PURPOSE:
We designed a decision tree in order to improve the double-contrast radiographic image quality in the prone position and compensate for the disparity of technique among radiological technologists.
MATERIALS AND METHODS:
We evaluated 391 consecutive individuals who underwent medical checkups at our hospital. Three decision trees, i.e., Tree 1, Tree 2 and Tree 3, were constructed based on the axis and contortion of the stomach with the use of a prone filling image, and then the insertion site of compression pillow was altered. The image quality at the gastric angulus, the gastric body and the antrum was evaluated based on our original numeric scale, and was compared between the previous method and the present method which employs a decision tree.
RESULTS:
The image quality improved more significantly in the present method employing a decision tree compared with the previous method, for each decision tree: from 90 points to 100 points for Tree 1, from 70 points to 95 points for Tree 2, and from 39.5 points for 85.7 points in Tree 3.
CONCLUSION:
These results indicate that our original procedure employing a decision tree improves the radiographic image quality in the prone position and compensates for the disparity of technique among radiological technologists. Therefore, the present method may be expected to serve as the standard procedure of double-contrast radiography in the prone position.

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Screening for gastric cancer with endoscopy in the aged residents of Niigata City started in 2003, in parallel with barium X-ray examination.
Over the course of 5 years, a total of 81,923 people underwent this endoscopic screening, in which a double-checking system for the interpretation of the endoscopic data and pictures by a committee was applied. During this 5-year period, 0.91% (821/90,041) of the people who received endoscopic screening were found to have gastric cancer.
The effectiveness of the endoscopic screening in reducing the false negative rate was appraised by investigating the records of the regional cancer registry.
The false negative rate in endoscopic screening during 2003 to 2004 was estimated to be 3.35% (7/209), which was lower compared with that in X-ray screening, 23.98% (44/185).
The death rates between patients who were diagnosed by endoscopic screening and and those who were diagnosed by X-ray screening over a period of 3 years were compared.
The gastric cancer death ratio during the 3-year period in the people who participated in the endoscopic screening in 2003 was 0.216% in males and 0.067% in females.
The gastric cancer death ratio in the X-ray screening was almost the same: 0.205% in males and 0.067% in females. On the other hand, the gastric cancer death ratio during the 3-year period in the people who had renounced both screenings in 2003 was 0.776% and 0.315%, respectively.
These data suggest that both endoscopic and X-ray screening for gastric cancer might have efficiently reduced the mortality of gastric cancer during the 3-year period.
In addition, the gastric cancer death ratio during the 3-year period in people who participated in the endoscopic screening and in the X-ray screening continuously in 2003 and 2004 was 0.00% and 0.23%, respectively. These results suggest that endoscopic screening might be more effective in reducing the mortality in the long term.

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In this study, the problem of accuracy control in gastroendoscopy was investigated by estimating the false negative ratio (FNR) of endoscopic examination for gastric cancer mass screenings with X-ray fluorography. A false negative was defined as a case registered in the Miyagi Prefectural Cancer Registry within 3 years of the initial endoscopic examination diagnosed as having no gastric cancer between 1989 and 1998. Firstly, the FNR was estimated and compared between the two subject groups undergoing gastroendoscopy at our facility and other local medical institutions. High expertise in gastroendoscopy, as well as an accuracy control program, was guaranteed at our facility but not at the other local medical institutions. Then, the FNR was compared between two local groups: "City A" established appropriate programs for accuracy control, such as double checking by other experts, clinical conferences, etc., but "City B" had no control programs. Consequently, the FNR at our facility (10.9%) was significantly lower than that at other local medical institutions (18.9%), and the FNR in "City A" (13.9%) was significantly lower than that in "City B" (26.5%). We concluded that the establishment of accuracy control programs in addition to the guarantee of high expertise may improve the quality of gastric cancer screening with gastroendoscopy.

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A follow-up study by linking the screening records to the Miyagi Prefecture Cancer Registry data was performed to estimate the number of biliary tract or pancreatic cancer cases which occurred after the ultrasonic screening conducted by the Miyagi Cancer Society. This study included 1,912 patients with gallbladder polyps, 370 patients with cholecystolithiasis, 57 patients with gallbladder wall thickening, 135 patients with common bile duct dilatation, 11 patients with intrahepatic bile duct dilatation and 114 patients with main pancreatic duct dilatation. These cases were diagnosed as non-malignant during the ultrasonic screening or after further medical examinations at the hospital. The length of the follow-up periods was from 1,104 to 2,823 days. During the follow-up periods, we documented no cases of biliary tract or pancreatic cancer. Therefore, we conclude that the clinical follow-up of the ultrasonic findings described above is not necessary to detect biliary tract or pancreatic cancer in the early stage. However, since the detection frequency for biliary tract or pancreatic cancer was rather low, we will have to collect many more cases for further study in the future.

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Barium enemas were performed in close examinations of 102 patients after incomplete total colonoscopy. Thirty six patients were males and 66 were females, with a mean age of 65 years. Among these patients, 29 received colorectal cancer screening and were positive for stool occult blood. In 61 cases, barium enemas were more useful than colonoscopy; in 34, barium enemas were equal in usefulness to colonoscopy; in 7, colonoscopy was more useful than barium enemas. Barium enemas made clear any existing colorectal diverticulosis or polyps. Stenosis of the colon caused by peritonitis carcinomatosa or endometriosis was successfully observed by barium enema. Among the 29 patients who received colorectal cancer screening, 13 showed colorectal diverticulosis and 4 demonstrated on barium enema the type of polyps that give a positive result in stool occult blood tests. Therefore, we believe that barium enema is a useful method of confirming the diagnosis of colorectal lesions.

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