cookbook portion of the text. Then there is the summary that reiterates the pattern previously presented. In order not to interrupt clarity and flow, some useful points are reserved in the final "additional comments." A short reference list is provided at the end of each chapter. Although the phrase "Cost-Effective Pathways" is included in the title of the book, the discussion is strictly oriented to medical issues, except for the listing at the end of the chapter on the costs of each test mentioned. The claim to cost-effectiveness is a pragmatic one in the sense that ordering the most useful and safest test is the most cost-effective test in the long run.
Thirty-six of the 269 pages are devoted to the gastrointestinal and biliary tracts. The specific topics are acute and chronic cholecystitis, gallstones, biliary obstruction, bile leaks, hepatic size, metastases, pancreatic tumor, and acute and chronic gastrointestinal bleeding in the adult. I find the information and advice in these chapters free of undue "lobbying" by radiologic subspecialists. However, the chapter on chronic gastrointestinal bleeding conveys the impression that sigmoidoscopy and barium enema in combination are still the standard initial approach when, in fact, colonoscopy is the test of choice in most cases.
The authors succeeded in packing a lot of information in a well-organized and succinct form. I found the discussions related to nuclide imaging and the many radiopharmaceuticals it employs especially helpful. Those who find the coexistence of many "species" of Tc, IDA, iodine and indium confusing will concur. However, for the subspecialist, the book is probably too simple, unless the physician ventures into sections not related to his or her specialty. For the generalist who has a daily rendezvous with the friendly and informative hospital radiologist, this book seems reminiscent of many conversations that they have had over time minus the fun and jokes, of course. In fact, the authors caution the readers that this book will not obviate the need for continued dialogue between the clinicians and the radiologists.