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9(b) - Which scan, for whom, when and why
from Part 3 - Clinical guidelines
Published online by Cambridge University Press: 15 January 2010
Summary
Why these questions?
A Grand Round was taking place at a well-known London medical school. The registrar (resident) presenting the case began by giving the results of the patient's investigations and asked for comments as to the diagnosis. No one in the audience knew what it was and further test results were given. Still the cause remained obscure. A number of consultants expressed their opinions: certainly a puzzling case. One senior physician remained silent. When asked by the chairman if he had anything to say, he replied ‘I couldn't possibly comment. We haven't been given any of the history or findings on examination, nor even his age. This is not life as we should know it’.
Hounsfield's invention (Hounsfield, 1973) of CT was so exciting and miraculous, especially because it permitted examination of the brain in vivo for the first time, that for some it seemed to be the beginning and the end of diagnosis. Of course, there is little doubt that it was a turning point in medicine and arguably the most important discovery in imaging since Roentgen first used X-rays. The benefits to patients were immediate, not least in the virtual disappearance of pneumoencephalography (PEG), an unpleasant procedure not without hazard and frequently causing severe headache. With the installation of their first EMI scanner at the Massachusetts General Hospital, there was an estimated reduction of 73% in PEG over 17 days (Fineberg, Bauman & Sosman, 1977).
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- Neuroimaging and the Psychiatry of Late Life , pp. 217 - 226Publisher: Cambridge University PressPrint publication year: 1997
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