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PubMed2004

[Diagnostic utility of radiography in head trauma: a critical review of the literature].

INTRODUCTION: The indication of distinct imaging studies in pediatric head trauma, and especially the use of skull radiography, is controversial. OBJECTIVE: To assess the effectiveness of skull radiography in the management of head trauma in pediatric patients. To do this, we aimed to determine the predictive value of this procedure in detecting intracranial injuries, independently of patients' symptoms and clinical examination. MATERIAL AND METHODS: We performed a review of the medical literature (MEDLINE) and of other resources available for searching biomedical information. Studies limited to pediatric patients (0-18 years old) that provided information on the diagnostic utility of skull radiography in head injury were selected. The source and characteristics of the populations studied and potential design limitations were taken into account. RESULTS: Twelve original studies were selected, three of which were performed in children younger than two years old. Differences were found in the origin of the sample populations, the prevalence of intracranial injury and skull fracture, the severity of the trauma included, and in the criteria for performing imaging tests. CONCLUSIONS: Because of the limited comparability of the articles, the usefulness of skull radiography was difficult to assess. Although the use of this technique is accepted in some circumstances in patients younger than two years old, the data obtained assign little value to the systematic use of radiography to assess head trauma in pediatric patients. Head computed tomography is indicated when symptoms or signs of possible neurological injury are present.

Adolescent↗
PubMed1999

Determination of the optimal conditions for dental subtraction radiography using a storage phosphor system.

OBJECTIVES: To determine the optimal kVp and exposure conditions for digital subtraction radiography system using a storage phosphor system. METHOD: Signal-to-noise (SNR) measurements were acquired using a Digora system (Soredex, Helsinki, Finland) of large area, low contrast, clinically realistic details against varying degrees of background attenuation for both single exposure unsubtracted and subtracted images. These results were combined with a measure of estimated thyroid dose to derive a figure of merit (FOM) for the unsubtracted and subtracted images. RESULTS: For both unsubtracted and subtraction radiography, an exposure at 50 kVp and 250 muGy produce the best overall FOM. However, using the system at the 60 kVp maximum a FOM at 1000 muGy for unsubtracted radiography and 500 muGy for subtraction radiography gave the best SNR performance. CONCLUSION: Operating parameters have been derived which allow the user to choose between optimising SNR and dose (50 kVp, 250 muGy for unsubtracted and subtracted radiography) or SNR alone (60 kVp, 1000 muGy for unsubtracted and 60 kVp, 500 muGy for subtracted), for the visualisation of clinically representative details using the Digora system.

Aluminum↗
PubMed1999

Mandibular osteoradionecrosis: a comparison of computed tomography with panoramic radiography.

OBJECTIVES: To compare the value of computed tomography (CT) with panoramic radiography in the diagnosis and presurgical evaluation of mandibular osteoradionecrosis (ORN). METHODS: Retrospective study comparing the diagnostic information from CT and panoramic radiography of 33 patients with clinical symptoms of ORN. In six patients the imaging was compared macroscopically with the resected mandible. RESULTS: Both panoramic radiography and CT revealed ORN in 31 cases. In 22 the anterior-posterior extent of the lesions could be estimated with equal reliability. In six patients the lesion appeared larger on CT and in three on panoramic radiography. Mono- or bicortical destruction, central necrosis and sequestration were better visualized by CT. Comparison between the imaging findings and the surgical resection showed that CT depicted the topography of the specimen more accurately. CONCLUSIONS: CT is superior to panoramic radiography in visualizing the features of mandibular ORN and the anterior-posterior extent of the lesion.

Adult↗
PubMedDate not supplied

Accuracy of radiography, nuclear scintigraphy, and histopathology for determining the proximal extent of distal radius osteosarcoma in dogs.

OBJECTIVE: To compare the accuracy of radiography, nuclear scintigraphy, and histopathology for determining the proximal extent of distal radius osteosarcoma in dogs. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Twenty client-owned dogs taken to Colorado State University with osteosarcoma of the distal radius. METHODS: Medical records of 20 dogs with confirmed osteosarcoma that underwent a limb-salvage procedure were reviewed. Measurements were performed directly from the lateral view of each radius, from both the scintigram and the radiograph, to determine the length of the radius and the distance from the proximal extent of the tumor to the distal radiographic or scintographic extent of the radius. The ratio of distal radial involvement to total radius length was calculated. A similar ratio was also determined using the macroslide, which included the entire portion of bone that was excised during the limb-salvage procedure. All 3 methods of measurement were compared. RESULTS: Nuclear scintigraphy significantly overestimated tumor length when compared with macroslide specimen measurements. Radiography also overestimated tumor length, but these results were not significantly different from macroslide specimen measurements. CONCLUSIONS: Both radiography and nuclear scintigraphy overestimate the extent of distal radius osteosarcoma in dogs when compared with histopathologic macroslides of the same lesions. Nuclear scintigraphy overestimated tumor extent to a larger degree than did radiography. CLINICAL RELEVANCE: Although radiography is a more accurate method of measurement of the extent of distal radius osteosarcoma, because nuclear scintigraphy overestimates tumor length to a greater degree, scintigraphy may provide a larger margin of safety for determining the site of proximal osteotomy during a limb-salvage procedure. However, caution should be taken when utilizing scintigraphy, because this method may overestimate length of radius involved to such an extent as to cause the surgeon to believe that a patient is not a suitable limb-salvage candidate.

Animals↗
PubMed2002

MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity.

PURPOSE: To compare MR imaging, radiography and bone scintigraphy in the diagnosis of stress injuries to bones of the pelvis and lower extremity. MATERIAL AND METHODS: Fifty consecutive conscripts with clinical signs of a stress injury to bone underwent MR imaging and bone scintigraphy. Forty-three patients also had radiographs available. Bone scintigraphy served as a gold standard. RESULTS: Compared to the bone scintigraphy, the sensitivity of radiography was 56%, specificity 94%, accuracy 67%, positive predictive value (PPV) 95%, and negative predictive value (NPV) 48%. The kappa value for radiography and bone scintigraphy was fair (0.39). Correspondingly, the sensitivity of MR imaging was 100%, specificity 86%, accuracy 95%, PPV 93% and NPV 100%. The kappa value for MR imaging and bone scintigraphy was very good (0.89). MR imaging depicted 3 bone stress injuries that were not visible on bone scintigraphy. Positive findings obtained from radiography correlated with MR signs of fracture line or callus (p<0.001). CONCLUSION: MR imaging is more sensitive than two-phase bone scintigraphy, and MR imaging should be used as the gold standard in the assessment of stress injuries of bone. Radiography reveals mainly the late phases of bone stress injuries, such as stress fracture and callus.

Adult↗
PubMed2003

Which is the better method for location of the gastro-esophageal junction: radiography or manometry?

PURPOSE: To evaluate whether location of the gastro-esophageal junction (GEJ) could be determined with the same accuracy on radiography as by manometry with special reference to pH probe positioning. MATERIAL AND METHODS: Ninety patients with suspected esophageal motility disorders underwent simultaneous manometry and video-radiography. The lower esophageal sphincter pressure (LESP) and location was determined, and pressure recordings were made in the body of the esophagus. The GEJ and any structural changes were diagnosed on radiography during single-barium swallows and continuous barium drinking. Simultaneous radiographic and manometric investigations were performed with the pressure-catheter placed 5 cm proximal to the superior border of the GEJ located by manometry, and the distance to the radiographically determined superior border could be measured directly on the videotapes using a radiopaque metric ruler placed under the patient. RESULTS: On radiography, the GEJ proved to be situated < 2 cm distally as compared to its location determined by manometry in 95.6% of the patients, and the maximal difference was 2.5 cm. The LESP or structural changes had no significant influence on the results. CONCLUSION: The variation of location of GEJ on radiography as compared with manometric findings was sufficiently small to accept both methods as valid in the positioning of the pH probe properly.

Adolescent↗
PubMed2003

Positioning of the pH-probe by manometry or radiography for monitoring of the esophagus. Influence on diagnostic results?

PURPOSE: To correlate gastroesophageal reflux (GER), demonstrated by radiography using bread and barium, with 24-h pH monitoring in the esophagus, with the pH-probe positioned by manometry or radiology. MATERIAL AND METHODS: In all, 146 patients, 41 females and 105 males, with a median age of 47 years, suspected of GER were examined. Radiography was performed with the patient in the supine right oblique position during mastication and swallowing a piece of rye bread with liver pâté and barium. The test was positive if barium was observed more than 5 cm proximal to the gastroesophageal junction (GEJ). An antimony pH-probe was placed 5 cm above the lower esophageal sphincter determined by manometry, or 5 cm above the GEJ determined by radiography. The total time of esophageal pH <4 exceeding 5% was considered pathological. RESULTS: The radiological method had a specificity of 100% and a sensitivity of 52% compared to 24-h pH monitoring with the pH-probe positioned manometrically, and a specificity of 100% and sensitivity of 67% with the pH-probe positioned by radiography, with no significant difference between the two positionings. CONCLUSION: In 146 patients submitted to 24-h pH monitoring, the pH-probe could be placed as safely by radiography as by manometry.

Barium Sulfate↗
PubMed2006

Calibrating automatic exposure control devices for digital radiography.

The energy responses of digital radiography detectors differ from those of screen-film systems. To provide a consistent level of image quality at different tube potentials automatic exposure control (AEC) devices must be calibrated to suit the energy response of the image receptor with which they are intended for use. AEC calibration for digital radiography systems requires an alternative parameter to optical density, ideally one related to the quality of a digital image. Energy responses of computed radiography (CR) and indirect digital radiography (IDR) image receptors have been calculated, and compared with those for screen-film systems. Practical assessments of the relative sensitivities of a CR detector made using the detector dose indicator (DDI), pixel value and signal-to-noise ratio showed similar variations with tube potential. The DDI has been used to determine the correct kV compensation curve required to calibrate the AECs for the loss in detector sensitivity with tube potential. AECs are set up relative to a predetermined air kerma incident on the detector at 80 kV for CR and IDR systems using this curve and the method used is described. Factors influencing the calibration of AECs for digital radiography including techniques, types of phantom and contributions from scatter are reviewed, and practical methods recommended for use.

Aluminum↗
PubMed2004

Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome.

BACKGROUND: Lung auscultation and bedside chest radiography are routinely used to assess the respiratory condition of ventilated patients with acute respiratory distress syndrome (ARDS). Clinical experience suggests that the diagnostic accuracy of these procedures is poor. METHODS: This prospective study of 32 patients with ARDS and 10 healthy volunteers was performed to compare the diagnostic accuracy of auscultation, bedside chest radiography, and lung ultrasonography with that of thoracic computed tomography. Three pathologic entities were evaluated in 384 lung regions (12 per patient): pleural effusion, alveolar consolidation, and alveolar-interstitial syndrome. RESULTS: Auscultation had a diagnostic accuracy of 61% for pleural effusion, 36% for alveolar consolidation, and 55% for alveolar-interstitial syndrome. Bedside chest radiography had a diagnostic accuracy of 47% for pleural effusion, 75% for alveolar consolidation, and 72% for alveolar-interstitial syndrome. Lung ultrasonography had a diagnostic accuracy of 93% for pleural effusion, 97% for alveolar consolidation, and 95% for alveolar-interstitial syndrome. Lung ultrasonography, in contrast to auscultation and chest radiography, could quantify the extent of lung injury. Interobserver agreement for the ultrasound findings as assessed by the kappa statistic was satisfactory: 0.74, 0.77, and 0.73 for detection of alveolar-interstitial syndrome, alveolar consolidation, and pleural effusion, respectively. CONCLUSIONS: At the bedside, lung ultrasonography is highly sensitive, specific, and reproducible for diagnosing the main lung pathologic entities in patients with ARDS and can be considered an attractive alternative to bedside chest radiography and thoracic computed tomography.

Aged↗
PubMed2003

Digital radiography of the chest: detector techniques and performance parameters.

Substantial advances in detector technology characterize digital chest radiography. This article compares the various systems from a radiologist's point of view. Computed radiography (CR) is a well-established system that is robust, has good reproducibility, and is relatively inexpensive. Image quality has been continuously improved in recent years while the physical size of the readout units has been reduced and the throughput increased. CR is the only digital system that can be used for bedside chest radiographs. Improved detector properties and dual reading have made it a dose-efficient system. Although now widely available, a 4K image matrix does not appear to offer a general diagnostic improvement for imaging the chest. New developments with respect to detector composition and readout process can be expected in the future. Direct radiography (DR) is the common name for different technologies that are characterized by a direct readout matrix that covers the whole exposure area. Conversion of x-ray intensity into electric signals can either be direct (selenium-based systems) or indirect (scintillator/photodiode systems). Advantages of DR systems are a high image quality and the potential for dose reduction. The role of selenium radiography (Thoravision) has decreased after the advent of DR systems although this dedicated chest unit offers high image quality at 400 speed acquisition dose. Especially in a PACS environment, CR and DR systems will increasingly substitute for conventional radiography with advantages for CR for bedside chest radiographs and for DR for high-end chest stands.

Humans↗
PubMed2006

Comparison of different radiography systems in an experimental study for detection of forearm fractures and evaluation of the Müller-AO and Frykman classification for distal radius fractures.

OBJECTIVES: We sought to compare the diagnostic performance of screen-film radiography, storage-phosphor radiography, and a flat-panel detector system in detecting forearm fractures and to classify distal radius fractures according to the Müller-AO and Frykman classifications compared with the true extent, depicted by anatomic preparation. MATERIALS AND METHODS: A total of 71 cadaver arms were fractured in a material testing machine creating different fractures of the radius and ulna as well as of the carpal bones. Radiographs of the complete forearm were evaluated by 3 radiologists, and anatomic preparation was used as standard of reference in a receiver operating curve analysis. RESULTS: The highest diagnostic performance was obtained for the detection of distal radius fractures with area under the receiver operating curve (AUC) values of 0.959 for screen-film radiography, 0.966 for storage-phosphor radiography, and 0.971 for the flat-panel detector system (P > 0.05). Exact classification was slightly better for the Frykman (kappa values of 0.457-0.478) compared with the Müller-AO classification (kappa values of 0.404-0.447), but agreement can be considered as moderate for both classifications. CONCLUSIONS: The 3 imaging systems showed a comparable diagnostic performance in detecting forearm fractures. A high diagnostic performance was demonstrated for distal radius fractures and conventional radiography can be routinely performed for fracture detection. However, compared with anatomic preparation, depiction of the true extent of distal radius fractures was limited and the severity of distal radius fractures tends to be underestimated.

Area Under Curve↗
PubMed2006

Comparison of radiography and magnetic resonance imaging for evaluating the extent of nasal neoplasia in dogs.

OBJECTIVES: Magnetic resonance imaging (MRI) is increasingly used in veterinary practice and, in some centres, is part of the diagnostic work-up of small animals with nasal disease. However, there are no published studies which critically evaluate the use of magnetic resonance imaging for this purpose. The purpose of this work was to assess the changes seen using magnetic resonance imaging and to compare them with radiography. METHODS: The study included 12 dogs that had undergone both radiography and magnetic resonance imaging of the nasal cavity and had a histopathological diagnosis of malignant nasal neoplasia. Two pairs of board-certified radiologists scored the radiographs and the MRI scans, evaluating 10 signs of abnormality using a simple scoring system. Magnetic resonance imaging features were described in detail, and radiographic and magnetic resonance imaging scores for each sign as well as total scores were compared. RESULTS: Magnetic resonance imaging often showed that the tumour was more extensive than it had appeared on radiography but occasionally showed that radiographs had overestimated its size. Although radiography was reliable for assessment of the presence and size of a mass and for the extent of turbinate destruction, it usually failed to show occlusion of the major airway passages that were evident on magnetic resonance imaging. Extension of the tumour into the opposite nasal cavity, frontal sinus, orbit and cranial cavity was shown much better on magnetic resonance imaging. CLINICAL SIGNIFICANCE: Minor but significant extension beyond the nasal cavity, which is important for treatment planning and prognosis, requires magnetic resonance imaging for demonstration, although radiography shows major changes reliably.

Animals↗
PubMedDate not supplied

Free-focus radiography using conventional films--radiation exposures in a simulated clinical study.

This study compared air exposures during conventional dental and maxillofacial radiography and similar views using free-focus radiography with conventional image receptors. The results show that periapical type surveys on nonscreen film placed extraorally or in the buccal fold may be carried out with an exposure to the surface tissues, which is similar to or less than conventional dental radiography. Extraoral survey type radiographs of the jaws may be carried out with significantly less surface exposure than lateral oblique views of the jaws. The least exposure was required, when the film was placed in the buccla fold instead of against the face during free-focus radiography. The exposures with film screen combinations were reduced by an order of magnitude when compared to the nonscreen techniques. Proper filtration of the beam of the miniaturized x-ray machines radiography in dentistry may thus be desirable and applications in other parts of the body encouraged.

Cadaver↗
PubMed1989

Radiography and fluoroscopy, 1920 to the present.

A survey of radiological procedures carried out in 1980 by J. L. Johnson and D. L. Abernathy indicated that of the 181 million procedures performed in that year, there were 77.5% plain radiographic studies, 12.7% contrast studies, 4.0% sonographic studies, 3.2% nuclear medicine studies, 1.8% CT studies and 0.8% special vascular procedures and cardiac catheterizations. Note that over 90% of all the studies were of the "conventional" type and that fewer than 2% were CT studies. In the early 70's when CT was introduced, it was predicted that it would soon take over most of radiography; some 7 or 8 years later, it was obvious that this would not take place. According to Tanako of the Fuji Photo Film Co. Ltd., conventional radiography has resisted being pushed aside because of its very high information content: 4-6 megabytes per image. A CT image contains about 0.5 megabytes. If a system is to take over from conventional radiography, it will have to overcome this large difference in information content. Digital or computed radiography seems capable of this, but probably not for some time (perhaps, 10 or 20 years). It seems unlikely that there will be much change, except for refinement, in the image intensified fluoroscopy equipment used for observing dynamic processes, and it will probably not be replaced. Another situation which will preclude the rapid demise of conventional radiography is financial inertia: There is between 5 and 10 billion dollars worth of diagnostic equipment in hospitals in this country and significant amount more in private offices and clinics. It is true that the amount has diminished in recent years, but this has been more because of DRG's than because of "takeover" by new modes of imaging. It is not likely that this investment will be given up quickly or easily. One must also keep in mind that the film digitization and the photostimulable phosphor digital systems, described above, do use existing radiographic equipment, and the image intensification system uses a great portion of existing fluoroscopic equipment, therefore "going digital" may not require complete replacement of existing equipment.

Fluoroscopy↗
PubMed2002

Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT--initial experience.

PURPOSE: To prospectively compare the accuracy of ultrasonography (US) with that of supine chest radiography in the detection of traumatic pneumothoraces, with computed tomography (CT) as the reference standard. MATERIALS AND METHODS: Thoracic US, supine chest radiography, and CT were performed to assess for pneumothorax in 27 patients who sustained blunt thoracic trauma. US and radiographic findings were compared with CT findings, the reference standard, for pneumothorax detection. For the purpose of this study, the sonographers were blinded to the radiographic and CT findings. RESULTS: Eleven of 27 patients had pneumothorax at CT. All 11 of these pneumothoraces were detected at US, and four were seen at supine chest radiography. In the one false-positive US case, the patient was shown to have substantial bullous emphysema at CT. Sensitivity and negative predictive value of US were 100% (11 of 11 and 15 of 15 patients, respectively), specificity was 94% (15 of 16 patients), and positive predictive value was 92% (11 of 12 patients). Chest radiography had 36% (four of 11 patients) sensitivity, 100% (16 of 16 patients) specificity, a 100% (four of four patients) positive predictive value, and a 70% (16 of 23 patients) negative predictive value. CONCLUSION: In this study, US was more sensitive than supine chest radiography and as sensitive as CT in the detection of traumatic pneumothoraces.

Adolescent↗
PubMed2004

FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy.

PURPOSE: To compare the diagnostic efficacy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with that of conventional radiography and three-phase bone scintigraphy in patients suspected of having infection in their total hip replacements. MATERIALS AND METHODS: Thirty-five patients with painful total hip replacements and possible septic prosthetic loosening were examined with FDG PET, conventional radiography, and three-phase bone scintigraphy. PET, radiographic, and scintigraphic images were each evaluated by two independent observers in a blinded fashion. For 32 of 35 patients, serial conventional radiographs were available. Results of microbiologic examinations of surgical specimens represented the standard of reference in 26 patients, and results of joint aspiration plus clinical follow-up of at least 6 months represented the standard of reference in the remaining nine patients. Sensitivity, specificity, accuracy, and interobserver variability (kappa) values were calculated. The imaging modalities were compared in terms of diagnostic confidence by using the sign test. RESULTS: Nine patients had septic and 21 patients had aseptic loosening. In five patients, neither loosening nor infection was confirmed. For diagnosing infection with FDG PET, conventional radiography, and bone scintigraphy, respectively, sensitivity values for reader 1 and reader 2 were 33% and 22%, 89% and 78%, and 56% and 44%, while specificity values were 81% and 85%, 50% and 65%, and 88% and 92% and accuracy values were 69% for both readers, 60% and 69%, and 80% for both readers. PET was significantly more specific (P =.035) but less sensitive (P =.016) than conventional radiography for the diagnosis of infection. CONCLUSION: In a study population of patients suspected of having infected total hip replacements, FDG PET performed similarly to three-phase bone scintigraphy. FDG PET was more specific but less sensitive than conventional radiography for the diagnosis of infection.

Aged↗
PubMed2005

Type B Niemann-Pick disease: findings at chest radiography, thin-section CT, and pulmonary function testing.

PURPOSE: To evaluate findings at radiography, computed tomography (CT), and pulmonary function testing in patients with type B Niemann-Pick disease. MATERIALS AND METHODS: The study was approved by the institutional review board or ethics committee at each study site and was compliant with HIPAA at the U.S. site. Written informed consent was obtained from each patient or guardian and minor assent was obtained from all children before any study-related procedures. Pulmonary involvement in 53 patients (27 male and 26 female patients; age range, 7-65 years; mean age, 23.3 years) with type B Niemann-Pick disease was evaluated with imaging and pulmonary function tests. All patients underwent chest radiography and thin-section CT, and images were independently interpreted by one of two radiologists. Spirometry (forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1]) was performed and diffusing capacity of lung for carbon monoxide (Dlco) was evaluated in all patients who could comply. A score for the degree of interstitial lung disease was derived at both radiography and CT, and the CT scores were then compared with results of pulmonary function testing and patient age by means of linear regression. CT scores were compared between the upper and lower lung zones by using the Wilcoxon signed rank test. RESULTS: Chest radiography and CT, respectively, revealed interstitial lung disease in 47 (90%) and 51 (98%) of the 52 patients who completed both imaging examinations. There was a basilar predominance of interstitial lung disease at CT. Six patients had pulmonary nodules, one of which was calcified at chest radiography. There were no statistically significant correlations between interstitial lung disease score at CT and age or percentage predicted FVC, FEV1, or Dlco values. CONCLUSION: Although pulmonary function test indexes may be abnormal, imaging findings do not necessarily correlate with pulmonary function in patients with type B Niemann-Pick disease.

Adolescent↗
PubMed1980

A critical look at the accuracy of endoscopy and double-contrast radiography of the upper gastrointestinal (UGI) tract in patients with substantial UGI hemorrhage.

Double-contrast radiography and endoscopy were compared in a prospective study of 100 patients with substantial hemorrhage of the upper gastrointestinal (UGI) tract. Endoscopy enabled detection of the primary bleeding site in 93% of the patients and correct diagnosis of 91% of all UGI lesions present. Double-contrast radiography detected 80% of primary bleeding sites and 76% of all UGI lesions present; whether the double-contrast examination was performed before or after endoscopy did not change its ability to detect lesions. Radiography demonstrated 68% (esophagitis) to 86% (duodenitis) of all superficial lesions. Endoscopy missed lesions in the duodenum and esophagus most frequently, while double-contrast radiography missed lesions in the esophagus most frequently. With the two modalities combined, the overall diagnostic accuracy for all lestions was 99%. Endoscopy and double-contrast radiography are complementary techniques for detecting acute bleeding sites of the UGI tract.

Adult↗