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PubMed1994

A comparison of the diagnostic advantages of panoramic radiography and computed tomography scanning for placement of root form dental implants.

This study evaluated the advantages of computed tomography (CT) in comparison to routine panoramic radiography for dental implant treatment planning. An in vitro validation study was performed to assess the accuracy of CT and panoramic radiography film images for measurement of anatomic structures and distances between anatomic structures. After correcting by a standard 25% magnification on the panoramic images, a significant difference in measurements was found between the CT and panoramic radiography images. Ten subjects requiring implants in compromised ridges were treatment planned with either CT and panoramic radiographs or panoramic radiographs alone. The ideal implant length was determined at surgery with direct digital radiography. The dentists were significantly more confident using CT and panoramic images than panoramic radiographs alone. Implant length treatment planned with panoramic radiography alone underestimated length significantly compared with the implant length determined to be ideal during surgery, whereas treatment planning with CT and panoramic radiography demonstrated no significant difference. The data indicate the CT may be of value in treatment planning for dental implants, especially when gaining maximum length is of critical importance.

Analysis of Variance↗
PubMed2004

[Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT].

PURPOSE: To compare the radiation dose of whole-body multislice CT (MSCT) and conventional radiography with organ-specific CT in polytrauma. MATERIALS AND METHODS: The whole-body MSCT encompassing brain, neck and midface, chest, abdomen and pelvis was performed on a Somatom Volume Zoom (Siemens). Conventional radiography consisted of chest and cervical, thoracic and lumbar spine in two views as well as pelvis (Polymat, Siemens). Three combinations of organ specific CT were chosen: CT examination of (1) head and cervical spine, (2) head, cervical spine and chest, (3) head, cervical spine and abdomen. The effective doses of whole-body MSCT and conventional radiography with organ-specific CT were calculated. RESULTS: Effective doses were 20 mSv for whole-body MSCT, 2 mSv for conventional x-ray, and 5 mSv for combination (1), 8 mSv for combination (2) and (3) 16 mSv for combination (3) of the organ-specific CT. The ratio of radiation dose between whole-body MSCT and radiography was 10 : 1. This ratio was reduced to 3 : 1, 2 : 1 and 1 : 1 when a combination of radiography and CT was performed. CONCLUSIONS: Whole-body MSCT in polytrauma compared to conventional radiography with organ-specific CT induces a threefold increased dose in unfavorable situations and no increased dose in favorable situations. Nevertheless, routine use of whole-body MSCT should be critically evaluated and should be adapted to the clinical benefit.

Humans↗
PubMed1998

Digital radiography in paediatrics: radiation dose considerations and magnitude of possible dose reduction.

The purpose of this study was to evaluate the radiation doses received by paediatric patients examined using a digital radiography unit, and to compare these doses with those received from conventional screen-film systems. In this way, guidelines could be drawn up concerning the magnitude of possible dose reductions achievable using digital radiography. The study was undertaken on approximately 900 patients undergoing abdomen, chest, pelvis and skull examinations. Patients were categorized into the following age groups: 0-1 month, 1-12 months, 1-5 years, 5-10 years and 10-15 years. Approximately half were X-rayed using a Fuji computed radiography system and half using a conventional screen-film system. Entrance surface dose was calculated from the recorded exposure parameters and measured X-ray tube outputs. Dose-area product was recorded directly. Image quality was assessed clinically using criteria recommended by a working group of the Commission of the European Communities. Apart from chest examinations, it was found possible to reduce doses by about 40% on average, by using a computed radiography system instead of a 600 speed screen-film combination. There was no significant difference in the dose for chest examinations. Satisfactory image quality can therefore be achieved by using computed radiography as a 1000 speed system for abdomen, pelvis and skull examinations, and as a 600 speed system for chests. Since very few departments appear to use screen-film systems of speeds greater than 400, then, for most departments, the use of computed radiography would result in dose reductions of at least 60%, or 33% for chests.

Adolescent↗
PubMed2004

Effective and organ doses from scanography and zonography: a comparison with periapical radiography.

OBJECTIVES: To compare absorbed and effective doses from scanographic and zonographic examinations performed in the Scanora unit with intraoral periapical radiography. METHODS: Absorbed dose measurements were made on an anthropomorphic phantom head with LiF thermoluminescent dosemeters in the regions of the pituitary gland, eye lenses, parotid glands, submandibular glands, thyroid gland and skin. Energy imparted was calculated from the measurements of air collision kerma and effective doses by using the quotient 24 mSv J-1 between energy imparted and effective dose. The upper and lower third molar region was examined with intraoral radiographs and with ramus scanograms, dental scanograms and dental zonograms. Radiation dose measurements were also performed for Scanora panoramic radiography (jaw and dental). RESULTS: The effective doses for the ramus and dental scanograms were 0.01 mSv, similar or lower than for intraoral radiography. Zonography yielded the highest effective dose (0.03 mSv). Except for the skin doses, the salivary glands received the highest doses. Salivary gland doses were slightly higher from narrow beam than from intraoral radiography. CONCLUSIONS: Detail narrow beam radiography with the Scanora is an alternative to periapical radiography and is preferred, from a radiation dose point of view, over zonography.

Humans↗
PubMed1986

Dose contributions to the Swedish population from oral radiography.

The purpose of the present investigation was to elucidate some factors which may influence the absorbed doses to organs of special interest, to determine the energy imparted (epsilon) and the effective dose equivalent (HE) from intraoral radiography, to estimate the collective effective dose equivalent (SE) to the Swedish population from oral radiography and to discuss these results regarding the biological effect of oral radiography on the Swedish population. The absorbed doses were found to be small from intraoral radiography (IR), with a reduction by a factor of about 50 to many organs since the 1960s. The epsilon to the patient from IR (20 exposures, 65 kVp, D-film) was 10 mJ with a circular (55 mm in diameter) and 6 mJ with a rectangular collimator (35 mm X 44 mm). For one bitewing the corresponding values were 0.4 mJ and 0.3 mJ, respectively. The mean value of epsilon for an ordinary bitewing examination in Sweden was 0.48 mJ. Energy imparted from IR was totally 5,500 J to the Swedish population. This corresponds to some per cent of the mean value of the annual natural irradiation. The use of film in speed group E reduces the energy imparted by 40 per cent. From panoramic radiography (PR) and lateral cephalographic radiography (CR) the mean values in Sweden were 0.5 mJ per examination. PR and CR imparted 56 J to the population. HE was calculated for IR and was found to be 0.23 mSv (20 exposures, D-film, circular collimator) and 0.14 mSv for the rectangular collimator, which corresponds to 12 and 7 mu Sv per intraoral film, respectively. The risk from IR, PR and CR to the population can be assessed by risk factors from the literature and estimated both from the sum of epsilon and from the sum of HE. Proceeding from the sum of epsilon and transforming to HE by dividing the body weight the collective effective dose equivalent was 79 manSv (IR) and 1 manSv (PR and CR). Proceeding from the calculated value of HE for IR would give 190 manSv. The risk of fatal cancer thus theoretically calculated would be between 1-3 cases. The magnitude of epsilon as well as HE is so low that it seems to be a very favourable ratio between benefit and risk for IR, when such examinations are indicated.

Adult↗
PubMed2005

Comparison of ultrasonography and conventional radiography in the diagnosis of nasal fractures.

OBJECTIVE: To compare the diagnostic findings of ultrasonography and radiography in nasal fractures. DESIGN AND MAIN OUTCOME MEASURES: In this prospective study, 63 patients (23 female and 40 male; mean age, 26.8 years) with clinical signs of a nasal bone fracture were investigated. All patients underwent radiography (lateral view of the nose plus occipitomental view) and ultrasonography (10-MHz ultrasound scanner) of the nasal dorsum and the lateral nasal walls and a clinical examination by 2 consultants. Thirty-six patients underwent nasal fracture reduction. Two radiographs and 3 ultrasound images of each patient were analyzed by 2 experienced readers at different times. After assessing the nasal dorsum and lateral nasal walls in radiographs and ultrasound images, they decided whether the nose was fractured or not or whether the results were uncertain. The results were analyzed by various statistical testing methods (for sensitivity, specificity, positive and negative predictive value, and accuracy). RESULTS: Assessment of the lateral nasal walls revealed that ultrasonography was statistically superior (P = .04) to radiography. In contrast, assessment of the nasal dorsum showed radiography to be statistically superior (P = .01) to ultrasonography. Assessment of the nasal pyramid revealed no statistical difference between radiography and ultrasonography (P = .91). CONCLUSION: In assessment of the nasal pyramid, ultrasonography can be considered an alternative to radiography, with equivalent diagnostic performance.

Adult↗
PubMed1999

The cost-effectiveness of routine pelvic radiography in the evaluation of blunt trauma patients.

OBJECTIVE: . To determine the cost-effectiveness of routine protocol-driven pelvic radiography in the evaluation of blunt trauma patients. DESIGN AND PATIENTS: A retrospective review was performed on 319 blunt trauma patients who underwent protocol-driven pelvic radiography to record the frequency of pelvic fracture. Medical records of the patients in whom fractures were identified radiographically were then examined to determine the clinical suspicion of injury prior to radiography. Using Medicare reimbursement data, the cost-effectiveness of routine pelvic radiography was calculated in terms cost per pelvic radiograph with evidence of fracture. These values were then compared with literature values of other screening studies, namely mammography and colonoscopy. RESULTS: Thirty-eight of 319 patients (11.9%) were found to have fractures identified on routine pelvic radiography. Using the 1997 Medicare reimbursement charge of $27.79 for a single anteroposterior radiograph of the pelvis, the total cost of performing these 319 trauma protocol-driven studies was calculated as $8865.01. The cost per protocol-driven pelvic radiograph with evidence of pelvic fracture was subsequently determined to be $233.29. Only 18 (47.4%) of these 38 patients were suspected to have pelvic fracture on the basis of the clinical findings alone. CONCLUSIONS: Trauma protocol-driven pelvic radiography is a necessary and cost-effective means of identifying acute pelvic injury in all trauma patients regardless of clinical presentation.

Cost-Benefit Analysis↗
PubMed1986

Role of routine emergency cervical radiography in head trauma.

This review of 406 patients with head injury examines the role of emergency cervical radiography in head trauma and the frequency of associated cervical spine injury. Of 293 patients who had emergency cervical radiography (72 percent), 8 showed some abnormality, but only 5 (1.2 percent) were significant for cervical spine injury. All eight patients were, however, clinically suspected to have associated cervical spine injury before emergency cervical radiography. One hundred thirteen patients (28 percent) did not undergo emergency cervical radiography based on clinical evaluation, and none was subsequently found to have a missed cervical spine injury. There was no correlation between severity of head injury and the presence of associated cervical spine injury (p greater than 0.16). Head trauma is infrequently associated with cervical spine injury and when present is usually not clinically occult. Emergency cervical radiography is not efficacious and should not be routine in the emergency room management of head trauma. When associated cervical spine injury is clinically suspected, adequate cervical immobilization should be maintained and cervical radiography performed on a low priority basis. Head injury due to automobile and pedestrian or motorcycle and automobile accident may be more likely to be associated with cervical spine injury.

Accidents, Traffic↗
PubMed2006

[Is systematic radiography needed before spinal manipulation? Recommendations of the SOFMMOO].

OBJECTIVES: The French National Health Authority recommends systematic radiography before lumbar manipulation. However, current research shows radiography to have more disadvantages than advantages. For the cervical spine, in cases of complication following cervical manipulation, the lack of prior radiography is a fault, even if such x-ray results would have advised manipulation. To establish clear recommendations on this topic, we searched in the literature for complications of spinal manipulations that could have been prevented had preliminary radiography been performed to determine whether these complications were anticipated or not by the international guidelines. MATERIAL AND METHODS: Literature search. RESULTS: For the lumbar and thoracic spine, the international guidelines are sufficient, except in cases of aneurysmal bone cyst, which can appear until the age of 25 years. For the cervical spine, despite a lack of data in the literature, prudence and medicolegal issues justify the performance of systematic radiography. CONCLUSION: The SOFMMOO recommends systematic radiography prior to cervical manipulation and in case of back or neck pain in patients of less than 25 years of age. In all other cases, the international guidelines provide sufficient recommendations.

Adolescent↗
PubMed2006

An audit of follow-up chest radiography after coronary artery bypass graft.

AIM: To investigate the clinical value and audit chest radiography, which is currently undertaken as part of routine practice, in the follow-up of coronary artery bypass graft (CABG) patients. MATERIAL AND METHODS: Six hundred and sixty-six first time CABG patients were identified from the Patient Analysis and Tracking System database representing the work of a single surgeon between February 2001 and September 2005. The data regarding the clinical and radiological findings on follow-up were collected from the follow-up clinic letters and case notes. Any need for re-admission/intervention was also noted. RESULTS: Of the 666 patients, 11 died and a further 10 either refused or failed to arrive for follow-up. Chest radiography was undertaken in 645 patients. Only 13 patients (2%) were found to have an abnormality on chest radiography. In all cases this was a pleural effusion that was confirmed on clinical examination in seven patients (53.9%) patients. Only one patient needed re-admission and intervention. In this case the effusion had been noted on clinical examination. Seven patients were discharged and the remaining five were followed up with repeat chest radiography before discharge. Seventy-four patients had a respiratory complication postoperatively, but only three had any evidence of an effusion on follow-up. CONCLUSION: The diagnostic yield of a routine chest radiography in a CABG follow-up clinic is low (2%) and the need for intervention is rare and is determined by clinical examination. The practice of routine radiography in this group of patients has now stopped and follow-up audit will be conducted in 12 months.

Ambulatory Care↗
PubMed1997

Digital radiography of the chest.

Digital radiography is an appropriate method for both bedside and in-department chest radiographs. Its major advantage in bedside chest radiography is its control of the displayed optical density of these radiographs. With dynamic range control processing, it improves the visibility of tubes and lines superimposed on the mediastinal tissues. When used for in-department chest radiography, it may offer slight advantages in the evaluation of disease in the mediastinum, but in general is equivalent to film-screen chest radiography. The main reasons for using digital chest radiography for in-department chest radiographs relate mainly to its use as a data entry point method of projection radiography for high-quality teleradiology or for its use in a picture archiving and communication system. Apart from these advantages, there is no reason to change from conventional to digital chest radiographs. Digital radiographs are, with certain systems, printed at smaller than life size. Because of this, there is a necessary period of learning as radiologists adjust to the new image size. The most important change in radiologists' work pattern appears to be the need to sit closer to the film. Findings of disease are smaller, but, with experience, just as easy to see.

Humans↗
PubMed2004

An investigation into the use of bitewing radiography in children in Greater Glasgow.

AIM: In recent years there have been a number of reviews and guidelines published with respect to the diagnosis and management of caries in children. Bitewing radiography remains the recommended method of choice for caries diagnosis in most circumstances. The aims of the study were to investigate the usage of bitewing radiography by general dental practitioners (GDPs) in Greater Glasgow, for the diagnosis of caries in children and to assess the usefulness of the technique as perceived by these dental practitioners. DESIGN: A questionnaire for self completion was sent to all GDPs with an NHS list number in the Greater Glasgow area. RESULTS: An 80% response rate was obtained with 303 GDPs responding. Less than half the dentists (44%) indicated that they always carried out caries risk assessments for all children, but 71% reported doing this for 6 and 7-year-old children. Approximately 60% of dentists stated they had read the recent radiation and caries management guidelines. Only 72% stated that they used radiography as a caries diagnostic tool in children, with 12 GDPs (4%) indicating they would never consider using bitewing radiography in children. Only 17% would consider taking bitewing radiographs in children under 6 years, and the majority of dentists (61%) reported that they would first consider taking radiographs in the 6-11-year-old age group. However, only a low proportion of children in this age band had dental x-rays taken. Bitewing radiography was considered to be more important for 12-year-olds than for 6-year-olds. Recommended methods for decreasing radiation exposure such as rectangular collimation and film holders were not being used universally, with 41% and 58% respectively using these devices. CONCLUSIONS: A significant proportion of dentists in Greater Glasgow are not complying with recent guidelines and recommendations and it would appear that the value of bitewing radiography as a diagnostic tool in children is not being fully exploited.

Adolescent↗
PubMed2001

Decision criteria and characteristics of Norwegian general dental practitioners selecting digital radiography.

OBJECTIVES: To evaluate Norwegian general dental practitioners' decision criteria and characteristics for choosing digital radiographic equipment. METHODS: A questionnaire was sent to all dental practitioners in Norway (n = 3940). They were categorised on the basis of their responses as either a 'digital radiography' (DR) or 'non-digital radiography' (non-DR) dentist. Demographic, clinical, and electronic technology variables were recorded. Dentists ranked on a six-point scale their reasons for choosing or not choosing digital radiography. Their responses were analysed by logistic regression. RESULTS: Two thousand, one hundred and ninety-nine dentists (56%) replied. Three hundred and nine (14%), (219 men, 86 women and four not stated) had chosen to use digital radiography. The logistic regression analysis revealed that gender, age and years in dentistry were not significant factors in determining their decision, whereas working in a private or group practice was. The number of computers in the practice was the most important of the electronic technology variables. The non-DR dentists strongly agreed that 'digital radiography is too expensive' and were 'satisfied with film'. The DR dentists strongly agreed that the 'use of chemicals can be avoided', 'patient dose is reduced', and 'archiving is facilitated'. CONCLUSION: Working in a private or group practice or using multiple computers were significant factors in choosing digital radiography.

Adult↗
PubMed2002

Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneum.

BACKGROUND: The aim of this study was to compare plain radiography with abdominal ultrasonography in the detection of pneumoperitoneum. METHODS: A total of 188 patients with suspected hollow organ perforation were studied. All patients had abdominal ultrasonography, upright chest radiography and left lateral decubitus abdominal radiography examinations. The sensitivity, specificity, positive and negative predictive value, and accuracy of chest and abdominal radiography were compared with that of abdominal ultrasonography. RESULTS: One hundred and seventy-eight patients underwent laparotomy; 170 patients had hollow organ perforation, five patients had perforated appendicitis and three had acute cholecystitis. In the diagnosis of pneumoperitoneum, ultrasonography had improved sensitivity (92 versus 78 per cent), negative predictive value (39 versus 20 per cent) and accuracy (88 versus 76 per cent), and similar specificity (both 53 per cent) and positive predictive value (95 versus 94 per cent) compared with plain radiography. CONCLUSION: Ultrasonography is more sensitive than plain radiography in the diagnosis of pneumoperitoneum.

Adolescent↗
PubMed2004

[The role of whole body spiral CT in the primary work-up of polytrauma patients--comparison with conventional radiography and abdominal sonography].

PURPOSE: To evaluate the role of routine "whole body spiral CT"in the primary work-up of polytrauma patients for injuries of the thorax, abdomen and spine, and to compare the results with those of conventional radiography of the chest and spine and abdominal ultrasound. MATERIALS AND METHODS: Fifty consecutive polytrauma patients underwent contrast-enhanced single slice spiral CT (5 mm collimation) from the vertex to the floor of the pelvis as part of the primary work-up after emergency room admission. Overlapping high resolution sections and sagittal reformations of the spine were obtained. Reports of additional chest radiographs (n=43), abdominal ultrasound examinations(n = 47) and spine radiographs (n = 36) performed in the emergency room were available for retrospective comparison. The "final diagnoses," which served as the standard of reference, were taken from the patients' records using all information that be-came available until discharge or death, such as findings from further imaging, surgery and autopsy. RESULTS: CT showed 109(97%) of 112 thoracic and abdominal soft-tissue injuries. Relevant injuries missed were an early splenic laceration and an early pelvic hematoma, both of which became clinically apparent several hours later. There were 4 false positive CT findings. Conventional chest radiography demonstrated only 20% of thoracic and sonography 22% of abdominal injuries. Chest radiography and sonography produced 2 false-positive findings each. CT showed 66 (87%) of 76 vertebral fractures including all 19 unstable ones.CT missed 5 anterior vertebral body and 5 spinous/transverse process fractures. Conventional radiography found 71 % of vertebral fractures including only 50 % of the unstable ones. CONCLUSION: Routine performance of whole body spiral CT as part of the primary work-up of polytrauma patients provides a fast and comprehensive survey and detects almost all soft tissue injuries of the chest and abdomen. It is clearly superior to chest radiography and abdominal sonography. All spinal injuries relevant for the acute management were also seen on CT, but not on conventional radiography.

Abdominal Injuries↗
PubMed1997

[Can digital selenium-based radiography in thoracic diagnosis replace the analog x-ray imaging technic?].

PURPOSE: To find out the diagnostic value of digital selenium radiography, we compared the image quality of chest x-ray images from 50 patients who had been examined via conventional chest x-ray and digital selenium radiography of the chest. METHOD: 50 patients with a malignant melanoma underwent chest x-ray within 3 months in conventional technique and with digital selenium radiography (Thoravision: Philips Medical Systems, Hamburg, Germany). In this period none of the patients showed a difference in respect of clinical status or radiological diagnosis. Simultaneous examinations on the same day were not performed to avoid unnecessary exposure to x-rays. The digital and conventional images were compared by 4 radiologists with regard to image quality by the detection of defined anatomic structures. RESULTS: Image quality of digital selenium radiography was considered superior to that of conventional chest x-rays in the mediastinum, the retrocardiac and retrodiaphragmatic areas, the superior and inferior lobes of the lung especially near the parietal pleura, and the chest wall. CONCLUSIONS: Compared to analogous techniques there is no loss of image information when employing digital selenium radiography in chest x-rays. On the contrary, new assessment criteria may be gained. We conclude that digital selenium radiography offers diagnostic advantages in chest x-ray examination.

Adult↗
PubMed1997

[Thoracic radiography as routine within cardiological diagnosis?].

OBJECTIVE: As chest radiography is still frequently used routinely in patients suspected of heart disease, the study was undertaken prospectively to assess its value in view of the potentials of modern noninvasive methods. PATIENTS AND METHODS: History, physical examination, electrocardiography, ergometry, echocardiography and colour Doppler echocardiography as well as chest radiography were undertaken in 201 consecutive patients (113 men, 88 women, age 60 [3-88] years) with known or suspected cardiac valvular defects or heart failure. Subsequently invasive investigations were performed in 92 of these patients. RESULTS: The value of chest radiography depended on the nature and severity of the particular cardiac disease. The diagnosis was established without chest radiography in all defects (40 patients) of grade III or IV (New York Heart Association) or NYHA class III or IV heart failure (30 patients). Chest radiography provided no additional prognostic or therapeutic information. CONCLUSION: These data indicate that routine chest radiography is of no value as a screening method in patients with chronic heart failure or cardiac defects, except in a few clearly defined specific circumstances.

Adolescent↗
PubMed1980

[Medical radiography with fast neutrons (author's transl)].

For physical reasons, radiography by neutrons produces radiographs which are quite different from x-ray images. Biological objects can be transradiated only by fast neutrons. Selective simultaneous recording of neutron images is accomplished best by using cellulose nitrate (CN) foils, used with a track etching method in order to exclude thermal neutrons and gamma quanta. A neutron-radiography set-up in connection with a research reactor is described, as well as optimal conditions for developing the CN foils and the optical display of the resultant image. Image quality of the individual CN foil is characterised by minimal interior unsharpness (35 mu) and a small range of blackening when compared with radiographic film (about 1). Image contrast can be increased by the use of many foils. In addition, this results in a reduction of maximal radiation dose to below 10 rem. Study of isolated spines has shown that fat and necrotic tumours can be demonstrated by neutron radiography without being superimposed by calcium-containing bone, even if these changes cannot be seen on a x-ray radiograph because of the regular bone structure. It appears that neutron radiography can be superior to conventional radiography for the diagnosis of abnormalities with bones, or of areas surrounded by bone. The use of neutron radiography in patients can, at the moment, only be justified for individuals undergoing neutron therapy for the treatment of tumours.

Fast Neutrons↗