Abreugraphy
Encyclopedia
Photofluorography
Photofluorography is photography of X-ray images from fluorescent screen. It is commonly used in some countries for chest X-ray screening, e.g...
technique for mass screening
Screening (medicine)
Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease....
for tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
using a miniature (50 to 100 mm) photograph of the screen of a x-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
fluoroscopy
Fluoroscopy
Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
of the thorax
Thorax
The thorax is a division of an animal's body that lies between the head and the abdomen.-In tetrapods:...
, first developed in 1935.
History
Abreugraphy receives its name from its inventor, Dr. Manuel Dias de Abreu, a BrazilBrazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
ian physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
and pulmonologist
Pulmonology
In medicine, pulmonology is the specialty that deals with diseases of the respiratory tract and respiratory disease. It is called chest medicine and respiratory medicine in some countries and areas...
. It has received several different names, according to the country where it was adopted: mass radiography, miniature chest radiograph (United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
and USA), roentgenfluorography (Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
), radiophotography (France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
), schermografia (Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
), photoradioscopy (Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
) and photofluorography (Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
).
In many countries, miniature mass radiographs (MMR) was quickly adopted and extensively utilized in the 1950s. For example, in Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
and in Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, 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
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, 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 benefits/costCost-benefit analysisCost–benefit analysis , sometimes called benefit–cost analysis , is a systematic process for calculating and comparing benefits and costs of a project for two purposes: to determine if it is a sound investment , to see how it compares with alternate projects...
ratio (a recent Canadian study 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 radiationIonizing radiationIonizing radiation is radiation composed of particles that individually have sufficient energy to remove an electron from an atom or molecule. This ionization produces free radicals, which are atoms or molecules containing unpaired electrons...
doses, particularly among children, in the presence of extremely low yield rates of detection.
Current use
Immigration
Immigration is the act of foreigners passing or coming into a country for the purpose of permanent residence...
applicants and foreign workers coming from countries with a higher risk for tuberculosis. Currently, 13 of the 26 Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
an countries use MMR as the primary screening tool for this purpose. Examples of countries with permanent programs are Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
, Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
, Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
, Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
and the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
.
For example, a study in Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
between 1988 and 1990, employing abreugraphy to detect tuberculosis in 50,784 immigrants entering the canton of Vaud
Vaud
Vaud is one of the 26 cantons of Switzerland and is located in Romandy, the French-speaking southwestern part of the country. The capital is Lausanne. The name of the Canton in Switzerland's other languages are Vaud in Italian , Waadt in German , and Vad in Romansh.-History:Along the lakes,...
, discovered 674 foreign people with abnormalities. Of these, 256 had tuberculosis as the primary diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
and 34 were smear or culture-positive (5% of all radiological abnormalities).
Elderly
Senescence
Senescence or biological aging is the change in the biology of an organism as it ages after its maturity. Such changes range from those affecting its cells and their function to those affecting the whole organism...
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.
MMR is most useful at detecting tuberculosis infection in the asymptomatic
Asymptomatic
In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...
phase, and it should be combined with tuberculin skin tests and clinical questioning in order to be more effective. The sharp increase in tuberculosis in all countries with large exposure to HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
is probably mandating a return of MMR as a screening tool focusing on high-risk populations, such as homosexuals and intravenous drug users. New advances in digital radiography, coupled with much lower x-ray dosages may herald better MMR technologies.