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Nevertheless purchase colchicine 0.5 mg bacteria fighting drug, the authors order generic colchicine on-line antibiotic 3 2, editors order colchicine american express antibiotic 3 2, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty purchase colchicine 0.5 mg overnight delivery infection jaw, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. The authors and editors have tried hard to include the most up-to-date material while keeping the verbiage to a minimum. We have followed a point form outline style where possible, also including tables and lists where long paragraphs would be problematic. A brief Cheat Sheet at the end of most chapters provides a simple quick study section for key facts or potential “board question” information, often those tricky eponyms that we all learn and rapidly forget. We have included some suggested readings for those who want to dive deeper into a review, but have not exhaustively referenced the chapters for the sake of space and clarity. Finally, there are 50 all-new questions with answers and explanations at the end of the book for self-assessment. The editors hope this text will provide a useful tool to students of neurology at multiple levels, and will help in review for whatever neurological examination looms in the future for the reader. Fernandez ix Acknowledgments the editors would like to acknowledge the support of Christine Moore, our editorial assistant, who valiantly assisted in organizing authors, managing editors, modifying manuscripts, and generally making the entire con- traption function. Thanks go to our authors, who carefully reviewed and updated the chapters to reflect recent changes in understanding of disease and approaches to treatment within the bounds of the Ultimate review format. We would like to acknowledge the support of the leadership of the Neurological Institute at the Cleveland Clinic for encouraging our authors and editors to contribute to clinical pedagogy. We would also like to thank our editor, Beth Barry, at Demos for her assistance and support during the edit- ing of this third edition of Ultimate Review for the Neurology Boards. The editors would also like to thank their loving wives (Mary Bruce, Ritika, Divya, and Cecilia) and their wonderful children (Michael, Tucker, George, Sasha, Jordan, and Annella Marie) for their unconditional support and understanding during this process. How to Use This Book Neurology covers a broad spectrum of disease processes and complex neuroanatomy, neurophys- iology, and neuropathology. Moreover, your certification examination will also include psychiatry and other neurologic subspecialties such as neuro-ophthalmology, neuro-otology, and neuroen- docrinology, to name a few. Covering all of the possible topics for these boards is not only impos- sible, it is impractical. Although this book is entitled Ultimate Review for the Neurology Boards, it is not intended to be your single source of study material in preparing for your examination. Rather, it presumes that throughout your residency training, or at the very least, several months before your board examination date, you will have already read primary references and textbooks (and, therefore, carry a considerable fund of knowledge) on the specific broad categories of neurology. Because you cannot possibly retain all the information you have assimilated, we offer this book as a convenient way of tying it all together. The point-form information will help you recall specific facts, associations, and clues that may help with answering questions correctly. Ultimate Review for the Neurology Boards contains detailed chapters on subjects included on the neurology board examination. For maximal retention within the shortest amount of time, we have used an expanded outline format in this manual. A few phrases or a short paragraph is spent on subtopics that we think are of particular importance. We suggest that you first read the entire chapter, including the brief sentences on each subtopic. After the first reading, you should go back a second time, focusing only on the headings and subtopics in bold and the italicized words within the outline. If you need to go back a third time to test yourself, or, alternatively, if you feel you already have a solid fund of knowledge on a certain topic, you can just concentrate on the backbone outline in bold to make sure you have, indeed, retained everything. Whenever appropriate, illustrations are liberally sprinkled throughout the text to tap into your “visual memory. We have added a few suggested readings where pertinent to help you extend your learning both for the exams and for your education. For example, some diseases discussed in the chapter on pediatric neu- rology and the chapter on neurogenetics can also be found in the individual chapters of the Clinical Neurology section. We have included 50 questions at the end of the book to help you practice for the tests. One of the best preparation methods for taking exams is practicing the exam situation over and over. We hope these questions will give you a chance to try out your hand at answering questions. Preparing for Your Board Examination Although most residents initially feel that after a busy residency training it is better to “take a break” and postpone their certification examination, we believe that, in general, it is best to take your examination right after residency, when “active” and “passive” learning are at their peak. There will never be “a perfect time” (or “enough time”) to review for your boards. The board examination is a present-day reality that you will need to prepare for whether you are exhausted, in private practice, expecting your first child, renovating your newly purchased 80-year-old house, or burning candles in your research laboratory. Luckily, all the others taking these tests are in the same boat, so you are not alone! Although most res- idency programs are clinically oriented and have a case-based structure of learning, here are some suggestions as to how you can create an “active” learning process out of your clinical training, rather than just passively learning from your patients and being content with acquiring clinical skills. Imagine you are on your sixth month of a boring ward rotation carrying eight pa- tients on your service. The following table contains the diagnoses of your patients in the neurology ward and the reading initiative we recommend. Our experience is that case-based learning “sticks” better than starting on page one of any textbook. Become familiar with the literature on 2 Embolic stroke the use of heparin versus aspirin. Master the differential diagno- 3 Guillain-Barre syndrome sis of axonal versus demyelinating polyneuropathy. Amyotrophic lateral Master the differential diagnosis of 4 sclerosis motor neuron diseases. Always carry a small notebook that fits in your coat pocket so you can write down all the questions and observations that may arise in the course of your day. This will help you in two ways: (a) the talk itself will serve as reinforcement because you already read about it; and (b) you can ask more intelligent questions that will, at the very least, impress your colleagues and mentors, if not make you learn and appreciate neurology even more. For the driven resident: have a monthly schedule of books or book chapters to read. On the average, a “good” resident reads 25 to 50 pages per day (from journals, notes, books, etc. If you read more than 50 pages per day, you are driven and will be rewarded with an almost ef- fortless board review period. If you read less than 10 pages per day, or, even worse, are an occasional reader, you are relying on passive learning and will need to make up a lot of lost time (and knowledge) during your board review. People who do well every year are the ones who pass their written board examination on the first attempt.

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Severe cases more than 10 days afer onset, especially if also require appropriate supportive care, antimicrobial therapy is initiated early. Microscopic aggluti- pulmonary hemorrhage syndrome require nation, the gold standard serologic test, is prompt dialysis and mechanical ventilation, performed only in reference laboratories and respectively, to improve clinical outcome. For requires seroconversion demonstrated between patients with mild disease, oral doxycycline acute and convalescent specimens obtained has been shown to shorten the course of illness at least 10 days apart. Immunohistochemical and decrease occurrence of leptospiruria; and immunofuorescent techniques can ampicillin or amoxicillin can also be used to detect leptospiral antigens in infected tissues. Leptospirosis is a common global zoonotic disease of humans and several warm-blooded animals, especially in subtropic regions of the world, caused by the spirochete bacteria Leptospira. Courtesy of Centers for Disease Control and Prevention National Center for infectious Disease/rob Weyant/Janice Haney Carr. Humans become infected by swallowing water contaminated by infected animals or through skin contact, especially with mucosal surfaces, such as the eyes or nose, or with broken skin. B, immunostaining of fragmented leptospire (arrowhead) and granular form of bacterial antigens (arrows) (original magnifcation x158). Listeria monocytogenes L monocytogenes can also cause rhombenceph- Infections alitis (brainstem encephalitis) in otherwise (Listeriosis) healthy adolescents and young adults. Out- breaks of febrile gastroenteritis caused by Clinical Manifestations food contaminated with a large inoculum of Listeriosis is a relatively uncommon but severe L monocytogenes have been reported; this ill- invasive infection caused by Listeria mono cyto­ ness typically lasts 2 to 3 days. Transmission predominantly is food- of stool carriage of L monocytogenes among borne, and illness occurs most frequently among healthy, asymptomatic adults is estimated to pregnant women and their fetuses or newborns, be 1% to 5%. The organism grows readily on blood Pregnancy-associated infections can result in agar and produces incomplete hemolysis. Fetal infec- Epidemiology tion results from transplacental transmission following maternal bacteremia. Approximately L monocytogenes causes approximately 65% of pregnant women with Listeria infection 1,600 cases of invasive disease and 260 deaths experience a prodromal illness before the diag- annually in the United States. Amnio- phytic organism is distributed widely in the nitis during labor, brown staining of amniotic environment and is an important cause of ill- fuid, or asymptomatic perinatal infection can ness in ruminants. Neonates can present with early-onset causes outbreaks and sporadic infections in and late-onset syndromes similar to those of humans. Preterm birth, include deli-style, ready-to-eat meats, parti- pneumonia, and septicemia are common in cularly poultry, and unpasteurized milk and early-onset disease (within the frst week of sof cheeses, including Mexican-style cheese. The last large outbreak in the tions occur at 8 to 30 days of life following term United States occurred in 2011, resulting in deliveries and usually result in meningitis with 143 hospitalizations, and was linked to con- fatality rates of approximately 25%. For pregnancy-associated cases, 2 to 4 weeks; for nonpregnancy-associated cases, 1 to 14 days; Clinical features characteristic of invasive for febrile gastroenteritis, 24 hours. Use of an alter- infected tissue specimens, including joint, native to an aminoglycoside that is active intra- pleural, or peritoneal fuid. In the penicillin- from an infected patient may demonstrate allergic patient, trimethoprim-sulfamethoxazole the organism. The organisms can be gram- or a quinolone has been used successfully as variable and resemble diphtheroids, cocci, monotherapy for Listeria central nervous sys- or diplococci. Cephalosporins are not active is not uncommon, and the isolation of a against L monocytogenes. Longer Treatment courses are necessary for patients with endo- No controlled trials have established the carditis or parenchymal brain infection (cere- drug(s) of choice or duration of therapy for britis, rhombencephalitis, brain abscess). Listeriosis occurs most frequently among pregnant women and their fetuses or newborns, people of advanced age, or immunocompromised people. Courtesy of Centers for Disease Control and Prevention/Dr Balasubr Swaminathan; Peggy Hayes. Carditis, Clinical manifestations of Lyme disease are which usually manifests as various degrees of divided into 3 stages: early localized, early dis- heart block, can occur in children but is rela- seminated, and late disease. Occasionally, people with ease is characterized by a distinctive lesion, early Lyme disease have concurrent human erythema migrans, at the site of a recent tick granulocytic anaplasmosis or babesiosis, which bite. Coinfection common manifestation of Lyme disease in can present as more severe disease than Lyme children. Erythema migrans begins as a red monoinfection, and the presence of a high macule or papule that usually expands over fever with Lyme disease or inadequate response days to weeks to form a large, annular, ery- to treatment should raise suspicion of concur- thematous lesion that typically increases in size rent anaplasmosis or babesiosis. Certain labo- to 5 cm or more in diameter, sometimes with ratory abnormalities, such as leukopenia, partial central clearing. The lesion is usually thrombocytopenia, anemia, or abnormal but not always painless, and it is not pruritic. A treated at an earlier stage of illness and most classic bull’s-eye appearance with concentric commonly manifests as Lyme arthritis in chil- rings appears in a minority of cases. Factors dren, which is characterized by infammatory that distinguish erythema migrans from local arthritis that is usually pauciarticular and allergic reaction to a tick bite include larger afects large joints, particularly knees. Constitutional symp- stage of Lyme disease, Lyme arthritis has toms, such as malaise, headache, mild neck objective evidence of joint swelling. Arthritis stifness, myalgia, and arthralgia, ofen accom- can occur without a history of earlier stages of pany the rash of early localized disease. Com- can be present but is not universal and is pared with pyogenic arthritis, Lyme arthritis generally mild. Poly- an infective tick bite and consist of secondary neuropathy, encephalopathy, and encephalitis annular, erythematous lesions similar to, but are extremely rare manifestations of late dis- usually smaller than, the primary lesion. Children who are treated with antimicro- manifestations of early disseminated illness bial agents in the early stage of disease almost (which may occur with or without rash) are never develop late disease. No evidence suggests Lyme junctivitis, optic neuritis, keratitis, uveitis) can disease can be transmitted via human milk. Although the cause between April and October; more than 50% is unknown, ongoing infection with Borrelia of cases occur during June and July. People burgdorferi has not been demonstrated, and of all ages can be afected, but incidence in long-term antibiotics have not been shown the United States is highest among children to be benefcial. Patients with posttreatment 5 through 9 years of age and adults 55 through Lyme disease syndrome usually respond to 59 years of age. A lesion similar to erythema migrans known “Chronic Lyme disease” is a nonspecifc term as “southern tick-associated rash illness” or that lacks a clinical defnition. The etiology and plained syndromes usually characterized by appropriate treatment of this condition pain and fatigue. Southern tick-associated be responsible for symptoms and should be rash illness results from the bite of the lone considered. In none of these situations is there star tick, Amblyomma americanum, which is credible evidence that persistent infection abundant in southern states and is biologically with B burgdorferi is demonstrable. Clinical manifestations of Lyme disease in Epidemiology eastern Canada, Europe, states of the former Lyme disease primarily occurs in 2 distinct Soviet Union, China, and Japan vary some- geographic regions of the United States. More what from manifestations seen in the United than 90% of cases occur in New England and States.

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Coronary ?ow reserve order colchicine 0.5mg on-line antibiotics kills good bacteria, esophageal motility buy cheapest colchicine antibiotic basics for clinicians pdf, and chest pain in patients with angiographically dosage discount colchicine online master card can antibiotics for uti cause yeast infection. Gastrointest then be prescribed colchicine 0.5mg lowest price bacteria are the simplest single cells that, although the accuracy of this test Endosc Clin N Am 1994;4:731. An etiologic association noncardiac chest pain or dysphagia: results of three years’ experience can be assumed if cardiac-type chest pain is temporally with 1161 patients. Motility disorders of the esophagus account for car- proton-pump inhibitors as a test for gastroesophageal re?ux disease: a diac-type chest pain in 5%–38% of patients evaluated meta-analysis of diagnostic test characteristics. Esophageal chest pain: current the pressure and function of the lower esophageal controversies in pathogenesis, diagnosis and therapy. Prevalence of esophageal Most motility abnormalities are intermittent and may disorders in patients with chest pain newly referred to the cardiologist. Belching, burping, and eructation have roughly the ?stula complicating a gastric carcinoma. In general, same meaning and refer to the passage of gas from the because gastric outlet obstruction or a carcinoma that stomach or esophagus through the mouth. In some is large enough to erode into the colon is likely to be patients, belching is the only symptom. However, in some patients with peptic dis- people swallow air in variable amounts, and all people ease who have a small ulcer or have erosions and gas- belch from time to time. This practice may be associated with psy- ally is made by ultrasonography of the upper abdomen. Perform a barium enema if the patient belches foul- lieve other abdominal symptoms. For unex- References plained reasons, patients who have symptomatic gall- American Gastroenterological Association website. How to help patients who to evaluate the stomach for partial gastric outlet ob- have troublesome abdominal gas. Dyspepsia is de?ned as chronic or recurrent pain or dyspepsia should be made cautiously to avoid unneces- discomfort centered in the upper abdomen, mainly in or sary cholecystectomy because gallstones may silently around the midline as opposed to the right or left hypo- coexist in patients with dyspepsia. Dyspepsia may or may not be related to eat- cause dyspepsia include potassium supplements, iron, ing meals. The annual prevalence of recurrent dyspepsia antibiotics (especially macrolides, sulfonamides, met- is approximately 25% over a 3- to 12-month period. If ronidazole), digitalis, corticosteroids, niacin, gem?- frequent heartburn is included in dyspeptic symptoms, brozil, narcotics, colchicine, quinidine, estrogens, and the prevalence exceeds 40%. Addi- carcinoma, and previous gastric surgery raise the sus- tional studies may include stool inspection for parasites, picion of gastric malignancy and should lead to prompt abdominal radiography (for obstruction, calci?cations), endoscopy. It is recommended that young patients with dyspepsia nonulcer dyspepsia, accounts for up to 60% of cases. Atypical gastroesophageal re- etiology of a minority of cases of chronic dyspepsia. A portant to identify because the treatment of this disorder 2- to 4-week trial of an antisecretory agent is recom- differs from the treatment of other causes of dyspepsia. Gastric or esophageal cancer is present in 2% of cases Endoscopy is recommended for all patients whose with dyspepsia. Biliary tract disease is a rare cause of symptoms persist or who relapse after empirical chronic dyspepsia. Patients who fail to respond to empiric therapeutic ap- exclusively relieved by defecation or associated with the proaches should also undergo endoscopy. These patients may respond to reassurance and if necessary a course of antisecretory or prokinetic therapy. If symptoms persist, other treatments may References include behavioral therapy, psychotherapy, or antide- Malfertheiner P, Megraud F, O’Morain C, et al. The effectiveness of endoscopy in the manage- ment of dyspepsia: a qualitative systematic review. American Gastro- dyspepsia (pain or discomfort and centered in the upper enterological Association medical position statement: evaluation of dyspepsia. Biopsies/treatments and/or histology Does the patient have panic based on endoscopic for H. In general, jaundice is not evident until serum biliru- patient’s history, physical examination, laboratory studies, bin concentration exceeds 3 mg/dl. Imaging studies are in- for the diagnosis of jaundice is recommended, which dicated to con?rm the presence or the absence of biliary should include a careful history, physical examination, and obstruction. Nuclear patients’ risks factors for intrinsic liver disease, active imaging of the biliary tree that measures hepatic uptake systemic and abdominal symptoms, medications (in- of radiolabeled derivatives of iminodiacetic acid (e. Even if the clinical suspicion for biliary obstruction is Physical examination may reveal clues toward a spe- thought to be low, evaluating liver parenchyma is as ci?c condition. For example, high fever or right upper important as excluding that remote possibility of biliary quadrant tenderness suggests cholangitis. Altogether, the sensitivity and spec- hypertension); and signs of chronic liver disease such i?city of these tests is 89%–100%. If there is no clinical evidence of biliary obstruction, laboratory studies include serum aspartate and alanine evaluation for underlying liver disease is mandatory. It is not possible to differentiate intrahepatic serum levels of iron, transferrin saturation and ferritin from extrahepatic cholestasis on the basis of the serum (for hemochromatosis), antimitochondrial antibodies(for level of alkaline phosphatase. Initial evaluation of hyperbilirubinemia should deter- smooth-muscle antibodies and serum electrophoresis mine whether the process is secondary to conjugated (for autoimmune hepatitis), and alpha-1-antitrypsin ac- (direct) or unconjugated (indirect) bilirubin predomi- tivity (alpha-1-antitrypsin de?ciency). In isolated and asymptomatic mild elevation of may be needed to con?rm a diagnosis if the previously unconjugated bilirubin, the patient should be evalu- mentioned serology testing is negative. Once a biliary obstruction is established, therapy is of bilirubin metabolism such as Gilbert’s or Crigler- directed toward the relief of the mechanical obstruc- Najjar syndrome, and medication-induced disorders tion. The optimal strategy depends abnormal levels of aminotransferases and/or alkaline on the location and the type of obstructing lesion. Yes F Therapeutic intervention Biliary tract obstruction No E Biochemical studies for specific a consideration? Sleisinger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. Increased liver chemistry in an asymptomatic physiology, Diagnosis, and Management. Cytology, tuberculosis smear and tes should be extensively questioned regarding risk factors culture, triglyceride, and bilirubin concentration for liver disease. Hence, prompt on the amount of ?uid present, technique, and clinical set- detection and treatment are very important. Approximately 1500 ml of Fluid loss and weight change are related directly to so- ?uid has to be present for ?ank dullness to be detected. Fluid restriction is not necessary in Ultrasound is helpful when physical examination is not treating patients with cirrhosis and ascites unless the de?nite. All patients with new-onset ascites should undergo ab- 100 mg and furosemide 40 mg. Abdominal paracentesis is the in increasing urinary sodium or decreasing body weight, most rapid and cost-effective method of diagnosing the the doses of both medications should be increased si- cause of ascites and determining whether ?uid is in- multaneously as needed at a 100:40 ratio (e.

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Sufficient exposure is given to achieve a point (a) image on the film and then a micro-densitometer is used to measure a profile density through the point center purchase generic colchicine from india bacteria yogurt lab. In practice it is difficult to measure since a very small point needs to be displayed requir- ing considerable exposure time under very steady conditions colchicine 0.5 mg amex antibiotic resistance veterinary. Long ‘tails’ cause spreading beyond the source boundaries which contributes to the total unsharpness (geometrical and radiographic) purchase colchicine toronto infection 7 days to die. This is an indication of the radia- (b) tion penetrating the lead strips in an antiscatter grid or collimator on a gamma camera order colchicine paypal antibiotics gut microbiome. A line source in the form of a 10 m metal slit (usually made from platinum) provides a measure along a complete axis of the imaging surface as shown in Fig. The density of the line profile, recorded by the image, is then read with a microdensitometer (c) as before. The recording system modu- A lates, or degrades, the signal so that the output amplitude is reduced. A complete fluoroscopy imag- ing chain can be studied: the image intensifier input phosphor, the photocathode, the output screen, the video camera, and the final video display, so that weak points can be identified and corrected. For a given X-ray exposure the film gamma (contrast) is proportional to the Wiener spectrum. A change in the speed (sensitivity) alters n 1 since noise increases with sensitivity. The background noise is predominantly low frequency, identified as film grain and phosphor struc- 0. High frequency noise is increased when detail (thin) intensifying screens are used and is related to B poor photon absorption (quantum efficiency). The basic components of a contrast 218 the analog image: film and video 100 detail curve obtained from the low contrast phantom Screen/Film are shown in Fig. The curve shows that larger objects can be seen more easily at low contrast levels while smaller objects require much higher contrast differ- Detail ences before they become visible in the same noisy 10 image. Above the curve the conditions (image noise) satisfy visibility of the object; below the curve conditions prevent visibility. The test image is obtained 1000 1000 100 Small detail visible 100 at high contrast 10 Large detail visible at low contrast 330 mAs 10 450 mAs 670 mAs 1 1 0 1 2 3 4 5 6 0 1 2 3 4 5 6 (a) Detail size (cm) (b) Object size (mm) Figure 8. The value of Nab is closely dependent on photon absorption which is influenced image plate > image digitization > by both and screen thickness. It enables display sensitivity, specificity and overall accuracy of a particular display system to be com- pared with another system so that decisions can be Table 8. For a either radio-opaque objects in the case of X-ray dual series of 200 images, one with a 50% incidence images or radio-active sources in the case of nuclear of lesions and the other with a 10% incidence the medicine. Certain images in the series are completely clear and These two examples demonstrate the real effect of contain no lesions. A noisy image background is disease incidence in the population being studied on present to a fixed degree in all the images. A high inci- images make up the series and these are given to a dence of disease (or a high number of lesions in the panel of observers for judging. This will Investigation Sensitivity (%) Specificity (%) exclude disease which should be the object with Test A 80 60 screening tests. Double viewing the same images formed on the same patient then the separate sensi- from one investigation (mammography) will similarly tivity and specificity figures for each test can be improve sensitivity and specificity in a population combined to give improved accuracy. A move towards the combined sensitivity/specificity figures for the the left denotes a more sensitive test, i. The upper right A and B are positive corner shows a 100% sensitivity and 0% specificity, i. The lower left cor- • ner shows 0% sensitivity but 100% specificity: all the are findings are normal. Roughly half the cases gations the first case will present a sensitivity of 98% in the image set have no objects. A ranking/scoring and a specificity of 54% and the second case will system from 1 to 5 would be: present a sensitivity of 72% and a specificity of 96%. So combining the results from carefully chosen 1 Definitely normal (only obvious normals scored) investigations markedly improves overall sensitivity where false positive rate would be high and the and specificity. The sec- (a) False positive fraction ond and third methods require electronic handling of the image information to produce a video signal 1. Since a video False positive fraction camera is commonly restricted to an 8 10 film size it is not possible to hold more than about six images 1. The main action of a laser imager is to capture the incoming digitized video signal which then modu- 2 Probably normal (probably no lesion) lates a laser beam scanning a film surface. The critical false negative would be high design concerns the prism and mirror scanning Hard-copy devices 223 Spinning penta-prism Lens Acoustic–Optical modulator Film surface Laser (a) 80 m (b) (c) Figure 8. Each line of pixels (4096) by a constantly rotating prism in the laser light beam is exposed in approximately 3. The He–Ne laser produces red light (630 nm) so beam is shifted down until the entire sheet of film has special red-sensitive film is necessary. An electrical signal is converted contrast detail diagram: graphic display comparing into an acoustic signal which changes the refractive contrast and resolution index of the crystal scattering the light at different contrast improvement factor: improvement of con- angles from the main beam, so reducing the main trast when grid is used beam intensity. The scatter intensity depends on the contrast: film: the slope of the characteristic curve: size of the acoustic signal. The main beam passes film gamma through a small slot which blocks the scattered light contrast: image: relative measure of density differ- from reaching the film surface. The laser beam passes through a film speed: film sensitivity measured for an optical lens system which gives a typical beam diameter of density of 1 85 m giving an image matrix size of typically grid factor: increase in exposure when grid is used 4096 5120 pixels, representing 12 pixels mm 1. The mechanical catter grid per centimeter precision is therefore very high and vibration must grid ratio: ratio of grid height to interspace distance be prevented over the exposure 20 s exposure time. Fields are interlaced the disadvantage of the laser imager is the to give each frame fixed image matrix size. Multiple images would share line pairs: resolution measurement using a grating of the total 4096 5120 matrix. High definition (1024/ paired light and dark lines 1249 line) video images in multi-format (4 5 line spread function: a count profile taken through a image set) would only just be faithfully recorded. Projection imaging delivers a great deal of ensure that photoelectric events are dominant, even in information compression, because anatomy that spans soft tissues giving maximum subject contrast. It is very the entire thickness of the patient is presented in one effective for differentiating soft tissue detail but is only image. A single chest radiograph can reveal impor- practical for tissue thicknesses of a few centimeters; tant diagnostic information concerning the lungs, its most important application is mammography. They are provided using just one radiograph, the position along the tra- in constant-potential and most high frequency genera- jectory of the X-ray beam of a specific radiographic tors. Both the tube loadability and the focus size are shadow, such as that of a pulmonary nodule, is not important for this application and a balance must be known.

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