Chest photofluorography
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Chest photofluorography, or abreugraphy (also called mass miniature radiography), is a
photofluorography Photofluorography (sometimes called just fluorography) is photography of X-ray images from a fluorescence, fluorescent screen. It is commonly used in some countries for chest X-ray screening, e.g. to diagnose tuberculosis (see Abreugraphy for more ...
technique for mass
screening Screening may refer to: * Screening cultures, a type a medical test that is done to find an infection * Screening (economics), a strategy of combating adverse selection (includes sorting resumes to select employees) * Screening (environmental), a ...
for
tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...
using a miniature (50 to 100 mm) photograph of the screen of an
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10  picometers to 10  nanometers, corresponding to frequencies in the range 30&nb ...
fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functio ...
of the
thorax The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the cre ...
, first developed in 1936.


History

Abreugraphy receives its name from its inventor, Dr.
Manuel Dias de Abreu Manuel Dias de Abreu (January 4, 1894 – January 30, 1962) was a Brazilian physician and scientist, the inventor of ''abreugraphy'', a rapid radiography of the lungs for screening tuberculosis. He is considered one of the most important Brazi ...
, a
Brazil Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...
ian
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
and
pulmonologist Pulmonology (, , from Latin ''pulmō, -ōnis'' "lung" and the Greek suffix "study of"), pneumology (, built on Greek πνεύμων "lung") or pneumonology () is a medical specialty that deals with diseases involving the respiratory tract.
. It has received several different names, according to the country where it was adopted: mass radiography, miniature chest radiograph (United Kingdom and United States), 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 Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...
and in Japan, tuberculosis prevention laws went into effect, obligating ca. 60% of the population to undergo MMR screening. A model of a mass radiograph used for screening for tuberculosis from 1936 to the mid 1950s can be seen in the Medical Gallery of the Science Museum. As a mass screening program for low-risk populations, the procedure was largely discontinued in the 1970s, following recommendation of the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
, 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/cost 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 radiation Ionizing radiation (or ionising radiation), including nuclear radiation, consists of subatomic particles or electromagnetic waves that have sufficient energy to ionize atoms or molecules by detaching electrons from them. Some particles can travel ...
doses, particularly among children, in the presence of extremely low yield rates of detection.


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 Immigration is the international movement of people to a destination country of which they are not natives or where they do not possess citizenship in order to settle as permanent residents or naturalized citizens. Commuters, tourists, and ...
applicants and foreign workers coming from countries with a higher risk for tuberculosis. Currently, 13 of the 26
Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...
an countries use MMR as the primary screening tool for this purpose. Examples of countries with permanent programs are Italy, Switzerland, Norway,
Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...
, Japan and the United Kingdom. For example, a study in Switzerland between 1988 and 1990, employing abreugraphy to detect tuberculosis in 50,784 immigrants entering the canton of
Vaud Vaud ( ; french: (Canton de) Vaud, ; german: (Kanton) Waadt, or ), more formally the canton of Vaud, is one of the 26 cantons forming the Swiss Confederation. It is composed of ten districts and its capital city is Lausanne. Its coat of arms b ...
, discovered 674 foreign people with abnormalities. Of these, 256 had tuberculosis as the primary
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...
and 34 were smear or culture-positive (5% of all radiological abnormalities).
Elderly Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...
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 Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the north ...
(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 In medicine, any disease is classified asymptomatic if a patient tests as carrier for a disease or infection but experiences no symptoms. Whenever a medical condition fails to show noticeable symptoms after a diagnosis it might be considered asy ...
phase, and it should be combined with
tuberculin skin test The Mantoux test or Mendel–Mantoux test (also known as the Mantoux screening test, tuberculin sensitivity test, Pirquet test, or PPD test for purified protein derivative) is a tool for screening for tuberculosis (TB) and for tuberculosis diagn ...
s and clinical questioning in order to be more effective. The sharp increase in tuberculosis in all countries with large exposure to
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
is probably mandating a return of MMR as a screening tool focusing on high-risk populations, such as
homosexual Homosexuality is romantic attraction, sexual attraction, or sexual behavior between members of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to peop ...
s and
intravenous drug Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body (usually intravenously, but also at an intramuscular or Subcutaneous injection, subcutaneous l ...
users. New advances in
digital radiography Digital radiography is a form of radiography that uses x-ray–sensitive plates to directly capture data during the patient examination, immediately transferring it to a computer system without the use of an intermediate cassette. Advantages inclu ...
, coupled with much lower x-ray dosages may herald better MMR technologies.


See also

*
Tuberculosis radiology Radiology (X-rays) is used in the diagnosis of tuberculosis. Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of TB, but can be used to rule out pulmonary TB. Chest X-ray A posterior-anterior (PA) chest X-ray i ...


References

{{Tuberculosis Fluoroscopy Infectious diseases Tuberculosis Brazilian inventions