Martin W. Donner

The advent in recent years of several new imaging modalities for the application in diag­ nosis and patient management has had an unprecedented impact on patient care. By per­ mitting the acquisition of information without intervention, these new modalities have made the diagnostic process more humane. They have also made possible the treatment of many disorders of the upper and lower urinary tract by means of interventional tech­ niques, replacing a number of surgical procedures. The editor of this volume has engaged international experts in radiology to describe the state of the art of radio log y of the upper urinary tract. Local and regional abnormalities are covered, but so too is the involvement of urinary structures in systemic disease. The radiologic approach and interpretation are combined with the presentation of pertinent clinical observations and important pathophysiologic concepts. The text is concise and the illustrations are appropriate. Up-to-date international bibliographies are provided. Both the text and the illustrations will serve as sources of information for the radiologists, urol­ ogists, nephrologists, gynecologists, and oncologists. Most importantly, the material is presented in such a way that practicing specialists dealing with urologic disorders, as well as physicians in training will benefit. We feel that it is timely to publish a present day treatise on urinary tract radiology in order to convey the contributions made by various newer imaging modalities to the diagnosis of urinary disorders.

The aim of radiation protection standards is to make the radiation workplace as safe as is humanly possible. The gradual evolution over the last 20 years has been towards a more precise definition of the limits for occupational exposure. These have been created not only in terms of short-term effects but also more importantly in terms of long-term risks involving such problems as the potential for carcinogenesis and genetic change. In the United States the National Committee for Radiation Protection has recom­ mended that 5 rems (50 mSv) should remain as the maximum permissible dose equiva­ lent for total body exposure. This would represent the sum of internal and external ex­ posure and should be regarded as the upper limit allowed. The community of radiation users is required to conduct its operations in such a man­ ner that the absolute value of the individual's dose equivalent in rems does not exceed his age in years. There should be additional limits for tissues and organs based on short­ term effects. Therefore, individual organs are limited to dose equivalents low enough to ensure that the dose threshold values are not exceeded.

This book reflects the views of an international faculty and provides an authoritative appraisal of modern radiology. It represents the sec­ ond volume in a planned series of competent overviews, and is mod­ eled on the successful first volume, Radiology Today, which was enthu­ siastically received by an international readership. We were encour­ aged by the comments we received to continue blending the latest ad­ vances in radiology with comprehensive teaching material concerning modern radiological practice. The Radiology Today 1982 meeting again brought together outstanding radiologists from Europe and North America for the purpose of sharing their experiences and their viewpoints of the current position and opportunities of imaging in medicine. Updating his/her knowledge of advances in medical imaging has be­ come an integral part of continuing medical education for every radiol­ ogist. Because all imaging modalities are continuously being refined, new clinical applications develop and frequently replace more com­ plex or more invasive procedures. Also, the relationship of imaging procedures to each other changes constantly, and with it the configura­ tion of critical diagnostic pathways for investigation of clinical signs and symptoms. To recognize this trend is important, because it is ex­ panding the role of the radiologist: our involvement in active guidance to the point of the patient's diagnostic workup has increased signifi­ cantly where it has become strategic.

The biennial symposium 'Radiology Today' continues its original mission to bring together European and American radiologists to discuss advances in the field. This volume presents material by well-known experts in cardiovascular and skeletal radiology. Its aim is to provide an overview of each major topic, trends in clinical development, and current interests in research. The future holds much promise for cardiovascular and skeletal radiology, primarily because of new techniques and procedures, but also because of the development of imaginative approaches to clinical problems. Ideas are born on both sides of the Atlantic, and we believe that it is important to ensure a rapid exchange of new information and to determine how it fits into today's medical care, keeping in mind the quality of patients' care, their safety and comfort, as well as cost. The traditional role of radiologists as consultants has increased greatly over time, with new responsibilities being continuously added. We radiologists are challenged to determine the diagnostic pathway appropriate to each patient. To arrive at the diagnosis quickly, safely, and at the lowest possible cost is as important as our participation in determining the patient's management. Some therapeutic procedures are even carried out by diagnostic radiol­ ogists themselves, employing ultrasound, computed tomography, or fluoroscopy and intracavitary catheters. Abscesses can be drained, and blood vessels dilated or blocked. In diagnosis and therapy, events are moving quickly, and advances are made at a rapid pace.

Radiology Today 3 presents papers and panel discussions from a multi­ national faculty at the biannual Salzburg Symposium, which this time covered three important topics: critical diagnostic pathways in gastro" intestinal and genitourinary radiology, interventional radiology of the abdomen, and cost containment in radiology. The choice of these topics illustrates the changing role of the radiolo­ gist in the practice of medicine today and in the foreseeable future. He will have to serve as a consultant more than ever before, assuming in­ creasing responsibility for sequencing of imaging procedures and par­ ticipating more and more in therapeutic intervention. In order to pro­ vide meaningful assistance, the imaging consultant must be aware of the efficacy and the limitations of every procedure. In this context, cost containment is a worldwide public concern, and the most appropriate procedures must be identified. Radiology Today 3 demonstrates how the radiologist functions as a member of diagnostic and management teams to provide optimal in­ formation and efficient, low-risk patient care at the lowest possible cost. Martin W. Donner Friedrich H. W. Heuck Contents Critical Diagnostic Pathways Abdomen 3 G. MARCHAL, A L. BAERT, K. GEBOES, E. PONETTE, 1. FEVERY The Diagnosis of Pancreatic Cancer ............ 3 W. REICHARDT Localization Techniques for Hormonally Active Pancreatic Tumors ........... . 7 AR. MARGULIS, S. MCCARTHY Hepatic Mass Lesions .... 12 M. KORMANO, K. PARTANEN, 1. KUIKKA Dynamic Liver CT and New Contrast Agents ....... . 17 W. FROMMHOLD, J. PIRSCHEL 20 Gallbladder Diseases: Imaging Sequences 1. A KIRKPATRICK, Jr.

This book encompasses the proceedings of a very successful post­ graduate course entitled "Radiology Today" held in Salzburg in June 1980. It was organised by Dr. Martin W. Donner of Baltimore and Dr. F. H. W. Heuck of Stuttgart. It was attended by 230 radiologists from 17 countries. The aim was to select a certain number of subjects in diagnostic radiology and in each to have a broad spectrum overview reviewing recent advances presented by an acknowledged expert, followed by a series of rather more detailed papers on various aspects of that field, again given by acknowledged experts drawn from countries throughout Europe and also from the United States of America. This series of presentations on a theme was then followed later the same day by a "workshop" discussion at which the speakers, sometimes joined by other experts from collateral fields of interest, acted as a panel for discussion with the over-view speaker acting as moderator.