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PubMed1993

Guidelines for the selective ordering of admission chest radiography in adult obstructive airway disease.

STUDY OBJECTIVE: To validate previously developed guidelines for the selective use of chest radiography in adults admitted for exacerbation of obstructive airway disease. DESIGN: Prospective, observational cohort study using criteria developed in a previous retrospective study. PARTICIPANTS: Unselected convenience sample of 128 adults with obstructive airway disease who did not respond to standard emergency department treatment and required admission. SETTING: Municipal hospital ED and inpatient medical service. INTERVENTIONS: Patients were categorized as "complicated" or "uncomplicated" according to previously developed criteria. Management was recorded as altered if the patient's physician answered the question, "Did the chest radiography alter your management of this patient?" affirmatively. RESULTS: Of 27 patients whose management was altered by the chest radiography, 26 were classified as complicated, for a sensitivity of 96% (95% confidence interval [CI], 81, 100). One of 44 admissions classified as uncomplicated had management altered by the chest radiography (negative predictive value, 98%, 95% CI, 88, 100). This chest radiography was later reread as normal. Classification as an uncomplicated patient with obstructive airway disease was strongly associated with either a normal chest radiography or a radiographic finding that was clinically unimportant (P = .0002). CONCLUSION: Patients with acute exacerbation of obstructive airway disease who are otherwise uncomplicated do not benefit from routine admission chest radiography. The use of this simple clinical strategy would safely reduce the number of chest radiographs by about one-third in this and similar patient populations, decreasing both health care costs and exposure to ionizing radiation.

Adolescent↗
PubMed1998

Comparative assessment of digital and analog radiography: diagnostic accuracy, cost analysis and quality of care.

OBJECTIVE: The aim of this study was to compare digital and conventional radiography for diagnostic accuracy, direct costs, and quality of care. MATERIALS AND METHODS: Diagnostic accuracy was assessed by a critical review of the literature on sensitivity, specificity and ROC analysis of these imaging techniques and by a survey with a panel of radiologists. Direct costs and quality of care were evaluated with a before/after study of the implementation of digital radiography in a Department of Radiology in 'Hospices Civils de Lyon' (France). We included 292 patients and measured duration of examinations and direct costs of equipment, films, maintenance and depreciation. To evaluate any changes in working conditions and patient management, a questionnaire was filled out by the staff of the department. RESULTS: Diagnostic accuracy with digital radiography was equivalent to that of conventional radiography but there were wide variations depending on the type of examination. In 1993, although digital radiography resulted in savings of FF 18,000 including tax (US$ 3600) on film consumption for 1 year of examinations, there was a global additional cost of FF 253,000 (US$ 50,600) for maintenance and depreciation. Results showed a nonsignificant tendency to reduced procedure times for all examinations. Working conditions improved, including greater availability for the patient, improved safety, and increased job interest. CONCLUSION: Digital radiography can be introduced into a large hospital to improve patient and staff conditions, at a higher cost than analog radiography, and depending on the type of examinations performed by the radiology department.

Cost Savings↗
PubMed1996

Effective dose and risk assessment from detailed narrow beam radiography.

Studies of the effectiveness of commonly used imaging techniques have shown that they are less than optimal in revealing oral disease. The diagnostic accuracy of detailed narrow beam radiography (scanography) has been reported to be significantly better than intraoral periapical radiography for the observation of periodontal pathoses and at least as good as periapical radiography for detecting periapical lesions. The purpose of this study was to calculate and compare the effective doses and risk estimates from the use of detailed narrow beam radiography and intraoral radiography. With the use of a tissue equivalent human phantom and thermoluminescent dosimetry, the effective dose from detailed narrow beam radiography was found to vary from 5 to 35 microSv depending on the anatomic location of the image layer and intraoral radiography from 9 to 150 microSv depending on the type of survey. Effective doses of these magnitudes represent 0.6 to 18.8 days of equivalent natural radiation exposure and a probability for stochastic effects on the order of 0.37 to 10.95 x 10(-6).

Humans↗
PubMed2002

The emergency department: an appropriate referral rate for radiography.

AIM: To evaluate the hypothesis that where there is good clinical practice in an emergency department (ED), there is a low uptake of plain radiography. MATERIALS AND METHODS: Emergency notes and radiography records were reviewed over one week in January 1999, to determine the rate of radiography of first time attenders at the North Staffordshire NHS Trust. The clinical appropriateness of the imaging was assessed by pairs of radiology specialist registrars and casualty physicians. They judged the appropriateness of the imaging by the 1998 Royal College of Radiologists (RCR) guidelines and/or their clinical judgement, by consensus. Where there was no consensus or the data appeared incomplete, the radiology and ED consultant reviewed the notes. RESULTS: A total of 1615 notes were found out of 1643 (98%). Of these, 147 (9%) return attenders were excluded and 32 patients left without being seen. The number of first time attenders was 1436 (87%), of whom 637 (44%) were radiographed; 95% of these radiography examinations were appropriate and 5% were inappropriate. Of the first time attenders who were not radiographed the decision was appropriate in 95% of cases, and inappropriate for 5%, i.e. 5% of those who had no radiography, should have been X-rayed. There were no disagreements between RCR guidelines and the clinical judgements, but in 16% there were no suitable RCR guidelines. Junior doctors were not always able to find the relevant RCR guideline (relevant clinical guideline found in 73% of cases) in the guideline book, compared to the consultants (relevant clinical guideline found in 84% of cases). CONCLUSION: The application of the RCR guidelines is taken as representing good clinical practice in determining when to refer a patient for radiography. Based on this assumption, a referral rate for radiography of 44% of first time attenders was found to be appropriate. This referral rate can be taken as a benchmark. A benchmark is necessary in order to allow departments to make a local assessment as to whether their local referral rate is likely to be too high or too low.

Clinical Competence↗
PubMed1998

Costs of plain-film radiography in a partially digitized radiology department. An activity-based cost analysis.

PURPOSE: The aim of the study was to analyse the costs of computed radiography (CR) as part of a small picture archiving and communication system (mini-PACS), and to compare these costs with those of conventional analogue radiography using activity-based accounting (ABC). MATERIAL AND METHODS: The study was conducted at the Central Hospital of Vaasa where in 1993 the Radiology Department acquired a mini-PACS with a CR reader, a chest CR unit, and a CT unit as digital image processing modalities. Of altogether 34140 plain-film examinations, 3/4 were made with CR and stored mostly on film, and 1/4 were made with conventional analogue radiography. The costs and activities of these two modes were analysed by means of the ABC method which identifies and allocates indirect costs in radiological procedures. RESULTS: The costs of CR imaging were 9% higher than those of conventional radiography. The costs of the chest CR unit were equal to those of conventional radiography. The difference was due to higher investment costs in digital image processing. The time gained from a reduction in the number of retakes did not shorten the time spent by patients in the examination room, and its effect on film costs was minimal. CONCLUSION: In planning the step-by-step transition of conventional film-based analogue radiography to fully digitized radiography, it should be noted that films are still used in the transition period and that this is associated with higher costs than in the previous system of conventional analogue plain-film imaging.

Costs and Cost Analysis↗
PubMed1997

Interpretation and utility of traction radiography in scoliosis surgery. Analysis of patients treated with Cotrel-Dubousset instrumentation.

STUDY DESIGN: An analysis of a standardized method of traction radiography for the evaluation of reducibility of scoliosis. OBJECTIVES: To determine whether and how preoperative fraction radiography can provide objective information and to compare traction radiography with supine side-bending radiography. SUMMARY OF BACKGROUND DATA: Flexibility of scoliosis deformity remains an arbitrary concept. No objective method of preoperative evaluation of reducibility has been established. METHODS: The utility of a standardized method of traction radiography was evaluated in 74 patients with idiopathic scoliosis who were aged 14-22 years and treated with Cotrel-Dubousset instrumentation. RESULTS: In thoracic curves, the postoperative Cobb angle was highly correlated with the preoperative Cobb angle in traction (r = 0.82). However, such correlation was much lower with lumbar curves (r = 0.54). The reducibility of the thoracic curve by traction as expressed by the ratio to the original curve was dependent on the magnitude of the original curve (P = 0.005), and this parameter proved less informative than the absolute angle values. Time-related analysis of 30 patients who were observed for more than 5 years revealed that the high correlation between the preoperative angle of thoracic curves in traction and their postoperative angle decreased with the follow-up time (r = 0.80-0.65). A comparison of traction radiography and supine side-bending radiography showed that these two tests were practically equivalent in terms of evaluating the reducibility of curves. CONCLUSION: The results provide an objective interpretation of traction radiographs for scoliosis.

Adolescent↗
PubMed2002

Cost-effectiveness of lumbar spine radiography in primary care patients with low back pain.

STUDY DESIGN: Fifty-two practices in the East Midlands, United Kingdom, were included. OBJECTIVES: To test the hypothesis that referral for lumbar spine radiography is cost-effective in primary care patients with low back pain of at least 6 weeks' duration compared with usual care in which referral is not routine. SUMMARY OF BACKGROUND DATA: Lumbar spine radiography is commonly used in the management of low back pain, although the yield of findings that alter clinical management is low. Evidence is needed on the cost-effectiveness of lumbar spine radiographs in patients with low back pain. METHODS: A prospective economic analysis alongside a randomized controlled trial was used. Outcomes included the Roland disability score, pain, health status scale, EuroQol, satisfaction, direct health care costs (primary, secondary, and community care; prescribed and over-the-counter medicines; special equipment), and indirect costs (informal care, extra expenses, welfare benefits, loss of earnings and productivity). RESULTS A total of 210 participants were randomly assigned to lumbar spine radiography, and 211, to usual care. At 9 months' postrandomization, no difference between the groups was found in any health outcomes other than satisfaction. The intervention group had a higher overall satisfaction score (21 19, < 0.01). The intervention group had higher direct costs (150 pounds sterling vs 109 pounds sterling, < 0.01). Cost-effectiveness analysis shows that patient satisfaction can be increased using lumbar radiography but at an additional cost (point estimate 20 pounds sterling per point on satisfaction scale). The simulated distribution based on trial data shows that only when a 1-point increase in satisfaction is valued at more than 50 pounds sterling can it be claimed that radiography is cost-effective in these terms (incremental net monetary benefit mean = 116 pounds sterling, 95% CI pound 7, 225 pounds sterling). CONCLUSIONS: Radiography is likely to be cost-effective only when satisfaction is valued relatively highly. Strategies to enhance satisfaction for patients with low back pain without using lumbar radiography should be pursued.

Adult↗
PubMed1998

Emergency physicians' attitudes toward and use of clinical decision rules for radiography.

OBJECTIVES: 1) To assess Canadian emergency physicians' (EPs') use of and attitudes toward 2 radiographic clinical decision rules that have recently been developed and to identify physician characteristics associated with decision rule use; 2) to determine the use of CT head and cervical spine radiography by EPs and their beliefs about the appropriateness of expert recommendations supporting the routine use of these radiographic procedures; and 3) to determine the potential acceptance of clinical decision rules for CT scan in patients with minor head injury and cervical spine radiography in trauma patients. METHODS: A cross-sectional anonymous mail survey of a random sample of 300 members of the Canadian Association of Emergency Physicians using Dillman's Total Design Method for mail surveys. RESULTS: Of 288 eligible physicians, 232 (81%) responded. More than 95% of the respondents stated they currently used the Ottawa Ankle Rules and were willing to consider using the newly developed Ottawa Knee Rule. Physician characteristics related to frequent use of the Ottawa Ankle Rules were younger age, fewer years since graduating from medical school, part time or resident employment status, working in a hospital without a CT scanner, and believing that decision rules are not oversimplified cookbook medicine or too rigid to apply. Eighty-five percent did not agree that all patients with minor head injuries should receive a CT head scan and only 3.5% stated they always refer such patients for CT scan. Similarly, 78.5% of the respondents did not agree that all trauma patients should receive cervical spine radiography and only 13.2% said they always refer such patients for cervical spine radiography. Ninety-seven and 98% stated they would be willing to consider using well-validated decision rules for CT scan of the head and cervical spine radiography, respectively. Fifty-two percent and 67% of the respondents required the proposed CT and C-spine to be 100% sensitive for identifying serious injuries, respectively. CONCLUSIONS: Canadian EPs are generally supportive of clinical decision rules and, in particular, have very positive attitudes toward the Ottawa Ankle and Knee Rules. Furthermore, EPs disagree with recommendations for routine use of CT head and cervical spine radiography and strongly support the development of well-validated decision rules for the use of CT head and cervical spine radiography. Most EPs expected the latter rules to be 100% sensitive for acute clinically significant lesions.

Adult↗
PubMed2003

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study.

BACKGROUND: General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. METHODS: Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. RESULTS: The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. CONCLUSIONS: Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.

Adult↗
PubMed1982

Radiography and bone scintigraphy in multiple myeloma: a comparative analysis.

The sensitivity of radionuclide imaging for detecting skeletal lesions was compared with that of radiography by evaluating 573 different anatomical sites in 41 patients with multiple myeloma. Radiography revealed a significantly greater number of myeloma-related bone lesions than did radionuclide imaging. Of the 179 myeloma-related bone lesions detected when both techniques were applied, 163 were seen by radiography and 82 by radionuclide imaging. Ninety-seven lesions were detected by radiography alone and 16 lesions seen by scintiscanning only, yielding a sensitivity of 91% for the former and of 46% for the latter technique. Radionuclide imaging proved superior to radiography only occasionally in the rib cage, and rarely in other anatomical sites. These findings suggest that radiography is the method of first choice in obtaining a skeletal survey in patients with multiple myeloma. In cases with continued pain, unexplained by standard radiography, the skeletal survey should be supplemented by tomography and radionuclide imaging.

Bone and Bones↗
PubMed2005

Filmless imaging: the uses of digital radiography in dental practice.

BACKGROUND: As use of digital radiography becomes more common, many dentists are wondering if and how they can replace conventional film-based imaging with a digital system. This article briefly describes the different technologies used for digital radiography in dentistry. The article provides general practitioners with a broad overview of the benefits and limitations of digital radiography to help them understand the role the technology can play in their practices. OVERVIEW: The two technologies now available are solid-state systems and phosphor plate systems. Each has its strong points, and the choice of which to use depends on the type of dental practice. Image processing improves the diagnostic quality of the radiographic information. Advanced image-processing techniques, such as subtraction radiography, are available for specialized clinics. CONCLUSIONS AND CLINICAL IMPLICATIONS: Digital radiography no longer is an experimental modality. It is a reliable and versatile technology that expands the diagnostic and image-sharing possibilities of radiography in dentistry. Optimization of brightness and contrast, task-specific image processing and sensor-independent archiving are important advantages that digital radiography has over conventional film-based imaging.

General Practice, Dental↗
PubMed2007

Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography.

OBJECTIVE: The purpose of this study was to prospectively evaluate the accuracy of transthoracic sonography in the detection of pneumothorax after transthoracic sonographically guided lung biopsy. SUBJECTS AND METHODS: Transthoracic sonography was performed on 285 patients after transthoracic sonographically guided lung biopsy. Disappearance of the sliding lung and comettail artifacts and appearance of reverberation artifacts were considered evidence of pneumothorax. Upright chest radiography was performed within 30 minutes of transthoracic sonography. If a discrepancy between transthoracic sonographic and chest radiographic findings occurred, CT was performed. When it was diagnosed, pneumothorax was sonographically monitored. After visualization of resolution of pneumothorax, chest radiography was performed to confirm the resolution. RESULTS: Pneumothorax occurred in eight (2.8%) of the patients. Transthoracic sonography depicted all cases of pneumothorax and excluded pneumothorax in the other cases. Chest radiography did not depict one case of pneumothorax, which was confirmed on CT. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were all 100% for transthoracic sonography and 87.5%, 100%, 100%, 99.6%, and 99.6%, respectively, for chest radiography. The 95% confidence intervals (CI) of the differences in sensitivity, negative predictive value, and overall accuracy were -10% to 35%, -0.1 to 0.9%, and -0.1 to 0.9%. Transthoracic sonographic visualization of resolution of pneumothorax was always confirmed with chest radiography. CONCLUSION: These preliminary results suggest that transthoracic sonography is as effective as chest radiography in the detection of pneumothorax after transthoracic sonographically guided lung biopsy and may become the method of choice for excluding, diagnosing, and monitoring pneumothorax after transthoracic sonographically guided biopsy. Chest radiography may be needed only for assessment of the extent of pulmonary collapse after transthoracic sonographic diagnosis of pneumothorax or in the presence of discrepancy between transthoracic sonographic findings and clinical presentation.

Adult↗
PubMed1998

The cost-effectiveness of oblique radiography in the exclusion of C7-T1 injury in trauma patients.

OBJECTIVE: The purpose of our study was to compare the cost-effectiveness of bilateral oblique radiography with that of CT for excluding C7-T1 injury in trauma patients. MATERIALS AND METHODS: Using a historical cohort model, we retrospectively studied two distinct groups of trauma patients. In the first group, which included 196 patients, CT was performed to show C7-T1 anatomy when this region was not adequately revealed on initial three-view cervical spine radiography. In the second group, which included 129 patients, routine three-view radiography was complemented by bilateral oblique views. If these five views failed to adequately reveal C7-T1 anatomy, CT was then performed to show the cervicothoracic junction. Using Medicare reimbursement data, we then compared the cost-effectiveness of CT with that of oblique radiography in terms of cost per cervical spine imaged completely to the level of C7-T1. RESULTS: In the first group, 50 (26%) of 196 patients underwent CT when C7-T1 anatomy was not adequately revealed on routine three-view cervical spine radiography. In the second group, only 17 (13%) of the 129 patients required CT when five-view radiography failed to adequately reveal C7-T1 anatomy. This difference was statistically significant (p < .01). The cost per completely imaged cervical spine was $92.00 when bilateral oblique radiographs were routinely obtained, compared with $116.28 per completely imaged cervical spine when these views were not obtained. CONCLUSION: Because bilateral oblique radiography appears to be cost-effective for the exclusion of cervical spine injuries, we suggest that it be performed routinely.

Adult↗
PubMed2002

Clinical comparative study with a large-area amorphous silicon flat-panel detector: image quality and visibility of anatomic structures on chest radiography.

OBJECTIVE: The objective of this study was to compare clinical chest radiographs of a large-area, flat-panel digital radiography system and a conventional film-screen radiography system. The comparison was based on an observer preference study of image quality and visibility of anatomic structures. MATERIALS AND METHODS: Routine follow-up chest radiographs were obtained from 100 consecutive oncology patients using a large-area, amorphous silicon flat-panel detector digital radiography system (dose equivalent to a 400-speed film system). Hard-copy images were compared with previous examinations of the same individuals taken on a conventional film-screen system (200-speed). Patients were excluded if changes in the chest anatomy were detected or if the time interval between the examinations exceeded 1 year. Observer preference was evaluated for the image quality and the visibility of 15 anatomic structures using a five-point scale. RESULTS: Dose measurements with a chest phantom showed a dose reduction of approximately 50% with the digital radiography system compared with the film-screen radiography system. The image quality and the visibility of all but one anatomic structure of the images obtained with the digital flat-panel detector system were rated significantly superior (p < or = 0.0003) to those obtained with the conventional film-screen radiography system. CONCLUSION: The image quality and visibility of anatomic structures on the images obtained by the flat-panel detector system were perceived as equal or superior to the images from conventional film-screen chest radiography. This was true even though the radiation dose was reduced approximately 50% with the digital flat-panel detector system.

Humans↗
PubMed2003

Comparison between sonographic and plain radiography in the diagnosis of small bowel obstruction at Mulago Hospital, Uganda.

OBJECTIVE: To evaluate the role of sonography compared to plain radiography in the diagnosis of patients with suspected small bowel obstruction as well as to determine their specificity, sensitivity and accuracy in the Ugandan setting. DESIGN: Prospective comparative study. SETTING: Mulago Hospital, Uganda's main referal Hospital and Makerere University Medical School. SUBJECTS: Seventy patients with suspected small bowel obstruction (SBO) were evaluated at Mulago Hospital between December 1998 and January 2000, 42 patients were males and 28 females. Patients were aged three days to two years and had a clinical suspicion of SBO. RESULTS: Of the 70 patients, 55 were confirmed to have had SBO. Four had ileus and 11 had no SBO. Sixty four per cent were managed surgically while 36% were managed conservatively. Sonography made a diagnosis of SBO in 92.7% and detected strangulation in 71% of patients. Plain radiography made a diagnosis in 85.5% of patients and did not detect strangulation. Specificity was 100% for both, sensitivity 93%, PPV 100%, NPV 73% for sonography. Sensitivity was 85%, PPV 100%, NPV 58% for plain radiography. MAIN OUTCOME MEASURES: The accuracy of sonography was 93% as compared to 87% for plain radiography. The level of obstruction was correctly predicted in 81% by sonography and 64% with plain radiography. CONCLUSION: It was concluded that sonography is as accurate, specific and sensitive as plain radiography in the diagnosis of SBO as well as determining the level of obstruction in a Ugandan setting. Sonography was found to be more accurate at determining the cause of obstruction and detecting strangulation. It is recommended that sonography should be the initial imaging modality for patients presenting with suspected SBO and plain radiography should only be used as a complimentary investigation.

Adolescent↗
PubMed2002

Primary care referrals for lumbar spine radiography: diagnostic yield and clinical guidelines.

BACKGROUND: Primary care requests for radiographs of the lumbar spine have come under increasing scrutiny. Guidelines aiming to reduce unnecessary radiographs by limiting referrals to patients at high risk of serious disease have been widely distributed. Trial evidence suggests that guidelines can reduce radiography referrals. It is not clear whether this reduction has been achieved in routine practice. AIM: This study, using routine data, was conducted to measure trends in pnmary care referrals for lumbar spine radiography at two hospitals between 1994 and 1999. DESIGN OF STUDY: Analysis of primary care requests for lumbar spine radiography from computerised records. SETTING: Addenbrooke's Hospital, Cambridge (1 July 1994 to 30 June 1999), and Ipswich General Hospital (1 July 1995 to 30 June 1999), United Kingdom. METHOD: All primary care requests for lumbar radiography were identified electronically from computerised information systems. A random sample of 2100 radiography reports were classified according to clinical importance. These classifications were used to examine whether the proportion of radiographs demonstrating potentially more serious findings had increased between 1994 and 1999. RESULTS: There was no evidence that primary care referrals for radiography of the lumbar spine had decreased between 1994 and 1999 at either hospital. General practitioners did not progressively refer more high-risk patients for lumbar radiography. Only a small proportion of patients had important radiographic findings that might warrant specialist referral or specific therapy. CONCLUSION: The implementation of diagnostic guidelines offers much to the NHS. However in these two hospitals, the reduction in radiograph utilisation evident in trials was not achieved. Guideline development is a resource intensive process; distribution must be supported by more effective implementation strategies.

Adolescent↗
PubMed1991

Digital chest radiography.

It is apparent that digital radiography holds considerable promise. Although there are some immediate advantages to be gained from using digital technology at present, such as more consistent image quality in portable radiography, most of the benefits have not been fully realized. To do so requires a completely integrated digital radiology department using high-resolution video displays throughout the hospital connected to a large digital image archiving system. This concept, referred to as picture archiving and communication systems (PACS), represents the logical culmination of the extensive research that is continuing in this area. Because of the great expense involved, it is likely that the transition from conventional to digital radiography will be evolutionary in most medical centers, with establishment of local PACS networks initially, such as between the intensive care units and the radiology department. At a more basic level, limited digital radiography systems can function in isolation and address specific needs successfully. Although the science of computer-aided diagnosis is at an early stage, it seems likely that the sensitivity and specificity of these programs will continue to improve. Their eventual utility will depend on their accuracy and ease of use. The ultimate goal would be a relatively "transparent" multifaceted program that would screen all radiographs prior to interpretation to provide the radiologist or clinician with diagnostic suggestions and quantitative data. Given the present rate of progress in this area, such a concept is not unrealistic. However, even the most ardent enthusiasts do not envision totally independent computer-based interpretation of radiographic images for some time. Although digital image processing has not greatly improved diagnostic accuracy merely by enhancing the appearance of the radiographs, there are other potential diagnostic advantages in using digital images, such as rapid retrieval of previous examinations and the ability to correlate chest radiographs with CT or MRI studies rapidly on a video display. Direct image correlation with registration and superimposition has been achieved in the case of positron-emission tomography and MRI studies of the brain. For chest radiograph examinations, superimposition and subtraction of earlier radiographs to enhance the detection of interval change is being studied. The question of when digital chest radiography will replace conventional imaging is controversial. In a recent multiauthored review of this subject, it was estimated that digital chest radiography will replace conventional film radiography in at least 50% of large teaching hospitals by the turn of the century.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis, Computer-Assisted↗
PubMed1997

[Digital radiography of the thorax].

Digital radiography of the thorax can, now be substituted to conventional chest radiography. Computed radiography with phosphor plates and the new selenium detector are emphasized. The major image processing are explained. Successively the main other methods of digital radiography are described: scanning equalization radiography, laser-digitized radiography and multiwire proportional chambers. Then the advantages and the drawbacks of chest computed radiography are extensively reviewed.

Humans↗