Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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3 Overview of Selected Techniques for Diagnosing and Evaluating Patients
3 Overview of Selected Techniques for Diagnosing and Evaluating Patients
Pages 49-72
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From page 49... ...
The discussion, organized by laboratory-based diagnostics, medical imaging, and functional assessments, provides background for chapters 4 through 8, which describe specific advances in the assessments of cardiovascular, neurologic, respiratory, hematologic, and digestive conditions, respectively. LABORATORY-BASED DIAGNOSTIC MEDICINE Clinical and Anatomic Pathology Pathology is a medical discipline concerned with the cause, development, structural/functional changes, and natural history associated with diseases (Funkhouser, 2009)
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From page 50... ...
The use of these tests is increasing in many areas of laboratory medicine including oncology, infectious diseases, clinical chemistry, and clinical genetics. For example, there are molecular diagnostic tests to detect common genetic mutations in tumors that inform diagnosis and treatment, identify the genetic material of organisms causing certain infectious diseases, and evaluate human DNA for inherited variants contributing to disease (AvaMedDx, 2013; NCI, 2023)
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. Since not all genetic changes affect health, it can be difficult to know which genetic variants are causing a patient's clinical symptoms.
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Specifically, the diagnostic imaging techniques described below include X-ray, computed tomography (CT) , ultrasound, and magnetic resonance imaging (MRI)
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Molecular imaging is a growing discipline that integrates cell biology, molecular biology, and advanced imaging techniques to visualize and measure physiological or pathological processes at the cellular and molecular level in the body. Molecular diagnostic imaging can help detect the presence and extent of disease in its early stages, even before abnormalities can be detected with other diagnostic tests.
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. X-ray Images of internal body structures, including bones, blood vessels, and soft tissues, can be produced by passing X-rays through the body.
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To assess musculoskeletal function, dynamic ultrasound is used to assess muscle and tendon motion in vivo and has been shown to help in diagnosing a variety of musculoskeletal disorders such as slipping rib syndrome, ulnar nerve subluxation, and fasciculation (Chuang et al., 2016; Duarte et al., 2020; Van Tassel et al., 2019)
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A nuclear medicine physician will select the tracer specific to patient's particular problem. After the radioactive tracer is administered to the patient, the path of the radioactive tracer is tracked using specialized imaging instruments, most commonly either PET or SPECT.
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. Multimodality imaging techniques that use SPECT and PET are rel evant to several clinical applications, such as oncology, cardiology, and neuropsychiatry (Martí-Bonmatí et al., 2010)
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for advanced diagnostic imaging services ordered for Medicare ben eficiaries. Providers are required to consult the relevant AUC at the time of a test order, using a qualified clinical support decision mechanism (i.e., an electronic portal)
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. Patient-reported and performance-based measures of physical function (such as cardio pulmonary exercise testing and the 6-minute walk test)
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identifies many different functional assessment scales that evaluate, for example, the performance of basic functional skills required to care for oneself independently, the effects of executive function deficits on everyday functioning through real-world tasks, the severity of pain, and functional tolerance (based on a medical condition) that is safe for a worker to perform.
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. • The FACIT (Functional Assessment of Chronic Illness Therapy)
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From page 62... ...
levels of difficulty, generally terminating in maximal exercise performance, so they have evaluative as well as diagnostic functions. Graded exercise testing with ECG monitoring is referred to here as routine cardiac stress testing and described briefly for comparison with cardiopulmonary exercise testing, which uses similar profiles and modes of exercise.
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From page 63... ...
Professionals administering stress tests need to be experienced in recognizing the typical signs of disease and risks during the test as well as in assessing the individual's degree of effort. An individual's intentional restraint of effort can be suspected from a lack of typical heart rate and blood pressure changes or from the appearance of vigorous effort during exercise.
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From page 64... ...
An individual's intentional restraint of effort can be suspected from a lack of typical heart rate and blood pressure changes or from a lack of the appearance of vigorous effort during exercise. More difficult is distinguishing individuals with true cardiac limitations from those who are peripherally deconditioned as a result of prolonged inactivity or as a result of non-cardiovascular pathology.
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From page 65... ...
Also, routine exercise stress tests have limited diagnostic information. Self-paced performance tests are prone to underestimating functional capacity because they are not designed as maximal tests and lack measurements that assess the degree of cooperation and effort.
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Diagnostic tests of resting organ system function may not reflect the net effect of impairment on overall functional capacity. Functional performance tests, including the 6MWT, are more likely to capture the effects on physical performance of secondary and coexisting conditions, such as disease in
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There are many performance tests or field tests used in the assessment of physical function, including other time-limited distance tests, timed tests of defined distance, incremental speed walk tests, step tests, and o thers (Singh et al., 2014)
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2003. ATS/ACCP statement on cardiopulmonary exercise testing.
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2016. Dynamic ultrasound imaging for ulnar nerve subluxation and snapping triceps syndrome.
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2014. An official European Respiratory Society/American Thoracic Society technical standard: Field walking tests in chronic respiratory disease.
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Nuclear Medicine and Molecular Imaging 51(4)
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From page 72... ...
2014. An official systematic review of the European Respiratory Society/American Thoracic Society: Measurement proper ties of field walking tests in chronic respiratory disease.
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