use

DXA

as the

valid

acronym

for

dual-energy

x-ray

jonity

absorp-

cer

tiometry.

of the

will

ceding Gl#{252}erCC,

2.

Steiger

Genant

HK.

ometry 228.

and

Kelly

TL,

P. Selvidge

R, Elliesen-Kliefoth

Comparative

assessment

dual-energy Slovik

radiography.

DM,

Neer

K, Hayashi

of dual-photon

RM.

1990;

Calibration

by

McClung

M,

4.

ments by 153-Gd and x-ray dual photon absorptiometry. Miner Res 1989; 4:368. Mazess RB, Hanson J, Gifford C, Prete J, Petersen P. ment of spinal density in the lateral projection (abstr). en Res 1989; 4:5229.

5.

Mazess

RB,

Barden

sorptiometry 6.

Ann

Mazess

7.

and

of bone

dual-energy

Gynaecol

x-ray

1988;

Measure-

x-ray

bone

diographic

E, Sartoris

DJ,

absorptiometny

with

et al.

dual-photon

absorptiometry.

Rupich

R, Pacifici

R, Delaban

dual energy radiography: L3 bone mineral density 9.

Slosman

DO,

mineral

density

tative

compani-

digital

Rizzoli

C, Susman

a new (abstn). R, Donath

technique

1989;

170:129-

a routine

system

Avioli

LV.

Lateral

for the measurement Miner Res 1989; 4:5194.

J Bone A, Bonjour

measurement:

radiography

N,

JP.

Lateral

procedure

spine

using

J Bone Miner

(abstr).

P0

Steigen,

PhD,

University

Francisco,

Res 1989;

and

JR.

Lung

cancer

Brookline

Avenue,

Cancer

on

Beth

Israel

Hospital

and

Harvard

by

Boston,

Hamen

MA

et al (2)

lung cancer on plain chest frequent cause of a missed

I believe placed, graphs

that missed

02215

failure

that

cancers

to diagnose.

and

subsequent

on mammograms missed reason

lawsuit.

have

re-

cancers on chest radiofor lawsuits because of a

Screening

mammography

has increased markedly in the recent past, and there is every indication that it will continue to do so. Meanwhile, cigarette smoking is diminishing, and, to quote Eddy (3), as Drs Potchen and Bisesi did, “virtually all organizations concur that screening for lung cancer is not justified.” Muhm et al (4) obtained short-interval screening chest madiognaphs on high-risk heavy cigarette smokers. Forty-five of the

50 (90%)

peripheral

lung

cancers

could

be

retrospectively

detected on the previous chest radiographs. This will come as no surprise to most radiologists. Similar statistics are almost certainly applicable to screening mammography. Full implementation of widely accepted recommendations for screening mammography would mean that all women over age 50 years would undergo annual mammography and women aged 40-50 years would undergo mammography cvcry 1-2 years. In the not-so-distant future I expect that a ma-

876

Radiology

#{149}

fears.

Ros

to miss

PR.

Medical

compensation, lung

lung

cancer

175:29-32. malpractice

and

cancer.

Ann

patient

Intern

in

injury.

Med

1989;

Fontana

RS,

Sanderson

radiographs.

1983;

mammography:

1986; Arch

Uhlenhopp

program

Radiology

Screening

DR.

a screening

using

MA. four-

148:609-615.

potential

problems

on

the

314:53-55.

second Sung

opinions prior to biopsy 1990; 125:298-299.

of non-

Radiology

U

Department

Organization

From: I. Gemell, MD of Medical

Street,

was indeed

Imaging,

Elgin,

gratified

in the

Sherman

Hospital

IL 60120

to read

February

other

1990

things,

vided by the his statement

older that

that a substantial happy to “help case

vices

“failure to observe a has become the most

radiographs diagnosis”

or soon will replace, as the most common

radiologist’s

of these

1990;

during

6.

the

much enjoyed the article by Drs Potchen and Bisesi (1), appeared in the April 1990 issue of Radiology. The emon lung cancer in their article apparently stems from

observation

mam-

discussion

the

issue

he refers

letter

from

Dr Richard

of Radiology,

to the

radiologists. our specialty

in

important

G.

which,

services

I wholeheartedly has done very

pro-

agree with poorly in at-

tracting these practitioners. I believe I speak for many of us out there, retired or semiretired, who are still in reasonably good health and with reasonably clear eyesight, when I say

Editor:

the

WE,

detected

chest

may

and

be,

plain

partments

I very which phasis

forthright

Editor:

From:

330

jeopardizes

is it malpractice HT,

for

horizon. N Engl J Med Hall FM. Mammographic palpable breast lesions.

Stiles

Breast

F, Foley

Miller

FM.

among

Ferris M. Hall, MD Department of Radiology, Medical School

too

minimal-

at mammography

The

some

When

Screening

Muhm

926 Center

of California,

to Miss

allay

Radiology

Hall

bone

a quanti-

CA 94143

U When Is It Malpractice Mammograms?

MA.

5.

I San

may

for

biopsies

(6).

why

performed

of

Francisco

Box 0628,

Bisesi

Morlock

DM.

Nicholas Department

Claus C. Gl#{252}er,PhD, Peter Harry K. Genant, MD Department of Radiology,

previous

identified

these

radiology: claims, 1987; 164:263-266.

month

4:S395.

San

Eddy

ra-

vivo

M,

diagnostic Radiology

4.

131. 8.

lesions

canpre-

111:232-237.

Tissue

dual-energy

chest

Hamer

ab-

Calcif

Radiology

and

radiographs?

J. Performance

in

nonpalpable

EJ, Bisesi

3.

spine:

and

cost of performing screening programs

on 2.

densitometer.

lumbar

of these

recommended

References 1 . Potchen

absorptiometry

Quantitative

of the

are

Potchen

J Bone Mm-

dual-photon

H, Hanson

review

breast in the

J Bone

77:197-203.

J, Barden

B, Trempe

by

measure-

44:228-232.

J, Kerr

Borders

of bone

Measurement

of a dual-energy

1989;

son

Chin

R, Collick

evaluation Int

HS.

(DPA)

(DEXA).

Correlation

who develop examination

conjures up medicolegal nightmares. that fear of litigation is a major reason

ly suspicious

density

3.

Retrospective

biopsies

Res 1989; 4:663-669.

mineral

L.

174:223-

standardization

of bone

Roberts

many

(5,6). The mography

and

J Bone Miner

densitometers.

C,

absorpti-

Radiology

year.

examinations I believe

References 1.

10% of American women undergone a screening

have

number out” by

of that working

to attend

to the

radiograph

still

group part-time

would be more than or shorter hours,

conventional

radiology

interpretation,

constitutes

about

which

75%-80%

in most

of the

as

ser-

de-

general

workload. That would also free many of our younger colleagues to become more involved with the more modern but also more time-consuming tional procedures, which doing dents

anyway. the more

tion,

which

our bly

age.

obtained the this

believe riences doing.

retired

in

most

which

a problem

with

in many

these

services

radiologists is important

this

probaday

insurance,

so-called tail-end coverage, since type of policy would be impractical.

for

of pro-

can in

malpractice

in

teaching resiintenpreta-

neglected cases,

or semiretired cost,

interveninterested

assist in radiograph

somewhat

Also,

at less

I do foresee

cluding pay for

is now

programs.

by already be

including to be more

of us could also features of plain

I am told

teaching

vidcd

Some basic

modalities, they seem

and

in-

most of us to However, I

that we should not let the accumulated lifetime expeof our older colleagues go to waste, as it seems we are That would be a tremendous loss, which we can ill af-

ford.

I believe

our

these

situations;

would

benefit.

professional surely, Many

organizations many

patients

businesses

and

should and

look

society

industries

into

at large are

availing

themselves of the services provided by their more expenienced retirees with considerable success. We should be doing the

same.

Reference 1.

Stiles

cation

RG.

(letter).

Radiology

Radiology

department

1990;

organization

and

radiology

edu-

174:579-580.

September

1990