Single X-Ray Sufficient

              Researcher draws conclusion
Single X-ray sufficient
By SALLY REESE
Times Medical Writer
How many X-rays are required for a particu-lar
examination?
Not as many as you may get, says Dr. Ronald
L. Eisenberg, who studied the question in 1977-79.
the chairman of radiology at LSU Medical
Center found that in patients receiving routine
chest X-rays, a single particular radiographic
view is sufficient for accurate diagnosis. In ex-aminations
of cervical and lumbar spine for
suspected degenerative disease or old injury, two
is enough.
The significance to patient costs and radiation
exposure is remarkable, he says.
Eisenberg did the 18-month study in the VA
Hospital in San Francisco where he was associate
chief of the radiology service. He was with the
University of California School of Medicine at the
time.
The research was undertaken to determine
the optimum number of radiographic (X-ray)
projections needed to assess applicants for VA
compensation for chest disease and possible de-generative
disease or old injury of the cervical
and lumbar spine. It was supported by a grant
from the VA.
Three separate readings were made for each
clinical problem, and for each reading the number
of projections was varied.
Results showed that in 99 percent of chest
examinations the final radiographic diagnosis
could have been made from a single post-eroanterior
view. In 100 percent of the cervical
and lumbar examinations, assessment could have
been made from anteroposterior and lateral
views.
Applying these results to data on compensa-tion
examinations performed in the entire VA
system for the fiscal year 1978, Eisenberg con-cluded
that limiting the screening X-ray examina-tion
of the chest to a single posteroanterior view
would eliminate 150,000 radiographs in the eval-uation
of 190,000 applicants for compensation and
save the VA almost $900,000.
As for the cervical and lumbar spines, it was
concluded that the VA could eliminate 193,000
radiographs in the evaluation of 100,000 applicants
for compensation at a savings of about $1 million.
In a paper presented before the American
Roentgen Ray Society last April, Eisenberg says
these results are consistent with "the radiologist's
goal to devise methods to decrease health care
costs and radiation exposure without sacrificing
diagnostic accuracy."
While emphasizing that they refer specifically
to chest, lumbar and cervical spine examinations
of patients applying for compensation within the
VA, Eisenberg says the findings apply to other
medical institutions and clinical settings as well.
"An estimated 65 million radiographic ex-aminations
of the chest are performed yearly in
the United States," he says. "In those routinely
made for screening purposes, one posteroanterior
view should be sufficient for accurate diagnostic
interpretation. When extrapolated to the national
level, the potential saving in manpower, health
costs and radiation exposure should be
enormous."
Medical overuse of X-ray is of concern to
health care professionals as well as patients,
Eisenberg says. It can be the result of excessive
irradiation per radiograph, excessive examina-tions
per patient, or excessive radiographs per
examination.
"Excessive irradiation per radiograph can be
reduced with high quality radiographic equipment
and appropriate training of technologists," he
says.