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PubMed1977

Panoramic radiography in dentistry.

Examples of panoramic radiography equipment in use are briefly reviewed and the differences pointed out between those operating on the principle of tomography and other "panoramic" instruments. The various uses to which panoramic radiography is put are described and the problems involved in using them explained. The advantages and disadvantages of panoramic radiography are listed and comparisons drawn between the degree of clarity and precision for diagnosis obtained with it as against that obtained using normal periapical radiographs.

Adult↗
PubMedDate not supplied

Dental radiography: an overview for the radiologic technologist.

The methods and techniques involved in dental radiography are presented to familiarize the radiologic technologist with this practice. Additionally, the uses and pathologies commonly encountered in dental radiography are discussed. Although dental radiography is seldom performed by many radiographers, the techniques and methods used may be of interest and use to the radiographer.

Cephalometry↗
PubMedDate not supplied

[Digital panoramic radiography in patients with rigid internal fixations devices after maxillofacial surgery].

INTRODUCTION: Digital techniques have found promising applications in dental radiology in the recent past, namely with radiovisiography and digital panoramic radiography. These images present some features making them particularly interesting for alveolar bone studies. MATERIAL AND METHODS: Digital panoramic radiography with light-emitting phosphors was performed on 16 patients during postoperative follow-up. The patients were previously submitted to multiple maxillofacial osteosynthesis with rigid internal fixation devices (32 miniplates, 12 microplates, 14 screws). Digital images were always observed and printed with analogic-like and Xeroradiographic-like post-processing. RESULTS: Digital panoramic radiographs yielded clear and effective images of the maxillary and mandibular arches and of surgical osteosynthesis, as demonstrated by a retrospective evaluation performed by three independent observers on a blind basis (score 3: 60.42%), with no major interobserver differences (p = .7286). Xeroradiographic-like images were the most effective in depicting bone structures and osteosynthesis materials, thanks to their better detailing and typically lower overall contrast. Among the drawbacks of the digital technique, reduced cassette size may prevent the full view of the mandibular arch from the symphysis to both condylar regions. The edge effect, which is typical of Xeroradiographic images, may mask useful details within the trabecular bone close to metal implants. This effect was present in some of our cases, but it was seldom disturbing according to our retrospective evaluation (score 3: 53.40%), with good interobserver agreement (p = .1117). CONCLUSION: Digital panoramic radiography proves to be a useful tool to study metal implants after maxillofacial surgery as well as alveolar bone structure. The digital technique markedly reduces the radiation dose to the patient, which is very important for an X-ray examination that must be repeated several times, often in young subjects.

Adult↗
PubMed2002

The utility of chest radiography following percutaneous dilational tracheotomy.

OBJECTIVE: To determine the need for routine chest radiography following percutaneous dilational tracheotomy (PDT). DESIGN: Retrospective chart review. SETTING: Tertiary care academic medical center. PATIENTS: The records of 119 patients undergoing PDT between 1993 and 2000 for indications of prolonged intubation or need for pulmonary toilet. All patients received a portable chest radiograph immediately following the procedure. OUTCOME MEASURE: Incidence of postoperative pneumothorax or pneumomediastinum. RESULTS: One patient (0.8%) undergoing PDT experienced a postoperative pnuemothorax. This patient was noted to have respiratory distress within 10 minutes following the procedure, suggesting a pneumothorax. A postoperative chest radiograph confirmed the clinical impression. No asymptomatic patients were diagnosed as having a pnuemothorax or pneumomediastinum using postoperative chest radiography. CONCLUSIONS: Chest radiography following PDT is indicated when there are clinical findings suggesting pneumothorax or pneumomediastinum. Without clinical signs or symptoms, routine use of postoperative chest radiographs are unnecessary and not cost-effective.

Academic Medical Centers↗
PubMed1993

Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation.

OBJECTIVE: To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. DESIGN: Survey prospectively administered in two stages: validation and refinement of the original rules (first stage) and validation of the refined rules (second stage). SETTING: Emergency departments of two university hospitals. PATIENTS: Convenience sample of adults with acute ankle injuries: 1032 of 1130 eligible patients in the first stage and 453 of 530 eligible patients in the second stage. MAIN OUTCOME MEASURES: Attending emergency physicians assessed each patient for standardized clinical variables and classified the need for radiography according to the original (first stage) and the refined (second stage) decision rules. The decision rules were assessed for their ability to correctly identify the criterion standard of fractures on ankle and foot radiographic series. The original decision rules were refined by univariate and recursive partitioning analyses. MAIN RESULTS: In the first stage, the original decision rules were found to have sensitivities of 1.0 (95% confidence interval [CI], 0.97 to 1.0) for detecting 121 maleolar zone fractures, and 0.98 (95% CI, 0.88 to 1.0) for detecting 49 midfoot zone fractures. For interpretation of the rules in 116 patients, kappa values were 0.56 for the ankle series rule and 0.69 for the foot series rule. Recursive partitioning of 20 predictor variables yielded refined decision rules for ankle and foot radiographic series. In the second stage, the refined rules proved to have sensitivities of 1.0 (95% CI, 0.93 to 1.0) for 50 malleolar zone fractures, and 1.0 (95% CI, 0.83 to 1.0) for 19 midfoot zone fractures. The potential reduction in radiography is estimated to be 34% for the ankle series and 30% for the foot series. The probability of fracture, if the corresponding decision rule were "negative," is estimated to be 0% (95% CI, 0% to 0.8%) in the ankle series, and 0% (95% CI, 0% to 0.4%) in the foot series. CONCLUSION: Refinement and validation have shown the Ottawa ankle rules to be 100% sensitive for fractures, to be reliable, and to have the potential to allow physicians to safely reduce the number of radiographs ordered in patients with ankle injuries by one third. Field trials will assess the feasibility of implementing these rules into clinical practice.

Adolescent↗
PubMed2004

Antepartum dental radiography and infant low birth weight.

CONTEXT: Both high- and low-dose radiation exposures in women have been associated with low-birth-weight offspring. It is unclear if radiation affects the hypothalamus-pituitary-thyroid axis and thereby indirectly birth weight, or if the radiation directly affects the reproductive organs. OBJECTIVE: To investigate whether antepartum dental radiography is associated with low-birth-weight offspring. DESIGN: A population-based case-control study. PARTICIPANTS AND SETTING: Enrollees of a dental insurance plan with live singleton births in Washington State between January 1993 and December 2000. Cases were 1117 women with low-birth-weight infants (<2500 g), of whom 336 were term low-birth-weight infants (1501-2499 g and gestation > or =37 weeks). Four control pregnancies resulting in normal-birth-weight infants (> or =2500 g) were randomly selected for each case (n = 4468). MAIN OUTCOME MEASURES: Odds of low birth weight and term low birth weight by dental radiographic dose during gestation. RESULTS: An exposure higher than 0.4 milligray (mGy) during gestation occurred in 21 (1.9%) mothers of low-birth-weight infants and, when compared with women who had no known dental radiography, was associated with an adjusted odds ratio (OR) for a low-birth-weight infant of 2.27 (95% confidence interval [CI], 1.11-4.66, P =.03). Exposure higher than 0.4 mGy occurred in 10 (3%) term low-birth-weight pregnancies and was associated with an adjusted OR for a term low-birth-weight infant of 3.61 (95% CI, 1.46-8.92, P =.005). CONCLUSION: Dental radiography during pregnancy is associated with low birth weight, specifically with term low birth weight.

Adult↗
PubMed1975

Detection of skeletal involvement in Hodgkin's disease: a comparison of radiography, bone scanning and bone marrow biopsy in 38 patients.

As part of the staging of 38 patients with Hodgkin's disease seen over an 18-month period, we have used radioisotopic scanning of bone, as well as radiography and bone marrow biopsy, in an attempt to assess osseous and bone marrow involvement. Of the 38 patients, 14 were found to have skeletal involvement. In 11 this was histologically proved. In 8 patients, the radioisotopic scan first raised the suspicion of localized bone involvement, which was subsequently proved by bone marrow biopsy or by radiography. We believe that bone marrow involvement may at times be localized when patients with Hodgkin's disease are first staged and may precede local osseous involvement. If this is so, a reasonable approach to the search for bone marrow or osseous involvement would be to start with a bone scan and to follow this with a bone marrow biopsy from the suspicious area or a careful radiography of the same site; the latter is important if the site of increased uptake of the radionuclide is inaccessible to the biopsy needle.

Adolescent↗
PubMed1981

The value of radiography in perinatal deaths.

A prospective study of 100 consecutive stillbirths/perinatal deaths was performed by routine radiography and subsequent autopsy. The object of the study was to correlate the clinical and the autopsy causes of death with any abnormal radiographic findings. A prime objective was to study the incidence of major skeletal abnormalities in the series and to ascertain if routine radiography could be used to detect abnormalities that might require genetic counselling. No skeletal abnormalities or dysplasias were detected that did not have obvious external stigmata. The use of routine radiography on undeformed stillbirths is not recommended.

Autopsy↗
PubMed2006

Novel display technique for reference images for visibility of temporal change on radiographs--color digital summation radiography.

PURPOSE: The present study investigated color digital summation radiography (CDSR) as a novel display technique for reference images for the visibility of temporal change on radiographs. In CDSR, only the parts with temporal differences are displayed in color. Moreover, all other parts are displayed in gray scale. MATERIALS AND METHODS: CDSR was defined as "radiographs combined by the additive color mixture method". The visibility of simulated nodules located in the lung fields and mediastinum was evaluated by 12 radiologists (mean experience, 9.8 years; range, 1-26 years) for 24 conventional radiographs and CDSR for 6 color patterns. A five-point rating system (5, very good; 4, good; 3, adequate; 2, poor; 1, very poor) was used. RESULTS: The mean scores (average +/- standard deviation) for the visibility of simulated nodules were as follows: magenta, 3.88 +/- 0.90; blue, 3.08 +/- 0.72; green, 3.04 +/- 0.86; red, 3.00 +/- 0.98; cyan, 2.71 +/- 0.86; and yellow, 2.50 +/- 0.72. Compared to conventional radiography in gray scale, at 1.21 +/- 0.41, all six color patterns for CDSR displayed significantly improved scores (p<0.001). CONCLUSION: CDSR might represent a useful technique for reference images from chest digital radiography.

Angiography↗
PubMed1992

Chest imaging within the radiology department by means of photostimulable phosphor computed radiography: a review.

Photostimulable phosphor computed radiography has been clinically used outside of Japan for more than 8 years. Results of at least 35 quantitative or semiquantitative studies have been published so far in which the clinical utility of computed radiography (CR) is compared with that of conventional screen/film radiography (FR) for the study of the adult chest within the radiology department. The results can be summarized as follows: CR is superior to FR in the mediastinum, retrocardiac region, and subdiaphragmatic recesses, as well as in the evaluation of coronary artery calcifications. CR is reported to be generally superior or equivalent in the detection and evaluation of pulmonary nodules and larger pulmonary opacities. Equivocal results have been reported for pathologies requiring the inspection of fine details, such as interstitial infiltrates or pneumothorax. The studies indicate that image processing algorithms dedicated to the delineation of specific anatomies or pathologies improve clinical performance.

Coronary Angiography↗
PubMed2004

Radiation dose and cancer risk to children undergoing skull radiography.

BACKGROUND: Limited data exist in the literature concerning the patient-effective dose from paediatric skull radiography. No information has been provided regarding organ doses, patient dose during PA skull projection, risk of cancer induction and dose to comforters, i.e. individuals supporting children during exposure. OBJECTIVE: To estimate patient-effective dose, organ doses, lifetime cancer mortality risk to children and radiation dose to comforters associated with skull radiography. MATERIALS AND METHODS: Data were collected from 136 paediatric examinations, including AP, PA and lateral skull radiographs. Entrance-surface dose (ESD) and dose to comforters were measured using thermoluminescent dosimeters. Patients were divided into the following age groups: 0.5-2, 3-7, 8-12 and 13-18 years. The patient-effective dose and corresponding organ doses were calculated using data from the NRPB and Monte Carlo techniques. The risk for fatal cancer induction was assessed using appropriate risk coefficients. RESULTS: For AP, PA and lateral skull radiography, effective dose ranges were 8.8-25.4, 8.2-27.3 and 8.4-22.7 microSv respectively, depending upon the age of the child. For each skull projection, the organs receiving doses above 10 microGy are presented. The number of fatal cancers was found to be less than or equal to 2 per 1 million children undergoing a skull radiograph. The mean radiation dose absorbed by the hands of comforters was 13.4 microGy. CONCLUSIONS: The current study provides detailed tabular and graphical data on ESD, effective dose, organ doses and lifetime cancer mortality risk to children associated with AP, PA and lateral skull projections at all patient ages.

Adolescent↗
PubMed2004

Comparison of ultrasound with plain radiography and CT for the detection of mediastinal lymphadenopathy in children with tuberculosis.

BACKGROUND: Lymphadenopathy, with or without parenchymal abnormality, is the radiological hallmark of primary tuberculosis (TB) in children. However, lymph node enlargement may pass undetected on plain chest radiographs. Ultrasonography provides complementary information to that obtained by radiographs. OBJECTIVE: To assess the clinical value of US for the detection of mediastinal lymphadenopathy in children with a positive intradermal tuberculin test. MATERIALS AND METHODS: Thirty-two children with a mean age of 6 years and a positive Mantoux test underwent chest radiography (frontal and lateral) and US (suprasternal and left parasternal access routes). Chest CT was performed at the discretion of the attending physician in six cases. RESULTS: Eleven children had clinical symptoms and 90% a recent contact with a person with active TB. In 90.5% of children with chest radiographic images compatible with TB, coincident findings in the mediastinal US study were found. By comparison, 66.7% of those with normal chest radiography had evidence of mediastinal lymphadenopathy on the US scan. In all cases but one, US and CT findings agreed. CONCLUSIONS: Mediastinal US is useful for the detection of enlarged lymph nodes in children with a positive tuberculin reaction and normal chest radiography.

Adolescent↗
PubMed2001

Acute paediatric ankle trauma: MRI versus plain radiography.

OBJECTIVE: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. METHODS: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three "masked" radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. RESULTS: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures, Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter-Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. CONCLUSIONS: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries.

Acute Disease↗
PubMed2005

Contrast-detail evaluation and dose assessment of eight digital chest radiography systems in clinical practice.

The purpose of this study was to assess contrast-detail performance and effective dose of eight different digital chest radiography systems. Digital chest radiography systems from different manufacturers were included: one storage phosphor system, one selenium-coated drum system, and six direct readout systems including four thin-film transistor (TFT) systems and two charge-coupled device (CCD) systems. For measuring image quality, a contrast-detail test object was used in combination with a phantom that simulates the primary and scatter transmission through lung fields (LucAl). Six observers judged phantom images of each modality by soft-copy reading in a four-alternative-forced-choice experiment. The entrance dose was also measured, and the effective dose was calculated for an average patient. Contrast-detail curves were constructed from the observer data. The blocked two-way ANOVA test was used for statistical analysis. Significant difference in contrast-detail performance was found between the systems. Best contrast-detail performance was shown by a CCD system with slot-scan technology, and the selenium-coated drum system was compared to the other six systems (p values <or=0.003). Calculated effective dose varied between 0.010 mSv and 0.032 mSv. Significant differences in contrast-detail performance and effective dose levels were found between different digital chest radiography systems in clinical practice.

Equipment Design↗
PubMed2001

Towards image quality, beam energy and effective dose optimisation in digital thoracic radiography.

This paper outlines how objective measurements of both image quality, in terms of signal-to-noise ratio, and effective dose may be used as tools to find the optimum kVp range for a digital chest radiography system. Measurements were made with Thoravision, an amorphous selenium-based digital chest X-ray system. The entrance surface dose and the effective dose to an anthropomorphic chest phantom were determined demonstrating how effective dose is related to beam quality. The image quality was measured using detective quantum efficiency, threshold contrast and a radiologist preference trial involving 100 patients. The results show that, despite the fact that the entrance surface dose decreases as the kVp increases, the effective dose, a better measure of the risk, reaches a minimum value between 90 and 110 kVp; however, the image quality decreases as the kVp increases. In this study the optimum kVp for chest radiography, using a selenium-based radiography system, is in the range 90-110 kVp. This is contrary to the 120- to 150-kVp range that is commonly used. Also, this study shows how objective measurements can be used to optimise radiographic technique without prolonged patient trials.

Radiation Dosage↗
PubMed2002

Workflow assessment of digital versus computed radiography and screen-film in the outpatient environment.

An objective assessment and comparison of computed radiography (CR) versus digital radiography (DR) and screen-film in terms of workflow, productivity, speed-of-service, and potential cost justification for imaging ambulatory patients is presented. Perceived ease-of-use and workflow of each device is collected via a technologist opinion survey. Productivity is measured as the rate of patient throughput from normalized timing studies. The overall speed-of-service is calculated from the time of examination ordering as stamped in the radiology information system (RIS), to the time of image availability on the picture archiving and communication system (PACS), to the time of interpretation rendered (from the RIS). Comparative results of screen-film (analog) versus a CR reader and a DR dedicated chest unit show a higher patient throughput for the digital systems. A mean of 10.7 patients were moved through the DR chest room per hour, and 9.2 patients per hour using CR, versus 8.2 patients per hour for the analog device. Measured time to image availability for interpretation is much faster for both DR and CR versus screen-film, with the mean minutes to image availability calculated as 5.7 +/- 2.5 minutes for DR, 6.7 +/- 1.5 minutes for CR, and 29.2 +/- 14.3 minutes for screen film. DR and CR can improve workflow and productivity over analog screen-film in a PACS for delivery of projection radiography services in an outpatient environment, but DR requires high volume to be cost effective over CR.

Efficiency, Organizational↗
PubMed1989

A subjective study of dental diagnostic utility comparing xeroradiography and film radiography.

This study determined the perceived strengths and weaknesses of xeroradiography, D-speed film, and E-speed film for intraoral radiography. Results indicated that xeroradiography was preferred for the imaging of structures useful in periodontics and endodontics whereas film demonstrated a low level of image artifacts and was judged to be better for the imaging requirements of routine restorative dentistry. D-speed film was rated higher than E-speed film. These subjective assessments are similar to previously reported pilot studies but differ from previously published objective studies, which showed no significant difference between the three imaging techniques. Although there are substantial subjective differences between xeroradiography, D-speed film radiography, and E-speed film radiography, all the techniques provide more than the threshold level of necessary diagnostic information and all techniques portray adequate information for evaluation of common abnormalities encountered in the oral cavity.

Dental Restoration, Permanent↗
PubMed1990

Nonrotational scanning in panoramic radiography.

A mathematical analysis of orthoradiography, nonrotational scanning in panoramic radiography, and rotational panoramic radiography shows that they may all be described by the same set of equations. The other two techniques may be regarded as special cases of rotational panoramic radiography.

Humans↗