THE VALUE OF CHEST FLUOROSCOPY

F. E. DIEMER
1919 Journal of the American Medical Association  
In the first draft quota (of about 50,000 men) inducted into the military service at Camp Lewis, the roentgen-ray staff of the base hospital made about 5,000 fluoroscopic chest examinations, with the cooperation of the president of the tuberculosis examining board. As our equipment and organization at that time were not adequate, we have no data to present covering this work. April 1, 1918, we installed a fluoroscopic outfit at the mustering office for performing work there, in conjunction with
more » ... in conjunction with the tuberculosis and the cardiovascular boards. It should be observed that the fluoroscopic examinations undertaken were intended not only to confirm the clinical diagnosis of tuberculosis but also for the recognition of abnormal chest conditions that might exist and be overlooked on physical examination. In the event that any abnormality was discovered on screen examination, the man was thereupon referred to specialists for reexamination. This proved of decided advantage to the president of the tuberculosis examining board on account of the fact that noise and haste do not improve the ability of the clinical examiners. From April 1, 1918, to Aug. 10, 1918, we screened 13,893 chests. Our equipment consists of the special type 3-inch self-rectifying Coolidge tube actuated by the standard bedside unit. The Edwards screen is used and affords a very sharp, contrasty illumination. We have found that in order to get the maximal diag¬ nostic assistance, first class equipment is essential. The tube must afford the smallest focal spot and the screen must be the most brilliant with no lag. To achieve greater efficiency it was necessary to adopt a standardized nomenclature and routine. According to our routine, ten patients, stripped to the waist, are admitted simultaneously to the fluoroscopic room. After completion of each examination a blue light, suspended over the fluoroscope, behind the oper¬ ator, controlled by the stenographer who records the findings, is turned on to permit rapid change of patients and to facilitate the penciling of areas on the chest requiring reexamination or reference to the cardio¬ vascular board. The stenographer at the mustering office makes two typewritten copies of each dictation, with the name of the operator on each, one for filing with the tuber¬ culosis examining board, the other for the roentgenray department. The findings are also tabulated in a ledger to check the work of each operator. The amount of fluoroscopic work that can be prop¬ erly done by one operator is limited. An efficient fluoroscopist should average sixty examinations an hour. Experience has shown, however, that to avoid undue fatigue he should confine himself to a maximum of two hours, the best procedure being to divide the work into two periods of an hour each, one in the morning and one in the afternoon. The draft quotas have arrived at Camp Lewis at the rate of about 10,000 a month, and have been examined, for the most part, during the first ten days, averaging 1,000 recruits a day. Of these about 250 have been eligible for screening. Our staff has been obliged to work at top speed averaging ten days a month. During the subsequent twenty days the daily fluoroscopic examinations have been from forty to sixty, including late arrivals, reexaminations of suspicious cases, and chest fluoroscopies of all pneumonia, influenza and measles patients. WHEN FLUOROSCOPY SHOULD BE UNDERTAKEN Our experience has demonstrated that practically 25 per cent, of all men between the ages of 21 and 31 should be subjected to thorough examination for the detection of possible-chest abnormalities. Such exam¬ ination should be undertaken in cases presenting any of the following points, which have been formulated by the president of the tuberculosis examining board :
doi:10.1001/jama.1919.02610030018005 fatcat:ma22zolrvfcu5k76mauqlyi2na