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PubMed2001

Patients' views on importance and usefulness of plain radiography for low back pain.

STUDY DESIGN: Quantitative and qualitative cross-sectional interview study. OBJECTIVES: To investigate how patients who are referred for plain radiography because of low back pain perceive the importance and usefulness of the examination. SUMMARY OF BACKGROUND DATA: Up to 50% of plain radiography examinations for low back pain may be unnecessary based on clinical criteria. However, many patients have great confidence in these examinations. A further exploration of the patients' views may indicate how their needs can be met without unnecessary use of radiography. METHODS: Ninety-nine patients (65 women, 34 men) 14-91 years of age who were referred from Norwegian general practitioners for plain radiography of the lumbosacral spine were asked to rate the examination as slightly/fairly or very important (93 responded). Chi-squared tests were used to evaluate differences in rating according to age, gender, clinical history, and clinical appropriateness of the examination, as determined by comparing information in the referral form with Norwegian (NR) and British (BR) recommendations for use of radiography. Each of the 99 patients also underwent a semistructured interview that was based on questions about importance, usefulness, and reasons for the radiography referral. Answers were categorized and described using a qualitative method (template analysis). RESULTS: Seventy-two percent (68 of 93) of patients rated radiography as very important. The proportion was higher for men than women (85% vs. 65%, P = 0.04), higher for those with worsening than those with improving/unchanged symptoms (86% vs. 65%, P = 0.03), and higher for inappropriately than appropriately referred patients (NR: 76% vs. 61%, P = 0.17; BR: 81% vs. 56%, P = 0.01). The qualitative analysis showed that the patients related their views on the importance and usefulness of receiving radiography to seven different issues: symptoms and clinical history, information and advice (especially from health care providers), need for emotional support from the physician, need for certainty and reassurance, need for symptom explanation and diagnosis, reliability of radiography compared with clinical evaluation, and expected practical consequences of the radiologic examination. CONCLUSIONS: The finding that inappropriately referred patients tended to rate their radiography referral as more important than appropriately referred patients indicates that the patient's view may be a substantial barrier to appropriate use of radiography. The study identified seven issues underlying the patients' views on importance and usefulness of receiving radiography. Strategies to prevent unnecessary use of plain radiography for low back pain that address these issues are suggested.

Adolescent↗
PubMed1981

Image resolution in dental and maxillofacial radiography with the conventional and "free focus" imaging concepts.

An investigation of the resolution capability of conventional and "free focus" dental radiography on non screen film was completed. The over-all imaging performance of conventional and "free focus" radiography exposed with three types of dental x-ray machines was comparable. Conventional "long-cone" radiography produced better resolution than "short-cone" radiography. "Short-cone" radiography exposed with conventional compact dental x-ray machines provided similar or better image resolution than those exposed with larger, high-energy machines. The miniaturized dental x-ray machines used in "free focus" radiography for periapical type exposures gave a resolution which was similar to or up to 100 percent higher than in conventional "long-cone" periapical radiographs. Differences in path length of the x-ray beam during clinical applications of conventional and "free focus" radiography indicated a higher potential for image noise and degradation in conventional films. A potential for segmental variation in image resolution in surveys of the dentition was seen only in the conventional techniques. These characteristics must be balanced against a tendency to variable segmental magnification in free focus radiography. Indications, however, are that applications of "free focus" radiography may be able to improve the early diagnosis of dental disease. Periapical type surveys of the dentition produced by "free focus" radiography may require only two exposures instead of the 14 to 20 required in conventional periapical surveys and may contain characteristics of periapical as well as bitewing films. "Free focus" radiography represents an attractive alternative that may be able to accomplish substantial time savings in the practice of dental radiography.

Face↗
PubMed2003

Reducing the radiation dose during excretory urography: flat-panel silicon x-ray detector versus computed radiography.

OBJECTIVE: The purpose of the study was to examine the possibilities for reducing radiation exposure in uroradiology using digital flat-panel silicon X-ray detector radiography. We compared the subjectively determined image quality of abdominal radiographs and urograms obtained on a digital flat-panel detector radiography system with those obtained on a computed radiography system. SUBJECTS AND METHODS. Fifty patients who had a clinical indication for urography underwent unenhanced abdominal imaging that was alternately performed using flat-panel silicon X-ray detector radiography or computed radiography. For patients who required a second radiograph with contrast medium, the examination modality was changed to avoid exposing the patients to excess radiation. The images obtained on flat-panel X-ray detector radiography were obtained at half the radiation dose of the images obtained on computed radiography (800 speed vs 400 speed). The resulting 50 pairs of images were interpreted by four independent observers who rated the detectability of structures of bone and the efferent urinary tract relevant to diagnosis and compared the image quality. RESULTS: At half the radiation dose, digital flat-panel X-ray detector radiography provided equivalent image quality of the liver and spleen, lumbar vertebrae 2 and 5, pelvis, and psoas margin on abdominal radiographs. The image quality obtained with digital flat-panel X-ray detector radiography of the kidneys, the hollow cavities of the upper efferent urinary tract, and the urinary bladder was judged to be statistically better than those obtained with computed radiography. CONCLUSION: With half the exposure dose of computed radiography, the flat-panel X-ray detector produced urograms with an image quality equivalent to or better than computed radiography.

Diagnosis, Computer-Assisted↗
PubMed2003

Radiographic assessment of the marginal bone level after implant treatment: a comparison of periapical and Scanora detailed narrow beam radiography.

OBJECTIVES: To compare assessments of the marginal bone level around dental implants in the mandible using periapical radiography and Scanora detailed narrow beam (DNB) radiography. METHODS: Forty patients treated with Brnemark dental implants in the lower jaw were examined with periapical and Scanora DNB radiography. Ten implants were selected from each of the four dental regions (molar, incisor, canine, premolar), and no more than one implant was selected from the same patient. Seven observers assessed the level of the marginal bone on the mesial and distal surfaces of the implants. Three of the observers made all the assessments twice. RESULTS: Agreement between the methods was 61%. The highest agreement was found in the molar region. In DNB radiography the marginal bone level was observed to be situated more "coronally" in 17% and more "apically" in 22% compared with periapical radiography. The kappa value for interobserver agreement for all observers was 0.33 for periapical radiography and 0.27 for DNB radiography. The weighted kappa value for intraobserver agreement ranged from 0.75 to 0.99 for DNB radiography and from 0.94 to 0.98 for periapical radiography. CONCLUSIONS: Scanora multimodal radiography simplifies examination of implants in the mandible, and observer variation is comparable with that in intraoral periapical radiography.

Aged↗
PubMed2000

Comparison of doses for bedside examinations of the chest with conventional screen-film and computed radiography: results of a randomized controlled trial.

PURPOSE: To compare the radiation doses received by patients during bedside chest radiography when a computed radiography system was used and when a 400-speed screen-film system was used. MATERIALS AND METHODS: A randomized controlled trial was performed whereby all patients who were admitted to an intensive care unit were randomly assigned at admission to have all radiographic chest images obtained with either computed or conventional screen-film radiography. Doses were measured for 1 year, during which 269 patients underwent imaging. For these patients, surface entry doses were measured by means of individual thermoluminescent dosimeters placed on the skin at the center of the radiation beam. In addition, data were collected relating to the patient and examination characteristics, as well as to repeat examinations. Effective doses were calculated. RESULTS: The patients in the two arms of the study were well matched. The surface entry doses were higher in the computed radiography group (median, 0.21 mGy for computed radiography and 0.16 mGy for conventional radiography), and the effective doses were also higher (median, 0.036 mSv for computed radiography and 0.027 mSv for conventional radiography). Fewer examinations were repeated when computed radiography was used. CONCLUSION: When computed radiography was used, patient doses increased. The speed of this computed radiography system, which uses phosphor plate imaging, equates approximately to a 300-speed screen-film system.

Adolescent↗
PubMed2000

Selenium-based digital radiography in the detection of bone lesions: preliminary experience with experimentally created defects.

PURPOSE: To compare the diagnostic performance of selenium-based digital radiography with that of conventional screen-film radiography and storage phosphor radiography for the detection of bone lesions simulating osteolyses. MATERIALS AND METHODS: Artificial osseous lesions 1.0-3.0 mm in diameter were created in 80 of 160 predefined regions in 16 porcine femoral specimens. Specimens were enclosed in containers filled with paraffin to ensure accurate repositioning and to obtain an absorption condition comparable to that of a human extremity. Imaging was performed with a selenium-based digital radiography system, a conventional screen-film system, and a storage phosphor radiography system with an exposure identical to that used during clinical imaging. The presence of a lesion was assessed with a five-point confidence scale. Receiver operating characteristic (ROC) analysis was performed for a total of 1,440 observations (480 per modality), and diagnostic performance was estimated with the area under the ROC curve (A(z)). Differences in diagnostic performance were assessed with the paired Student t test. RESULTS: ROC analysis results showed A(z) values of 0.656 for selenium-based digital radiography, 0.679 for storage phosphor radiography, and 0.680 for conventional screen-film radiography. Differences between the three modalities were not significant (P =.60-.93). CONCLUSION: Image quality with selenium-based digital radiography was comparable to that with conventional screen-film radiography and storage phosphor radiography.

Animals↗
PubMed1991

Observer performance in the assessment of periapical pathology: a comparison of panoramic with periapical radiography.

Observer performance in the assessment of the periapical pathology from panoramic and periapical radiography was examined. Five endodontists, five general practitioners and five oral radiologists were asked to assess the periapical status of 117 teeth. The observers assessed the panoramic and periapical radiographs of the teeth, which were evenly distributed throughout the jaws with a 50% probability that either an osteolytic or sclerotic lesion was present. The results of the comparison between panoramic and periapical radiography were influenced by the selection of observers. When the oral radiologists acted as observers, the mean P(A) value for periapical radiography was higher than for panoramic radiography (P less than 0.001), resulting in periapical radiography presenting a higher overall diagnostic accuracy than panoramic radiography for all 15 observers (P less than 0.01). There was, however, no difference between panoramic and periapical radiography when the two groups of endodontists and general practitioners acted as observers. The comparison of the three groups of observers showed no difference between their diagnostic accuracy when assessing panoramic radiographs. With periapical radiography, the oral radiologists demonstrated a higher diagnostic accuracy than the endodontists (P less than 0.05). The observers in each group with the highest diagnostic accuracy also had the highest intra-observer agreement. The mean intra-observer agreement of the five general practitioners was higher than those of the other two groups of observers for panoramic radiography. For periapical radiography, the mean agreement rates of the groups were comparable.

Adult↗
PubMed2004

Traction radiography performed under general anesthetic: a new technique for assessing idiopathic scoliosis curves.

STUDY DESIGN: A prospective review of 24 patients with late-onset idiopathic scoliosis. OBJECTIVES.: To compare curve flexibility measured using supine bending radiography and traction radiography; to examine the correlation of each technique with postoperative correction; and to determine the influence of each technique on the decision to perform concomitant anterior release surgery with posterior instrumentation. SUMMARY OF BACKGROUND DATA: Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. No literature has shown a conclusively superior role for traction radiography in assessing idiopathic scoliosis curves. METHODS: Each patient had erect anteroposterior radiographs and supine bending radiographs. On the day of surgery, traction radiography was performed under general anesthetic. The correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography on the decision for anterior release surgery and its correlation with postoperative result was examined. RESULTS: Traction radiography demonstrated significantly greater curve flexibility than supine bending radiographs (P < 0.001). Eleven of 13 patients planned for anterior release surgery and posterior instrumentation avoided anterior release after review of the traction radiography. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.13). CONCLUSION: Traction radiography is superior to supine bending radiography in assessing curve mobility before surgery. This method benefits patients by allowing them to avoid anterior release surgery and helps predict postoperative correction.

Adolescent↗
PubMed2001

Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial.

OBJECTIVE: To test the hypothesis that radiography of the lumbar spine in patients with low back pain is not associated with improved clinical outcomes or satisfaction with care. DESIGN: Randomised unblinded controlled trial. SETTING: 73 general practices in Nottingham, north Nottinghamshire, southern Derbyshire, north Lincolnshire, and north Leicestershire. 52 practices recruited participants to the trial. SUBJECTS: 421 patients with low back pain of a median duration of 10 weeks. INTERVENTION: Radiography of the lumbar spine. MAIN OUTCOME MEASURES: Roland adaptation of the sickness impact profile, visual analogue scale for pain, health status, EuroQol, satisfaction with care, use of primary and secondary care services, and reporting of low back pain at three and nine months after randomisation. RESULTS: The intervention group were more likely to report low back pain at three months (relative risk 1.26, 95% confidence interval 1.00 to 1.60) and had a lower overall health status score and borderline higher Roland and pain scores. A higher proportion of participants consulted their doctor in the three months after radiography (1.62, 1.33 to 1.97). Satisfaction with care was greater in the group receiving radiography at nine but not three months after randomisation. Overall, 80% of participants in both groups at three and nine months would have radiography if the choice was available. An abnormal finding on radiography made no difference to the outcome, as measured by the Roland score. CONCLUSIONS: Radiography of the lumbar spine in primary care patients with low back pain of at least six weeks' duration is not associated with improved patient functioning, severity of pain, or overall health status but is associated with an increase in doctor workload. Guidelines on the management of low back pain in primary care should be consistent about not recommending radiography of the lumbar spine in patients with low back pain in the absence of indicators for serious spinal disease, even if it has persisted for at least six weeks. Patients receiving radiography are more satisfied with the care they received. The challenge for primary care is to increase satisfaction without recourse to radiography.

Adult↗
PubMed2003

Conventional radiography, rapid MR imaging, and conventional MR imaging for low back pain: activity-based costs and reimbursement.

PURPOSE: To incorporate personnel and equipment use time in an activity-based cost comparison of conventional radiography and conventional and rapid magnetic resonance (MR) imaging for low back pain (LBP). MATERIALS AND METHODS: At each of four Seattle Lumbar Imaging Project (SLIP) sites, patients were randomized to undergo conventional radiography or rapid MR imaging of the lumbar spine. For sample SLIP patients and for similar non-SLIP patients undergoing conventional lumbar spine MR imaging as usual care in calendar year 2000, measured imaging room use and technologist and radiologist times were multiplied by costs per minute of standard equipment acquisition, personnel compensation, and related expenses. Resulting provider-perspective costs and Seattle area Medicare reimbursements for conventional MR imaging and radiography for calendar year 2001 were used to estimate future "normative" reimbursement for rapid MR imaging. RESULTS: For 23 conventional radiography, 27 rapid MR imaging, and 38 conventional MR imaging examinations timed in calendar year 2000, all rapid MR imaging times exceeded those of conventional radiography but were less than those of conventional MR imaging. All 0.3- and 0.35-T MR imaging room and technologist times exceeded those for 1.5-T MR imaging. Average costs (in 2001 dollars) were $44 for conventional radiography, 126 US dollars for 1.5-T rapid MR imaging, 128 US dollars for 0.3-0.35-T rapid MR imaging, 267 US dollars for 1.5-T conventional MR imaging, and 264 US dollars for 0.3-0.35-T conventional MR imaging. Conclusions regarding cost differences between conventional radiography and rapid MR imaging were robust to plausible parameter value changes evaluated in sensitivity analyses. Conventional radiography reimbursement was 44 US dollars. Applying the ratio of reimbursement (620 US dollars) to costs (264-267 US dollars) for conventional MR imaging to rapid MR imaging costs predicted reimbursement of 292-300 US dollars for the new modality. CONCLUSION: Times and costs for rapid MR imaging are roughly three times those for conventional radiography but about half those for conventional MR imaging for LBP. While current conventional radiography costs exceed reimbursement, current conventional MR and projected rapid MR imaging reimbursements exceed costs.

Cost-Benefit Analysis↗
PubMed2005

Dental digital radiography: a survey of quality aspects.

The aim was to evaluate the experiences of Swedish general dental practitioners (GDPs) with digital radiography and their opinion on the same, particularly regarding quality issues. A letter was sent to all GDPs in private care in Region Skåne, Sweden, asking whether they used digital radiography (n=513). The response rate was 79%. The number of private GDPs who replied that they used digital radiography was 106. The Public Dental Service in Region Skåne listed 33 GDPs who worked with digital radiography. Based on these answers, a questionnaire was sent to the GDPs working with digital radiography (n=139). The questionnaire comprised 27 questions about the dentists, the system of intra-oral digital radiography, and the GDPs' experiences of and opinions on issues regarding image quality and quality control. The response rate to the questionnaire was 94%. Almost all, 92%, worked with charge-coupled device (CCD) and complementary metal oxide semiconductor (CMOS) sensors. Most GDPs were satisfied with their digital radiographic system. The majority (65%) experienced problems. Detector failure and trouble with the software were common. The GDPs wrote that they used lower exposure times in digital radiography than traditional film radiography. The estimated reduction in exposure time was said to be between 51% and 75%. Thirty-five per cent continued to use film parallel with digital radiography. The answers indicated that less than half of the equipment (40%) underwent quality control. Quality controls, when conducted, were undertaken once or twice a year, mainly by technicians from the companies that had sold the digital equipment. Based on the results of the questionnaire, there seems to be a need to improve the maintenance and the quality of digital radiography. It is also important that the GDPs become more aware of the problems that can occur when a new technique is introduced and that they develop the skills to handle these problems.

Attitude of Health Personnel↗
PubMed2005

Clinical evaluation of pulmonary nodules with dual-exposure dual-energy subtraction chest radiography.

PURPOSE: The purpose of this study was to assess the effect of dual-exposure dual-energy (DE) subtraction chest radiography with flat-panel detector. MATERIALS AND METHODS: One hundred patients underwent dual-exposure DE subtraction chest radiography and chest CT for evaluation of pulmonary nodules. Fifty-two patients with pulmonary nodules and 48 patients with normal lungs were selected for receiver operating characteristic (ROC) curve analysis. Ten radiologists who were unaware of the CT results evaluated chest radiography alone and chest radiography with DE subtraction images in the detection of pulmonary nodules. For each radiologist, we calculated the areas under the ROC curve (Az) for chest radiography alone and chest radiography with DE subtraction images. RESULTS: The average detectability of dual-exposure DE subtraction chest radiography was statistically significantly higher than that of chest radiography without subtraction images (mean Az value increased from 0.784 to 0.815, p<0.001). CONCLUSION: Dual-exposure DE subtraction chest radiography improves diagnostic accuracy of pulmonary nodules.

Adolescent↗
PubMed1996

Panoramic radiography in dental diagnostics.

Panoramic radiography was studied with the aim to answer some questions about technical and diagnostic properties regarding dental diagnostics. A unit with an intraoral X-ray tube was studied regarding radiation beam area, absorbed doses, and image quality for various screen-film combinations. The beam area for lateral views was wider than optimal and the contact dose high. Modifications of shielding cylinders would reduce both radiation beam and contact dose. One screen-film combination was most sensitive and produced radiographs with best subjectively perceived image quality. Agreement between panoramic (rotational and intraoral X-ray tube techniques) and intraoral radiography in diagnosis of periapical pathology, assessment of marginal bone height, and caries diagnosis was evaluated in 400 patients. Average agreement between panoramic and intraoral radiographs in periapical diagnosis was 55% for the rotational and 46% for the intraoral tube technique. Agreement in marginal bone height was 55% and 49%, respectively and in caries diagnosis 34% and 46%. Radiographs from 40 patients were used to evaluate a procedure starting with rotational panoramic radiography followed by intraoral radiographs considered necessary to achieve a comprehensive examination of teeth and surrounding bone. The number of intraoral radiographs, information loss, and monetary costs with this procedure were evaluated. Mean number of adjunct intraoral radiographs was 5.1 per patient whilst 8.5 should have been chosen to satisfy a "gold standard" used. Monetary costs were similar for an optimal combination of panoramic and intraoral radiography as for a survey with 20 intraoral images Sensitivity for a combination of radiographs was 80-96% in periapical diagnosis and marginal bone loss assessment, and 42-96% in caries diagnosis. Specificity was 95-97% for periapical and caries diagnosis and 50-92% for marginal bone loss. Radiographs from six conventional units and two programs ("dental" and "jaw" panorama) of a new multi-modal unit were compared in diagnostic quality of periapical and crestal bone areas. Number of adjunct intraoral radiographs to achieve a comprehensive evaluation of periapical and marginal bone was estimated. Quality of the "dental" panorama was significantly better than that of other machines/programs. There were no significant differences between images obtained with conventional units and the "jaw" panorama. Number of adjunct intraoral radiographs was lowest for the "dental" panorama. Quality obtained with an old unit was similar to that from modern machines. Rotational and intraoral X-ray tube panoramic radiography perform equally well. Agreement between panoramic and intraoral radiography is not sufficient for panoramic radiography to be used alone to diagnose periapical lesions, marginal bone loss and caries. It is possible to perform a full-mouth survey with a combination of panoramic and intraoral radiography but when limited regions need to be examined intraoral radiography is the method of choice.

Alveolar Bone Loss↗
PubMed2003

Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging.

OBJECTIVE: To determine the role of ultrasound and magnetic resonance imaging (MRI) compared with conventional radiography in the detection of chronic and acute inflammatory manifestations of rheumatoid arthritis (RA) of the shoulder joint. METHODS: Forty-three consecutive patients with known RA prospectively underwent clinical examination, radiography, ultrasound, and MRI of the shoulder joints. Each patient was assigned a clinical/laboratory score consisting of 7 parameters, including measurements of shoulder mobility, the erythrocyte sedimentation rate, and C-reactive protein level. Conventional radiography was standardized and performed in 2 planes. Ultrasound was performed in 10 predefined planes using a 7.5-MHz linear transducer. MRI at 1.5T comprised transverse and oblique coronal T1- and T2*-weighted fast spin-echo, gradient-echo (GRE), and inversion-recovery sequences with a matrix size of up to 512 pixels. A dynamic T1-weighted GRE sequence was acquired with intravenous administration of contrast medium. Erosions were assessed using all 3 imaging techniques on a 4-point scale. Soft-tissue involvement was evaluated according to the presence of synovitis, tenosynovitis, and bursitis on ultrasound and MRI. The results in the study group were compared with those obtained in a control group of 10 patients with shoulder pain. RESULTS: In the study group, erosions of the humeroscapular joint were detected by conventional radiography in 26 patients, by ultrasound in 30 patients, and by MRI in 39 patients; the differences were statistically significant for the comparisons of conventional radiography with MRI and for ultrasound versus MRI (P < 0.0001). Conventional radiography detected 12 erosions of the scapula and MRI detected 15. Synovitis was demonstrated in 12 patients by ultrasound and in 27 patients by MRI (P = 0.0003). Tenosynovitis was observed in 15 patients by ultrasound and in 28 patients by MRI (P = 0.0064). Bursitis was detected in 13 patients by ultrasound and in 18 patients by MRI. The findings on dynamic contrast-enhanced MRI correlated significantly with the detection of synovitis by ultrasound and erosions by static MRI (P < 0.05). CONCLUSION: Ultrasound and MRI supplement conventional radiography in assessing the shoulder joint. Although conventional radiography can be used as the sole method of following up known joint destruction in RA, ultrasound and, preferably, MRI are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results.

Adult↗
PubMed1983

High-yield radiography of the maxillofacial complex using the free focus and conventional imaging concepts. The resolution performance of nonscreen and screen-film combinations.

Free focus radiography with miniaturized dental x-ray machines may be a valuable source of "high-yield" diagnostic information in dentistry. This study evaluated the resolution performance of conventional image receptors, including nonscreen and screen-film combinations which were available in sizes suitable for panoramic free focus radiography or conventional extraoral radiography. Results with nonscreen films produced resolution performances ranging from about 10 lp/mm. to about 20 lp/mm. For each film tested, the performances in conventional radiography as well as in free focus radiography with the film in the buccal fold approached the maximum measurable of 20 lp/mm. In a mode of free focus radiography with the film positioned extraorally, there were significant variations in performance according to film brand. A significant reduction in resolution performance occurred when screen-film combinations were tested; resolution ranged between 4.0 lp/mm. and 7.4 lp/mm., with the better performance obtained with free focus radiography. The performance of a rare earth system was similar to other screen-film combinations tested in conventional radiography. In free focus radiography the performance of the rare earth system was slightly below the mean resolution for conventional screen-film combinations at 4.0 lp/mm. and 4.3 lp/mm. An example of a small cassette adapted for intraoral use was given.

Face↗
PubMed1992

Radiography of the carpal scaphoid. Experimental evaluation of "the carpal box" and first clinical results.

RATIONALE AND OBJECTIVES: The authors describe a new device ("the carpal box") for the radiographic detection of occult scaphoid fracture. METHODS: Fractures in the scaphoid of five cadaver specimens were mechanically produced. Subsequent examinations included conventional scaphoid radiography, multi-angle radiography, and radiography using the new device. The anatomic analysis of the specimens served as the standard for comparison. A pilot study was performed in six consecutive patients with suspected scaphoid fracture. RESULTS: Neither scaphoid radiography nor multi-angle radiography could confirm a fracture in two specimens, whereas all fractures were recognized on the carpal box radiographs. All scaphoid fractures were visualized by carpal box radiography, whereas scaphoid radiography was equivocal in one patient and negative in the other. CONCLUSIONS: Carpal box radiography may have additional value in the diagnosis of occult scaphoid fracture. This may lead to a reduction in costs and inconvenience for patients with clinically suspected scaphoid fracture and negative scaphoid radiography.

Carpal Bones↗
PubMed1997

Radiography for head trauma in children: what guidelines should we use?

OBJECTIVE: To audit the appropriateness of skill radiography in children attending an accident and emergency (A&E) department with head injuries. METHODS: 569 children presenting to a large teaching hospital A&E unit were retrospectively audited. The indications for radiography according to British published guidelines and American published guidelines were compared with the actual requests for radiography. The criteria for admission from the two guidelines were also compared with the actual admissions. RESULTS: 50% of children presenting with head injury actually had skull radiography. If British guidelines for the use of skull radiography had been complied with, 63% of children should have had radiography, but if American guidelines had been used, 18% would have required radiography. All the actual fractures identified were in this 18%. CONCLUSIONS: The British guidelines overinvestigate children with head injury. This seems to have been recognised clinically, and the doctors did not adhere to the guidelines. Neither did they adhere to the American guidelines, which would have resulted in a further reduction in radiography. All the fractures identified were covered by the American guidelines. The American guidelines for skull radiography can be safely used in a British A&E unit.

Adolescent↗
PubMed1997

Pulmonary complications in children with hematologic malignancies: accuracy of diagnosis with chest radiography and CT.

PURPOSE: To determine the diagnostic accuracy of chest radiography and computed tomography (CT) in patients with complications during treatment for hematologic malignancies. MATERIALS AND METHODS: CT scans were obtained 1 week or less before bronchoscopic sampling or biopsy in 48 pediatric patients (age range, 8 months to 18 years at diagnosis) undergoing treatment for leukemia, lymphoma, or myeloproliferative disease. Radiographs were obtained less than 1 week before CT. Pulmonary complications comprised fungal (n = 11), viral (n = 4), and bacterial (n = 5) pneumonias; cryptogenic organizing pneumonia ([COP] n = 4); and pulmonary tumor (n = 4). Chest radiographs and CT scans were rated independently by three radiologists who were unaware of these diagnoses. RESULTS: Satisfactory diagnostic accuracy, defined by the area under the receiver operating characteristic (ROC) curve, was noted for fungal pneumonia (radiography, ROC area = 0.82; CT, ROC area = 0.78), COP (radiography, ROC area = 0.75; CT, ROC area = 0.75), and pulmonary tumor (radiography, ROC area = 0.73; CT, ROC area = 0.83). Generalizability was good for fungal pneumonia (radiography, generalizability coefficient [GC] = 0.84; CT, GC = 0.84) and COP (radiography, GC = 0.75; CT, GC = 0.99). There was no statistically significant difference in diagnostic accuracy between radiography and CT for any of the diagnoses. CONCLUSION: Radiography and CT have satisfactory accuracies for fungal pneumonia and COP. For these conditions, CT identified more true-positive cases than did radiography.

Adolescent↗