Rofo 2002; 174(8): 965-972
DOI: 10.1055/s-2002-32921
Community Medicine
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Community Medicine und Diagnostische Radiologie

Community medicine and diagnostic radiologyW.  A.  Golder
  • 1Institut für Klinische Radiologie, DRK Kliniken Berlin, Westend
Further Information

Publication History

Publication Date:
25 July 2002 (online)

Zusammenfassung

Community Medicine befasst sich mit den so genannten Volkskrankheiten, der Lebensqualität und der Effizienz diagnostischer und therapeutischer Verfahren unter den Bedingungen der ambulanten Versorgung. Zu ihren Partnerdisziplinen gehört auch die Diagnostische Radiologie. Programme der Community Medicine profitieren in allen Phasen der Durchführung von bildgebender Diagnostik. Wichtige radiologische Arbeitsgebiete (Osteodensitometrie, Mammographie, Gefäß- und Thoraxradiologie) sind bereits aus der Sicht der Community Medicine begutachtet worden. Für die Differenzialindikation der Schnittbildverfahren und der Teleradiologie steht eine vergleichbar umfangreiche Prüfung noch aus. Bei der weiteren Erforschung der Beziehungen zwischen Community Medicine und Radiologie muss methodisches Neuland (Entscheidungsbäume, Modelle, Kosten-Nutzen-Analysen) betreten werden. Auf diese Weise werden die Mechanismen aufgedeckt, die den Transfer von radiologischen Studienergebnissen in die so genannte gute klinische Praxis steuern.

Abstract

The main topics of community medicine are widespread diseases, quality of life and the efficiency of diagnostic and therapeutic procedures under out-patient conditions. Among its allied disciplines, diagnostic radiology is of some importance. Studies in community medicine take advantage of diagnostic imaging in all stages of their development. Many fields of radiologic activity (bone absorptiometry, mammography, vascular and chest radiology) have been examined by community medicine researchers. A similar evaluation of differential indications for cross-sectional imaging and teleradiology is still to be expected. In order to increase the research on interrelations between the two disciplines, radiologists have to set foot on new grounds of scientific methods (decision trees, models, cost-efficiency analysis). In this way, the mechanisms that control the transfer of research into the so-called good radiological practice can be clarified.

Literatur

  • 1 WHO and UNICEF .Report of the International Conference on Primary Care. Alma Ata; WHO, Genève 1978
  • 2 Epstein L. Research - An Integral Part of Community Oriented Primary Care.  In: Community Medicine. 1. Internationaler Workshop in Greifswald. Frankfurt am Main; Peter Lang 1995: 185-196
  • 3 Fitt N S, Mitchell S L, Cranney A, Gulenchyn K, Huang M, Tugwell P. Influence of bone densitometry on the treatment of osteoporosis.  CMAJ. 2001;  164 777-781
  • 4 Wuster C, Hadji P, Blaul G, Nass-Griegoleit I. Quantitative Knochenultrasonometrie (QUS) am Fersenbein zur Osteoporose-Diagnostik in der Bevölkerung.  Zentralbl Gynäkol. 1999;  121 137-142
  • 5 Moskowitz H, Kron E, Hall D. Screening mammography: the Mount Sinai Breast Check experience.  Conn Med. 1993;  57 777-780
  • 6 Kerlikowske K, Barclay J. Outomes of modern screening mammography.  J Natl Cancer Inst Monogr. 1997;  22 105-111
  • 7 Lipkus I M, Rimer B K, Halabi S, Strigo T S. Can tailored interventions increase mammography use among HMO women?.  Am J Prev Med. 2000;  18 1-10
  • 8 Worden J K, Solomon L J, Flynn B S, McVety D J, Dorwaldt A L, Geller B M. Community-based promotion of breast screening using small group education.  J Public Health Manag Pract. 1999;  5 54-62
  • 9 Grady K E, Lemkau J P, McVay J M, Carlson S, Lee N, Minchella M, Caddell C. Clinical decision-making and mammography referral.  Prev Med. 1996;  25 327-338
  • 10 Messecar D C. Mammography screening for older women with and without cognitive impairment.  J Gerontol Nurs. 2000;  26 14-24
  • 11 Margolis J R, Chen J T, Kong Y, Peter R H, Behar V S, Kisslo J A. The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases.  Radiology. 1980;  137 609-616
  • 12 Maher J E, Raz J A, Bielak L F, Sheedy P F, Schwartz R S, Peyser P A. Potential of quantity of coronary artery calcification to identify new risk factors for asymptomatic atherosclerosis.  Am J Epidemiol. 1996;  144 945-953
  • 13 Maher J E, Bielak L F, Raz J A, Sheedy P F, Schwartz R S, Peyser P A. Progression of coronary artery calcification: a pilot study.  Mayo Clin Proc. 1999;  74 347-355
  • 14 Smith F C, Grimshaw G M, Paterson I S, Shearman C P, Hamer J D. Ultrasonographic screening for abdominal aortic aneurysm in an urban community.  Br J Surg. 1993;  80 1406-1409
  • 15 Lucarotti M, Shaw E, Poskitt K, Heather B. The Gloucestershire Aneurysm Screening Programme: the first 2 years' experience.  Eur J Vasc Surg. 1993;  7 397-401
  • 16 Khoo D E, Ashton H, Scott R A. Is screening once at age 65 an effective method for detection of abdominal aortic aneurysm?.  J Med Screen. 1994;  1 223-225
  • 17 Lucarotti M E, Heather B P, Shaw E, Poskitt K R. Psychological morbidity associated with abdominal aortic aneurysm screening.  Eur J Vasc Endovasc Surg. 1997;  14 499-501
  • 18 New G, Roubin G S, Oetgen M E, Lawrence E J, Iyer S S, Moussa I, Vitek J J, Moses J W. Validity of duplex ultrasound as a diagnostic modality for internal carotid artery disease.  Catheter Cardiovasc Interv. 2001;  52 9-15
  • 19 Byrd S, Robless P, Baxter A, Emson M, Halliday A. Carotid duplex ultrasonography: importance of standardisation. Asymptomatic Carotid Surgery Trial Collaborators and Vascular Laboratories.  Int Angiol. 1998;  17 248-254
  • 20 Takahashi M, Korogi Y. Diagnosis of cerebral aneurysms with MR angiography - can MRA be applied to mass screening?.  Jpn Med J. 1995;  3633 19-25
  • 21 King J T, Glick H A, Mason T J, Flamm E S. Elective surgery for asymptomatic, unruptured, intracranial aneurysms: a cost-effectiveness analysis.  J Neurosurg. 1995;  83 403-412
  • 22 Yoshimoto Y, Wakai S. Cost-Effectiveness Analysis of Screening for Asymptomatic, Unruptured Intracranial Aneurysms. A Mathematical Model.  Stroke. 1999;  30 1621-1627
  • 23 Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, Hasegawa M, Yamada T, Kubo K, Hanamura K, Asakura K. Mass screening for lung cancer with mobile spiral computed tomography scanner.  Lancet. 1998;  351 1242-1245
  • 24 Flehinger B J, Kimmel M, Melamed M R. Survival from early lung cancer: implications for screening.  Chest. 1992;  101 1013-1018
  • 25 Sobue T, Suzuki R, Matsuda M, Kuroishi T, Ikeda S, Naruke T. Survival for clinical stage I lung cancer not surgically treated.  Cancer. 1992;  69 685-692
  • 26 Henschke C I, McCauley D I, Yankelevitz D F, Naidich D P, McGuinness G, Miettinen O S, Libby D M, Pasmantier M W, Koizumi J, Altorki N K, Smith J P. Early Lung Cancer Action Project: overall design and findings from baseline screening.  Lancet. 1999;  354 99-105
  • 27 Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suemasu K, Moriyama N. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography.  Radiology. 1996;  201 798-802
  • 28 Wee A S, Cowart M A, Mosley P D. Referral patterns of physicians requesting brain MRI procedures: a community-based study.  J Miss State Med Assoc. 2000;  41 439-441
  • 29 Caicoya M, Alonso M, Natal C, Sanchez L M, Alonso P, Moral L. Variation in medical practice. Apropos of the use of CAT and NMR in INSALUD.  Gac Sanit. 2000;  14 435-441
  • 30 Boulanger B, Kearney P, Ochoa J, Tsuei B, Sands F. Telemedicine: a solution to the follow-up of rural trauma patients?.  J Am Coll Surg. 2001;  192 447-452
  • 31 Apple S L, Schmidt J H. Technique for neurosurgically relevant CT image transfers using inexpensive video digital technology.  Surg Neurol. 2000;  53 411-416
  • 32 Rosen M P, Levine D, Carpenter J M, Frost L, Hulka C A, Western D L, McArdle C R. Diagnostic accuracy with US: remote radiologists' versus on-site radiologists' interpretations.  Radiology. 1999;  210 733-736
  • 33 Hunink M GM. Outcomes research and cost-effectiveness analysis in radiology.  Eur Radiol. 1996;  6 615-620
  • 34 Wagner J L, Herdman R C, Wadhawa S. Cost effectiveness of colorectal cancer screening in the elderly.  Ann Intern med. 1991;  115 807-817
  • 35 Golder W. Entscheidungsanalysen in der Radiologie mit Hilfe von Markov-Modellen.  Fortschr Röntgenstr. 2000;  172 80-85
  • 36 Gray D T, Fyler D G, Walker A M, Weinstein M C, Chalmers T C. Clinical outcomes and costs of transcatheter as compared with surgical closure of patent ductus arteriosus.  N Engl J Med. 1993;  329 1517-1523
  • 37 Powe N R. Economic and Cost-Effectiveness Investigations of Radiologic Practices.  Radiology. 1994;  192 11-18
  • 38 Golder W. Nutzen, Kosten und Analytik in der diagnostischen Radiologie: Definitionen und Glossar.  Fortschr Röntgenstr. 1999;  170 73-79
  • 39 Garber A M, Phelps C E. Economic foundations of cost-effectiveness analysis.  J Healt Econ. 1997;  16 121-128
  • 40 Hunink M GM, Boss J J. Triage of patients to angiography for detection of aortic rupture after blunt chest trauma: Cost-Effectiveness analysis of using CT.  Amer J Roentgenol. 1995;  165 27-36
  • 41 Galanski M, Nagel H D, Stamm G. CT-Expositionspraxis in der Bundesrepublik Deutschland.  Fortschr Röntgenstr. 2001;  173 R1-R66
  • 42 Fischer G C, Niederstadt C. Grundlagenforschung in der Medizin. Das Konzept ist erweiterungsbedürftig.  Dt Ärztebl. 1999;  96 A1192-1195
  • 43 Hillmann B J. Outcomes research and cost-effectiveness analysis for diagnostic imaging.  Radiology. 1994;  193 307-310

Prof. Dr. Werner A. Golder

Institut für Klinische Radiologie, DRK Kliniken Berlin, Westend


Spandauer Damm 130

14050 Berlin

Phone: + 49-30-35304100

Email: radiologie@drk-kliniken-westend.de