Chest photofluorography
1990971
216329975
2008-06-01T03:53:35Z
Fernando S. Aldado
832904
+[[pt:Abreugrafia]]
[[Image:Tuberculosis radiography.jpeg|thumb|right|Chest radiography showing advanced bilateral pulmonary tuberculosis. Source: CDC]]
'''Chest photofluorography''', or '''abreugraphy''' (also called '''mass miniature radiography''') is a [[photofluorography]] technique for mass [[Screening (medicine)|screening]] for [[tuberculosis]] using a miniature (50 to 100 mm) photograph of the screen of a [[x-ray]] [[fluoroscopy]] of the [[thorax]], first developed in [[1935]].
==History==
Abreugraphy receives its name from its inventor, Dr. [[Manuel Dias de Abreu]], a [[Brazil]]ian [[physician]] and [[pulmonology|pulmonologist]]. It has received several different names, according to the country where it was adopted: mass radiography, miniature chest radiograph ([[United Kingdom]] and [[USA]]), roentgenfluorography ([[Germany]]), radiophotography ([[France]]), schermografia ([[Italy]]), photoradioscopy ([[Spain]]) and photofluorography ([[Sweden]]).
In many countries, miniature mass radiographs (MMR) was quickly adopted and extensively utilized in the 1950s. For example, in [[Brazil]] and in [[Japan]], tuberculosis prevention laws went into effect, obligating ca. 60% of the population to undergo MMR screening. However, as a mass screening program for low-risk populations, the procedure was largely discontinued in the 1970s, following recommendation of the [[World Health Organization]], due to three main reasons:
# The dramatic decrease of the general incidence of tuberculosis in developed countries (from 150 cases per 100,000 inhabitants in 1900, 70/100,000 in 1940 and 5/100,000 in 1950);
# Decreased [[Cost-benefit analysis|benefits/cost]] ratio (a recent Canadian study [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10712322] has shown a cost of CD$ 236,496 per case in groups of immigrants with a low risk for tuberculosis, versus CD$ 3,943 per case in high risk groups);
# Risk of exposure to [[ionizing radiation]] doses, particularly among children, in the presence of extremely low yield rates of detection.
<!-- Unsourced image removed: [[Image:Abreugraphy.jpg|thumb|right|Early device used for abreugraphy (1939)]] -->
==Current use==
MMR is still an easy and useful way to prevent transmission of the disease in certain situations, such as in prisons and for [[immigration]] applicants and foreign workers coming from countries with a higher risk for tuberculosis. Currently, 13 of the 26 [[Europe]]an countries use MMR as the primary screening tool for this purpose. Examples of countries with permanent programs are [[Italy]], [[Switzerland]], [[Norway]], [[Netherlands]], [[Japan]] and the [[United Kingdom]].
For example, a study in [[Switzerland]] [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1292710&dopt=Abstract] between 1988 and 1990, employing abreugraphy to detect tuberculosis in 50,784 immigrants entering the canton of [[Vaud]], discovered 674 foreign people with abnormalities. Of these, 256 had tuberculosis as the primary [[diagnosis]] and 34 were smear or culture-positive (5% of all radiological abnormalities).
[[Senescence|Elderly]] populations are also a good target for MMR-based screening, because the radiation risk is less important and because they have a higher risk of tuberculosis (85 per 100,000 in developed countries, in the average). In Japan, for example, it is still used routinely, and the [[Japan Anti-Tuberculosis Association]] (JATA) reported the detection of 228 cases in 965,440 chest radiographs in 1996 alone [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12030038&query_hl=2].
MMR is most useful at detecting tuberculosis infection in the [[asymptomatic]] phase, and it should be combined with [[tuberculin skin test]]s and clinical questioning in order to be more effective. The sharp increase in tuberculosis in all countries with large exposure to [[HIV]] is probably mandating a return of MMR as a screening tool focusing on high-risk populations, such as [[homosexual]]s and [[intravenous drug]] users. New advances in [[digital radiography]], coupled with much lower x-ray dosages may herald better MMR technologies.
==See also==
* [[Tuberculosis radiology]]
==Bibliography==
* Bonvin L, Zellweger JP. Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. ''Tuber Lung Dis.'' 1992 Dec;73(6):322-5. PMID 1292710
* Ohmori M, Wada M, Uchimura K, Nishii K, Shirai Y, Aoki M. Discussing the current situation of tuberculosis case-finding by mass miniature radiography in Japan. ''Kekkaku.'' 2002 Apr;77(4):329-39. In Japanese. PMID 12030038
* Schwartzman K, Menzies D. Tuberculosis screening of immigrants to low-prevalence countries. A cost-effectiveness analysis. ''Am J Respir Crit Care Med.'' 2000 Mar;161(3 Pt 1):780-9. PMID 10712322
[[Category:Medical tests]]
[[Category:Infectious diseases]]
[[Category:Tuberculosis]]
[[pt:Abreugrafia]]
[[ru:Флюорография]]