINI,R ; BARD, R PRINCIPLES OF COMPUTERIZED TOMCGRAPHY PUB. IN JOURNAL OF THE NATIONAL MEDICAL ASSOCI - ¥68 N2, PTI10-112, MARCH 1976. HATAM, A ; BERGVALL,U ; LEWANDER,R ; LARSSON,S ; LIND, M CONTRAST MEDIUM ENHANCEMENT WITH TIME IN COMPUTER TOMCGRAPHY: DIFFERENTIAL DIAGNOSIS OF INTRA- CRANIAL LESIONS PUB. IN ACTA RADIOLOGY {SUPPL) , Y346, P63-81, 197.5. HAYWARD, RD ; O'REILLY,GV INTRACEREBRAL HAEMORRHAGE: ACCURACY OF COMPUTER- IZED TRANSVERSE AXIAL SCANNING IN PREDICTING THE UNDERLYING AETIOLOGY PUB. IN LANCET, V1 N7949, P1-4, JANUARY 3, 1976. ~20« AU: TIP; 1SO: PR: AN : AU: [20s ‘PR: HEALTH PLANNING COUNCIL, INC. ACQUISITION AND USE OF COMPUTER-ASSISTED TOMO- GRAPHY IN RHODE ISLAND 34 P, JANUARY 1976, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 CONTACT NTIS (ORDER NUMBER HRP-0009207) . Guidelines for the acquisition and use of computer-assisted TOMOGRAPEIC {(CAT) SCANNERS are presented by the Health Planning Council, Inc. The background and technology of CAT is noted, and resource and operational requirements are considered. General policies for assessing and meeting the need for CAT in Rhode Island are outlined. General recommendations include: adoption of a policy of limited and regionalized initial placement of CAT SCANNERS; affiliation of those hospitals which will use the SCANNERS with the Brown University Program in Medical Sciences; establishment of the CAT function as a hospital-based activity in a separate department; establishment of referral mechanisms to assure appropriate statowide access to CAT SCANNERS; and placement of SCANNERS in relation to a demonstrated service area need. Specific recommendations are: limitation of initial acquisitions to hospitals with active radiology, neurology, and neurosurgery departments; consideration by both Miriam and Rhode Island hospitals of the purchase of body SCANNERS; periodic assessment of the utilization of SCANNERS at theso kospitals; adoption of policies and quidelines identifying the characteristics of appropriate locations for CAT SCANNER placement; consideration of the advisability of legislated certificate-of-need processes, and reimbursement by Blue Cross / Blue Shield only for brain scanning until such time as applications of body scanning are appropriately demonstrated. Supplementary data are appended. HEALTH RESEARCH GRCUP cAT SCANNERS: IS FANCIER TECHNOLOGY WORTH A BELEICN DOLLARS OF HEALTH CONSUMERS!" MONEY? AVAILABLE FROM THE HEALTH RESEARCH GROUP, 2000 .P STREET, WASHINGTON, D.C.,200 36 $. 75 {PUBLICATION NUMBER 401). oJ. AU: T I: so : AU: TI SO P R AN: HEALTH SERVICES MANAGEMENT, INC. ; THE SEVEN AREA-WIDE COMPREHENSIVE HEALTH PLANNING AGENCIES OF INDIANA COMPUTERIZED TOMOGRAPHY: HOW MANY SCANNERS ARE ENOUGH? TEMPOFRARILY AVAILABLE FROM THE NATIONAL HEALTH PLANNING INFORMATICN CENTER, P.O. BOX 31, ROCEKYILLE, MARYLAND 20850 (ORDER NUMBER HRA-0O014055) . HILL, KR ; JOYNER, RW COMPUTERIZED X-RAY TOMOGRAPHY PUB. IN SCIENCE PROGRESS, V62 N246, P 237-263, SUMMER 1975. This article, which includes pictures, describes the x-ray technique which produces pictures of horizontal TOMOGRAPHIC sections of the head. HOSPITAL AND HEALTH PLANNING COUNCIL OF METRO- POLITAN NEW JERSEY, INC. COMPUTERIZED AXIAL TOMOGRAPHY UNITS: GUIDELINES 4P, MAY 1975, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 CcONTACT NTIS (ORDER NUMBER HRP - 00 04184) . Guidelines for use of two types of computerized axial TOMOGRAPHY units -- the head SCANNER and the whole body SCANNER -- are formulated by the Hospital and Health Planning Council (HHPC) of Metropolitan New Jersey. Because this diagnostlc equipment is complicated, expensive, and in limited supply, use is recommended on a regional basis with cooperatlve arrangements among several institutions for maximum utilization. Criteria are suggested for institutions considering acquisition of the units: anticipated utilization should be a minimum of eight patients daily; institutions applying for a SCANNER for neurological use must have an active neurosurgical, neurological, and radiological service or an affiliation which has these services, physicians must undergo training in a facility with experience with a unit; and a peer review program should be instituted. Other recommendations for «IF 3» aw as AU T 4 # « S01 PER": | AN: institutions considering SCANNERS include allocation of 5060 square feet of space for the unit, submission of monthly reports to the State Health Department and local CHP B agencies, no discrimination against non-paying patients, and submission of cooperative arrangements with other hospitals. - For the metropolitan New Jersey area, the HHPC recommends a maximum of four SCANNERS (Ewo hsad SCANNERS}, an additional unit for the medical school, and the institution granted cortificate of need approval should provide requested information. HOUDEK,PV ; CHARYULU,KK ; ET. AL. THE ROLE - OF TRANSVERSE AXIAL TOMOGRAPHY IN ITHREE- DIMENSIONAL TREATMENT PLANNING PUB. IN RADIOLOGY, -V112 N2, PHO9-W12, AUGUST 1974. HUCKMAXN,'MS ; - FOX,J 4° TOP THE VALIDITY OF CRITERIA FOR THE EVALUATION OF CEREBRAL ATROPHY BY COMPUTED TOMOGRAPHY PUB IN RADIOLOGY, Y¥116- N1, PBDS5-92, JULY 1975. HUCK MAN, MS CURRENT -STATE GUIDELINES FOR AWARDING CERTIFICATES OF NEED FOR CT -SCANNERS IN PROCEEDINGS OF THE CONFERENCE ON COMPUTERIZED TOMOGERAPHY IN RADIOLOGY, ST. LOUIS, MISSOURI, APRIL 25-28, 1976. (ORTIERING INFORMATICN LISTED UNDER AU: AMERICAN COLLEGE OF RADIOLOGY). HU MA N, J CAPITAL EXPENDITURE REVIEW FOR THE PURCHASE OF A COMPUTERIZED TOMOGRAPHY (CT) SCANNING DEVICE BY THE FAIRFAX HOSPITAL ASSOCIATION 31P, NOVEMBER 18, 1975, AVAILABLE FROM THE SATICHXAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL BROAP, SPRINGFIELD, VIRGINIA 22161 (ORDER NUMBER 0006278) . The review of a certificate of need request concerning the -23- NUS TI: SO: PR;: A N: proposed purchase of a computerized TOMOGRAPHY (CT) scanning device by the Fairfax (Virginia) Hospital Association {FHA) is documented. The review was performed by the staff of the Comprehensive Health Planning Council of Northern Virginia preparatory to making its recommendation to the Commissioner of Health and the Virginia Health Department, concerning approval of the purchase. - A background discussion and summary of the proposal is presented, together with a summary of the FHA application, which requests approval to purchase a scanning device without specifying which specific device will be purchased. The staff analysis of the proposal includes consideration of community need for computerized TOMOGRAPHY, inc lud ing investigation of the current utilization of various CT devices in other communities; quality of care considerations; cost considerations; and other considerations. The staff concluded that evidence warrants the purchase of a CT scanning device by the FHA and recommended that approval for the capital expenditure be granted. Proof of the diagnostic effectiveness of the CT SCANNER, an estimate of need based on a methodology using the numbers of three types of neurodiagnostic procedures performed, and the size of the neurosurgical caseload of FHA are cited as factors in the recommendation. The staff also suggested that comparison of the three CT machines on the market with clinical experience in non-experimental settings indicates that the Delta SCANNER is apparently preferable to the ACTA SCANNER, and is superior to the EMI Brain SCANNER in that it has extra-cranial scanning capability and is as effective as the EMI in scanning the head. Additional recommendations are offered concerning the coordination of future development of CT technology in Virginia. Supporting documents are appended. INDIANA STATE BOARD OF HEALTH ; INDIANA REGION- AL METIICAL PROGRAM INTERIM PLAN FOR COMPUTERIZED TOMOGRAPHY IN INDIA NA T4P, SRPTEMBER 1975, AVAILABLE FROM THE NATIONAL TECHNICAL ILNFORMATION.SERVICE, ® 5285. PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 CONTACT NTIS {ORDER NUMBER . Criteria, standards, and requirements for establishment of AU: TI:; so: | AU: TI:; | 30; - A0 TI: «e SO : computerized TOMOGRAPHY services in Indiana are set forth in an interim plan developed by a committee of the Indiana State Board of Health in accordance with Section 1122 of the Social Security Act. Following a brief of the committee's activities and of the technical background of computerized TOMOGRAPHY, a policy statement concerning the development of computerized TOMOGRAPHY services in Indiana is presented. It is noted that a final plan awaits clinical evaluation of available scanning equipment. The interim criteria and standards address equipment specifications for both brain scanning and whole body scanning devices. Medical service areas in Indiana requiring computerized TOMOGRAPHY services are identified, and specific requirements for applications by hospitals or consortiums of hospitals wishing to develop scanning services are stated. A bibliography is provided. JACOBSEN, HH ; KRAGSHOLM,M ; HOLM,C ECONCMY OF EMI -SCANNER PUB. IN NEURORADIOLOGY, V11 N4, P183-184, 1976. JELDEN,GL ; CHERNAK,ES ; RODRIGUEZ-ANTUNEZ,A ; HAAGA,JR ; LAVIK,PS ; DHALIWAL, RS FURTHER PROGRESS IN CT SCANNING AND COMPUTERIZED RADIATION THERAPY TREATMENT PLANNING PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, V127 §17,>-E179=-185, JULY" 1976. KAZNEE, E ; LANKSCH,W ; STEINHOFF, H CRANIAL COMPUTERIZED TOMOGRAPHY IN THE DIAGNOSIS OF BRAIN DISORDERS IN INFANTS AND CHILCEEN PUB. IN NEUROPAEDIATRIE, V7 N2, P136-174, MAY 1976. KEANE,WM ; LOWRY,LD ; POTSIC,WP COMPUTERIZED AXIAL TOMOGRAPHY;:; USES IN CTO- LARYNGOLOGY PUB. EN TRANSACTIONS OF THE AMERICAN ASSOCIATION FOR CEPHTHMOLOGY, V82 N4, P173, 1976. ' 252 S0 AU TL S0 P R A N a* 00 Co KNAUS,jW ; IMPACT OF NEW TECHNOLOGY - EMI SCANNER PUB} IN .CLINICAL RESEARCH,-V24 - N3, E298, 1976. KREFL, L COMPUTERIZED TRANSVERSE AXIAL TOMOGRAPHY PUB. IN NURSING TIMES, ¥I12 N25, P17=20, JUNE 24, 1976. KREEL, L PRELIMINARY EVALUATION OF EMI WHOLE-BODY SCANNER PUB. IN BELGIUM JOURNAL OF RADICLOGY, V59 N3, P267-280, 1976. KRICHEFF, II INTRCDUCTION: RECENT ADVANCES IN DIAGNOSTIC RADIOLOGY PUB. IN POSTGRADUATE < MEDICINE, V59 NB, P83, AUGUST 1976. LANE,ER ; JONES,PA METHODOLOGY OUTLINE FOR DEVELOPMENT OF A COMPUTED TCOMOGEAPHY (CT) PLAN 77P, JANUARY 1976, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22161 cONTACT NTIS (ORDER NUMBER HRP-O007827) . A 12-step approach is presented for use. in developing a plan for the introduction and utilization of computed TOMOGRAPHY (CT) equipment in a given community. The steps are as follows: (1) provide a current, local assessment of the capabilities and limitations of CT scanning as a diagnostic technique; (2) demonstrate the range of estimates of nsced based on known methodologies; (3) demonstrate the potential financial impact on the health care system if there is an average of one CT SCANNER pet community hospital of 200 beds or more; (4) develop community guidelines for use in determining when it is appropriate to refer a patient for a CT scan; (5) demonstrate and apply to the given region or community methodologies known to have been used by other communities to determine need for CT equipment; (6) establish +26 3» a # ¢ TI: so: A N: standards of equipment capacity for the region and calculate estimates of need for each methodology used in the previous step; (7) examine established referral patterns of the community and any unique needs, such as need for a major research institution; (8) demonstrate potential financial impact on the region at each level of estimate of nced; (9) determine the number of pieces of CT equipment necded and compare with existing and / or approved supply of SCANNERS; (10) develop criteria for determining location of CT equipment; (11) establish criteria for review of applications for CT equipment; and (12) develop conditions of approval to be attached to an approval of any CT equipment request. Each step is elaborated; formulas are noted where appropriate. Appended materials include performance data on various kinds of CT equipment, a 1975 nationwide survey of CT SCANNERS in use, and findings of a survey of Genesee Region (New York) hospitals with regard to their neurological services. Portions of this document are not fully legible. LEDLEY,RS ; EBT. AL. ACTA-SCANNER: THE WHOLE BODY COMPUTERIZED TRANSAXIAL TOMOGRAPH PUB. INX COMBUTEES IW BIOLOGY AND MEDICINE, V4 N24. P145-155%,°- 1974. Describes ACTA SCANNFR as a new clinical tool made possible through modern computer technology and the recently developing science of 'pattern recognition.! LEDLEY,;RS "; TWIGG,;HL ; -LUESSENHOP,AJ ; CcChPUITIEBRIZED TRANSAXILAL X-RAY TOMOGRAPHY OF THE HUMAN BCDY PUB. IN. SCIENCE, VI186,;, P OCTGOBEER 18,. 1974. The capabilities of the Automatic Computerized Transverse Axial SCANNER (ACTA-Scanner)}, its technology, and clinical uses are discussed. The ACTA-Scanner is able to distinguish between soft tissues anywhere in the body, and. Has both -a long scan- pass of 48 on and a short scan - pass of 24 cm. A complete 180-degree scan takes less than five minutes with the short scan and about «27- six minutes with long scan. The x-ray voltage used varies from 90 to 120 kilovolts. The maximum x-ray exposure to the skin is about 1 rad for a complete scan. It is concluded that the ACTA-Scanner has virtually unlimited potential in evaluation of any part of the body. Usefulness of the instrument has been demonstrated in appraisal of pathologies of the brain and cerebrospinal fluid cavities, orbits and eyeballs, the facial sinuses, and skull base lesions. It is suggested that the impact of ACTA-scanning will not be limited to the diagnostic area, but will extend to general patient management and to some aspects of medical economics, eliminating the need for risk - laden, technically complex, and costly diagnostic procedures requiring lengthy hospitalization. The article is accompanied by photographs and illustrations of the ACTA-Scanner in use and color photographs of ACTA-grams. LEWIS, HL HOW MANY SCANNERS ARE ENOUGH? PUB. IN MODERN HEALTH CARE, V4 N2, P62-64, AUGUST 1975 . LIDDELL , FH MEDICARE DOES NOT PAY FOR MOST CAT SCANNING PUB. IN HOSPITALS, VSO N21, P44, NOVEMEER 1, 1976. MCCULLOUGH,EC ; BAKER, HL ; HOUSER,OW ; REESE,DF EVALUATION OF THE QUANTITATIVE AND RADIATION FEATURES OF A SCANNING X-RAY TRANSVERSE AXIAL TOMOGRAPH: THE EMI SCANNER PUB. IN RADIOLOGY, V¥111 N3, P709-716, JUNE 1974. Evaluation has shown that the unit provides numerical values which are linearly related to the 73 keV attenuation coefficient values with an agreement of better than one-half of one percent. Precision of these determinations has also been shown to be 0.5 percent. -28- AV: EI: 30% MECCULLCUGHK,EC .; Clear visualization of the lungs, heart, and mediastinal formations was possible. Early experience with the ACTA SCANNER is judged to be "quite promising." Photographs of ACTA output and of the unit in action accompany the text. SEIDEIMAN,FE ; REICH,NE CcCMPUTED TOMOGRAPHY USING THE EML SCANNER: PART 1 THE APPARATUS, THE NORMAL SCAN, AXD ITS VARIANTS PUB. IN JOURNAL OF THE AMERICAN OSTFEFOPATHIC ASSOCI - ATION, VT4 N12, P1125-1132, AUGUST 1975. Describes EMI SCANNER, techniques for use, and physical and clinical data and their interpretation. SHAPIRO, SH ; WYMAN, SM C.A.T FEVER PUB. IN THE NEW ENGLAND JOURNAL OF MEDICINE, P954 - 956, APRIL ,22, 1976. SsSHEFELYj PF ; ; HATEERY,RR ;.MUNMY, JR ; HARTMAN, GW coOunPUIED TONOGRAPHY OF THE BODY: INITIAL CLINICAL TRIAL WITH THE EMI PROTOTYPE PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, V127 N1, P234-5A, JULY :1T976. -36- AU AU TI 00 S0 : AU TI so: TI 6 6 S0 : AU: TI: S0: AN: ; DELAND,FH ; MAGOUN,S ; BEIHN, R RADILCEHARMACEUTICAL DISTRIBUTION STUDIES USING A LINEAR WHOLE-BODY SCANNER PUB. IN JOURNAL OF NUCLEAR MEDICINE, V 16 N6, P570, 1895. SMALLgJG '; 'DIAN, DX ; 'MILSTEINyV '; SATO,T LETTER: CAT SCANS IN CHILDREN WITH BEHAVIOR DIS- ORDERS PUB. IN AMERICAN JOURNAL OF PSYCHIATRY, V133 N5, P5B4j MAY 1976. SMIT H, A BODY-SCANNER - MAJOR MEDICAL ADVANCE CCMES FROM ONE MAN'S RESEARCH PUB. IN SCIENCE FORUM, V8 N4, P24-25, 1975. SMITE,CR ; PRESSMAN,BD -; LAWRENCE,WH .; DAVIS,DO ; RIZZOLI, HV COMPUTERIZED TOMOGRAPHY: A NEW CLINICAL MODALITY PUB. IN VIRGINIA MEDICAL MONTHLY, Y¥102 N10, P827- 834, CCTOBER 1975. Description of computerized TOMOGRAPHY in clinical use at George Washington University. Technique can be used to visualize both normal and pathologic intracranial structures. SMITH;PR ; PETERS,IW @q MUOLLERyHR! ; BLEKE,N TOWARCLS ASSESSMENT OF LIMITATIONS ON COMPUTERIZED AXIAL TOMOGRAPHY. PUBL IN NEURORADIOLOGY, V9 N1, 'P1T-8, 1975. STANLEY, RJ ; SAGEL, SS ; COMPUTED TOMOGRA PHY OF THE BODY: EARLY TRENDS IN APPLICATION AND ACCURACY OF THE METHOD PUB. IN AMERICAN JOURNAL OF ROENTGENOLOGY, V127 N1, P53=~67, JULY 1976. AU TI a % S03 AU: TI; so: AN: ; BERGVALL,U- ; ZWETNOW, N QUANTITATIVE ESTIMATION OF INTRACEREBRAL AND INTRA - «*. VENTRICULAR HEMATOMA BY COMPUTER TOMOGRAPHY j PUB.. IN-ACTA RADIOLOGY (SUPPL), Y.346, PA143=~154, 1975. TAVERAS, JT COMPUTERIZED AXIAL TOMOGRAPHY - HOW IT WORKS PUB. IN MODERN MEDICINE, V43 N18, P4LT7-Sz, OcToBEr 15, 1975. The development and function of computerized A axial TOMOGRAPHY (CT) is described as a breakthrough V in diagnostic medicine which provides greater accuracy and less radiation exposure of the patient than standard roentgenographic techniques. Although currently used only for the brain, CT employs a thin-X-ray beam whereby absorption by the tissues can be accurately calculated. The X-ray tube and the detecting sodium iodide crystal move together in a linear fashion across the head 180 times; each time, the entire assembly shifts one degree around the stationary head. In this manner each point of the brain is looked at from 180 different angles. This information is fed to a computer that B calculates more than 28,000 simultaneous equations and generates an image on the cathode ray tube composed of 6,40C picture elements, the brightness of each being proportional to the ® density in that arsa of the brain. A separate device can be used that will print out numerical values for each three-millimeter area representing average absorption for that portion of the brain. The process takes from 20 to 25 minutes. ~One of the most important applications of this new technique is the diagnosis of hemorrhage, said to be 100 percent accurate. Other diagnostic uses include:; epidural hematomas which show up very well; subdural hematomas which exhibit less accuracy due to brain fluids; cerebral infarction, 80 percent accurate; and intracranial tumors, 95 percent accurate.. »It is expected that improvements in present equipment will permit use for other parts of body, specifically, the. Lungs, heart; and abdominal organs. A U: S0: PR: AN: AU: a I% so : TENNESSEE STATE OFFICE OF HEALTH PLANNING AND RESOURCES DEVELOPMENT CRITEEIA FOR DETERMINING NEED FOR COMPUTERIZED TOMOGCEAPHY -(CT) SERVICES 2P, MARCH 30, 1976, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SPRINGFIELD, VIRGINIA 22 161 CONTACT NTIS (ORDER NUMBER HRP-O0O011213) . Criteria are presented for determining the nseed for computerized TOMOGRAPHY SCANNERS in the State of Tennessee. The criteria are based on an estimate of need as projected from sample demands for certain indexical, diagnostic neurological procedures on which the computerized TOMOGRAPHY SCANNFR is believed to have varying degrees of significant impact and on the level of experience which has been invested in standardization techniques for the cerebral area. Tennessee's State Office of Health Planning and Resources Development has established need criteria for computerized TOMOGRAPHY scanning services. These criteria relate to the applicant facility proposing the installation of a TOMOGRAPHIC body SCANNER. Criteria for determining need are noted in relation to use rates, availability of qualified personnel, geographical location, size of health provider area or region, and.availability. of financing. _ The criteria were approved by the Tennessee State Health Planning ; March 30, 1976. TER-FCSOSSIA N, MM LIMITATIONS OF PRESENT RADIONUCLIDE METHODS IN THE EVALUATICN OF MYOCARDIAL ISCHEMIA ANC INFARCTION PUB. IN CIRCULATION, ¥53 (3 SUPPL}, P119-121, MARCH 1976. THOMPSCN, JL THE CCMPUTED AXIAL TOMOGRAPH IN ACUTE HERPES SIMPLEX ENCEPHALITIS PUB.+ IN BRITLESH:JOURNALE«OF RADIOLOGY, v¥49 NS77, JANUARY 1976. ~3G.. A U: T E+ SO: A U T IL: a ® sO : AU: TI. Ii S0: AU TI *+ So: AN: A U TL: so: PR: AN: THOMPSON , JL VALUE OF EMIL SCANNER PUB. IN BRITISH JOURNAL OF RADIOLOGY, V2 N5962, PgS-f8¢,. 1975. TILL, K COMPUTERIZED AXIAL TOMOGRAPHY WITH EMI SCANNER - EARLY AND FRUITFUL EXPERIENCE IN PAEDIATRIC NEURO- SURGERY PUB. IN JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY V37 N11, P1282, 1974. TILL «E COMPUTERIZED AXIAL TOMOGRAPHY - PARTICULAR APPLICA - TIONS AND ADVANTAGES IN PEDIATRIC NEUROSURGERY PUB. IN CHILD'S BRAIN, V2 N1, PULG6-53, 1576. TILL, K COMPUTERIZED AXIAL TOMOGRAPHY IN PEDIATRIC NEUROLOGY AND NFEUROSURGERY PUB. IN PROCEEDINGS OF THE ROYAL SOCIETY OF MEDICINE, Y68 K11, P713-716,;NOVEMBER 1975. Describes anantages of using computerized axial TOMOGRAPHY in neurology and neurosurgery for children. © TRI-STATE AREA HEALTH PLANNING COUNCIL, INC. STANDARDS AND CRITERIA FOR COMPUTERIZED AXIAL TCMOGEAPHY (C. A. T.) AS IT APPLIES TC INTRA-CRANIAL DIAGNOSIS 12P, 198975, AVAILABLE FROM THE NATIONAL TECHNICAL INFORMATION SERVICE, 5285 PORT ROYAL ROAD, SsPBRINCFIELD, VIRGINIA 22161 CONTACT NTIS (ORDER NUMBER HRP-O0002772) . Following analysis of a survey of 11 computerized axial TOMOGERAPHY (C.A.T.) facilities in this country, conducted by the Comprehensive Health Planning Council of Philadelphia, criteria and guidelines were established to evaluate proposed SCANNBR® installations. The C.A.T. SCANNER, which combines a standard X-ray source with a computer, is capable of distinguishing ~40> T I 4 SO: between soft tissue densities in the brain, and avoids patient hazand and discomfort. Drawn up by the Tri-State Area Health Planning Council of Evansville, Indiana, the criteria were based on three broad classifications: need, manpower considerations, and physical design considerations. Specific requirements included the recommendsd minimum / maximum utilization level for an eight-hour day, which should be eight patients, with a 50 percent increasos if the SCANNER is used 12 hours a day. - A written documentation of the geographic area to be served should be submitted. At least 1000 radioisotope brain scans and skull X-rays should be performed annually before initiation of C.A.T. service. Interpretation of scans should rest with a physician, (radiologist, neurosurgeon, neurologist), with speciality training in C.A.T. scanning interpretation as it relates to intracranial diagnosis. Space requirements for a SCANNER dictate a minimum of 400 square feet, with loading capabilities of the floor of 24 pounds per square foot. Partitions and proper- air-cohkditioning are important considerations. A Aflagram of a typical installation is shown, and tables present data on utilization 'of facilities in T1 institutions. Portions of this document are not fully legible. TWIGG,HL ; AXELBAUM,SP ; SCHELLINGER, D COMPUTERIZED BODY TOMOGRAPHY WITH THE ACTA SCANNER PUB. IN JOURNAL OF THE AMERICAN MEDICAL ASSOCI - ATION, iV23W N3, 17, OCTOBER 20, 1975. Discusses the first year's experience with the ACTA SCANNER with emphasis on the extracerebral (pertains to all parts of the body except the brain) applications. Includes head and neck, spine and spinal cord, aneurysms, thorax, abdomen, and extremities. WATSCN, RC THE WHOLE-BODY SCAN: COMPUTED TOMOGRAPHY (CT) -A MAJOR ADVANCE IN THE DIAGNOSIS OF CANCER PUB. IN. CLINICAL! BULLETIN,: ¥6 N2, PUJ-S51,, 1976. -41- AU lac +4 + SQ: A U TL 00 SO : A U TL so: AU II: SQ : AU TIL; u so: AU k So: AU: TX: S0: A N: WELLING, K CAT LOVERS - THE MEDICAL PROFESSION EMBRACES THE COMPUTERIZED SCANNER PUB. IN BARRON'S, Y56 N3, P16-17, AUGUST 16, 1976. WILBRAND,HF ; EKVALL, L MULTICIRECTIONAL TOMOGRAPHY IN RECONSTRUCTIVE MIDDLE EAR SURGERY PUB. IN ACTA RADIOLOGY (DIAGN), V 16 N5, P436-448, SEPTEEBER 1975. WING, SD ; NORMAN,D ; POLLOCK,JA ; NEWTON, TH CONTRAST ENHANCEMENT OF CEREBRAL INFARCTS IN cOMPUTED TOMOGRA PHY PUB. IN RADIOLOGY, 'V12 N1, PB9-~92,° OCTCBER: 1976. WOOD, EH RADICLOGICAL TECHNIQUES IN THE EXAMINATION OF PATIENTS WITH HEADACHES PUB. IN RESEARCH IN CLINICAL STUDIES ON HEADACHES, V4, ES6~- 106, 19786. WORTZMAN,G ; HOLGATE,R ; MORGAN,P COST IMPLICATIONS IN USE OF COMPUTERIZED TOMO- GRAPHY (EMI SCANNER) PUB. IN NEURORADIOLOGY, V9 N5, P285, 1975. WORTZMAN,G ; HOLGATE,R ; MORGAN,P CRANIAL COMPUTED TCMOGRAPHY: AN EVALUATION OF CcosST EFFECTIVENESS PUB. IN RADIOLOGY, V117 N1, P75-77, OCTOBER 1975. ZELCHL,JV ; DUCHESNEAU,PM ; MEANEY,TF ; LALLI, AF ; ALFIDI, RJ EMI SCANNER AND ITS APPLICATION TO CLINICAL DIAGNCSIS PUB. IN CLEVELAND CLINIC QUARTERLY, VHT N3, P79- 91, 1974... The early experience of the Cleveland Clinic with an EMI SCANNER installed in January 1974 is assessed, based on the first 450 scans performed with the device. Among the categories of problems examined are dementia, vascular, metastatic, suspected brain tumor, postoperative follow-up, orbit pathology, trauma, and nonspecific clinical diagnoses. The operational charactsosristics of the EMI device and its diagnostic capabilities with regard to various clinical diagnoses are described and assessed. The remarkable ability of the SCANNER to reproduce for analysis the internal structures of the brain is noted. An accurate diagnosis of brain tumor, without "the use of contrast agents and without danger or discomfort to the patient, was made in 57 proven cases, and a probable diagnosis was possible in 18 cases. Two major drawbacks of the EMI system are noted: the patient must lie perfectly still during the scanning sequence, and there is a time delay of five to ten minutes before viewing is possible. The diagnostic advantages of the technique with respect to each of the categories of problems are summarized. It is concluded that the EMI SCANNER approaches the ideal in diagnostic.capabllity in that it is fast, accurate, ard safe." Photographs of, BMI output. and line drawings illustrating the use of the device are included. #43 * U.S, GOVERNMENT PRINTING OFFICE : 1977 0-730-387/639 BHPRD@ U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration Bureau of Health Planning and Resources Development DHEW Publication No. (HRA) 77-4538