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Effective Choices for Diagnostic Imaging in Clinical Practice
Report of a WHO Scientific Group
Technical Report Series, No. 795
1990, 131 pages [C, E, F, R, S]
ISBN 92 4 129685 7
Sw.fr. 16.-/US $14.40; in developing countries: Sw.fr. 11.20
Order no. 1100795
Guides medical practitioners through the maze of options for clinical problems where diagnostic imaging may be indicated. Authored by 12 international experts, the book takes its focus from the need - for reasons of quality patient care, costs, and the risks of radiation damage - to use ionizing radiation sparingly and thus to restrict imaging to those cases where useful diagnostic information can be expected. Some 90 common clinical problems are covered.
The overriding objective is to help physicians decide which approach is the most effective for the imaging of any specific clinical problem and what order of imaging should be followed to make the diagnosis accurately, quickly, and economically. For each clinical problem, indications are discussed for three different levels of imaging equipment, ranging from standard radiography and ultrasonography to sophisticated facilities equipped with magnetic resonance imaging, positron emission tomography, and immunoscintigraphy. Level I clinical procedures are presented as the minimum required for good patient care.
"... Much clinical wisdom is contained in the
succinct pithy formulations ... The report is interesting and well written ...Certainly
practitioners and health care planners in the developing world will find it a useful
guide... Western governments and third-party payers will be intrigued by the possibilities
for more uniform and standardized imaging choices..."
American Journal of Roentgenology
Efficacy and Radiation Safety in Interventional Radiology
2000, vi + 90 pages (available in English; French in
ISBN 92 4 154529 1
Sw.fr. 31./US $27.90; in developing countries: Sw.fr. 21.70
Order no. 1150472
This book provides an expert guide to the many complex factors that influence the safe and effective use of interventional radiology as a tool for the treatment of vascular and non-vascular diseases. Addressed to clinicians and public health administrators, the book responds to the special problems raised by these minimally invasive therapeutic procedures, which are generally safer than surgical interventions yet result in relatively high radiation exposure of patients and personnel. With these problems in mind, the book aims to make readers fully aware of both the advantages of these procedures for specific indications and the added risks to patients and clinical staff. Measures for reducing radiation dose without compromising clinical objectives are considered in detail.
Recommendations, which apply to the development of new services as well as the improvement of existing ones, reflect the consensus reached by a group of 33 international experts. Information ranges from technical advice on when bypass surgery is preferable to angioplasty, through examples of measures that reduce both patient dose and occupational exposure, to a discussion of factors to consider when defining acceptable levels of risk. To assist administrators planning to introduce interventional radiology, the book also contains abundant practical advice that can help them weigh benefits against safety concerns and understand the implications in terms of staff, training, equipment, maintenance, and budgets.
The book has five chapters. The first addresses clinical issues surrounding the growing use of these complex and sophisticated procedures. An overview of world trends is followed by a discussion of specific procedures, indications, contraindications, and efficacy in the areas of cardiology, general radiology, and neuroradiology. The chapter concludes with an outline of logistic requirements, including rooms, equipment, and personnel, for the introduction and performance of interventional radiology at a hospital or in a radiological practice.
As these procedures involve considerably prolonged periods of fluoroscopy and extended use of radiography, the second and most extensive chapter considers radiation safety, concentrating on techniques for dose assessment and dose reduction aimed at avoiding the occurrence of deterministic effects and reducing the risk of long-term stochastic effects. Techniques for reducing patient dose and occupational exposure are described as part of a comprehensive programme for quality assurance that covers both the procedures and the equipment used. The use of reference dose values for specific procedures is recommended as a tool for detecting potentially unacceptable practices that require investigation.
Subsequent chapters outline training requirements in the medical aspects of interventional radiology and in radiation protection for physicians, radiographers, nurses, and service engineers, and present a series of purchase specifications to facilitate the selection and procurement of radiological imaging units. A summary of key recommendations concludes the report.
Maintenance and Repair of Laboratory, Diagnostic Imaging, and Hospital Equipment
1994, vi + 158 pages [C*, E, F*, R, S]
ISBN 92 4 154463 5
Sw.fr. 39.-/US $35.10; in developing countries: Sw.fr. 27.30
Order no. 1150423
A practical guide to the maintenance and repair of essential laboratory and hospital equipment. Intended for use in institutions that do not have specially trained technicians or engineers, the book responds to the situation, frequently seen in developing countries, where much of the equipment is imported and adequate information on maintenance and repair is rarely provided by suppliers. With these special needs in mind, the manual aims to help staff using specific types of equipment to understand basic principles of construction and operation, adopt good working practices, avoid common errors, perform routine maintenance, and spot the early signs of defects or deterioration. Advice on equipment repair concentrates on common causes of problems that can be solved without expertise in engineering.
Throughout the manual, line drawings illustrate features of construction and design, while numerous checklists offer advice on periodic inspection and cleaning, good working practices, and the essential do's, don'ts, must's, and never's of routine operation and maintenance. Information ranges from the steps to follow when recharging batteries, through advice on how to protect microscopes in hot climates, to instructions for changing a blown fuse in an ultrasound scanner. Basic safety procedures, for protecting staff as well as patients, are also described.
The most extensive chapter covers the maintenance and repair of basic laboratory equipment, moving from autoclaves and incubators, to cell counters and systems for water purification. The remaining chapters describe the correct use, maintenance, and repair of diagnostic equipment, anaesthetic and resuscitation equipment, operating room equipment, and ultrasound and X-ray diagnostic equipment.
Manual of Darkroom Technique
WHO Basic Radiological System
1985, 25 pages [C, E, F, S]
ISBN 92 4 154178 4
Sw.fr. 8.-/US $7.20; in developing countries: Sw.fr. 5.60
Order no. 1150238
A complete and practical training programme for any clinic or centre interested in teaching darkroom personnel the procedures and precautions required to process X-ray films into high quality radiographs. Instructions, which are clearly presented and illustrated, cover every step and detail of processing, from when to switch off the lights, through the mixing of chemicals, to the exact procedures for developing, fixing, rinsing, and drying. Instructions are given in a standard order and can be easily mastered in a short training course.
Designed for use with the WHO Basic Radiological System (BRS) unit, the manual contains instructions for processing X-ray films by hand at temperatures which may rise to 32oC. The technique, which allows a developing time of from three to five minutes, uses any X-ray developer. The operator is instructed to take and record temperature readings every morning and afternoon.
"... an easily understood basic manual of
darkroom processing... a timely contribution to assist those working in isolated or rural
British Journal of Radiology
Manual of Diagnostic Ultrasound
edited by P.E.S. Palmer
1995, 334 pages, 600 illustrations [E, F, S]
ISBN 92 4 154461 9
Sw.fr. 65.-/US $58.50; in developing countries: Sw.fr. 45.50
Order no. 1150393
A didactic, illustrated guide to the use of ultrasound as a diagnostic tool in clinical practice. Prepared by an international group of experts with wide experience in both developed and developing countries, the manual responds to the need for a basic reference text that can help doctors, sonographers, nurses, and midwives solve imaging problems when no experts are available. With this need in mind, the manual adopts a practical approach aimed at providing a thorough grounding in both the techniques of ultrasound and the interpretation of images. The need for extensive supervised training is repeatedly emphasized.
Because the clinical value of ultrasound depends so greatly on the experience and skill of the operator, the manual makes a special effort to alert readers to common pitfalls and errors, and to indicate specific clinical situations where ultrasound may not be helpful or reliable as a diagnostic tool. Explanatory text is supported by numerous practical tips, warnings, checklists and over 600 illustrations.
The opening chapters explain how ultrasound works, outline the factors to consider when choosing a scanner, and introduce the basic rules of scanning, including advice on how to recognize and interpret artefacts. Guidance on the selection of ultrasound equipment includes clear advice concerning where costs can be spared and where investment is essential.
The core of the manual consists of seventeen chapters providing guidance on scanning techniques and the interpretation of images for specific organs and anatomical sites, with the most extensive chapter devoted to obstetrics. Each chapter contains illustrated information on indications for scanning, preparation of the patient, including choice of transducer and setting of the correct gain, general scanning techniques, and specific techniques for identifying anatomical landmarks and recognizing abnormalities. The manual concludes with WHO specifications for a general purpose scanner judged entirely suitable for 90-95% of the most common ultrasound examinations.
"... readable, simply written, and well
organized ... (the) high quality images are ideal for less experienced practitioners ... a
superb introductory text for radiology residents with no background in sonography and for
clinicians who have an interest in the subject."
American Journal of Roentgenology
Manual of Radiographic Interpretation for General Practitioners
WHO Basic Radiological System
P.E.S. Palmer, W. P. Cockshott, V. Hegedüs and E.
1985, 216 pages [C, E, F, S]
ISBN 92 4 154177 6
Sw.fr. 34.-/US $30.60; in developing countries: Sw.fr. 23.80
Order no. 1150231
A practical aid for physicians who must order or interpret X-rays without the assistance of a trained radiologist. Focused on common injuries and diseases, the manual features well over 400 X-rays and line drawings accompanied by an explicitly didactic text. Readers are shown general principles and procedures, taught how to correlate a particular set of signs and symptoms with an appropriate X-ray procedure, and then instructed in moving from an image to the correct diagnosis.
"... an excellent book... the section on chest
radiographs is one of the best available."
Respiratory Diseases in Practice
"... The material is excellent and the
reproductions of the radiographs are superb... "
British Journal of Radiology
"... Any general practitioner who has X-ray
facilities and responsibility for reporting his own films will find this a most useful and
Journal of the Royal College of General Practitioners
"... concisely expresses a good deal of
practical wisdom... well illustrated with radiographs and line drawings... I believe that
all tropical doctors handling x ray films without ready access to a radiologist
should obtain and use it. Even better, buy the WHO Basic Radiological System x ray
unit as well..."
British Medical Journal
Development, Quality Assurance and Radiation Protection in Radiology Services :
Imaging and Radiation Therapy
1997, 317 pages [E, S]
ISBN 92 75 32236 8
In developing countries: Sw.fr. 36.40
Order no. 1630108
This publication explores organizational and technical aspects of radiology, analyzed within the context of the Pan American Health Organization's strategic and programmatic orientations for 1995-1998. It seeks to strike a balance between basic principles of decentralized health services and the requirements that emerge as advances in knowledge are incorporated and applied in various areas of the health services. As a complement to the concepts developed in the text, the appendices in the second half of the book present examples of equipment specifications and legislation on practices and specialties, and provide information on technical aspects of quality assurance and radiation protection.
Politicians, administrators, planners, and health professionals, as well as
the ministries of health, will find this publication useful as they allocate
resources and determine technological configurations for the provision of
services. Moreover, it is hoped that this book will help ease the task of those
who must reconcile universal health care coverage with quality assurance and
P.E.S. Palmer, G. Walker and M.M. El-Nageh
WHO Regional Publications, Eastern Mediterranean Series, No. 21
1999, 76 pages [E]
ISBN 92 9021 250 0
Sw.fr. 5./US $4.50
In developing countries: Sw.fr. 3.50
Order no. 1440021
A practical guide to the principles and procedures of quality control in medical imaging. Noting that all medical imaging services use expensive and complex equipment, the manual explains how implementation of a quality system can ensure that only the correct imaging procedures are chosen and performed by appropriately trained staff, and that equipment is well maintained, calibrated, and regularly serviced. The book also responds to the serious harm to both equipment operators and patients that can occur when equipment, techniques, and facilities are poorly controlled. Throughout, emphasis is placed on the overriding goal of obtaining the maximum diagnostic benefit for patients with the minimum radiation dose.
The manual has three parts. The first provides a general introduction to the implementation and monitoring of quality systems, emphasizing the need to have written instructions for managing any situation, whether involving the cooperation of patients or the operation of equipment. The second and most extensive part sets out technical guidelines for quality control in ten areas. Minimum quality standards are provided for patient and staff care, building and facilities, personnel, equipment, drugs, imaging techniques, reports and records, audits, and ethics.
Part three covers the same areas with a series of practical checklists that can be used by any medical imaging service to review and check its compliance with the minimum requirements for quality. The book concludes with a model schedule for the quality control of equipment.
Training in Diagnostic
Ultrasound: Essentials, Principles and Standards
Report of a WHO Study Group
Technical Report Series, No. 875
1998, vi + 47 pages [E, F*, S*]
ISBN 92 4 120875 9
Sw.fr. 14.-/US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1100875
Addresses the urgent need to improve the training and clinical performance of physicians and allied health professionals who use ultrasound for diagnostic applications. Noting that the clinical benefits of this safe, effective, and highly flexible diagnostic tool depend on the training and skills of the user, the report responds to the problems created by the absence, in all but a few affluent countries, of properly developed programmes for training in ultrasonography. These problems, which include the expense of unnecessary examinations as well as the risk of misdiagnosis, are further compounded by the lack of regulation of equipment, its low cost, and recent technical innovations that have increased the difficulties of performing examinations and interpreting their results.
With these problems in mind, the report sets out international guidelines, including recommended curriculum content, for training users to perform and interpret clinical examinations commonly required in different health care settings. While noting that nurses, physicians' assistants, and other health workers often perform examinations, the report recognizes that the interpretation of ultrasound images and diagnostic decision-making are everywhere the responsibility of physicians. Recommended minimum standards for training reflect the consensus reached by an international group of 15 experts. Several professional societies, including the World Federation for Ultrasound in Medicine and Biology, also contributed their considerable experience and advice.
The report has six main sections. The first traces the rapid development of diagnostic ultrasound and explains why standards for ultrasonography training must be regarded as a prerequisite for the provision of high-quality diagnostic ultrasound services. Section two reviews recent trends in the utilization of diagnostic ultrasound in clinical practice, and examines the variety of practices, in a range of different countries, that govern the training of users.
Against this background, section three presents recommended ultrasonography curricula judged appropriate for medical students, and for the general, advanced, and specialized training of physicians. General ultrasonography training for sonographers and other allied health professionals is covered in section four.
The recommended content of curricula is expanded in section five, which describes the aspects of basic sciences and instrumentation that should be included in general and advanced training for physicians and allied health professionals. Section six discusses the level of competence that should be reached during training, and presents recommended standards for training programmes and the training process, including requirements for instructors and training centres. The report concludes with a summary of recommendations and conclusions, followed by a list, organized according to clinical specialty, of common applications of diagnostic ultrasound.
The WHO Manual of Diagnostic Imaging
Radiographic Anatomy and Interpretation of the Musculoskeletal System
WHO in collaboration with the International Commission for Radiologic Education (ICRE) of the International Society of Radiology (ISR) and the other members of the Global Steering Group for Education and Training in Diagnostic Imaging is creating a series of "Manuals of Diagnostic Imaging". The full series of manuals will primarily cover the examination techniques and interpretation of conventional diagnostic X-ray procedures. These manuals will replace and update the WHO Manual of Radiographic Interpretation for General Practitioners and the WHO Manual of Radiographic Technique.
The present volume in this series, the manual Radiographic Anatomy and Interpretation of the Musculoskeletal System, provides an exhaustive description of radiographic normal anatomy as well as pathologic changes most frequently seen in musculoskeletal system including trauma, infections in bone and joints, metabolic, endocrine, and toxic disorders, tumours, congenital and developmental disorders.
Backed by high-quality reproduction of radiographs, this manual will
prove essential reading to general practitioners, medical specialists, radiographers and
radiologists in any medical settings, although focusing specifically on needs in small and
by A. Mark Davies and H. Pettersson
2002, 231 pages [E]
ISBN 92 4 154555 0
Swiss francs 65.--/US $58.50
In developing countries: Sw.fr. 45.-
Order no. 1150493