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PubMed1993

Full-spine radiography: a review.

OBJECTIVE: The literature pertaining to full-spine radiography was reviewed to clarify its current role in clinical practice, to identify appropriate parameters for patient selection criteria, to evaluate the validity of spinographic analysis procedures, and to review the latest technological advancements in radiation protection and radiographic technology. DATA SOURCES: The English language literature search included chiropractic textbooks, technique manuals and position papers as well as references from MEDLINE, Chiropractic Research Archives Collection (CRAC) and Chiropractic Literature Analysis and Retrieval System (CHIROLARS). References from non-indexed sources were reviewed from sources obtained in the indexed literature. Current texts on radiographic technology, radiation biology and radiation physics also were reviewed. STUDY SELECTION: The literature was reviewed by a single reviewer. All chiropractic references obtained were referenced. Nonchiropractic references that addressed relevant related topics were also included. DATA EXTRACTION: This study was primarily a qualitative review of the literature. A single observer extracted quantitative data only from controlled studies that examined validity, inter- and intraobserver reliability, and clinical relevance. DATA SYNTHESIS: The conclusions and recommendations in this review are based primarily on the work of experts in the field and well-established principles of radiation biology, radiation protection and radiation physics. CONCLUSIONS: Full-spine radiography and spinographic analysis are controversial procedures in chiropractic. An extensive review of the literature reveals that the role of full-spine radiography is well established. With proper patient selection, careful attention to technical detail and utilization of several technological advancements, full-spine radiography is an effective diagnostic and analytic procedure with an acceptable risk/benefit ratio. Although the reliability of certain spinographic parameters has been established, many questions remain regarding the validity and clinical relevance of those parameters.

Biomechanical Phenomena↗
PubMed1995

Surface and internal absorbed doses in mandibular and maxillary occlusal radiography.

The objective of this study was to determine the absorbed radiation doses to various structures within the head and neck as a result of routine mandibular and maxillary occlusal radiography. Five projections were investigated: the anterior mandibular; true mandibular; anterior maxillary; lateral maxillary; and maxillary vertex occlusal radiographic views. Standard thermoluminescent dosimetry methodology was employed using a humanoid phantom of the skull. Multiple exposures were done for each view to ensure adequate precision. The absorbed doses to various locations following a single occlusal exposure are presented in centiGray (cGy). It was found that the absorbed dose values for occlusal radiography observed in this study were similar in magnitude to previously reported absorbed dose values for other forms of dental radiography. Values ranged from 0.0014 cGy to 1.301 cGy. The highest absorbed doses were generally the skin entrance doses. The results of this study provide an accurate, concise summary of surface and internal absorbed radiation doses for five commonly used occlusal radiographs. They can be used in the calculation of risk estimates for dental radiography, and may assist dentists in their discussions with patients concerned about radiation exposure.

Absorption↗
PubMed1977

[Correction osteotomies of the knees. Factors altering the static angles on the radiographies through fault projection (author's transl)].

Comparing radiographies we have examined the degree in which the static angles of the knee are affected, because of a fault projection under the influence of some factors. We have found that an inwards or an outwards turn, even of a small degree (IQ), a bending or preexistent (pathological) anomalies, each alone or in combination, affected the right projection of the angles in a face radiography. Physiological knees possibly are presented like "varum" or "valgum" projectional. It is clear that the right position during the taking of the radiography is of a great significance in order to decide about the indication of osteotomy and to determine the degree of correction. We suggest as a criterion of the right radiographies the factor "patellacondylus".

Anthropometry↗
PubMed1996

Must radiation dose for CT of the maxilla and mandible be higher than that for conventional panoramic radiography?

We evaluated the feasibility of performing preoperative spiral CT of the maxilla and mandible with a radiation dose similar to that used for conventional panoramic radiography. The skin entrance doses of radiation used for spiral CT (collimation, 1 mm; pitch, 2; tube voltage, 80 kV; tube current, 40 mA) and for panoramic radiography (75 kV, 8 mA, 15 seconds) were measured in one patient by using thermoluminescent dosimeter chips. Results were 0.56 +/- 0.06 mGy for CT and 0.59 +/- 0.04 mGy for radiography. Image quality was adequate for preoperative implant planning. Spiral CT of the mandible and maxilla may therefore be feasible with a radiation dose of similar magnitude as that used for conventional panoramic radiography.

Dental Implants↗
PubMed1997

[Rationalization of the use of preoperative thoracic radiography in obstetrics and gynecology].

INTRODUCTION: Rationalizing preoperative chest radiography remains a problem in our Country. Therefore, we tried to use preoperative chest films rationally in obstetrics and gynecology to assess their impact on anesthesia planning and patient management and their use in early postoperative complications. MATERIAL AND METHODS: We examined two groups of patients: group A consisted of 570 women (mean age: 31 years) scheduled to be submitted to cesarean section but with no preoperative chest radiography; group B consisted of 471 patients (homogeneous in age to group A patients) submitted to nononcologic gynecologic surgery and with a single-projection preoperative chest radiograph. Anesthesiologic assessment, preoperative biochemical tests and EKG were performed in all patients. All patients underwent abdominal surgery under general anesthesia. The first 24 postoperative hours were monitored for possible anesthesia-related complications. The anesthesiologist need of chest radiography based on clinical findings was investigated in group A patients, as well as the importance of chest film findings in possible anesthesia-related complications. RESULTS: Group A and group B were homogeneous by mean patient age and anesthesia duration; clinical findings never suggested the need of chest radiography in group A patients. Three cardiorespiratory complications occurred (two respiratory arrests in group A and a gas embolism in group B), but the (un)availability of chest film findings made no difference in treatment. DISCUSSION: The availability of the preoperative chest radiographs of a group of healthy women of 31 years mean age does not make any difference in anesthesia planning and type. In our series, the most severe cardiorespiratory complications were homogeneous in the two groups, which confirms their random character, and the (un)availability of preoperative chest film findings made no real difference, even though the lack of radiographic evidence made patient management more demanding for anesthesiologists.

Abdomen↗
PubMed2004

Comparison between subtraction radiography and conventional radiographic interpretation during long-term evaluation of periodontal therapy in Class II furcation defects.

BACKGROUND: Limited information comparing digital subtraction radiographic assessment with conventional radiographic interpretation is available from longitudinal clinical trials. The aim of this study was to evaluate the ability to detect periodontal bone changes during the long-term maintenance of Class II furcation defects by conventional radiographic interpretation compared to interpretation of digital subtraction images. METHODS: Standardized radiographs of 18 Class II furcation defects in mandibular molars were taken at baseline and at 6, 12, 18, and 24 months after non-resective periodontal surgery. Conventional radiographic and digital subtraction interpretations were performed masked, respectively, by two and three experienced examiners, according to the following categories: bone gain; bone loss; unchanged appearance; and impossible to visualize. Percent concordance and the kappa statistic value (kappa) were computed. RESULTS: Conventional radiographic and digital subtraction interpretation images resulted in 72 decisions for each examiner. The visual interpretation of digital subtraction images by two examiners revealed the same results. The interpretation of conventional radiographic images showed a low concordance between examiners (kappa < 0.40) at all examinations. The concordance between subtraction radiography and conventional radiographic interpretation was also low for all examiners (kappa < 0.36) at all examinations. Using subtraction radiography as a reference, bone changed and bone unchanged were diagnosed correctly in 47.2% of cases by examiner A, in 43.1% by examiner B, and in 38.9% by examiner C. CONCLUSION: It can be concluded that conventional radiographic interpretation is a more subjective and inaccurate method of detecting periodontal bone changes in Class II furcation defects in mandibular molars when compared with subtraction radiography.

Alveolar Bone Loss↗
PubMed1994

Role of skull radiography in the initial evaluation of minor head injury: a retrospective study.

The use of skull radiography in the initial evaluation of minor head injured patients is controversial. In an attempt to evaluate its benefits, a retrospective study of 566 cases subjected to skull radiography following close minor head trauma (Glasgow Coma Scale 13-15), is presented. A skull fracture (linear vault, depressed or base of skull) was present in 64 (11%) cases. Only three (5%) who were found to have a skull fracture on skull radiography developed an intracranial injury which required surgery. Intracranial injuries developed in 19 (3%) cases and were followed by surgery in six (32%). All, except for one case, had a decreased level of consciousness and a Glasgow Coma Scale less than 15, few had focal neurological deficits. Management had not been altered by the results of skull radiography in any of the cases. We concluded that skull radiographs are unnecessary for the decision process in closed minor head injury because management decisions are based primarily on a careful neurological examination. When intracranial injuries are a concern, a CT scan should be obtained.

Adolescent↗
PubMed1997

Musculoskeletal computed radiography in children: scatter reduction and improvement in bony trabecular sharpness using air gap placement of the imaging plate.

The effect of various air gaps on computed radiographic musculoskeletal images was investigated using a knee phantom. Scatter to primary radiation ratios were measured using the beam stop method at air gaps ranging from 0 to 30 in. (0-762-mm). Bony trabecular sharpness, line pair resolution, quantum mottle and visualization of low-contrast beads in the soft tissues were evaluated. A significant reduction of scatter to primary radiation ratio, from a value of almost 1 at table top to about 0.4 at 10-in. (254-mm) air gap and about 0.2 at 25-in. (635-mm) air gap placement of the computed radiography (CR) imaging plate, was obtained. A progressive improvement in bony trabecular sharpness and line pair resolution, compared with the table top and Bucky images was observed on 10-in. (254-mm) through 25-in. (635-mm) air gap images. Sharpness of the bony trabeculae and line pair resolution were best on the 25-in. (635-mm) air gap images. The skin entrance radiation dose does not have to be increased for air gap digital radiography. The radiographic noise or quantum mottle is highest on the Bucky image, higher on air gap images and minimal on the table top images, despite a high scatter to primary radiation ratio at the table top. The lower quantum mottle on the table top images allowed for maximal visualization of low contrast densities in the soft tissues. Air gap radiography further improves musculoskeletal computed imaging by reducing the scatter to primary radiation ratio without an increase in the skin entrance dose. For significant reduction of the scatter to primary radiation ratio and best evaluation of line pair spatial resolution and bony trabeculae, a 25-in. (635-mm) air gap with digital radiography would be optimal. For evaluation of low contrast densities in the soft tissues, table top placement would be the technique of choice.

Air↗
PubMed1998

Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis.

OBJECTIVE: To compare magnetic resonance (MR) imaging, computed tomography (CT), and radiography in the detection of sacroiliitis accompanying ankylosing spondylitis (AS). DESIGN AND SUBJECTS: Nine volunteers and 24 patients were recruited. Radiography, CT, and MR imaging were completed within a 1-week period in 24 patients with AS. In precontrast MR examination, spin-echo T1, fast spin-echo T2, and gradient echo with rephasing T2* images were obtained without fat saturation using a 0.3-T imager for all volunteers and patients. Postcontrast MR examination was performed using the same precontrast SE T1 sequence for patients with AS. RESULTS AND CONCLUSIONS: MR imaging directly showed the normal cartilage in all 16 sacroiliac joints of the 8 volunteers. In the 24 patients with AS, cartilage abnormalities were observed in 42 sacroiliac joints. More diagnoses of sacroiliitis were made using MR and CT imaging than using radiography (P < 0.001). Therefore, low-field-strength MR can be useful in detecting early sacroiliitis in patients with AS. MR imaging was able to reveal early cartilage changes and bone marrow edema, which could not be found by either CT or radiography.

Adolescent↗
PubMed2006

Effect of digital radiography on emergency department radiographic examinations.

The purpose of this paper is to determine the time-savings realized as a result of conversion from film-based radiography to digital radiography (DR) in emergency department patients receiving multiple radiographic examinations. We retrospectively reviewed the computer records of 69 patients from the preconversion group (January 2004) and 62 patients from the postconversion group (January 2005), calculated the mean examination time per image from each group, and used a one-tailed t test to compare the two means. The preconversion (a mix of screen-film and computed radiography) group had a mean examination time of 3.27+/-1.50 min per image. The postconversion (DR) group had a mean examination time of 2.51+/-1.16 min. The p value between the two means is 0.000822 with a standard error of 0.330 min. DR reduces radiographic examination time by 23% when compared to conventional screen-film radiography.

Efficiency↗
PubMed1993

Iodine-induced hyperthyroidism due to nonionic contrast radiography in the elderly.

PURPOSE: To identify the number of cases of hyperthyroidism that followed the performance of contrast radiography in elderly patients at a geriatric hospital in a non-iodine-deficient area and to determine the clinical course of the condition. PATIENTS AND METHODS: All patients over a 20-month period with biochemical hyperthyroidism (plasma free thyroxine level greater than 25.0 pmol/L and thyroid-stimulating hormone level less than 0.10 IU/L) were identified. Clinical features of hyperthyroidism and exposure to nonionic contrast media radiographs within the previous 12 months were sought. Follow-up extended from 6 to 22 months. RESULTS: A total of 28 patients with hyperthyroidism (aged 70 to 96 years) were identified. Seven patients (25%) had documented biochemical development of hyperthyroidism (five) or subsequent hyperthyroidism (two) 3 to 8 weeks after nonionic contrast media radiography. The four patients who underwent scanning had a multinodular thyroid, and thyroid antibodies were not detected in five of five patients. Although the condition appeared self-limited and six of six patients were euthyroid after 18 months, the condition was not benign; progress and recovery were adversely affected by hyperthyroidism. Four patients had a good response to treatment with an antithyroid drug (carbimazole). CONCLUSION: Iodine-induced thyrotoxicosis following contrast radiography was found in 7 of 28 cases of hyperthyroidism seen at a geriatric hospital. Although the condition appears ultimately self-limited, pharmacologic control of severe clinical features may be required. The frequency of this condition in a non-iodine-deficient area appears related to the more common occurrence of autonomous thyroid nodules in the elderly. Because performance of contrast radiography is more common in this age group, the recognition and treatment of iodine-induced thyrotoxicosis are of increasing clinical importance.

Age Factors↗
PubMed2004

Trial of very cold neutron radiography in Kyoto University reactor.

A practical very cold neutron (VCN) radiography using a neutron imaging plate was carried out in VCN facility, Kyoto University Reactor (KUR: 5MW). The neutron flux from the VCN bender with the characteristic wavelength of 4.8 nm gives a good image with 5 min irradiation time when CNS was operated. The macroscopic total cross sections of water were measured by imaging plates. It is Sigma(th)=0.87 cm(-1) measured in KUR E2 thermal neutron radiography facility and that of VCN is Sigma(VCN)=9.4 cm(-1). The resolution of water thickness is less than 0.1 mm for VCN radiography and close to the positional resolution of an imaging plate. VCN radiography can show the change of water quantity in gypsophila during a drying procedure.

Journal Article↗
PubMed1996

Fetal radiation exposure is minimal after pelvimetry by modified digital radiography.

OBJECTIVE: Our purpose was to determine the maximal fetal exposure to radiation by use of thermoluminescent dosimeters when pelvic measurements were performed by standard or modified digital radiography. STUDY DESIGN: Digital radiography of the pelvis was performed according to a standard technique. Lithium fluoride thermoluminescent dosimeters were positioned on the patient's skin to quantitate the maximal amount of radiation exposure to the fetus. The standard technique often included a portion of fetal vertex. The axial view technique was modified to use an angle of inclination of 17 to 29 degrees relative to the vertical axis. RESULTS: Digital radiography was well tolerated and interpretable images were consistently obtained. The maximal dose to the fetal vertex by use of the standard digital axial slice was 465 mrad. By modifying the standard digital technique and using an angle of inclination of 17 to 29 degrees it was possible to obtain an axial section without including any portion of the fetal vertex. This reduced the maximal total dose to the fetal vertex to 55 mrad, which is less than the background radiation exposure to the fetus over a 9-month period from natural sources. CONCLUSION: Data reported indicate that total fetal radiation exposure is minimal after pelvimetry by digital radiography. Incorporating the modification of the angle for the axial slice, as reported here, resulted in a further significant decrease in fetal radiation exposure.

Female↗
PubMed1991

Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease.

One hundred individuals who had undergone both high resolution computed tomography (HRCT) and chest radiography were studied to determine the accuracy of each technique in establishing the diagnosis of diffuse lung disease. The group consisted of 86 patients with a diagnosis of a chronic diffuse infiltrative lung disease and 14 normal subjects. Two independent observers assessed the HRCT examinations and chest radiographs and recorded the three most likely diagnoses. Overall a confident diagnosis was reached more often with HRCT (49%) than with chest radiography (41%). The diagnoses were correct in 82% of HRCT examinations and 69% of chest radiographs. Diagnoses made on HRCT, irrespective of the degree of certainty, were accurate more often than diagnoses made on chest radiography (56% and 47% respectively). Of the patients thought to have a normal chest radiograph, 42% had diffuse infiltrative lung disease (DILD). Of the patients thought to be normal on HRCT, 18% had DILD. Conversely, normal subjects were correctly identified as such in 82% of chest radiographs and in 96% of HRCT examinations. This study emphasizes the important role of CT in helping to confirm or refute the presence of abnormality when the chest radiograph is normal or questionably abnormal, and underlines the superior diagnostic accuracy of HRCT compared with conventional chest radiography in DILD.

Chronic Disease↗
PubMed1996

Use of air enema radiography to assess depth of ulceration during acute attacks of ulcerative colitis.

BACKGROUND Acute colitis is usually assessed by means of plain abdominal radiographs, the diagnostic utility of which can be enhanced by barium enema. Colonoscopy can also be useful. The latter methods may be laborious and carry risk. We describe a radiographic technique using air as the contrast medium to show mucosal or deeper ulceration. METHODS Of 60 patients undergoing colectomy for acute ulcerative colitis, 35 had air enema radiography and 14 had plain films with sufficient amount of spontaneously occurring gas to allow visualisation of the mucosa, during the 10 days before surgery. The degree of inflammation on air enema films and the extent of histopathological ulceration in colectomy specimens were independently graded and compared with each other. Depth of ulceration was compared with clinical data including a preoperative risk stratification, the APACHE II score. FINDINGS The degree of inflammation on air enema radiography correlated significantly with depth of ulceration at histopathological examination (rs 0.61, p<0.001). Presence of mucosal changes had a close association with deep ulceration extending into the muscularis propria layer or beyond (p<0.001). Air enema radiography had a high sensitivity (0.91) for presence of and specificity (0.75) in the exclusion of deep ulceration, with positive and negative predictive values of 0.88 and 0.80. 42 of 49 patients were correctly classified as regards deep ulcers. The correlation between higher preoperative APACHE II scores and severity of histopathological colitis was weak (rs 0.30, p<0.05). INTERPRETATION Air enema radiography reliably assesses the presence of colonic ulceration in patients with an acute attack of ulcerative colitis. It is a first-line investigation to assess the presence of deeper ulceration in acute colitis.

APACHE↗
PubMed2000

Comparison of ultrasound, radiography, and clinical examination in the diagnosis of acute maxillary sinusitis: a systematic review.

The objective of this study was to assess the discriminative properties of the methods for diagnosing acute maxillary sinusitis (AMS) in unselected patients. The study design was a systematic review of evaluation studies identified by using Medline, by searching reference lists, by hand searches, and by contacting investigators. Evaluation studies were conducted anywhere in the world. Subjects were adults with suspected AMS. Main outcome measures were: sensitivity, specificity, positive and negative likelihood ratios of the primary studies, weighted means of these parameters in each comparison (clinical examination, radiography, and ultrasound compared to a reference standard in diagnosing AMS), and summary ROC curves and their Q* points where sensitivity equals specificity. For the years from 1962 to present, 49 study reports were found; 11 articles on studies that included a total of 1144 patients were eligible. Compared to sinus puncture, radiography was the most accurate method for diagnosing AMS: the Q* point on the summary ROC curve was 0.82 (95% confidence interval, CI, 0.78-0.85). Ultrasound was slightly less accurate than radiography compared to sinus puncture (Q* 0.80, 95% CI 0.76-0.83). Only two articles reported clinical examination compared to sinus puncture and the Q* for them was 0.75 (95% 0.58-0.86). Clinical examination is a rather unreliable method for diagnosing AMS, even in the hands of experienced specialists. Using radiography or ultrasound improves the accuracy of diagnosis. The diagnosis of AMS is rarely studied in primary care settings. Future comparative trials should preferably combine diagnosis and treatment, evaluating the two aspects of clinical management as unit.

Acute Disease↗
PubMed2002

The experience and opinions of teachers of radiography students regarding pressure ulcer prevention and management in x-ray departments.

As part of a survey of pre-registration radiography course providers about pressure ulcer education, we asked respondents to comment on their personal experience of pressure ulcer prevention and management in x-ray environments, and also to identify what they consider to be important issues in this area. Responses were received from 14 out of the 24 providers of radiography education in the UK. The qualitative data was content analysed. The data suggests that radiography teachers have varied experience and a range of opinion about pressure ulcer prevention and management. The evidence supports partially anecdotal comments made to one of the authors (DJ) that radiographers cannot be expected to have knowledge of pressure ulcer prevention and management. Clinical staff with experience of pressure ulcer prevention and management should be aware of the potential risks in x-ray departments and provide support and education to radiography colleagues.

Humans↗
PubMed1998

Computed radiography versus screen-film mammography in detection of simulated microcalcifications: a receiver operating characteristic study based on phantom images.

RATIONALE AND OBJECTIVES: The authors compare a 43-micron computed radiographic system with a mammographic screen-film system for detection of simulated microcalcifications in an observer-performance study. MATERIALS AND METHODS: The task of detecting microcalcifications was simulated by imaging aluminum wire segments (200-500 microns in length; 100, 125, or 150 microns in diameter) that overlapped with tissue background structures produced by beef brisket. A total of 288 such simulations were generated and examined with both computed radiography and conventional screen-film mammography techniques. Computed radiography was performed with high-resolution plates, a 43-micron image reader, and a 43-micron laser film printer. Computed radiographic images were printed with simple contrast enhancement and compared with screen-film images in a receiver operating characteristic study in which experienced readers detected and scored the simulated microcalcifications. Observer performance was quantitated and compared by computing the area under the receiver operating characteristic curve. RESULTS: Although the resolution of the computed radiography system was better than that of commercial systems, it fell short of that of screen-film systems. For the 100-micron microcalcifications, the difference in the average area under the curve was not statistically significant, but it was significant for the larger simulated microcalcifications: the average area under the curve was 0.58 for computed radiography versus 0.76 for screen-film imaging for the 125-micron microcalcifications and 0.83 versus 1.00, respectively, for the 150-micron microcalcifications. CONCLUSION: Observer performance in the detection of small simulated microcalcifications (100-150 microns in diameter) is better with screen-film images than with high-resolution computed radiographic images.

Breast Diseases↗