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PubMed2002

[Report based on fiscal 2000 diagnostic x-ray equipment questionnaire survey(conditions of radiography)].

X-ray equipment has seen advances in inverters and the digitalization of reception systems. The X-ray Systems Study Group, in order to examine changes in the conditions of radiography, including pediatric radiography, variations in shortest irradiation time, and standardization of the conditions of radiography, carried out investigative research using a questionnaire survey that was sent to 400 facilities. The recovery rate was 33%. In terms of the reception system, half of the general radiography systems were using computed radiography (CR). Seventy percent of respondents used an intensifying screen and film(S EF)in stomach double-contrast radiography. About 80% used digital radiography (DR) and digital subtraction angiography (DSA) in aorta abdominalis angiography. At least 70% of high-voltage generators were of the inverter type. The conditions of radiography were not greatly influenced by changes in reception systems and X-ray equipment. Many pediatric radiographies were carried out by radiological technologists. We consider it useful to conduct such survey investigations.

Angiography, Digital Subtraction↗
PubMed1985

Diagnosis of reflux esophagitis. With special reference to double contrast radiography.

The correlation between radiography, endoscopy, and histology in the diagnosis of reflux esophagitis, as well as the effect of glucagon on double contrast radiography was studied. The material consisted of 220 out-patients sent to the Oulu University Central Hospital for upper gastrointestinal endoscopy. 109 of these were shown to have reflux esophagitis at endoscopy, the other 111 formed a control group with normal esophageal mucosa. Radiologic examinations were performed after endoscopy on the same day by a radiologist, who knew neither the clinical history of the patients nor the findings at endoscopy. Using endoscopy as a reference, 56% (28/50) of the patients with grade E I reflux esophagitis (erythema, oedema) were diagnosed correctly by double contrast radiography. The corresponding figures concerning grade E II (erosions), grade E III (localized deformity, ulcer), and grade E IV (stricture) reflux esophagitis were 84% (41/49), 100% (4/4), and 100% (6/6). False positive findings were found in 4.5% (5/111). The sensitivity of double contrast radiography as compared to endoscopy in all grades was 73%, its specificity was 96%, and accuracy 84%. The corresponding figures, when only grades E II, E III, and E IV are considered, were 86%, 96%, and 92%. In double contrast radiography, signs sometimes visible in grade E I reflux esophagitis were thick mucosal folds and mucosal granularity. Reliable signs of grade E II reflux esophagitis were streaks and dots of barium against the mucosa either alone or together with thick mucosal folds and mucosal granularity. Specific signs of grade E III and E IV reflux esophagitis were--along with the above--localized deformities, ulcers, and strictures. A hiatus hernia or wide hiatus was detected radiologically in 2/3 of the reflux esophagitis patients, and in 1/3 of the controls. Histologic findings correlated poorly with both endoscopic and radiologic findings. Single contrast radiography was less sensitive than double contrast radiography in detection of superficial mucosal lesions. Glucagon had no advantagous effect on esophageal double contrast radiography. Its use, however, in connection with double contrast radiography of the stomach is unlikely to have any disadvantagous effect on the evaluation of the hiatus and gastroesophageal reflux.

Adult↗
PubMed1997

Variation in emergency department use of cervical spine radiography for alert, stable trauma patients.

OBJECTIVE: To, assess the emergency department use of cervical spine radiography for alert, stable adult trauma patients in terms of utilization, yield for injury and variation in practices among hospitals and physicians. DESIGN: Retrospective survey of health records. SETTING: Emergency departments of 6 teaching and 2 community hospitals in Ontario and British Columbia. PATIENTS: Consecutive alert, stable adult trauma patients seen with potential cervical spine injury between July 1, 1994, and June 30, 1995. MAIN OUTCOME MEASURES: Total number of eligible patients, referral for cervical spine radiography (overall, by hospital and by physician), presence of cervical spine injury, patient characteristics and hospitals associated with use of radiography. RESULTS: Of 6855 eligible patients, cervical spine radiography was ordered for 3979 (58.0%). Only 60 (0.9%) patients were found to have an acute cervical spine injury (fracture, dislocation or ligamentous instability); 98.5% of the radiographic films were negative for any significant abnormality. The demographic and clinical characteristics of the patients were similar across the 8 hospitals, and no cervical spine injuries were missed. Significant variation was found among the 8 hospitals in the rate of ordering radiography (p < 0.0001), from a low of 37.0% to a high of 72.5%. After possible differences in case severity and patient characteristics at each hospital were controlled for, logistic regression analysis revealed that 6 of the hospitals were significantly associated with the use of radiography. At 7 hospitals, there was significant variation in the rate of ordering radiography among the attending emergency physicians (p < 0.05), from a low of 15.6% to a high of 91.5%. CONCLUSIONS: Despite considerable variation among institutions and individual physicians in the ordering of cervical spine radiography for alert, stable trauma patients with similar characteristics, no cervical spine injuries were missed. The number of radiographic films showing signs of abnormality was extremely low at all hospitals. The findings suggest that cervical spine radiography could be used more efficiently, possibly with the help of a clinical decision rule.

Adolescent↗
PubMed2005

Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma.

The purpose of the study was to evaluate the diagnostic value of pelvic radiography in the initial trauma series when compared to multidetector CT (MDCT) findings in serious blunt trauma. Inclusion criteria were blunt trauma and pelvic radiography in the initial trauma series, followed by a whole-body MDCT. A total of 1386 patients (874 male, 512 female, age 16-91 years, mean 41 years) met the inclusion criteria. Imaging studies were evaluated retrospectively by anatomical region and classified, when possible, using the Tile classification. Based on MDCT, a total of 629 injuries occurred in 226 (16%) of these 1386 patients. Radiography depicted 405 fractures in these 226 patients, giving an overall sensitivity of 55%. In 24 patients (11%) radiography was false-negatively normal. The sensitivity of radiography was mainly good in the anteroinferior parts of the pelvis, fair in the acetabulum and ileum, and poor in the posterior ring. By MDCT 141 (62%) patients were classified using the Tile classification and by radiography 133 patients (59%) were classified. MDCT and radiography showed the same type of pelvic injury in 72 patients (59%) and the subtype in 17 patients (14%). In 48 patients (40%) the pelvis was shown to be stable by radiography but unstable by MDCT. In conclusion, the sensitivity of pelvic radiography is low, and it is not reliable for determining if the pelvic injury is stable or not.

Adult↗
PubMed2006

Screening chest radiography: results from a Greek cross-sectional survey.

BACKGROUND: Public health authorities worldwide discourage the use of chest radiography as a screening modality, as the diagnostic performance of chest radiography does not justify its application for screening and may even be harmful, since people with false positive results may experience anxiety and concern. Despite the accumulated evidence, various reports suggest that primary care physicians throughout the world still prescribe chest radiography for screening. We therefore set out to index the use of chest radiography for screening purposes among the healthy adult population and to analyze its relationship with possible trigger factors. METHODS: The study was designed as a cross-sectional survey. Five thousand four hundred and ninety-nine healthy adults, coming from 26 Greek provinces were surveyed for screening practice habits in the nationwide anticancer study. Data were obtained for the use of screening chest radiography. Impact of age, gender, tobacco exposure, family history positive for malignancies and professional-risk for lung diseases was further analyzed. RESULTS: we found that 20% (n = 1099) of the surveyed individuals underwent chest radiography for screening purposes for at least one time during the previous three years. Among those, 24% do so with a frequency equal or higher than once yearly, and 48% with a frequency equal or higher than every three years. Screening for chest radiography was more commonly adopted among males (OR 1.130, 95% CI 0.988-1.292), pensioners (OR 1.319, CI 1.093-1.593) and individuals with a positive family history for lung cancer (OR 1.251, CI 0.988-1.583). Multivariate analysis confirmed these results. CONCLUSION: Despite formal recommendations, chest radiography for screening purposes was a common practice among the analyzed sample of Greek adults. This practice is of questionable value since the positive predictive value of chest radiography is low. The implementation of even a relatively inexpensive imaging study on a national scale would greatly burden health economics and the workload of radiology departments.

Adult↗
PubMed1991

Osteoarthritis of the knee: comparison of radiography, CT, and MR imaging to assess extent and severity.

Although conventional radiography is the method most frequently used for monitoring progression of osteoarthritis, it may not show osteoarthritic changes of the knee until late in the disease, and it may show involvement of only one or two compartments in patients who have tricompartmental disease. We compared radiography, CT, and MR imaging for assessing the extent and severity of osteoarthritis of the knee in 20 patients. Radiography included posteroanterior weight-bearing, true lateral, and sunrise patellar projections. Axial CT scans were reformatted in sagittal and coronal planes. MR imaging consisted of spin-echo (600-800/20; 2000/60, 120 [TR/TE]), and gradient-echo (600/30, theta = 30 degrees) sequences. The severity of osteoarthritic changes was graded from 0 to 3. MR frequently showed tricompartmental cartilage loss when radiography and CT showed only bicompartmental involvement in the medial and patellofemoral compartments. In the lateral compartment, MR showed a higher prevalence of cartilage loss (60%) than radiography (35%) and CT (25%) did. In the medial compartment, CT and MR showed osteophytes in 100% of the knees, whereas radiography showed osteophytes in only 60%. Notably, radiography often failed to show osteophytes in the posterior medial femoral condyle. On MR images, meniscal degeneration or tears were found in all 20 knees studied. Partial and complete tears of the anterior cruciate ligament were found in three and seven patients, respectively. MR is more sensitive than radiography and CT for assessing the extent and severity of osteoarthritic changes and frequently shows tricompartmental disease in patients in whom radiography and CT show only bicompartmental involvement. MR imaging is unique for evaluating meniscal and ligamentous disease related to osteoarthritis.

Adult↗
PubMed2001

The Canadian C-spine rule for radiography in alert and stable trauma patients.

CONTEXT: High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine (C-spine) radiography in alert and stable trauma patients. OBJECTIVE: To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients. DESIGN: Prospective cohort study conducted from October 1996 to April 1999, in which physicians evaluated patients for 20 standardized clinical findings prior to radiography. In some cases, a second physician performed independent interobserver assessments. SETTING: Ten EDs in large Canadian community and university hospitals. PATIENTS: Convenience sample of 8924 adults (mean age, 37 years) who presented to the ED with blunt trauma to the head/neck, stable vital signs, and a Glasgow Coma Scale score of 15. MAIN OUTCOME MEASURE: Clinically important C-spine injury, evaluated by plain radiography, computed tomography, and a structured follow-up telephone interview. The clinical decision rule was derived using the kappa coefficient, logistic regression analysis, and chi(2) recursive partitioning techniques. RESULTS: Among the study sample, 151 (1.7%) had important C-spine injury. The resultant model and final Canadian C-Spine Rule comprises 3 main questions: (1) is there any high-risk factor present that mandates radiography (ie, age >/=65 years, dangerous mechanism, or paresthesias in extremities)? (2) is there any low-risk factor present that allows safe assessment of range of motion (ie, simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness)? and (3) is the patient able to actively rotate neck 45 degrees to the left and right? By cross-validation, this rule had 100% sensitivity (95% confidence interval [CI], 98%-100%) and 42.5% specificity (95% CI, 40%-44%) for identifying 151 clinically important C-spine injuries. The potential radiography ordering rate would be 58.2%. CONCLUSION: We have derived the Canadian C-Spine Rule, a highly sensitive decision rule for use of C-spine radiography in alert and stable trauma patients. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ED use of C-spine radiography.

Adult↗
PubMed1995

Diagnostic approach to reflex sympathetic dystrophy after fracture: radiography or bone scintigraphy?

The aim of this paper was to compare the value of bone scintigraphy and radiography in the early diagnosis of post-fracture reflex sympathetic dystrophy (RSD). Thirty-seven adult patients with post-fracture RSD (28 in the first and nine in the second clinical stage of RSD), as well as seven patients with fracture but without RSD (control group), were investigated by radiography and bone scintigraphy. All of them were immobilized (duration of immobilization: 4-22 weeks). In 21 persons three phase bone scintigraphy was performed. The best distinction between the control group and the RSD patients was achieved by delayed bone scintigrams. The sensitivity (97%), positive predictive value (97%) and accuracy (95%) of delayed bone scintigraphy were very high compared to the values for radiography, which were 73%, 90% and 70% respectively. Bone scintigraphy also displayed higher specificity (86%) and negative predictive value (86%) than radiography (57% and 29% respectively). In the first clinical stage the difference between the accuracy of bone scintigraphy (97%) and radiography (63%) was greater than for the whole group. In the second stage of RSD the accuracy of bone scintigraphy (86%) and radiography (81%) was similar. Three-phase bone scintigraphy is not necessary for the diagnosis of post-fracture RSD: it is sufficient to perform delayed bone scintigraphy. It is concluded that bone scintigraphy is to be preferred to radiography for the early diagnosis of post-fracture RSD in the first clinical stage. In the second stage the diagnostic capabilities of bone scintigraphy and radiography are more comparable.

Adult↗
PubMed2006

Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography.

PURPOSE: The purpose of this study was to determine the role of plain chest radiography in the evaluation of patients with suspected foreign-body aspiration. MATERIALS AND METHODS: During a 5-year period, 31 patients (18 men and 13 women; age range 6 months to 85 years) were referred to our observation for clinical suspicion of foreign-body aspiration. Clinically, the patients presented with cough in 27/31 cases (87.1%), decreased breath sounds in 22/31 (71%), choking in 18/31 (58.1%), fever in 7/31 (22.6%) and cyanosis in 5/31 (16.1%). Suspected foreign-body aspiration had occurred 2-72 h before hospitalisation. Within 2 h of hospitalisation, all patients underwent plain chest radiography performed in the upright position (two projections) in 10/31 (32.3%) patients and in the supine decubitus position in the remaining 21 (67.7%) patients. Plain chest radiography was subsequently integrated with multislice computed tomography (MSCT) of the chest in 3/31 (9.7%) patients and with bronchoscopy in 27/31 (87.1%) patients. RESULTS: Plain chest radiography showed the presence of a foreign body in the tracheobronchial tree in 7/31 (22.6%) patients, who subsequently underwent successful bronchoscopy in all cases. Foreign bodies included tooth fragment (three cases), nail (two cases), metallic spiral of a ball-point pen (one case) and an earring (one case). In the remaining 24/31 patients, plain chest radiography was positive in 14 cases, showing atelectasis (seven cases), pneumonia (six cases), pulmonary hyperinflation (one case) and pneumomediastinum (one case). Such findings had been caused by an aspirated foreign body, which was subsequently removed by means of bronchoscopy in all 14 patients. Moreover, three of the remaining ten patients with negative plain chest radiograph were submitted to MSCT of the chest, which required in 1 case tracheobronchial aspiration of a foreign body that was subsequently removed by means of bronchoscopy. Overall, plain chest radiography showed the presence of foreign-body aspiration and/or pleuroparenchymal lesions in 21/31 patients (67.7%); bronchoscopy was positive in 23/27 patients (85.2%), localising the foreign body in the right main bronchus in 16/27 patients (59.3%), left main bronchus in 7/27 patients (25.9%), intermediate bronchus in 2/27 patients (7.4%) and right lower lobe bronchus in 2/27 patients (7.4%). No late complications were observed within 6 months of hospital discharge. CONCLUSIONS: Plain chest radiography remains the initial imaging modality for patients with clinically suspected tracheobronchial aspiration of a foreign body. Nevertheless, in the case of negative chest radiography and a clinical suspicion of foreign-body aspiration, MSCT-possibly integrated with virtual bronchoscopy-should be considered in order to avoid unnecessary bronchoscopy.

Adolescent↗
PubMed1989

The role of yearly chest radiography in the early detection of lung cancer following oral cancer.

In a study of 213 patients with oral cancer, we investigated the incidence and prognosis of lung malignancies in patients offered a yearly chest radiography in the follow-up. Three conclusions can be drawn. (1) Metastatic or primary lung cancer was diagnosed in 22 (10.3%) patients. The 2-year actuarial incidence rate of lung cancer following cancer of the oral cavity is 13%. No new lung cancers were detected after 2 years follow-up. This suggests that after this period, yearly chest radiography may be superfluous for the early detection of lung cancer. (2) The survival rate of patients with a lung malignancy following cancer of the oral cavity is poor (1-year = 25%). The survival rate of patients detected by the yearly chest radiography without symptoms is higher than for patients detected after symptoms (p = 0.006). It is not clear to what extent this different survival rate is biased by lead-time and selection of patients with a favourable prognosis. A randomized study would be required to assess whether patients with oral cancer do benefit from the yearly chest radiography compared with no regular chest radiography. (3) Of 22 patients with lung cancer, 13 (59%) were detected by chest radiography without symptoms. In the first year following oral cancer, 11 patients were diagnosed with lung cancer. Only 4 of these 11 patients (36%) were detected by chest radiography in an asymptomatic stage. The detection of patients with lung cancer in an asymptomatic stage may be increased by more frequent chest radiography examinations in the 1st year following oral cancer.

Adult↗
PubMed2002

Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community.

BACKGROUND: Recent studies suggest that chiropractors continue to widely use radiography for assessing patients with acute low back pain. This practice is contrary to growing evidence that suggests only a small percentage of patients with acute low back pain require radiographic evaluation. OBJECTIVES: To assess quantitatively and qualitatively the views of chiropractors in a selected community in Ontario on the use of radiography for evaluating patients with acute low back pain. STUDY DESIGN: Mailed surveys and focus group interview. METHOD: Surveys were mailed to all chiropractors (N = 26) in a selected community in Ontario, followed by a focus group session with local chiropractors (n = 7). Surveys requested information on personal and practice characteristics and the management of low back pain, including the use of radiography. The focus group, led by a facilitator, discussed issues surrounding practice guidelines and radiography use. RESULTS: There was a 76% response rate to the mailed surveys. Of those who responded, 63% stated they would use radiography on patients with uncomplicated acute low back pain lasting 1 week; 68% stated that radiographs were useful in the diagnostic evaluation of patients with acute low back pain lasting less than 1 month. Most reasons given for use of radiography in this patient population are not supported by existing evidence. CONCLUSIONS: There appears to be a high rate of radiographic use by chiropractors in the study community, which is consistent with findings in previous studies. Many of the reasons given for use of radiography are not supported by existing evidence and may contribute to the gap between current chiropractic practice and available evidence with respect to use of radiography for acute low back pain.

Acute Disease↗
PubMed2000

US versus conventional radiography in the diagnosis of sternal fractures.

PURPOSE: To investigate the value of ultrasonography (US) in the diagnosis of sternal fractures. MATERIAL AND METHODS: Twenty-three patients (mean age 35.4 years) with a clinical suspicion of sternal fracture after blunt chest trauma were retrospectively reviewed. At admission, a.p. and lateral chest radiographies and sternal US were obtained. Sternal fractures were classified as nondisplaced or displaced. US and conventional radiographic findings were compared. RESULTS: In 3/23 (13.0%) of the patients, no fracture was found by radiography or by US. Both radiography and US demonstrated sternal fractures in 16/23 (69.6%) of the patients. Sternal fractures were detected only by US while the conventional radiography was negative in 2/23 (8.7%) cases. Also in 2/23 (8.7%) of the patients with US positive for fracture, radiographies were suspicious. In 2 patients, the degree of fracture displacement on US was lesser than that found by radiography. CONCLUSION: US was better than lateral radiography to diagnose sternal fractures; however, conventional radiography remains the standard means of demonstrating grade of displacement.

Adolescent↗
PubMed2004

Can computed tomography scout radiography replace plain film in the evaluation of patients with acute urinary tract colic?

PURPOSE: To determine the sensitivity of computed tomography (CT) scout view in detecting ureteral stones and whether CT scout radiography can replace plain film in the evaluation of patients with acute urinary tract colic. MATERIAL AND METHODS: Between January 2000 and 2002, 110 patients with ureterolithiasis were prospectively evaluated for the detection of ureteral stones on CT scout radiographs. The findings were compared with those of plain films. All patients were examined with plain film, CT scout radiography, and unenhanced helical CT. CT scans were performed within 24 h of plain films. Each CT scout radiograph was interpreted without knowledge of the findings on plain film. RESULTS: 111 stones were detected by unenhanced helical CT. Mean stone size was 3.9 mm (range 1-10 mm). Of all stones, 57 (52%) were visible on plain film; 44 (40%) were seen on CT radiographs. The sensitivity of 79 small stones (< 5 mm) on CT scout radiography was 29% and of abdominal radiography 37%. For 32 big stones (> 5 mm), the sensitivity of CT scout radiography was 66% and of abdominal radiography 87.5%. CONCLUSION: In this study, plain film was more sensitive than CT scout radiography in revealing ureteral calculi. However, the detection of stones 5 mm or larger had a sensitivity of 66% on CT scout radiographs; 77% (44/57) of the stones visible on plain films were also seen on CT scout radiographs. We therefore believe that CT scout radiography can be used as a baseline study in most patients with big ureteral stones.

Acute Disease↗
PubMed1997

Radiography and bone scintigraphy in bone marrow transplant multiple myeloma patients.

PURPOSE: To compare conventional radiography and bone scintigraphy in relation to clinical outcome in bone marrow transplant multiple myeloma patients. MATERIAL AND METHODS: A total of 70 radiographies and 70 bone scintigraphies were compared in 35 patients. RESULTS: The skull, the extremities, the iliac and public bones were better assessed with radiography. For new vertebral lesions and for lesions in the ribs and sternum, bone scintigraphy proved superior. For the sacrum, the methods were equal. When bone scintigraphy was used as a complement to radiography, 4% more pathological sites were found. No patient had both a normal radiography and a pathological bone scintigraphy, but 5 patients had both a normal bone scintigraphy and a pathological radiography. The results of the radiological examinations did not always correlate with the clinician's grading of the patient's disease. The radiological examinations had no prognostic value for the 7 patients examined on several occasions. CONCLUSION: The ability of conventional radiography and bone scintigraphy to disclose myeloma lesions varies, depending on location and size of the lesions. Radiography should remain the primary examination modality also for bone marrow transplant multiple myeloma patients. Bone scintigraphy can serve as a complement for investigating unexplained pain, e.g. caused by lesions in vertebrae or ribs.

Adult↗
PubMed2004

Empirical treatment followed by a test-and-treat strategy is more cost-effective in comparison with prompt endoscopy or radiography in patients with dyspeptic symptoms: a randomized trial in a primary care setting.

OBJECTIVE: Management of patients with dyspepsia remains controversial. No consensus has yet been reached concerning diagnostic and medical strategies. We conducted a randomized trial to assess the effectiveness of three management strategies for patients with uninvestigated persistent dyspeptic symptoms. METHODS: A total of 199 patients presenting in primary care with dyspeptic symptoms (age 18-65 years, no alarming symptoms) were randomized to either empirical treatment with omeprazole and, in the case of symptomatic relapse, serological Helicobacter pylori infection testing plus eradication therapy (treat-and-test group), prompt upper gastrointestinal endoscopy (endoscopy group) or prompt upper gastrointestinal radiography (radiography group) followed by directed medical treatment. Symptoms, patients' satisfaction and use of resources were recorded during 6 months of follow-up. RESULTS: Sixty-nine patients were assigned to the treat-and-test group, 64 to the radiography group and 66 to the endoscopy group. The median age was 44 years; 104 patients were male and 37% were H.pylori infected. A total of 170 patients (85%) returned the 6 months questionnaire. The numbers of patients with complete symptom relief in the treat-and-test group, endoscopy group and radiography group were 21, 16 and 15, respectively, at 3 months (P = 0.59), and 23, 13 and 12, respectively, at 6 months (P = 0.05). Twenty-two patients in the treat-and-test group underwent endoscopy or radiography. Two patients in the endoscopy group and four patients in the radiography group underwent more than one diagnostic test. The average medical cost per patient for the treat-and-test group was euro 276, for the endoscopy group euro 426 and for the radiography group euro 321, respectively. CONCLUSION: Empirical treatment followed by a test-and-eradicate strategy resulted in fewer diagnostic tests, more symptom relief and lower medical costs compared with prompt upper gastrointestinal radiography or endoscopy in the management of uninvestigated patients with persistent dyspeptic symptoms.

Adult↗
PubMed1997

Selection of the most accurate method of conventional radiography for the assessment of periodontal osseous destruction.

The purpose of the present study was to compare the radiographic measurements of periodontal osseous destruction with the surgical measurements, which represent the true value of osseous destruction, and to select the most successful method of conventional radiography in detecting and accurately assessing periodontal osseous destruction. A total of 5072 proximal surfaces in 2536 teeth of 100 patients with periodontitis were evaluated surgically during periodontal flap surgery and radiographically by using periapical and panoramic radiography. Comparative evaluation of the measurements obtained by these 3 different methods of osseous destruction assessment revealed the following. (1) The radiographic detection ability of small osseous destruction (1-4 mm) was very low for both methods of assessment and became even lower for the initial osseous destruction (1 or 2 mm). (2) Periapical radiography was more successful than panoramic in the detection of osseous destruction, especially of the small destruction (4.7x). (3) Panoramic radiography underestimated the osseous destruction, whereas periapical radiography was relatively accurate in the osseous destruction assessment. (4) Periapical radiography was more accurate in the osseous destruction assessment than panoramic, regardless of the location of the dental surfaces (jaw, tooth group, mesial or distal) and the degree of osseous destruction. (5) The deviation of the radiographic measurements of osseous destruction from the surgical measurements, as well as the difference between the two radiographic methods, depended on the jaw location, the tooth group and the degree of osseous destruction. (6) The radiographic assessment of osseous destruction underestimated the osseous destruction in initial periodontitis, it was relatively accurate in moderate periodontitis, but overestimated it in severe periodontitis. The radiographic measurements of osseous destruction deviated least from the surgical measurements in the group of moderate periodontitis and most in that of severe osseous destruction. (7) The 2 radiographic methods agreed most in the assessment of osseous destruction in the severe periodontitis group and least in the initial periodontitis group. (8) The indirect Schei method was less successful in detecting the small osseous destruction and less accurate in assessing the osseous destruction than the direct millimetric method of radiographic evaluation. (9) The osseous destruction as assessed from periapical radiographs by the Schei method was not significantly different from that assessed by the radiopaque Fixot-Everett grid. The results of the present study suggest that periapical radiography is more successful in detecting periodontal osseous destruction and more accurate in assessing it than panoramic radiography.

Adolescent↗
PubMed1994

Comparison of periapical and detailed narrow-beam radiography for diagnosis of periodontal pathology.

The diagnostic performance of the detailed narrow-beam (DNB) technique of the Scanora multimodal X-ray system was compared with periapical radiography for detecting periodontal pathology. In total, 253 sites in 133 patients were examined. Receiver operating characteristics (ROC) of both imaging modalities were analyzed in relation to the ratings of five observers for the whole dentition, three dental regions and five types of periodontal lesion. ROC analysis demonstrated that the overall diagnostic performance of DNB radiography was better (P < 0.05) than that of periapical radiography. DNB radiography was significantly superior (P < 0.01) for detecting marginal widening of periodontal membrane space, but there was no significant difference between the two techniques for crestal erosion, vertical bone loss, furcation involvement or calculus. The regional differences found in overall diagnostic performance of the two imaging modalities were not significant. The sensitivity for periapical radiography was 71% and for DNB radiography 85%, and the specificities 82% and 81% respectively. It is concluded that DNB radiography is a good radiographic examination for periodontal disease, and an acceptable alternative to periapical radiography.

Adult↗
PubMed1998

The yield of CT of children who have complicated pneumonia and noncontributory chest radiography.

OBJECTIVE: Our purpose was to investigate the usefulness of CT in evaluating children who do not respond appropriately to treatment for pneumonia, when chest radiography is noncontributory. MATERIALS AND METHODS: Fifty-six contrast-enhanced CT scans were compared with radiographs obtained on the same day in children with complicated pneumonia. CT scans were evaluated for clinically significant findings that were not revealed by radiography: lung parenchymal complications (cavitary necrosis, abscess, decreased enhancement, bronchopleural fistula, or cavity suspected on radiography but not seen on CT), pleural complications (loculation, malpositioned chest tube), inaccurate estimation of cause of chest opacity on radiography (pleural versus parenchymal), bronchial obstruction, or pericardial effusion. RESULTS: One hundred ten CT findings, not revealed by radiography, were seen on 56 CT scans (2.0 per CT scan): parenchymal complications (n = 40), pleural complications (n = 37), inaccurate estimation of cause of chest opacity on radiography (n = 20), pericardial effusion (n = 13). All CT scans showed at least one significant finding (100% yield) not seen on radiography. CONCLUSION: In the evaluation of children with complicated pneumonia, CT often reveals clinically significant findings not apparent on radiography.

Child↗